[Extensions of Remarks]
[Pages E2298-E2300]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

REPUBLICANS BLOCK DEMOCRATS FROM OFFERING MAJOR IMPROVEMENTS TO
MEDICARE

______

HON. FORTNEY PETE STARK

of california

in the house of representatives

Monday, November 8, 1999

Mr. STARK. Mr. Speaker, last Friday, the House passed an okay
Medicare improvements bill.
But it could have been much better; it could have helped seniors get
a better price for pharmaceuticals; it could have helped low-income
women fight cancer; it could have provided more help to providers hurt
by excessive cuts in the 1997 Balanced Budget Act. But Republicans
blocked any amendments to the bill--they did not want to be embrassed
by having to vote against helping seniors with the high costs of drugs.
Following is a letter which 119 Democrats (many more would have
signed if we had had more time) sent to the Speaker, outlining our
request for amendments to H.R. 3075.
Mr. Speaker, the majority should be ashamed for a legislative gag
rule that prevented us from improving this legislation.

[[Page E2299]]

Congress of the United States,

House of Representatives,

Washington, DC, November 4, 1999.
Hon. Dennis Hastert,
Speaker of the U.S. House of Representatives, The Capital,
Washington, DC.
Dear Mr. Speaker: We are writing to ask that you not bring
the Medicare Balanced Budget Act legislation (HR 3075 as
amended in negotiations with Commerce Committee Republicans)
to the floor under suspension of the rules, but instead
provide a rule permitting Democratic amendments and a motion
to recommit. Because Democrats were not included in the
negotiations between the Ways and Means and Commerce
Committee Republican members, it is particularly important
that we be offered the opportunity for floor amendments.
While the Republican bills that have been introduced
provide a great deal of needed relief, we believe that (1)
some additional relief to providers, (2) some beneficiary
improvements (in particular help with the high cost of
pharmaceuticals), and (3) some alternative policies are
desperately needed.
The amendments we propose would provide an additional $2.4
billion in paid-for relief, with some going to beneficiaries
in lower pharmaceutical prices and other program
improvements. Our amendments would also eliminate several
policies in the Republican bill which the Administration has
identified as unworkable or which would hurt Medicare
beneficiaries.
As fiscally responsible Democrats, we are concerned that
the Republican bill is not paid for, and we urge you to find
a way to pay for it, rather than further spending Social
Security surpluses. For example, because it is not currently
paid for, the Ways and Means bill (HR 3075) shortens the
solvency of the Medicare Part A Trust Fund by at least a
year, and increases Part B premiums for seniors.
Therefore, to avoid this problem, we pay for the additional
relief offered by our amendments. Thus we do not hurt
Medicare's solvency. The $2.4 billion in relief over five
years is paid for by $2.4 billion in Medicare savings from
the President's budget proposal of last January. These
savings come from Medicare anti-fraud, waste, and abuse
proposals.

Providing Needed Additional Relief

The $2.4 billion provides important, much needed additional
relief to
--beneficiaries to meet the cost of fighting cancer and the
high costs of pharmaceutical insurance \1\
---------------------------------------------------------------------------
\1\ We assume that the bill the Majority brings to the floor
will include an expansion of Medicare's coverage of immuno-
suppressive drugs, so that transplant patients do not suffer
organ rejection. If this provision is not included, we ask
permission to include it and pay for it with additional anti-
fraud and abuse provisions.
---------------------------------------------------------------------------
--teaching hospitals,
--safety net hospitals, which have the lowest overall
operating margins,
--rural hospitals, which have the lowest Medicare margins,
--skilled nursing homes,
--home health agencies which are serving the sickest
patients,
--a more rational rehabilitation cap program that will help
our most severely disabled stroke patients and amputees,
--help for hospice agencies facing sky-rocketing
pharmaceutical costs for end-of-life painkillers, and
--the Medicaid and Children's Health Insurance Program, to
help the providers serving the low income and to help Puerto
Rico and the Possessions with more adequate payment rates.
This additional relief will further ensure that Medicare
beneficiaries are buffered from the cuts in the 1997 BBA and
will allow Medicare beneficiaries to continue to receive high
quality care.
The attached memo describes these amendments in more
detail.

