Gene Green

Mr. GREEN

Mr. GREEN. Madam Chairman, I will try and talk as fast as I can in 2 minutes on what I have heard just since I have been here on the floor. My colleague, the gentleman from Texas (Mr. DeLay), he and I share Harris County. I know if he gets $31 million, I know where he is taking it out of. He is taking it out of inner city schools like I represent. The gentleman from Texas (Mr. DeLay) represents a very suburban district. If that is the intent of this bill, and that may very well be happening, then that is a great reason to oppose it. Let me talk a little bit about the title of the this bill, the truth in taxation is truth in Dollars to the Classroom. The truth in the labeling in this bill is something we should have, because if it actually sends dollars to the classroom, how come the report I see from my folks in Texas show that we are going to lose $17 million, 9.3 percent of the programs that are allocated under this to the Dollars in the Classroom? So I think maybe the numbers are incorrect. This is just a continuation, Madam Chairman, of what I have seen in the last 4 years. In 1995, we saw an effort to eliminate the Department of Education, attack on school lunches, the effort just last week to have Federal Government tell local States what to do with bilingual education even with State money and eliminate safe and drug-free schools. So what we are seeing now is under a false labeling, Dollars to the Classroom. We are seeing an effort to block grant a great many Federal funds. Eighty-five percent of the Federal funding for education goes to 12 key programs, Title I, Pell Grants, IDE, Individuals with Disabilities. That is where most of the money is at. That is in these programs, not in the programs they are talking about, although these are impacted by this. So, again, the block granting to States would probably benefit districts like my colleague, the gentleman from Texas (Mr. DeLay). I represent a very inner city district; 60 percent minority population. Most of the students are minority. They are either poor or they have language needs that need to be addressed. What we are seeing in this bill is the taking away of the urban needs where this targeted money goes to and sending it to the suburbs. That should be a State decision, but let us not give them Federal money to make that State decision.

Mr. GREEN

Mr. GREEN. Mr. Chairman, I thank the gentleman for yielding. I share his concern. Not being on either foreign affairs committee but from the Committee on Commerce I have watched, and the concern I have is that when we are dealing with the central Asian republics and the republic of Turkey, we cannot continue to turn our back on this part of the world. That is why I rise and agree with my colleague from Texas.

Mr. GREEN. Mr. Chairman, will the gentleman yield?

Mr. GREEN

Mr. GREEN. Mr. Speaker, while we know there are lots of other issues swirling around the Capitol these days, I think it is important that we focus on other issues that really affect the American people. Last week, the Tuesday before we came back into session, four Members of Congress from the Houston area met with over 100 people to discuss an important issue that is facing the American public. That public meeting was about managed care reform and the Republican majority's misnamed bill that we passed earlier this year, the Patient Protection Act. This was the first public hearing held on the bill since our committee that I serve on did not have any hearings on the bill that passed this House. That hearing confirmed what we have been saying for months, that families in managed care want and need some reform this year. They do not want a sham bill like the Patient Protection Act that does more for insurance companies than patients and they do not want a bill that actually preempts Texas law that was passed by our legislature last year. They want a patients' bill of rights that is not right because it is a Democratic bill but because it contains meaningful reforms to complement the State laws that are passed. Eliminate the gag rules, provide choice and also allow people to go to adequate emergency rooms without having to call their insurance company first.

Mr. GREEN

Mr. GREEN. Mr. Speaker, I want to thank my colleagues from New Jersey for requesting this time tonight. I know it is 8:30 on the East Coast, but it is 7:30 in Texas and our folks are just getting up from the dinner table, so we can let them know what is happening in Congress. I heard some of my colleagues in earlier 5-minute special orders, and I agree that truth and righteousness should have the first place in our society and our halls of Congress and our government. But what I am concerned about is all the smoke and the fire on what is happening with the President's problems may be masking what may be happening over the next week or 2 here with this tax cut bill that comes up. I am glad the gentleman pointed out that there really is no budget surplus; that until we pass legislation to remove the receipts of Social Security from the unified Federal budget, that we will not have a surplus because Social Security receipts, those that are paid in by employees and employers, are part of the general revenue, supposedly, of the Federal Government, even though it cannot be used for our other programs. So it is masking the deficit. Sure, we have a balanced budget using funny numbers. Or we have a surplus this year, at the end of this month, using funny numbers, but the American people ought to deserve the truth. We talk about truth from the President, let us tell them the truth here. In fact, I remember when our Republican colleagues were not in the majority that there was a bill that they were talking about that would remove the Social Security Trust Fund from the budget. I agree with that. In fact, why do they not bring that bill up tomorrow? They could do it without committee meetings or committee hearings. They have done that so often this year with bills anyway. We can bring a bill up that removes the Social Security receipts from the Federal budget and we will have actual honest budgeting. That would be a great bill, and I would hope that we would have a majority on each side to pass it, and the Senate, and send it on to the President. Maybe that is the honesty we need to have on ourselves and to say let us be honest with the American people about the real Federal budget deficit, or the Federal debt. We talk about a surplus this year. The economy is good. More people are paying taxes, welfare rolls are down, and that is great, but it is masking the Federal deficit for this year because of Social Security receipts. It is not honest budgeting and we ought to fix it. I am saying that as a minority member because I cannot bring up a bill on the floor of the House, but my Republican colleagues can, and so they ought to do that. I have town hall meetings, like everybody else does, and I have heard even my Republican colleagues and leadership about how they want to safeguard Social Security first and to pay down the debt. I agree with that. Why do we not do that? Why do we not give a tax cut? They say, well, we are going to give two-thirds to Social Security. That is not the case. That is smoke and mirrors, because that money, until we actually have an honest Federal budget, that money is Social Security. That money is Social Security receipts that is being paid for by employees and employers so they will have a retirement income. Maybe not enough to buy them a Cadillac but maybe enough to buy them a used Chevy when they retire. Social Security was established 60 years ago after our Great Depression to combat poverty and, most importantly, to protect the elderly. Today, two-thirds of our elderly rely on Social Security to keep them out of poverty when they retire. It is estimated that 44 million workers and their families across the country receive Social Security benefits. Knowing the vital role it plays in our lives and many Americans, how can we even consider risking its future? We have this surplus, the first one on an annual basis since 1969, although, again, it is masked. In 1969, we did not include Social Security receipts into the Federal budget. Sometime in the seventies, Congress did that to mask the Federal deficit. And now, because we have that, that is the first step we ought to make instead of giving tax cuts, even with smoke and mirrors by saying two-thirds is going to the Social Security, because it is not. Every penny we take out is taking away from the Social Security Trust Fund. In 1993, we recognized that the financial solvency of Social Security would be a major challenge. And that is when we were in the majority, by the way. We also recognized that in order to protect its financial security we had to balance the budget. Fortunately, today, we are closer to that balanced budget and are, hopefully, heading in the right direction. But to say that we have a surplus and so let us go shopping is really outrageous. And that is, I think, the truth and honesty that we are worried about in our country. We need to have truth and honesty on the floor of this House and when we are talking to our constituents and the American people about what is being done with their tax dollars and these budget gimmicks that we are living with today. According to my Republican colleagues, we have a surplus. Does that mean we can then provide tax cuts while at the same time continuing to borrow from Social Security, which is what we are doing? I am not a mathematician, but I know that if we borrow money, it is because we do not have that money left over to pay our bills. So we are continuing to borrow from Social Security. In my district, the average income is a little over $20,000 a year. Few of them will benefit from the proposed tax cuts, but many of them would be devastated if they lost their retirement income in Social Security. Let us not kid these people. Let us not say that we are safeguarding Social Security with two-thirds of this imaginary surplus, because every penny of that is Social Security money masked and it is hidden. Again, I think we need to have some truth in taxation, truth in tax cutting, and we have a responsibility to save Social Security first. We have a responsibility to continue our efforts for a balanced budget. We have no right to risk the retirement future not only of my father, who is 83 years old, but also of the generation who are 50, and 40 today, or the generation of individuals who are 30 and 40 who are paying into Social Security not only for their parents and their grandparents but also for their income so they will not be destitute when they retire. This means putting 100 percent of this surplus into the Social Security Trust Fund. I remember my colleagues on the other side agreeing that their first priority, again, was to save Social Security. Well, now we hear, and we do not know what the bill may say until the bill comes out of the Committee on Ways and Means, but now they are saying, well, it is our first priority, that two-thirds of this will go to Social Security. It is not two-thirds of it. All of it should go to Social Security because it is Social Security receipts that they are giving back as tax cuts. Again, what worries me is that in the year 2020 or 2029, when we say we will run out of money, we may have to reduce Social Security payments in 2020. I wonder how many people will look back at 1998 and say if the Republican Members of Congress had made some financially correct decisions, then we would not be in the shape we are today. I do not want to wait until 2020, because I may not be here, and neither will the gentleman from New Jersey, and, frankly, most Members of Congress may not be. We need to make some reasonable decisions today and this week and before October. And again I call on my colleagues, instead of worrying about tax cuts, and I would like to have a tax cut, I would like to get my constituents a tax cut. That would be great. There are some things in that bill, I have heard, that actually is a bill that I introduced to give tax reductions for people who pay their insurance premiums when their employer may or may not provide insurance, may not provide their whole insurance premium. I would like to see that happen, but I would like to see it without jeopardizing Social Security, and that is what I worry that my colleagues on the Republican side are doing. They are willing to take the money and run and mask this deficit in smoke and mirrors, and that is what I worry about. If we see that they are committed to putting Social Security at risk, they are playing with the lives of those individuals who have already paid into the system. Americans pay into the program and they have the right to rely on that for their retirement. Our first priority should be to strengthen Social Security and protect its solvency. We cannot do this without a real balanced budget. And I say a real one, not one that is using Social Security receipts to mask the budget deficit. I am proud that this year, for the first time since the 1970s, we actually will have a balanced budget. But, again, it is not a balanced budget. There is no surplus until we not consider Social Security receipts. Again, I ask where that bill is. I saw a poll that was mentioned today in Congress Daily that said 41 percent of the people surveyed would prefer to put all surplus funds into the Social Security Trust Fund. Another 28 percent would pay off the Federal debt. So 41 and 28, and only 23 percent favored using the money for tax cuts. But, again, when we ask another question and say, okay, wait a minute, if we have a surplus and two-thirds of the surplus goes to Social Security do you support it then? That question was badly worded because they did not say it is not real surplus, it is Social Security receipts that is causing that surplus and it is not honest budgeting. So this poll our colleagues may be relying on may get a surprise when they see ``the rest of the story'', as Paul Harvey says; that over 70 percent of the American people want Social Security saved first and then pay down the deficit. We have a $5 trillion debt that has been built up over the last 50 years, and yet we are not going to pay any part of that on the deficit. Again, we can only provide our own experiences in the real world, whether it is the gentleman's own personal life or the business that I help run. If we had a good year, we tried to pay off some of our equipment that we had borrowed on. Same thing. If we have a real surplus, let us safeguard Social Security first and then let us start paying down that $5 trillion plus debt that exploded in the 1980s when Congress gave tax cuts and increased spending at the same time. Bad fiscal management. Let us do not make that same mistake in 1998 and try to have our cake and icing before we actually take care of the meat and potatoes of people's security in their retirement. With that, I thank my colleague. I see my colleague from the Midwest is here, and I know it is good tonight to be able to talk about this, but I will be glad to thank my colleague for yielding the time to me.

