[Congressional Record (Bound Edition), Volume 154 (2008), Part 11]
[House]
[Pages 15060-15072]
[From the U.S. Government Publishing Office, www.gpo.gov]




  MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT OF 2008--VETO 
 MESSAGE FROM THE PRESIDENT OF THE UNITED STATES (H. DOC. NO. 110-131)

  The SPEAKER pro tempore laid before the House the following veto 
message from the President of the United States:
To the House of Representatives:
  I am returning herewith without my approval H.R. 6331, the ``Medicare 
Improvements for Patients and Providers Act of 2008.'' I support the 
primary objective of this legislation, to forestall reductions in 
physician payments. Yet taking choices away from seniors to pay 
physicians is wrong. This bill is objectionable, and I am vetoing it 
because:
  It would harm beneficiaries by taking private health plan options 
away from them; already more than 9.6 million beneficiaries, many of 
whom are considered lower-income, have chosen to join a Medicare 
Advantage (MA) plan, and it is estimated that this bill would decrease 
MA enrollment by about 2.3 million individuals in 2013 relative to the 
program's current baseline;
  It would undermine the Medicare prescription drug program, which 
today is effectively providing coverage to 32 million beneficiaries 
directly through competitive private plans or through Medicare-
subsidized retirement plans; and
  It is fiscally irresponsible, and it would imperil the long-term 
fiscal soundness of Medicare by using short-term budget gimmicks that 
do not solve the problem; the result would be a steep and unrealistic 
payment cut for physicians--roughly 20 percent in 2010--likely leading 
to yet another expensive temporary fix; and the bill would also 
perpetuate wasteful overpayments to medical equipment suppliers.
  In December 2003, when I signed the Medicare Prescription Drug, 
Improvement, and Modernization Act (MMA) into law, I said that ``when 
seniors have the ability to make choices, health care plans within 
Medicare will have to compete for their business by offering higher 
quality service. For the seniors of America, more choices and more 
control will mean better health care.'' this is exactly what has 
happened--with drug coverage and with Medicare Advantage.
  Today, as a result of the changes in the MMA, 32 million seniors and 
Americans with disabilities have drug coverage through Medicare 
prescription drug plans or a Medicare-subsidized retirement plan, while 
some 9.6 million Medicare beneficiaries--more than 20 percent of all 
beneficiaries--have chosen to join a private MA plan. To protect the 
interests of these beneficiaries, I cannot accept the provisions of 
this legislation that would undermine Medicare Part D, reduce payments 
for MA plans, and restructure the MA program in a way that would lead 
to limited beneficiary access, benefits, and choices and lower-than-
expected enrollment in Medicare Advantage.
  Medicare beneficiaries need and benefit from having more options than 
just the one-size-fits-all approach of traditional Medicare fee-for-
service. Medicare Advantage plan options include health maintenance 
organizations, preferred provider organizations, and private fee-for-
service (PFFS) plans. Medicare Advantage plans are paid according to a 
formula established by the Congress in 2003 to ensure that seniors in 
all parts of the country--including rural areas--have access to private 
plan options.
  This bill would reduce these options for beneficiaries, particularly 
those in hard-to-serve rural areas. In particular, H.R. 6331 would make 
fundamental changes to the MA PFFS program. The Congressional Budget 
Office has estimated that H.R. 6331 would decrease MA enrollment by 
about 2.3 million individuals in 2013 relative to its current baseline, 
with the largest effects resulting from these PFFS restrictions.
  While the MMA increased the availability of private plan options 
across the country, it is important to remember that a significant 
number of beneficiaries who have chosen these options earn lower 
incomes. The latest data show that 49 percent of beneficiaries enrolled 
in MA plans report income of $20,000 or less. These beneficiaries have 
made a decision to maximize their Medicare and supplemental benefits 
through the MA program, in part because of their economic situation. 
Cuts to MA plan payments required by this legislation would reduce 
benefits to millions of seniors, including lower-income seniors, who 
have chosen to join these plans.
  The bill would constrain market forces and undermine the success that 
the Medicare Prescription Drug program has achieved in providing 
beneficiaries with robust, high-value coverage--including comprehensive 
formularies and access to network pharmacies--at lower-than-expected 
costs. In particular, the provisions that would enable the expansion of 
``protected classes'' of drugs would effectively end meaningful price 
negotiations between Medicare prescription drug plans and 
pharmaceutical manufacturers for drugs in those classes. If, as is 
likely, implementation of this provision results in an increase in the 
number of protected drug classes, it will lead to increased beneficiary 
premiums and copayments, higher drug prices, and lower drug rebates. 
These new requirements, together with provisions that interfere with 
the contractual relationships between Part D plans and pharmacies, are 
expected to increase Medicare spending and have a negative impact on 
the value and choices that beneficiaries have come to enjoy in the 
program.
  The bill includes budget gimmicks that do not solve the payment 
problem for physicians, make the problem worse with an abrupt payment 
cut for physicians of roughly 20 percent in 2010, and add nearly $20 
billion to the Medicare Improvement Fund, which would unnecessarily 
increase Medicare spending and contribute to the unsustainable growth 
in Medicare.
  In addition, H.R. 6331 would delay important reforms like the Durable 
Medical Equipment, Prosthetics, Orthotics, and Supplies competitive 
bidding program, under which lower payment rates went into effect on 
July 1, 2008. This program will produce significant savings for 
Medicare and beneficiaries by obtaining lower prices through 
competitive bidding. The legislation would leave the Federal 
Supplementary Medical Insurance Trust Fund vulnerable to litigation 
because of the revocation of the awarded contracts. Changing policy in 
mid-stream is also confusing to beneficiaries who are receiving 
services from quality suppliers at lower prices. In order to slow the 
growth in Medicare spending, competition within the program should be 
expanded, not diminished.
  For decades, we promised America's seniors we could do better, and we 
finally did. We should not turn the clock back to the days when our 
Medicare system offered outdated and inefficient benefits and imposed 
needless costs on its beneficiaries.
  Because this bill would severely damage the Medicare program by 
undermining the Medicare Part D program and by reducing access, 
benefits, and choices for all beneficiaries, particularly the 
approximately 9.6 million beneficiaries in MA, I must veto this bill.
  I urge the Congress to send me a bill that reduces the growth in 
Medicare

[[Page 15061]]

spending, increases competition and efficiency, implements principles 
of value-driven health care, and appropriately offsets in physician 
spending.
                                                      George W. Bush.  
                                        The White House, July 15, 2008.

  The SPEAKER pro tempore. The objections of the President will be 
spread at large upon the Journal, and the veto message and the bill 
will be printed as a House document.
  The question is, Will the House, on reconsideration, pass the bill, 
the objections of the President to the contrary notwithstanding?
  The gentleman from Michigan (Mr. Dingell) is recognized for 1 hour.
  Mr. DINGELL. Madam Speaker, for purposes of debate only, I yield 30 
minutes to my dear friend, the gentleman from Texas (Mr. Barton).
  Madam Speaker, I also yield 15 minutes of my time to my dear friend, 
the gentleman from New York (Mr. Rangel), and I ask unanimous consent 
that he be allowed to control that time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Madam Speaker, once again, the House has before it an 
irresponsible, flint-hearted veto sent by the White House, which has 
participated in no way in bringing us to the point where we are today.
  The legislation before us is critical to ensuring access to high-
quality physician services for Medicare beneficiaries. If we fail to 
override this veto, physicians will face a 10 percent pay cut, which 
will jeopardize access to care for seniors and for the disabled. If we 
fail to override this veto, low-income beneficiaries will lose out on 
additional protections and benefits in the traditional Medicare 
programs, such as coverage for more preventive benefits.

                              {time}  1445

  Finally, if we fail to override this veto, we will miss out on an 
opportunity to begin addressing the most egregious abuses made by the 
private health plans operating under Medicare. Private Fee-for-Service 
(PFFS) plans, one type of Medicare Advantage plan, do not have to sign 
providers to be a part of their networks. The result of this is that 
beneficiaries have no idea which physicians accept payments for their 
plans. And if the physician does not accept payment, the physician and 
the beneficiary are left holding the bag. These plans create tremendous 
uncertainty, confusion and hardships for all concerned, beneficiaries 
and providers.
  I urge Members to vote to override the President's veto.
  Madam Speaker, I reserve the balance of my time.
  Mr. BARTON of Texas. Madam Speaker, I ask unanimous consent to yield 
15 minutes of the 30 minutes that I control to the ranking member of 
the Ways and Means Committee, Mr. McCrery of Louisiana.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BARTON of Texas. Madam Speaker, I rise in support of the 
President's veto. I know that's not a popular position to take on this 
floor since only 59 Members of this body supported the President when 
the vote was to pass the bill a month or so ago, but I think the 
position that I take is the right position on policy.
  The bill before us, if the veto is not sustained, would delay--and 
I'm being charitable to use that verb--the reform of competitive 
bidding for durable medical equipment. It would delay that for 18 
months, which in all probability would kill a program that would save 
billions and billions of dollars if implemented.
  We have over 300 successful bidders for durable medical equipment 
that are not now going to be able to provide that. We have a program 
that, according to the Government Accountability Office, 10 percent of 
all the expenditures are for fraud, and we're going to perpetuate that 
program. The bill before us delays the reform of competitive bidding. I 
think that's a mistake.
  The bill before us does prevent a, I believe, 10 percent cut going 
into effect for our physicians, and that's a good thing. I don't think 
any Member of this body wants our physicians that provide services for 
our Medicare and Medicaid beneficiaries to have to take a payment cut. 
So that is the one socially redeeming value of this bill. But it 
doesn't permanently fix the system, it simply delays the cut for 
another year. And next year it will be 20 percent, I think 20.7 
percent. So there is no long-term fix for that, it's another kick-the-
can-down-the-road for one more year.
  There are some changes in the way pharmacies are reimbursed or are 
paid for or priced for their prescription drugs, a reform called 
Average Manufacturing Price, which I think is a good reform. We have 
had some consultations with the pharmaceutical community and the 
pharmaceutical manufacturers about how to actually calculate that 
price, but that reform replaced the system that was ridden with 
inequity and subject to quite a bit of gamesmanship. The bill before us 
would revert, as I understand it, back to the old system, which I think 
is a mistake.
  So I know it's not politically popular to say we ought to stand on 
principle and do the right thing, but that's the position that I'm 
taking. I think that's the position the President is taking. So when 
the vote comes, I would hope that people would look at the underlying 
issues and vote to sustain the President's position on this, which is 
the position that's the best public policy for all Americans.
  I haven't talked about Medicare Advantage. My good friend from 
Louisiana I think will make those points, but it's obvious that this 
bill significantly impacts, in a negative way, Medicare Advantage, 
which is a program that 10 million of our senior citizens have chosen 
to participate in to receive their Medicare benefits.
  With that, Madam Speaker, I reserve the balance of my time.
  Mr. RANGEL. Madam Speaker, I ask unanimous consent that the remainder 
of the time that I use be yielded to Mr. Stark, the chairman of the 
Subcommittee on Health, and he would have the right to distribute it to 
Members that he recognizes.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New York?
  There was no objection.
  Mr. RANGEL. Madam Speaker, I rise in support of the veto, of the 
President demonstrating once again a reckless, mean-spirited disregard 
of the health of our children, our poor folks, and now the aging. And 
yet I stand on the floor proud of the fact that we're on the brink of a 
new day, where people like Chairman Stark, working with Chairman 
Dingell and Chairman Pallone, will be able to create a system where, 
whether you're old or young or live in rural or urban areas, that 
health care is going to be a priority, and we don't have to come to 
this floor and fight each other as to who can be the meanest in denying 
people health care.
  And so I just want the people to know that this really isn't a 
question of Republican and Democrats because, to some extent, we're 
united in sending a message to the President: Think about what you're 
doing to the American people and try to help us to move forward. I hope 
I'm not violating the rules by saying that.
  When Ted Kennedy got out of his sick bed and walked over to the 
Senate floor, it wasn't a Democratic Senator speaking to a bipartisan 
Senate. It was the voice of someone who has demonstrated compassion for 
all of the things that all of us believe in. As a result of that, he 
has brought us together. Let us stay together; and let's send a message 
to the President, his days of doing us harm are very, very limited.
  I yield the balance of my time to Chairman Stark.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. The Chair will remind Members to avoid 
making improper references to the President.
  Mr. McCRERY. Madam Speaker, I yield myself so much time as I may 
consume.
  Madam Speaker, I'm glad that you admonished Members to not improperly 
invoke the President's name. I

