Nancy Johnson

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself such time as I may consume. It is too bad that in these debates we stray so far from the facts of the matter. The 1997 bill was passed unanimously by the Subcommittee on Health of the Committee on Ways and Means, almost unanimously by the full committee. I am proud to say that under Republican leadership we added coverage for the first preventive benefits under Medicare, mammograms and, since then, pap smears and also prostate cancer testing and a variety of other preventive benefits for diabetics and for other critical tests. As Republicans led the effort to add preventive benefits to Medicare and President Clinton supported them, those bills had a lot of bipartisan support; and to say now that this bill privatizes Medicare when all it does is to strengthen both fee-for-service Medicare and the choice plans that can offer seniors some things that Medicare cannot offer them is simply a disservice to the seniors of America. Just like Republicans led the effort to modernize Medicare by covering prescription drugs which had never been done before, so in this bill we are leading the effort to provide disease management and other tools to help seniors with chronic illnesses, never proposed by my Democrat colleagues. It pains me to have my Democrat colleagues just focus on the word ``privatization,'' which actually ignores the modernization of this plan and has no place in this debate because in every year from now to 2010, 2020, all seniors will have the choice of fee-for-service Medicare or these plans, and the government will pay for coverage under both of those options and will control both of those options. So they are government-controlled, government paid-for options, all part of Medicare, with a voluntary choice by seniors, an entitlement under the law. Mr. Speaker, I yield such time as he may consume to the gentleman from Pennsylvania (Mr. Greenwood).

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield such time as he may consume to the gentleman from Georgia (Mr. Norwood).

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2 minutes to the gentleman from California (Mr. Cunningham).

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield the balance of my time to the gentleman from California (Mr. Thomas), the chairman of the Committee on Ways and Means.