Mr. GREEN

Mr. GREEN. Mr. Speaker, because of the visit from Energy Secretary Bill Richardson in my district, I missed roll call votes 426 to 430. Had I been present, I would have voted yes on roll call 426; yes on roll call 427; yes on roll call 428; yes on roll call 429; and yes on roll call 430.

Mr. GREEN

Mr. GREEN. Mr. Chairman, I move to strike the requisite number of words. Mr. Chairman, I would like to join my colleague from Texas (Mr. Reyes) in supporting his amendment to the Traficant amendment. I know my colleague, my other colleague from Texas who is here, the gentleman from Texas (Mr. Ortiz), was a former sheriff like my colleague from Ohio is a former sheriff; but the background that I know of Congressman Reyes, and I knew of him long before he decided to run for Congress, he was an INS officer not only in the El Paso district, but also in south Texas a few years ago, and he showed us how we can handle the problem with illegal immigration. He created the hold-the-line program that now INS is doing in California, and they are doing in south Texas and the Rio Grande Valley without military presence. He showed us how to do it, and that is why it is so important that we listen to his expertise in law enforcement and not necessarily even my colleague from Texas or my colleague from Ohio, because as my colleague from Texas (Mr. Ortiz) mentioned, it is different to be a sheriff in middle America or even a sheriff in Texas than it is to be a law enforcement officer charged with the border protection that the INS does. The hold-the-line was successful without military personnel. We have military personnel now on the border, and we know the tragedy that happened. That was just one tragedy, and one tragedy is too many, particularly the incident. And I know I heard from my colleagues that that young man took a couple of shots at somebody that was following. Well, I also know, coming from Texas, the difference between a 22 rifle that a young man a 16-, 17-, 18-year-old may be using and someone carrying an M-16. So we know the difference between a 22 shell that does not have the velocity or the threat that maybe a bigger weapon does. The concern I have is that we already have them for detection. They need to have more oversight there, more civilian cooperation, but that is why I support the Reyes amendment. We have the way that can be done, the success that can be done, and this Congress has passed every session more INS agents to go to the border and to institute hold-the- line from the Rio Grande all the way out to the Pacific Ocean. We just have to put the resources there and not bring our military to have to guard our borders. The United States has a great tradition of military only being used in national emergencies. Now I know the gentleman from Ohio (Mr. Traficant) will make that case, and I have some constituents who are concerned about illegal immigration, but we have a way to solve it using civilian personnel without using the military. And one last thing before I yield to my colleague from Texas. We also have a concern that our military is being overutilized or used in functions that they should not be done, not only around the world, but I think this is another case that we may be over-extending the military commitment that our country needs in using it to be a border patrol, and we can do that with civilian authority and keep our military highly trained to protect our Nation from terrorists and from foreign enemies and not just do civilian police work. Mr. Chairman, I yield to my colleague, the gentleman from San Antonio, Texas (Mr. Rodriguez).

Mr. GREEN

Mr. GREEN. Mr. Speaker, I thank my colleague on the Committee on Rules for yielding time to me. Mr. Speaker, I rise not only in opposition to the bill, but also I am concerned a little bit about the rule, even though it is fairly flexible. I rise in opposition to the English Language Fluency Act because the bill makes bilingual education a political issue. It seems to me that my colleagues on the Republican side have forgotten children should not be a political issue. The English Language Fluency Act is not only an assault on bilingual education, but it is an attack on the very openness and broadness that we have come to value in our country. We have all come from somewhere. I am proud of my heritage, just like everyone is proud of theirs. We all come from somewhere. Bilingual education was designed on a national basis but enhanced by our local and State governments to provide for that diversity. It is our duty as Americans to make sure our children are educated, and our educational systems must be designed to provide for America's diverse population. This bill would make successful education impossible without destroying bilingual education. It is something our country simply cannot afford. Let me talk from a Texas perspective, because the State of Texas has provided, since 1973, more money for bilingual education on the State level. We would like to be able to set our own standards, not 2 years or maybe an extra third year. Why should Washington know what the State of Texas or the city of Houston is already doing in our school districts? That is what is wrong with this bill. The concern I have is that it is a political issue set up for this November 3 election. This bill will not see the light of day in the U.S. Senate after the vote of today. Let me give some background. I grew up in the city of Houston, went to a majority Hispanic high school in the sixties, before we had a Federal bilingual program or a State program. I watched when students would come in to my high school when I was 16 and 17 years old and try to immerse. Those students did not stay more than a day or two. They dropped out, and that is why bilingual education is needed. It is a transition program, and it is important. I strongly support bilingual education because it is an essential, transitional tool that allows students to become fluent in English while they progress in subjects like math and science. Eliminating bilingual education would create a society with no mechanism to integrate new citizens into reading and writing English. Mr. Speaker, I urge a no vote on the bill.

