ANNOUNCEMENT BY THE CHAIRMAN
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ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)
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ANNOUNCEMENT BY THE CHAIRMAN
The CHAIRMAN. The Chair would like to take the time to remind Members
that it is not appropriate to wear or display badges while engaging in
debate.
Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from
Louisiana [Mr. McCrery], a valuable member of the Subcommittee on
Health.
Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the
Medicare system has skyrocketed since 1970. Here we are today and
Members can see, if nothing is done, it goes off the chart.
In 1970, Medicare spent about $8 billion; in 1994, Medicare spending
was about $165 billion. That is an increase of almost 2,100 percent in
just 14 years. In the part B side alone, growth rates have been so
rapid that outlays of the program have increased 40 percent per
enrollee just in the past 5 years. More alarming is that Medicare
spending is projected to explode to over $350 billion in 2002. Clearly,
this is an unsustainable trend and one that neither seniors nor younger
Americans working to support themselves and their families can be asked
to underwrite.
The financial crisis in the Medicare program is not a short-term cash
flow problem, as the Democrats would like the American people to
believe. The trustees of the Medicare trust fund, three of whom are
President Clinton's own Cabinet members, said in their report on the
HI, or part A, trust fund, ``The trust fund fails to meet the trustee's
test of long range close actuarial balance by an extremely wide
margin.'' Further, the same trustees said in their report on the SMI
trust fund, the part B trust fund, ``while in balance on an annual
basis, shows a rate of growth of costs which is clearly
unsustainable.''
The public trustees of the Medicare program were very clear when they
said, ``The Medicare Program is clearly unsustainable in its present
form.''
The Democrats in the past have ignored the long-range spending
problem of the Medicare Program. Their solution has been to continually
raise taxes on working Americans, and that is still their solution.
In the years since the enactment of Medicare, the maximum taxable
amount has been raised 23 times. Two years ago, the Congress, then
controlled by Democrats, raised taxes, Medicare taxes again. All that
did was just put another financial burden on the taxpayers and put off
the financial crisis in the trust fund for just a few months. Clearly,
raising taxes yet again on the American people is not the answer.
The Medicare Preservation Act, on the other hand, addresses the out-
of-control spending in the Medicare Program by opening up the private
health care market to the senior population. By harnessing some of the
innovative cost effective and high quality private sector health care
delivery options, Medicare beneficiaries will not only have a choice in
their health care coverage for the first time, but the Government will
also be able to rein in out-of-control Medicare spending. It is a win/
win situation.
The Republican plan provides security for not only today's seniors
but also lays the groundwork for the retirement of my generation, and
it does it without increasing the tax burden on working people.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Pennsylvania [Mr. Klink].
Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to
me.
I would like to begin by yielding to the gentleman from Ohio [Mr.
Brown].
Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the
Gingrich Medicare plan, the hospitals in and around the district of the
gentleman from Louisiana [Mr. McCrery], will lose $158 million over the
next 7 years under the Gingrich Medicare cut plan.
[[Page H 10334]]
Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here
is the chart which actually shows the reduction in Medicare spending
per beneficiary under the House Republican plan. I have to get this
straight. When is a cut not a cut?
Last year when we were trying to do health care, every Republican on
the Committee on Ways and Means signed a letter which said, ``the
additional massive cuts in reimbursement to providers proposed in this
bill''--the Clinton bill--``will reduce the quality of care for the
Nation's elderly.'' That was $168 billion versus $70 billion now.
The current chairman of the Committee on Ways and Means made the
statement, ``I just don't believe that the quality of care and
availability of care can survive these additional cuts.'' Now they are
saying that these are not cuts. It is cuts in the rate of growth. Were
you lying to us now or are you lying to us then?
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
I resent the fact that the gentleman implied that I have lied. No. 1,
that does not belong on this floor. But the gentleman, as usual, has
not given the factual information.
The plan that I made those comments on cut $490 billion out of
Medicare and Medicaid. Without transforming Medicare, without giving
other options, without including true savings in the cost drivers. That
was a totally different time, a totally different program. But it cuts
$490 billion out of Medicare and Medicaid.
Mr. Chairman, I reserve the balance of my time.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Georgia [Mr. Lewis].
Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for
yielding time to me.
Mr. Chairman, I rise today in strong opposition to the Republican
Medicare plan. I rise to tell you there is another way, a better way.
We Democrats have a plan. We save the Medicare trust fund, and we do it
without hurting the poor, the sick, and the elderly.
How can we do it? We can do it because we do not pay for tax breaks
for the rich. There is only so much money--you can either use it to
help the sick and the elderly or you can give it to the rich. My
Republican colleagues may say whatever they wish, but the truth is that
these very large--these huge Medicare cuts are needed to pay for their
tax breaks for the rich.
The Republicans say they want to help Medicare. But what they do is
different. Thirty years ago, the Democrats created Medicare and the
Republicans voted against it.
Two years ago, Democrats passed a bill that helped the Medicare trust
fund. Every Republican voted no.
Earlier this year. the Republicans took $87 billion from the Medicare
trust fund. Today, they want to cut an additional $270 billion.
They voted against Medicare 30 years ago, and they are voting against
it again today. My colleagues, actions speak louder than words, and the
Republican actions are loud and clear.
The Republicans did not want Medicare 30 years ago and they want to
dismantle it now.
I do not believe that we must destroy Medicare to save it. Democrats
do not raise premiums for seniors. Democrats ensure that Medicare is
there for our families, for our children, for our grandchildren, and
their children.
Under their plan, the Republicans eliminate nursing home standards.
Poor seniors lose help for copayments and deductibles.
Under the Republican plan, the rich get tax cuts, and our Nation's
elderly and hard-working families get higher Medicare bills. It's a
scam, a sham, and a shame. I know it. You know it. Now the American
people know it.
Mr. Chairman, on this day, October 19, let the word go forth from
this place into every State, every city, every town, every village,
every hamlet that it was the Republicans who voted to cut Medicare--
they voted to cut Medicare by $270 billion in order to give a $245
billion tax break to the wealthy. The Republican plan is too much, too
radical, too extreme.
We have more than a legislative responsibility to oppose this
Republican plan. We have a mandate, a mission, and a moral obligation
to protect Medicare.
This vote--this debate is about something much bigger than one vote.
It is bigger than one bill. It is about two contracts, the Republican
contact with the rich, and the Democratic contract with the American
people--Medicare. Medicare is a contract--a sacred trust with our
Nation's seniors and our Nation's hard-working families.
My fellow Americans, remember--it was the Democrats who found the
courage and the strength to provide health care to our seniors, and it
is the Democrats who will preserve it for unborn generations.
We must not and will not break the contract with America's seniors
and families. I urge my colleagues to support the Democratic
alternative and oppose the Republican plan to cut Medicare.
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the facts have already been presented to this
committee. Medicare increases per beneficiary go from $4,800 to $6,700
per year. The total aggregate increase in medical expenditures
increases $1.4 trillion under our plan over the next 7 years. But only
in Washington can an increase be called a cut.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad
news for Americans and senior citizens. The trustees of the Medicare
funds told us that under all sets of assumptions the fund goes
bankrupt, and it goes bankrupt in 7 years. Taking our responsibility
very seriously, we Republicans went to work.
We gathered with senior citizens, with experts from around the
country, and we said, what can we do? Is there any good news? Can we
fix the situation? We found good news. We found that health insurance
costs for working people, not retired people, were going down.
Inflation rates at 10.5 percent in Medicare are killing it.
{time} 1230
The private sector using intelligent new programs have brought the
inflation rate down below to virtually zero. We said the good news is
this. We can preserve Medicare, we can preserve fee-for-service options
for everyone who wants to stay that way, but we have new and exciting
options.
Mr. Chairman, my mother and father have chosen the managed-care
option. They love it. They save $1,000 a year each because they no
longer buy MediGap insurance. They have new prescription drug benefits.
They get all of the referrals they want. They are delighted.
This plan is very straightforward. We preserve fee-for-service, we
increase the per beneficiary expenditure from $4,800 a year to $6,700 a
year, and for those seniors who want new choices, we have excellent new
choices in managed care. This is a spectacular bill. Americans will be
proud of it. Senior citizens love it. Vote ``yes.''
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentleman from Oregon [Mr. Wyden].
(Mr. WYDEN asked and was given permission to revise and extend his
remarks.)
Mr. WYDEN. Mr. Chairman, our Nation needs----
Mr. STARK. Mr. Chairman, will the gentleman yield?
Mr. WYDEN. I yield to the gentleman from California.
Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the
district of the gentleman from Pennsylvania [Mr. Greenwood] there will
be $128 cut from hospitals over the next 7 years.
Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of
Medicare, but instead today's bill will deliver a nationwide Medicare
migraine. Instead of listening to our seniors, and our families, and to
the inspector general, this is a cut first, ask questions later
Medicare initiative, and the fraud section is a metaphor for the whole
bill. Instead of legislation to protect seniors and taxpayers, it
protects the crooks and the thieves. Instead of improving access to
health care, it provides a freeway to fraud, and, my colleagues, think
of the words of the nonpartisan fraud-buster at the Office of the
Inspector General who said that this bill will cripple, it will
cripple, efforts to bring justice.
[[Page H 10335]]
Let me tell my colleagues it is possible to develop 21st century
Medicare that works for seniors and taxpayers. Reject this bill and
come with me to Oregon because I will show each of you programs that
protect seniors, hold down costs, and insure that we have a path to the
21st century. We can do this job right. We can do it in a bipartisan
way. But let us listen to our seniors and our taxpayers.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentlewoman from Oregon [Ms. Furse].
Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time
to me.
I have here a list of words that I am told the Republicans were asked
to use in this debate, words like historic, successful, saves. Well,
there was a historic event 30 years ago. The Democrats in this House
passed Medicare. Not one Republican voted for it.
Successful? Well, yes. This bill successfully guts Medicare.
Saves? Well, yes. This bill saves the promised tax breaks for the
rich.
Mr. Chairman, also on this list it says we should say the Democrats
are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I
know that it was the Republicans who ordered the arrest of 85-year-olds
who came to the committee. They came there. They came to ask the
committee what is going to happen to our Medicare protection. They were
Americans. It is a disgrace that they were arrested.
I think there is a word that is not on this list, Mr. Chairman, and
that word is shame.
Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond.
Mr. Chairman, the rules of this House are explicit. The chairman of
any committee is required to preserve order, and when citizens of any
persuasion, any age, come in, refuse to obey the orders of this House,
the chairman has no choice but to have them escorted out of the room.
Mr. Chairman, that is exactly what happened in the Committee on
Commerce, and that is what we had to do regrettably, but that is the
truth.
Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds.
Mr. Chairman, I love my dear friend from Virginia, but I notice he
did nothing when a bunch of people came in and dumped bags of mail from
dead men, from people who were not supporting the legislation in
question, and some of which were addressed ``contributor.'' Our
Republican colleagues have a great sensitivity about the senior
citizens, but none whatsoever about rascality by high-paid lobbyists.
Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the organization that disrupted that meeting, I would
like the Record to show, 96 percent of those funds come from the public
treasury. The person who was the ringleader was a paid staff person.
Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr.
Bilirakis].
(Mr. BILIRAKIS asked and was given permission to revise and extend
his remarks.)
Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on
those politicians who over the years, not just now, use scare tactics
and misinformation to frighten our senior citizens all in the interests
of getting votes through fear. These actions are unconscionable.
Only the most affluent retirees are having their part B premiums
raised substantially. We are not raising Medicare copayments or
deductibles. We will not be reducing services or benefits--our
legislation ensures that the core services in the current Medicare
Program will be retained and must be offered to all beneficiaries.
I also want to make it clear that no one will be forced into HMO's.
If Medicare beneficiaries wish to keep the current fee-for-service
benefit where they have complete choice of their doctor, they will be
permitted to do so. If beneficiaries want to enroll in an HMO which
might include additional health benefits, or some other Medicare-plus
plan, they can do so. It will be their choice. Under our proposal,
coverage will be assured to all senior citizens, regardless of prior
health history or age.
From the beginning of this effort, I have insisted that protecting
beneficiaries was an essential part of any Medicare report effort. I
represent a congressional district that has one of the highest
percentages of senior citizens in the country. I also worked for years
as an attorney and a community volunteer with many retirees. Recently,
I myself, reached Medicare age.
This bill is the product of listening and learning. It is a product
of many discussions with people who had real life, day to day
experiences with the Medicare Program. It protects our current
beneficiaries while ensuring that Medicare will exist for future
beneficiaries.
In a recent Washington Post article, Robert Samuelson said it well
when he stated that ``Republicans occupy the high moral ground and the
low political ground. They have raised critical questions at the risk
of political suicide.''
And, knowing that, Republicans still believe it is our responsibility
to show pure guts and courage to save Medicare for our seniors, their
children, and grandchildren. We have taken on the task of protecting
and preserving Medicare because it is our moral responsibility, not
because of political necessity. We have taken the higher ground and
this is ground that I am proud to stand on.
Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from
Texas [Mr. Bryant] and I ask him if he would yield back to me 15
seconds.
Mr. BRYANT of Texas. I yield to the gentleman from California.
Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement
made by the previous gentleman. He claimed we are not cutting benefits,
we are not going to make people pay for benefits for their health care.
How are we getting $270 billion in Medicare cuts and the AMA supports
the bill? Something just does not add up.
Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is
impeccable. I would point out that the losses to hospitals in and
around the district of the gentleman from Florida [Mr. Bilirakis] are
going to be $210 million over the next 7 years, and my colleague says
there are no cuts. His folks are going to feel them.
The fact of the matter is, Mr. Bilirakis, as chairman of the
Subcommittee on Health, my colleague and his Republican friends ought
to be working on the fact that health care costs are rising. Instead my
colleague is working on cutting health care insurance that elderly
people use to cope with health care costs. That is the problem.
The fact of the matter is it is not a secret that my colleague's
party philosophically does not believe Medicare is the appropriate role
of government, and yet he comes in here and tells us they are not
cutting it. Mr. Chairman, my colleague has gotten power, and now he is
cutting it. He boasts throughout the land he is cutting government, but
today, as he takes $270 billion out of the program that insures the
health needs of seniors, he says he is not cutting it.
Only in Washington would anybody believe that, Mr. Archer.
I would point out that with regard to these cuts, Mr. Chairman, the
gentleman from Texas [Mr. Archer] and I are pretty much both in the
same situation. In Harris County, TX, we are talking about $2.4 billion
in cuts between 1996 and the year 2002 according to the Health Care
Finance Administration.
Now my colleagues asked for facts, There is facts. Dallas County,
$1.6 billion in cuts between 1996 and the year 2002. Why? To pay for
tax cuts for wealthy people out of the hides of elderly people who are
not going to be able to pay their medical bills because they have cut
their insurance.
Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume
very simply to say that once again we are back into the same rhetoric.
There will be increases for hospitals across this country. Those
increases have already been demonstrated by the facts.
Only in Washington can a Member of Congress stand up and call
increases a cut.
Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr.
Camp], a respected member of the committee.
(Mr. CAMP asked and was given permission to revise and extend his
remarks.)
Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from
[[Page H 10336]]
Texas [Mr. Archer] for yielding this time to me, and I rise today in
support of the Medicare Preservation Act because it officially ends the
policy of just raise taxes.
Mr. Chairman, some who oppose our program have called it extreme.
What is extreme is that year after year the Democrat's answer to the
Medicare crisis has been to raise taxes. Almost every year, Democrats
dug deeper into the pockets of working Americans just to get through
the next election. And in 1993, they even raised taxes on seniors
citizens.
Nine times, since 1965, the Medicare Board of Trustees has stated
that Medicare was in severe financial trouble and needed reform. What
was the Democrats answer? Raise taxes. Just throw more money at it to
get through the next election.
Since 1965, Democrats raised the payroll tax on working Americans
eight times, over 450 percent. They raised the earnings subject to tax
for Medicare 10 times, an increase of over 2000 percent. Then they
raised taxes on Federal and State employees, and, when they still
needed more, in 1993, they raised taxes on American seniors who had
already paid their fair share into the program. Now, a senior earning
just $34,000 pays not half of their Social Security in taxes but 85
percent. And now even the President admits taxes were raised too much
in 1993.
Mr. Chairman, that is extreme.
Could we put the Medicare crisis off a few years if we raise taxes
again? Sure we could.
Could we avoid the vicious attacks by special interest groups if we
didn't reform the system? Sure.
But we are not going to do that. We are going to preserve, protect
and strengthen Medicare not to get through the next election, but for
the next generation. We will ensure the solvency of this program. We
will increase benefits. We will maintain the current premium rate and
for the first time in the history of Medicare, we will give seniors the
right to choose the health care plan that best suits their health
needs.
Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from
Florida [Mr. Stearns].
Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I
could, with the gentleman from Pennsylvania. Both he and I have worked
hard in our districts getting the message out how important it is to
look at this program because it is going bankrupt, and we want to offer
them choices, much like the choices that the gentleman and I have.
Perhaps many Members do not know that a large number of the Federal
employees are retired and they have choices, HMO's, PPO's, and all
these other things. Let us talk, for example, about a widow whose $600-
a-month pension is too low to pay for this expensive part C medigap
insurance and whose biggest problem is that she cannot afford the
deductible portion of her doctor's bill.
{time} 1245
So what happens, she does not go to take care of herself. Now, what
would we have under this program with our HMO's and PPO's and the
PSN's? I mean, even a $5 doctor bill is something that she would be
concerned about. You might want to amplify on that.
Mr. GREENWOOD. If the gentleman will yield, the option that would be
very attractive for the constituent in your district that you just have
described would be a managed care option. Most of the managed care
companies have told us that, and they are already doing this in many
areas of the country, that they will offer managed care plans in which
there is no requirement whatsoever to pay Medigap insurance. So that
$1,000 a year that she may be paying now toward her Medigap insurance
would disappear. Suddenly she would gain new benefits. She would
probably gain a prescription drug benefit. She may get an improved
dental or vision benefit. She would no longer have that out-of-pocket
cost at all and still be able to go to her doctors within her network
whenever she chooses. She would, I think, would welcome this change
very much and be far better off and have more money left over in her
budget at the end of each month.
Mr. STEARNS. Is it not a point of fact that all the people in this
room have the Federal employee health benefit program, and is it not a
point of fact that people on this side are in HMO's, in fact, there are
Members of Congress who have retired who are in health management
organizations and they are not picketing and screaming and worried?
Because actually what we are trying to do is develop a program for
Medicare that is much like the First Lady and the President has and all
of us have, which basically says that health management organizations
might work for some people. It should be a choice, and surely if it is
good enough for Members of Congress, these same choices should be
available for the seniors. So I think that is what you are saying for
this particular woman in Florida who is on a very small pension every
month. This would be a possible choice for her. You might want to just
amplify on that, because I know you have toured, like I have, many
health maintenance organizations, talked to the seniors, and for some
of them they are very happy.
There are people that have high monthly drug costs, and the HMO is
paying for that, and it is paying for their deductible. So that surely
that is an approach we should not rule out by keeping the one
warehouse, one-size-fits-all program we now have. Surely moving it to
what we have in the Federal employee health benefits program is a step
forward.
Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this
country already have chosen the option of receiving their Medicare
benefits through managed care. That number is growing rapidly because
you know how seniors will get together and talk and compare notes, and
when one learns from the other that they have a new prescription drug
program benefit, they say, ``How do I get that,'' and they make the
choice.
One of the things about this debate that has been interesting to me
is you and I and Members of this side of the aisle know our friends on
the other side of the aisle will spend all day, as they have spent the
last 6 or 7 months, scaring senior citizens that all of these terrible
things are going to befall them.
The fact of the matter is that we are confident today, we are
confident because we know when the political dust settles, when this
plan is finally signed into law, that the senior citizens will then,
beginning in January, have these new options. They will see, my
goodness, their copays did not go up, deductibles did not go up, their
Social Security check, even with part B deduction, is bigger than it
was this year. They will then thank us. Once this debate is over, we
think we will be able to say we told you so.
Mr. STEARNS. Is it not also true, if they want to remain in Medicare
as it is right now, they can still do that? They still have that
choice?
Mr. GREENWOOD. Absolutely. That is the beauty part. We have made
certain from day one there is the fee-for-service option will always be
available to every single senior citizen in America that wants to keep
it. Those that may be a little too old for change, do not like to
change, can keep their fee-for-service and enjoy the kind of Medicare
that they have grown to enjoy these past years.
Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds.
I know the two gentlemen who just had this colloquy on the floor are
sincere. But last year I checked all of the Medicare policies of every
Member in Congress here. Ninety-nine percent of us have fee-for-
service. Ninety-nine percent of us have fee-for-service, and all of
those, all of those that have fee-for-service have abortion benefits in
our medical care policies. You know, those are in the records of the
House. Go check them.
parliamentary inquiry
Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry.
The CHAIRMAN. The gentleman will state his parliamentary inquiry.
Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans,
buttons, while addressing the Committee of the Whole, and did the
Chairman not already indicate what the rules are?
The CHAIRMAN. The gentleman is correct.
Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from
New York [Mr. Manton].
Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman
from Michigan [Mr. Stupak].
Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker
in
[[Page H 10337]]
the well down here, the gentleman from Florida [Mr. Stearns], his
district will lose $154 million over the next 7 years if this
Republican plan goes through, just to give a tax break to the rich.
I am more concerned about the State of Michigan where the gentleman
from Michigan [Mr. Camp] spoke in which in his district the hospitals
will lose $125 million between now and 2002 just to pay for this tax
break for the rich. Being from Michigan, I am very concerned about
that.
Mr. MANTON. Mr. Chairman, I rise in strong opposition to this
draconian plan to slash $270 billion from Medicare. This so-called
Medicare preservation plan will seriously threaten the integrity of the
program and inflict undue pain on America's elderly.
Under this bill, the elderly will suffer an increase in their
premiums and a decrease in the quality of their health care services.
Quite simply, you are asking seniors to pay a lot more, but expect a
lot less.
And last night, Mr. Chairman, in one final act of cruelty, the
majority included a provision to deny anti-nausea drugs for
chemotherapy patients. How can you possibly justify denying basic
dignity and comfort to those in the twilight of their life, who are
fighting for that very life.
Speaking out against this outrageous proposal is not a matter of
demagoguery, its a matter of duty. Duty to the senior citizens we
represent.
Oppose this legislation.
Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from
Louisiana [Mr. McCrery].
Mr. McCRERY. Mr. Chairman, the gentleman stated something that is
just incorrect, and it has been stated in the media some. We are not
denying payments for anti-nausea drugs for cancer patients. The fact is
that we will continue to pay for the intravenous drug that people, the
cancer patients, use to fight nausea.
Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from
Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York
[Mr. Paxon] for a question.
Mr. PAXON. Mr. Chairman, I have many constituents back in western New
York, in the Buffalo and Rochester, Finger Lakes areas, that are
concerned about catastrophic costs in health care. How would medical
savings accounts help those with recurring health problems pay for
these catastrophic expenses?
Mr. GREENWOOD. The medical savings account is a new component of
Medicare that we have included in this reform. Those seniors who choose
it would have deposited into their medical savings account a number of
dollars that would average about $5,000 across the Nation; the first
portion of that deposit would be used to buy catastrophic or major
medical insurance that would cover them above he deductible. Then the
senior gets to use what is left in the account for his or her medical
benefits, go to whatever doctor or hospital he or she wants. Once the
deductible is reached, then in a year in which that particular
individual has high costs, then the medical, the catastrophic, coverage
would kick in and they would have no more out-of-pocket costs
whatsoever.
In a year in which she was particularly healthy, managed her costs
and did not go to a doctor very often, she would be able to keep the
balance in the medical savings account. It is a good opportunity for
savings for those seniors.
Mr. PAXON. I would make a comment. My parents are both retired. Both
have had catastrophic health care concerns. Of course, this would be
very important to them.