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield back the balance of my time.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, I rise in support of this bill that names the Post Office in Signal Hill, California, after one of the most distinguished individuals to have served in this House, Congressman Steve Horn. Congressman Horn retired this past January after a lifetime of public service. He was known as an independent, intellectually honest individual who brought to his work a sharp mind, remarkably broad experience, and an outstanding understanding and respect for the needs and abilities of every person. Congressman Horn has worked in the public policy arena throughout his life. He began his professional career as an aide for President Eisenhower's secretary of labor, James P. Mitchell. He then worked as a legislative assistant to former California Senator Tom Kuchel and served as a senior fellow at the Brookings Institute, Dean of American University and President of California State University at Long Beach from 1970 to 1988. After leading the University for eleven years, he was elected to Congress where his depth of knowledge of government, public administration, education, the arts, and community needs enabled him to provide valuable leadership to his colleagues and this body. Steve served his constituents with diligence, effectiveness, and honor. I wish Steve and his wife Nini the best in retirement.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, this is simple, serious, and sad. Significant errors of utterance and judgment were made by members of the Committee on Ways and Means of both parties this morning. The chairman responded to what were fast-paced comments and actions. There were good reasons for the chairman's judgments and actions and good reasons why he altered those judgments and actions as circumstances changed. For that he is to be commended. To elevate an incident of which no Member on either side of the aisle is proud is destructive to this body. I regret the minority party's decision to enshrine in a resolution some facts while omitting others crucial to the flow of events. That does this House no good, and I urge opposition to this resolution.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Madam Chairman, I thank the gentleman for yielding me this time. Study after study and the experience of nation after nation has demonstrated that the more knowledge women have of how to control their reproductive capability, the more the abortion rate declines. We have seen this in spades in Russia and in countries around the world. Give women the knowledge they need to assume their family planning responsibilities, and they do not have abortions. So why would you want to deny the women of Haiti $2.8 million in family planning funds and all of the women's health that accompanies these funds, all of the education women gain about how to care for themselves, how to have healthy babies as opposed to unhealthy babies, how to have safe deliveries, how to recover postpartum? Why would you want to deny the women of Nicaragua $1.1 million in women's healthcare and in safe pregnancies? Why would you want to deny the women of El Salvador $600,000? Nigeria, a country in which there is terrible starvation, terrible deprivation, women get terrible healthcare and children die of hunger routinely, why would you want to deny the women of Nigeria $5.3 million so they could have the knowledge to handle their reproductive capabilities responsibly, plan their families so their children are spaced far enough apart, so their children survive and they survive to care for their children? Why would you want to deny the women of Pakistan $4.1 million, India $13 million, and so on? I do not comprehend. Why? Because China has a policy we absolutely oppose. So let's withhold our funds from China, but not from the rest of the women of the world! Why can we not help us focus, as we have been willing to, on the problem in China? But do not deny the women of the world the power of knowledge, because it is that power of knowledge that helps them have healthy pregnancies, healthy babies, and reduces the rate of abortions dramatically; and that is a fact that cannot be denied.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman for yielding me time. First, let us get some facts straight. Any senior watching this debate needs to understand that the law provides a Medicare bundle of benefits, period. That bundle of benefits will be provided to seniors through the Medicare fee-for-service program and through any plan that cares to participate in Medicare. But the law defines that bundle of benefits, and there is nothing in this bill that changes that law. So do not scare seniors that something is going to happen to their benefits. There is not any plan that can participate under this bill that is not obliged to offer the Medicare bundle of benefits. Then let us look at a statement made earlier about costs. All this bill does is allow the government to pay a plan the same amount per average senior beneficiary that we spend anyway per senior under Medicare. Not a penny more; not a penny less. So this is not going to increase Medicare spending. This is not going to explode spending. That is why CBO and OMB disagreed, because in the private sector, yes, plan costs are rising, but in this program we are only paying the plan precisely what it costs us for the care of an average senior under Medicare; no more and no less. So that is not the issue. There is only one issue here in terms of the plans in competition. In 2010, something important happens. Our seniors have the right to know in 2010 what the plan in any area where it provides the care for 20 percent of the seniors, what the average premiums are in those plans and what it is costing Medicare to provide care for the average senior under Medicare in those same areas. This is just a sort of ``right-to- know'' issue. Then, when you know, you can make the choice. If by that time, 2010, the plans have gotten a lot more efficient and are either offering a lot more benefits for the same money or lower premiums or are inefficient and it is costing them more and Medicare turns out to be the more efficient provider, which many of you on the other side of the aisle have always claimed was true, then, Medicare's premiums will be lower and it will make the plans look bad. If in fact the plans are more efficient providers than Medicare, then the premium amount will be somewhat higher for the Medicare plan and seniors will have a choice. The whole process is prejudiced toward weighting the Medicare premiums heavier than anyone else's premiums and phasing in any discrepancy. But the bottom line is that nobody in the private sector is going to be paid any more than the average we spend for a senior under Medicare. So if Medicare cannot compete on those terms, I will tell you, the seniors have a right to know, and, under this bill, they will. Now, let us look at this fallback issue. One of the reasons our bill is so very efficient and the most efficient and rated by CBO as saving the most money for our seniors under the prescription drug program is because the plan's sponsors have not only the tools to manage prescription drugs in a cost-effective way, they have the motivation. I will tell you, how many times have you seen your kid in college have all the preparation, have good skills, but they did not care enough to work hard and get an A instead of a B-plus? It is not just a matter of tools, of intelligence, of skills, it is a matter of will, of desire. The reason CBO gives us so much higher an efficiency quota than any other plan is because our plans have not the big motivation we gave them a few years ago, we decided that was too hard for them to meet, but just a little motivation. They have a little reason to care whether or not they notice whether seniors are going to get the lowest cost prescription that will help them, the generic where it is appropriate, so on and so forth, or negotiate hard with the manufacturers to get the lowest prices. So if you do a fallback and a guarantee, what plan in their right mind is going to get in? They are going to wait until you get to the fallback so they have no risk. If you do not have that, two things happen. First of all, this is a very big market. A lot of companies cannot afford not to be plan sponsors. So they are going to get in, and they are going to get in early. Twenty-eight plans wanted to get in when the President offered his discount card just as a voluntary thing. Those same 28 companies are going to be interested when, under this bill, they get the right to offer a discount card. Why? Because they want to line up their participants so when the real plan comes along with the subsidies, the taxpayer subsidies, they will already have a constituency signed up in their program. But this is entirely too big a business for plan sponsors not to want to be part of it, so they will accept that risk. In our bill we guarantee not one fallback but two fallbacks: One that is a pure drug fallback, and one is a plan fallback. How are we going to get it? There are lots of way. You will have Federal Employee Health Benefit Plans that already contract the drug benefit with a plan sponsor. That plan sponsor might very well be interested in providing drugs-only to seniors. He is already in the district; he is already working with the Federal Government. That is one option. Other options are to entice enhanced plans and advantage plans to provide that. There are lots of ways to do this. But if you check off and you check out the responsibility for some risk in the game, then you will never have the price cuts, you will never have the efficiency, and our seniors will be the victims.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Chairman, I thank the gentleman, and I would be happy to work with him to see if we can resolve this problem, because I appreciate the gentleman's dedication to giving CMS the administrative funds they are going to need to implement some of the reforms. I look forward to working with the gentleman on that.