Mr. GREEN

Mr. GREEN. Mr. Speaker, I want to share with my colleagues a letter I recently received from two Republican State legislators from Texas. Representative John Smithee, Chairman of the House Committee on Insurance, and Senator David Sibley, Chairman of the Committee on Economic Development opened their letter with a plea to Congress not to disturb the substantial progress already achieved in Texas on managed care reform. Their letter is written because the two Republican leaders of the legislature in Texas read the Gingrich Insurance Protection Act that was passed by the House and they know what it would do to the protections already passed by the Texas legislature. It would render them useless. In place of the strong patient protections passed in Texas, which include HMO accountability, binding independent reviews, coverage for emergency care and the elimination of gag clauses, Texas would be left with a sham bill that for every patient protection, it gives the insurance companies a loophole they can drive a truck through because of the bill that passed on this floor. Like many States around the country, Texas has passed laws that meet the needs of its citizens to deal with insurance companies licensed by the State. We should not undermine their work, we should complement it on a national basis.

Mr. GREEN

Mr. GREEN. Mr. Chairman, I thank my colleague from West Virginia for yielding me this time. I rise in support of the Mollohan amendment to ensure an accurate count and the most cost-effective census in the year 2000. I am glad to follow my good friend from Ohio, because I pray that we will have an accurate count so we are on the right side of theology. That is why this amendment is so important. I am glad the chairman of the Committee on Appropriations agreed that in 1990 there was an undercount. There was, not only in my district in Houston but in the State of Texas and around the country. In its current form the Commerce, State, Justice appropriations act would hinder the 2000 census. It funds the census only for 6 months and it continues the funding only after Congress determines the counting method to be used. We are not going to be here from October, November or December, maybe half of January, so we are going to set back the census planning even in the year 1999. This action is shortsighted and will hinder the Bureau's attempt to plan and prepare for the census. The Mollohan amendment will strike that restriction. It has been estimated that the 1990 census undercounted my home town of Houston by 67,000 people. It is unfair that these people were not counted. The State of Texas lost a billion dollars in Federal funds because of the undercount. That is a billion dollars in title I funding, road construction, senior citizen services. The undercount was so severe that President Clinton actually came in June to the district that I am honored to represent to highlight the needs of an accurate census count. Dr. Mary Kendrick, Director of the City of Houston Health Department, said at that meeting that accurate census count data is critical to public health. She noted that the census data on child poverty helps determine nutrition and children's nutrition health programs. Many people are not easily counted, whether they are in an urban area like mine because sometimes they fear the government, or maybe in a rural area like Montana they may not want to send back that form that the government sent, they may not want to answer that door when that enumerator comes by and knocks on that door. But they still deserve to be counted, even if they do not want to be. That is why this amendment is so important. The Houston Chronicle, on two separate occasions, reported on the need for a fair and accurate census in their editorial. The June 23 editorial said, ``But Texas Republicans should know better than most the stakes riding on a fair and accurate count. Houston has a great deal at stake with the accuracy of the next census.'' Mr. Chairman, I include for the Record the following editorials: [From the Houston Chronicle, June 23, 1997] Accuracy a Must--Much Riding on Correct Census Count for Houston In Congress, even the method for counting the American people is regrettably politicized. With the 2000 Census approaching. Republicans and Democrats are at odds, imagine that, over what method the Census Bureau should use to count the nation's population. Republicans want to physically count each and every one, while the Democrats favor using statistical sampling a method never before used but one Census officials believe will yield a more accurate count. For years the Census Bureau has infamously undercounted the population, particularly in Texas. In the 1990 count, more than 4 million people in the country--an estimated 500,000 in Texas--were missed. Undercounting the population is not inconsequential. Texas and other states where undercounts were greatest lost out on additional House seats and, more important, billions of federal dollars ranging from Medicaid to highway construction funds. State officials believe missed heads in the 1980 Census cost Texas roughly $600 million in federal money. That is funding that, in fairness, the state of Texas cannot afford to concede again. The Census has been particularly inept at counting inner- city minorities and the poor. An estimated 5 percent of all Hispanics and blacks were not counted in 1990. In Houston, where Hispanics and blacks account for more than half of the population, that's a major problem. Republicans argue that the Constitution mandates that every American be physically counted. However, doing so is a practical impossibility. As well, maintaining the status quo with the traditional count contradicts the GOP's movement to make government more accountable. Understandably, House Republicans are being dutifully protectionist about their slight seat margin, one that they feel will be threatened by more minorities being counted. But Texas Republicans should know better than most the stakes riding on an accurate count. Houston has a great deal at stake with the accuracy of the next Census, and political party interest shouldn't take a front seat over the greater interests of the community as a whole.

Mr. GREEN

Mr. GREEN. Mr. Speaker, it is important for every American to be counted. How can Congress determine what a community needs if we really do not know how many people are in that community? It is estimated that the 1990 census undercounted the population in my hometown of Houston, Texas by 67,000 people. It is estimated the State of Texas lost $1 billion in title I school funding, road construction and senior citizen services because of the undercount in 1990. Statisticians and scientists have determined that using scientific statistical methods will produce a census that is more accurate and less costly to taxpayers. We should stop playing politics with the census issue and say let us count every American. Today the Mollohan amendment will ensure that the Census Bureau be able to conduct an accurate and cost effective census in the year 2000. We need to support the Mollohan amendment. Mr. Speaker, everyone deserves to be counted.

Mr. GREEN

Mr. GREEN. Again, I would like to thank the gentleman for this special order, and I do not think it is too strong a language to say that this bill that we passed, H.R. 4250, will not only not provide improvements, but it will set us back in patient responsibility, patient ability to be able to control their own destiny, physicians and providers being able to treat their patients, and that is what is so bad. I would hope that the American people will see what is happening, and I think they will after not only special orders like these, but also when we are back in our own districts. I have town meet hall meetings in August and I expect to explain to my constituents on how it works and what happened and how it is such a travesty that the State of Texas passed a law in 1997, it was actually passed in 1995, but it was vetoed by the governor then, and in 1997 it became law without his signature, and yet we are taking away that local legislature's ability to solve their problems locally. Again, 34 cents. Let me talk about the GAO report that talked about $2. I know that was an amount I used in the example for the price of a Big Mac, maybe a Supersized Big Mac now, that we could get these protections. Yet in Texas it is 34 cents. Thirty-four cents a month. So we are going to see cost estimates all over the board because it is hard to decide it. But, actually, in the State of Texas, the protections have been in effect and it costs 34 cents.