Help Seniors with the High Cost of Pharmaceuticals

We believe we need to help all Medicare beneficiaries with
a prescription drug insurance benefit, but that is a larger
issue that cannot be addressed in this limited BBA
corrections legislation. We hope, Mr. Speaker, that you will
make this a priority issue for the Second Session of this
Congress.
In the meantime, we do believe that this bill gives us the
one opportunity this year to help seniors with the exorbitant
cost of prescription drugs. We propose an amendment which was
offered in the Ways and Means Committee by Rep. Karen Thurman
(and supported by all the Democratic members of the
Committee) that makes the Allen-Turner-Waxman-Berry
pharmaceutical discount bill (HR 664) germane to Medicare.
Basically, the amendment says that if a drug manufacturer
wants to sell pharmaceuticals to a hospital participating in
Medicare, it must also make available to pharmacies for sale
to seniors drugs at the best available price for which they
offer that drug. By some estimates, this type of program
could lower drug costs to seniors by as much as 40%.
If we can't pass a major Medicare drug reform bill this
fall, we can at least give seniors a chance for the discounts
available to large buyers.

Preventing Bad Policies

If the Majority bill includes certain provisions, we ask
that the rule governing debate permits us to strike those
anti-beneficiary and anti-consumer provisions:
Specifically, we are concerned that the Administration has
warned that the hospital out-patient department (HOPD)
provisions of the Ways and Means bill are so complicated that
they will delay the start of HOPD Prospective Payment (PPS)
by at least a year. Such a delay in the PPS will cost
beneficiaries about $1.4 billion, with patients' share of
total HOPD payments running about 50%. We would move to
strike the House HOPD provisions in favor of the Senate's
more administrable proposals, but keep the amount of relief
to hospitals and patients at the House level.
Second, if the Majority bill includes the `Commerce
Republicans' provision giving ``deemed status'' to HMOs, we
would strike that provision. An overwhelming number of House
members have just voted in favor of higher quality in managed
care plans. Therefore, we find it incredible that the
majority may be proposing an amendment to the BBA which would
weaken our ability to ensure quality by turning over approval
of these plans to participate in Medicare to private groups
which are often dominated by the very industry they are
supposed to be regulating. If such `deemed status' language
is included, we will seek to strike it in order to protect
beneficiaries.
Third, as mentioned above, we propose to strike the
unworkable $1500 limit on rehabilitation caps for two years
while the Secretary develops a rational therapy payment plan.
This is the same approach as taken by the Senate Finance
Committee.
In conclusion, our beneficiaries and providers need the
improvements made by the Democratic amendment. We urge you to
make it in order. Thank you for your consideration.
Sincerely,
Neil Abercrombie, Gary Ackerman, Tom Allen, Robert Andrews,
Tammy Baldwin, Tom Barrett, Jim Barcia, Xavier Becerra,
Shelly Berkley, Howard Berman, Marion Berry, Bob Borski, Rick
Boucher, Corrine Brown, Sherrod Brown, Lois Capps, Michael
Capuano, John Conyers, Ben Cardin, Julia Carson, Bob Clement,
Bill Coyne, Elijah Cummings, Danny Davis, Jim Davis.
Peter DeFazio, Diane DeGette, Rosa DeLauro, Peter Deutsch,
John D. Dingell, Julian Dixon, Lloyd Doggett, Eliot Engel,
Anna G. Eshoo, Lane Evans, Eni Faleomavaega, Sam Farr,
Michael Forbes, Bart Gordon, Gene Greene, Ralph Hall, Earl
Hilliard, Maurice Hinchey, Darlene Hooley, Steny Hoyer, Paul
Kanjorski, Carolyn Kilpatrick, Ron Klink, Dennis J. Kucinich,
John LaFalce, Tom Lantos.
Barbara Lee, Sandy Levin, John Lewis, Nita M. Lowey, Bill
Luther, Karen McCarthy, Jim McDermott, Jim McGovern, Mike
McNulty, Carolyn B. Maloney, Jim Maloney, Ed Markey, Matthew
Martinez, Robert T. Matsui, Carrie Meek, Robert Menendez,
George Miller, Joe Moakley, Jerry Nadler, Richard Neal,
Eleanor Holmes Norton, Jim Oberstar, John Olver, Major Owens.
Frank Pallone, Donald Payne, Nancy Pelosi, David Phelps,
Earl Pomeroy, Nick Rahall, Charles Rangel, Lynn Rivers, Ciro
Rodriguez, Carols Romero-Barcello, Lucille Roybal-Allard,
Bobby Rush, Martin Sabo, Bernie Sanders, Tom Sawyer, Jan
Schakowsky, Louise Slaughter, Vic Snyder.
Debbie Stabenow, Peter Stark, Ted Strickland, Bart Stupak,
Ellen Tauscher.
Mike Thompson, Karen Thurman, John Tierney, Edolphus Towns,
Jim Traficant, Peter Visclosky, Maxine Waters, Melvin Watt,
Henry Waxman, Robert Wexler, Robert Weygand, Bob Wise, Lynn
Woolsey, Al Wynn.