Mrs. JOHNSON of Connecticut. Mr. Chairman, in deference to all, and the time constraints we are under, I will not take the full minute, but I do want to say that often very small amendments are extremely important. This amendment is absolutely key to reducing the costs of drugs. There are many expensive products on the market that are no better than aspirin, and we need to be able to demonstrate that and provide senior citizens and all Americans with that information so they can choose the most cost-effective, medically effective pharmaceutical for their particular needs. I commend the gentleman from Nebraska on his amendment.

Mrs. JOHNSON of Connecticut. Mr. Chairman, I raise a point of order against section 217(B) on page 57, lines 7 through 25, and page 58, lines 1 through 24, of this bill, H.R. 2660, on the grounds that this provision violates clause 2(b) of House rule XXI because it is legislation included in a general appropriations bill.

Mrs. JOHNSON of Connecticut. Mr. Chairman, I raise this point of order respectfully and regretfully, but it is important that this section be struck. In 2001, I helped author and pass in this House a requirement that providers be required as of this October to submit all Medicare claims electronically. Because most electronic billing systems eliminate inaccurate and duplicate claims, the user fee is unnecessary, as Medicare will get dramatically fewer mistakes after October. Harnessing a new claims processing and billing technology is preferable to using a punitive, per-claim tax to reduce mistakes. In addition, current law gives small providers the leeway that they need. Hospitals with fewer than 25 full-time employees or a physician practice with fewer than 10 full-time employees are exempted from this requirement. In sum, the current law that goes into effect October 1 covers this matter and provides the proper small business exemption. But in addition, the issue of what is a clean claim can be a very controversial issue and intermediaries have enormous power in this matter.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, scare tactics have no place in this debate. There are no vouchers in this bill. In 2010, a senior that wants to be in the Medicare program will be in the Medicare program exactly as they are now. They will be in that Medicare program and have that choice of the Medicare program in 2010, in 2011, in 2012, in 2013. They will never receive a voucher. That word is not in this legislation. It is used rhetorically to scare seniors. I want to assure the seniors listening that this bill represents the most dramatic expansion of benefits under Medicare since the program was founded, not only prescription drugs but additional preventive benefits and a whole system to support seniors with chronic illness.

Mrs. JOHNSON of Connecticut. Mr. Speaker, this bill does not allow the IRS to share your income information with insurance companies. The bill very clearly protects the confidentiality of your information, and there are criminal and civil penalties for violating those provisions. Violators can go to jail. It is true that for 5 percent of the seniors, they will have a higher threshold for catastrophic coverage. I personally do not believe that someone with a $200,000 income living in a gated community should have exactly the same subsidy as someone struggling along on $25,000 or $30,000 of income. I think that is a strength of this bill. But if someone does not want the government to tell you what your catastrophic threshold is, you can opt out and just take the highest threshold. That is your right. But only 5 percent will fall above the threshold, and we think that is progressive. We think we need to target this benefit at those who need it the most, and that is what we do.

Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman for yielding me the time. Today, is an historic day for America's seniors. Congress is about to fulfill the promise and the potential of Medicare, which has been one of our greatest success stories in our history; but when Medicare was created in 1965, prescription drugs were few and far between. Instead, painful and invasive surgeries were standard treatment; but now, with the health security of our seniors tied directly to medicines, medicines that extend life and restore hope, we must add prescription drugs to Medicare for all our seniors. A Medicare program without a drug benefit is a false promise in the 21st century. I am proud to stand here on this House floor and bring prescription drugs to Medicare for all of our seniors and a benefit that is simple, generous, and fair. It is simple because it pays 80 percent of the first $2,000 of drug costs; and it guarantees the peace of mind of our seniors, protecting them against catastrophic drug costs, covering all costs above $3,500. It is generous because the average senior spends $1,200 on prescription drugs every year. Yet in this bill we cover 80 percent of the cost up to $2,000. It is fair because it helps the low-income seniors more than any other group. It not only helps the very poor, below 150 percent of poverty, but for the first time, by allowing State subsidies to help seniors toward that threshold of catastrophic coverage, we help the next income group to have that security that seniors depend on in their retirement. In addition, there is fairness at both ends of this bill. Should someone with a $200,000 income have the same level of catastrophic protection as a low-income senior? Of course not. But modernizing Medicare cannot be just about prescription drugs, as important as prescription drugs are. It must also be about addressing the most crippling threat to our seniors' well-being and their retirement. It must address chronic illness. Current Medicare is an old-fashioned illness treatment program. This bill will provide seniors with chronic illnesses a chance to have truly progressive care, whose goal it is to prevent the progression of chronic illness. Our goal must be to be sure that if you have diabetes, you do not end up on dialysis. Disease management is the new frontier in medicine. It will slow, interrupt or reverse disease. It requires more sophisticated technology. It requires greater patient involvement in their own care. But it results in higher quality health care and much improved quality of life and lower costs for hospital care, emergency room care, and doctors' visits. Mr. Speaker, this bill will bring the cutting edge of medical science and modern technology to the service of our seniors and disabled veterans. With over half of our seniors suffering from five or more chronic illnesses and using 80 percent of Medicare's resources, we must bring chronic disease management to the service of our seniors. And no bill to this point has ever done that. So I am proud to say that this bill brings both prescription drugs and preventive health care programs to Medicare and will provide unprecedented vitality to our Medicare program. In conclusion, let me remind us all that this bill will revitalize our Medicare Choice plans and provide that reliable high-quality care year after year after year that seniors depend on, a more holistic integrated care than fee-for-service can provide. So I ask my colleagues tonight to support wholeheartedly and enthusiastically H.R. 1. It is historic. It brings prescription drugs into Medicare and it prepares Medicare to provide 21st century medicine to our seniors in the years to come.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2 minutes to the gentleman from Iowa (Mr. Nussle), a member of the Committee on Ways and Means and esteemed chairman of the Committee on the Budget.

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, let us look at the facts behind the rhetoric here. What is going to be the impact of this Democratic substitute on seniors? My colleague from Louisiana just reminded us that 100 percent of employers are going to drop their plans. If there is one thing my senior citizens say to me when I go into senior centers it is, look, help those who need it, but do not destroy my employer-provided retiree plan. Do not touch it. This amendment destroys it, wipes it out. That is not in the interest of your seniors. But let us look at what it will do to premiums. You were concerned that we did not sock a premium into law. Look what you do in your bill. You sock the premium into law and then you have it rise according to drug inflation. Drug inflation is double-digit. Do you not get it? Those premiums are going to rise steeply. Why would you do that to our seniors? And let us look at the effect on prices. There is one thing seniors say to you over and over again, the prices are too high. Yet according to Dr. Holtz-Eakin's testimony of April 9, 2003, he says, ``If you subsidize 90 percent of any insurance product versus 70 percent of the product, the larger subsidy will lead to a lower incentive to control costs and will lead to higher prices and higher spending.'' Yours is a giveaway to the pharmaceutical industry. It will drive prices up because there is no incentive for the PBM or the plan to negotiate prices down and they can just pass it on to the government, because we are going to pay it all. Yours is going to drive prices up, premiums up and employer plans out of the market. I do not know why you think you are doing the seniors a good service. And look at the impact on their kids, because they care about their kids and their grandkids. We have heard testimony over and over again that if you have a 10-year-old child, in 20 years when that kid is 30 and trying to pay back college loans, trying to buy a house, trying to get established, having to buy a car, that child will live in a Nation in which three-quarters of all the Federal revenues will go to Social Security, Medicare and Medicaid. What is that child to do about education for their children? What is that young person to do to make a living? You shoulder so much debt on the next generation that they will not have public education the way we know it today. They will not have the roads and bridges that a strong economy depends on. They will not be able to defend this Nation in a world that is going to be far more dangerous than the one we have known. This is utterly irresponsible. It is so irresponsible that when the other body proposed this plan in the Senate the last session of Congress, they could not write a budget resolution because they did not know how to handle the extraordinary debt that this creates in the decades ahead. I urge my colleagues to think that something that looks pretty for your seniors, in fact, will be terrible for their health. Mr. Speaker, I reserve the balance of my time.

Mrs. JOHNSON of Connecticut. Mr. Speaker, it is my pleasure to yield 2 minutes to the gentleman from Wisconsin (Mr. Ryan), a member of the Committee on Ways and Means.

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2 minutes to the gentleman from Arizona (Mr. Hayworth), a member of the Committee on Ways and Means.

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Ohio (Mr. Portman).

Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Virginia (Mr. Tom Davis).

Mrs. JOHNSON of Connecticut. Mr. Speaker, will the gentleman yield?

Mrs. JOHNSON of Connecticut. Mr. Speaker, yes, that is correct.

Mrs. JOHNSON of Connecticut. That is correct.