Mr. GREEN. I thank my colleague from New Jersey for allowing for this special order this evening and asking for the time, and I thank the gentleman for yielding to me. I want to make a few points, because I think the gentleman led into the concerns I had with the bill that we passed, literally, on the Friday of the tragedy that occurred here in the Capitol, make a few points about the Republican majority bill, a bill that we talked about, the Democratic plan actually had bipartisan support. The Republican bill would do to state passed, State protections like Texas has done, and share with you some of the concerns that have been raised by officials in my home State. Very simply, it would destroy some of the local initiatives that we have seen in the State of Texas. I do not know if that is true in New Jersey or other parts of the country, but the Republicans so-called Patient Protection Act would really be called the Patient Protection Elimination Act. First, let me refer to a letter from our State comptroller, John Sharp. He writes, literally on July 29, after the bill was passed, The following question should be asked of anyone considering supporting this bill, the HMO reform conference committee report. Will the Federal legislation preempt Texas's current managed care protection laws? Will Federal legislation preempt Texas' HMO Legal Accountability Act? Is there a Federal floor that States may improve upon, or will new Federal legislation create a ceiling and preempt Texas from enacting tougher patient protection laws? For example, would the Federal legislation erase the Texas gag clause legislation as well as the gag clause legislation in other States and provide a weaker substitute nationwide? Does the Federal legislation preempt Texas OB/GYN direct access bill and substitute weaker language that permits direct access for routine care? Will the Federal legislation be the final word on managed care accountability, or will Texas and other States experiment with different kinds of approaches such as their own external review process? Because, again, this is quoting from John Sharp, Comptroller of Public Accounts, I will put it into the Record. I am reading from the verbiage because the Gingrich supported HMO reform legislation is silent on many more kinds of patient protections enacted into Texas. Are those protections also preempted or nullified by this legislation? Will this proposed bill erase Texas laws protecting patients and doctors from retaliation by a plan or due process provisions for health care providers or continuity of care that guarantees after a provider has been deselected? These are just a few of the questions that Comptroller John Sharp raised. We just received this letter today. It was dated at the end of last week and, again, because of the tragedies that we saw here happen that Friday afternoon, I do not think a lot of Members have thought about what Congress did pass that day. Let me talk about a letter from a person who I served with when I was a State representative and a State Senator. John Smithee is a Republican State representative from North Texas, Armstrong, Deaf Smith, Oldham and Randall Counties which is very far north in Texas. He writes, again on the 22nd of July, We are writing to respectfully urge, and he is writing not only himself but also David Sibley, chairman of the Senate Committee on Economic Development for the State of Texas, and John Smithee is the chairman of the House Insurance Committee and, by the way, both these members in the legislature in Texas are Republican members. And they write, we are writing to respectfully urge that in the course of your deliberations on managed care and patients rights, you do not disturb the substantial progress already achieved in Texas. As chairman of the committees of jurisdiction over insurance and managed care in Texas, we have presided over hundreds of hours of public hearings on every conceivable aspect of managed care. I doubt there is an argument or threat that we have not heard in the course of the legislative lobbying, advertising or debate. The 75th legislature, the one this 1997, both Representative Smithee and Senator Sibley cosponsored the legislation and, along with many other colleagues in their House and Senate, some of the most comprehensive and sweeping managed care reforms in the country. They have not had the opportunity to review fully the Federal managed care legislation that was selected, scheduled for debate in the House, but judging from the news reports and their own preliminary analysis it appears that the deliberations are following an identical pattern as the debate in Texas, especially regarding medical liability. While we intend to provide a more detailed analysis of the impact as it proceeds to conference, we respectfully submit the following observations. HMO accountability. The Texas legislature, in 1997, in a strong bipartisan display established a legal duty on the part of managed care organizations to exercise ordinary care when determining medical necessity. Aetna Insurance filed suit against the State of Texas claiming that the Senate bill was preempted by Federal ERISA. Ideally, Federal legislation should clarify ERISA does not preempt a State's right to determine health plan accountability and quality. If such clarification is not achievable, we suggest that the Texas congressional delegation push for Texas as a designated national pilot project for 3 years so the experiences can be measured and evaluated by future Congresses. We know what happened on that Friday and we know that there are cases where the experiments and the innovative techniques that a lot of our States are using, particularly Texas, will not stand the muster of the bill that passed this House. Also they ask for an independent review in item 2. It is our understanding that H.R. 4250, the House GOP bill, would weaken Texas independent review provisions. Again, these are a Republican State Senator and a Republican member of the State legislature, State House. Apparently H.R. 4250's independent review is not binding compared to Texas law that requires managed care organizations to provide the care deemed appropriate by the independent review organization. Once again, the Texas legislature's preference in this regard was overwhelmingly stated in 1997. Number 3, this is the last one of Representative Smithee and Senator Sibley's letter. We are also concerned that H.R. 4250 weakens current Texas law regarding emergency care and gag clauses. As we understand it, the bill waters down Texas prudent layperson by allowing a health plan to override the treatment decision by the emergency department physician. The gag clause provision does not protect health care providers from retaliation when they act as advocates for their patients. They end it by saying, we know you are hearing from many points of view on managed care. Thank you for considering our comments on Texas law. And that copy was sent to Governor Bush and also to the whole Texas delegation. My concern and a lot of Members' concern is what the House passed as HMO is a sham. What it is actually doing is taking a step backwards from States who have made efforts to try and control it in their own States, like Texas has and I think New Jersey has and other States. So what we are doing is taking away States' rights. It is ironic that as a Democratic member that I am concerned about Congress taking away States' rights, but that is what happened, I think, in H.R. 4250. And I am really surprised that some of my Republican colleagues would allow that to happen here on the floor when so often we talk about the importance of states being the experimental, the embryo, the way to say, okay, we have a problem with HMOs, we have a problem with education. Let us see what the States are doing. We have 50 laboratories out there. Yet in Congress, in H.R. 4250, we are deciding what is best for the State of Texas and New Jersey, even though those legislators made some tough decisions, as Representative Smithee pointed out and Senator Sibley pointed out. They made some tough decisions and went forward with it. While many Republicans here in Washington keep saying real reform is too expensive and would be too great a burden on insurance companies, it is important to note that similar provisions in Texas raised premiums only 34 cents per month per member. I would not mind going to any constituent in my district and saying, for 34 cents, would you like to have your doctor have the ability to talk to you about your health care needs, even though your HMO may not cover it so we can eliminate the gag clause? Would you really like to have a swift and sure external and internal appeals process for 34 cents a month, 34 cents a month? Would you really rather not have the decision made by you if you go to an emergency room? If someone has chest pains and they go to that emergency room and the doctor says, well, I am sorry, those chest pains were really gas. And the doctor asks what they had for dinner, and they probably had some good Mexican food that we have in Texas, and that probably caused them to have gas. But that person could have been having a heart attack. But for 34 cents people would be willing to pay to make that determination themselves with that doctor in that emergency room. That is why I think we need to continue to call the American people's attention to what happened on that Friday here on the floor of this House. The tragedy that happened outside these doors we all pray about and we support those families, but I am concerned that what happened on the floor of this House that Friday, with the passage of that bill, will not only not help Americans but it will set back the States who have made progressive efforts to try and provide that ability to their patients and to their providers and their physicians: The right to sue an HMO if they are inappropriately denied care; to have access to a binding independent review; to communicate freely with the provider without fear of retaliation against the doctor; and utilize emergency room services if an individual experience symptoms that a prudent layperson would consider an emergency. And again, what does it cost? Thirty-four cents per patient per month. We hear all sorts of huge costs. In fact, I heard from this mike that day people saying how our bill does not cost anything. I heard it time and time again. It doesn't cost anything because it takes away rights. No wonder it does not cost anything. It takes away rights. We do not get something for nothing, but for 34 cents under Texas law they are providing those protections. And I would hope that we would see our way clear that when this bill goes to the Senate they would reform H.R. 4250, and maybe the conference could even make some changes with the encouragement and working with the administration. But I would hope when we get another vote on that bill in a conference committee report that it will be a much better product for our constituents than what we sent out here that Friday that all of us regret the tragedy that happened that day. And, again, I want to thank my colleague from New Jersey. I cannot say it enough; that for the small cost that we are seeing in Texas for these rights, why we cannot on this floor of the House do as well as the State legislature in the State of Texas, why we cannot do as well as the legislature in New Jersey and as well as many of the State legislatures all over this country, because, as my colleague pointed out, they only affect insurance companies that are licensed by the State of Texas. They do not affect employers in my district who are multi-State employers who have to come under Federal law because there is a plan in Houston and a plan in New Jersey. They do not want to have to comply with two laws. So we need to provide those protections, and I again thank the gentleman for allowing me to be here tonight and to speak. Mr. Speaker, I provide for the Record the letters from both John Sharp and John Smithee and David Sibley. I read most of them into the Record, anyway. The State of Texas, House of Representatives, Austin, TX, July 22, 1998. Hon. Gene Green, House of Representatives, Washington, DC. Dear Representative Green: We are writing to respectfully urge that, in the course of your deliberations on managed care and patients' rights, you not disturb the substantial progress already achieved in Texas. As chairmen of the committees that have jurisdiction over insurance and managed care in Texas, we have presided over hundreds of hours of public hearings on every conceivable aspect of managed care. I doubt there is an argument or threat we haven't heard in the course of legislative lobbying, advertising, or debate. In the 75th Legislature, we authored, along with many of our colleagues, some of the most comprehensive and sweeping managed care reforms in the country. We have not had an opportunity to fully review the federal managed care legislation that is scheduled for debate in both chambers of Congress this week. But judging from news accounts and our own preliminary analysis, it appears that the deliberations are following an identical pattern as the debate in Texas, especially regarding managed care liability. While we intend to provide a more detailed analysis of the impact of the congressional legislation as the bills proceed to a conference committee, we respectfully submit the following observations at this time. 1. HMO Accountability As you know, the 1997 Texas Legislature, in a strong bipartisan display, enacted S.B. 386, which establishes a legal duty on the part of a managed care organization to exercise ordinary care when determining medical necessity. Aetna has filed suit against the State of Texas claiming that S.B. 386 is preempted by federal ERISA. Ideally, federal legislation should clarify that ERISA does not preempt a states right to determine health plan accountability and quality. If such clarification is not achievable, we suggest that the Texas Congressional Delegation push for Texas to be designated as a national ``pilot project'' for three years so that the experience can be measured and evaluated by a future Congress. We would respectfully urge you to oppose any language that would jeopardize, weaken, or preempt Texas'