[[Page 15062]]

don't think Chairman Rangel really thought through what he said there 
at first about the President being mean-spirited with this veto. I 
disagree with the policy in this bill, but I don't think Mr. Stark or 
Mr. Dingell or any of my colleagues were mean-spirited in putting 
together flawed policy. And I think the more that we recognize that 
we're all here, including the President, for the same reason, and 
that's to make this country a better place, the quicker we will get on 
to solving the bigger problems of the country on a bipartisan basis. So 
I appreciate the Speaker's admonition.
  As I say, I don't agree with the policy that's in the bill, but I do 
commend those who worked on solving at least the immediate problem of 
the pending cut to physicians. It is an intractable problem, very, very 
difficult for us to deal with, both substantively and politically. So I 
recognize that this was a tough process, a very difficult process to 
bring legislation to the floor that at least solved the immediate 
problem. But I think this bill represents missed opportunities. I think 
it is premised on false choices, and surely does nothing to protect the 
long-term solvency of the Medicare program, which we are going to have 
to tackle eventually in the Congress.
  I support reversing the physician pay cuts that are scheduled under 
current law, but there is a right way to do it and a wrong way. I think 
this bill represents the wrong way. According to CBO, more than 2 
million seniors will lose the Medicare health plan that they have today 
if this bill becomes law.
  Now, as these provisions are fully implemented, I believe Members of 
Congress will begin hearing from seniors around the country, angry, 
confused, wanting to know why we passed a bill that has taken away 
their health care plan. The last time we made changes that negatively 
impacted these kinds of plans, we certainly heard from seniors in our 
offices, and they were not happy.
  Now, maybe if in this bill we permanently fix the problems of the 
flawed Sustainable Growth Formula, then we might be willing to make 
that trade to put up with a few angry seniors because we really did 
something the right way, we permanently fixed the problem. But this 
bill doesn't do that; it is another just-kick-the-can-down-the-road. 
And, in effect, we make the problem worse because, as my colleague from 
Texas said earlier, the next time Congress has to address this in just 
a year from now, the physicians will be facing a 20 percent cut in 
reimbursement. That's what this bill puts in place. That's what this 
bill sets up the Congress for in about a year.
  So I don't believe that the policy that is used in this bill to pay 
for this temporary fix is the appropriate policy. And I believe seniors 
will not be happy with us for having just used their health care plans 
to kick this can down the road.
  Now, I'm retiring, Madam Speaker, at the end of this Congress; I 
won't be here next year. But I am hopeful that sooner, and not later, 
Members of the House and Senate, on a bipartisan basis, will decide 
that year-to-year rentals of this patch no longer make sense and roll 
up their sleeves in a concerted effort to develop a long-term solution 
to ensure that the Medicare program will be able to serve seniors for 
generations to come. I don't hold any hope that we're going to do that 
this year, but I do believe that this legislation, if there is a silver 
lining, by creating this even higher cliff for physicians, will 
probably get Congress closer to that bipartisan cooperation to solve 
the problem.
  With that, Madam Speaker, I reserve the balance of my time.


                             General Leave

  Mr. DINGELL. Madam Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks on 
the legislation before us.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Madam Speaker, I yield 2 minutes to my distinguished 
colleague and friend, Mr. Pallone, chairman of the Health Subcommittee 
of the Commerce Committee.
  Mr. PALLONE. Madam Speaker, last week, Congress sent to the President 
a commonsense proposal that passed both Chambers with strong bipartisan 
support. The bill that we sent to President Bush was a balanced 
approach that would keep Medicare working for America's seniors, 
doctors and taxpayers.
  This bill makes a number of improvements to Medicare that have been 
long overdue. The bill expands access to services for beneficiaries and 
provides additional financial assistance for low-income seniors. This 
bill also staves off the 10.6 percent cut to physicians' payments that 
are being implemented right now by CMS.
  What this bill does not do is make drastic cuts to Medicare 
Advantage; it makes very modest and sensible reforms to the program. 
Now, do I think that we should do more to reform Medicare Advantage? 
The answer is yes. Because the Bush administration has created a bias 
in favor of Medicare Advantage.
  I would like to make reference to yesterday's New York Times 
editorial called Medicare's Bias. It says, ``Many of the private plans 
that participate in the huge government-sponsored health insurance 
program for older Americans have become a far too costly drain on 
Medicare's overstretched budget.''
  ``These private plans--that now cover a fifth of the total Medicare 
population--receive large subsidies to deliver services that 
traditional Medicare provides more cheaply and more efficiently by 
paying hospitals and doctors directly. Congress was right--for reasons 
of equity and of fiscal sanity--to pass a bill that would at least 
begin to remove some of these subsidies.''
  Madam Speaker, now is the time to vote to protect health care for the 
elderly and disabled. Now is the time to vote to protect fair 
reimbursements for our Nation's doctors and pharmacists. And now is the 
time to vote to protect Medicare. Now is the time to vote to override 
the President's misguided veto.
  Mr. BARTON of Texas. Madam Speaker, I yield 1 minute to the 
distinguished minority whip, Mr. Blunt of Missouri.
  Mr. BLUNT. Madam Speaker, I thank the gentleman for yielding and for 
his leading this debate today.
  I think we all know what's going to happen today, but we don't know 
what this debate is all about. The gentleman just mentioned that one 
out of five people on Medicare now take advantage of Medicare 
Advantage. This is not a debate about the insurance companies and the 
doctors, this is a debate about competition.
  Now, there is a legitimate division on the floor of this House about 
whether competition and patient choice is part of the key to the future 
of Medicare.

                              {time}  1500

  I believe it is, and I think we could have taken care of the 
providers in a way that didn't step in and impact competition. In my 
district alone--and, in fact, in rural districts and minority 
districts, that's where that one out of five Americans live. In my 
district alone 28,000 people take advantage of the opportunity to be 
part of Medicare Advantage. Half of them take advantage of the 
opportunity to select their own doctor. That opportunity goes away if 
this bill becomes law.
  I intend to vote ``no'' today not because I don't respect the 
providers but because I think this is a terrible way to solve this 
problem that could be solved otherwise.
  Mr. STARK. Madam Speaker, I yield myself 2 minutes.
  I would like to concur and respond to my friend from Louisiana, we 
are just kicking the can down the road, but we have been doing that 
under his party's leadership for the past 8 years or so. And the truth 
is that none of us, the distinguished ranking member, the distinguished 
ranking member of the Health Subcommittee, the distinguished Chair of 
the Health Subcommittee, have any idea how we're going to solve this 
physician reimbursement for the long run, and we don't have time. But I 
think we have all agreed on a bipartisan basis that it is an issue that 
we have to address as

[[Page 15063]]