I also want to make the point Medicare is important to them today,
too. They want to see Medicare protected and strengthened. It is their
health care needs. It concerns me deeply. If their Medicare is not safe
and secure, they have to turn to the family to help. We want to make
certain for them and all of the constituents this plan is preserved and
protected for the coming years.
Mr. FRISA. Mr. Chairman, will the gentleman yield?
Mr. GREENWOOD. I yield to the gentleman from New York.
Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this
is such a serious issue, it is an important one for our senior
citizens. My folks are both retired and are counting on Medicare being
there throughout their retirement, and they are happy that we are
taking the opportunity to make Medicare safe and sound and better for
all of us.
So I would like to ask the gentleman, are there going to be increased
funds for seniors under the Republican plan?
Mr. GREENWOOD. Well, of course, there are. Despite all of the
rhetoric to the contrary, we are actually taking, right now, we are
spending on average $4,800 per each beneficiary in the Medicare
Program. Our plan increases that about 5 percent each year for a 40-
percent increase over the next 7 years. So 7 years from now we will be
spending $6,700 for beneficiaries. It is a huge increase.
What we are doing is bringing down the unsustainable inflation rate
which is bankrupting the system.
Mr. FRISA. In other words, and I think this is very important,
despite the rhetoric, it is really not truthful. We are saying the
average senior citizen will be getting an extra 100 $20-bills spent on
their medical behalf. So there is more money being spent for senior
citizens under the Republican plan.
It is absolutely incredible, I think you would agree, that my
colleagues on the other side of the aisle are trying to say that 100
additional $20-bills for our senior citizens is a cut. It is absolutely
incredible.
I thank the gentleman for explaining that and making it clear to the
American people and, most importantly, to our senior citizens that the
Republicans, by providing a $2,000-per-beneficiary increase is what is
going to save Medicare for our seniors so they can feel that it is safe
and sound and better for them.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Florida [Mr. Deutsch].
Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make
complicated issues simple. If we are saving $270 billion and there are
37.6 million beneficiaries, this is what it is going to cost each
Medicare beneficiary in America, whether in terms of direct out-of-
pocket expenses or not.
There is another chart which I think is probably the best chart and
the clearest and most factual, and if we can focus in on this so people
watching can see, my Republican colleagues have said we have to do
something, there is this incredible crisis, the trust fund is gong to
go bankrupt in 7 years.
Well, the Medicare Program has existed for 30 years. Twelve of those
thirty years there was a shorter life expectancy than 7 years that
exists today, and we did incremental changes. We fixed it.
It is a flat-out lie that this is unprecedented. It is a flat-out lie
that $270 billion needs to be cut. It is a flat-out lie that choice
will be available for Medicare beneficiaries.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Tennessee [Mr. Clement].
(Mr. CLEMENT asked and was given permission to revise and extend his
remarks.)
Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican
Medicare reform plan and ask my colleagues to support the Dingell-
Gibbons substitute.
Mr. Chairman, when President Lyndon Johnson began the Medicare
Program in 1965, less than half of all seniors had health insurance. It
was understood that the elderly had declining resources, costly health
care needs, and few insurers willing to sell them coverage. Since its
creation, the Medicare Program has been a great success. Today, 99
percent of senior citizens and a substantial proportion of the disabled
are covered by Medicare. It has contributed to reducing poverty among
the elderly and causing the life expectancy rate in America to exceed
that of every country in the world except Japan. Medicare is fulfilling
its mission.
Let me review briefly the two areas of the Medicare Program. Part A
of Medicare is financed by the hospital insurance trust fund, which
comes primarily from the hospital insurance or Medicare payroll tax
contributions paid by employers, employees, and self-employed
individuals. Medicare part A will pay for inpatient hospital care,
skilled nursing facilities, home health care, and hospice services. It
is the trust fund of part A which the Medicare trustees say is
``severely out of financial balance'' and must receive ``prompt,
effective,
[[Page H 10338]]
and decisive action'' from Congress to restore the stability of the
program.
The second aspect of the Medicare Program is part B, the
supplementary medical insurance trust fund. Part B is optional, and
primarily finances physician and hospital outpatient services. Part B
is financed by premium payments from enrollees and by general revenue
funds from the Federal Government. The part B premium is currently
$46.10 monthly or 31.5 percent of total costs of Medicare, and the
budget of 1993 would bring the premium down to 25 percent of total
costs from 1996 to 1998. Beneficiaries are responsible for an annual
deductible of $100 and coinsurance, usually a 20-percent copayment. The
part B trust fund is not in financial crisis, though only because it is
financed partially by the general fund which is experiencing runaway
health care costs and driving up the deficit of the U.S. Government.
Let me be clear that I do not believe Medicare is out of control or
too generous as some have stated. In truth, Medicare pays only 45
percent of the Nation's health care bill for the elderly, and it is
less generous than 85 percent of private health insurance plans.
The problems we are facing with Medicare today are primarily
external, not internal. Though some problems do exist internally such
as fraud and abuse, most of the factors which bring us to the present
crisis are external. Let me share a few with you.
First, the primary threat to Medicare is its rising costs which are
consequently driving up the Federal deficit at alarming rates. The
ability of any reform proposal must be measured by the following
yardstick if we are to balance the budget and get our financial house
in order: Does the reform measure control the costs of Medicare? Over
the past 20 years the cost of the Medicare Program has increased an
average of 15 percent a year. In this year alone, Medicare will account
for 11.6 percent of all Federal spending. This will rise to 18.5
percent by 2005 if costs are not controlled.
Another factor which threatens the future of Medicare is the growing
number of senior citizens in America. The Baby Boomers will begin
retiring shortly after 2010, and recent years have seen a dramatic
increase in life expectancy. During the 30-year period from 1990 to
2020, the growth rate of the senior citizen population will be double
the growth rate of the total U.S. population. This means that those
receiving Medicare benefits will outnumber those employees and
employers paying into Medicare.
Among other contributors to the rising cost of Medicare are the high
cost of advanced medical technologies, the rapid increase in procedures
by doctors after a fee schedule was imposed by Medicare, the fee-for-
service arrangement which gives no cost-saving incentives to providers
or patients, and the rise of Medicare fraud and abuse. All these
factors, some of which I applaud such as life expectancy and miraculous
technology, have brought us to this present moment of crisis.
Before looking at the specific proposals to reform Medicare, I wish
to suggest the values which I believe should drive any attempt at
reform. I believe you will agree with me. These values are:
First, ensuring that every dollar saved from Medicare goes directly
toward strengthening the part A trust fund and eliminating the Federal
deficit;
Second, making the trust fund sound for the short term and the long
term;
Third, protecting beneficiaries from dramatically increased costs and
reduced access to care;
Fourth, improving patient choice without coercion or compromising the
quality of care;
Fifth, reasonable sacrifice by all while ensuring the quality and
viability of provider services for all Americans.
Let us now turn to a quick overview of the two major proposals now
before the Congress, one from each party. First, let's look at the
Republican plan to reform Medicare.
The Republicans, in their noble effort to balance the Federal budget
and reduce the deficit, agreed to a fiscal year 1996 budget resolution
which would reduce the rate of increase in Medicare spending by $270
billion by the year 2002, bringing its rate of growth down from its
current 10 percent a year to about 6 percent a year.
The most important innovation in the Republican proposal is a feature
which would allow Medicare beneficiaries to opt for a wide range of
privately run health plans, with the Government paying the premium. The
plan would provide an incentive for beneficiaries to choose an option
that is less costly, such as managed care or preferred provider groups,
while allowing those who want to stay in the traditional fee-for-
service style Medicare Program to do so. However, the Republican plan
would force many low-income seniors out of the traditional program
because of the high cost of staying in the fee-for-service as compared
to other options. The Dingell-Gibbons substitute, which I will support
today, allows seniors to move into managed care and rewards this cost-
saving sacrifice without punishing those who wish to stay in
traditional fee-for-service programs.
Another set of cost-saving provisions in the Republican plan would
reduce the growth of fees paid to hospitals, doctors, and other care
providers by an estimated $110 billion over 7 years. The Democratic and
Republican plans both rely heavily on reductions in the increase of
payments to providers, but the Republican plan also contains a look
back provision which I oppose that would balance the budget on the
backs of providers if the projected cost savings are not realized. This
will only mean that doctors and hospitals will begin turning down
Medicare patients, leading to a national health care travesty.
Both Democratic and Republican plans also contain provisions to
eliminate excessive fraud and abuse within the Medicare Program. The
Congressional Budget Office estimates that at least $20 billion could
be saved over 7 years by reducing fraud and abuse in the Medicare
Program. I believe it is wrong to raise premiums for seniors until the
cheats and ripoff artists are weeded out of Medicare. The Democratic
plan makes significant headway toward reducing fraud, but the
Republican plan will repeal existing statutes that keep doctors from
preying on their patients for their own financial self-interests.
These measures, and others, are slated to ensure the viability of the
Medicare part A trust fund. Let us turn to part B for a moment. I
remind you that the primary reason to reform part B is to reduce the
growth in the Federal deficit, not to build up the part A trust fund
which receives its revenues from elsewhere. The Republicans choose to
deal with the rising cost of part B by keeping the part B premium at
31.5 percent of total cost rather than at 25 percent as now planned.
This means a doubling of Medicare part B premiums by 2002, increasing
from $46.10 now to approximately $104 in 2002. While I do not oppose a
sensible increase in premiums, I believe this increase is out of reach
for many low-income seniors. I support the Democratic plan which would
permanently maintain premiums at 25 percent of total cost.
As you can see, many of the aims and methods are the same in the two
plans. But the details differ at significant points, particularly with
regard to how much of the burden seniors are asked to bear.
I would like to sum up the Medicare debate as I see it. First, I
support many of the reforms both sides support including incentives for
entering managed care, slowing the increase in provider payments, and
eliminating fraud and abuse. These are all contained in the Democratic
substitute which I am supporting.
Let me share with you my disagreements with both plans, Democratic
and Republican. Too often Democrats have sat on the sidelines this year
while the Super Bowl is being played on the field--we have offered more
critique than solutions. While this may be a good political stunt, it
is not responsible nor respectful of our Nation's senior citizens or
our children who will bear the cost of the Medicare Program if we do
nothing. But I have not been content to sit on the sidelines. Before
this debate even began, I stepped out in support of health care reform
bill this year that would have made many of the adjustments we are now
discussing. Even today, I would have preferred to have voted for the
coalition substitute which would have dealt with part A and part B. But
the Republicans in the Rules Committee would not allow this bill to
come to the House floor for a vote. So, today I will choose between the
better of two evils and support the Democratic substitute.
I sharply disagree with Republicans at one major point. Earlier this
year, the Republicans voted for a $245 billion tax cut which gives over
50 percent of the cut to those who make over $100,000 a year. It is any
wonder then that Republicans now need to save $270 billion from the
Medicare Program to pay for these tax cuts. I believe a tax cut of this
magnitude at this time is irresponsible, especially when the majority
of the tax cut goes to wealthy Americans. This translates into the
outrageous premium and deductible increases Republicans now propose.
The seniors in my district are telling me, ``Congressman, I don't
mind sacrificing some benefits and bearing some of the financial burden
of the Medicare Program to ensure the viability of the trust fund. But
it seems to me that the Republicans are asking us to bear most of the
burden for this reform, and it is not fair.'' I've been hearing a lot
of people at home saying that they are beginning to think that GOP
stands for Get the Old People party. I am not so sure they are wrong.
The Greek word for crisis is krisis. The Greeks used this word to
point to a critical moment in time when the road ahead would either
mean a time of devastation or a time of great opportunity. This is a
time of krisis. The decisions Congress make at this time will mean a
future of prosperity and health security for all Americans, or it will
mean a bleak future
[[Page H 10339]]
of prosperity and health care for only the privileged few. I believe
this is the time of great opportunity, and together we will forge out a
Medicare Program that will provide the best health care for our
Nation's elderly for decades to come.
Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from
Wisconsin [Mr. Kleczka].
Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are
going to be giving all of this cash to senior citizens under the
Republican plan.
What he did not tell the seniors that are watching today is we are
going to double your premiums in part B; all right. The Senate
provisions provides more copays, more out-of-pocket-expenses.
Seniors, this is what you are getting: Nothing.
Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from
Massachusetts [Mr. Neal].
Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital
Association and the gentleman from Massachusetts [Mr. Torkildsen] have
rejected the Republican Medicare bill. The MHA says the spending
reductions in these proposals are too fast, too deep, and would
jeopardize the ability of Massachusetts hospitals to provide quality
health care to patients and communities.
Health care in Massachusetts is world-class. When Raisa Gorbachev and
Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of
the Committee on Rules, all were ill, they came to Massachusetts.
{time} 1300
If the Medicare bill was a good bill, would not the Massachusetts
teaching hospitals, with the renowned reputation that they have earned
over many years, take the lead and endorse the bill? We trust these
hospitals with our lives. We should also trust their assessment of the
Republican Medicare bill.
The Gingrich Medicare cuts are simply too large for hospitals to
absorb. Cuts of this magnitude will damage the quality of health care
in America, especially for senior citizens and future generations. We
should be investing, and not cutting research and education.
These outlandish cuts to hospitals will cause massive job loss across
this country. The people hurt most by these cuts will be the hard
working men and women of America, all so that a tax cut can be given to
wealthy Americans who have not even asked for it. It is just not right.
Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the
distinguished gentleman from New Mexico [Mr. Richardson].
(Mr. RICHARDSON asked and was given permission to revise and extend
his remarks.)
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. RICHARDSON. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan,
the hospitals in and around the district of the gentleman from New York
[Mr. Paxon] will lose $64 million over the next several years to give
tax breaks to the wealthy. Under the Gingrich Medicare plan, the
district of the gentleman from New York [Mr. Frisa] will lose $262
million, again to give tax breaks to the wealthiest people in this
country that do not need it.
Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk
about the effect of this plan on rural hospitals. That is what I
represent. On Indian reservations throughout the State of New Mexico
and many States in this country, rural health care will be devastated.
Rural hospitals will close under this plan. In no way are they going to
get more funds and resources.
Now, this is according to the American Hospital Association. The
typical rural hospital will lose $5 million in Medicare funding over 7
years, and that means many of them are going to close. In my own
district, the average senior lives on $800 a month, and paying $92 a
month in premiums and unlimited out-of-pocket expenses is going to be
devastating.
Rural Medicare patients are going to lose access to doctors.
America's rural areas are going to need at least 5,000 more primary
care physicians to have the same access to those that accept Medicare.
The American Medical Association says cuts in Medicare are so severe
they will unquestionably cause some rural physicians to leave Medicare.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Ohio [Mr. Brown].
Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding
time.
Mr. Chairman, we have listened to the Republicans talk over and over
about what a great plan this is, how it expands choice. The fact is
senior citizens in this country now have full choice with Medicare.
Yes, under the Gingrich plan seniors will have their choice of a plan,
but they lose their choice of doctor.
The Gingrich plan gives physicians financial incentives, the New York
Times calls it ``bribes for doctors,'' to move out of traditional fee-
for-service into HMO's. Medicare beneficiaries therefore will be pushed
out of traditional fee-for-service and forced into HMO's, forced into
managed care.
This is purely and simply a political payoff to big insurance
companies. We know it, Newt Gingrich knows it, the Republicans know it,
and the American people know it.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New
York [Mr. Houghton], a respected member of the Committee on Ways and
Means.
(Mr. HOUGHTON asked and was given permission to revise and extend his
remarks.)
Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue,
and I can understand it. It is a very important issue. I always think
of what Wilbur Mills said, that there are probably more votes changed
in the House Chapel than there are on the House floor.
I am not going to try to convince anybody, but I am just going to
tell you where I am coming from. The gentleman from Ohio [Mr. Brown]
has thrown around a lot of numbers is terms of how many cuts will be in
people's hospitals. I would question those numbers. I have seen those
numbers myself as far as my own district is concerned and I question
the authenticity of them.
Second, I think the issue is are we going to face up to this thing or
not? Everybody agrees we should. The President agrees, the Democrats
agree, the Republicans agree. How are we going to do it? It is a matter
in terms of timing and numbers.
Also, there always is a better way. I can devise a better way. I am
not sure this plan is exactly the way I want, but it is a good plan.
The next point is that there are no eternal fixes for the Medicare
problem. We never can go asleep. We are always going to have to be on
top of this thing. The question is are we going to have a short-term or
longer term approach to this thing.
Let me talk a little bit about cuts. If I spend $1 today and I spend
90 cents 7 years from now, that is a cut. If I spend $1 today and I
spend $1.45 7 years from now, that is not a cut. Those are the
relationships we are talking about.
Let me talk a little bit about taxes. I did not vote for a tax cut. I
did not think it was appropriate, I did not think it was the right
timing. However, the Republican Party has felt that is important, the
President has felt that is important, the gentleman from Missouri [Mr.
Gephardt], the minority leader, has felt that is important. It is a
fact we deal with everyday. Why can we not get together; why can we
not, if our philosophy is the same, do something which is important as
far as this overall Medicare issue is concerned?
Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Indiana [Mr. Jacobs].
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. JACOBS. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr.
Houghton] mentioned he has other figures and he did not believe these
figures. Under the Gingrich Medicare plan, the hospitals in and around
the gentleman's district, my friend from New York, will lose $167
million over the next 7 years.
I would ask if he would come back in the well and perhaps tell us
what the numbers he has that are different from
[[Page H 10340]]
the numbers that we have been recounting, because we have heard no
debate or no questioning of those numbers.
Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers,
the proponents of this measure cite approvingly the trustees' report
that there will be a shortfall in the next 7 years in Medicare part A,
and that is the truth. But it is not all the truth.
The rest of the trustees' report states how much that shortfall is,
$90 billion. So if you accept approvingly the one part, you should
accept approvingly the other; $90 billion is considerably less than
$270 billion. I wonder anyone remembers the city of Bentre in Vietnam.
That is the one that was wiped out, every lock, stock, horse carriage,
human being, and building, the Army major declaring it became necessary
to destroy it in order to save it.
My father used to say that in politics you can get people to eat the
pudding, but you cannot get them to read the recipe. Today we are
talking the recipe. We will see how the pudding tastes.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentlewoman from California [Ms. Eshoo].
Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being
encouraged to use certain words, probably put together by some PR
agency or PR person, to describe their Medicare plan, words like
``historic, serious, and long-term.''
Well, in some ways, I could not agree with them more. Their plan is
historic because it marks the end of a 30-year commitment to provide
our seniors with health care. It is serious. It is radical surgery,
because it places the lives and well-being of 37 million Americans at
risk. And it is long-term because it will tear holes in our social
safety net that will remain for many years to come.
It ``saves, preserves, and protects,'' not Medicare, but $245 billion
in tax breaks that no one is asking for. It ``protects the right to
stay with your doctor,'' but only if you are able to pay more for the
privilege. It ``protects the right to choose,'' only if your choices
are slim and none. It is ``responsible,'' but only if you are a member
of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new
ground for being cruel to seniors. It is ``the right thing to do,'' but
only if your parents did not raise you to know any better.
Mr. Chairman, the Republican Medicare plan is all these words and one
more, disgraceful, and I urge my colleagues to defeat it so that we can
go on and make America a stronger, better, and more gentle Nation.
Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from
Washington [Mr. McDermott].
Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr.
Houghton], I wish that this debate would be about substance and we
could actually talk about what is going to happen. We can argue about
$90 billion or $270 billion, but the real issue here is what is
happening to the health security of senior citizens.
Right now, senior citizens in this country get enough money to buy a
program that covers what they need. And the Republicans are saying that
in the first year, 1996, in the dark bar, we are going to give them
enough to buy exactly what they have today. By the year 2000, you can
see that the dark bar does not go as high as the CBO says an equivalent
health plan is going to cost. The difference is $1,100. That is the
national average.
Now, if you are from California and watching this, you are going to
need another $1,200. If you are from New York, you are going to need
another $1,100. If you are from Texas, you are only going to need $994.
Ask yourself where those senior citizens are going to come up with that
extra $1,100 to buy the same thing they have today.
Every time the Republicans use the word, ``choice,'' listen to that
and say to yourself ``voucher.'' They are putting my father and my
mother, my father 90, my mother 86, and everybody else's grandparents
and parents, out on the street with a voucher. They call it choice. We
are going to let you choose anything you want. But if you do not have
the money, if that voucher only buys 75 percent of what it buys today,
who will make it up? The kids will make it up.
This is the hidden agenda here. They are shoving that $1,000, they
will not say it is cuts and I will not say it is cuts, they are shoving
that additional $1,000 into their kids.
If you happen to be out there watching this or if Members are on this
floor and happen to have a kid in college, you know what tuition does
to you. To have your parents show up at the same time and say, ``well,
I cannot afford it. It is not paid for by my health insurance,'' for
the first time in 30 years, people my age, 58 and down, are going to
have to think about how they make up that difference for their parents.
One can talk about $90 billion and actuarials and all the rest of
this stuff. There is 96 pages of things where they give away to
doctors. As a doctor, I am ashamed by the kind of deal they came in and
cut. When we are cutting money from senior citizens and putting them at
risk like this, for doctors to come in and negotiate for another $500
million, is a shame. There is no reason to do that.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Washington [Mr. White].
Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the
explanation we just heard from my colleague from the Seattle area, who
I have a great deal of affection and respect for, is exactly the kind
of thinking that got us in this mess in the first place. We have been
doing this for 30 years, and the fact is it is a self-fulfilling
prophecy.
If the Government tells you the cost of medical care is going to go
up 10 percent every year, you can be sure that it will, because people
who are buying health care or selling health care to the Government are
going to spend every nickel their customer tells them they are going to
spend the next year.
The fact is we have to exercise some control at the Federal
Government level to control these costs. Otherwise, they will be out of
control forever and that is the reason we find ourselves in this
situation. We have to fix this program. Otherwise, it is going to go
bankrupt.
{time} 1315
I want to say one other word about the Seattle area because it is
very important. Seattle is an urban community and yet it is one of the
healthiest communities in the Nation. It is also one where we have one
of the most efficient health care systems in the Nation.
Why is that, Mr. Chairman? It is because in Seattle we essentially
invented the managed care program. Under managed care individuals get
to sign up in a program that looks out for your health over the long-
term basis. Instead of trying to cure diseases as they come up, it
actually prevents individuals from getting sick in the first place. A
lot of people in the Seattle area have found that to be a good idea.
One of the great things about this bill is that it tries to do for
the rest of the Nation what we have done very successfully in Seattle
by having the option to take managed care instead of the fee-for-
service program. We have been able to keep the costs down across the
board, and that is what this bill will do for the entire country.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the
gentleman from Ohio [Mr. Portman], another respected member of the
Committee on Ways and Means.
Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to
me.
We have heard a lot today from the other side of the aisle about how
the increases in spending in our Medicare plan will not keep up with
the private sector growth. We just heard from the gentleman from
Washington [Mr. McDermott]. I wish his chart were still up. Maybe it
can be put up again. It might be useful to have it. It is just not
accurate. It is not accurate.
The charts we just saw from the gentleman compares apples to oranges.
It is full of unknowns. It is full of false assumptions. Let me give
Members a couple.
First of all, the Medicare figures are per beneficiary. The private
sector figures are not per beneficiary. How can we compare those two?
The private sector figures are, thus, inflated.
Second, the Medicare figures the Democrats use do not include a lot
of other costs, including administrative costs. It is comparing apples
to oranges.
Here is a better chart that illustrates clearly what the gentleman
from New
[[Page H 10341]]
York [Mr. Houghton] and others have been trying to explain, which is
that under this bill before us Medicare spending actually goes up.
Guess what? It actually keeps pace with the private sector. It will be
higher than the private sector 7 years from now as it is today.