Mr. GREEN

Mr. GREEN. Mr. Speaker, I rise today to honor Airline United Methodist Church in Houston, Texas, on its 50th Anniversary. On August 30th, Airline Church will celebrate fifty years of faith, love, and friendship. My family has attended Airline Church for many years now, and I want to personally thank the entire congregation for their fellowship and their contributions to our community. In 1948, forty-four Houstonians gathered under the leadership and vision of Reverend C.E. Clark to form Airline United Methodist Church. Airline today has expanded from its humble beginnings in surplus Army barracks to become a multi-structure facility with a membership of 700 individuals. While Houston and the United States have changed dramatically in the past 50 years, Airline has remained true to its original mission: to be faithful to God and to provide for the spiritual, emotional, and physical needs of the community. The strength and longevity of Airline United Methodist comes from its people, their faith, and the relationships they build within our church family. The United Methodist Women encourages its members to study how the Methodist Church is at work in the world and the United Methodist Men participate in several service projects. Planning for the future, Airline youth fellowship seeks to instill Christian values in our younger members in order to prepare them for the challenges that today's youth face. Airline United Methodist Church believes that its mission extends beyond the membership to the entire community. In collaboration with other Houston food programs, the Society of St. Stephen's operates a food pantry and serves as a food distribution point. At Thanksgiving, Church members furnish meals to local families, and at Christmas, both children and adults provide presents and meals for families identified by the local school district and for children whose parents are incarcerated. Today, church members have established a multicultural program designed to reach out to a rapidly changing community and our church services are translated into Spanish. In recognition of its evangelism efforts, Airline United Methodist Church has twice been presented with the Copeland Evangelism Award by the Texas Annual Conference. Airline United Methodist's 50th Anniversary is both a milestone and a beginning. This celebration provides us the opportunity to review what has been accomplished through faith in God and to look forward to all that lies ahead.

Mr. GREEN

Mr. GREEN. Mr. Speaker, I rise today to reflect on the passing of an outstanding man, a legendary Houstonian, and a great Texan, Carl S. Smith, who died this week at the age of 89. Carl served 51 years as Harris County's Tax Assessor and Collector. Mr. Smith served the citizens of Harris County with distinction and honor. Carl was a legend in Harris County politics. He was first appointed to the office by the Harris County Commissioners Court in 1947. The next year, he won election to the office and was re-elected 12 times. Well liked and respected, Mr. Smith was revered by many of his employees. He was always known for insisting, from his staff, on unwavering courtesy to the public. He expected much of this staff, but he treated them kindly and with respect. Carl had a real interest in helping all people. In 1952, he was the first Harris County official to promote an African-American employee to an important government position, a deputy clerkship. In addition, he wrote the statewide property tax exemption for citizens over 65 that was later adopted as a constitutional amendment. Carl's wife of 59 years, Dorothy DeArman Smith, died in 1991. They were parents of two daughters, Nancy Stewart and Pam Robinson, both of Houston. Mr. Speaker, I ask all the Members of the House to join me in offering their gratitude for the hard work and dedication of Carl S. Smith.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Chairman, for the past five years I have struggled with the Department of Housing and Urban Development to help the citizens of Houston. Houston is the fourth largest city--yet for a long time, they have lacked a full service HUD office. Out of the ten largest metropolitan areas, Houston was the only one without a fully serviceable HUD office. Over the past five years I have worked with HUD and have received various verbal commitments and assurances that Houston would receive the necessary HUD staff and programs to be an effective agency to help the citizens of Houston. We've made some progress, but we still have a ways to go. In past years, I have considered offering an amendment to this bill to require better HUD service for Houston residents. This year I will again try to work with the agency to ensure proper services for the city. This would include establishing an Office of Community Planning and Development, which would provide technical assistance and monitoring of state and local entities receiving federal funding to assist with elderly and disabled housing loans, CDBG, and funds for Houston's Enhanced Enterprise Community. This service is particularly important because of the city's growing population. Unfortunately, because there is no full service HUD office in the city, quality housing opportunities have not keep pace with the growth. When I go back to my district and I talk with seniors, families and local officials, one of their greatest concerns is housing for the elderly. No one wants to see our elderly without shelter. An Office of Community Planning and Development would aid the citizens of Houston to gain access and administer funds to renovate, locate, and build elderly housing. This office also oversees funding and provides technical assistance to our Enhanced Enterprise Community. HUD came up with a good idea to provide funds to local governments to help their economically disadvantaged areas through Empowerment Zones and Enterprise Communities. Through tax breaks to businesses and access to federal funds and a plan drawn up by local communities, HUD hoped to revitalize disadvantaged areas. Houston has an Enhanced Enterprise Community, and we have access to two hundred million dollars to help revitalize parts of Houston. It would be a shame to see that money go to waste without proper support and assistance by HUD. The nearest HUD office that offers this service is in Ft. Worth Texas, which is over two hundred miles away. My constituents have had to call to Ft. Worth to get someone from CPD to come down to Houston to check out a faulty foundation. Most of the time the response from Ft. Worth is that they don't have the money in their budget for travel or they have to wait for years for a response. The citizens of Houston deserve better than having to call HUD in Ft. Worth, which is over 200 miles away, to get an inspector who can not travel because of budgetary constraints. I still do not understand why the fourth largest city in the nation does not have all the HUD programs to serve its citizens. When we first started looking into upgrading the Houston HUD field office, we received assurances from former Secretary Cisneros and now Secretary Cuomo that the Houston office would receive all available programs. Without these offices who is going to monitor these programs, who is going to check for fraud, waste, and abuse. Who is going to help the citizens of Houston provide for their housing needs. If this critical change isn't made soon, I am concerned that more residents will be denied services they are entitled to. While I am not offering an amendment this year, I am looking forward to working with the committee and administration to see that this issue can finally be resolved.