quickly as possible. So we do recognize that this is a temporary fix, 
and we do recognize the serious problem of reimbursing physicians, but 
I don't think there's any chance that we could get that done in the 
time left to us in this session.
  And some of the things that we have added, not all of the things we 
have passed in the CHAMP Act, but there is mental health parity for 
seniors, which means that they no longer have to pay a 50 percent co-
pay for mental health but a 20 percent co-pay, as they would for other 
services. There are preventative care opportunities for Medicare 
beneficiaries. There is support for low-income beneficiaries. There is 
work toward resolving medical disparities, an issue which is of concern 
to many people in this country. There is electronic prescribing, e-
prescribing, as it's called, which we think will be safer and more cost 
effective in the distribution for pharmaceuticals.
  As to the durable medical equipment bidding, I want to correct a 
statement made earlier. It isn't going to cost the taxpayers anything. 
The CBO has told us that the way this bill is designed, the durable 
medical equipment providers will pay for this at their option to take 
an across-the-board cut in their reimbursement rather than have a 
bidding system which they felt was unworkable and not realistic.
  The SPEAKER pro tempore. The gentleman's time has expired.
  Mr. STARK. I yield myself an additional 30 seconds, Madam Speaker.
  So while I think that it's not everything that we wanted and that we 
voted for in this House on a somewhat less strong bipartisan basis a 
year ago, we have made some bipartisan steps down the road. We got 
bipartisan support in the Senate. And what I hope, recognizing that 
many of us would do each of these things somewhat differently, a vast 
majority of us here and in the other body have come together as I have 
not seen in the past 10 or 12 years to work out a bipartisan agreement 
to proceed, and I hope that is a harbinger of the future.
  Madam Speaker, I reserve the balance of my time.
  Mr. McCRERY. Madam Speaker, I yield 2 minutes to the distinguished 
ranking member of the Health Subcommittee of the Ways and Means 
Committee, the gentleman from Michigan (Mr. Camp).
  Mr. CAMP of Michigan. I thank the gentleman for yielding.
  Madam Speaker, this is not some huge legislative victory, as some 
would suggest. Instead, it's about maintaining the status quo.
  I am committed to finding a way around this unworkable physician 
payment system that we have now, which rewards volume over quality. 
Every 15 minutes doctors have to see somebody else. That system's just 
plain wrong. But let's be honest. This bill only buys us about 18 
months, and where has that gotten us before, as the gentleman points 
out?
  I would like to quote the distinguished chairman of the Ways and 
Means Health Subcommittee, who said back in 2006: ``I am glad that this 
bill includes a temporary update for physicians, giving us a little 
breathing room heading into next year. But we're still going to have to 
do some very heavy lifting in order to dig ourselves out of the $250 
billion hole Republicans created by kicking the can down the road the 
last few years. In the next Congress, I hope my colleagues on the other 
side of the aisle work with me to address this problem once and for 
all.''
  Well, now we can add Democrats to the list of those digging the hole 
and kicking the can down the road. And at what cost? CBO estimates that 
up to 2 million seniors, mostly low income, will permanently, 
permanently, lose their current health coverage under this bill for a 
temporary 18-month increase in pay for physicians. Not addressing any 
of the longstanding problems in terms of rewarding value and not 
volume.
  I can't in good conscience support this bill that pits seniors 
against physicians. It's a lose-lose proposition and I will vote to 
sustain the President's veto.
  Mr. DINGELL. Madam Speaker, I yield myself 15 seconds.
  My colleagues on the other side talk about Medicare Advantage. 
Medicare Advantage gets somewhere between 11 and 30 percent more than 
they are supposed to get and more than regular Medicare gets. That's 
absolutely wrong. If we support this veto, we would continue that 
outrage. This is something that needs to be corrected.
  Madam Speaker, I am now happy to yield to my dear friend, the 
distinguished majority leader, Mr. Hoyer, for 1 minute.
  Mr. HOYER. I thank the chairman for yielding and would observe, as I 
have before on this floor, that there is no Member of this House who 
has been involved any more deeply, any more passionately, any more 
effectively to protect, preserve, and expand the availability of health 
care to the American people more than my friend John Dingell, the 
chairman of the committee. I want to congratulate him. Not only has he 
done that, but his father before him did that as well.
  Madam Speaker, last week we watched as Senator Ted Kennedy returned 
from the treatment of his brain cancer to cast his vote in favor of 
this vital Medicare bill. I don't have to tell you how many of us in 
both Chambers were moved to see that lifelong crusader for health care 
come back to cast one more vote for America's seniors.
  With that as inspiration, the Senate joined the House in voting by 
overwhelming margins for legislation that would and does replace a 10.6 
percent payment cut for thousands of doctors in Medicare with a 1.1 
percent increase, a cut that would put at risk coverage and 
availability of doctors for our seniors. The bill extends expiring 
provisions and bonus payments critical to rural communities and 
providers. The bill expands the preventive services that are available 
to our seniors. The bill phases mental health parity into the Medicare 
program. And it improves protections and assistance programs for our 
low-income seniors, about whom all of us are concerned.
  Three hundred and fifty-five of us in this House voted to pass this 
legislation. Three hundred and fifty-five in an overwhelming bipartisan 
vote which said this is good legislation, our people need it, and we're 
going to pass it. Sixty-nine Members of the United States Senate stood 
up and supported this piece of legislation. And I was pleased to see so 
many Republicans lining up with us. This is an overwhelmingly 
bipartisan bill as it was sent to the President of the United States.
  Preventing these Medicare cuts isn't a Republican issue or a 
Democratic issue. It's an issue of protecting and preserving the health 
care that over 44 million seniors count on, depend on, and, yes, 
deserve. And our message to the President was unambiguous: We will 
stand with our seniors and our health care providers, our military 
families and our disabled. And when it comes to protecting and 
preserving the health care they depend on, we will put aside party 
politics and we will stand together. Three hundred and fifty-five of 
us, sixty-nine in the Senate.
  Today President Bush decided that the overwhelming majority of the 
Congress was wrong. He will have to explain, however, to America's 
seniors why he was so willing to stand between them and their health 
care.
  But, thankfully, we don't have to take ``no'' for an answer. 
Thankfully, the Constitution provides us with the ultimate policy-
making authority. And I expect, hope, and urge that the 355 of us that 
stood for this legislation just a short time ago will do so again 
today, not in opposition to the President but as a proponent of 
legislation which seeks to solve a problem and to provide health care 
for our seniors.
  I urge my colleagues on both sides of the aisle to override this 
misguided veto. And with their support, this bill for our seniors will 
become law and they will be better for it.
  Mr. BARTON of Texas. Madam Speaker, I want to yield 3 minutes to a 
member of the Energy and Commerce Committee, the gentleman from 
Michigan (Mr. Rogers).
  Mr. ROGERS of Michigan. Madam Speaker, I rise with a little bit of 
apprehension today, but this is really a horrible way to do what we're 
trying to

[[Page 15064]]

do today, and we've known that every year certainly since I have been a 
Member of Congress. I think this is my eighth time trying to fix what 
is really a bad system of telling doctors every year you're going to be 
cut unless we do something. A horrible system. I think we all agree we 
have to do something.
  But something really spectacular happened today and I don't think in 
a good way. For the first time since I've been in Congress, we've 
decided that we're going to fix it as we have every single year since I 
have been here except we are going to cut senior citizens off from 
their programs in Medicare, for the first time since I have been here, 
and that we're going to do that today. And I scratch my head a little 
bit. We have always been able to come together in a bipartisan way and 
say we can fix it for the doctors without taking it out of the seniors. 
We don't have to punish the patients to help the doctors. And I know 
they can get on planes and they are doing okay financially and they can 
fly here and lobby us and talk to us and get in our ears, and that's 
important. And you know what? They should. Because every single year we 
tell them don't invest in your company because we are not going to tell 
you their business, their business of providing medical services. Don't 
invest in that because we're not sure if we are going to cut you 10 
percent or give you 2 percent. Pretty hard to make that investment 
decision to go to health information technology that we know will save 
lives or add a new staff member that they know they might be not able 
to pay for if we don't get our act together, which tells us why this 
system is so horrible. But because we failed to act, this Congress 
failed to act, I think the provision starts tomorrow with a 10 percent 
cut. We said 2 million poor seniors in this country, you're going to 
get a letter in the mail that says you no longer have service under 
Medicare Advantage. Think about the fear and the confusion. Do we have 
to do that? Is that the best that we can do here in this Chamber and 
call it a bipartisan effort?
  Ten million seniors depend on Medicare Advantage. They voluntarily 
signed up. And after this bill, 200,000 of them that live in Michigan 
will have fewer choices, reduced benefits, higher out-of-pocket costs.
  Half of the Medicare Advantage enrollees have incomes below $20,000 a 
year. Imagine the fear when your electric bills are going up because we 
haven't done anything here in this Congress, when your gasoline prices 
are over $4 and maybe your kids don't even come to see you anymore. 
But, oh, by the way, we are going to give you this letter and we are 
going to celebrate that in a bipartisan way we have stood up and said 
the heck with you, you're going to have to deal with it on your own, 
you 10 million seniors. Can't we do better? I think we can.
  So when the President vetoed this, it wasn't about mean spiritedness 
and taking things away and we're not going to help those seniors. It 
was about please renegotiate. If for the last 7 years we could come 
together and say we can help you doctors without punishing you senior 
citizen patients, why can't we do that today? It's the first time that 
we have had to do that since I have been in Congress. I know we can do 
better. And when you're done, think of this: Fully 70 percent are 
minorities making under $20,000 on Medicare Advantage.
  The SPEAKER pro tempore. The gentleman's time has expired.
  Mr. BARTON of Texas. Madam Speaker, I yield the gentleman an 
additional 30 seconds.
  Mr. ROGERS of Michigan. I thank the chairman.
  Madam Speaker, 70 percent are minorities making under $20,000. 
They'll get that letter in the mail. I doubt that they'll be 
celebrating the warmth and the fuzzy feeling that we are all feeling 
today because 355 people tried to read a bill that we only had 24 hours 
to read.
  Please, sustain the President's veto. It doesn't mean it's over. It 
means we get to negotiate a bill that protect doctors, as they should, 
allows them to make investments in the future of health information 
technology and other things without facing a 20 percent cut. By the 
way, if we did nothing, it would be a 15 percent cut by the end of next 
year. Because of this bill, it's a 20 percent cut.
  We have to do better. I will vote to sustain. I would urge you to 
sustain the President's veto.

                              {time}  1515

  Mr. STARK. Madam Speaker, I would like to yield 1 minute to the 
distinguished gentleman from California (Mr. Becerra).
  Mr. BECERRA. I thank the gentleman for yielding.
  Madam Speaker, over 1 year ago, we were trying to figure out how we 
would resolve this situation where seniors were on the verge of losing 
access to their doctor and where doctors were fretting whether they 
would be able to get enough reimbursement to be able to continue to 
offer services to these seniors. And it's very difficult to come to 
consensus.
  We almost went over the cliff. That 10 percent cut to doctors almost 
came to be. But today we have a chance after the President's veto to 
make sure that doctors will get their payment, seniors will get their 
services and then we can all move forward to try to deal with the major 
reforms to Medicare that we must make. Three hundred fifty-five to 
fifty-nine. That was the vote in the House some 3 weeks ago to pass 
this legislation. Sixty-nine to thirty in the Senate.
  It's not often that you get a strong vote in the House. It's not 
often that you get a strong vote in the House and the Senate. This is 
bipartisan. This is bicameral. It is the type of consensus we need. We 
did something for our seniors who are modest income. We did something 
to make sure that we have better oversight over those doctors that are 
unscrupulous. And at the same time, we did this without adding a single 
cent to the deficit for a Federal budget which right now is in the hock 
for $400 billion. This is the right way to go. We will overturn the 
President's veto on a bipartisan basis.
  Mr. McCRERY. I yield 3 minutes to the gentleman from Kansas (Mr. 
Moran).
  Mr. MORAN of Kansas. I thank the gentleman from Louisiana.
  Madam Speaker, I voted in favor of H.R. 6331 and will vote to 
override the President's veto today. This is a very important piece of 
legislation for those of us who care strongly about our communities and 
their survival. And in rural America the delivery of health care is in 
jeopardy. The pharmaceutical aspect of this bill is one that perhaps 
has been understated. But those of us who care about the community 
pharmacists believe that the direction that this bill provides in 
requiring a timely payment through prompt payments under part D and the 
elimination for 1 year of the average manufacturers' price, which will 
undercut the ability of pharmacists to deliver prescription drugs under 
Medicaid, and the elimination of bidding for durable medical equipment 
is awfully important.
  Much of the focus is upon the elimination of the 10 percent reduction 
in reimbursement to our physicians for Medicare. And I want to quote 
from one of my physicians back home in Kansas in a letter to me dated 
July 7. ``It is with mixed emotions that I am writing to inform you of 
my intent to leave my Family Medicine practice in Kansas. I have 
reached the point where I am no longer willing to expose myself or my 
family to the risk of having to rely upon an increasingly unreliable 
(and poor) source of income; specifically Medicare. I do not have the 
margin to absorb others' incompetence or our government's capricious 
reimbursement. I am no longer willing to be a pawn in the ideological 
chess match in Washington and therefore as of today I will no longer 
accept Medicare patients.
  ``I am at a point in my career where I must consider my family as 
well as my retirement. We once again have been threatened with an 
across-the-board 10 percent cut. Congress and the Medicare system are 
taking advantage of good-intentioned physicians who are more interested 
in caring for patients and upholding and honoring the Hippocratic Oath 
than lining their pockets. I