This chart compares apples to apples
Major Actions:
All articles in House section
ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)
Text of this article available as:
TXT
PDF
[Pages
H10333-H10455]
ANNOUNCEMENT BY THE CHAIRMAN
The CHAIRMAN. The Chair would like to take the time to remind Members
that it is not appropriate to wear or display badges while engaging in
debate.
Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from
Louisiana [Mr. McCrery], a valuable member of the Subcommittee on
Health.
Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the
Medicare system has skyrocketed since 1970. Here we are today and
Members can see, if nothing is done, it goes off the chart.
In 1970, Medicare spent about $8 billion; in 1994, Medicare spending
was about $165 billion. That is an increase of almost 2,100 percent in
just 14 years. In the part B side alone, growth rates have been so
rapid that outlays of the program have increased 40 percent per
enrollee just in the past 5 years. More alarming is that Medicare
spending is projected to explode to over $350 billion in 2002. Clearly,
this is an unsustainable trend and one that neither seniors nor younger
Americans working to support themselves and their families can be asked
to underwrite.
The financial crisis in the Medicare program is not a short-term cash
flow problem, as the Democrats would like the American people to
believe. The trustees of the Medicare trust fund, three of whom are
President Clinton's own Cabinet members, said in their report on the
HI, or part A, trust fund, ``The trust fund fails to meet the trustee's
test of long range close actuarial balance by an extremely wide
margin.'' Further, the same trustees said in their report on the SMI
trust fund, the part B trust fund, ``while in balance on an annual
basis, shows a rate of growth of costs which is clearly
unsustainable.''
The public trustees of the Medicare program were very clear when they
said, ``The Medicare Program is clearly unsustainable in its present
form.''
The Democrats in the past have ignored the long-range spending
problem of the Medicare Program. Their solution has been to continually
raise taxes on working Americans, and that is still their solution.
In the years since the enactment of Medicare, the maximum taxable
amount has been raised 23 times. Two years ago, the Congress, then
controlled by Democrats, raised taxes, Medicare taxes again. All that
did was just put another financial burden on the taxpayers and put off
the financial crisis in the trust fund for just a few months. Clearly,
raising taxes yet again on the American people is not the answer.
The Medicare Preservation Act, on the other hand, addresses the out-
of-control spending in the Medicare Program by opening up the private
health care market to the senior population. By harnessing some of the
innovative cost effective and high quality private sector health care
delivery options, Medicare beneficiaries will not only have a choice in
their health care coverage for the first time, but the Government will
also be able to rein in out-of-control Medicare spending. It is a win/
win situation.
The Republican plan provides security for not only today's seniors
but also lays the groundwork for the retirement of my generation, and
it does it without increasing the tax burden on working people.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Pennsylvania [Mr. Klink].
Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to
me.
I would like to begin by yielding to the gentleman from Ohio [Mr.
Brown].
Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the
Gingrich Medicare plan, the hospitals in and around the district of the
gentleman from Louisiana [Mr. McCrery], will lose $158 million over the
next 7 years under the Gingrich Medicare cut plan.
[[Page H 10334]]
Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here
is the chart which actually shows the reduction in Medicare spending
per beneficiary under the House Republican plan. I have to get this
straight. When is a cut not a cut?
Last year when we were trying to do health care, every Republican on
the Committee on Ways and Means signed a letter which said, ``the
additional massive cuts in reimbursement to providers proposed in this
bill''--the Clinton bill--``will reduce the quality of care for the
Nation's elderly.'' That was $168 billion versus $70 billion now.
The current chairman of the Committee on Ways and Means made the
statement, ``I just don't believe that the quality of care and
availability of care can survive these additional cuts.'' Now they are
saying that these are not cuts. It is cuts in the rate of growth. Were
you lying to us now or are you lying to us then?
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
I resent the fact that the gentleman implied that I have lied. No. 1,
that does not belong on this floor. But the gentleman, as usual, has
not given the factual information.
The plan that I made those comments on cut $490 billion out of
Medicare and Medicaid. Without transforming Medicare, without giving
other options, without including true savings in the cost drivers. That
was a totally different time, a totally different program. But it cuts
$490 billion out of Medicare and Medicaid.
Mr. Chairman, I reserve the balance of my time.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Georgia [Mr. Lewis].
Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for
yielding time to me.
Mr. Chairman, I rise today in strong opposition to the Republican
Medicare plan. I rise to tell you there is another way, a better way.
We Democrats have a plan. We save the Medicare trust fund, and we do it
without hurting the poor, the sick, and the elderly.
How can we do it? We can do it because we do not pay for tax breaks
for the rich. There is only so much money--you can either use it to
help the sick and the elderly or you can give it to the rich. My
Republican colleagues may say whatever they wish, but the truth is that
these very large--these huge Medicare cuts are needed to pay for their
tax breaks for the rich.
The Republicans say they want to help Medicare. But what they do is
different. Thirty years ago, the Democrats created Medicare and the
Republicans voted against it.
Two years ago, Democrats passed a bill that helped the Medicare trust
fund. Every Republican voted no.
Earlier this year. the Republicans took $87 billion from the Medicare
trust fund. Today, they want to cut an additional $270 billion.
They voted against Medicare 30 years ago, and they are voting against
it again today. My colleagues, actions speak louder than words, and the
Republican actions are loud and clear.
The Republicans did not want Medicare 30 years ago and they want to
dismantle it now.
I do not believe that we must destroy Medicare to save it. Democrats
do not raise premiums for seniors. Democrats ensure that Medicare is
there for our families, for our children, for our grandchildren, and
their children.
Under their plan, the Republicans eliminate nursing home standards.
Poor seniors lose help for copayments and deductibles.
Under the Republican plan, the rich get tax cuts, and our Nation's
elderly and hard-working families get higher Medicare bills. It's a
scam, a sham, and a shame. I know it. You know it. Now the American
people know it.
Mr. Chairman, on this day, October 19, let the word go forth from
this place into every State, every city, every town, every village,
every hamlet that it was the Republicans who voted to cut Medicare--
they voted to cut Medicare by $270 billion in order to give a $245
billion tax break to the wealthy. The Republican plan is too much, too
radical, too extreme.
We have more than a legislative responsibility to oppose this
Republican plan. We have a mandate, a mission, and a moral obligation
to protect Medicare.
This vote--this debate is about something much bigger than one vote.
It is bigger than one bill. It is about two contracts, the Republican
contact with the rich, and the Democratic contract with the American
people--Medicare. Medicare is a contract--a sacred trust with our
Nation's seniors and our Nation's hard-working families.
My fellow Americans, remember--it was the Democrats who found the
courage and the strength to provide health care to our seniors, and it
is the Democrats who will preserve it for unborn generations.
We must not and will not break the contract with America's seniors
and families. I urge my colleagues to support the Democratic
alternative and oppose the Republican plan to cut Medicare.
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the facts have already been presented to this
committee. Medicare increases per beneficiary go from $4,800 to $6,700
per year. The total aggregate increase in medical expenditures
increases $1.4 trillion under our plan over the next 7 years. But only
in Washington can an increase be called a cut.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad
news for Americans and senior citizens. The trustees of the Medicare
funds told us that under all sets of assumptions the fund goes
bankrupt, and it goes bankrupt in 7 years. Taking our responsibility
very seriously, we Republicans went to work.
We gathered with senior citizens, with experts from around the
country, and we said, what can we do? Is there any good news? Can we
fix the situation? We found good news. We found that health insurance
costs for working people, not retired people, were going down.
Inflation rates at 10.5 percent in Medicare are killing it.
{time} 1230
The private sector using intelligent new programs have brought the
inflation rate down below to virtually zero. We said the good news is
this. We can preserve Medicare, we can preserve fee-for-service options
for everyone who wants to stay that way, but we have new and exciting
options.
Mr. Chairman, my mother and father have chosen the managed-care
option. They love it. They save $1,000 a year each because they no
longer buy MediGap insurance. They have new prescription drug benefits.
They get all of the referrals they want. They are delighted.
This plan is very straightforward. We preserve fee-for-service, we
increase the per beneficiary expenditure from $4,800 a year to $6,700 a
year, and for those seniors who want new choices, we have excellent new
choices in managed care. This is a spectacular bill. Americans will be
proud of it. Senior citizens love it. Vote ``yes.''
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentleman from Oregon [Mr. Wyden].
(Mr. WYDEN asked and was given permission to revise and extend his
remarks.)
Mr. WYDEN. Mr. Chairman, our Nation needs----
Mr. STARK. Mr. Chairman, will the gentleman yield?
Mr. WYDEN. I yield to the gentleman from California.
Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the
district of the gentleman from Pennsylvania [Mr. Greenwood] there will
be $128 cut from hospitals over the next 7 years.
Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of
Medicare, but instead today's bill will deliver a nationwide Medicare
migraine. Instead of listening to our seniors, and our families, and to
the inspector general, this is a cut first, ask questions later
Medicare initiative, and the fraud section is a metaphor for the whole
bill. Instead of legislation to protect seniors and taxpayers, it
protects the crooks and the thieves. Instead of improving access to
health care, it provides a freeway to fraud, and, my colleagues, think
of the words of the nonpartisan fraud-buster at the Office of the
Inspector General who said that this bill will cripple, it will
cripple, efforts to bring justice.
[[Page H 10335]]
Let me tell my colleagues it is possible to develop 21st century
Medicare that works for seniors and taxpayers. Reject this bill and
come with me to Oregon because I will show each of you programs that
protect seniors, hold down costs, and insure that we have a path to the
21st century. We can do this job right. We can do it in a bipartisan
way. But let us listen to our seniors and our taxpayers.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentlewoman from Oregon [Ms. Furse].
Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time
to me.
I have here a list of words that I am told the Republicans were asked
to use in this debate, words like historic, successful, saves. Well,
there was a historic event 30 years ago. The Democrats in this House
passed Medicare. Not one Republican voted for it.
Successful? Well, yes. This bill successfully guts Medicare.
Saves? Well, yes. This bill saves the promised tax breaks for the
rich.
Mr. Chairman, also on this list it says we should say the Democrats
are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I
know that it was the Republicans who ordered the arrest of 85-year-olds
who came to the committee. They came there. They came to ask the
committee what is going to happen to our Medicare protection. They were
Americans. It is a disgrace that they were arrested.
I think there is a word that is not on this list, Mr. Chairman, and
that word is shame.
Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond.
Mr. Chairman, the rules of this House are explicit. The chairman of
any committee is required to preserve order, and when citizens of any
persuasion, any age, come in, refuse to obey the orders of this House,
the chairman has no choice but to have them escorted out of the room.
Mr. Chairman, that is exactly what happened in the Committee on
Commerce, and that is what we had to do regrettably, but that is the
truth.
Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds.
Mr. Chairman, I love my dear friend from Virginia, but I notice he
did nothing when a bunch of people came in and dumped bags of mail from
dead men, from people who were not supporting the legislation in
question, and some of which were addressed ``contributor.'' Our
Republican colleagues have a great sensitivity about the senior
citizens, but none whatsoever about rascality by high-paid lobbyists.
Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the organization that disrupted that meeting, I would
like the Record to show, 96 percent of those funds come from the public
treasury. The person who was the ringleader was a paid staff person.
Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr.
Bilirakis].
(Mr. BILIRAKIS asked and was given permission to revise and extend
his remarks.)
Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on
those politicians who over the years, not just now, use scare tactics
and misinformation to frighten our senior citizens all in the interests
of getting votes through fear. These actions are unconscionable.
Only the most affluent retirees are having their part B premiums
raised substantially. We are not raising Medicare copayments or
deductibles. We will not be reducing services or benefits--our
legislation ensures that the core services in the current Medicare
Program will be retained and must be offered to all beneficiaries.
I also want to make it clear that no one will be forced into HMO's.
If Medicare beneficiaries wish to keep the current fee-for-service
benefit where they have complete choice of their doctor, they will be
permitted to do so. If beneficiaries want to enroll in an HMO which
might include additional health benefits, or some other Medicare-plus
plan, they can do so. It will be their choice. Under our proposal,
coverage will be assured to all senior citizens, regardless of prior
health history or age.
From the beginning of this effort, I have insisted that protecting
beneficiaries was an essential part of any Medicare report effort. I
represent a congressional district that has one of the highest
percentages of senior citizens in the country. I also worked for years
as an attorney and a community volunteer with many retirees. Recently,
I myself, reached Medicare age.
This bill is the product of listening and learning. It is a product
of many discussions with people who had real life, day to day
experiences with the Medicare Program. It protects our current
beneficiaries while ensuring that Medicare will exist for future
beneficiaries.
In a recent Washington Post article, Robert Samuelson said it well
when he stated that ``Republicans occupy the high moral ground and the
low political ground. They have raised critical questions at the risk
of political suicide.''
And, knowing that, Republicans still believe it is our responsibility
to show pure guts and courage to save Medicare for our seniors, their
children, and grandchildren. We have taken on the task of protecting
and preserving Medicare because it is our moral responsibility, not
because of political necessity. We have taken the higher ground and
this is ground that I am proud to stand on.
Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from
Texas [Mr. Bryant] and I ask him if he would yield back to me 15
seconds.
Mr. BRYANT of Texas. I yield to the gentleman from California.
Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement
made by the previous gentleman. He claimed we are not cutting benefits,
we are not going to make people pay for benefits for their health care.
How are we getting $270 billion in Medicare cuts and the AMA supports
the bill? Something just does not add up.
Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is
impeccable. I would point out that the losses to hospitals in and
around the district of the gentleman from Florida [Mr. Bilirakis] are
going to be $210 million over the next 7 years, and my colleague says
there are no cuts. His folks are going to feel them.
The fact of the matter is, Mr. Bilirakis, as chairman of the
Subcommittee on Health, my colleague and his Republican friends ought
to be working on the fact that health care costs are rising. Instead my
colleague is working on cutting health care insurance that elderly
people use to cope with health care costs. That is the problem.
The fact of the matter is it is not a secret that my colleague's
party philosophically does not believe Medicare is the appropriate role
of government, and yet he comes in here and tells us they are not
cutting it. Mr. Chairman, my colleague has gotten power, and now he is
cutting it. He boasts throughout the land he is cutting government, but
today, as he takes $270 billion out of the program that insures the
health needs of seniors, he says he is not cutting it.
Only in Washington would anybody believe that, Mr. Archer.
I would point out that with regard to these cuts, Mr. Chairman, the
gentleman from Texas [Mr. Archer] and I are pretty much both in the
same situation. In Harris County, TX, we are talking about $2.4 billion
in cuts between 1996 and the year 2002 according to the Health Care
Finance Administration.
Now my colleagues asked for facts, There is facts. Dallas County,
$1.6 billion in cuts between 1996 and the year 2002. Why? To pay for
tax cuts for wealthy people out of the hides of elderly people who are
not going to be able to pay their medical bills because they have cut
their insurance.
Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume
very simply to say that once again we are back into the same rhetoric.
There will be increases for hospitals across this country. Those
increases have already been demonstrated by the facts.
Only in Washington can a Member of Congress stand up and call
increases a cut.
Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr.
Camp], a respected member of the committee.
(Mr. CAMP asked and was given permission to revise and extend his
remarks.)
Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from
[[Page H 10336]]
Texas [Mr. Archer] for yielding this time to me, and I rise today in
support of the Medicare Preservation Act because it officially ends the
policy of just raise taxes.
Mr. Chairman, some who oppose our program have called it extreme.
What is extreme is that year after year the Democrat's answer to the
Medicare crisis has been to raise taxes. Almost every year, Democrats
dug deeper into the pockets of working Americans just to get through
the next election. And in 1993, they even raised taxes on seniors
citizens.
Nine times, since 1965, the Medicare Board of Trustees has stated
that Medicare was in severe financial trouble and needed reform. What
was the Democrats answer? Raise taxes. Just throw more money at it to
get through the next election.
Since 1965, Democrats raised the payroll tax on working Americans
eight times, over 450 percent. They raised the earnings subject to tax
for Medicare 10 times, an increase of over 2000 percent. Then they
raised taxes on Federal and State employees, and, when they still
needed more, in 1993, they raised taxes on American seniors who had
already paid their fair share into the program. Now, a senior earning
just $34,000 pays not half of their Social Security in taxes but 85
percent. And now even the President admits taxes were raised too much
in 1993.
Mr. Chairman, that is extreme.
Could we put the Medicare crisis off a few years if we raise taxes
again? Sure we could.
Could we avoid the vicious attacks by special interest groups if we
didn't reform the system? Sure.
But we are not going to do that. We are going to preserve, protect
and strengthen Medicare not to get through the next election, but for
the next generation. We will ensure the solvency of this program. We
will increase benefits. We will maintain the current premium rate and
for the first time in the history of Medicare, we will give seniors the
right to choose the health care plan that best suits their health
needs.
Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from
Florida [Mr. Stearns].
Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I
could, with the gentleman from Pennsylvania. Both he and I have worked
hard in our districts getting the message out how important it is to
look at this program because it is going bankrupt, and we want to offer
them choices, much like the choices that the gentleman and I have.
Perhaps many Members do not know that a large number of the Federal
employees are retired and they have choices, HMO's, PPO's, and all
these other things. Let us talk, for example, about a widow whose $600-
a-month pension is too low to pay for this expensive part C medigap
insurance and whose biggest problem is that she cannot afford the
deductible portion of her doctor's bill.
{time} 1245
So what happens, she does not go to take care of herself. Now, what
would we have under this program with our HMO's and PPO's and the
PSN's? I mean, even a $5 doctor bill is something that she would be
concerned about. You might want to amplify on that.
Mr. GREENWOOD. If the gentleman will yield, the option that would be
very attractive for the constituent in your district that you just have
described would be a managed care option. Most of the managed care
companies have told us that, and they are already doing this in many
areas of the country, that they will offer managed care plans in which
there is no requirement whatsoever to pay Medigap insurance. So that
$1,000 a year that she may be paying now toward her Medigap insurance
would disappear. Suddenly she would gain new benefits. She would
probably gain a prescription drug benefit. She may get an improved
dental or vision benefit. She would no longer have that out-of-pocket
cost at all and still be able to go to her doctors within her network
whenever she chooses. She would, I think, would welcome this change
very much and be far better off and have more money left over in her
budget at the end of each month.
Mr. STEARNS. Is it not a point of fact that all the people in this
room have the Federal employee health benefit program, and is it not a
point of fact that people on this side are in HMO's, in fact, there are
Members of Congress who have retired who are in health management
organizations and they are not picketing and screaming and worried?
Because actually what we are trying to do is develop a program for
Medicare that is much like the First Lady and the President has and all
of us have, which basically says that health management organizations
might work for some people. It should be a choice, and surely if it is
good enough for Members of Congress, these same choices should be
available for the seniors. So I think that is what you are saying for
this particular woman in Florida who is on a very small pension every
month. This would be a possible choice for her. You might want to just
amplify on that, because I know you have toured, like I have, many
health maintenance organizations, talked to the seniors, and for some
of them they are very happy.
There are people that have high monthly drug costs, and the HMO is
paying for that, and it is paying for their deductible. So that surely
that is an approach we should not rule out by keeping the one
warehouse, one-size-fits-all program we now have. Surely moving it to
what we have in the Federal employee health benefits program is a step
forward.
Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this
country already have chosen the option of receiving their Medicare
benefits through managed care. That number is growing rapidly because
you know how seniors will get together and talk and compare notes, and
when one learns from the other that they have a new prescription drug
program benefit, they say, ``How do I get that,'' and they make the
choice.
One of the things about this debate that has been interesting to me
is you and I and Members of this side of the aisle know our friends on
the other side of the aisle will spend all day, as they have spent the
last 6 or 7 months, scaring senior citizens that all of these terrible
things are going to befall them.
The fact of the matter is that we are confident today, we are
confident because we know when the political dust settles, when this
plan is finally signed into law, that the senior citizens will then,
beginning in January, have these new options. They will see, my
goodness, their copays did not go up, deductibles did not go up, their
Social Security check, even with part B deduction, is bigger than it
was this year. They will then thank us. Once this debate is over, we
think we will be able to say we told you so.
Mr. STEARNS. Is it not also true, if they want to remain in Medicare
as it is right now, they can still do that? They still have that
choice?
Mr. GREENWOOD. Absolutely. That is the beauty part. We have made
certain from day one there is the fee-for-service option will always be
available to every single senior citizen in America that wants to keep
it. Those that may be a little too old for change, do not like to
change, can keep their fee-for-service and enjoy the kind of Medicare
that they have grown to enjoy these past years.
Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds.
I know the two gentlemen who just had this colloquy on the floor are
sincere. But last year I checked all of the Medicare policies of every
Member in Congress here. Ninety-nine percent of us have fee-for-
service. Ninety-nine percent of us have fee-for-service, and all of
those, all of those that have fee-for-service have abortion benefits in
our medical care policies. You know, those are in the records of the
House. Go check them.
parliamentary inquiry
Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry.
The CHAIRMAN. The gentleman will state his parliamentary inquiry.
Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans,
buttons, while addressing the Committee of the Whole, and did the
Chairman not already indicate what the rules are?
The CHAIRMAN. The gentleman is correct.
Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from
New York [Mr. Manton].
Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman
from Michigan [Mr. Stupak].
Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker
in
[[Page H 10337]]
the well down here, the gentleman from Florida [Mr. Stearns], his
district will lose $154 million over the next 7 years if this
Republican plan goes through, just to give a tax break to the rich.
I am more concerned about the State of Michigan where the gentleman
from Michigan [Mr. Camp] spoke in which in his district the hospitals
will lose $125 million between now and 2002 just to pay for this tax
break for the rich. Being from Michigan, I am very concerned about
that.
Mr. MANTON. Mr. Chairman, I rise in strong opposition to this
draconian plan to slash $270 billion from Medicare. This so-called
Medicare preservation plan will seriously threaten the integrity of the
program and inflict undue pain on America's elderly.
Under this bill, the elderly will suffer an increase in their
premiums and a decrease in the quality of their health care services.
Quite simply, you are asking seniors to pay a lot more, but expect a
lot less.
And last night, Mr. Chairman, in one final act of cruelty, the
majority included a provision to deny anti-nausea drugs for
chemotherapy patients. How can you possibly justify denying basic
dignity and comfort to those in the twilight of their life, who are
fighting for that very life.
Speaking out against this outrageous proposal is not a matter of
demagoguery, its a matter of duty. Duty to the senior citizens we
represent.
Oppose this legislation.
Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from
Louisiana [Mr. McCrery].
Mr. McCRERY. Mr. Chairman, the gentleman stated something that is
just incorrect, and it has been stated in the media some. We are not
denying payments for anti-nausea drugs for cancer patients. The fact is
that we will continue to pay for the intravenous drug that people, the
cancer patients, use to fight nausea.
Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from
Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York
[Mr. Paxon] for a question.
Mr. PAXON. Mr. Chairman, I have many constituents back in western New
York, in the Buffalo and Rochester, Finger Lakes areas, that are
concerned about catastrophic costs in health care. How would medical
savings accounts help those with recurring health problems pay for
these catastrophic expenses?
Mr. GREENWOOD. The medical savings account is a new component of
Medicare that we have included in this reform. Those seniors who choose
it would have deposited into their medical savings account a number of
dollars that would average about $5,000 across the Nation; the first
portion of that deposit would be used to buy catastrophic or major
medical insurance that would cover them above he deductible. Then the
senior gets to use what is left in the account for his or her medical
benefits, go to whatever doctor or hospital he or she wants. Once the
deductible is reached, then in a year in which that particular
individual has high costs, then the medical, the catastrophic, coverage
would kick in and they would have no more out-of-pocket costs
whatsoever.
In a year in which she was particularly healthy, managed her costs
and did not go to a doctor very often, she would be able to keep the
balance in the medical savings account. It is a good opportunity for
savings for those seniors.
Mr. PAXON. I would make a comment. My parents are both retired. Both
have had catastrophic health care concerns. Of course, this would be
very important to them.