Mr. GREEN

Mr. GREEN. Mr. Speaker, I rise in support of the conference committee regard. Mr. Speaker, I have a prepared statement, and talking about the history of it, we have heard that already. Again, if we do not have a compact, then a State site in Texas will be subject to waste from all over the country. The policy was developed in the State of Texas. I would not have picked Sierra Blanca if I had a vote, but I did not have a vote when I was in the legislature or a vote now as a Member of the House. That is going to be decided by the people in the legislature who confirm the people who make that decision and the governor appoints them. Let me talk about some of the debate that we have had. One, the interstate commerce clause requires that Texas would take low-level waste from everyone if we do not have a compact. My colleague from California is opposed to it because of the Sierra Blanca location and the poor community. I represent a very poor community in Houston, Texas, and we have some of the same problems. A statement, the letter from LULAC opposing the site, I am a member of LULAC and work with my local councils in Houston on a lot of issues and I share their concern. But, this is not the venue for their opposition. Granted, if they defeat it here, they could still create a compact and we could have it for Texas, but it would be for all the country. Mr. Speaker, I notice that the State of California does have a compact and I do not know where their site is. But I was wondering if it was in a site that was also a rural area that was sparsely populated, compared to an urban area. That is why this is something that has been done by this Congress many times before, allowing States to join together to dispose of these low-level nuclear wastes. I have a district in an urban area and we have this material all over our district right now and we would like to have a permanent place for it. Mr. Speaker, I rise in support of the Conference Report on H.R. 629, the Texas Compact Consent Act. This bill grants Congressional approval to the proposed Texas, Maine, and Vermont compact for low-level radioactive waste disposal and deserves the quick support of the House. As my colleagues know, the national policy for managing low-level radioactive waste is spelled out in the Low-Level Radioactive Waste Policy Amendments Act of 1985. This policy was developed by the states and passed by Congress, with overwhelming bipartisan support. The objective of the policy is to provide for the safe, permanent disposal of the nation's low-level waste. Under the terms of the Texas-Maine-Vermont compact, low-level radioactive waste produced in each state will be carefully disposed at a single facility in the State of Texas. The waste will be transported from the hospitals, university research centers, utilities or other waste producers in each state to a safe, permanent disposal and storage facility which will be built in Texas. It is very important to understand that H.R. 629 does not designate a site for the Texas disposal facility. In the Low-Level Radioactive Waste Policy Amendments Act of 1985, Congress clearly reserved for the states the authority to decide where low-level radioactive waste facilities would be built within their borders. Even though H.R. 629 does not designate a specific site for the Texas facility, federal and state law requires that any low-level radioactive waste facility built by a state must be engineered to withstand any potential natural disasters that might occur at the chosen site. Much has been said about the proposed site for the waste disposal facility. In fact, a permit to build a waste disposal facility in West Texas has been requested from the Texas Natural Resources Conservation Commission. If the Commission finds that the permit meets all the necessary requirements, it will grant the permit. If the Congress does not approve this bill, under the Interstate Commerce Clause, Texas must accept low-level radioactive waste from other states. H.R. 629 will allow Texas to limit who sends waste to the facility and be in compliance with the Low-Level Radioactive Waste Policy Act. With this compact in place, Texas will be able to limit access to its facility to only those states that are signatories to the compact-- Maine and Vermont. The compact makes it possible to manage Texas' facility in an orderly, effective manner. Without the compact, the State of Texas would have no effective control over access. The Texas, Maine, and Vermont compact is an excellent arrangement for the three states. It received overwhelming bipartisan support in the state legislatures of the three states. At a time when state budgets are constrained, the ratification of this compact will result in shared cost for the construction and subsequent operation of the low-level waste disposal facility. Since 1985, the Congress has approved nine compacts which now include 41 states. It is vitally important that we move forward with the approval of the Texas-Vermont-Maine compact. I urge my colleagues to support this very important bill.

Mr. GREEN. Mr. Speaker, the gentleman may come as our guest.

Mr. GREEN. Mr. Speaker, I thank the gentleman from Texas (Mr. Hall) for yielding me this time, and I will be glad to take my three colleagues to lunch today for our weekly luncheon.

Mr. GREEN. Mr. Speaker, I thank my colleague on the Committee on Rules for allowing me to speak today. As she mentioned, now we can hear the rest of the story. I rise in support of the rule and support of the conference committee report. Let me give the Members who are here on the floor and also in their offices and who are watching a little history about this compact. I think they have heard it over the last few years because I was in the State Senate in 1991, when we actually passed an interstate compact with Texas and Vermont and Maine, because under the interstate commerce clause, without a compact, if this site is built, whether it is in Sierra Blanca or anywhere else, it will be required to take waste from every State in the Union. I think my colleague, the gentleman from Texas (Mr. Hall) pointed that out. All 44 other States would like to send it here or 46, after we get other than what is in the compact. So if this site is going to be built without a compact, it would have to accept it from everywhere. Again, we did not pick the site, either in the legislature or here on the floor of this Congress. The site was selected by the folks in Texas which is what the intent was. It was not supposed to be by those of us who serve in Congress or in the legislature, because in Texas the legislature meets every 2 years whether they have to or not. It was selected by people who have the expertise to select sites, and they looked at sites in south Texas and west Texas, and they picked Sierra Blanca. If it was my choice, I would not pick Sierra Blanca, because we have another site in Texas who may not be at the same level now in the application process who actually wants it. But that is not our decision on this floor and that is not the decision on the floor of the State legislature. It is a decision by the experts and the people that the State hires in their regulatory agencies to make that decision. So that is why this bill is so important. If we are going to have that site, then the compact, just like the other compacts, is important that we ratify it here. The Low-Level Radioactive Waste Policy Amendments of 1985 established where States could develop compacts. Texas, under a former governor, not Governor Bush but Governor Ann Richards, worked out an agreement with Maine and Vermont to have this so Texas could limit our exposure. Again, we do not want to be the waste site for the Nation or the world, but we recognize the responsibility we have in our own State for our low-level waste that we generate. Some of it is from hospitals, some of it is from nuclear power plants, it is from all sources. But that product, that waste is now being stored on sites all over the State of Texas. That is why we need to put it in a secure location, a permanent location. My colleague from Austin mentioned that we are passing a bill for the ages. Granted, this low-level waste has a life much longer than any of us ever expect to be here in Congress or even our own lives, but we also know that Congress is in session all the time, the legislature is in session on a regular basis. They can change this, and they can deal with it. That is why it is so important today we pass this rule and adopt the conference committee report.