[[Page 15065]]

feel a sense of guilt, as though I am betraying my Medicare patients. I 
have realized, however, that it is not I that has betrayed the elderly, 
rather Congress.''
  I think it's important for us to move forward with this legislation. 
It's a matter of survival for the delivery of health care to many 
seniors, particularly those who come from places like I do where the 
population is Medicare dependent. And I appreciate the gentleman from 
Louisiana giving me the opportunity to express my position and to 
indicate once again that I will override President Bush's veto.
  Mr. DINGELL. Madam Speaker, at this time, I'm happy to yield to the 
distinguished gentlewoman from Colorado (Ms. DeGette) 2 minutes.
  Ms. DeGETTE. Madam Speaker, although these much-needed updates for 
physician payments are the crux of today's bill, numerous improvements 
to the Medicare program and beneficiary protections are also included. 
It also provides incentives for physicians to use e-prescribing 
technology, and it extends and vastly improves low-income-assistance 
programs for very-low-income Medicare beneficiaries.
  And it includes a 2-year reauthorization of the Special Diabetes 
Programs for Type 1 diabetes and for American Indians, which has been a 
priority of the Congressional Diabetes Caucus for many years. Thanks to 
over a decade of investment in the Special Diabetes Programs, we can 
point to tangible and significant progress, such as the creation of an 
artificial pancreas, that is improving the lives of many people.
  And this multiyear reauthorization was just what we needed. I want to 
talk for a minute about Medicare Advantage though. Medicare Advantage 
was originally conceived of as a way to save money in the Medicare 
system. But the way it has evolved over the years, we now have 13 
percent overpayments to the insurance companies that administer 
Medicare Advantage. There is no evidence that this money goes to the 
senior citizen beneficiaries. And there is further no evidence that if 
we cut these overpayments that these senior citizens are going to lose 
their insurance, because there is no evidence that they're getting that 
13 percent overpayment.
  Now I would suggest if there was a 13 percent overpayment to the 
traditional Medicare program, the other side would be having a fit 
because we would just be throwing money away. But, according to them, 
it's all right if we throw 13 percent away and give it to private 
insurance companies.
  In my opinion, we need to bring our entire Medicare program into 
balance no matter how it is being administered. We need to be sure that 
it's ministered efficiently. And ultimately, we need to restore balance 
to our entire health care system. Vote ``yes'' to override this veto 
and restore the physician payments.
  Mr. BARTON of Texas. Madam Speaker, could I inquire as to the time 
remaining on the four sides.
  The SPEAKER pro tempore. The gentleman from Texas has 7 minutes, and 
the gentleman from Michigan has 8. The gentleman from Louisiana has 
5\1/2\, and the gentleman from California has 9\1/2\.
  Mr. BARTON of Texas. Madam Speaker, I don't have any speakers at this 
time, so I will reserve the balance of my time.
  Mr. STARK. Madam Speaker, I'm pleased to yield 1 minute to the 
distinguished gentleman from North Dakota (Mr. Pomeroy).
  Mr. POMEROY. I thank the gentleman for yielding.
  This debate has a familiar feel. Once again the President has vetoed 
legislation important to rural America, legislation that was supported 
by a broad bipartisan consensus in this body. We saw the same thing in 
the farm bill, overrode him once, overrode him twice, and we need to 
override today as well. Those that argue that rural interests are best 
served by standing with the President's position on this are arguing 
that we ought to pay insurance companies more, cut doctors, cut 
hospitals and somehow this produces a better health result. It doesn't 
stand up.
  This bill provides very important reimbursements, not just to 
physicians, but also to struggling rural facilities representing the 
infrastructure for health care in rural America. Passing this bill and 
overriding the veto addresses physician payments. It addresses 
critical-access hospitals. It addresses sole-community hospitals. It 
addresses rural ambulance services. It addresses rural pharmacies. That 
is why the Rural Health Care Association supports the bill. It is why 
the Rural Health Care Coalition supports the bill. Please vote to 
override.
  Madam Speaker, I rise in strong support of overriding the President's 
veto of H.R. 6331, the Medicare Improvements for Patients and Providers 
Act, legislation that strengthens the Medicare Program and maintains 
our commitment to rural America.
  With an estimated 40 percent cuts in physician payment reductions 
under Medicare expected by 2016, Medicare's physician payment system is 
clearly broken. Because of the flawed Sustainable Growth Rate, 2008 
Medicare physician payment rates are about the same as they were in 
2001. This has prevented some physicians and the hospitals who employ 
them from making needed investments in staff and health information 
technology as well as created a great deal of uncertainty and 
instability for physicians and hospitals as they run their businesses.
  H.R. 6331 takes an important step forward by reversing these 
previously scheduled cuts in Medicare payments over the next 18 months 
while also providing a 1.1 percent update for 2009. This translates to 
at least $30 million for North Dakota's doctors and hospitals over the 
next year and a half, bringing relief for many of our struggling 
hospital systems. I am hopeful that these 18 months will give Congress 
the time it needs to make commonsense and much needed reforms to the 
SGR system so that North Dakota hospitals and doctors will have the 
fairness and stability in Medicare payments they deserve.
  H.R. 6331 also makes a strong commitment to maintaining access to 
important rural health services by investing in $3 billion in our 
vulnerable rural health care delivery system. Rural America continues 
to be challenged by shortages of health care providers, barriers to 
health care access, and geographic isolation. In my own home State of 
North Dakota, approximately 80 percent of the State is designated as a 
partial or full county Health Professional Shortage Area. In order to 
address these unique challenges, the Medicare Modernization Act (MMA) 
enacted special payment enhancements to make sure that rural health 
care facilities and providers have the resources they need to deliver 
quality care in their communities.
  Unfortunately, many of these important provisions have expired and 
further assistance is needed to ensure that seniors living in rural 
America have access to quality, affordable health care. That is why 
Representative Greg Walden and I, as co-chairs of the bipartisan Rural 
Health Care Coalition, introduced H.R. 2860, the Health Care Access and 
Rural Equity (H-CARE) Act, legislation that addresses these and other 
barriers to quality health care by recognizing the unique 
characteristics of health care delivery in rural areas and assisting 
rural health care providers in their efforts to continue to provide 
quality care to rural Americans.
  I am pleased that the Medicare Improvements for Patients and 
Providers Act (MIPPA) of 2008 incorporates many important provisions 
from H-CARE that will do much to protect the fragile rural health care 
safety net. More specifically, MIPPA will do the following:
  Ensure that rural doctors are paid the same rate for their work as 
their urban counterparts by extending the 1.0 work floor on the 
Medicare work geographic adjustment applied to physician payments 
through 2009, bringing in $9 million to North Dakota;
  Improve Medicare reimbursements for Critical Access Hospitals by 
directly increasing payments for critical lab services performed 
outside the hospital that will benefit North Dakota's 34 CAHs;
  Boost reimbursements to sole community hospitals by updating the data 
used to calculate their Medicare reimbursements;
  Protect access to rural ambulance services by providing rural 
ambulance providers an additional three percent of their Medicare 
reimbursement in order to help cover their costs;
  Require prompt payment to rural pharmacies by Medicare prescription 
drug plans;
  Extend a provision that allows 19 North Dakota hospital-based labs to 
directly bill Medicare for pathology services;
  Expand access to telehealth services by allowing hospital-based renal 
dialysis facilities, skilled nursing facilities, and community mental 
health centers to be reimbursed under Medicare for telehealth services;

[[Page 15066]]

  Reauthorize and expand the FLEX Grant Program to include a new grant 
program that could mean up to $1 million to Richardton, North Dakota, 
as they convert from their status as a Critical Access Hospital; and
  Extend Section 508 of the Medicare Modernization Act which provides 
nearly $10 million a year to North Dakota hospitals to give them the 
resources they need to compete in an increasingly competitive labor 
market.
  The Medicare Improvements for Patients and Providers Act is a good 
bill that has been endorsed by the National Rural Health Association 
and deserves every Member's support. We should quickly override this 
veto so that our health care providers can get back to their business 
of caring for our seniors without the uncertainty that has been hanging 
over their heads for the last 2 weeks.
  Mr. McCRERY. Madam Speaker, I reserve the balance of my time.
  Mr. DINGELL. Madam Speaker, at this time I yield to the distinguished 
gentlewoman from California (Ms. Solis) 2 minutes.
  Ms. SOLIS. Madam Speaker, today I rise with my colleagues to support 
the overriding of the President's veto on this legislation that will 
protect our seniors. Did you know that over 44 million vulnerable 
Medicare patients are depending on us to pass this bill? By vetoing the 
legislation, President Bush is ignoring the needs of our seniors, the 
disabled individuals and our doctors.
  Less than a month ago, Congress passed the bill by a margin of 355-
59. I voted for the bill so I could help ensure that 70,000 Medicare 
beneficiaries, patients in my district, would be able to receive their 
continued health care. The bill includes programs that help low-income 
Medicare patients, including low-income Latinos. Although Latinos make 
up only 6 percent of the overall Medicare beneficiaries, more than 14 
percent are considered low-income seniors. Allowing a 10 percent cut 
would be devastating to patient providers practicing in communities 
like mine in East Los Angeles.
  I have heard from many of my constituents that some California 
physicians, even in my own district, are considering not taking any 
more Medicare patients because of the inadequate reimbursement rate. 
Even less access would be imposed upon a community that is already 
faced with health care disparities and being able to access health 
care. Organizations across the country understand the importance of 
this piece of legislation including AARP and the American Medical 
Association.
  I encourage all of my colleagues, Members of Congress, to help us 
override the President's misguided veto and to stand first and foremost 
for our seniors and those disabled Americans that are counting on our 
work here in the Congress.
  Mr. STARK. Madam Speaker, I am delighted to recognize the gentlelady 
from Ohio (Mrs. Jones) for 1 minute.
  Mrs. JONES of Ohio. I thank the gentleman for yielding.
  I know sometimes we stand on this floor and we talk about health care 
for seniors in isolation. I stand here among my colleagues with many 
like me who have lost both of their parents. And but for Medicare and 
the services they received, their last health care probably would not 
have been as good or as great. We can stand here and talk about, well, 
the President didn't want to hurt anybody by overriding the veto. And 
we can stand here and talk about long-term policy down the line. But 
what we can't talk about is the health disparities that exist in our 
country and the study that was recently released that talked about 
minorities have more amputations than any other group of folks in 
America. And it doesn't talk about the issue of diabetes that overrides 
the minority communities across this country. Come on, y'all, let's get 
a life. Let's wake up, and let's help these seniors by overriding this 
veto.
  And if we want to talk about better health care, better policy down 
the line, then let's do it. But let's not do it on the backs of the 
seniors who have worked all of their lives in order for us to be here 
to even be in Congress. Thank God I had a mom and a dad.
  Mr. DINGELL. Madam Speaker, at this time, I yield to the 
distinguished gentlewoman from California, the vice chairman of the 
Subcommittee on Health, Mrs. Capps, 2 minutes.
  Mrs. CAPPS. Madam Speaker, I rise in strong support of this veto 
override. It is apparent that President Bush has chosen to ignore the 
will of the American people and an overwhelming bipartisan majority in 
the House and the Senate. He would rather cozy up to his friends in the 
insurance industry than improve access to health care for our seniors, 
our frail seniors, and those with disabilities.
  I am proud to support H.R. 6331, our seniors and our health care 
professionals who need this legislation. Yes, this is an 11th-hour fix, 
so it is not the best way to do business here. It allows me to express 
a strong word of appreciation for our Chairman Dingell and chairman of 
the subcommittee, Mr. Pallone, for their leadership in bringing to the 
floor and supporting a long-term solution which we passed in this House 
last year, known as the CHAMP Act, a comprehensive way to deal with 
challenges for our seniors on Medicare.
  It is a solution that will bring us to where we should be in the 
long-term for reimbursing our physicians and those who provide 
services. So until we have a new administration in the White House, we 
have to do what we can to protect physicians and to protect their 
patients. H.R. 6331 does the right thing by preventing a 10 percent cut 
in reimbursements. And we all know the stories of our senior citizens 
who fear the loss of their provider, particularly in hard-to-serve 
areas like rural America.
  I urge my colleagues to do the right thing, to vote to override the 
President's veto.