____

Issue Area:
In addition to HR 3075, a $2.4 billion paid-for package
[dollars expressed as additions to costs in HR 3075]
Hospitals:
Freeze indirect medical education cut for 1 year more than
HR 3075 ($0.2); Freeze disproportionate share hospital
cuts for 1 year more than HR 3075 ($0); Carve out DSH
payments from payments to M+C plans. Moves about $1
billion per year to the nation's safety net hospitals; is
not in HR 3075 ($0).
Rural hospitals:
Tanner Amendment to protect rural and cancer hospitals
against outpatient department PPS cuts (HR 3075 phases in
cuts to these hospitals, still leaving huge payment
reductions) ($0.2).
$1500 therapy caps:
Strike HR 3075 limits by suspending caps for 2 years while
a new, more rational system is developed (net $0).
Community health centers & rural CHCs:
Establish a PPS system which protects CHCs against State
Medicaid cuts ($0.2).
Nursing homes:
Raise HR 3075's payment to high acuity cases from 10% to
30% ($0.1); Raise HR 3075's nursing home inflation
adjustment from 0.8% in FY01 to 1% ($0.1) and authorize
extra payments for hi cost of living in Hawaii and
Alaska.
Physicians:
Study of why payment rates in certain States and Puerto
Rico are low.
Home health:
Provide $250 million ``outlier'' pool for home health
agencies that treat tough cases ($0.3) HR 1917, by Rep.
Jim McGovern and 102 cosponsors.
Hospice:
Eliminate 1% cut in FY 01 and 02 ($0.2).
Medicaid:
Help for Medicaid DSH formula errors in NM, DC, MN, and WY
($0.2) Permanent fix for CA Medicaid DSH problem $0; Help
families not lose Medicaid coverage as a

[[Page E2300]]

result of delinking of welfare and Medicaid eligibility
($0.2).
CHIPs:
Increase CHIPs amount for Possessions and provide technical
fix to CHIPs formula ($0.1).
Beneficiary improvements:
Immuno-suppressive drugs, cover without a time limit
($0.3); Allow States to require M+C plans to cover
certain benefits (like MA used to do with Rx ($0); Allow
people abandoned by M+C plans to buy a medi-gap policy
which covers Rx ($0); Coverage of cancer treatment for
low-income women ($0.3) HR 1070, by Rep Eshoo and Lazio
and 271 cosponsors.
Pay-fors:
3 Medicare items from President's budget: mental health
partial hospitalization reform, Medicare Secondary Payer
data match, and pay for outpatient drugs at 83% of
average wholesale price. ($2.4).

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