Mr. GREEN

Mr. GREEN. Mr. Speaker, I rise today to join my colleagues in honoring Special Agent John Gibson and Officer Jacob Chestnut. These two brave men gave their lives to save other Members, staff and tourists from the most vicious attack in recent memory. Special Agent Gibson and Officer Chestnut are truly American heroes and it is fitting that we honor their memory today. As the country unites to offer the families of these fallen heroes our condolences and prayers, I cannot begin to express my sorrow. The United States Capitol is a great example of freedom our country enjoys. No other country allows its citizens as much access to its government as the United States of America. I know everyone in this body appreciates and understands the importance of this freedom, and we thank Special Agent Gibson and Officer Chestnut for protecting us, our families, our friends, and our freedom from the evil and hatred the attacker carried within himself. The Book of John, Chapter 15, verse 13 states: Greater love has no man than this, that a man lay down his life for his friends. I believe this message has special meaning today and forever. As a father of two children, I cannot begin to understand the pain and heartache being felt by the Gibson and Chestnut families. I hope and pray that these deaths were not in vain, and we all join together to pray for them and their families. Mr. Speaker, I join my colleagues in honoring the memories of these two brave men. Our nation owes them a debt of gratitude that can never be repaid. July 24, 1998 will be remembered as a day of heroes at the United States Capitol and we must never forget the ultimate sacrifice Jacob Chestnut and John Gibson made for their country.

Mr. GREEN

Mr. GREEN. Mr. Speaker, for many months, a lot of Members have been working for this debate today. What is frustrating is the debate we have now. I rise in support of the Dingell-Ganske amendment. But instead of a real debate and a committee process we have, the Republican leadership is forcing this weak fig leaf bill through which will do little to give the American people what they really need for their health insurance. In fact, it will hurt State laws now in effect. In my home State of Texas, this Republican bill would override State law on mammogram screening, Alzheimer's treatment, and prostate cancer screening, and many more. On page 187 of their bill, because some of us had a chance to skim their bill that was released last night, line 19 exempts these State protections. So maybe they ought to read their bill before they defend it. I think it is ironic they talk about this being a trial lawyer bill, Mr. Speaker, and I ask unanimous consent to place in the Record a letter from the American Medical Association, who typically does not support the trial lawyers. It was sent to me yesterday, talking about the reasons that the Republican bill is so bad and the Dingell-Ganske amendment is so good. The letter referred to is as follows: American Medical Association, Chicago, IL, July 23, 1998. Hon. Gene Green, House of Representatives, Rayburn House Office Building, Washington, DC. Dear Congressman Green: The American Medical Association (AMA) recognizes that changes may be offered to H.R. 4250, the House Republican ``Patient Protection Act of 1998,'' when it is brought to the House floor, to begin to address some of the serious concerns with the legislation as introduced. We urge Members of Congress to take the time to fully explore whether any such amendments correct the problems outlined below. As you may know the AMA has carefully reviewed and lent its full support to H.R. 3605, the ``Patients' Bill of Rights Act of 1998.'' We believe that H.R. 3605 provides comprehensive and meaningful patient protections that should be enacted before Congress adjourns this fall. On behalf of the 300,000 physician members of the AMA and the millions of patients we serve, we strongly urge you to oppose H.R. 4250, as introduced, and to vote in favor of the Ganske-Dingell substitute (text of H.R. 3605). In our view, only H.R. 3605 would provide meaningful patient protections to address existing abuses in managed health care. There are ten reasons to vote against H.R. 4250 and to vote for H.R. 3605. Reason #10: ``The Devil is in the Details''--Here are the facts. H.R. 4250 claims to offer ``similar'' protections to those extended in H.R. 3605, but the legislative language of H.R. 4250, at nearly every turn, clearly favors health plans and insurance companies at the expense of patients. These problems are much more than just ``technical drafting matters.'' In fact, Members of Congress have not had time to fully understand critical differences in the two bills since last Friday's introduction of the House Republican bill. By contrast, H.R. 3605 was drafted and introduced earlier this year, with ample time for public examination; its provisions ensure that patients would receive medically necessary covered services. H.R. 4250 would continue to allow insurance companies and health plans to put their financial bottom-line ahead of patient care. Reason #9: H.R. 4250 would allow health insurance companies to decide what is medically necessary; H.R. 3605 would restore physician medical decision-making. By retaining the power to define what is and what is not medically necessary, under H.R. 4250, health plans--not physicians--would continue to decide all patient health care decisions, Linda Peeno, MD, a former HMO medical director, described this retained control ``as a health plan's smart bomb capability'' in testimony before the House Commerce Committee. Consequently, the external appeals process proposed by H.R. 4250 would be of little or no value if the health plan were always allowed to define what is medically necessary or appropriate. By contrast, H.R. 3605, promotes good medical practice by specifically prohibiting health plans from practicing medicine by substituting their decisions for the patient-specific medical judgments of the treating physician. Reason #8: The internal and external review process in H.R. 4250 does not require health plans to use physicians with the appropriate medical specialty training to review treatment denials. H.R. 3605 is clear that only ``clinical peers''-- physicians with similar specialty training will review other physicians' medical decisions. As an example, only cancer specialists should review cancer treatment. Reviewers must have the right specialty training to decide life and death issues. Only H.R. 3605 would provide this critical patient protection. Reason #7: H.R. 4250 would require patients to pay for the privilege of an external review of treatment denial; H.R. 3605 imposes no such fees on patients seeking to exercise their rights. Patients should not have to pay to have a treatment denial reviewed. Reason #6: H.R. 4250 does not contain several key physician choice provisions that are included in H.R. 3605. H.R. 4250 does not include a provision found in H.R. 3605 that would allow a patient in the midst of serious illness or pregnancy to continue a relationship with a physician who leaves or is forced to leave a health plan network. The House Republican bill also does not provide patients with critical ongoing access to specialists for chronic conditions (such as asthma, diabetes, etc). H.R. 4250 also does not require plans to disclose to prospective enrollees the adequacy of the physician network to serve a given patient population. H.R. 2605 provides both access to necessary specialty care and disclosure of the plan's physician mix to patients. Reason #5: H. R. 4250 would provide a huge loophole for plans to circumvent the point of service provisions. Under the terms of H.R. 4250, employers would not have to offer employees point of service coverage if they could prove that the plan's premiums would increase by 1%. The AMA has always said that patients may choose to bear reasonable additional costs to obtain a point of service option that would ensure greater choice of physicians. This opt-out provision of H.R. 4250 could effectively ``gut'' the concept of a point of service option for many plan participants. Reason #4: H.R. 4250 would delay the effective date of patient protections for up to two years after the date of enactment. H.R. 3605 would provide for nearly immediate implementation of most patient protections. The evidence is overwhelming that patients need and are demanding protections now. The delayed effective date in H.R. 4250 is an opportunity for more legislative mischief by health plans seeking passage of ``gutting'' amendments before patient protections are actually offered to patients. H.R. 3605 would generally extend all patient protections soon after enactment. Reason #3: H.R. 4250 does not adequately protect the broadest possible range of ``medical communications,'' nor would it ensure all necessary emergency care. It even cuts back on the Balanced Budget Act's antigag clause/practices and prudent layperson provisions that cover Medicare patients. On anti-gag practices, H.R. 4250 does not include the words ``otherwise restrict'' medical communications. The omission of these key words would allow health plans to continue to gag physicians. The ``prudent layperson'' provision for emergency services in H.R. 4250 does not include ``severe pain'' in the definition of what a reasonable person would think requires immediate treatment. Reason #2: H.R. 4250 creates a new federal preemption of state patient protections laws for association health plans and would override many of the patient protections laws already enacted by some 43 states. Association health plans would be exempt from state patient protection requirements. H.R. 4250 also lacks express language recognizing the authority of state legislators to regulate the health care delivery practices of such entities for state residents. Reason #1: H.R. 4250 does not hold health plans properly accountable for making medical treatment decisions that result in patient injury or death. The managed care liability issue is about basic fairness and holding health plans accountable for their conduct. No other industry in America enjoys the special legal protections currently extended to health plans. Members of Congress have spoken out against special legal protections for tobacco companies. Why should health plans continue to be given special liability protections? The AMA continues to lobby for tort reforms, but we have never advocated that patients should be denied adequate compensation for true medical negligence. The damages and penalties in H.R. 4250 fall far short of providing patients with proper compensation for preventable injuries and death. Again, we urge you to vote for a House floor procedure rule that will allow a vote on H.R. 3605, and to vote for passage of H.R. 3605. Respectfully, E. Ratcliffe Anderson, Jr., MD. Parliamentary Inquiry