                              {time}  1530

  Mr. STARK. Madam Speaker, I am pleased to yield 1\1/2\ minutes to the 
gentleman from Illinois (Mr. Emanuel).
  Mr. EMANUEL. Madam Speaker, this isn't the cure-all for everything, 
but it is a step in the right direction, and we should take note.
  It cracks down on fraud in Medicare which is one of the ways we make 
payments to doctors and seniors. It ensures that we don't overpay 
health insurance companies for the care you get for less money. It 
begins us on a process to make sure that we have an e-prescribe system. 
And most importantly, what this does is preserve the doctor and senior 
patient relationship. This is the right step to do.
  Not only are we taking this step in helping Medicare and preserving 
the relationship between doctors and patients, it builds on the 
progress we have made by restoring $14 billion to veterans' health 
care.
  Also, just the other day we reversed six of the President's rules and 
regulations as it relates to Medicaid. Unfortunately, we haven't taken 
that step as it relates to 10 million children and their health care 
program.
  But this Congress, from Medicare to Medicaid to our veterans, has 
begun to take the steps that are necessary, that are important to 
health care reform, to ensure that people have access to the doctors 
that they need and the system that we have that once again preserves 
the relationship between doctors and patients.
  So on a host of fronts, whether you want to crack down on fraud, 
whether we want to make sure that we are not overpaying insurance 
companies, whether we want to make sure we are preserving the 
relationship between doctors and their patients, this is the right step 
in the right direction, and I am proud that it is done in a bipartisan 
fashion, once again putting the American people first.
  Mr. DINGELL. Madam Speaker, I yield at this time to the distinguished 
gentleman from Pennsylvania (Mr. Altmire) 1 minute.
  Mr. ALTMIRE. Madam Speaker, today's vote will be a significant 
victory for seniors, their doctors, and home medical suppliers. I am 
especially pleased that two important Medicare provisions that I 
spearheaded are included in this bill, and after this override will be 
enacted into law.
  This bill delays for 18 months the ill-conceived Medicare durable 
equipment competitive bidding proposal that, if implemented, will do 
serious harm to small medical equipment suppliers in

[[Page 15067]]

western Pennsylvania and around the country.
  This bill also incorporates my legislation to provide prescription 
drug coverage to millions of low-income seniors by permanently 
eliminating the late enrollment penalty under Medicare part D.
  Through his veto, President Bush demonstrates that he does not share 
our values on these important issues. But this bill is good for western 
Pennsylvania and good for the Nation, and I ask my colleagues to join 
me in overriding this veto today.
  Mr. STARK. Madam Speaker, I am pleased to yield 1\1/2\ minutes to the 
distinguished gentleman from Texas (Mr. Doggett).
  Mr. DOGGETT. I thank the gentleman for his leadership.
  ``Pay more, get less,'' that's the Bush Medicare plan. The 
President's veto means that taxpayers get an opportunity to pay more 
unnecessarily to subsidize private insurers, while seniors and the 
disabled get less.
  Each person in privatized Medicare costs American taxpayers $1,000 
more each year than the cost for one relying on the traditional, more 
efficient Medicare system. Without change, $150 billion will be wasted 
on unnecessary subsidies to highly profitable private insurers. Even 
Medicare's only actuary reports absolutely zero quantifiable savings 
have occurred through private Medicare, and that savings will never 
occur through private Medicare as currently set up, a waste of $150 
billion bestowed on the insurers. That's the waste that President Bush 
is so intent on protecting through his veto. We take some of that 
unnecessary waste and we use it to pay physicians who are working hard 
and ought not to have a cut in their reimbursement rates, and more 
importantly, for the many people around this country who rely on those 
physicians to care for them.
  The Administration has refused time and again to offer us any 
legislative fix on this waste in the so-called Medicare Advantage plan, 
which is nothing but a disadvantage to American taxpayers and Medicare 
recipients.
  Today, we must overcome this continued obstructionism of the 
Administration and its allies here in the Congress. We should reject 
wasteful corporate welfare, protect our physicians, and override this 
veto.
  Mr. DINGELL. Madam Speaker, I yield at this time 2 minutes to the 
distinguished gentlewoman from California (Ms. Eshoo).
  Ms. ESHOO. Madam Speaker, I thank the chairman of our committee, Mr. 
Dingell, for his leadership on this issue and so many others.
  There are two things that relate to health care that absolutely 
mystify me. The first is that any President, this President, would 
oppose insuring children in the United States of America. Fought that, 
fought that, fought that, would not expand and add 10 million children 
to the health care rolls in our country. I don't understand any 
President of the United States doing that.
  And today, we are here to override his veto. Imagine, vetoing a bill 
that allows seniors to have doctors take care of them. It's one heck of 
a way to gut Medicare. There isn't any Medicare unless there are 
doctors to treat the patients. In this case, it is the seniors of our 
country.
  I am proud that Republicans and Democrats are coming together to 
provide the vote to override that bad, bad idea. And it serves the 
country well because when we invest in our people, whether they are 
children or seniors, we strengthen our Nation.
  I thank God for Edward Kennedy and showing his tenacity to get up out 
of his sick bed to cast that vote which then injected some iron in the 
spine of Members of Congress. So I join with my colleagues gladly and 
proudly today to override the President's veto in order to sustain 
Medicare, to save money, but more importantly than anything else, to 
invest in their precious lives and to celebrate that generation that 
all of us hail that made America so strong and so good. Thank you, 
Congress, for providing the votes to do so.
  Mr. STARK. Madam Speaker, I am pleased to yield 1 minute to the 
distinguished gentleman from New Jersey (Mr. Pascrell).
  Mr. PASCRELL. We must overturn the President's veto, Madam Speaker. 
This time the President has gone too far. He is jeopardizing the health 
of over 44 million seniors.
  This legislation is in the best interest of Medicare patients, 
physicians, pharmacies, and other care providers. Rolling back this 
administration's efforts to privatize Medicare is a critical first step 
in extending the program's long-term solvency.
  In overturning the President's veto of this legislation, Congress has 
the unique opportunity to upend the years of this administration's 
destructive attempts to privatize Medicare. And if we don't, the risk 
of not implementing these modest but necessary Medicare changes is 
incalculable.
  Low-income families stand to become further removed from basic 
medical care, services and drugs. Physicians stand to be forced out of 
practice. Pharmacies, overburdened by financial stress, will have to 
consider closing their doors or laying off workers, actions that will 
only further depress regional economic activity.
  As the number of uninsured Americans climbs to new record highs and 
the economy continues to struggle, this is called for. We must come 
together, both sides of the aisle, and veto what the President has 
done.
  Mr. STARK. Madam Speaker, I am pleased to recognize the distinguished 
gentleman from Wisconsin (Mr. Kagen) for 1 minute.
  Mr. KAGEN. Madam Speaker, I rise in support of overriding a veto that 
is misguided. And I have the honor of speaking here today for the 
nearly 90,000 people in northeast Wisconsin who are covered by 
Medicare, people who would otherwise have to pay more money out of 
their pocket to the insurance company rather than to where it really 
belongs, for their health care.
  This is an opportunity to join together as Democrats and Republicans 
and do the right thing. Let's override this meaningless veto. Let's 
allow our President to do the right thing. President Bush needs our 
help; let's help him by overriding this veto.
  Mr. STARK. May I inquire, Madam Speaker, are we prepared to close?
  Mr. BARTON of Texas. Madam Speaker, the Energy and Commerce 
Republicans are prepared to close.
  Mr. DINGELL. Madam Speaker, I have one speaker remaining who will 
close for us.
  Mr. BARTON of Texas. Madam Speaker, I yield myself the balance of my 
time to close, and I believe I have 7 minutes, although I don't believe 
I will take 7 minutes.
  Madam Speaker, I want to try to at least let the American people know 
what is going on here this afternoon.
  I think everybody on both sides of the aisle are for our health care 
providers. We want our doctors to be fairly reimbursed. We want our 
hospitals to be fairly reimbursed. We want our pharmacists to be fairly 
reimbursed. We want our durable medical equipment suppliers to be 
fairly reimbursed. We want our Medicare and Medicaid beneficiaries and 
recipients to get quality health care and have the minimum copayments 
and out-of-pocket expenses necessary for those services. So we have 435 
votes for good health care policy in America.
  The bill before us is not a good government bill. It is an 
accountability avoidance bill, in my opinion. It is hard to read 
exactly what CBO scores this bill, but on subtitle D, provisions 
relating to part C, section 161, it says, phaseout of indirect medical 
education, that scores over 5 years a saving of $12.5 billion and over 
10 years, $47.5 billion. That's a cut.
  Now I am told, I can't prove it, but I am told that $20 billion to 
$25 billion of that is coming directly out of Medicare Advantage. Those 
are reimbursement cuts to the 10 million seniors who have chosen 
Medicare Advantage.
  Now the statement has been made on the floor that we are overpaying 
Medicare Advantage. What happens when there is an overpayment is that 
75 percent of that overpayment goes back into the benefit pool for the 
Medicare beneficiaries that choose that option,

[[Page 15068]]

and 25 percent goes to the U.S. Treasury. It doesn't go to the 
insurance companies.