I also want to make the point Medicare is important to them today,
too. They want to see Medicare protected and strengthened. It is their
health care needs. It concerns me deeply. If their Medicare is not safe
and secure, they have to turn to the family to help. We want to make
certain for them and all of the constituents this plan is preserved and
protected for the coming years.
Mr. FRISA. Mr. Chairman, will the gentleman yield?
Mr. GREENWOOD. I yield to the gentleman from New York.
Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this
is such a serious issue, it is an important one for our senior
citizens. My folks are both retired and are counting on Medicare being
there throughout their retirement, and they are happy that we are
taking the opportunity to make Medicare safe and sound and better for
all of us.
So I would like to ask the gentleman, are there going to be increased
funds for seniors under the Republican plan?
Mr. GREENWOOD. Well, of course, there are. Despite all of the
rhetoric to the contrary, we are actually taking, right now, we are
spending on average $4,800 per each beneficiary in the Medicare
Program. Our plan increases that about 5 percent each year for a 40-
percent increase over the next 7 years. So 7 years from now we will be
spending $6,700 for beneficiaries. It is a huge increase.
What we are doing is bringing down the unsustainable inflation rate
which is bankrupting the system.
Mr. FRISA. In other words, and I think this is very important,
despite the rhetoric, it is really not truthful. We are saying the
average senior citizen will be getting an extra 100 $20-bills spent on
their medical behalf. So there is more money being spent for senior
citizens under the Republican plan.
It is absolutely incredible, I think you would agree, that my
colleagues on the other side of the aisle are trying to say that 100
additional $20-bills for our senior citizens is a cut. It is absolutely
incredible.
I thank the gentleman for explaining that and making it clear to the
American people and, most importantly, to our senior citizens that the
Republicans, by providing a $2,000-per-beneficiary increase is what is
going to save Medicare for our seniors so they can feel that it is safe
and sound and better for them.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Florida [Mr. Deutsch].
Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make
complicated issues simple. If we are saving $270 billion and there are
37.6 million beneficiaries, this is what it is going to cost each
Medicare beneficiary in America, whether in terms of direct out-of-
pocket expenses or not.
There is another chart which I think is probably the best chart and
the clearest and most factual, and if we can focus in on this so people
watching can see, my Republican colleagues have said we have to do
something, there is this incredible crisis, the trust fund is gong to
go bankrupt in 7 years.
Well, the Medicare Program has existed for 30 years. Twelve of those
thirty years there was a shorter life expectancy than 7 years that
exists today, and we did incremental changes. We fixed it.
It is a flat-out lie that this is unprecedented. It is a flat-out lie
that $270 billion needs to be cut. It is a flat-out lie that choice
will be available for Medicare beneficiaries.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Tennessee [Mr. Clement].
(Mr. CLEMENT asked and was given permission to revise and extend his
remarks.)
Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican
Medicare reform plan and ask my colleagues to support the Dingell-
Gibbons substitute.
Mr. Chairman, when President Lyndon Johnson began the Medicare
Program in 1965, less than half of all seniors had health insurance. It
was understood that the elderly had declining resources, costly health
care needs, and few insurers willing to sell them coverage. Since its
creation, the Medicare Program has been a great success. Today, 99
percent of senior citizens and a substantial proportion of the disabled
are covered by Medicare. It has contributed to reducing poverty among
the elderly and causing the life expectancy rate in America to exceed
that of every country in the world except Japan. Medicare is fulfilling
its mission.
Let me review briefly the two areas of the Medicare Program. Part A
of Medicare is financed by the hospital insurance trust fund, which
comes primarily from the hospital insurance or Medicare payroll tax
contributions paid by employers, employees, and self-employed
individuals. Medicare part A will pay for inpatient hospital care,
skilled nursing facilities, home health care, and hospice services. It
is the trust fund of part A which the Medicare trustees say is
``severely out of financial balance'' and must receive ``prompt,
effective,
[[Page H 10338]]
and decisive action'' from Congress to restore the stability of the
program.
The second aspect of the Medicare Program is part B, the
supplementary medical insurance trust fund. Part B is optional, and
primarily finances physician and hospital outpatient services. Part B
is financed by premium payments from enrollees and by general revenue
funds from the Federal Government. The part B premium is currently
$46.10 monthly or 31.5 percent of total costs of Medicare, and the
budget of 1993 would bring the premium down to 25 percent of total
costs from 1996 to 1998. Beneficiaries are responsible for an annual
deductible of $100 and coinsurance, usually a 20-percent copayment. The
part B trust fund is not in financial crisis, though only because it is
financed partially by the general fund which is experiencing runaway
health care costs and driving up the deficit of the U.S. Government.
Let me be clear that I do not believe Medicare is out of control or
too generous as some have stated. In truth, Medicare pays only 45
percent of the Nation's health care bill for the elderly, and it is
less generous than 85 percent of private health insurance plans.
The problems we are facing with Medicare today are primarily
external, not internal. Though some problems do exist internally such
as fraud and abuse, most of the factors which bring us to the present
crisis are external. Let me share a few with you.
First, the primary threat to Medicare is its rising costs which are
consequently driving up the Federal deficit at alarming rates. The
ability of any reform proposal must be measured by the following
yardstick if we are to balance the budget and get our financial house
in order: Does the reform measure control the costs of Medicare? Over
the past 20 years the cost of the Medicare Program has increased an
average of 15 percent a year. In this year alone, Medicare will account
for 11.6 percent of all Federal spending. This will rise to 18.5
percent by 2005 if costs are not controlled.
Another factor which threatens the future of Medicare is the growing
number of senior citizens in America. The Baby Boomers will begin
retiring shortly after 2010, and recent years have seen a dramatic
increase in life expectancy. During the 30-year period from 1990 to
2020, the growth rate of the senior citizen population will be double
the growth rate of the total U.S. population. This means that those
receiving Medicare benefits will outnumber those employees and
employers paying into Medicare.
Among other contributors to the rising cost of Medicare are the high
cost of advanced medical technologies, the rapid increase in procedures
by doctors after a fee schedule was imposed by Medicare, the fee-for-
service arrangement which gives no cost-saving incentives to providers
or patients, and the rise of Medicare fraud and abuse. All these
factors, some of which I applaud such as life expectancy and miraculous
technology, have brought us to this present moment of crisis.
Before looking at the specific proposals to reform Medicare, I wish
to suggest the values which I believe should drive any attempt at
reform. I believe you will agree with me. These values are:
First, ensuring that every dollar saved from Medicare goes directly
toward strengthening the part A trust fund and eliminating the Federal
deficit;
Second, making the trust fund sound for the short term and the long
term;
Third, protecting beneficiaries from dramatically increased costs and
reduced access to care;
Fourth, improving patient choice without coercion or compromising the
quality of care;
Fifth, reasonable sacrifice by all while ensuring the quality and
viability of provider services for all Americans.
Let us now turn to a quick overview of the two major proposals now
before the Congress, one from each party. First, let's look at the
Republican plan to reform Medicare.
The Republicans, in their noble effort to balance the Federal budget
and reduce the deficit, agreed to a fiscal year 1996 budget resolution
which would reduce the rate of increase in Medicare spending by $270
billion by the year 2002, bringing its rate of growth down from its
current 10 percent a year to about 6 percent a year.
The most important innovation in the Republican proposal is a feature
which would allow Medicare beneficiaries to opt for a wide range of
privately run health plans, with the Government paying the premium. The
plan would provide an incentive for beneficiaries to choose an option
that is less costly, such as managed care or preferred provider groups,
while allowing those who want to stay in the traditional fee-for-
service style Medicare Program to do so. However, the Republican plan
would force many low-income seniors out of the traditional program
because of the high cost of staying in the fee-for-service as compared
to other options. The Dingell-Gibbons substitute, which I will support
today, allows seniors to move into managed care and rewards this cost-
saving sacrifice without punishing those who wish to stay in
traditional fee-for-service programs.
Another set of cost-saving provisions in the Republican plan would
reduce the growth of fees paid to hospitals, doctors, and other care
providers by an estimated $110 billion over 7 years. The Democratic and
Republican plans both rely heavily on reductions in the increase of
payments to providers, but the Republican plan also contains a look
back provision which I oppose that would balance the budget on the
backs of providers if the projected cost savings are not realized. This
will only mean that doctors and hospitals will begin turning down
Medicare patients, leading to a national health care travesty.
Both Democratic and Republican plans also contain provisions to
eliminate excessive fraud and abuse within the Medicare Program. The
Congressional Budget Office estimates that at least $20 billion could
be saved over 7 years by reducing fraud and abuse in the Medicare
Program. I believe it is wrong to raise premiums for seniors until the
cheats and ripoff artists are weeded out of Medicare. The Democratic
plan makes significant headway toward reducing fraud, but the
Republican plan will repeal existing statutes that keep doctors from
preying on their patients for their own financial self-interests.
These measures, and others, are slated to ensure the viability of the
Medicare part A trust fund. Let us turn to part B for a moment. I
remind you that the primary reason to reform part B is to reduce the
growth in the Federal deficit, not to build up the part A trust fund
which receives its revenues from elsewhere. The Republicans choose to
deal with the rising cost of part B by keeping the part B premium at
31.5 percent of total cost rather than at 25 percent as now planned.
This means a doubling of Medicare part B premiums by 2002, increasing
from $46.10 now to approximately $104 in 2002. While I do not oppose a
sensible increase in premiums, I believe this increase is out of reach
for many low-income seniors. I support the Democratic plan which would
permanently maintain premiums at 25 percent of total cost.
As you can see, many of the aims and methods are the same in the two
plans. But the details differ at significant points, particularly with
regard to how much of the burden seniors are asked to bear.
I would like to sum up the Medicare debate as I see it. First, I
support many of the reforms both sides support including incentives for
entering managed care, slowing the increase in provider payments, and
eliminating fraud and abuse. These are all contained in the Democratic
substitute which I am supporting.
Let me share with you my disagreements with both plans, Democratic
and Republican. Too often Democrats have sat on the sidelines this year
while the Super Bowl is being played on the field--we have offered more
critique than solutions. While this may be a good political stunt, it
is not responsible nor respectful of our Nation's senior citizens or
our children who will bear the cost of the Medicare Program if we do
nothing. But I have not been content to sit on the sidelines. Before
this debate even began, I stepped out in support of health care reform
bill this year that would have made many of the adjustments we are now
discussing. Even today, I would have preferred to have voted for the
coalition substitute which would have dealt with part A and part B. But
the Republicans in the Rules Committee would not allow this bill to
come to the House floor for a vote. So, today I will choose between the
better of two evils and support the Democratic substitute.
I sharply disagree with Republicans at one major point. Earlier this
year, the Republicans voted for a $245 billion tax cut which gives over
50 percent of the cut to those who make over $100,000 a year. It is any
wonder then that Republicans now need to save $270 billion from the
Medicare Program to pay for these tax cuts. I believe a tax cut of this
magnitude at this time is irresponsible, especially when the majority
of the tax cut goes to wealthy Americans. This translates into the
outrageous premium and deductible increases Republicans now propose.
The seniors in my district are telling me, ``Congressman, I don't
mind sacrificing some benefits and bearing some of the financial burden
of the Medicare Program to ensure the viability of the trust fund. But
it seems to me that the Republicans are asking us to bear most of the
burden for this reform, and it is not fair.'' I've been hearing a lot
of people at home saying that they are beginning to think that GOP
stands for Get the Old People party. I am not so sure they are wrong.
The Greek word for crisis is krisis. The Greeks used this word to
point to a critical moment in time when the road ahead would either
mean a time of devastation or a time of great opportunity. This is a
time of krisis. The decisions Congress make at this time will mean a
future of prosperity and health security for all Americans, or it will
mean a bleak future
[[Page H 10339]]
of prosperity and health care for only the privileged few. I believe
this is the time of great opportunity, and together we will forge out a
Medicare Program that will provide the best health care for our
Nation's elderly for decades to come.
Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from
Wisconsin [Mr. Kleczka].
Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are
going to be giving all of this cash to senior citizens under the
Republican plan.
What he did not tell the seniors that are watching today is we are
going to double your premiums in part B; all right. The Senate
provisions provides more copays, more out-of-pocket-expenses.
Seniors, this is what you are getting: Nothing.
Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from
Massachusetts [Mr. Neal].
Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital
Association and the gentleman from Massachusetts [Mr. Torkildsen] have
rejected the Republican Medicare bill. The MHA says the spending
reductions in these proposals are too fast, too deep, and would
jeopardize the ability of Massachusetts hospitals to provide quality
health care to patients and communities.
Health care in Massachusetts is world-class. When Raisa Gorbachev and
Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of
the Committee on Rules, all were ill, they came to Massachusetts.
{time} 1300
If the Medicare bill was a good bill, would not the Massachusetts
teaching hospitals, with the renowned reputation that they have earned
over many years, take the lead and endorse the bill? We trust these
hospitals with our lives. We should also trust their assessment of the
Republican Medicare bill.
The Gingrich Medicare cuts are simply too large for hospitals to
absorb. Cuts of this magnitude will damage the quality of health care
in America, especially for senior citizens and future generations. We
should be investing, and not cutting research and education.
These outlandish cuts to hospitals will cause massive job loss across
this country. The people hurt most by these cuts will be the hard
working men and women of America, all so that a tax cut can be given to
wealthy Americans who have not even asked for it. It is just not right.
Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the
distinguished gentleman from New Mexico [Mr. Richardson].
(Mr. RICHARDSON asked and was given permission to revise and extend
his remarks.)
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. RICHARDSON. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan,
the hospitals in and around the district of the gentleman from New York
[Mr. Paxon] will lose $64 million over the next several years to give
tax breaks to the wealthy. Under the Gingrich Medicare plan, the
district of the gentleman from New York [Mr. Frisa] will lose $262
million, again to give tax breaks to the wealthiest people in this
country that do not need it.
Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk
about the effect of this plan on rural hospitals. That is what I
represent. On Indian reservations throughout the State of New Mexico
and many States in this country, rural health care will be devastated.
Rural hospitals will close under this plan. In no way are they going to
get more funds and resources.
Now, this is according to the American Hospital Association. The
typical rural hospital will lose $5 million in Medicare funding over 7
years, and that means many of them are going to close. In my own
district, the average senior lives on $800 a month, and paying $92 a
month in premiums and unlimited out-of-pocket expenses is going to be
devastating.
Rural Medicare patients are going to lose access to doctors.
America's rural areas are going to need at least 5,000 more primary
care physicians to have the same access to those that accept Medicare.
The American Medical Association says cuts in Medicare are so severe
they will unquestionably cause some rural physicians to leave Medicare.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Ohio [Mr. Brown].
Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding
time.
Mr. Chairman, we have listened to the Republicans talk over and over
about what a great plan this is, how it expands choice. The fact is
senior citizens in this country now have full choice with Medicare.
Yes, under the Gingrich plan seniors will have their choice of a plan,
but they lose their choice of doctor.
The Gingrich plan gives physicians financial incentives, the New York
Times calls it ``bribes for doctors,'' to move out of traditional fee-
for-service into HMO's. Medicare beneficiaries therefore will be pushed
out of traditional fee-for-service and forced into HMO's, forced into
managed care.
This is purely and simply a political payoff to big insurance
companies. We know it, Newt Gingrich knows it, the Republicans know it,
and the American people know it.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New
York [Mr. Houghton], a respected member of the Committee on Ways and
Means.
(Mr. HOUGHTON asked and was given permission to revise and extend his
remarks.)
Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue,
and I can understand it. It is a very important issue. I always think
of what Wilbur Mills said, that there are probably more votes changed
in the House Chapel than there are on the House floor.
I am not going to try to convince anybody, but I am just going to
tell you where I am coming from. The gentleman from Ohio [Mr. Brown]
has thrown around a lot of numbers is terms of how many cuts will be in
people's hospitals. I would question those numbers. I have seen those
numbers myself as far as my own district is concerned and I question
the authenticity of them.
Second, I think the issue is are we going to face up to this thing or
not? Everybody agrees we should. The President agrees, the Democrats
agree, the Republicans agree. How are we going to do it? It is a matter
in terms of timing and numbers.
Also, there always is a better way. I can devise a better way. I am
not sure this plan is exactly the way I want, but it is a good plan.
The next point is that there are no eternal fixes for the Medicare
problem. We never can go asleep. We are always going to have to be on
top of this thing. The question is are we going to have a short-term or
longer term approach to this thing.
Let me talk a little bit about cuts. If I spend $1 today and I spend
90 cents 7 years from now, that is a cut. If I spend $1 today and I
spend $1.45 7 years from now, that is not a cut. Those are the
relationships we are talking about.
Let me talk a little bit about taxes. I did not vote for a tax cut. I
did not think it was appropriate, I did not think it was the right
timing. However, the Republican Party has felt that is important, the
President has felt that is important, the gentleman from Missouri [Mr.
Gephardt], the minority leader, has felt that is important. It is a
fact we deal with everyday. Why can we not get together; why can we
not, if our philosophy is the same, do something which is important as
far as this overall Medicare issue is concerned?
Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Indiana [Mr. Jacobs].
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. JACOBS. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr.
Houghton] mentioned he has other figures and he did not believe these
figures. Under the Gingrich Medicare plan, the hospitals in and around
the gentleman's district, my friend from New York, will lose $167
million over the next 7 years.
I would ask if he would come back in the well and perhaps tell us
what the numbers he has that are different from
[[Page H 10340]]
the numbers that we have been recounting, because we have heard no
debate or no questioning of those numbers.
Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers,
the proponents of this measure cite approvingly the trustees' report
that there will be a shortfall in the next 7 years in Medicare part A,
and that is the truth. But it is not all the truth.
The rest of the trustees' report states how much that shortfall is,
$90 billion. So if you accept approvingly the one part, you should
accept approvingly the other; $90 billion is considerably less than
$270 billion. I wonder anyone remembers the city of Bentre in Vietnam.
That is the one that was wiped out, every lock, stock, horse carriage,
human being, and building, the Army major declaring it became necessary
to destroy it in order to save it.
My father used to say that in politics you can get people to eat the
pudding, but you cannot get them to read the recipe. Today we are
talking the recipe. We will see how the pudding tastes.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentlewoman from California [Ms. Eshoo].
Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being
encouraged to use certain words, probably put together by some PR
agency or PR person, to describe their Medicare plan, words like
``historic, serious, and long-term.''
Well, in some ways, I could not agree with them more. Their plan is
historic because it marks the end of a 30-year commitment to provide
our seniors with health care. It is serious. It is radical surgery,
because it places the lives and well-being of 37 million Americans at
risk. And it is long-term because it will tear holes in our social
safety net that will remain for many years to come.
It ``saves, preserves, and protects,'' not Medicare, but $245 billion
in tax breaks that no one is asking for. It ``protects the right to
stay with your doctor,'' but only if you are able to pay more for the
privilege. It ``protects the right to choose,'' only if your choices
are slim and none. It is ``responsible,'' but only if you are a member
of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new
ground for being cruel to seniors. It is ``the right thing to do,'' but
only if your parents did not raise you to know any better.
Mr. Chairman, the Republican Medicare plan is all these words and one
more, disgraceful, and I urge my colleagues to defeat it so that we can
go on and make America a stronger, better, and more gentle Nation.
Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from
Washington [Mr. McDermott].
Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr.
Houghton], I wish that this debate would be about substance and we
could actually talk about what is going to happen. We can argue about
$90 billion or $270 billion, but the real issue here is what is
happening to the health security of senior citizens.
Right now, senior citizens in this country get enough money to buy a
program that covers what they need. And the Republicans are saying that
in the first year, 1996, in the dark bar, we are going to give them
enough to buy exactly what they have today. By the year 2000, you can
see that the dark bar does not go as high as the CBO says an equivalent
health plan is going to cost. The difference is $1,100. That is the
national average.
Now, if you are from California and watching this, you are going to
need another $1,200. If you are from New York, you are going to need
another $1,100. If you are from Texas, you are only going to need $994.
Ask yourself where those senior citizens are going to come up with that
extra $1,100 to buy the same thing they have today.
Every time the Republicans use the word, ``choice,'' listen to that
and say to yourself ``voucher.'' They are putting my father and my
mother, my father 90, my mother 86, and everybody else's grandparents
and parents, out on the street with a voucher. They call it choice. We
are going to let you choose anything you want. But if you do not have
the money, if that voucher only buys 75 percent of what it buys today,
who will make it up? The kids will make it up.
This is the hidden agenda here. They are shoving that $1,000, they
will not say it is cuts and I will not say it is cuts, they are shoving
that additional $1,000 into their kids.
If you happen to be out there watching this or if Members are on this
floor and happen to have a kid in college, you know what tuition does
to you. To have your parents show up at the same time and say, ``well,
I cannot afford it. It is not paid for by my health insurance,'' for
the first time in 30 years, people my age, 58 and down, are going to
have to think about how they make up that difference for their parents.
One can talk about $90 billion and actuarials and all the rest of
this stuff. There is 96 pages of things where they give away to
doctors. As a doctor, I am ashamed by the kind of deal they came in and
cut. When we are cutting money from senior citizens and putting them at
risk like this, for doctors to come in and negotiate for another $500
million, is a shame. There is no reason to do that.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Washington [Mr. White].
Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the
explanation we just heard from my colleague from the Seattle area, who
I have a great deal of affection and respect for, is exactly the kind
of thinking that got us in this mess in the first place. We have been
doing this for 30 years, and the fact is it is a self-fulfilling
prophecy.
If the Government tells you the cost of medical care is going to go
up 10 percent every year, you can be sure that it will, because people
who are buying health care or selling health care to the Government are
going to spend every nickel their customer tells them they are going to
spend the next year.
The fact is we have to exercise some control at the Federal
Government level to control these costs. Otherwise, they will be out of
control forever and that is the reason we find ourselves in this
situation. We have to fix this program. Otherwise, it is going to go
bankrupt.
{time} 1315
I want to say one other word about the Seattle area because it is
very important. Seattle is an urban community and yet it is one of the
healthiest communities in the Nation. It is also one where we have one
of the most efficient health care systems in the Nation.
Why is that, Mr. Chairman? It is because in Seattle we essentially
invented the managed care program. Under managed care individuals get
to sign up in a program that looks out for your health over the long-
term basis. Instead of trying to cure diseases as they come up, it
actually prevents individuals from getting sick in the first place. A
lot of people in the Seattle area have found that to be a good idea.
One of the great things about this bill is that it tries to do for
the rest of the Nation what we have done very successfully in Seattle
by having the option to take managed care instead of the fee-for-
service program. We have been able to keep the costs down across the
board, and that is what this bill will do for the entire country.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the
gentleman from Ohio [Mr. Portman], another respected member of the
Committee on Ways and Means.
Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to
me.
We have heard a lot today from the other side of the aisle about how
the increases in spending in our Medicare plan will not keep up with
the private sector growth. We just heard from the gentleman from
Washington [Mr. McDermott]. I wish his chart were still up. Maybe it
can be put up again. It might be useful to have it. It is just not
accurate. It is not accurate.
The charts we just saw from the gentleman compares apples to oranges.
It is full of unknowns. It is full of false assumptions. Let me give
Members a couple.
First of all, the Medicare figures are per beneficiary. The private
sector figures are not per beneficiary. How can we compare those two?
The private sector figures are, thus, inflated.
Second, the Medicare figures the Democrats use do not include a lot
of other costs, including administrative costs. It is comparing apples
to oranges.
Here is a better chart that illustrates clearly what the gentleman
from New
[[Page H 10341]]
York [Mr. Houghton] and others have been trying to explain, which is
that under this bill before us Medicare spending actually goes up.
Guess what? It actually keeps pace with the private sector. It will be
higher than the private sector 7 years from now as it is today.