Mr. GREEN

Mr. GREEN. Mr. Speaker, I thank my colleague and friend, the gentleman from Texas, and a Member of the Committee on Rules for allowing me to speak this morning. I rise, not in opposition to the rule, but in opposition to the process where we have gotten to today, Mr. Speaker. Managed care reform is not about politics; it is about people. We have a responsibility to guarantee the American people top quality health care. We have a responsibility to protect our children from negligent medical decisions made by insurance companies. The Republican proposal that we will be debating today is simply profit over people. The only people in our country who are guaranteed immunity from their decisions are foreign diplomats and HMO officials. We cannot really have a Patients' Bill of Rights without access to specialists, a timely internal and external appeals process, point of service options, choice for our patients, accountability of that decision matter, and open communication between the patient and a provider; in other words, no gag rule. Can we honestly say that the system will protect patients without an enforcement mechanism, without an accountability? There is no responsibility. The Republican bill that will be voted on today never enjoyed a public hearing. It was drafted behind closed doors. In fact, I serve on the committee that would have been helping draft this bill, and we did have hearings over the last few months, but this bill never had a public hearing. We did not see it until late last night. Do my colleagues know why? Because, one, it does not end gag rules. It does not define severe pain as a reason a constituent of mine can go to the emergency room. It also does not actually provide for the point of service option that we want, the choice for that patient. That is easily bypassed by the HMO decision makers. The Republican bill also will decide what medically necessary is. My concern is we are not giving the patient and that physician or that provider the decision making that the Democratic bill provides; and that is why, later on today, we hopefully will pass the Dingell-Ganske bill. Mr. Speaker, I include the following for the Record: Issues of Concern in the Hastert Task Force Bill Does not end gag rules While the bill claims to end gag rules, the statutory language creates a loophole that guts the protection. Under the Balanced Budget Act, Medicare and Medicaid plans cannot ``prohibit or otherwise restrict'' medical communications. The GOP bill only refers to prohibitions. So a plan could ``allow'' medical communications, but only after the doctor first complies with certain restrictions (such as calling the plan first and delivering the advice in pig latin). The deletion of the words ``or restrict'' render this protection hollow. This also creates the possibility for lawsuits over whether something is a restriction or a prohibition. Does not define/include ``severe pain'' as a reason to get ``emergency medical care The access to emergency care language in Medicare and Medicaid contains a specific definition of what a prudent layperson would think required immediate treatment: ``a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in--(1) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, (2) serious impairment to bodily functions, or (3) serious dysfunction of any bodily organ or part.'' By contrast, the GOP bill does not include ``severe pain'' as a condition that health plans must cover in the emergency room. The deletion is significant. For example, the American Heart Association advises that anyone experiencing crushing chest pain should go to the ER immediately, as that is a warning sign of a possible heart attack. Under H.R. 4250, a health plan can refuse to pay the ER bills of a man who went to the emergency room with crushing chest pain but whose EKG came out negative. That might be only a temporary result; he might have a heart attack when the plan gives him a bill for the ER services! Allows the plan to decide what is ``medically necessary'' At its heart, the debate over HMO reform is really about ensuring that health care decisions are made by doctors and patients, not by HMO business executives. H.R. 4250, however, does not fulfill that promise. Under the disclosure section, plans must inform participants of whether care may be excluded because ``of a failure to meet the plan's requirements for medical appropriateness. . . .'' In other words, it is not the doctor and patient who decide what is medically necessary; it is the plan which retains that capability. During Commerce Committee testimony two years ago, Dr. Linda Penno, a former HMO medical reviewer, described this as a plan's `smart-bomb' capability. By retaining the power to define what is and what is not medically necessary, the plan is able to take control of health care decisionmaking. This is also relevant to the external appeals provisions of the Hastert Task Force Bill. The review is limited to whether the plan followed its own definition of medical necessity or whether or not a treatment is experimental. Point of service provision is easily by-passed The most powerful argument in the health care debate is the right to choose your own doctor. The GOP bill attempts to respond to this by including a point of service provision for closed panel HMOs (allowing patients to see providers outside the network). H.R. 4250, however, contains loopholes that effectively gut the provision. Employers would not have to offer employees point of service coverage if they could prove that this will cause premiums to rise just 1%--even if all of the added costs would be borne by employees who chose this option! And this ``proof'' could be prospective--meaning a company would not have to offer a single employee a POS option to determine its actual effect on premiums. I am concerned that it will be easy for employers to ``prove'' that premiums will increase 1%. For example, one study by opponents of this legislation suggested that managed care reform legislation would increase premiums between 3 and 90%. While CBO's very low estimate of 4% should put those wild allegations to bed, they show how easy it is to prospectively make a doom and gloom forecast with a straight face. Combine that with the fact that insurance premiums are expected to take a big jump this year, and it is not hard to see how health plans will be able to use the 1% threshold to avoid offering their employees a choice of health care providers.

Mr. GREEN

Mr. GREEN. Mr. Speaker, during rollcall votes 319 through 322, last night and today, I was in my district on official business. Had I been present, I would have voted ``no'' on rollcall 319; ``yes'' on rollcall 320; ``no" on rollcall 321; and ``yes'' on rollcall 322.

Mr. GREEN

Mr. GREEN. Mr. Chairman, I move to strike the requisite number of words. Mr. Chairman, I will not take my whole 5 minutes, but I want to thank my colleague from Ohio and all the speakers this evening, because I think what they are talking about is what really America is about. And I want to thank my colleague from Wisconsin, who is here and said if he had part of this in his district, that he would be for it. Well, I do represent the Houston area, but I do not represent part of the NASA area. In fact, my joke is when somebody in my district gets a job at the Space Station, or NASA, in Clear Lake, they actually move to the district of the gentleman from Texas (Mr. Lampson) or the district of the gentleman from Texas (Mr. DeLay). They are not in my district, because they move closer to their jobs. I rise in opposition to the Roemer amendment because it strikes the funding for the International Space Station. The International Space Station represents the future of space exploration for our country. It represents a high-tech lab whose innovations will have countless applications in the daily lives of Americans. Whether we live in one of those districts that have the module being built or not, it represents an era of international cooperation that everyone will benefit from. We heard tonight the talk about how the Russians may not be able to do their part. It is not just the Russians, it is lots of other countries, our neighbors in Canada and Japan and in Europe. To date, the International Space Station has been a model of international cooperation and responsible management. If Congress does undermine the funding for the Space Station with an unexpected reduction, it will represent a major reversal in the commitment made to the program's stability over the past few years and it will be a betrayal of our entire international partners. The International Space Station is well on its way to assembly, with the first of the hardware elements already in the final stages of preparation for launch in November of this year, just 5 months away. Critics have said the cost for the life cycle of the space station has dramatically risen, when in fact the cost for the life cycle of the space station has actually gone up only by 2 percent in the past 3 years. Mr. Chairman, this debate is more about not necessarily the space station. I watched one of our astronauts, Dr. Ellen Ochoa, visit middle schools in my district. It is an inner-city district in Houston, predominantly minority children in those districts. I watched Dr. Ochoa captivate those students with her talk of being in space and what she is planning to do. That is what we are talking about, the future of our country, the future of those middle school children. Whether they are white, black, Hispanic, or whatever their nationality, space is their goal, and that is why I think it is so important and that is why I think tomorrow hopefully, when the House votes, we will vote again resoundingly to defeat the Roemer amendment.