                              {time}  1545

  Seventy-five percent of an overpayment is reinvested in benefits for 
Medicare Advantage beneficiaries, and 25 percent goes as a savings to 
the taxpayers who are providing the funds. That sounds to me like a 
pretty good deal.
  Now let's talk about the physicians. One of the few good things in 
the bill is that we are going to delay the physician reimbursement cut 
of 10 percent that was effective this year. It would have been 
effective July 1, I believe. That's a good thing.
  But is there a reform in this package that sets a different formula 
for next year and the next year and the next year? No. Were there 
discussions on a bipartisan basis about that? No. Has any effort that I 
am aware of really been made to fix that program, to fix that fee 
schedule? No.
  So what happens on the floor next year? We have a 20 percent cut that 
will go into effect if we don't do something between now and July of 
next year. That's not good government. That's, as I said, 
accountability avoidance.
  Let's talk about the pharmaceutical system. There is a good thing in 
this bill, I have to be honest about that. The prompt pay is a good 
thing. I support that. But the delay of the average manufacturing price 
reform is a bad thing. Is a bad thing.
  Now I admit there are some problems with average manufacturing price, 
about definitions of what's included in the cost and what kinds of 
costs are included, but that's a technical detail that could be worked 
out. But to delay a true reform that tries to reimburse pharmacists for 
the true cost of the drugs, to me, is another avoidance in 
accountability.
  Then let's talk about durable medical equipment. GAO says that 10 
percent of everything that we pay for durable medical equipment through 
Medicare is fraud. What we do is delay for 18 months the competitive 
bidding system that we have been working on for over 10 years. Now it 
should tell us something that the industry apparently signed off on an 
across-the-board cut of about 10 percent in order to avoid competitive 
bidding.
  That would tell me that we are overpaying right now for durable 
medical equipment and oxygen supplies, at least that much, if they are 
willing to accept an across-the-board cut instead of competitive 
bidding. The 300 suppliers that won the competitive bidding contracts, 
they are just out on a limb now. They probably have lawsuit remedies 
that will cost the taxpayer billions and billions of dollars more. So 
all we are doing is delaying the reforms that we have worked so hard in 
the past to implement for 1 year. For 1 year.
  Now I understand the politics of that. Any time you tell a 
constituency, we're going to give you more money this year, that's 
probably a good thing politically. As I said at the start, I'm friends 
with the physicians in my district, I'm friends with the pharmacists in 
my district, I'm friends with the durable medical suppliers in my 
district, and they're good people. They're trying to provide good 
services.
  But to simply delay some of these reforms for 1 year or 18 months at 
the costs that are going to be incurred, as I said at the start of my 
closing remarks, that's not good government, that's accountability 
avoidance.
  I am very happy to support the President's veto. If by some stroke of 
good public policy we did sustain the veto, we would be happy to work 
with my friends on both sides of the aisle and in the other body to 
come up with some true reform, some true changes in public policy that 
were permanent and would fix this problem, because, mark my words, if 
we don't sustain the veto, we will be back here next year, and we will 
probably be doing the same thing that we are doing today.
  That's not good government. I hope we will vote to sustain the 
President's veto.
  Madam Speaker, I yield back the balance of my time.
  Mr. STARK. Madam Speaker, I yield myself the balance of my time and 
urge a vote to override the veto.
  It isn't everything that everybody wants, but it protects 40 million 
seniors from losing their access to primary care physicians, and it 
gives us time to deal with the reforms that are necessary in an orderly 
way.
  We should put an end to the overpayment to Medicare Advantage, to 
stop giving them a blank check to provide services, which, in many 
cases, are second rate. Good managed care plans that are not for profit 
and come under the Medicare Advantage plan can exist at 98 percent of 
payment. There is no reason to overpay the charlatans who provide 
second-rate service and overbill the taxpayers by anywhere from 13 to 
40 percent.
  We have made some advantages and some benefits come together on a 
bipartisan basis to give us time to do the work that we should to make 
our Medicare system sustainable, expand its benefits, save money for 
the taxpayers and provide the kind of quality medical care to which our 
seniors are entitled. I urge a ``yes'' vote to override the veto.
  Madam Speaker, I yield back the balance of my time.
  Mr. McCRERY. Madam Speaker, I yield myself the balance of my time.
  I want to talk about two things quickly in closing. There has not 
been much said during this debate about part of the President's veto 
message that I think is important. So I am going to read that section 
from the veto message. It concerns the prescription drug program. The 
President says, ``The bill would constrain market forces and undermine 
the success that the Medicare Prescription Drug Program has achieved in 
providing beneficiaries with robust, high-value coverage--including 
comprehensive formularies and access to network pharmacies--at lower-
than-expected costs. In particular, the provisions that would enable 
the expansion of ``protected classes'' of drugs would effectively end 
meaningful price negotiations between Medicare prescription drug plans 
and pharmaceutical manufacturers for drugs in those classes. If, as is 
likely, implementation of this provision results in an increase in a 
number of protected drug classes, it will lead to increased beneficiary 
premiums and copayments, higher drug prices, and lower drug rebates. 
These new requirements, together with provisions that interfere with 
the contractual relationships between part D plans and pharmacies, are 
expected to increase Medicare spending and have a negative impact on 
the value and choice that beneficiaries have come to enjoy in the 
program.''
  I think that is an important consideration as we decide whether to 
sustain or override the President's veto.
  Just one other item, and that's this question of paying the insurance 
companies more than the regular Medicare reimbursement. That has been 
often stated but still is not the case. By law, the margin over the 
regular Medicare payments have to go in these plans to beneficiary 
services or reduction of premiums or go back to the trust fund. That 
extra margin does not go to the insurance companies.
  In fact, GAO did a study of the margins of profit of these insurance 
plans and Medicare Advantage and found that the average margin of 
profit was 5 percent, a margin that is considerably lower, I might add, 
than some other sectors of Medicare services. I just wanted to clear 
that up and urge all of my colleagues to consider this vote very 
carefully and urge them to sustain the President's veto.
  Madam Speaker, I yield back the balance of my time.
  Mr. DINGELL. Madam Speaker, at this time I yield to the distinguished 
Speaker of the House, Ms. Pelosi, the remainder of my time.
  Ms. PELOSI. I thank the gentleman for yielding, I commend him for his 
extraordinary leadership on this subject.
  Madam Speaker, I have not been able to watch the entire debate, 
because I was involved in meetings, but I hope it was made known to all 
who are following this debate how historic this is that we have Mr. 
Dingell as part of

[[Page 15069]]

the management of this bill and bringing this bill to the floor. He 
comes from a strong tradition of access to affordable, reliable health 
care for all Americans.
  His father had it as his life's work in the Congress. Mr. Dingell was 
a young Congressman at the time he sat and presided. He sat in the 
chair and presided and gaveled the passage of the Medicare bill. I 
don't know if that has been discussed here today, but I want to be sure 
that all who follow the record of Congress know of the long history, 
the family tradition and the tremendous leadership that Mr. Dingell has 
provided in this regard.
  I also want to commend Mr. Pallone from the Energy and Commerce 
Committee for his work in this important legislation; Mr. Stark, the 
Chair of the committee of jurisdiction in the Ways and Means Committee. 
Thank you, Mr. Stark, for your leadership. I also commend Mr. Rangel 
for the important work that he did to make this vote possible today.
  People across America saw us pass this bill before the Fourth of July 
break, and it was celebrated by seniors who were concerned, and with 
people with disabilities, who were concerned about the impact of this 
however modest reform of Medicare. After the break, the Senate took up 
the bill once again. They failed with 59 votes the first time. You need 
60 in the Senate, as you know.
  The whole country was jubilant and applauded when Senator Kennedy 
came to the floor, a fighter for America's seniors, a fighter for 
people with disabilities, a fighter for our children, a fighter for 
working families in America. He left his own physical challenge behind 
to come to the floor of the Senate all the way from Massachusetts to be 
the 60th vote.
  It was such an historic moment, and nine Republican Senators changed 
their votes on the strength of Senator Kennedy's vote. It was 59 until 
he voted, and then he made the 60th, and then it became 69, and it was 
pretty exciting. People cheered, and everyone was tear filled and happy 
that this happened, affordable, reliable, health care for America's 
seniors and those with disabilities passed.
  Then the President said that he would veto the bill. It was such a 
downer.
  Here we are again today to come back to have an overwhelming 
bipartisan support in the Congress of the United States, in the House 
of Representatives, to say to the American people we understand the 
challenges they face. All of the seniors organizations and disabilities 
groups, of course, support this legislation, but just about every 
health-care providing group in our country supports this legislation as 
well, except one, and that is some in the health insurance industry. I 
guess the President is voting with them and not with America's seniors 
and those with disabilities when he vetoes the bill.
  I am very proud of the work of, again, Mr. Rangel, Mr. Dingell, Mr. 
Pallone, Mr. Stark. I thank them for their leadership. You have given 
us an opportunity to vote for the American people, not only as their 
representatives, but on their behalf, and we are all grateful to you 
for that. I urge a vote to override the veto.
  Mr. MICA. Madam Speaker, I plan to vote to sustain the President's 
veto on H.R. 6331.
  I wanted to clarify my action to sustain the President's veto on H.R. 
6331, the Medicare Improvements for Patients and Providers Act of 2008. 
First let me say that I in no way support a 10.6 percent reduction in 
payment to our physicians that participate in Medicare, nor do I 
support the meager .5 percent increase to physicians in this 
legislation. Both the proposed cuts and the increase are an insult to 
one of our Nation's most honorable and vital professions.
  I did not support this measure when it came before the House of 
Representatives because of the aforementioned reasons, and furthermore 
I think it is degrading to the medical profession to force physicians 
and medical professionals to come before Congress time and time again 
since 2002 and most recently in December of last year to plead with 
Congress not to cut their Medicare reimbursements for services 
rendered.
  The override of this Presidential veto is not a victory for the 
medical profession, the American Medical Association or the hard 
working dedicated physicians that I represent. In fact passage of this 
measure over the President's veto only exacerbates the situation and in 
18 months physicians will face the prospect of a 20 percent cut in 
their payment. Furthermore this bill takes an estimated $48 billion 
from the Medicare Advantage Program--a program designed to provide our 
seniors with choices.
  It is imperative that Congress address the deteriorating condition of 
the Medicare program and enacts corrective measures that will keep this 
reoccurring nightmare cast upon our medical professionals from 
happening again in the future. What is even worse, the bill has 
proposed budget gimmicks that will contribute to further unnecessary 
increases in Medicare spending and aid in the further financial 
destruction of the Medicare program.
  Congress must get serious and address the deficiencies in our 
Medicare system especially as we face an onslaught of baby boomers soon 
to be eligible for the program.
  Mr. BACA. Madam Speaker, today, we find ourselves fighting for H.R. 
6331, the Medicare Improvements for Patients and Providers Act of 2008.
  It is with great pleasure that I stand here today in support of this 
necessary veto override measure, fighting and doing my part to protect 
our seniors, the disabled and the American people.
  For months now, I have been actively listening to leaders in my 
district in San Bernardino, California, about the necessary need to 
pass H.R. 6331.
  Congress has made it clear over the last weeks that we are standing 
our ground on behalf of the American family.
  Unfortunately, President Bush is playing politics on the backs of our 
seniors and today vetoed H.R. 6331. This is unacceptable. Congress will 
not stand by and watch our seniors on Medicare get turned away next 
time they go see their doctor.
  This is not about politics; it's about our struggling American 
families that are constantly choosing between putting food on the table 
and paying for medicines.
  Today, I proudly will vote to override the President's veto and put 
America's seniors and their families first.
  I urge my colleagues to vote for this veto override and remember that 
we are here to represent the families in our district that so 
desperately need help.
  Mr. ETHERIDGE. Madam Speaker, I rise to express my support for this 
vote to override the President's veto of H.R. 6331, the ``Medicare 
Improvements for Patients and Providers Act of 2008.'' We cannot 
abandon Medicare's promise to America's seniors and disabled citizens 
that they would have access to high quality health care in their time 
of need.
  As of July 1, physicians face a 10.6 percent cut in their payments 
from Medicare. As of July 1, patients undergoing a variety of medical 
treatments, from radiology to oxygen treatments, face a cutoff in 
services. As of July 1, the relationship between medical suppliers and 
the beneficiaries they serve is at risk.
  Madam Speaker, this bill fixes all of these threats to Medicare and 
improves access in many other ways. Instead of a cut, it provides a 
slight increase in payment for physicians, ensuring doctors can 
continue providing Medicare services. Instead of cutting beneficiaries 
off from their medical services, it allows exceptions to current caps 
on medical therapy. It also ensures access to community pharmacies, by 
providing for fair and prompt payment for prescriptions.
  Additionally, H.R. 6331 improves access to health services for all 
Medicare beneficiaries. It extends grants that rural health care 
providers can use to improve the quality of care facilities provide and 
to strengthen health care networks. It supports telehealth services in 
rural communities, improves access to ambulance services for small 
hospitals, and increases Medicare payments for community health 
centers.
  By overriding the President's veto, Congress is standing with seniors 
and their ability to continue to see the doctors they know and trust. 
By overriding the veto, we are standing for better health care for all 
Medicare beneficiaries. I urge my colleagues to join me in continued 
support of this bill.
  Mrs. CHRISTENSEN. Madam Speaker, today I rise in strong support of 
H.R. 6331--The Medicare Improvements for Patients and Providers Act. I 
also rise to urge all of my colleagues--on both sides of the aisle--to 
do what this President won't: to protect the millions of seniors and 
people with disabilities who rely on Medicare to preserve their health 
and well-being.
  As a physician and as the Chair of the CBC Health Braintrust, I find 
it more than unfortunate that this President would veto a piece of 
sound health legislation that would help our Nation's most vulnerable, 
and that would prevent the catastrophic payment cuts to physicians. 
With this override, we will ensure that