This chart compares apples
Amendments:
Cosponsors:
ANNOUNCEMENT BY THE CHAIRMAN
Sponsor:
Summary:
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ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)
Text of this article available as:
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[Pages
H10333-H10455]
ANNOUNCEMENT BY THE CHAIRMAN
The CHAIRMAN. The Chair would like to take the time to remind Members
that it is not appropriate to wear or display badges while engaging in
debate.
Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from
Louisiana [Mr. McCrery], a valuable member of the Subcommittee on
Health.
Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the
Medicare system has skyrocketed since 1970. Here we are today and
Members can see, if nothing is done, it goes off the chart.
In 1970, Medicare spent about $8 billion; in 1994, Medicare spending
was about $165 billion. That is an increase of almost 2,100 percent in
just 14 years. In the part B side alone, growth rates have been so
rapid that outlays of the program have increased 40 percent per
enrollee just in the past 5 years. More alarming is that Medicare
spending is projected to explode to over $350 billion in 2002. Clearly,
this is an unsustainable trend and one that neither seniors nor younger
Americans working to support themselves and their families can be asked
to underwrite.
The financial crisis in the Medicare program is not a short-term cash
flow problem, as the Democrats would like the American people to
believe. The trustees of the Medicare trust fund, three of whom are
President Clinton's own Cabinet members, said in their report on the
HI, or part A, trust fund, ``The trust fund fails to meet the trustee's
test of long range close actuarial balance by an extremely wide
margin.'' Further, the same trustees said in their report on the SMI
trust fund, the part B trust fund, ``while in balance on an annual
basis, shows a rate of growth of costs which is clearly
unsustainable.''
The public trustees of the Medicare program were very clear when they
said, ``The Medicare Program is clearly unsustainable in its present
form.''
The Democrats in the past have ignored the long-range spending
problem of the Medicare Program. Their solution has been to continually
raise taxes on working Americans, and that is still their solution.
In the years since the enactment of Medicare, the maximum taxable
amount has been raised 23 times. Two years ago, the Congress, then
controlled by Democrats, raised taxes, Medicare taxes again. All that
did was just put another financial burden on the taxpayers and put off
the financial crisis in the trust fund for just a few months. Clearly,
raising taxes yet again on the American people is not the answer.
The Medicare Preservation Act, on the other hand, addresses the out-
of-control spending in the Medicare Program by opening up the private
health care market to the senior population. By harnessing some of the
innovative cost effective and high quality private sector health care
delivery options, Medicare beneficiaries will not only have a choice in
their health care coverage for the first time, but the Government will
also be able to rein in out-of-control Medicare spending. It is a win/
win situation.
The Republican plan provides security for not only today's seniors
but also lays the groundwork for the retirement of my generation, and
it does it without increasing the tax burden on working people.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Pennsylvania [Mr. Klink].
Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to
me.
I would like to begin by yielding to the gentleman from Ohio [Mr.
Brown].
Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the
Gingrich Medicare plan, the hospitals in and around the district of the
gentleman from Louisiana [Mr. McCrery], will lose $158 million over the
next 7 years under the Gingrich Medicare cut plan.
[[Page H 10334]]
Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here
is the chart which actually shows the reduction in Medicare spending
per beneficiary under the House Republican plan. I have to get this
straight. When is a cut not a cut?
Last year when we were trying to do health care, every Republican on
the Committee on Ways and Means signed a letter which said, ``the
additional massive cuts in reimbursement to providers proposed in this
bill''--the Clinton bill--``will reduce the quality of care for the
Nation's elderly.'' That was $168 billion versus $70 billion now.
The current chairman of the Committee on Ways and Means made the
statement, ``I just don't believe that the quality of care and
availability of care can survive these additional cuts.'' Now they are
saying that these are not cuts. It is cuts in the rate of growth. Were
you lying to us now or are you lying to us then?
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
I resent the fact that the gentleman implied that I have lied. No. 1,
that does not belong on this floor. But the gentleman, as usual, has
not given the factual information.
The plan that I made those comments on cut $490 billion out of
Medicare and Medicaid. Without transforming Medicare, without giving
other options, without including true savings in the cost drivers. That
was a totally different time, a totally different program. But it cuts
$490 billion out of Medicare and Medicaid.
Mr. Chairman, I reserve the balance of my time.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Georgia [Mr. Lewis].
Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for
yielding time to me.
Mr. Chairman, I rise today in strong opposition to the Republican
Medicare plan. I rise to tell you there is another way, a better way.
We Democrats have a plan. We save the Medicare trust fund, and we do it
without hurting the poor, the sick, and the elderly.
How can we do it? We can do it because we do not pay for tax breaks
for the rich. There is only so much money--you can either use it to
help the sick and the elderly or you can give it to the rich. My
Republican colleagues may say whatever they wish, but the truth is that
these very large--these huge Medicare cuts are needed to pay for their
tax breaks for the rich.
The Republicans say they want to help Medicare. But what they do is
different. Thirty years ago, the Democrats created Medicare and the
Republicans voted against it.
Two years ago, Democrats passed a bill that helped the Medicare trust
fund. Every Republican voted no.
Earlier this year. the Republicans took $87 billion from the Medicare
trust fund. Today, they want to cut an additional $270 billion.
They voted against Medicare 30 years ago, and they are voting against
it again today. My colleagues, actions speak louder than words, and the
Republican actions are loud and clear.
The Republicans did not want Medicare 30 years ago and they want to
dismantle it now.
I do not believe that we must destroy Medicare to save it. Democrats
do not raise premiums for seniors. Democrats ensure that Medicare is
there for our families, for our children, for our grandchildren, and
their children.
Under their plan, the Republicans eliminate nursing home standards.
Poor seniors lose help for copayments and deductibles.
Under the Republican plan, the rich get tax cuts, and our Nation's
elderly and hard-working families get higher Medicare bills. It's a
scam, a sham, and a shame. I know it. You know it. Now the American
people know it.
Mr. Chairman, on this day, October 19, let the word go forth from
this place into every State, every city, every town, every village,
every hamlet that it was the Republicans who voted to cut Medicare--
they voted to cut Medicare by $270 billion in order to give a $245
billion tax break to the wealthy. The Republican plan is too much, too
radical, too extreme.
We have more than a legislative responsibility to oppose this
Republican plan. We have a mandate, a mission, and a moral obligation
to protect Medicare.
This vote--this debate is about something much bigger than one vote.
It is bigger than one bill. It is about two contracts, the Republican
contact with the rich, and the Democratic contract with the American
people--Medicare. Medicare is a contract--a sacred trust with our
Nation's seniors and our Nation's hard-working families.
My fellow Americans, remember--it was the Democrats who found the
courage and the strength to provide health care to our seniors, and it
is the Democrats who will preserve it for unborn generations.
We must not and will not break the contract with America's seniors
and families. I urge my colleagues to support the Democratic
alternative and oppose the Republican plan to cut Medicare.
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the facts have already been presented to this
committee. Medicare increases per beneficiary go from $4,800 to $6,700
per year. The total aggregate increase in medical expenditures
increases $1.4 trillion under our plan over the next 7 years. But only
in Washington can an increase be called a cut.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad
news for Americans and senior citizens. The trustees of the Medicare
funds told us that under all sets of assumptions the fund goes
bankrupt, and it goes bankrupt in 7 years. Taking our responsibility
very seriously, we Republicans went to work.
We gathered with senior citizens, with experts from around the
country, and we said, what can we do? Is there any good news? Can we
fix the situation? We found good news. We found that health insurance
costs for working people, not retired people, were going down.
Inflation rates at 10.5 percent in Medicare are killing it.
{time} 1230
The private sector using intelligent new programs have brought the
inflation rate down below to virtually zero. We said the good news is
this. We can preserve Medicare, we can preserve fee-for-service options
for everyone who wants to stay that way, but we have new and exciting
options.
Mr. Chairman, my mother and father have chosen the managed-care
option. They love it. They save $1,000 a year each because they no
longer buy MediGap insurance. They have new prescription drug benefits.
They get all of the referrals they want. They are delighted.
This plan is very straightforward. We preserve fee-for-service, we
increase the per beneficiary expenditure from $4,800 a year to $6,700 a
year, and for those seniors who want new choices, we have excellent new
choices in managed care. This is a spectacular bill. Americans will be
proud of it. Senior citizens love it. Vote ``yes.''
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentleman from Oregon [Mr. Wyden].
(Mr. WYDEN asked and was given permission to revise and extend his
remarks.)
Mr. WYDEN. Mr. Chairman, our Nation needs----
Mr. STARK. Mr. Chairman, will the gentleman yield?
Mr. WYDEN. I yield to the gentleman from California.
Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the
district of the gentleman from Pennsylvania [Mr. Greenwood] there will
be $128 cut from hospitals over the next 7 years.
Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of
Medicare, but instead today's bill will deliver a nationwide Medicare
migraine. Instead of listening to our seniors, and our families, and to
the inspector general, this is a cut first, ask questions later
Medicare initiative, and the fraud section is a metaphor for the whole
bill. Instead of legislation to protect seniors and taxpayers, it
protects the crooks and the thieves. Instead of improving access to
health care, it provides a freeway to fraud, and, my colleagues, think
of the words of the nonpartisan fraud-buster at the Office of the
Inspector General who said that this bill will cripple, it will
cripple, efforts to bring justice.
[[Page H 10335]]
Let me tell my colleagues it is possible to develop 21st century
Medicare that works for seniors and taxpayers. Reject this bill and
come with me to Oregon because I will show each of you programs that
protect seniors, hold down costs, and insure that we have a path to the
21st century. We can do this job right. We can do it in a bipartisan
way. But let us listen to our seniors and our taxpayers.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentlewoman from Oregon [Ms. Furse].
Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time
to me.
I have here a list of words that I am told the Republicans were asked
to use in this debate, words like historic, successful, saves. Well,
there was a historic event 30 years ago. The Democrats in this House
passed Medicare. Not one Republican voted for it.
Successful? Well, yes. This bill successfully guts Medicare.
Saves? Well, yes. This bill saves the promised tax breaks for the
rich.
Mr. Chairman, also on this list it says we should say the Democrats
are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I
know that it was the Republicans who ordered the arrest of 85-year-olds
who came to the committee. They came there. They came to ask the
committee what is going to happen to our Medicare protection. They were
Americans. It is a disgrace that they were arrested.
I think there is a word that is not on this list, Mr. Chairman, and
that word is shame.
Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond.
Mr. Chairman, the rules of this House are explicit. The chairman of
any committee is required to preserve order, and when citizens of any
persuasion, any age, come in, refuse to obey the orders of this House,
the chairman has no choice but to have them escorted out of the room.
Mr. Chairman, that is exactly what happened in the Committee on
Commerce, and that is what we had to do regrettably, but that is the
truth.
Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds.
Mr. Chairman, I love my dear friend from Virginia, but I notice he
did nothing when a bunch of people came in and dumped bags of mail from
dead men, from people who were not supporting the legislation in
question, and some of which were addressed ``contributor.'' Our
Republican colleagues have a great sensitivity about the senior
citizens, but none whatsoever about rascality by high-paid lobbyists.
Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the organization that disrupted that meeting, I would
like the Record to show, 96 percent of those funds come from the public
treasury. The person who was the ringleader was a paid staff person.
Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr.
Bilirakis].
(Mr. BILIRAKIS asked and was given permission to revise and extend
his remarks.)
Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on
those politicians who over the years, not just now, use scare tactics
and misinformation to frighten our senior citizens all in the interests
of getting votes through fear. These actions are unconscionable.
Only the most affluent retirees are having their part B premiums
raised substantially. We are not raising Medicare copayments or
deductibles. We will not be reducing services or benefits--our
legislation ensures that the core services in the current Medicare
Program will be retained and must be offered to all beneficiaries.
I also want to make it clear that no one will be forced into HMO's.
If Medicare beneficiaries wish to keep the current fee-for-service
benefit where they have complete choice of their doctor, they will be
permitted to do so. If beneficiaries want to enroll in an HMO which
might include additional health benefits, or some other Medicare-plus
plan, they can do so. It will be their choice. Under our proposal,
coverage will be assured to all senior citizens, regardless of prior
health history or age.
From the beginning of this effort, I have insisted that protecting
beneficiaries was an essential part of any Medicare report effort. I
represent a congressional district that has one of the highest
percentages of senior citizens in the country. I also worked for years
as an attorney and a community volunteer with many retirees. Recently,
I myself, reached Medicare age.
This bill is the product of listening and learning. It is a product
of many discussions with people who had real life, day to day
experiences with the Medicare Program. It protects our current
beneficiaries while ensuring that Medicare will exist for future
beneficiaries.
In a recent Washington Post article, Robert Samuelson said it well
when he stated that ``Republicans occupy the high moral ground and the
low political ground. They have raised critical questions at the risk
of political suicide.''
And, knowing that, Republicans still believe it is our responsibility
to show pure guts and courage to save Medicare for our seniors, their
children, and grandchildren. We have taken on the task of protecting
and preserving Medicare because it is our moral responsibility, not
because of political necessity. We have taken the higher ground and
this is ground that I am proud to stand on.
Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from
Texas [Mr. Bryant] and I ask him if he would yield back to me 15
seconds.
Mr. BRYANT of Texas. I yield to the gentleman from California.
Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement
made by the previous gentleman. He claimed we are not cutting benefits,
we are not going to make people pay for benefits for their health care.
How are we getting $270 billion in Medicare cuts and the AMA supports
the bill? Something just does not add up.
Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is
impeccable. I would point out that the losses to hospitals in and
around the district of the gentleman from Florida [Mr. Bilirakis] are
going to be $210 million over the next 7 years, and my colleague says
there are no cuts. His folks are going to feel them.
The fact of the matter is, Mr. Bilirakis, as chairman of the
Subcommittee on Health, my colleague and his Republican friends ought
to be working on the fact that health care costs are rising. Instead my
colleague is working on cutting health care insurance that elderly
people use to cope with health care costs. That is the problem.
The fact of the matter is it is not a secret that my colleague's
party philosophically does not believe Medicare is the appropriate role
of government, and yet he comes in here and tells us they are not
cutting it. Mr. Chairman, my colleague has gotten power, and now he is
cutting it. He boasts throughout the land he is cutting government, but
today, as he takes $270 billion out of the program that insures the
health needs of seniors, he says he is not cutting it.
Only in Washington would anybody believe that, Mr. Archer.
I would point out that with regard to these cuts, Mr. Chairman, the
gentleman from Texas [Mr. Archer] and I are pretty much both in the
same situation. In Harris County, TX, we are talking about $2.4 billion
in cuts between 1996 and the year 2002 according to the Health Care
Finance Administration.
Now my colleagues asked for facts, There is facts. Dallas County,
$1.6 billion in cuts between 1996 and the year 2002. Why? To pay for
tax cuts for wealthy people out of the hides of elderly people who are
not going to be able to pay their medical bills because they have cut
their insurance.
Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume
very simply to say that once again we are back into the same rhetoric.
There will be increases for hospitals across this country. Those
increases have already been demonstrated by the facts.
Only in Washington can a Member of Congress stand up and call
increases a cut.
Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr.
Camp], a respected member of the committee.
(Mr. CAMP asked and was given permission to revise and extend his
remarks.)
Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from
[[Page H 10336]]
Texas [Mr. Archer] for yielding this time to me, and I rise today in
support of the Medicare Preservation Act because it officially ends the
policy of just raise taxes.
Mr. Chairman, some who oppose our program have called it extreme.
What is extreme is that year after year the Democrat's answer to the
Medicare crisis has been to raise taxes. Almost every year, Democrats
dug deeper into the pockets of working Americans just to get through
the next election. And in 1993, they even raised taxes on seniors
citizens.
Nine times, since 1965, the Medicare Board of Trustees has stated
that Medicare was in severe financial trouble and needed reform. What
was the Democrats answer? Raise taxes. Just throw more money at it to
get through the next election.
Since 1965, Democrats raised the payroll tax on working Americans
eight times, over 450 percent. They raised the earnings subject to tax
for Medicare 10 times, an increase of over 2000 percent. Then they
raised taxes on Federal and State employees, and, when they still
needed more, in 1993, they raised taxes on American seniors who had
already paid their fair share into the program. Now, a senior earning
just $34,000 pays not half of their Social Security in taxes but 85
percent. And now even the President admits taxes were raised too much
in 1993.
Mr. Chairman, that is extreme.
Could we put the Medicare crisis off a few years if we raise taxes
again? Sure we could.
Could we avoid the vicious attacks by special interest groups if we
didn't reform the system? Sure.
But we are not going to do that. We are going to preserve, protect
and strengthen Medicare not to get through the next election, but for
the next generation. We will ensure the solvency of this program. We
will increase benefits. We will maintain the current premium rate and
for the first time in the history of Medicare, we will give seniors the
right to choose the health care plan that best suits their health
needs.
Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from
Florida [Mr. Stearns].
Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I
could, with the gentleman from Pennsylvania. Both he and I have worked
hard in our districts getting the message out how important it is to
look at this program because it is going bankrupt, and we want to offer
them choices, much like the choices that the gentleman and I have.
Perhaps many Members do not know that a large number of the Federal
employees are retired and they have choices, HMO's, PPO's, and all
these other things. Let us talk, for example, about a widow whose $600-
a-month pension is too low to pay for this expensive part C medigap
insurance and whose biggest problem is that she cannot afford the
deductible portion of her doctor's bill.
{time} 1245
So what happens, she does not go to take care of herself. Now, what
would we have under this program with our HMO's and PPO's and the
PSN's? I mean, even a $5 doctor bill is something that she would be
concerned about. You might want to amplify on that.
Mr. GREENWOOD. If the gentleman will yield, the option that would be
very attractive for the constituent in your district that you just have
described would be a managed care option. Most of the managed care
companies have told us that, and they are already doing this in many
areas of the country, that they will offer managed care plans in which
there is no requirement whatsoever to pay Medigap insurance. So that
$1,000 a year that she may be paying now toward her Medigap insurance
would disappear. Suddenly she would gain new benefits. She would
probably gain a prescription drug benefit. She may get an improved
dental or vision benefit. She would no longer have that out-of-pocket
cost at all and still be able to go to her doctors within her network
whenever she chooses. She would, I think, would welcome this change
very much and be far better off and have more money left over in her
budget at the end of each month.
Mr. STEARNS. Is it not a point of fact that all the people in this
room have the Federal employee health benefit program, and is it not a
point of fact that people on this side are in HMO's, in fact, there are
Members of Congress who have retired who are in health management
organizations and they are not picketing and screaming and worried?
Because actually what we are trying to do is develop a program for
Medicare that is much like the First Lady and the President has and all
of us have, which basically says that health management organizations
might work for some people. It should be a choice, and surely if it is
good enough for Members of Congress, these same choices should be
available for the seniors. So I think that is what you are saying for
this particular woman in Florida who is on a very small pension every
month. This would be a possible choice for her. You might want to just
amplify on that, because I know you have toured, like I have, many
health maintenance organizations, talked to the seniors, and for some
of them they are very happy.
There are people that have high monthly drug costs, and the HMO is
paying for that, and it is paying for their deductible. So that surely
that is an approach we should not rule out by keeping the one
warehouse, one-size-fits-all program we now have. Surely moving it to
what we have in the Federal employee health benefits program is a step
forward.
Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this
country already have chosen the option of receiving their Medicare
benefits through managed care. That number is growing rapidly because
you know how seniors will get together and talk and compare notes, and
when one learns from the other that they have a new prescription drug
program benefit, they say, ``How do I get that,'' and they make the
choice.
One of the things about this debate that has been interesting to me
is you and I and Members of this side of the aisle know our friends on
the other side of the aisle will spend all day, as they have spent the
last 6 or 7 months, scaring senior citizens that all of these terrible
things are going to befall them.
The fact of the matter is that we are confident today, we are
confident because we know when the political dust settles, when this
plan is finally signed into law, that the senior citizens will then,
beginning in January, have these new options. They will see, my
goodness, their copays did not go up, deductibles did not go up, their
Social Security check, even with part B deduction, is bigger than it
was this year. They will then thank us. Once this debate is over, we
think we will be able to say we told you so.
Mr. STEARNS. Is it not also true, if they want to remain in Medicare
as it is right now, they can still do that? They still have that
choice?
Mr. GREENWOOD. Absolutely. That is the beauty part. We have made
certain from day one there is the fee-for-service option will always be
available to every single senior citizen in America that wants to keep
it. Those that may be a little too old for change, do not like to
change, can keep their fee-for-service and enjoy the kind of Medicare
that they have grown to enjoy these past years.
Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds.
I know the two gentlemen who just had this colloquy on the floor are
sincere. But last year I checked all of the Medicare policies of every
Member in Congress here. Ninety-nine percent of us have fee-for-
service. Ninety-nine percent of us have fee-for-service, and all of
those, all of those that have fee-for-service have abortion benefits in
our medical care policies. You know, those are in the records of the
House. Go check them.
parliamentary inquiry
Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry.
The CHAIRMAN. The gentleman will state his parliamentary inquiry.
Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans,
buttons, while addressing the Committee of the Whole, and did the
Chairman not already indicate what the rules are?
The CHAIRMAN. The gentleman is correct.
Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from
New York [Mr. Manton].
Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman
from Michigan [Mr. Stupak].
Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker
in
[[Page H 10337]]
the well down here, the gentleman from Florida [Mr. Stearns], his
district will lose $154 million over the next 7 years if this
Republican plan goes through, just to give a tax break to the rich.
I am more concerned about the State of Michigan where the gentleman
from Michigan [Mr. Camp] spoke in which in his district the hospitals
will lose $125 million between now and 2002 just to pay for this tax
break for the rich. Being from Michigan, I am very concerned about
that.
Mr. MANTON. Mr. Chairman, I rise in strong opposition to this
draconian plan to slash $270 billion from Medicare. This so-called
Medicare preservation plan will seriously threaten the integrity of the
program and inflict undue pain on America's elderly.
Under this bill, the elderly will suffer an increase in their
premiums and a decrease in the quality of their health care services.
Quite simply, you are asking seniors to pay a lot more, but expect a
lot less.
And last night, Mr. Chairman, in one final act of cruelty, the
majority included a provision to deny anti-nausea drugs for
chemotherapy patients. How can you possibly justify denying basic
dignity and comfort to those in the twilight of their life, who are
fighting for that very life.
Speaking out against this outrageous proposal is not a matter of
demagoguery, its a matter of duty. Duty to the senior citizens we
represent.
Oppose this legislation.
Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from
Louisiana [Mr. McCrery].
Mr. McCRERY. Mr. Chairman, the gentleman stated something that is
just incorrect, and it has been stated in the media some. We are not
denying payments for anti-nausea drugs for cancer patients. The fact is
that we will continue to pay for the intravenous drug that people, the
cancer patients, use to fight nausea.
Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from
Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York
[Mr. Paxon] for a question.
Mr. PAXON. Mr. Chairman, I have many constituents back in western New
York, in the Buffalo and Rochester, Finger Lakes areas, that are
concerned about catastrophic costs in health care. How would medical
savings accounts help those with recurring health problems pay for
these catastrophic expenses?
Mr. GREENWOOD. The medical savings account is a new component of
Medicare that we have included in this reform. Those seniors who choose
it would have deposited into their medical savings account a number of
dollars that would average about $5,000 across the Nation; the first
portion of that deposit would be used to buy catastrophic or major
medical insurance that would cover them above he deductible. Then the
senior gets to use what is left in the account for his or her medical
benefits, go to whatever doctor or hospital he or she wants. Once the
deductible is reached, then in a year in which that particular
individual has high costs, then the medical, the catastrophic, coverage
would kick in and they would have no more out-of-pocket costs
whatsoever.
In a year in which she was particularly healthy, managed her costs
and did not go to a doctor very often, she would be able to keep the
balance in the medical savings account. It is a good opportunity for
savings for those seniors.
Mr. PAXON. I would make a comment. My parents are both retired. Both
have had catastrophic health care concerns. Of course, this would be
very important to them.
I also want to make the point Medicare is important to them today,
too. They want to see Medicare protected and strengthened. It is their
health care needs. It concerns me deeply. If their Medicare is not safe
and secure, they have to turn to the family to help. We want to make
certain for them and all of the constituents this plan is preserved and
protected for the coming years.
Mr. FRISA. Mr. Chairman, will the gentleman yield?
Mr. GREENWOOD. I yield to the gentleman from New York.
Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this
is such a serious issue, it is an important one for our senior
citizens. My folks are both retired and are counting on Medicare being
there throughout their retirement, and they are happy that we are
taking the opportunity to make Medicare safe and sound and better for
all of us.
So I would like to ask the gentleman, are there going to be increased
funds for seniors under the Republican plan?
Mr. GREENWOOD. Well, of course, there are. Despite all of the
rhetoric to the contrary, we are actually taking, right now, we are
spending on average $4,800 per each beneficiary in the Medicare
Program. Our plan increases that about 5 percent each year for a 40-
percent increase over the next 7 years. So 7 years from now we will be
spending $6,700 for beneficiaries. It is a huge increase.
What we are doing is bringing down the unsustainable inflation rate
which is bankrupting the system.
Mr. FRISA. In other words, and I think this is very important,
despite the rhetoric, it is really not truthful. We are saying the
average senior citizen will be getting an extra 100 $20-bills spent on
their medical behalf. So there is more money being spent for senior
citizens under the Republican plan.
It is absolutely incredible, I think you would agree, that my
colleagues on the other side of the aisle are trying to say that 100
additional $20-bills for our senior citizens is a cut. It is absolutely
incredible.
I thank the gentleman for explaining that and making it clear to the
American people and, most importantly, to our senior citizens that the
Republicans, by providing a $2,000-per-beneficiary increase is what is
going to save Medicare for our seniors so they can feel that it is safe
and sound and better for them.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Florida [Mr. Deutsch].
Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make
complicated issues simple. If we are saving $270 billion and there are
37.6 million beneficiaries, this is what it is going to cost each
Medicare beneficiary in America, whether in terms of direct out-of-
pocket expenses or not.
There is another chart which I think is probably the best chart and
the clearest and most factual, and if we can focus in on this so people
watching can see, my Republican colleagues have said we have to do
something, there is this incredible crisis, the trust fund is gong to
go bankrupt in 7 years.
Well, the Medicare Program has existed for 30 years. Twelve of those
thirty years there was a shorter life expectancy than 7 years that
exists today, and we did incremental changes. We fixed it.
It is a flat-out lie that this is unprecedented. It is a flat-out lie
that $270 billion needs to be cut. It is a flat-out lie that choice
will be available for Medicare beneficiaries.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Tennessee [Mr. Clement].
(Mr. CLEMENT asked and was given permission to revise and extend his
remarks.)
Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican
Medicare reform plan and ask my colleagues to support the Dingell-
Gibbons substitute.
Mr. Chairman, when President Lyndon Johnson began the Medicare
Program in 1965, less than half of all seniors had health insurance. It
was understood that the elderly had declining resources, costly health
care needs, and few insurers willing to sell them coverage. Since its
creation, the Medicare Program has been a great success. Today, 99
percent of senior citizens and a substantial proportion of the disabled
are covered by Medicare. It has contributed to reducing poverty among
the elderly and causing the life expectancy rate in America to exceed
that of every country in the world except Japan. Medicare is fulfilling
its mission.
Let me review briefly the two areas of the Medicare Program. Part A
of Medicare is financed by the hospital insurance trust fund, which
comes primarily from the hospital insurance or Medicare payroll tax
contributions paid by employers, employees, and self-employed
individuals. Medicare part A will pay for inpatient hospital care,
skilled nursing facilities, home health care, and hospice services. It
is the trust fund of part A which the Medicare trustees say is
``severely out of financial balance'' and must receive ``prompt,
effective,
[[Page H 10338]]
and decisive action'' from Congress to restore the stability of the
program.
The second aspect of the Medicare Program is part B, the
supplementary medical insurance trust fund. Part B is optional, and
primarily finances physician and hospital outpatient services. Part B
is financed by premium payments from enrollees and by general revenue
funds from the Federal Government. The part B premium is currently
$46.10 monthly or 31.5 percent of total costs of Medicare, and the
budget of 1993 would bring the premium down to 25 percent of total
costs from 1996 to 1998. Beneficiaries are responsible for an annual
deductible of $100 and coinsurance, usually a 20-percent copayment. The
part B trust fund is not in financial crisis, though only because it is
financed partially by the general fund which is experiencing runaway
health care costs and driving up the deficit of the U.S. Government.
Let me be clear that I do not believe Medicare is out of control or
too generous as some have stated. In truth, Medicare pays only 45
percent of the Nation's health care bill for the elderly, and it is
less generous than 85 percent of private health insurance plans.
The problems we are facing with Medicare today are primarily
external, not internal. Though some problems do exist internally such
as fraud and abuse, most of the factors which bring us to the present
crisis are external. Let me share a few with you.
First, the primary threat to Medicare is its rising costs which are
consequently driving up the Federal deficit at alarming rates. The
ability of any reform proposal must be measured by the following
yardstick if we are to balance the budget and get our financial house
in order: Does the reform measure control the costs of Medicare? Over
the past 20 years the cost of the Medicare Program has increased an
average of 15 percent a year. In this year alone, Medicare will account
for 11.6 percent of all Federal spending. This will rise to 18.5
percent by 2005 if costs are not controlled.
Another factor which threatens the future of Medicare is the growing
number of senior citizens in America. The Baby Boomers will begin
retiring shortly after 2010, and recent years have seen a dramatic
increase in life expectancy. During the 30-year period from 1990 to
2020, the growth rate of the senior citizen population will be double
the growth rate of the total U.S. population. This means that those
receiving Medicare benefits will outnumber those employees and
employers paying into Medicare.
Among other contributors to the rising cost of Medicare are the high
cost of advanced medical technologies, the rapid increase in procedures
by doctors after a fee schedule was imposed by Medicare, the fee-for-
service arrangement which gives no cost-saving incentives to providers
or patients, and the rise of Medicare fraud and abuse. All these
factors, some of which I applaud such as life expectancy and miraculous
technology, have brought us to this present moment of crisis.
Before looking at the specific proposals to reform Medicare, I wish
to suggest the values which I believe should drive any attempt at
reform. I believe you will agree with me. These values are:
First, ensuring that every dollar saved from Medicare goes directly
toward strengthening the part A trust fund and eliminating the Federal
deficit;
Second, making the trust fund sound for the short term and the long
term;
Third, protecting beneficiaries from dramatically increased costs and
reduced access to care;
Fourth, improving patient choice without coercion or compromising the
quality of care;
Fifth, reasonable sacrifice by all while ensuring the quality and
viability of provider services for all Americans.
Let us now turn to a quick overview of the two major proposals now
before the Congress, one from each party. First, let's look at the
Republican plan to reform Medicare.
The Republicans, in their noble effort to balance the Federal budget
and reduce the deficit, agreed to a fiscal year 1996 budget resolution
which would reduce the rate of increase in Medicare spending by $270
billion by the year 2002, bringing its rate of growth down from its
current 10 percent a year to about 6 percent a year.
The most important innovation in the Republican proposal is a feature
which would allow Medicare beneficiaries to opt for a wide range of
privately run health plans, with the Government paying the premium. The
plan would provide an incentive for beneficiaries to choose an option
that is less costly, such as managed care or preferred provider groups,
while allowing those who want to stay in the traditional fee-for-
service style Medicare Program to do so. However, the Republican plan
would force many low-income seniors out of the traditional program
because of the high cost of staying in the fee-for-service as compared
to other options. The Dingell-Gibbons substitute, which I will support
today, allows seniors to move into managed care and rewards this cost-
saving sacrifice without punishing those who wish to stay in
traditional fee-for-service programs.
Another set of cost-saving provisions in the Republican plan would
reduce the growth of fees paid to hospitals, doctors, and other care
providers by an estimated $110 billion over 7 years. The Democratic and
Republican plans both rely heavily on reductions in the increase of
payments to providers, but the Republican plan also contains a look
back provision which I oppose that would balance the budget on the
backs of providers if the projected cost savings are not realized. This
will only mean that doctors and hospitals will begin turning down
Medicare patients, leading to a national health care travesty.
Both Democratic and Republican plans also contain provisions to
eliminate excessive fraud and abuse within the Medicare Program. The
Congressional Budget Office estimates that at least $20 billion could
be saved over 7 years by reducing fraud and abuse in the Medicare
Program. I believe it is wrong to raise premiums for seniors until the
cheats and ripoff artists are weeded out of Medicare. The Democratic
plan makes significant headway toward reducing fraud, but the
Republican plan will repeal existing statutes that keep doctors from
preying on their patients for their own financial self-interests.
These measures, and others, are slated to ensure the viability of the
Medicare part A trust fund. Let us turn to part B for a moment. I
remind you that the primary reason to reform part B is to reduce the
growth in the Federal deficit, not to build up the part A trust fund
which receives its revenues from elsewhere. The Republicans choose to
deal with the rising cost of part B by keeping the part B premium at
31.5 percent of total cost rather than at 25 percent as now planned.
This means a doubling of Medicare part B premiums by 2002, increasing
from $46.10 now to approximately $104 in 2002. While I do not oppose a
sensible increase in premiums, I believe this increase is out of reach
for many low-income seniors. I support the Democratic plan which would
permanently maintain premiums at 25 percent of total cost.
As you can see, many of the aims and methods are the same in the two
plans. But the details differ at significant points, particularly with
regard to how much of the burden seniors are asked to bear.
I would like to sum up the Medicare debate as I see it. First, I
support many of the reforms both sides support including incentives for
entering managed care, slowing the increase in provider payments, and
eliminating fraud and abuse. These are all contained in the Democratic
substitute which I am supporting.
Let me share with you my disagreements with both plans, Democratic
and Republican. Too often Democrats have sat on the sidelines this year
while the Super Bowl is being played on the field--we have offered more
critique than solutions. While this may be a good political stunt, it
is not responsible nor respectful of our Nation's senior citizens or
our children who will bear the cost of the Medicare Program if we do
nothing. But I have not been content to sit on the sidelines. Before
this debate even began, I stepped out in support of health care reform
bill this year that would have made many of the adjustments we are now
discussing. Even today, I would have preferred to have voted for the
coalition substitute which would have dealt with part A and part B. But
the Republicans in the Rules Committee would not allow this bill to
come to the House floor for a vote. So, today I will choose between the
better of two evils and support the Democratic substitute.
I sharply disagree with Republicans at one major point. Earlier this
year, the Republicans voted for a $245 billion tax cut which gives over
50 percent of the cut to those who make over $100,000 a year. It is any
wonder then that Republicans now need to save $270 billion from the
Medicare Program to pay for these tax cuts. I believe a tax cut of this
magnitude at this time is irresponsible, especially when the majority
of the tax cut goes to wealthy Americans. This translates into the
outrageous premium and deductible increases Republicans now propose.
The seniors in my district are telling me, ``Congressman, I don't
mind sacrificing some benefits and bearing some of the financial burden
of the Medicare Program to ensure the viability of the trust fund. But
it seems to me that the Republicans are asking us to bear most of the
burden for this reform, and it is not fair.'' I've been hearing a lot
of people at home saying that they are beginning to think that GOP
stands for Get the Old People party. I am not so sure they are wrong.
The Greek word for crisis is krisis. The Greeks used this word to
point to a critical moment in time when the road ahead would either
mean a time of devastation or a time of great opportunity. This is a
time of krisis. The decisions Congress make at this time will mean a
future of prosperity and health security for all Americans, or it will
mean a bleak future
[[Page H 10339]]
of prosperity and health care for only the privileged few. I believe
this is the time of great opportunity, and together we will forge out a
Medicare Program that will provide the best health care for our
Nation's elderly for decades to come.
Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from
Wisconsin [Mr. Kleczka].
Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are
going to be giving all of this cash to senior citizens under the
Republican plan.
What he did not tell the seniors that are watching today is we are
going to double your premiums in part B; all right. The Senate
provisions provides more copays, more out-of-pocket-expenses.
Seniors, this is what you are getting: Nothing.
Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from
Massachusetts [Mr. Neal].
Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital
Association and the gentleman from Massachusetts [Mr. Torkildsen] have
rejected the Republican Medicare bill. The MHA says the spending
reductions in these proposals are too fast, too deep, and would
jeopardize the ability of Massachusetts hospitals to provide quality
health care to patients and communities.
Health care in Massachusetts is world-class. When Raisa Gorbachev and
Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of
the Committee on Rules, all were ill, they came to Massachusetts.
{time} 1300
If the Medicare bill was a good bill, would not the Massachusetts
teaching hospitals, with the renowned reputation that they have earned
over many years, take the lead and endorse the bill? We trust these
hospitals with our lives. We should also trust their assessment of the
Republican Medicare bill.
The Gingrich Medicare cuts are simply too large for hospitals to
absorb. Cuts of this magnitude will damage the quality of health care
in America, especially for senior citizens and future generations. We
should be investing, and not cutting research and education.
These outlandish cuts to hospitals will cause massive job loss across
this country. The people hurt most by these cuts will be the hard
working men and women of America, all so that a tax cut can be given to
wealthy Americans who have not even asked for it. It is just not right.
Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the
distinguished gentleman from New Mexico [Mr. Richardson].
(Mr. RICHARDSON asked and was given permission to revise and extend
his remarks.)
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. RICHARDSON. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan,
the hospitals in and around the district of the gentleman from New York
[Mr. Paxon] will lose $64 million over the next several years to give
tax breaks to the wealthy. Under the Gingrich Medicare plan, the
district of the gentleman from New York [Mr. Frisa] will lose $262
million, again to give tax breaks to the wealthiest people in this
country that do not need it.
Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk
about the effect of this plan on rural hospitals. That is what I
represent. On Indian reservations throughout the State of New Mexico
and many States in this country, rural health care will be devastated.
Rural hospitals will close under this plan. In no way are they going to
get more funds and resources.
Now, this is according to the American Hospital Association. The
typical rural hospital will lose $5 million in Medicare funding over 7
years, and that means many of them are going to close. In my own
district, the average senior lives on $800 a month, and paying $92 a
month in premiums and unlimited out-of-pocket expenses is going to be
devastating.
Rural Medicare patients are going to lose access to doctors.
America's rural areas are going to need at least 5,000 more primary
care physicians to have the same access to those that accept Medicare.
The American Medical Association says cuts in Medicare are so severe
they will unquestionably cause some rural physicians to leave Medicare.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Ohio [Mr. Brown].
Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding
time.
Mr. Chairman, we have listened to the Republicans talk over and over
about what a great plan this is, how it expands choice. The fact is
senior citizens in this country now have full choice with Medicare.
Yes, under the Gingrich plan seniors will have their choice of a plan,
but they lose their choice of doctor.
The Gingrich plan gives physicians financial incentives, the New York
Times calls it ``bribes for doctors,'' to move out of traditional fee-
for-service into HMO's. Medicare beneficiaries therefore will be pushed
out of traditional fee-for-service and forced into HMO's, forced into
managed care.
This is purely and simply a political payoff to big insurance
companies. We know it, Newt Gingrich knows it, the Republicans know it,
and the American people know it.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New
York [Mr. Houghton], a respected member of the Committee on Ways and
Means.
(Mr. HOUGHTON asked and was given permission to revise and extend his
remarks.)
Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue,
and I can understand it. It is a very important issue. I always think
of what Wilbur Mills said, that there are probably more votes changed
in the House Chapel than there are on the House floor.
I am not going to try to convince anybody, but I am just going to
tell you where I am coming from. The gentleman from Ohio [Mr. Brown]
has thrown around a lot of numbers is terms of how many cuts will be in
people's hospitals. I would question those numbers. I have seen those
numbers myself as far as my own district is concerned and I question
the authenticity of them.
Second, I think the issue is are we going to face up to this thing or
not? Everybody agrees we should. The President agrees, the Democrats
agree, the Republicans agree. How are we going to do it? It is a matter
in terms of timing and numbers.
Also, there always is a better way. I can devise a better way. I am
not sure this plan is exactly the way I want, but it is a good plan.
The next point is that there are no eternal fixes for the Medicare
problem. We never can go asleep. We are always going to have to be on
top of this thing. The question is are we going to have a short-term or
longer term approach to this thing.
Let me talk a little bit about cuts. If I spend $1 today and I spend
90 cents 7 years from now, that is a cut. If I spend $1 today and I
spend $1.45 7 years from now, that is not a cut. Those are the
relationships we are talking about.
Let me talk a little bit about taxes. I did not vote for a tax cut. I
did not think it was appropriate, I did not think it was the right
timing. However, the Republican Party has felt that is important, the
President has felt that is important, the gentleman from Missouri [Mr.
Gephardt], the minority leader, has felt that is important. It is a
fact we deal with everyday. Why can we not get together; why can we
not, if our philosophy is the same, do something which is important as
far as this overall Medicare issue is concerned?
Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Indiana [Mr. Jacobs].
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. JACOBS. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr.
Houghton] mentioned he has other figures and he did not believe these
figures. Under the Gingrich Medicare plan, the hospitals in and around
the gentleman's district, my friend from New York, will lose $167
million over the next 7 years.
I would ask if he would come back in the well and perhaps tell us
what the numbers he has that are different from
[[Page H 10340]]
the numbers that we have been recounting, because we have heard no
debate or no questioning of those numbers.
Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers,
the proponents of this measure cite approvingly the trustees' report
that there will be a shortfall in the next 7 years in Medicare part A,
and that is the truth. But it is not all the truth.
The rest of the trustees' report states how much that shortfall is,
$90 billion. So if you accept approvingly the one part, you should
accept approvingly the other; $90 billion is considerably less than
$270 billion. I wonder anyone remembers the city of Bentre in Vietnam.
That is the one that was wiped out, every lock, stock, horse carriage,
human being, and building, the Army major declaring it became necessary
to destroy it in order to save it.
My father used to say that in politics you can get people to eat the
pudding, but you cannot get them to read the recipe. Today we are
talking the recipe. We will see how the pudding tastes.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentlewoman from California [Ms. Eshoo].
Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being
encouraged to use certain words, probably put together by some PR
agency or PR person, to describe their Medicare plan, words like
``historic, serious, and long-term.''
Well, in some ways, I could not agree with them more. Their plan is
historic because it marks the end of a 30-year commitment to provide
our seniors with health care. It is serious. It is radical surgery,
because it places the lives and well-being of 37 million Americans at
risk. And it is long-term because it will tear holes in our social
safety net that will remain for many years to come.
It ``saves, preserves, and protects,'' not Medicare, but $245 billion
in tax breaks that no one is asking for. It ``protects the right to
stay with your doctor,'' but only if you are able to pay more for the
privilege. It ``protects the right to choose,'' only if your choices
are slim and none. It is ``responsible,'' but only if you are a member
of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new
ground for being cruel to seniors. It is ``the right thing to do,'' but
only if your parents did not raise you to know any better.
Mr. Chairman, the Republican Medicare plan is all these words and one
more, disgraceful, and I urge my colleagues to defeat it so that we can
go on and make America a stronger, better, and more gentle Nation.
Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from
Washington [Mr. McDermott].
Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr.
Houghton], I wish that this debate would be about substance and we
could actually talk about what is going to happen. We can argue about
$90 billion or $270 billion, but the real issue here is what is
happening to the health security of senior citizens.
Right now, senior citizens in this country get enough money to buy a
program that covers what they need. And the Republicans are saying that
in the first year, 1996, in the dark bar, we are going to give them
enough to buy exactly what they have today. By the year 2000, you can
see that the dark bar does not go as high as the CBO says an equivalent
health plan is going to cost. The difference is $1,100. That is the
national average.
Now, if you are from California and watching this, you are going to
need another $1,200. If you are from New York, you are going to need
another $1,100. If you are from Texas, you are only going to need $994.
Ask yourself where those senior citizens are going to come up with that
extra $1,100 to buy the same thing they have today.
Every time the Republicans use the word, ``choice,'' listen to that
and say to yourself ``voucher.'' They are putting my father and my
mother, my father 90, my mother 86, and everybody else's grandparents
and parents, out on the street with a voucher. They call it choice. We
are going to let you choose anything you want. But if you do not have
the money, if that voucher only buys 75 percent of what it buys today,
who will make it up? The kids will make it up.
This is the hidden agenda here. They are shoving that $1,000, they
will not say it is cuts and I will not say it is cuts, they are shoving
that additional $1,000 into their kids.
If you happen to be out there watching this or if Members are on this
floor and happen to have a kid in college, you know what tuition does
to you. To have your parents show up at the same time and say, ``well,
I cannot afford it. It is not paid for by my health insurance,'' for
the first time in 30 years, people my age, 58 and down, are going to
have to think about how they make up that difference for their parents.
One can talk about $90 billion and actuarials and all the rest of
this stuff. There is 96 pages of things where they give away to
doctors. As a doctor, I am ashamed by the kind of deal they came in and
cut. When we are cutting money from senior citizens and putting them at
risk like this, for doctors to come in and negotiate for another $500
million, is a shame. There is no reason to do that.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Washington [Mr. White].
Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the
explanation we just heard from my colleague from the Seattle area, who
I have a great deal of affection and respect for, is exactly the kind
of thinking that got us in this mess in the first place. We have been
doing this for 30 years, and the fact is it is a self-fulfilling
prophecy.
If the Government tells you the cost of medical care is going to go
up 10 percent every year, you can be sure that it will, because people
who are buying health care or selling health care to the Government are
going to spend every nickel their customer tells them they are going to
spend the next year.
The fact is we have to exercise some control at the Federal
Government level to control these costs. Otherwise, they will be out of
control forever and that is the reason we find ourselves in this
situation. We have to fix this program. Otherwise, it is going to go
bankrupt.
{time} 1315
I want to say one other word about the Seattle area because it is
very important. Seattle is an urban community and yet it is one of the
healthiest communities in the Nation. It is also one where we have one
of the most efficient health care systems in the Nation.
Why is that, Mr. Chairman? It is because in Seattle we essentially
invented the managed care program. Under managed care individuals get
to sign up in a program that looks out for your health over the long-
term basis. Instead of trying to cure diseases as they come up, it
actually prevents individuals from getting sick in the first place. A
lot of people in the Seattle area have found that to be a good idea.
One of the great things about this bill is that it tries to do for
the rest of the Nation what we have done very successfully in Seattle
by having the option to take managed care instead of the fee-for-
service program. We have been able to keep the costs down across the
board, and that is what this bill will do for the entire country.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the
gentleman from Ohio [Mr. Portman], another respected member of the
Committee on Ways and Means.
Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to
me.
We have heard a lot today from the other side of the aisle about how
the increases in spending in our Medicare plan will not keep up with
the private sector growth. We just heard from the gentleman from
Washington [Mr. McDermott]. I wish his chart were still up. Maybe it
can be put up again. It might be useful to have it. It is just not
accurate. It is not accurate.
The charts we just saw from the gentleman compares apples to oranges.
It is full of unknowns. It is full of false assumptions. Let me give
Members a couple.
First of all, the Medicare figures are per beneficiary. The private
sector figures are not per beneficiary. How can we compare those two?
The private sector figures are, thus, inflated.
Second, the Medicare figures the Democrats use do not include a lot
of other costs, including administrative costs. It is comparing apples
to oranges.
Here is a better chart that illustrates clearly what the gentleman
from New
[[Page H 10341]]
York [Mr. Houghton] and others have been trying to explain, which is
that under this bill before us Medicare spending actually goes up.
Guess what? It actually keeps pace with the private sector. It will be
higher than the private sector 7 years from now as it is today.