[[Page 15070]]

seniors and active-duty military personnel and retirees have access to 
doctors who they not only know, but who they trust.
  Additionally, I feel strongly--as do more than 150 national 
organizations--that H.R. 6331 is a bill that needs to be enacted 
because it will reduce many of the health inequities that 
disproportionately and detrimentally affect millions of racial and 
ethnic minorities, as well as rural Medicare beneficiaries, by: 
strengthening the collection of data to better assess and identify 
solutions to health disparities; enhancing the scope of preventive and 
mental health benefits; bolstering low-income assistance programs for 
Medicare beneficiaries; improving access to quality health care for the 
millions of rural Americans--a disproportionate number of whom are 
racial and ethnic minorities--who currently experience insurmountable 
barriers to care; strengthening and reforming the Medicare Advantage 
plans without reducing access to the services needed by the tens of 
thousands of seniors who rely on them to stay healthy; and protecting 
access to pharmacies so that our seniors have consistent and reliable 
access to their medications and so that our pharmacies--particularly 
those in low-income communities--are reimbursed promptly and adequately 
by Part D programs.
  Madam Speaker, this bill passed in the Senate 1 month after it passed 
in the House, and did so with a veto-proof margin.
  We--as a Congress--have not had many successes with introducing and 
passing smart and sound health policies that are as socially and 
medically appropriate as they are fiscally responsible. This bill could 
be one such success and I therefore urge my colleagues to vote ``yes'' 
on this important bill.
  Mr. CONYERS. Madam Speaker, I rise to voice my strong support for 
overriding the President's veto of H.R. 6331, the Medicare Improvements 
for Patients and Providers Act of 2008. This important legislation 
amends titles XVIII and XIX of the Social Security Act to extend, for 
18 months, expiring provisions under the Medicare program. This bill 
prevents the implementation of a scheduled 10.6 percent cut in Medicare 
reimbursements for physicians and other health care professionals, and 
extends the 0.5 percent payment update for 2008 and provides a 1.1 
percent payment increase for physicians in 2009.
  In addition to delaying reimbursement cuts, H.R. 6331 speeds up 
reimbursements for Medicare Part D claims and delays cuts to Medicaid 
generic prescription drug reimbursement. The bill also includes a delay 
in the flawed Medicare DMEPOS (durable medical equipment, prosthetics 
and supplies) competitive bidding program. H.R. 6331 also improves 
beneficiary access to preventive and mental health services by 
eliminating discriminatory co-payment rates for Medicare outpatient 
psychiatric services.
  The reimbursement cuts that went into effect on July 1 have shaken 
the Medicare system to its very core. It boggles the mind to think 
that, with an aging population and a worsening physician shortage, this 
administration and congressional Republicans have turned their backs on 
hard-working physicians who care for millions of Medicare patients 
across the country.
  I want to reassure Michigan's Medicare doctors that I will never turn 
my back on those who care for our parents and grandparents. I am proud 
that, with this vote, the Democratic majority is standing up for 
Michigan's Medicare doctors--a group of physicians who regularly make 
financial sacrifices when they accept Medicare patients. Our support 
stands in sharp contrast to the administration's position. Instead of 
encouraging our best and brightest doctors to participate in the 
Medicare program, the administration would encourage doctors to turn 
needy seniors away from their waiting rooms.
  Similarly, I will never play politics with health security of those 
in our society who survived the Great Depression and won two world 
wars.
  Madam Speaker, at this time the passage of H.R. 6331 is a simple 
necessity. We must protect our seniors and Medicare doctors while we 
work to achieve a comprehensive solution to our Medicare problems. I 
encourage my colleagues to support this veto override effort.
  Mr. MARKEY. Madam Speaker, I rise today to urge a ``yes'' vote on 
overriding President Bush's veto of the urgently needed Medicare 
Improvements for Patients and Providers Act of 2008. Over the last 
several months, President Bush has had an opportunity to work with a 
bipartisan majority of Congress to enhance access to care for our 
Nation's seniors, disabled, and military families by preventing cuts in 
reimbursement to physicians.
  The President had an opportunity to invest in our country's health by 
ensuring that seniors would continue to have access to physicians in 
the Medicare program. But instead, he opted to throw patients and 
physicians under the proverbial bus, all for the sake of padding the 
pockets of the Medicare Advantage program.
  A veto of the President's override would not only improve seniors' 
access to health care, it would also increase investment in preventive 
health care, expand programs in rural communities, and guarantee mental 
health benefits. For our active-duty military personnel and military 
retirees, a veto override will ensure they have access to doctors they 
know and trust in the military health care program, Tricare.
  This bill is supported by over 150 large organizations, and most 
importantly, by a vast majority of our Nation's seniors, disabled, 
military families, and physicians. We need to build on the success of 
this program and override this ill-timed and unconscionable veto.
  At a time when the population of seniors seeking Medicare services 
continues to grow, what does the President do? He vetoes a bill written 
to prevent cuts to Medicare physicians, and in doing so, threatens 
seniors' access to Medicare providers. This is absolutely unacceptable.
  To my Republican colleagues, who are considering how to vote on this 
bill today--given the overwhelming support for this bill from the 
patient and provider community, I urge you to reject the President's 
stand against patients and physicians in favor of the insurance 
industry and join the overwhelming majority of the American public who 
support this legislation.
  It has been said that ``Health is the first wealth.'' Well, what does 
it say about our country when seniors, military families, and 
physicians are pushed aside for the interests of the insurance 
industry? Let's not put increased wealth for the insurance companies 
above the health of our seniors. We must give seniors the access to the 
health care that they need and deserve, and that is what today's veto 
override vote will accomplish.
  I urge an ``aye'' vote to override this veto.
  Mr. LEVIN. Madam Speaker, I urge the House to join me in voting to 
override the President's veto of the ``Medicare Improvement for 
Patients and Providers Act of 2008.''
  A vote to override the President's veto of this bill is a vote in 
support of our seniors and their doctors. It is a vote in support of 
people who have worked hard, who have contributed, who have earned the 
best health care available to them at this stage of their lives. It is 
a vote that sends a clear message that politics should not get in the 
way of their access to the care they deserve.
  H.R. 6331 prevents a pending 10 percent reduction in the payments 
physicians receive for treating Medicare patients. The bill also allows 
for the expansion of preventive care services under Medicare, reforms 
the pharmacy payment process for the benefit of our small community 
pharmacies, and delays and repairs a flawed competitive bidding process 
for durable medical equipment.
  We must continue a vigorous effort to ensure that Medicare remains 
strong for all of the Nation's citizens. This bill honors that 
commitment without delaying difficult decisions about Medicare's 
funding future; it is fully paid for.
  I encourage all of my colleagues to vote in favor of the veto 
override.
  Ms. JACKSON-LEE of Texas. Madam Speaker, I rise today in strong 
support of overriding President Bush's veto of H.R. 6331, the 
``Protecting the Medicaid Safety Net Act of 2008.'' I would like to 
thank my colleague from New York, Chairman Charles Rangel and 
Congressman Dingell for their leadership in this important issue.
  This legislation could not come at a more crucial time. Americans are 
in need of support. Rising gas prices, food costs at an all time high, 
and a rocky housing market has pushed this great Nation toward an 
economic downturn. Families are clinging to basic necessities and 
quality healthcare is own of those essential needs.
  I am pleased to see that there is no language that inhibits physician 
ownership of general acute care hospitals. I have worked tirelessly 
with members of leadership and with the Texas delegation to support 
general acute-care hospitals and their future development. Physicians 
who have decided to build in areas where often no other hospital will--
should not be penalized for their commitment to work on the clinical 
and business side of health care.
  General acute-care hospitals still need to be able to:
  Maintain a minimum number of physicians available at all times to 
provide service;
  Provide a significant amount of charity care;
  Treat at least one-sixth of its outpatient visits for emergency 
medical conditions on an urgent basis without requiring a previously 
scheduled appointment;
  Maintain at least 10 full-time interns or residents-in-training in a 
teaching program;

[[Page 15071]]

  Advertise or present themselves to the public as a place which 
provides emergency care;
  Serve as a disproportionate share provider, serving a low-income 
community with a disproportionate share of low-income patients; and
  Have at least 90 hospital beds available to patients.
  This issue is of the utmost importance to me because I, like others 
in the Democratic Caucus, have hospitals and hospital systems such as 
University Hospital Systems of Houston in my district that would have 
been greatly affected by this provision.
  For example, 2 years ago St. Joseph Medical Center, downtown 
Houston's first and only teaching hospital, was on the verge of closing 
its doors. However, a hospital corporation in partnership with 
physicians purchased it, and as a result of proper and responsible 
management, has made it the premier hospital in the region, with a 
qualified emergency room responsive to a heavily populated downtown 
Houston. St. Joseph Medical Center is also in the process of reopening 
Houston Heights Hospital, the fourth oldest acute care hospital in 
Houston. This hospital will be serving a large Medicare/Medicaid 
population.
  I am committed to this issue and to the issue of health care for all 
Americans. Provisions that could end the expansion of truly 
compassionate hospital care in places like Texas, Maryland, New York, 
and California have no place in health care legislation.
  What I do support is legislation that seeks to aid our elderly, our 
disabled, our veterans, our children and our indigent populations. I 
stand here today to show my support not only for the physicians and 
medical care providers of Houston, Texas, but for all of our health 
care providers across this country. We need them to continue to be able 
to care for our underserved and elderly--this bill allows them to do 
just that.
  This bill provides a delay of 18 months for the competitive bidding 
program for durable medical equipment (DMEPOS). It also prevents the 
10.6 percent pay cut to physicians that is scheduled to take place on 
July 1, and provides a 1.1 percent update starting January 1, 2009.
  This bill also includes important beneficiary improvements such as 
Medicare mental health parity, improved preventive coverage, and 
enhanced assistance for low-income beneficiaries.
  It contains provisions that will protect the fragile rural health 
care safety net. In my home state of Texas, we have not only great 
urban areas such as Houston, Dallas and Austin, we have over 300 rural 
areas in Texas with cities such as Rollingwood and Hamilton.
  Our rural health care providers are scheduled to receive steep cuts 
in Medicare reimbursement rates on July 1 unless we take action now. 
Such cuts are catastrophic in rural America, where a disproportionate 
number of elderly Americans live. These seniors are, per capita, older, 
poorer and sicker (with greater chronic illnesses) than their urban 
counterparts. Additionally, recruitment and retention of providers to 
much of rural America is often daunting. Provider shortages are rampant 
throughout many rural and most frontier regions.
  Additionally, H.R. 6331 also includes several other critical 
provisions for rural providers which, cumulatively, create a rural 
package that will help protect both the rural health safety net and the 
health of tens of millions of seniors who call rural America home.
  H.R. 6331 focuses on strengthening primary care and takes significant 
strides in protecting rural seniors' access to care by correcting 
certain long-standing inequities between rural and urban providers.
  Thank you both for your continued concern for the health of rural 
Americans. So many enduring inequities in health care must be faced by 
rural patients and providers daily. H.R. 6331 offers critical 
assistance and will go far to improving the health of millions of rural 
Medicare beneficiaries.
  Quality measures must continue to be adequately funded in order to 
promote quality, cost-effective health care for consumers and 
employers. The uncertainty of Medicare payments makes it increasingly 
difficult for surgeons and their practices to plan for the expenses 
that they will incur as they serve their patients.
  The provisions included in H.R. 6331 would enable surgeons and 
surgical practices to plan for the rising costs that they will continue 
to face over the next year and a half.
  By addressing payment levels through 2009, Chairman Rangel has given 
us more time to study the payment issues surrounding Medicare and allow 
us to look at the systemic reforms needed to preserve access to quality 
surgical care and other physician services.
  As a longtime advocate for universal health care, I believe we must 
continue to support our essential medical providers so that they can 
focus on patient care. We need more physicians as we seek to expand 
health care for all Americans. Yet, how can we expect to grow that 
workforce when we continue to cut their reimbursement levels? We must 
support our physicians so that they may support and care for their 
patients. We have to continue to look at how we can save Medicare and 
expand it to care for those who need it most. Finally, with the recent 
passing of Dr. Michael E. Debakey, I hope his life and legacy will 
inspire the Congress to continue to build up the system of the health 
in America for all Americans.
  I urge my colleagues to join me in overriding the President's veto of 
this very important legislation.
  Mr. FARR. Madam Speaker, I rise today in support of overriding the 
President's veto of this Medicare bill. I may not sit on the Ways and 
Means Committee but I have followed the progress of this bill minute-
by-minute, it seems. The seniors in my community need this bill. The 
doctors in my community need this bill. If this country wants to assure 
affordable health care for its elderly, this country needs this bill.
  The President's veto of this bill was a poorly cloaked nod to the 
insurance industry. While the rest of us are trying to find a way to 
reform the Medicare system, the White House is trying to find a way to 
privatize it. Whereas government has the charge of making sure the 
program delivers health care efficiently, private insurance has the 
charge of making sure the program brings a profit to shareholders. 
Taxpayer dollars should not be making insurance companies rich.
  I urge all my colleagues to vote to override.
  Mr. VAN HOLLEN. Madam Speaker, I rise in strong support of overriding 
the President's veto of the Medicare Improvements for Patients and 
Providers Act of 2008.
  It is very unfortunate that the President has sided with the 
interests of certain big insurance companies against the health care 
needs of seniors. There are a number of important provisions in this 
legislation that will benefit more than forty-four million Medicare 
beneficiaries by preserving patient access to physicians, enhancing 
preventive and mental health benefits in the Medicare program, 
extending expiring provisions for rural and other providers, and 
improving assistance for low-income seniors. Unlike the President, 
Congress has put aside party politics and is protecting and preserving 
the health care that seniors depend on.
  Madam Speaker, this is an issue that affects all Americans. I 
strongly urge my House colleagues to override the President's veto on 
this bipartisan legislation.
  Mrs. BACHMANN. Madam Speaker, today, the House voted to override the 
President's veto of H.R. 6331, the Medicare Improvements for Patients 
and Providers Act. Although I had previously opposed this legislation, 
I reluctantly cast my vote in favor of overriding the veto. While I 
maintain my concerns over the funding cuts to Medicare Advantage plans 
contained in the bill, H.R. 6331 corrects the scheduled physician 
payment cuts and we have simply run out of time to negotiate further on 
this matter.
  Ensuring access to health care is critical for all Americans. It is 
especially important that senior citizens, who are at a particularly 
vulnerable time, receive high quality, affordable care. Consequently, 
in 2003, Congress created Medicare Advantage plans which combine the 
reliable nature of Medicare with the quality and value of a 
competitively driven market. With nearly 10 million Medicare 
beneficiaries currently enrolled in Medicare Advantage plans, up nearly 
60 percent since 2004, America's seniors are seeing the benefits of 
these plans, offering greater choice, lower out-of-pocket costs, and 
expanded service.
  Unfortunately, the bill placed before us today actually falls short 
of a compromise that would have staved off the devastating 
reimbursement cuts and preserved valuable access to Medicare Advantage 
plans. Seeing how near Senate Finance Committee leaders were to 
reaching an optimal compromise, I originally opposed H.R. 6331. 
However, it is clear now that this bill represents the only vehicle to 
combat the painful cuts to physician payments and to maintain seniors' 
access to Medicare providers, and therefore it must be supported.
  Madam Speaker, America's physicians have called on Congress to 
prevent a devastating cut to their Medicare reimbursement payments. 
This cut could have dangerous implications for America's seniors, 
risking access to the health coverage on which they rely. While H.R. 
6331 does not represent the full extent of what I feel could have been 
done to address the health care needs for our senior citizens, it does 
defeat the most imminent threat. I remain hopeful that Congress will 
revisit this matter and restore Medicare Advantage to its true 
potential

[[Page 15072]]

  Mrs. MALONEY of New York. Madam Speaker, I rise in strong opposition 
to the President's shortsighted veto of H.R. 6331, the Medicare 
Improvements for Patients and Providers Act of 2008, and urge my 
colleagues to vote to override this veto.
  Medicare has been a true success story for seniors--but Medicare will 
continue to succeed only as long as doctors continue to participate. 
And no doctor can afford to take a 10 percent cut in payments.
  Last week, H.R. 6331 passed by overwhelming bipartisan majorities in 
both the House and Senate because our Nation's health depends on it. 
The bill eliminates the Medicare-killing payment cut and provides a 1.1 
percent increase for physicians for 2009. It provides mental health 
parity in the Medicare program--something I've been fighting for, 
because people suffering from mental illness are just as in need of 
treatment as people suffering physical illness. The bill also allows 
poor people to keep more of their assets and still qualify for help 
with Medicare costs.
  My district includes more hospitals than probably any other district 
in the country--and all the doctors affiliated with those hospitals 
have offices in my district. They have been clear--unless they receive 
fair payment for their work, they cannot afford to continue to treat 
Medicare patients. Without good doctors, seniors' health will suffer. 
Congress was right to pass this bill the first time, and I hope we 
stand strong to pass it again today. I urge my colleagues to join me in 
voting to override the President's veto.
  Mr. REYES. Madam Speaker, I rise in strong support of overriding the 
President's veto of H.R. 6331, the Medicare Improvements for Patients 
and Providers Act.
  For the past several weeks, Congress has debated an issue that should 
not be considered controversial--health care for our Nation's seniors. 
This important piece of legislation addresses impeding cuts to 
physicians' Medicare payment rates. The issue not only affects seniors 
in my district of El Paso, Texas, but also hurts access to health care 
for all El Pasoans.
  The most important issue to consider when discussing this bill is 
that the provisions not only stop the impeding 10.6 percent cut, but it 
ensures that seniors and people with disabilities can continue to see 
the doctors of their choice.
  It is also critical to understand that a cut to Medicare will have a 
significant impact on similar programs. For instance, these cuts would 
not only affect those covered by Medicare, but it would also threaten 
access to health care for military members and their families under the 
military health program, TRICARE. Physicians serving our troops also 
face the 10.6 percent cut due because TRICARE payments are directly 
tied to Medicare.
  Also, private insurance companies look to Medicare to base their 
physician reimbursement rates. Physicians in El Paso and across the 
Nation rely on reimbursement by Medicare and other health care 
insurance groups to cover health care services rendered when a patient 
does not pay the full cost of care. In a recent survey of Texas 
physicians, more than 60 percent stated they would be forced to stop 
seeing Medicare patients should their reimbursement rates be cut.
  H.R. 6331 is significant legislation that eliminates the cuts to 
Medicare payments for the remainder of 2008 and provides a 1.1 percent 
increase for 2009. The bill also extends and improves low-income 
assistance programs for Medicare beneficiaries. Finally, the bill 
protects seniors' access to therapy services.
  I am extremely disappointed at President Bush's obvious disregard for 
Congress and the people they represent by vetoing this critical 
legislative proposal. By doing so, the President has sent a clear 
message to seniors that he does not believe providing them with access 
to quality health care is a priority of his administration.
  Madam Speaker, I urge my colleagues to vote in favor of overriding 
the veto and by doing so, support Medicare beneficiaries' ability to 
choose their physicians.
  Mr. TIAHRT. Madam Speaker, I rise today in opposition to President 
Bush's veto of H.R. 6331. This legislation is a critical bill to ensure 
that our seniors have access to health care and so I will again vote in 
its favor. I am disappointed with the President's decision and am 
compelled to make a stand in support of our seniors.
  By the nature of our democratic process, almost no bill considered in 
Congress is perfect, and H.R. 6331 is no exception. We cannot, however, 
``let the perfect be the enemy of the good.'' H.R. 6331 is a good 
compromise that will help preserve our health care delivery system. 
This bill will increase investment in preventive and quality care, 
expand programs in rural communities, expand the patient centered 
medical home, and begin to transform the health care delivery system 
through the adoption of electronic prescribing. This investment will 
yield generations of healthier adults, improved quality of life, and 
long-term health care savings.
  One of the most important pieces of this bill is the physician 
reimbursement rate fix--which is really an access issue. Perhaps the 
most critical situation facing our seniors in the coming decades will 
be access to physicians. Due to the paltry reimbursement rates for 
their services, more and more doctors are unable to take on new 
Medicare patients, or even serve any Medicare patients. They simply 
cannot pay the bills. The formula that CMS uses to determine the 
reimbursement for physician services is not based on cost accounting 
standards. No one seems to understand why CMS adopted this formula 
decades ago, yet no one at the agency seems willing to overhaul it. The 
result is decreasing reimbursement for physicians. When they cannot 
cover their own costs, they have to stop seeing Medicare patients and 
this is a grave concern. We are not only concerned that our parents 
will not be able to see a physician when in need, but also that there 
won't be adequate health care access when the baby boomers and our 
children become Medicare eligible. I'm for a permanent fix, which this 
House voted for in 2004 as part of the Medicare Modernization Act 
before the Senate stripped it, but until we get there, preventing the 
annual cuts must be our priority. This bill prevents a reimbursement 
rate cut and helps physicians continue to see their senior patients.
  I strongly disagree with the President--and even my own leadership--
on his position. Access to healthcare is one of the greatest issues 
facing our seniors--along with rising fuel costs--and it is 
irresponsible to stand in the way of providing that access. I urge my 
colleagues to join me in overriding the veto of H.R. 6331.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered.
  There was no objection.
  The SPEAKER pro tempore. The question is, Will the House, on 
reconsideration, pass the bill, the objections of the President to the 
contrary notwithstanding?
  Under the Constitution, the vote must be by the yeas and nays.
  Pursuant to clause 8 of rule XX, further proceedings on this question 
will be postponed.

                          ____________________