This chart compares apples to apples
Major Actions:
All articles in House section
ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)
Text of this article available as:
TXT
PDF
[Pages
H10333-H10455]
ANNOUNCEMENT BY THE CHAIRMAN
The CHAIRMAN. The Chair would like to take the time to remind Members
that it is not appropriate to wear or display badges while engaging in
debate.
Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from
Louisiana [Mr. McCrery], a valuable member of the Subcommittee on
Health.
Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the
Medicare system has skyrocketed since 1970. Here we are today and
Members can see, if nothing is done, it goes off the chart.
In 1970, Medicare spent about $8 billion; in 1994, Medicare spending
was about $165 billion. That is an increase of almost 2,100 percent in
just 14 years. In the part B side alone, growth rates have been so
rapid that outlays of the program have increased 40 percent per
enrollee just in the past 5 years. More alarming is that Medicare
spending is projected to explode to over $350 billion in 2002. Clearly,
this is an unsustainable trend and one that neither seniors nor younger
Americans working to support themselves and their families can be asked
to underwrite.
The financial crisis in the Medicare program is not a short-term cash
flow problem, as the Democrats would like the American people to
believe. The trustees of the Medicare trust fund, three of whom are
President Clinton's own Cabinet members, said in their report on the
HI, or part A, trust fund, ``The trust fund fails to meet the trustee's
test of long range close actuarial balance by an extremely wide
margin.'' Further, the same trustees said in their report on the SMI
trust fund, the part B trust fund, ``while in balance on an annual
basis, shows a rate of growth of costs which is clearly
unsustainable.''
The public trustees of the Medicare program were very clear when they
said, ``The Medicare Program is clearly unsustainable in its present
form.''
The Democrats in the past have ignored the long-range spending
problem of the Medicare Program. Their solution has been to continually
raise taxes on working Americans, and that is still their solution.
In the years since the enactment of Medicare, the maximum taxable
amount has been raised 23 times. Two years ago, the Congress, then
controlled by Democrats, raised taxes, Medicare taxes again. All that
did was just put another financial burden on the taxpayers and put off
the financial crisis in the trust fund for just a few months. Clearly,
raising taxes yet again on the American people is not the answer.
The Medicare Preservation Act, on the other hand, addresses the out-
of-control spending in the Medicare Program by opening up the private
health care market to the senior population. By harnessing some of the
innovative cost effective and high quality private sector health care
delivery options, Medicare beneficiaries will not only have a choice in
their health care coverage for the first time, but the Government will
also be able to rein in out-of-control Medicare spending. It is a win/
win situation.
The Republican plan provides security for not only today's seniors
but also lays the groundwork for the retirement of my generation, and
it does it without increasing the tax burden on working people.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Pennsylvania [Mr. Klink].
Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to
me.
I would like to begin by yielding to the gentleman from Ohio [Mr.
Brown].
Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the
Gingrich Medicare plan, the hospitals in and around the district of the
gentleman from Louisiana [Mr. McCrery], will lose $158 million over the
next 7 years under the Gingrich Medicare cut plan.
[[Page H 10334]]
Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here
is the chart which actually shows the reduction in Medicare spending
per beneficiary under the House Republican plan. I have to get this
straight. When is a cut not a cut?
Last year when we were trying to do health care, every Republican on
the Committee on Ways and Means signed a letter which said, ``the
additional massive cuts in reimbursement to providers proposed in this
bill''--the Clinton bill--``will reduce the quality of care for the
Nation's elderly.'' That was $168 billion versus $70 billion now.
The current chairman of the Committee on Ways and Means made the
statement, ``I just don't believe that the quality of care and
availability of care can survive these additional cuts.'' Now they are
saying that these are not cuts. It is cuts in the rate of growth. Were
you lying to us now or are you lying to us then?
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
I resent the fact that the gentleman implied that I have lied. No. 1,
that does not belong on this floor. But the gentleman, as usual, has
not given the factual information.
The plan that I made those comments on cut $490 billion out of
Medicare and Medicaid. Without transforming Medicare, without giving
other options, without including true savings in the cost drivers. That
was a totally different time, a totally different program. But it cuts
$490 billion out of Medicare and Medicaid.
Mr. Chairman, I reserve the balance of my time.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Georgia [Mr. Lewis].
Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for
yielding time to me.
Mr. Chairman, I rise today in strong opposition to the Republican
Medicare plan. I rise to tell you there is another way, a better way.
We Democrats have a plan. We save the Medicare trust fund, and we do it
without hurting the poor, the sick, and the elderly.
How can we do it? We can do it because we do not pay for tax breaks
for the rich. There is only so much money--you can either use it to
help the sick and the elderly or you can give it to the rich. My
Republican colleagues may say whatever they wish, but the truth is that
these very large--these huge Medicare cuts are needed to pay for their
tax breaks for the rich.
The Republicans say they want to help Medicare. But what they do is
different. Thirty years ago, the Democrats created Medicare and the
Republicans voted against it.
Two years ago, Democrats passed a bill that helped the Medicare trust
fund. Every Republican voted no.
Earlier this year. the Republicans took $87 billion from the Medicare
trust fund. Today, they want to cut an additional $270 billion.
They voted against Medicare 30 years ago, and they are voting against
it again today. My colleagues, actions speak louder than words, and the
Republican actions are loud and clear.
The Republicans did not want Medicare 30 years ago and they want to
dismantle it now.
I do not believe that we must destroy Medicare to save it. Democrats
do not raise premiums for seniors. Democrats ensure that Medicare is
there for our families, for our children, for our grandchildren, and
their children.
Under their plan, the Republicans eliminate nursing home standards.
Poor seniors lose help for copayments and deductibles.
Under the Republican plan, the rich get tax cuts, and our Nation's
elderly and hard-working families get higher Medicare bills. It's a
scam, a sham, and a shame. I know it. You know it. Now the American
people know it.
Mr. Chairman, on this day, October 19, let the word go forth from
this place into every State, every city, every town, every village,
every hamlet that it was the Republicans who voted to cut Medicare--
they voted to cut Medicare by $270 billion in order to give a $245
billion tax break to the wealthy. The Republican plan is too much, too
radical, too extreme.
We have more than a legislative responsibility to oppose this
Republican plan. We have a mandate, a mission, and a moral obligation
to protect Medicare.
This vote--this debate is about something much bigger than one vote.
It is bigger than one bill. It is about two contracts, the Republican
contact with the rich, and the Democratic contract with the American
people--Medicare. Medicare is a contract--a sacred trust with our
Nation's seniors and our Nation's hard-working families.
My fellow Americans, remember--it was the Democrats who found the
courage and the strength to provide health care to our seniors, and it
is the Democrats who will preserve it for unborn generations.
We must not and will not break the contract with America's seniors
and families. I urge my colleagues to support the Democratic
alternative and oppose the Republican plan to cut Medicare.
Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the facts have already been presented to this
committee. Medicare increases per beneficiary go from $4,800 to $6,700
per year. The total aggregate increase in medical expenditures
increases $1.4 trillion under our plan over the next 7 years. But only
in Washington can an increase be called a cut.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad
news for Americans and senior citizens. The trustees of the Medicare
funds told us that under all sets of assumptions the fund goes
bankrupt, and it goes bankrupt in 7 years. Taking our responsibility
very seriously, we Republicans went to work.
We gathered with senior citizens, with experts from around the
country, and we said, what can we do? Is there any good news? Can we
fix the situation? We found good news. We found that health insurance
costs for working people, not retired people, were going down.
Inflation rates at 10.5 percent in Medicare are killing it.
{time} 1230
The private sector using intelligent new programs have brought the
inflation rate down below to virtually zero. We said the good news is
this. We can preserve Medicare, we can preserve fee-for-service options
for everyone who wants to stay that way, but we have new and exciting
options.
Mr. Chairman, my mother and father have chosen the managed-care
option. They love it. They save $1,000 a year each because they no
longer buy MediGap insurance. They have new prescription drug benefits.
They get all of the referrals they want. They are delighted.
This plan is very straightforward. We preserve fee-for-service, we
increase the per beneficiary expenditure from $4,800 a year to $6,700 a
year, and for those seniors who want new choices, we have excellent new
choices in managed care. This is a spectacular bill. Americans will be
proud of it. Senior citizens love it. Vote ``yes.''
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentleman from Oregon [Mr. Wyden].
(Mr. WYDEN asked and was given permission to revise and extend his
remarks.)
Mr. WYDEN. Mr. Chairman, our Nation needs----
Mr. STARK. Mr. Chairman, will the gentleman yield?
Mr. WYDEN. I yield to the gentleman from California.
Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the
district of the gentleman from Pennsylvania [Mr. Greenwood] there will
be $128 cut from hospitals over the next 7 years.
Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of
Medicare, but instead today's bill will deliver a nationwide Medicare
migraine. Instead of listening to our seniors, and our families, and to
the inspector general, this is a cut first, ask questions later
Medicare initiative, and the fraud section is a metaphor for the whole
bill. Instead of legislation to protect seniors and taxpayers, it
protects the crooks and the thieves. Instead of improving access to
health care, it provides a freeway to fraud, and, my colleagues, think
of the words of the nonpartisan fraud-buster at the Office of the
Inspector General who said that this bill will cripple, it will
cripple, efforts to bring justice.
[[Page H 10335]]
Let me tell my colleagues it is possible to develop 21st century
Medicare that works for seniors and taxpayers. Reject this bill and
come with me to Oregon because I will show each of you programs that
protect seniors, hold down costs, and insure that we have a path to the
21st century. We can do this job right. We can do it in a bipartisan
way. But let us listen to our seniors and our taxpayers.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentlewoman from Oregon [Ms. Furse].
Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time
to me.
I have here a list of words that I am told the Republicans were asked
to use in this debate, words like historic, successful, saves. Well,
there was a historic event 30 years ago. The Democrats in this House
passed Medicare. Not one Republican voted for it.
Successful? Well, yes. This bill successfully guts Medicare.
Saves? Well, yes. This bill saves the promised tax breaks for the
rich.
Mr. Chairman, also on this list it says we should say the Democrats
are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I
know that it was the Republicans who ordered the arrest of 85-year-olds
who came to the committee. They came there. They came to ask the
committee what is going to happen to our Medicare protection. They were
Americans. It is a disgrace that they were arrested.
I think there is a word that is not on this list, Mr. Chairman, and
that word is shame.
Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond.
Mr. Chairman, the rules of this House are explicit. The chairman of
any committee is required to preserve order, and when citizens of any
persuasion, any age, come in, refuse to obey the orders of this House,
the chairman has no choice but to have them escorted out of the room.
Mr. Chairman, that is exactly what happened in the Committee on
Commerce, and that is what we had to do regrettably, but that is the
truth.
Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds.
Mr. Chairman, I love my dear friend from Virginia, but I notice he
did nothing when a bunch of people came in and dumped bags of mail from
dead men, from people who were not supporting the legislation in
question, and some of which were addressed ``contributor.'' Our
Republican colleagues have a great sensitivity about the senior
citizens, but none whatsoever about rascality by high-paid lobbyists.
Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the organization that disrupted that meeting, I would
like the Record to show, 96 percent of those funds come from the public
treasury. The person who was the ringleader was a paid staff person.
Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr.
Bilirakis].
(Mr. BILIRAKIS asked and was given permission to revise and extend
his remarks.)
Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on
those politicians who over the years, not just now, use scare tactics
and misinformation to frighten our senior citizens all in the interests
of getting votes through fear. These actions are unconscionable.
Only the most affluent retirees are having their part B premiums
raised substantially. We are not raising Medicare copayments or
deductibles. We will not be reducing services or benefits--our
legislation ensures that the core services in the current Medicare
Program will be retained and must be offered to all beneficiaries.
I also want to make it clear that no one will be forced into HMO's.
If Medicare beneficiaries wish to keep the current fee-for-service
benefit where they have complete choice of their doctor, they will be
permitted to do so. If beneficiaries want to enroll in an HMO which
might include additional health benefits, or some other Medicare-plus
plan, they can do so. It will be their choice. Under our proposal,
coverage will be assured to all senior citizens, regardless of prior
health history or age.
From the beginning of this effort, I have insisted that protecting
beneficiaries was an essential part of any Medicare report effort. I
represent a congressional district that has one of the highest
percentages of senior citizens in the country. I also worked for years
as an attorney and a community volunteer with many retirees. Recently,
I myself, reached Medicare age.
This bill is the product of listening and learning. It is a product
of many discussions with people who had real life, day to day
experiences with the Medicare Program. It protects our current
beneficiaries while ensuring that Medicare will exist for future
beneficiaries.
In a recent Washington Post article, Robert Samuelson said it well
when he stated that ``Republicans occupy the high moral ground and the
low political ground. They have raised critical questions at the risk
of political suicide.''
And, knowing that, Republicans still believe it is our responsibility
to show pure guts and courage to save Medicare for our seniors, their
children, and grandchildren. We have taken on the task of protecting
and preserving Medicare because it is our moral responsibility, not
because of political necessity. We have taken the higher ground and
this is ground that I am proud to stand on.
Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from
Texas [Mr. Bryant] and I ask him if he would yield back to me 15
seconds.
Mr. BRYANT of Texas. I yield to the gentleman from California.
Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement
made by the previous gentleman. He claimed we are not cutting benefits,
we are not going to make people pay for benefits for their health care.
How are we getting $270 billion in Medicare cuts and the AMA supports
the bill? Something just does not add up.
Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is
impeccable. I would point out that the losses to hospitals in and
around the district of the gentleman from Florida [Mr. Bilirakis] are
going to be $210 million over the next 7 years, and my colleague says
there are no cuts. His folks are going to feel them.
The fact of the matter is, Mr. Bilirakis, as chairman of the
Subcommittee on Health, my colleague and his Republican friends ought
to be working on the fact that health care costs are rising. Instead my
colleague is working on cutting health care insurance that elderly
people use to cope with health care costs. That is the problem.
The fact of the matter is it is not a secret that my colleague's
party philosophically does not believe Medicare is the appropriate role
of government, and yet he comes in here and tells us they are not
cutting it. Mr. Chairman, my colleague has gotten power, and now he is
cutting it. He boasts throughout the land he is cutting government, but
today, as he takes $270 billion out of the program that insures the
health needs of seniors, he says he is not cutting it.
Only in Washington would anybody believe that, Mr. Archer.
I would point out that with regard to these cuts, Mr. Chairman, the
gentleman from Texas [Mr. Archer] and I are pretty much both in the
same situation. In Harris County, TX, we are talking about $2.4 billion
in cuts between 1996 and the year 2002 according to the Health Care
Finance Administration.
Now my colleagues asked for facts, There is facts. Dallas County,
$1.6 billion in cuts between 1996 and the year 2002. Why? To pay for
tax cuts for wealthy people out of the hides of elderly people who are
not going to be able to pay their medical bills because they have cut
their insurance.
Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume
very simply to say that once again we are back into the same rhetoric.
There will be increases for hospitals across this country. Those
increases have already been demonstrated by the facts.
Only in Washington can a Member of Congress stand up and call
increases a cut.
Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr.
Camp], a respected member of the committee.
(Mr. CAMP asked and was given permission to revise and extend his
remarks.)
Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from
[[Page H 10336]]
Texas [Mr. Archer] for yielding this time to me, and I rise today in
support of the Medicare Preservation Act because it officially ends the
policy of just raise taxes.
Mr. Chairman, some who oppose our program have called it extreme.
What is extreme is that year after year the Democrat's answer to the
Medicare crisis has been to raise taxes. Almost every year, Democrats
dug deeper into the pockets of working Americans just to get through
the next election. And in 1993, they even raised taxes on seniors
citizens.
Nine times, since 1965, the Medicare Board of Trustees has stated
that Medicare was in severe financial trouble and needed reform. What
was the Democrats answer? Raise taxes. Just throw more money at it to
get through the next election.
Since 1965, Democrats raised the payroll tax on working Americans
eight times, over 450 percent. They raised the earnings subject to tax
for Medicare 10 times, an increase of over 2000 percent. Then they
raised taxes on Federal and State employees, and, when they still
needed more, in 1993, they raised taxes on American seniors who had
already paid their fair share into the program. Now, a senior earning
just $34,000 pays not half of their Social Security in taxes but 85
percent. And now even the President admits taxes were raised too much
in 1993.
Mr. Chairman, that is extreme.
Could we put the Medicare crisis off a few years if we raise taxes
again? Sure we could.
Could we avoid the vicious attacks by special interest groups if we
didn't reform the system? Sure.
But we are not going to do that. We are going to preserve, protect
and strengthen Medicare not to get through the next election, but for
the next generation. We will ensure the solvency of this program. We
will increase benefits. We will maintain the current premium rate and
for the first time in the history of Medicare, we will give seniors the
right to choose the health care plan that best suits their health
needs.
Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from
Florida [Mr. Stearns].
Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I
could, with the gentleman from Pennsylvania. Both he and I have worked
hard in our districts getting the message out how important it is to
look at this program because it is going bankrupt, and we want to offer
them choices, much like the choices that the gentleman and I have.
Perhaps many Members do not know that a large number of the Federal
employees are retired and they have choices, HMO's, PPO's, and all
these other things. Let us talk, for example, about a widow whose $600-
a-month pension is too low to pay for this expensive part C medigap
insurance and whose biggest problem is that she cannot afford the
deductible portion of her doctor's bill.
{time} 1245
So what happens, she does not go to take care of herself. Now, what
would we have under this program with our HMO's and PPO's and the
PSN's? I mean, even a $5 doctor bill is something that she would be
concerned about. You might want to amplify on that.
Mr. GREENWOOD. If the gentleman will yield, the option that would be
very attractive for the constituent in your district that you just have
described would be a managed care option. Most of the managed care
companies have told us that, and they are already doing this in many
areas of the country, that they will offer managed care plans in which
there is no requirement whatsoever to pay Medigap insurance. So that
$1,000 a year that she may be paying now toward her Medigap insurance
would disappear. Suddenly she would gain new benefits. She would
probably gain a prescription drug benefit. She may get an improved
dental or vision benefit. She would no longer have that out-of-pocket
cost at all and still be able to go to her doctors within her network
whenever she chooses. She would, I think, would welcome this change
very much and be far better off and have more money left over in her
budget at the end of each month.
Mr. STEARNS. Is it not a point of fact that all the people in this
room have the Federal employee health benefit program, and is it not a
point of fact that people on this side are in HMO's, in fact, there are
Members of Congress who have retired who are in health management
organizations and they are not picketing and screaming and worried?
Because actually what we are trying to do is develop a program for
Medicare that is much like the First Lady and the President has and all
of us have, which basically says that health management organizations
might work for some people. It should be a choice, and surely if it is
good enough for Members of Congress, these same choices should be
available for the seniors. So I think that is what you are saying for
this particular woman in Florida who is on a very small pension every
month. This would be a possible choice for her. You might want to just
amplify on that, because I know you have toured, like I have, many
health maintenance organizations, talked to the seniors, and for some
of them they are very happy.
There are people that have high monthly drug costs, and the HMO is
paying for that, and it is paying for their deductible. So that surely
that is an approach we should not rule out by keeping the one
warehouse, one-size-fits-all program we now have. Surely moving it to
what we have in the Federal employee health benefits program is a step
forward.
Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this
country already have chosen the option of receiving their Medicare
benefits through managed care. That number is growing rapidly because
you know how seniors will get together and talk and compare notes, and
when one learns from the other that they have a new prescription drug
program benefit, they say, ``How do I get that,'' and they make the
choice.
One of the things about this debate that has been interesting to me
is you and I and Members of this side of the aisle know our friends on
the other side of the aisle will spend all day, as they have spent the
last 6 or 7 months, scaring senior citizens that all of these terrible
things are going to befall them.
The fact of the matter is that we are confident today, we are
confident because we know when the political dust settles, when this
plan is finally signed into law, that the senior citizens will then,
beginning in January, have these new options. They will see, my
goodness, their copays did not go up, deductibles did not go up, their
Social Security check, even with part B deduction, is bigger than it
was this year. They will then thank us. Once this debate is over, we
think we will be able to say we told you so.
Mr. STEARNS. Is it not also true, if they want to remain in Medicare
as it is right now, they can still do that? They still have that
choice?
Mr. GREENWOOD. Absolutely. That is the beauty part. We have made
certain from day one there is the fee-for-service option will always be
available to every single senior citizen in America that wants to keep
it. Those that may be a little too old for change, do not like to
change, can keep their fee-for-service and enjoy the kind of Medicare
that they have grown to enjoy these past years.
Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds.
I know the two gentlemen who just had this colloquy on the floor are
sincere. But last year I checked all of the Medicare policies of every
Member in Congress here. Ninety-nine percent of us have fee-for-
service. Ninety-nine percent of us have fee-for-service, and all of
those, all of those that have fee-for-service have abortion benefits in
our medical care policies. You know, those are in the records of the
House. Go check them.
parliamentary inquiry
Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry.
The CHAIRMAN. The gentleman will state his parliamentary inquiry.
Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans,
buttons, while addressing the Committee of the Whole, and did the
Chairman not already indicate what the rules are?
The CHAIRMAN. The gentleman is correct.
Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from
New York [Mr. Manton].
Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman
from Michigan [Mr. Stupak].
Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker
in
[[Page H 10337]]
the well down here, the gentleman from Florida [Mr. Stearns], his
district will lose $154 million over the next 7 years if this
Republican plan goes through, just to give a tax break to the rich.
I am more concerned about the State of Michigan where the gentleman
from Michigan [Mr. Camp] spoke in which in his district the hospitals
will lose $125 million between now and 2002 just to pay for this tax
break for the rich. Being from Michigan, I am very concerned about
that.
Mr. MANTON. Mr. Chairman, I rise in strong opposition to this
draconian plan to slash $270 billion from Medicare. This so-called
Medicare preservation plan will seriously threaten the integrity of the
program and inflict undue pain on America's elderly.
Under this bill, the elderly will suffer an increase in their
premiums and a decrease in the quality of their health care services.
Quite simply, you are asking seniors to pay a lot more, but expect a
lot less.
And last night, Mr. Chairman, in one final act of cruelty, the
majority included a provision to deny anti-nausea drugs for
chemotherapy patients. How can you possibly justify denying basic
dignity and comfort to those in the twilight of their life, who are
fighting for that very life.
Speaking out against this outrageous proposal is not a matter of
demagoguery, its a matter of duty. Duty to the senior citizens we
represent.
Oppose this legislation.
Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from
Louisiana [Mr. McCrery].
Mr. McCRERY. Mr. Chairman, the gentleman stated something that is
just incorrect, and it has been stated in the media some. We are not
denying payments for anti-nausea drugs for cancer patients. The fact is
that we will continue to pay for the intravenous drug that people, the
cancer patients, use to fight nausea.
Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from
Pennsylvania [Mr. Greenwood].
Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York
[Mr. Paxon] for a question.
Mr. PAXON. Mr. Chairman, I have many constituents back in western New
York, in the Buffalo and Rochester, Finger Lakes areas, that are
concerned about catastrophic costs in health care. How would medical
savings accounts help those with recurring health problems pay for
these catastrophic expenses?
Mr. GREENWOOD. The medical savings account is a new component of
Medicare that we have included in this reform. Those seniors who choose
it would have deposited into their medical savings account a number of
dollars that would average about $5,000 across the Nation; the first
portion of that deposit would be used to buy catastrophic or major
medical insurance that would cover them above he deductible. Then the
senior gets to use what is left in the account for his or her medical
benefits, go to whatever doctor or hospital he or she wants. Once the
deductible is reached, then in a year in which that particular
individual has high costs, then the medical, the catastrophic, coverage
would kick in and they would have no more out-of-pocket costs
whatsoever.
In a year in which she was particularly healthy, managed her costs
and did not go to a doctor very often, she would be able to keep the
balance in the medical savings account. It is a good opportunity for
savings for those seniors.
Mr. PAXON. I would make a comment. My parents are both retired. Both
have had catastrophic health care concerns. Of course, this would be
very important to them.
I also want to make the point Medicare is important to them today,
too. They want to see Medicare protected and strengthened. It is their
health care needs. It concerns me deeply. If their Medicare is not safe
and secure, they have to turn to the family to help. We want to make
certain for them and all of the constituents this plan is preserved and
protected for the coming years.
Mr. FRISA. Mr. Chairman, will the gentleman yield?
Mr. GREENWOOD. I yield to the gentleman from New York.
Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this
is such a serious issue, it is an important one for our senior
citizens. My folks are both retired and are counting on Medicare being
there throughout their retirement, and they are happy that we are
taking the opportunity to make Medicare safe and sound and better for
all of us.
So I would like to ask the gentleman, are there going to be increased
funds for seniors under the Republican plan?
Mr. GREENWOOD. Well, of course, there are. Despite all of the
rhetoric to the contrary, we are actually taking, right now, we are
spending on average $4,800 per each beneficiary in the Medicare
Program. Our plan increases that about 5 percent each year for a 40-
percent increase over the next 7 years. So 7 years from now we will be
spending $6,700 for beneficiaries. It is a huge increase.
What we are doing is bringing down the unsustainable inflation rate
which is bankrupting the system.
Mr. FRISA. In other words, and I think this is very important,
despite the rhetoric, it is really not truthful. We are saying the
average senior citizen will be getting an extra 100 $20-bills spent on
their medical behalf. So there is more money being spent for senior
citizens under the Republican plan.
It is absolutely incredible, I think you would agree, that my
colleagues on the other side of the aisle are trying to say that 100
additional $20-bills for our senior citizens is a cut. It is absolutely
incredible.
I thank the gentleman for explaining that and making it clear to the
American people and, most importantly, to our senior citizens that the
Republicans, by providing a $2,000-per-beneficiary increase is what is
going to save Medicare for our seniors so they can feel that it is safe
and sound and better for them.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Florida [Mr. Deutsch].
Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make
complicated issues simple. If we are saving $270 billion and there are
37.6 million beneficiaries, this is what it is going to cost each
Medicare beneficiary in America, whether in terms of direct out-of-
pocket expenses or not.
There is another chart which I think is probably the best chart and
the clearest and most factual, and if we can focus in on this so people
watching can see, my Republican colleagues have said we have to do
something, there is this incredible crisis, the trust fund is gong to
go bankrupt in 7 years.
Well, the Medicare Program has existed for 30 years. Twelve of those
thirty years there was a shorter life expectancy than 7 years that
exists today, and we did incremental changes. We fixed it.
It is a flat-out lie that this is unprecedented. It is a flat-out lie
that $270 billion needs to be cut. It is a flat-out lie that choice
will be available for Medicare beneficiaries.
Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the
gentleman from Tennessee [Mr. Clement].
(Mr. CLEMENT asked and was given permission to revise and extend his
remarks.)
Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican
Medicare reform plan and ask my colleagues to support the Dingell-
Gibbons substitute.
Mr. Chairman, when President Lyndon Johnson began the Medicare
Program in 1965, less than half of all seniors had health insurance. It
was understood that the elderly had declining resources, costly health
care needs, and few insurers willing to sell them coverage. Since its
creation, the Medicare Program has been a great success. Today, 99
percent of senior citizens and a substantial proportion of the disabled
are covered by Medicare. It has contributed to reducing poverty among
the elderly and causing the life expectancy rate in America to exceed
that of every country in the world except Japan. Medicare is fulfilling
its mission.
Let me review briefly the two areas of the Medicare Program. Part A
of Medicare is financed by the hospital insurance trust fund, which
comes primarily from the hospital insurance or Medicare payroll tax
contributions paid by employers, employees, and self-employed
individuals. Medicare part A will pay for inpatient hospital care,
skilled nursing facilities, home health care, and hospice services. It
is the trust fund of part A which the Medicare trustees say is
``severely out of financial balance'' and must receive ``prompt,
effective,
[[Page H 10338]]
and decisive action'' from Congress to restore the stability of the
program.
The second aspect of the Medicare Program is part B, the
supplementary medical insurance trust fund. Part B is optional, and
primarily finances physician and hospital outpatient services. Part B
is financed by premium payments from enrollees and by general revenue
funds from the Federal Government. The part B premium is currently
$46.10 monthly or 31.5 percent of total costs of Medicare, and the
budget of 1993 would bring the premium down to 25 percent of total
costs from 1996 to 1998. Beneficiaries are responsible for an annual
deductible of $100 and coinsurance, usually a 20-percent copayment. The
part B trust fund is not in financial crisis, though only because it is
financed partially by the general fund which is experiencing runaway
health care costs and driving up the deficit of the U.S. Government.
Let me be clear that I do not believe Medicare is out of control or
too generous as some have stated. In truth, Medicare pays only 45
percent of the Nation's health care bill for the elderly, and it is
less generous than 85 percent of private health insurance plans.
The problems we are facing with Medicare today are primarily
external, not internal. Though some problems do exist internally such
as fraud and abuse, most of the factors which bring us to the present
crisis are external. Let me share a few with you.
First, the primary threat to Medicare is its rising costs which are
consequently driving up the Federal deficit at alarming rates. The
ability of any reform proposal must be measured by the following
yardstick if we are to balance the budget and get our financial house
in order: Does the reform measure control the costs of Medicare? Over
the past 20 years the cost of the Medicare Program has increased an
average of 15 percent a year. In this year alone, Medicare will account
for 11.6 percent of all Federal spending. This will rise to 18.5
percent by 2005 if costs are not controlled.
Another factor which threatens the future of Medicare is the growing
number of senior citizens in America. The Baby Boomers will begin
retiring shortly after 2010, and recent years have seen a dramatic
increase in life expectancy. During the 30-year period from 1990 to
2020, the growth rate of the senior citizen population will be double
the growth rate of the total U.S. population. This means that those
receiving Medicare benefits will outnumber those employees and
employers paying into Medicare.
Among other contributors to the rising cost of Medicare are the high
cost of advanced medical technologies, the rapid increase in procedures
by doctors after a fee schedule was imposed by Medicare, the fee-for-
service arrangement which gives no cost-saving incentives to providers
or patients, and the rise of Medicare fraud and abuse. All these
factors, some of which I applaud such as life expectancy and miraculous
technology, have brought us to this present moment of crisis.
Before looking at the specific proposals to reform Medicare, I wish
to suggest the values which I believe should drive any attempt at
reform. I believe you will agree with me. These values are:
First, ensuring that every dollar saved from Medicare goes directly
toward strengthening the part A trust fund and eliminating the Federal
deficit;
Second, making the trust fund sound for the short term and the long
term;
Third, protecting beneficiaries from dramatically increased costs and
reduced access to care;
Fourth, improving patient choice without coercion or compromising the
quality of care;
Fifth, reasonable sacrifice by all while ensuring the quality and
viability of provider services for all Americans.
Let us now turn to a quick overview of the two major proposals now
before the Congress, one from each party. First, let's look at the
Republican plan to reform Medicare.
The Republicans, in their noble effort to balance the Federal budget
and reduce the deficit, agreed to a fiscal year 1996 budget resolution
which would reduce the rate of increase in Medicare spending by $270
billion by the year 2002, bringing its rate of growth down from its
current 10 percent a year to about 6 percent a year.
The most important innovation in the Republican proposal is a feature
which would allow Medicare beneficiaries to opt for a wide range of
privately run health plans, with the Government paying the premium. The
plan would provide an incentive for beneficiaries to choose an option
that is less costly, such as managed care or preferred provider groups,
while allowing those who want to stay in the traditional fee-for-
service style Medicare Program to do so. However, the Republican plan
would force many low-income seniors out of the traditional program
because of the high cost of staying in the fee-for-service as compared
to other options. The Dingell-Gibbons substitute, which I will support
today, allows seniors to move into managed care and rewards this cost-
saving sacrifice without punishing those who wish to stay in
traditional fee-for-service programs.
Another set of cost-saving provisions in the Republican plan would
reduce the growth of fees paid to hospitals, doctors, and other care
providers by an estimated $110 billion over 7 years. The Democratic and
Republican plans both rely heavily on reductions in the increase of
payments to providers, but the Republican plan also contains a look
back provision which I oppose that would balance the budget on the
backs of providers if the projected cost savings are not realized. This
will only mean that doctors and hospitals will begin turning down
Medicare patients, leading to a national health care travesty.
Both Democratic and Republican plans also contain provisions to
eliminate excessive fraud and abuse within the Medicare Program. The
Congressional Budget Office estimates that at least $20 billion could
be saved over 7 years by reducing fraud and abuse in the Medicare
Program. I believe it is wrong to raise premiums for seniors until the
cheats and ripoff artists are weeded out of Medicare. The Democratic
plan makes significant headway toward reducing fraud, but the
Republican plan will repeal existing statutes that keep doctors from
preying on their patients for their own financial self-interests.
These measures, and others, are slated to ensure the viability of the
Medicare part A trust fund. Let us turn to part B for a moment. I
remind you that the primary reason to reform part B is to reduce the
growth in the Federal deficit, not to build up the part A trust fund
which receives its revenues from elsewhere. The Republicans choose to
deal with the rising cost of part B by keeping the part B premium at
31.5 percent of total cost rather than at 25 percent as now planned.
This means a doubling of Medicare part B premiums by 2002, increasing
from $46.10 now to approximately $104 in 2002. While I do not oppose a
sensible increase in premiums, I believe this increase is out of reach
for many low-income seniors. I support the Democratic plan which would
permanently maintain premiums at 25 percent of total cost.
As you can see, many of the aims and methods are the same in the two
plans. But the details differ at significant points, particularly with
regard to how much of the burden seniors are asked to bear.
I would like to sum up the Medicare debate as I see it. First, I
support many of the reforms both sides support including incentives for
entering managed care, slowing the increase in provider payments, and
eliminating fraud and abuse. These are all contained in the Democratic
substitute which I am supporting.
Let me share with you my disagreements with both plans, Democratic
and Republican. Too often Democrats have sat on the sidelines this year
while the Super Bowl is being played on the field--we have offered more
critique than solutions. While this may be a good political stunt, it
is not responsible nor respectful of our Nation's senior citizens or
our children who will bear the cost of the Medicare Program if we do
nothing. But I have not been content to sit on the sidelines. Before
this debate even began, I stepped out in support of health care reform
bill this year that would have made many of the adjustments we are now
discussing. Even today, I would have preferred to have voted for the
coalition substitute which would have dealt with part A and part B. But
the Republicans in the Rules Committee would not allow this bill to
come to the House floor for a vote. So, today I will choose between the
better of two evils and support the Democratic substitute.
I sharply disagree with Republicans at one major point. Earlier this
year, the Republicans voted for a $245 billion tax cut which gives over
50 percent of the cut to those who make over $100,000 a year. It is any
wonder then that Republicans now need to save $270 billion from the
Medicare Program to pay for these tax cuts. I believe a tax cut of this
magnitude at this time is irresponsible, especially when the majority
of the tax cut goes to wealthy Americans. This translates into the
outrageous premium and deductible increases Republicans now propose.
The seniors in my district are telling me, ``Congressman, I don't
mind sacrificing some benefits and bearing some of the financial burden
of the Medicare Program to ensure the viability of the trust fund. But
it seems to me that the Republicans are asking us to bear most of the
burden for this reform, and it is not fair.'' I've been hearing a lot
of people at home saying that they are beginning to think that GOP
stands for Get the Old People party. I am not so sure they are wrong.
The Greek word for crisis is krisis. The Greeks used this word to
point to a critical moment in time when the road ahead would either
mean a time of devastation or a time of great opportunity. This is a
time of krisis. The decisions Congress make at this time will mean a
future of prosperity and health security for all Americans, or it will
mean a bleak future
[[Page H 10339]]
of prosperity and health care for only the privileged few. I believe
this is the time of great opportunity, and together we will forge out a
Medicare Program that will provide the best health care for our
Nation's elderly for decades to come.
Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from
Wisconsin [Mr. Kleczka].
Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are
going to be giving all of this cash to senior citizens under the
Republican plan.
What he did not tell the seniors that are watching today is we are
going to double your premiums in part B; all right. The Senate
provisions provides more copays, more out-of-pocket-expenses.
Seniors, this is what you are getting: Nothing.
Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from
Massachusetts [Mr. Neal].
Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital
Association and the gentleman from Massachusetts [Mr. Torkildsen] have
rejected the Republican Medicare bill. The MHA says the spending
reductions in these proposals are too fast, too deep, and would
jeopardize the ability of Massachusetts hospitals to provide quality
health care to patients and communities.
Health care in Massachusetts is world-class. When Raisa Gorbachev and
Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of
the Committee on Rules, all were ill, they came to Massachusetts.
{time} 1300
If the Medicare bill was a good bill, would not the Massachusetts
teaching hospitals, with the renowned reputation that they have earned
over many years, take the lead and endorse the bill? We trust these
hospitals with our lives. We should also trust their assessment of the
Republican Medicare bill.
The Gingrich Medicare cuts are simply too large for hospitals to
absorb. Cuts of this magnitude will damage the quality of health care
in America, especially for senior citizens and future generations. We
should be investing, and not cutting research and education.
These outlandish cuts to hospitals will cause massive job loss across
this country. The people hurt most by these cuts will be the hard
working men and women of America, all so that a tax cut can be given to
wealthy Americans who have not even asked for it. It is just not right.
Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the
distinguished gentleman from New Mexico [Mr. Richardson].
(Mr. RICHARDSON asked and was given permission to revise and extend
his remarks.)
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. RICHARDSON. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan,
the hospitals in and around the district of the gentleman from New York
[Mr. Paxon] will lose $64 million over the next several years to give
tax breaks to the wealthy. Under the Gingrich Medicare plan, the
district of the gentleman from New York [Mr. Frisa] will lose $262
million, again to give tax breaks to the wealthiest people in this
country that do not need it.
Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk
about the effect of this plan on rural hospitals. That is what I
represent. On Indian reservations throughout the State of New Mexico
and many States in this country, rural health care will be devastated.
Rural hospitals will close under this plan. In no way are they going to
get more funds and resources.
Now, this is according to the American Hospital Association. The
typical rural hospital will lose $5 million in Medicare funding over 7
years, and that means many of them are going to close. In my own
district, the average senior lives on $800 a month, and paying $92 a
month in premiums and unlimited out-of-pocket expenses is going to be
devastating.
Rural Medicare patients are going to lose access to doctors.
America's rural areas are going to need at least 5,000 more primary
care physicians to have the same access to those that accept Medicare.
The American Medical Association says cuts in Medicare are so severe
they will unquestionably cause some rural physicians to leave Medicare.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Ohio [Mr. Brown].
Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding
time.
Mr. Chairman, we have listened to the Republicans talk over and over
about what a great plan this is, how it expands choice. The fact is
senior citizens in this country now have full choice with Medicare.
Yes, under the Gingrich plan seniors will have their choice of a plan,
but they lose their choice of doctor.
The Gingrich plan gives physicians financial incentives, the New York
Times calls it ``bribes for doctors,'' to move out of traditional fee-
for-service into HMO's. Medicare beneficiaries therefore will be pushed
out of traditional fee-for-service and forced into HMO's, forced into
managed care.
This is purely and simply a political payoff to big insurance
companies. We know it, Newt Gingrich knows it, the Republicans know it,
and the American people know it.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New
York [Mr. Houghton], a respected member of the Committee on Ways and
Means.
(Mr. HOUGHTON asked and was given permission to revise and extend his
remarks.)
Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue,
and I can understand it. It is a very important issue. I always think
of what Wilbur Mills said, that there are probably more votes changed
in the House Chapel than there are on the House floor.
I am not going to try to convince anybody, but I am just going to
tell you where I am coming from. The gentleman from Ohio [Mr. Brown]
has thrown around a lot of numbers is terms of how many cuts will be in
people's hospitals. I would question those numbers. I have seen those
numbers myself as far as my own district is concerned and I question
the authenticity of them.
Second, I think the issue is are we going to face up to this thing or
not? Everybody agrees we should. The President agrees, the Democrats
agree, the Republicans agree. How are we going to do it? It is a matter
in terms of timing and numbers.
Also, there always is a better way. I can devise a better way. I am
not sure this plan is exactly the way I want, but it is a good plan.
The next point is that there are no eternal fixes for the Medicare
problem. We never can go asleep. We are always going to have to be on
top of this thing. The question is are we going to have a short-term or
longer term approach to this thing.
Let me talk a little bit about cuts. If I spend $1 today and I spend
90 cents 7 years from now, that is a cut. If I spend $1 today and I
spend $1.45 7 years from now, that is not a cut. Those are the
relationships we are talking about.
Let me talk a little bit about taxes. I did not vote for a tax cut. I
did not think it was appropriate, I did not think it was the right
timing. However, the Republican Party has felt that is important, the
President has felt that is important, the gentleman from Missouri [Mr.
Gephardt], the minority leader, has felt that is important. It is a
fact we deal with everyday. Why can we not get together; why can we
not, if our philosophy is the same, do something which is important as
far as this overall Medicare issue is concerned?
Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Indiana [Mr. Jacobs].
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. JACOBS. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr.
Houghton] mentioned he has other figures and he did not believe these
figures. Under the Gingrich Medicare plan, the hospitals in and around
the gentleman's district, my friend from New York, will lose $167
million over the next 7 years.
I would ask if he would come back in the well and perhaps tell us
what the numbers he has that are different from
[[Page H 10340]]
the numbers that we have been recounting, because we have heard no
debate or no questioning of those numbers.
Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers,
the proponents of this measure cite approvingly the trustees' report
that there will be a shortfall in the next 7 years in Medicare part A,
and that is the truth. But it is not all the truth.
The rest of the trustees' report states how much that shortfall is,
$90 billion. So if you accept approvingly the one part, you should
accept approvingly the other; $90 billion is considerably less than
$270 billion. I wonder anyone remembers the city of Bentre in Vietnam.
That is the one that was wiped out, every lock, stock, horse carriage,
human being, and building, the Army major declaring it became necessary
to destroy it in order to save it.
My father used to say that in politics you can get people to eat the
pudding, but you cannot get them to read the recipe. Today we are
talking the recipe. We will see how the pudding tastes.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentlewoman from California [Ms. Eshoo].
Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being
encouraged to use certain words, probably put together by some PR
agency or PR person, to describe their Medicare plan, words like
``historic, serious, and long-term.''
Well, in some ways, I could not agree with them more. Their plan is
historic because it marks the end of a 30-year commitment to provide
our seniors with health care. It is serious. It is radical surgery,
because it places the lives and well-being of 37 million Americans at
risk. And it is long-term because it will tear holes in our social
safety net that will remain for many years to come.
It ``saves, preserves, and protects,'' not Medicare, but $245 billion
in tax breaks that no one is asking for. It ``protects the right to
stay with your doctor,'' but only if you are able to pay more for the
privilege. It ``protects the right to choose,'' only if your choices
are slim and none. It is ``responsible,'' but only if you are a member
of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new
ground for being cruel to seniors. It is ``the right thing to do,'' but
only if your parents did not raise you to know any better.
Mr. Chairman, the Republican Medicare plan is all these words and one
more, disgraceful, and I urge my colleagues to defeat it so that we can
go on and make America a stronger, better, and more gentle Nation.
Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from
Washington [Mr. McDermott].
Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr.
Houghton], I wish that this debate would be about substance and we
could actually talk about what is going to happen. We can argue about
$90 billion or $270 billion, but the real issue here is what is
happening to the health security of senior citizens.
Right now, senior citizens in this country get enough money to buy a
program that covers what they need. And the Republicans are saying that
in the first year, 1996, in the dark bar, we are going to give them
enough to buy exactly what they have today. By the year 2000, you can
see that the dark bar does not go as high as the CBO says an equivalent
health plan is going to cost. The difference is $1,100. That is the
national average.
Now, if you are from California and watching this, you are going to
need another $1,200. If you are from New York, you are going to need
another $1,100. If you are from Texas, you are only going to need $994.
Ask yourself where those senior citizens are going to come up with that
extra $1,100 to buy the same thing they have today.
Every time the Republicans use the word, ``choice,'' listen to that
and say to yourself ``voucher.'' They are putting my father and my
mother, my father 90, my mother 86, and everybody else's grandparents
and parents, out on the street with a voucher. They call it choice. We
are going to let you choose anything you want. But if you do not have
the money, if that voucher only buys 75 percent of what it buys today,
who will make it up? The kids will make it up.
This is the hidden agenda here. They are shoving that $1,000, they
will not say it is cuts and I will not say it is cuts, they are shoving
that additional $1,000 into their kids.
If you happen to be out there watching this or if Members are on this
floor and happen to have a kid in college, you know what tuition does
to you. To have your parents show up at the same time and say, ``well,
I cannot afford it. It is not paid for by my health insurance,'' for
the first time in 30 years, people my age, 58 and down, are going to
have to think about how they make up that difference for their parents.
One can talk about $90 billion and actuarials and all the rest of
this stuff. There is 96 pages of things where they give away to
doctors. As a doctor, I am ashamed by the kind of deal they came in and
cut. When we are cutting money from senior citizens and putting them at
risk like this, for doctors to come in and negotiate for another $500
million, is a shame. There is no reason to do that.
Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Washington [Mr. White].
Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the
explanation we just heard from my colleague from the Seattle area, who
I have a great deal of affection and respect for, is exactly the kind
of thinking that got us in this mess in the first place. We have been
doing this for 30 years, and the fact is it is a self-fulfilling
prophecy.
If the Government tells you the cost of medical care is going to go
up 10 percent every year, you can be sure that it will, because people
who are buying health care or selling health care to the Government are
going to spend every nickel their customer tells them they are going to
spend the next year.
The fact is we have to exercise some control at the Federal
Government level to control these costs. Otherwise, they will be out of
control forever and that is the reason we find ourselves in this
situation. We have to fix this program. Otherwise, it is going to go
bankrupt.
{time} 1315
I want to say one other word about the Seattle area because it is
very important. Seattle is an urban community and yet it is one of the
healthiest communities in the Nation. It is also one where we have one
of the most efficient health care systems in the Nation.
Why is that, Mr. Chairman? It is because in Seattle we essentially
invented the managed care program. Under managed care individuals get
to sign up in a program that looks out for your health over the long-
term basis. Instead of trying to cure diseases as they come up, it
actually prevents individuals from getting sick in the first place. A
lot of people in the Seattle area have found that to be a good idea.
One of the great things about this bill is that it tries to do for
the rest of the Nation what we have done very successfully in Seattle
by having the option to take managed care instead of the fee-for-
service program. We have been able to keep the costs down across the
board, and that is what this bill will do for the entire country.
Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the
gentleman from Ohio [Mr. Portman], another respected member of the
Committee on Ways and Means.
Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to
me.
We have heard a lot today from the other side of the aisle about how
the increases in spending in our Medicare plan will not keep up with
the private sector growth. We just heard from the gentleman from
Washington [Mr. McDermott]. I wish his chart were still up. Maybe it
can be put up again. It might be useful to have it. It is just not
accurate. It is not accurate.
The charts we just saw from the gentleman compares apples to oranges.
It is full of unknowns. It is full of false assumptions. Let me give
Members a couple.
First of all, the Medicare figures are per beneficiary. The private
sector figures are not per beneficiary. How can we compare those two?
The private sector figures are, thus, inflated.
Second, the Medicare figures the Democrats use do not include a lot
of other costs, including administrative costs. It is comparing apples
to oranges.
Here is a better chart that illustrates clearly what the gentleman
from New
[[Page H 10341]]
York [Mr. Houghton] and others have been trying to explain, which is
that under this bill before us Medicare spending actually goes up.
Guess what? It actually keeps pace with the private sector. It will be
higher than the private sector 7 years from now as it is today.
This chart compares apples
Amendments:
Cosponsors: