Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I also want to address the problem of waste, fraud, and abuse in Medicare and say that I am very pleased to be a cosponsor, an original cosponsor, of the gentleman from Connecticut, Ms. DeLauro's, bill to deal with the problem. As she pointed out, she is trying to address this problem. But, unfortunately, the Republican leadership, in their Medicare bill, which we are going to vote on, I understand, this Thursday, does not. In fact, Speaker Gingrich's proposal, the Republican leadership proposal on Medicare actually makes the problem of waste, fraud, and abuse in the Medicare Program seriously worse. The reason for that is, essentially what the Republican leadership is doing with this Medicare bill is trying to achieve savings by cutting Medicare to provide money for a tax cut primarily for the well-to-do. So their concern about problems dealing with waste, fraud, and abuse is really relatively minor in the overall bill that they have and that they will bring before the House. I am concerned, Mr. Speaker, because we had a hearing, we were not allowed a hearing in the Committee on Commerce, which I sit on, to actually deal with the Republican Medicare proposal, but we decided that we would have our own hearing. And the day after the bill was first presented to us last week, we had our own Democratic hearing on Medicare. Interestingly enough, a number of representatives from the various Federal agencies that go after those who abuse the Medicare System, or commit fraud on the Medicare System, testified to the problems that exist in this bill with fraud and abuse. Essentially, Mr. Speaker, what they say is that the Medicare restructuring proposed by Speaker Gingrich and the Republican leadership actually weakens the Government's ability to weed out bad practices and Medicare scams. Over the course of 7 years, $126 billion could be saved by reducing fraud and abuse, but the GOP bill makes the existing civil monetary penalties and the antikickback laws considerably more lenient. According to the inspector general of the Department of Health and Human Services, the Medicare restructuring legislation by the Republicans would substantially increase the Government's burden of proof in cases under the Medicare-Medicaid antikickback statute. And although a fund would be created to direct money recovered from wrongdoers, this fund would not go to further law enforcement efforts. Now, just to put this in perspective, here we are, pursuant to this Republican proposal, squeezing every last dime or nickel out of the Medicare Program with these spending caps that limit how much can be spent on Medicare, and in the context of that, with our health care system and the quality of our health care system significantly declining because of these cuts, we are now, instead of addressing fraud and abuse and trying to save some more money there, actually making it easier for fraud and abuse to take place. Mr. Speaker, I think one of the speakers mentioned that the Congressional Budget Office actually estimated that over the 7 years of this Republican Medicare Program, the regulatory relief would actually incur an additional expense of $1.1 billion. In other words, it would cost us another billion dollars or more in this Medicare Program because of the relaxation of the laws that deal with fraud and abuse. Now, I just want to just give some brief statements that were made by June Gibbs Brown, the inspector general of the U.S. Department of Health and Human Services, at our Commerce alternative hearing on October 3, because she basically specifies why it is true that this Republican bill will cripple efforts of the Federal and State law enforcement agencies to control fraud and abuse in the Medicare system. She says, ``We believe that H.R. 2425 contains several provisions which would seriously erode our ability to address Medicare and Medicaid fraud and abuse.'' Here are some of the examples she cites. ``The bill would make the existing civil monetary penalty and anti-kickback laws considerably more lenient.'' She goes on to say, ``The bill would relieve providers of the legal duty to use reasonable diligence for ensuring that the claims they submit to Medicare and Medicaid are true and accurate. This will have the effect of increasing the government's burden of proof in cases under the civil monetary penalties law. In an era where there is great concern about fraud and abuse in the Medicare and Medicaid Programs, it would not be appropriate to relieve providers of the duty to use reasonable diligence to ensure that their claims for payment are truthful and accurate.'' She then says, ``The bill would substantially increase the government's burden of proof in cases under the Medicare-Medicaid antikickback statutes. For the vast majority of present-day kickback schemes, the proposed legislation would place an insurmountable burden of proof on the government.'' She then says, ``The bill would create new exemptions to the Medicare-Medicaid antikickback statute, which could be readily exploited by those who wish to pay rewards or incentives to physicians for the referral of patients.'' [[Page H 10122]] But worst of all, Mr. Speaker, even though the bill creates a fund for directing moneys recovered from wrongdoers, the moneys do not go to the enforcement agencies within the Government to continue their efforts to try to stop fraud and abuse. It is incredible to me, Mr. Speaker, that in all the talk about Medicare, that this is what we have in this Republican bill.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I probably will not use all the hour, but I will ask for at least that initially. I wanted to come because of the developments that have occurred in the last few weeks particularly this week with regard to Medicare and the Republican leadership proposal to change Medicare. I happen to be a member of the House Committee on Commerce. The Committee on Commerce spent this past Monday and Tuesday doing a markup of the Medicare bill and did report the bill out on Tuesday late in the evening. I am very concerned about that bill. I understand it may be coming to the floor sometime next week, perhaps as early as next Thursday. I think it is a terrible thing that this legislation is coming to the floor of the House of Representatives without ample opportunity for hearings and sufficient debate. As I have mentioned before on the floor of this House, Mr. Speaker, our Committee on Commerce did not have hearings on the legislation. In fact, a substitute bill, which was actually the bill that we voted on just this past week, we only received about 24 hours before the time we were actually asked in committee to mark up the bill. So what, in effect, the Republican majority is doing is rushing Congress into these Medicare changes without most of us even knowing what the changes are and what the implications are going to be on America's seniors. Just to illustrate that point, I wanted to start out, Mr. Speaker, by entering into the Record, ands I think part of it may already be in the Record, but I wanted to mention some highlights of an editorial that was in my hometown newspaper, the Asbury Park Press, on Tuesday, October 10. And if I could just highlight some of the statements that were made in the editorial, it is captioned ``Explain The Changes'': Congress should not be rushing on Medicare. The editorial starts out by saying that congressional Republicans are moving too fast on reforming Medicare, the Federal health insurance program for the elderly. They propose to squeeze $270 billion from Medicare spending over the next 7 years, about a 14-percent reduction. And, as they did in their first 100 days, the Republicans plan to speed up the voting on their Medicare spending bills without taking much time for floor debate. Given their importance, the revolutionary changes the Republicans propose are worth at least as much time and attention as they have given to, say, the Whitewater affair. As it stands, two House committees plan to complete action on the Medicare changes by tomorrow night. That was earlier this week, just 2 days after revised versions of the bill were distributed to committee members. And again, that is exactly what we did. Under one major GOP proposal to save money, senior citizens would be [[Page H 10072]] given incentives to switch to managed care plans instead of the traditional and more expensive fee-for-service. Yet Congress so far has given short shrift to some of the reservations expressed by seniors and others about managed care. Polls indicate that most senior citizens as well as other Americans fear that congressional Republicans seeking not only to slow the growth of Medicare spending but also to wring enough savings for a tax cut that would benefit mostly the wealthy. Finally, the editorial says that it is difficult to determine just how the Republicans arrived at their numbers because too few details have been released. That is not information the Republicans should shield the public from. The debate should be open, robust and based on a complete understanding of the facts. Anything else invites misperceptions and misinterpretations. I think what we are seeing in this editorial is that more and more the media around the country, the newspapers, are coming to the realization that these Medicare reforms by Speaker Gingrich and the Republican majority are being moved too fast without adequate opportunity for debate, without anyone really knowing exactly what the changes are going to mean other than the fact that we know that the savings are going to be used for a tax cut, which, once again, goes mostly to wealthy Americans. Now, one of the things that I was most upset about this week, and I know it has received a lot of attention in the media, but I want to mention it myself because I was there, and that is on the second day of our hearings earlier this week, there were senior citizens representatives. I did not know where they were from, but they turned out to be people from the National Council of Senior Citizens, who came to our Committee on Commerce room. Some of them were very elderly. Some were as old as 90, and wanted an opportunity to address the committee. They basically were told that that opportunity would not be presented and, after they tried to speak, they were arrested. They were handcuffed and they were basically led out of the Rayburn Office Building into a paddy wagon where they were taken down by the Capitol Police, potentially to be booked, although I understand later that they were released and not charged with any kind of trespass. Mr. Speaker, I subsequently got a couple of pictures of these senior citizens. Just to give you an idea of the situation, I would just like to point them out here. This is the woman who initially tried to speak and basically was told that she could not. You can see there where she is being taken away, essentially. Then afterward, out in the corridor, there were additional senior citizens, as I said, who were actually handcuffed and taken away. I do not want to get into all the details of this, but it was very upsetting to me, because I think it would not have happened if the opportunity had presented itself for seniors and their representatives to actually have addressed the House Committee on Commerce, and the fact that they were not given that opportunity is the reason why so many of them were upset and why we had this very unfortunate incident. I only point it out again because I think it is important, and it is not just individual seniors. It is also the newspapers, including my own in my own area, the part of New Jersey that I represent, who have expressed outrage and astonishment over the fact that there has not been an opportunity for seniors and other Americans to make their case about these Medicare changes that are so important to the country. The previous speaker, the person who spoke before me, suggested, and I know this has been a basic tenet of the Republican leadership that somehow Medicare is broke; it faces bankruptcy if we do not do something about it that that is significant, we are going to be faced with a situation where it will not exist any more. Nothing could be further from the truth with a lot of statements made by the previous speaker about the trustees' report and how the trustees have predicted insolvency in 7 years. One of the things I want to point out in response to that is that every year the Medicare trustees issue a report, and they predict how many years it will be before the fund that finances Medicare will be insolvent, and if you look at it, there are great variations over the years. Starting in 1970, I have a chart here where if trustees predicted insolvency in 2 years, in 1971, again, in 2 years, in 1972 in 4 years, most recently in 1995, the report that the gentleman, my previous speaker mentioned, 7 years, in 1994 it was 7, in 1993 it was 6, and it goes on and on. The point of the matter is that a tremendous amount of attention has been focused by the Republic leadership on these trustees' reports, but they fail to mention that many times over the last 30 years or so or the last 25 years, that these reports have come out that indicated a certain number of years in the future when this program would possibly be insolvent. It has really been an issue before except that Congress periodically steps in and tries to correct the situation. The bottom line is this is nothing new. This is not an emergency situation that requires the level of cuts and the level of changes that the Republican leadership is basically suggesting. Mention was also made of Secretary Rubin, the Secretary of the Treasury Rubin letter of September 21 to the Speaker and to Senator Dole wherein he points out, and I will quote that: No Member of Congress should vote for $270 billion in Medicare cuts, believing that reductions of this size have been recommended by the Medicare trustees or that such reductions are needed now to prevent an imminent funding crisis. That would be factually incorrect. So basically not only Secretary Rubin but other trustees I could cite have specifically said that the Republican proposal to cut this huge amount of money out of Medicare, $270 billion, 14 percent, is not the answer to the trustees' concerns and, in fact, by cutting the program by that amount of money, all you are really doing is making the situation even worse for the Medicare Program and for those who benefit from it. I also wanted to address the fact, and I was very concerned when the previous speaker mentioned Medicare savings accounts as somehow being the answer to all of our problems. My concern with these so-called Medicare savings accounts, which is one of the new ideas that the Republican leadership have come up with in this Medicare plan, is that what it is going to do is make the situation even more serious in terms of the amount of money that is available to the Medicare Program, in other words, aggravate the situation so that even less money is available in the program. What we know now is that 90 percent of Medicare beneficiaries basically cost the Government about $1,000 a year, in other words, most, the overwhelming 90 percent of seniors who receive Medicare basically do not take advantage of much health care activity, if you will, over the course of the year, because they are not sick and they only cost the Government, the Medicare Program, about $1,000 a year. So if all of these, or a significant number of these well seniors who do not need a lot of medical attention end up getting Medicare savings accounts and the Government has to contribute something like $4,000 a year to these Medicare savings accounts, the Government is basically going to be losing money, because it would normally cost them only about $1,000 a year to maintain the health of those seniors, and now the Government is transferring all of these additional funds to these Medicare savings accounts. It is nice, I mean, I am not going to be critical of the fact that some of the seniors may actually end up having some more money as a result of this, but in a situation where the Republican leadership is talking about the insolvency or suggesting that Medicare is insolvent and how we have to cut $270 billion out of the program, why in the world are we trying to, in effect, inflate the program by costing the Government as much as $3,000 more per person if the majority of the people who go into Medicare savings account are people who are fairly well? And those are the people that are likely to do it, because if you think that your health is not that great, you are not going to want to risk going into the Medicare savings account where you might have to shell out a lot of money. [[Page H 10073]] So we know that these Medicare savings accounts are going to cost the Government a lot of money, and I think it is fiscally irresponsible to rob the Medicare Program of billions of dollars by setting up these savings accounts when theoretically your reason for Medicare reform is to try to save the Medicare Program some Federal dollars. I think that what we really have here, I know what we really have here, and it is documented well based on the statements that were made in the Committee on Commerce when we marked up the Republican Medicare bill this week. What we really have here is an effort to try to come up with some money by squeezing Medicare to pay for a tax cut, and I know that my Republican colleagues deny this is the case, but if you look at the way this program is set up, the way this bill has come out of committee, there is no question in my mind that that in fact is what is going on. Now, let me explain why I say that. Of the $270 billion that is proposed for reduction in Medicare by the Republicans, nearly half of that money would not even go to shoring up the Medicare hospital trust fund, known as Medicare part A, which the Republican leaders claim faces insolvency. This part A, the hospital trust fund, is what is discussed in the trustees' report, not part B, which is the separate program that seniors pay into which goes to pay for their doctor bills, and basically part A is where if we have extra money, if we ever have the money, we should be trying to put it in order to shore up the plan. We estimate that about $90 billion would be needed to shore up, if you will, and to avoid that potential insolvency 7 years from now in part A. So if you took about $270 billion, compared to the $90 billion that the trustees really need, you can see that the difference is essentially what would be used for the tax cut. What they are doing with part B, instead of, in order to guarantee that there is a lot more money available there that could be used for a tax cut is increasing premiums. We have heard over and over again on the floor of this House that the part B premium will go from about $46 a month that the seniors pay right now to over $90 a month by the year 2002, in a sense doubling, and the problem is that this part B, the money that goes into part B, including all that additional money that is going to come from the increased or doubling of the premiums, the seniors would pay under the Republican plan, that comes out of the same fund or goes into the same fund as it used for the $245 billion in tax cuts that has been proposed by the Republican leadership. Since any changes to part B do not impact the insolvency of part A, again they are separate funds, it is highly likely that the part B cuts could be used for tax cuts, again which I said much of which goes to the wealthiest Americans. In an effort to try to make sure that was not the case, in other words, that whatever cuts came to this Medicare Program under the Republican bill would not be used for tax cuts, we, the Democrats on the Committee on Commerce, tried a number of amendments earlier this week, because our point was, well, if you on the other side are saying that you are not going to use this for tax cuts, well then, fine, you know, go along with some of the amendments that will make that perfectly clear that this money that is being cut from Medicare is not going to be used for tax cuts, and so we came up with a few amendments. I actually proposed the first amendment, which was basically to say that since part B is not insolvent, since part B, which is generated through these premiums as well as general revenues, is not a program that faces potential insolvency or bankruptcy, why do we need to deal with part B at all? So the amendment that I proposed basically struck part B from the Medicare bill, the idea being that we would only deal with part A, since that is where the potential problem is. Well, that amendment was, of course, defeated. I would maintain the reason it was defeated is primarily because the fact of the matter is the Republican leadership intends to use this money for tax cuts. But then in the Committee on Commerce, the gentleman from California [Mr. Waxman] offered another amendment after mine that basically I called directed scorekeeping. It is sort of a technical term. But what it means is that if the money is saved in Medicare and it is put aside under the budget rules, a tax cut can be implemented, because he knows that that money for Medicare from the cuts in Medicare has been set aside and is sitting there as part of the Federal budget. In other words, the idea is that since the money is there, you can score against it or charge against it to implement a tax cut, and so the gentleman from California [Mr. Waxman] had an amendment that basically said that the Director of the Congressional Budget Office shall not include estimates of net reduction in outlays under the Medicare Program for fiscal years 1996 through 2002, the 7 years, to the extent that such net reductions exceed $89 billion. So what he was saying is that you can score $89 billion of that $279 billion for the savings to shore up the part A hospital trust fund, but you cannot score any more of it that could possibly be used for a tax cut, and again that amendment was defeated. I think that the defeat of the amendment offered by the gentleman from California [Mr. Waxman] showed definitively that what the Republican leadership has in mind is to use this money for a tax cut, because if they did not have that intention, they would not have found it necessary to use that money for scoring for budget purposes. Now, what is it, what is this Republican Medicare? What are these Medicare changes essentially going to do? We know they are trying to save $270 billion or cut $270 billion. I believe very strongly that is going to be used for a tax cut. How are they going to do it? In other words, what is actually going to happen to the Medicare Program, and how is that going to translate into the type of health care, quality of health care that seniors will actually get if that level of cuts is implemented? Basically what the Republicans are doing is they are limiting Medicare spending to specific dollar amounts in the law. It is what we call caps. In other words, they are saying that only so much money can be spent on Medicare, and that is it. It is capped. The problem though is that if you look at these caps and the level of spending that is going to be allowed with all the cuts is that they do not bear any relationship to the actual cost of health care. All of us would like to save money. Frankly it would be wonderful if we could save billions of dollars in the Medicare Program, and we can to some extent. But if you put artificial caps on the amount of spending that is available because you want to use that other money for a tax cut, well, the problem is if they have no relation to the actual costs of health care, what you are doing is squeezing the Medicare system. You are making it so that traditional care and the quality of care that hospitals and physicians give you they can no longer give you, because the money is not there to pay for it. What I think that the most important or the most significant aspect of this initially is that a lot of seniors are going to lose their choice of doctors. In other words, the Republicans feel very strongly that if they put a lot of seniors, if they force a lot of seniors in effect into what we call HMO's or managed care where they do not have a choice of doctors, the Republicans believe that that will then accomplish a lot of savings, and they will save a lot of money, because they feel that the HMO's or managed care ultimately will save money. I would argue that the jury is definitely out on whether or not HMO's or managed care actually save dollars in the long run, but clearly what the Republican leadership is doing here in coercing seniors into HMO's or managed care. I know that the previous speaker said that, you know, seniors are going to continue to have choices if they want to stay in a traditional fee-for-service plan where they have their choice of doctor; they go to the doctor that they have been seeing for years, and he just gets reimbursed. They can continue to do that; they do not have to necessarily sign up for an HMO. But there are some very cute budgetary gimmicks in this Republican Medicare proposal that are going to make it increasingly difficult for you to stay in a traditional fee- for-service plan where you have your own doctor, and the reason for that, there are many reasons, [[Page H 10074]] but one of the key reasons is because the cuts impact much greater on the traditional fee-for-service plan than they do on HMO's or managed care. This is in the bill that came out of the Committee on Commerce, what we call a fail-safe that says that after a few years if savings are not achieved in this sufficiently to reach that goal of $270 billion--through the changes that we have suggested in Medicare, if we find after a couple of years that we are not saving that level of money, we are not likely to save that level of money over the seven years--then a fail-safe comes into play that cuts back on the reimbursement rate that doctors and hospitals and other health care providers get from Medicare. But the fail-safe, the cutbacks at that point, do not come on the HMO's or the managed care patients or systems but strictly on the fee-for-service side. So in essence what is happening is after a couple of years the squeeze, if you will, the amount of money that goes into the traditional fee-for-service plan where you can choose your own doctor and get reimbursed, the squeeze is solely on the people that remain in those traditional fee-for-service plans. So what it is going to mean is less and less money is going to go to doctors or hospitals that are in the traditional fee-for-service plan and you will find increasingly that you cannot find a doctor through a traditional fee-for-service plan, and you have to go to an HMO if you want to get any kind of attention. It is very unfortunate, but it is a rather cynical way, if you will, of eventually abolishing or making it impossible for seniors to stay in the traditional fee-for-service system. I wanted to just talk a little bit more about some of the amendments that Democrats proposed in the Committee on Commerce to try to improve on this terrible proposal that the Republican leadership has put forward on Medicare. I think a lot of us recognize that even though we thought the overall plan was terrible that if there was some way we could amendment it in committee to lessen some of the worst aspects of it, at least we would have accomplished something. But every one of these amendments, every one of these attempts on our part to try to correct the bill or make it a little less onerous failed. Some of these amendments though, or corrections if you will, do point out how sinister this plan is in various ways. I just want to talk about a few of them. I do not want to talk about too many of them, because we could stay here all day, and I do not want to take up that much time. The gentleman from Massachusetts [Mr. Markey] offered an amendment basically that would have decreased the part B premiums and taking the law back, the Medicare law back to what it is today. A lot of people, a lot of the Republicans have come on this floor and they have said, well look, why are you Democrats talking about doubling the part B premiums, the premiums that you pay for doctors, when in reality the part B premiums would be going up anyway over the next few years? Well, the fact of the matter is under the current law the part B premiums do go up. It is now about $46 a month, and under current law by the year 2002, 7 years from now, the premiums would go up to about $60 a month. But I would point out that that $60 a month under current law, assuming current inflation, is significantly less than what Speaker Gingrich has proposed. Speaker Gingrich's proposal and the bill that came out of committee would double the premiums. They'd probably be at least $90 per month as opposed to the $60 that exists under the current law. The reason for that is very simple. Under the current law, the percentage that senors pay actually goes down in the next few years, because it was understood that it is very, very difficult for a lot of seniors who live on fixed incomes to pay very high premiums, and so if we do not change the law you will see the actual percentage seniors have to pay out of pocket for part B go down, and that even with inflation, although there will be some increase in your part B premiums, it will not be anywhere near as great as what Speaker Gingrich has proposed. That amendment, of course, by the gentleman from Massachusetts [Mr. Markey] to try to strike those drastic increases in the part B premiums also failed because of Republican opposition. The other thing I think is particularly sad, when you talk about the part B premiums, and, again, something we tried to change in committee unsuccessfully, is that under current law Medicaid pays the total cost of the part B premium for seniors who fall below a certain income, who are low-income seniors. Well, the Medicare bill and the Medicaid bill that we passed out of the Committee on Commerce a week earlier has eliminated the requirement for the Federal Government to pay the part B premiums, the $40-some odd a month for those low-income seniors. And there are millions of them. What we did in committee this week is we tried to incorporate into Medicare, into this Republican Medicare bill, a requirement that that premium for the low-income seniors would be paid under Medicare. Again, that amendment was defeated. I think some of my colleagues on the other side have suggested that, well, that is OK, because these low-income seniors can all go into an HMO and the HMO will take care of their physicians' bills, so they do not need part B anymore. That is a false assumption. First of all, there is absolutely nothing in this Republican Medicare legislation that guarantees anyone that they are going to have an HMO in their area that will pay for physicians' bills that is available to them at a decent cost. So I think what you are going to see is a lot of low-income seniors, or even middle-income seniors, will simply not be able to pay for their part B premiums, and the consequence of that is they simply go without part B and they do not have health insurance that pays for their doctors' bills. The other thing we tried in committee that I was very supportive of is if you have this terrible Republican bill that basically forces a lot of seniors into HMO's or managed care where they do not have a choice of doctor, at least change the law when we pass this bill, let us put into the bill what we call a point of service provision, that says that if you are in an HMO or managed care system, and all of a sudden you need to go to a specialist or a doctor that is not part of the system, that is not on the list, so-to-speak, that at least you can opt out of the system and go to that other doctor, even if it means you have to pay a little more out-of-pocket in order to see the doctor that is not part of the HMO. I am not saying that is a great alternative, because you have to shell out more money out of your pocket. But at least the option would exist under point of service, as we call it, so that if you were forced into the HMO or managed care, but you wanted to go see a doctor not in the system in a particular circumstance, if you could afford a little extra copayment, you could operate to do that. Again, that point of service provision was defeated. It was actually an amendment that was offered by a Republican member of the committee, the gentleman from Iowa [Mr. Ganske], who is a physician, but we did not have sufficient votes on the Republican side in order to guarantee that the point of service option would be available. One of the most sinister things in this Republican Medicare bill the way it came out of committee, again, is that there has been an effort to try to change the current law that limits the amount of money that seniors have to pay a physician out-of-pocket. In other words, under current law if you are under Medicare and if you are covered by Medicare and you see a physician, they can only charge you a certain percentage increase for a copayment. But in this bill that came out of our committee that is going to be voted on the floor of this House probably next week, those provisions were changed in certain circumstances. If you decide to join that we call a hospital network, or doctors network system, in other words, if you decide to join a managed care system which is put together by a hospital or by a certain group of doctors, rather than the ones that are advertised on TV, the large ones, the large HMO's, managed care systems, then they allow what is called balanced billing in those systems, where the doctors can charge you [[Page H 10075]] basically whatever they want for a copayment. This is the first time under Medicare in my memory that any exemption has existed from the limitation on what the doctors can charge for a copayment. And what I would say is happening here, and the reason this is happening, is very simple: So much money is being squeezed out of the Medicare system, so much money for health care needs is being squeezed by these cuts in Medicare, that the recognition is out there on behalf of the Republican leadership that they need to provide a situation where seniors can be charged a lot more by their physicians in order to provide quality care. So they are building this exemption, knowing full well that some seniors may want to get into a better quality system through a hospital or doctor network in their area that is going to provide the quality physicians, that is going to provide the quality care, but the only way to pay for it is by charging the seniors more out-of-pocket so the physicians can charge whatever they want. I think it is a terrible recognition of the fact that there is not going to be enough money in this Medicare system the way the Republicans have put their bill together to provide for quality care. That is just a beginning, I think, of what you are going to see, where more and more money has to be paid out of pocket by senior citizen in order to guarantee them quality care. I had a little chart, which I do not actually have in front of me, but to give you an idea I will read from it, that gives the percent of income spent on out-of-pocket costs by adults 65 and older in 1994. Of the total elderly population, 21 percent of their income is basically spent for out-of-pocket health care costs. If you look at senior citizens who are below poverty, that shoots up to 34 percent. Low- income seniors, 34 percent of their income was actually spent on out- of-pocket costs for health care. So already we are in a situation where a lot of senior citizens spend a significant amount of their money out-of-pocket to make up for deductibles, copayments, and other health care necessities. And with this bill, you are going to see even more of that occurring, particularly when it comes to the balanced billing provisions. I just wanted to mention a couple more things, because I think they are particularly egregious, and these again were things that the Democrats tried to change in the bill, in the Medicare bill in the Committee on Commerce, but, again, we were unsuccessful. The Republican leadership, and particularly the Speaker, have made such an issue over the fact that there is a tremendous amount of fraud and abuse in the Medicare Program under current law, and that is certainly true. Estimates are that something like 10 percent or perhaps more of the money in the Medicare Program is wasted, either because of fraud or abuse or just general waste. All of us, I think, on both sides of the aisle, Republican and Democrat, would like to see certain things done to correct that. And we were hoping that any kind of Medicare reform legislation that came out of the Committee on Commerce as a result of this Medicare debate would seriously try to address the fraud and abuse problems. The sad thing is this bill that was reported out of committee actually makes it more difficult for the Federal Government to go after those who are committing fraud and to weed out the abuse in the system. I think it is a particularly sad commentary on the fact that here was an opportunity, particularly in a climate where we are trying to save money and we know there is a tremendous amount of money that could be saved, to make it more difficult for the Government to go after fraud and abuse. If I could just read from some of the statements that were made by the inspector general of the Department of Health and Human Services about the bill and why it would make it more difficult for the Government to go after those who are defrauding the system. Over the course of 7 years, the 7 years we are talking about here, it is estimated that $126 billion could be saved by reducing fraud and abuse. But the GOP bill actually makes the existing civil monetary penalties and antikickback laws considerably more lenient. According to the inspector general, the Medicare restructuring legislation: Would substantially increase the government's burden of proof in cases under the Medicare-Medicaid antikickback statute. Although a fund would be created to direct moneys recovered from wrongdoers, this fund would not go to further law enforcement efforts. What the inspector general said is that the one way that we can significantly crack down on fraud and abuse is if there are more enforcers out there. This bill actually makes it more difficult for enforcement to take place, because, on the one hand, it increases the standard of proof of the Government in going after those who are taking advantage of the Medicare system, and that whatever money is recovered does not go to hire more people to do law enforcement. So actually there ends up being less people out there who are going after the abusers. I just think that is a particularly egregious situation, because so much has been played about the need to deal with the fraud and abuse problem. I would like to conclude in just a couple more minutes by saying that although I talked about Medicare today, and that is what we are going to be voting on next week, the problem of what seniors are going to face with Medicare because they are going to have to pay so much more money out of pocket is aggravated because of what is happening on other fronts with regard to senior citizen concerns. A couple weeks ago in the Committee on Commerce we reported out a Medicaid bill which, and, again, the Republican leadership is trying to cut about $180 billion in the Medicaid program in order to pay for their tax cuts. If you combine the cuts in Medicaid, $180 billion, with the cuts in Medicare, $270 billion, you see a tremendous amount of money is going toward cuts that primarily impact the elderly, because 70 percent or so of the money that is spent on Medicaid, which is the program for the poor, health care for the poor, still goes to pay for senior citizens, most of whom are in nursing homes. So what we are going to see is that senior citizens are going to have to pay more out of pocket for Medicare, they or their families are going to have to pay more out of pocket because of the cuts in Medicaid. Then looking on the horizon, and it had a lot of attention in the media today, is the proposed cut in the COLA for Social Security. I mention that again, first of all, because I am opposed to the cuts in the COLA that are being presented; but even more important because, think, about the senior citizen. Let me give you an example, let's say a senior citizen of low income, who now is being told that your Medicare part B premium is going to go up, it is going to be doubled over the next 7 years; that the supplement, the Medicaid provision that pays for part of your Medicare part B is possibly going to be eliminated; and then you are not going to get the COLA that you expect to take into consideration inflation over the next few years. Well, if you think of that combination, less of a COLA, more out of pocket for Medicare, and loss of any kind of supplement for Medicaid, you are talking about senior citizens that are getting a double, triple, or even more possibly with cutbacks in other programs like nutrition or outpatient care, a double, triple, quadruple whammy. The thing that is amazing to me is how so many of our colleagues on the other side just refuse to recognize how the combination of all these cuts and increased out-of-pocket expenditures and less of a COLA are going to have such a devastating impact on people who have fixed incomes. I have to say, and I am not just talking in an insider's sense here, when I go home on weekends, when I am in the district, when I am in New Jersey, seniors come up to me on the street, they come up to me in my district offices, and they explain how they have budgeted down to the last penny or the last dollar, and they simply cannot afford the types of increases that we are going to see here. These increases are not necessary. If we eliminated or even cut back significantly on the tax cut, particularly those provisions that are going to the wealthy, then we would not have to make these kinds of cuts and cause [[Page H 10076]] these out-of-pocket expenditures to occur. So, again, this is a needless effort on the part of the Republican leadership. I think it is a shame. I hope that more and more Americans will see the light on these terrible changes that are being proposed.

Mr. PALLONE

Mr. PALLONE. It is not just fishermen Mr. Chairman. It was anyone basically who are coastal users, people who lived at the shore, people involved in commercial cargo activities. I really do not think we should eliminate one aspect of it but perhaps by try to see how money can be used, reduced perhaps but used for all 3 functions rather than eliminate one aspect.

Mr. PALLONE. Mr. Chairman, I have a parliamentary inquiry.

Mr. PALLONE. My understanding was that the gentleman from New Jersey [Mr. Saxton] made a motion to strike and now the gentleman from Pennsylvania's motion relates to the funding level. Is that in order?

Mr. PALLONE. If the Weldon amendment passes, if I could inquire, then is the Saxton amendment still in order?

Mr. PALLONE. Mr. Chairman, I move to strike the last word to speak on the Saxton amendment. Mr. Chairman, again I have no problem with raising the funding level, I certainly would support that, but my concern is that this not impact the motion to strike offered by the gentleman from New Jersey [Mr. Saxton], because I think that that is certainly equally if not more important in the context of the underlying bill. My concern is that the underlying bill not only provides less funding, which now presumably would be corrected with the Weldon amendment, but also has some significant changes in the authorization of what the Sea Grant program would be all about. I much prefer the Committee on Resources version, which is why I support the Saxton amendment, because the Committee on Resources version essentially is well thought out and continues much of the outreach in education that currently exists in the Sea Grant program. In other words, Sea Grant is not just research. Sea Grant is not just grants that are given to academia or to institutions in order to do research. It is very much an outreach program that provides education and takes that research and translates it into the field. Let me just give an example. I myself am a former Sea Grant specialist. I worked as part of what we called the Sea Grant Advisory Service. The Sea Grant Advisory Service exists in most if not all the coastal States, and basically what they do is, they go out into the community and they help marine owners and they help fishermen and they help coastal users with various problems that they have on a daily basis. Sea Grant also is involved in actual educational functions. Some of the people actually teach in the universities. There is a lot of public outreach, which is the reason the Sea Grant has received so much public support. It is a very unique program because the public supports it, because they see the direct results of the research and what is done in the universities transferred into the field. The problem with the Committee on Science version of this bill is it essentially eliminates marine advisory services, it essentially eliminates the Sea Grant Fellows Program, it eliminates a lot of the education and outreach programs that are an integral part of Sea Grant. For that reason, I support very much the Saxton amendment because the Committee on Resources continues these outreach and educational activities. I have no problem with increasing the funding, but that does not take away in any way from what the Saxton amendment would accomplish.

Mr. PALLONE. I yield to the gentleman from California.

Mr. PALLONE. Reclaiming my time, Mr. Chairman, absolutely not. Let me give an example, if I could. When I worked at Rutgers University as a Sea Grant extension specialist, many of the people that were there actually had 3 functions. One was what we called research, one was teaching, and one was outreach. I was totally outreach. I used to just go out in the field with the marine owners, the fishermen, whatever, and work with them. But basically what would happen, there would be people at Rutgers doing research, often that had direct applicability to what was going on in the field. [[Page H 9928]] For example, research would be done on how to improve, for example, certain types of fish species or prevent pollution, and then we as extension specialists would go out and apply that research actually with the fishermen. Of course there was also the teaching element, those who would teach at the university. The unique relationship between those 3 things, extension, research, and academia, was very important. I think if we eliminate the extension, which is one of the things that is in this bill essentially, we are going to really eliminate a lot of the public support as well as why Sea Grant makes sense.

Mr. PALLONE. Mr. Chairman, I would disagree with the gentleman completely. I think maybe that is one difference between the Committee on Resources and the Committee on Science. They put the emphasis on the research and the academia. We on the other hand are looking at the practical application of those skills in the field. I would argue just the opposite that those are just as important if not more.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, on October 10, 1995, the Republic of China on Taiwan celebrated its National Day. This day of celebration marks the occasion of the end of more than 3,000 years of dynastic rule. I salute the great changes that have been undertaken by the people of Taiwan to transform their country into one that respects the right of the individual to participate in democratic self-rule. While Taiwan's National Day is a happy occasion, we here in the United States must be concerned by the recent heightening of tensions in the region. The People's Republic of China (PRC) has undertaken a program of intimidation toward Taiwan. The PRC has launched missiles less than 100 miles off the coast of Taiwan, staged ``Island Landing'' military exercises and openly threatened mock naval blockades. All because democratic Taiwan continues to seek greater international recognition. The United States has an important role to play in this situation. President Clinton will be meeting with PRC President Jiang in New York as part of the celebration of the 50th anniversary of the United Nations. Under the Taiwan Relations Act of 1980, the United States has an interest in promoting a peaceful solution to the Taiwan situation. I do not think the PRC's actions reflect a move toward peace, and our President needs to remind the PRC of our goals. Taiwan will have open Presidential elections in March 1996. The two primary political parties have nominated their candidates, and even a powerful independent candidate may take the stage. We have promoted the ideal of democracy throughout the world. Now that it is a reality on Taiwan, we must do what we can to maintain it. Again, I want to congratulate Taiwan on its National Day, and send warm regards to President Lee Teng-hui on his country's amazing success.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise today to pay tribute to the visiting doctors from Zhong Shan Hospital and welcome them all to the United States. The visit is being celebrated at a reception and dinner on Tuesday, October 17, 1995. The visit reciprocates the very successful and beneficial visit that representatives from the Robert Wood Johnson University Hospital, [[Page E 1940]] the University of Medicine and Dentistry of New Jersey, and the Robert Wood Johnson Medical School made to Shanghai last year. These exchange visits are designated to improve the knowledge and understanding of knowledgeable practitioners of our two countries. It is therefore a sincere pleasure to recognize this visit as an important step in what I believe is the right direction for the future. As globalization of the economy and the environment increase in importance these joint efforts to establish good relationships enabling important scientific research to be shared across borders will be of significant importance to us all in the future. We will all benefit from this initiative establishing this highly successful relationship at such an early stage. I find this effort to correspond perfectly with the needs of tomorrow's world, and I applaud the cooperation of these sister hospitals in making this joint effort such a success. It is my firm belief that this joint effort by these honorable institutions will contribute not only to my constituents but to many other people across both our countries. I would therefore once again like to welcome these distinguished visitors to our country and ask my colleagues to join me in offering these two hospitals the best of luck for their future cooperation.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I was astonished yesterday, as a member of the Committee on Commerce, to watch while a group of about 15 or 20 senior citizens came into the room, asked to speak, were denied the opportunity to speak or say anything about Medicare which is going to affect them so greatly, and then were told that they were going to be arrested, were actually arrested, handcuffed, put into a paddy wagon, and taken down to the Capitol Police to be booked or whatever. I know the charges were eventually dropped, but it was a very sad day to know there was really no opportunity for these seniors and for America's seniors in general to be heard on an issue so important as Medicare. Then I watched as the Republican leadership on the committee proceeded to mark up a Medicare bill that essentially destroyed Medicare as we know it. What that bill will do is to force most seniors into HMO's or managed care. It will make those who would like to continue to be able to choose their hospital, their doctor, in a traditional fee-for-service program more and more be squeezed out of that program where they have no choice. It is a sad day for America.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I would like to continue with part of what I was talking about earlier today, and, that is, the new Republican leadership Medicare plan which I say new because as a member of the House Committee on Commerce, I first received the actual legislation not yesterday, but a week ago Monday on the day when the Committee on Commerce was expected to mark up the bill without any opportunity for a hearing. As a consequence, the Commerce Democrats decided to have their own hearings a week ago last Tuesday, on October 3, and there were a number of things that came out of that hearing that were very interesting in terms of where this Republican Medicare plan is taking us. The concern that I have or one of the major concerns that I have is that this bill seeks to lure seniors into HMO's or other managed care programs with no choice of doctors in order to try to achieve the $270 billion in savings that are proposed. If seniors do not move into managed care plans, budgetary gimmicks would kick in to take even more money out of the Medicare system. So I consider this plan a very unhealthy plan for the future of Medicare. Let me talk a little bit about the concerns I have and why I say that it will force essentially seniors into HMO's or managed care systems. One of the concerns that I had a few months ago was that the Republican plan was going to basically put forward a voucher system whereby the Federal Government would give the senior a certain amount of money in a voucher or coupon and that if that was not enough to pay for a good quality health care plan, the senior would have to make up the difference by putting out more money. [[Page H 9766]]

Mr. PALLONE. One of the things we found in this bill is that only a set amount of money would be directed to pay for the HMO or the managed care plan and that seniors, if they wanted a better plan or if they felt that HMO did not provide adequate coverage, would, in fact, be asked or could, in fact, be asked by the HMO or managed care system to pay more out of pocket. That is the reality. That is what we have before us when we look at this, when we look at this GOP Medicare plan that is before the Committee on Commerce. It is essentially a voucher system. But worse than that is that there is a proposal, if enough savings are not achieved, in other words, if enough seniors do not opt to go into a managed care HMO system, then cuts would automatically occur a few years down the line. But the cuts, again, would be not to those people who go into the HMO or to the managed care system but rather for those seniors who opt to stay in a traditional fee-for-service system where they choose their own doctor or own hospital. All of the cuts that would come into play, if enough people do not go into HMO's or managed care, all of the cuts in the reimbursement rates to the hospitals or physicians or to other health care providers would come on the fee-for-service side. What that would mean is that eventually those hospitals and doctors that continue in the fee-for-service system, where you can choose your own doctor and you do not have to go into managed care, they would find less and less money coming to them from the Federal Government, and they ultimately would have to, again, move into an HMO or managed care system because it would not pay for them to stay in the traditional fee-for-service system. So what we have here is a program that essentially forces all of our senior citizens ultimately into an HMO or fee-for-service where they do not have choice of doctors. The other thing that came to light in the document that was given to the Committee on Commerce last week is that the whole discussion on the part of the Republican leadership about how they were trying to go after fraud and abuse in Medicare, well, essentially that is a hoax. Because if you look at the actual bill, it makes it more and more difficult for the Federal Government to weed out fraud and abuse in the Medicare system. We estimate that over a course of 7 years, $126 billion could be saved by reducing fraud and abuse. But the GOP bill makes the existing civil monetary penalties and anti-kickback laws considerably more lenient. According to the inspector general of the Department of Health and Human Services, who testified before our alternative Commerce Democrats' meeting, hearing last week, the Medicare restructuring legislation would substantially increase the Government's burden of proof in cases under the Medicare- Medicaid anti-kickback statute. Although a fund would be created to direct funds recovered from wrongdoers, this fund would not go to further law enforcement efforts. What that means is it is going to be harder for the Government to prove fraud and abuse because the Government would have a higher burden of proof. If we do recover monies, because we do find fraud and abuse, find these kickback schemes that have existed, that money will not go back to law enforcement. There will be less and less, and it will be more and more difficult for the Government to go after fraud and abuse.

Mr. PALLONE

Mr. PALLONE. I am very concerned, Mr. Speaker, that the Speaker, the gentleman from Georgia, Newt Gingrich, and the Republican leadership are basically moving forward with this Medicare plan that they have proposed much too fast and without any real opportunity for public scrutiny. I am a member of the Committee on Commerce, and not yesterday but the Monday previous, on October 2, we received a copy for the first time of the 421-page House Medicare restructuring legislation proposed by the Republican leadership. Later that same day, on Monday, October 2, our Committee on Commerce was expected to mark up the bill, without any opportunity for a hearing, without any opportunity, really, to even have looked at the legislation. At the time, I proposed an amendment to postpone voting until hearings were held to review the impact of the legislation on senior citizens and the health care industry. All but one Republican voted against the measure, voted against the effort to postpone until we had hearings, and, of course, the amendment failed. Because of that, many members, the Democratic members of the Committee on Commerce, including myself, felt we really were just witnessing a railroad job, and there was no point in staying at the markup anymore. Instead, on the next day, Tuesday, October 3, a week ago, the Democratic members of the Committee on Commerce called our own hearing to begin discussing the ramifications of this bill. I learned a number of things in the course of those hearings on the Republican Medicare proposal. First, I learned that of the $270 billion proposed for reductions in Medicare, nearly half would not even go to shoring up the Medicare Hospital Trust Fund, known as Medicare part A, which the Republicans, and I believe falsely, are suggesting faces insolvency. Instead, the seniors would be asked to pay more for physicians' and outpatient services under what is known as Medicare part B, and premiums would double from $46.10 per month over the next 7 years to over $90 a month. I make this distinction between part A and part B again because the Republicans keep talking about the insolvency, which is not really true, of part A, which is the hospital trust fund. Medicare part B, though, the fund which pays for physicians' care, and where the seniors are being asked now to pay twice as much for their premiums, that Medicare part B comes out of the same fund as would $245 billion in tax cuts proposed by the Republican leadership. I would maintain that since any changes to Medicare part B do not really impact part A, they are separate funds, it is highly likely that the part B cuts would be used for tax cuts, and most of those, of course, much of that to the wealthiest of Americans. Do not let the Republican leadership fool you. Most of the money that they are talking about cutting is, in effect, going to be used for a tax cut. The amount of the cut in Medicare is almost equivalent to the $245 billion tax cut they are proposing. The other thing that I learned about this Medicare plan is that it essentially seeks to lure seniors into HMO's and other managed care programs with no choice of doctors. This is the main way that the Republican leadership proposes to save a lot of money, if seniors do not move into managed care plans. There are budgetary gimmicks in this legislation that would kick in and take even more money out of the Medicare system. Previous to having received this Medicare legislation, I had talked on the House floor about the Republican proposals for a voucher system, where they would simply give a senior a voucher or a coupon for a certain amount of money and say, that is all we can afford. That is all we are going to give you for your Medicare. Of course, the Republican leadership said that is not what they had proposed as part of their Medicare program, but if you look at the details of the Medicare program, you can see that is exactly what it is. It is a voucher system, because essentially what they are doing is giving the HMO and the managed care system a certain set amount of money, and if a senior wants a better system, or if the HMO or managed care system wants to charge seniors more for a better quality health care system, then the senior has to pay for it. That is another thing that are not brought out, but if you look at the legislation, it is exactly true. Then, beyond that, if over the next 7 years or over the next 5 years we find out that not enough money is saved because not enough seniors are going into the voucher system or into the HMO or the managed care system, then all the cutbacks, the so-called failsafe, where if they do not save enough money they are going to cut back more on the reimbursement to doctors, hospitals, and health care providers, all those cuts come in the fee-for-service system, the current system where seniors choose their own doctor or their own hospital. What is effect you are going here with this Medicare legislation is saying, you either go into a voucher system, or if you do not, we are going to force you into one, because the cuts are going to come on the fee-for-service side. Mr. Speaker, I would like to talk about this more. Maybe there will be more of an opportunity later this afternoon.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I would also like to point out that one of the items that the gentleman from West Virginia mentioned as one of his top Republican outrages was the fact that there was only 1 day of hearings on Medicare last week in the House of Representatives before the Committee on Ways and Means. However, I would like to point out that in my committee, the Committee on Commerce which also has jurisdiction over Medicare, as well as jurisdiction over Medicaid, which is the Federal Health Care Program for poor people, we have not had any hearings on either one of the issues. In fact, last Friday, we reported out a Medicaid reform bill that cuts Medicaid by $180 billion and essentially eliminates the entitlement status of Medicaid, so that poor people have no guarantee of health insurance anymore. We did not have a single day of hearings on the Medicaid changes. In addition, I understand now that the Republican leadership has finally introduced a Medicare reform bill in order to implement the $270 billion in cuts to Medicare, and my committee, the Committee on Commerce, will be meeting on Monday, this coming Monday, to mark up the Medicare bill without even 1 hour or 1 minute of hearings on the Medicare bill. So here we have a situation where probably the most important change that will take place in this House and in this Congress, the effects and the changes on Medicare and Medicaid which affect millions and millions of Americans, and we will not have had a single day of hearings on either one of these bills before the time when they came to the committee to be marked up. It is indeed an outrage. It is an outrage that is out of proportion, when we think about the level of cuts; $270 billion in cuts in Medicare and $180 billion in cuts in Medicaid. Cuts that these two health insurance programs, primarily for seniors, cannot take without major changes that are going to be negative and affect the quality of Americans' health care, and particularly seniors' health care, in a very, very negative way. Fortunately, the Democrats, realizing the fact that there were not going to be any hearings on either one of these programs, decided, starting last week, to have their own hearings, alternative hearings on the Medicare Program on the lawn of the Capitol. We finished 4 days, today, of those hearings, and I want to tell my colleagues that they were very productive hearings. Mr. Speaker, I wanted to give some information about what some of my constituents said who attended the hearings, both health care providers, representatives of hospitals in my district in New Jersey, as well as senior citizens and senior citizen advocates from my home State of New Jersey. Before I get to that, I wanted to point out the fact that increasingly [[Page H 9725]] this opposition to Speaker Gingrich and the Republican leadership's Medicare cuts and Medicare changes for both Medicare and Medicaid are being opposed in a bipartisan fashion. One of the things that has bothered me the last few weeks in listening to some of the statements on the floor of this House is that increasingly my colleagues on the other side, on the Republican side, suggest that somehow this is all very partisan, that the Democrats are attacking the Republican leadership for the changes that are being proposed in Medicare and Medicaid, and that all of this is coming from the Democratic side and that we are just being very partisan about it. The reality is that increasingly, over the last weeks, it has not been a partisan battle. There has been bipartisan opposition to the Medicare and Medicaid proposals that Speaker Gingrich and the Republican leadership have come forward with. In a sampling of opposition, this Wednesday there were a number of Republican Senators who expressed concern about the Medicare proposal put forward by the Republican leadership. On Wednesday, there were three Republican Senators who voiced doubts about mixing a big tax cut with planned surgery on Medicare and Medicaid. They said in essence, look, why is it that we are cutting Medicare and Medicaid this amount in order to finance a very large tax cut primarily for wealthy people? Senator Orrin Hatch of Utah and Senator Alan Simpson of Wyoming and Senator Alfonse D'Amato of New York expressed skepticism about cutting taxes while Congress is struggling to balance the budget. They indicated strongly their concern about how they are going to make these cuts in Medicare at the same time that tax cuts were being proposed for wealthy Americans. In addition to that, I was very pleased to see that in my own home State, the gentlewoman from New Jersey [Mrs. Roukema] has expressed concern about both the Medicare changes as well as the Medicaid changes. The gentlewoman is quoted in an article that is in today's New York Times where she says she is concerned about the effects of the Medicare proposals. Mr. Speaker, the gentlewoman noted recent estimates from the Congressional Budget Office showing that most of the $270 billion in Medicare savings would be achieved by limiting payments to hospitals, nursing homes, and home care agencies. These are sobering numbers. They open up a number of concerns about whether the savings will come through a reduction of care or through the new choices that people are given. I would like to repeat again. In my home State of New Jersey, along the Jersey shore which I represent in Congress, I represent a large part of the New Jersey shore, we had three Republican State legislators. they are Senator Leonard Connors, Assemblyman Jeffrey Moran and Assemblyman Christopher Moran, all Republicans from Ocean County in New Jersey. They sent a letter to Senator Dole and also to Speaker Gingrich this week asking them to back off on the proposed cuts in Medicare because of the impacts that they could have on senior citizens. They pointed out that financing tax breaks for the rich on the backs of our elderly is morally bankrupt. The Senator and the two assemblymen, again all Republican, also were critical of the increases proposed by Speaker Gingrich in his plan in the Medicare part B coverage, from $552 annually to $1,116. they said the plan is signing a death warrant for millions of senior citizens across the country. So for my colleagues on the other side of the aisle who would suggest that somehow this is strictly the Democrats that are complaining about these cuts in Medicare and what they are going to mean for senior citizens, I tell you we have U.S. Senators, U.S. Congressmen, we have State legislators from the State of New Jersey, all Republicans who are concerned about what is happening here. They have reason to be concerned, for a number of reasons. Let me give some of the concerns expressed at the alternative hearings that were held by the Democratic Caucus on the lawn on the East Front of the Capitol this week. I attended each of those hearings. We had some representatives from my district in New Jersey who spoke out each of the days, Wednesday through today, and expressed their concerns. One of the speakers who gave testimony who I was most impressed with was Dr. Anita Curran, who is associate dean for Environmental and Community Medicine at the University of Medicine and Dentistry in New Jersey and the Robert Wood Johnson Medical School in New Brunswick, which is in my district. Dr. Curran pointed out how every aspect of health care in New Jersey as well as in this country as a whole is very interconnected and that programs like Medicaid for the poor, Medicare for senior citizens, nutrition programs, even some of the welfare reform that we have talked about on the House floor, the very cuts that impact health care in each of these programs have a cumulative effect. She represents the Robert Wood Johnson Medical School, a teaching hospital. Many of the significant cuts in Medicare affect teaching hospitals, making it more difficult for those hospitals to train residents and train doctors who are going to go into the community in the future. A lot of those doctors at the Robert Wood Johnson Medical School also work at the Eric B. Chandler Health Center, which is a community-based health center in New Brunswick that handles a lot of Medicaid recipients, poor people who are on Medicaid. What Dr. Curran pointed out is that when you cut back on the amount of money going to teaching hospitals, like Robert Wood Johnson, you are also having an impact on the community health center because there will not be the teachers there to work at the community health center and help the poor and needy people in New Brunswick and in the area served by the Eric B. Chandler Health Center. Also, the Medicaid dollars that are being cut for the health center through Medicaid are going to have an effect on the teaching hospital because now all of a sudden there is less money coming in through Medicaid as well. So the cutbacks in Medicare and the cutbacks in Medicaid do not just affect seniors, they do not just affect poor people, they also affect everyone. Essentially, if the hospital in the community does not have the money to operate and either has to close or cut back on services either for inpatients or for outpatients, everyone suffers, and that is the dramatic impact of these cuts both in Medicare and Medicaid. We had other people that spoke at the hearings that were held out on the lawn. I wanted to mention Margaret Chester, who is executive director of the Middlesex County Office on Aging in my district. She spoke very eloquently about the programs and how these cutbacks are going to affect the senior population that are helped by the Middlesex County Office on Aging. One of the things I asked about, which was particularly disturbing, again points out how the interrelationship between cuts in Medicare and Medicaid, are a group of seniors or elderly who are called qualified Medicaid beneficiaries. These are seniors who are low income. I think they cannot be making more than about $625 a month through Social Security or pensions or whatever they get. And right now under current law, their Medicare part B premiums the premium that they have to pay in order to have their doctor bills covered through Medicare, that money is paid by Medicaid. So even though they are on Medicare, the program for seniors, and they have to pay this premium to get their doctor's bills paid, Medicaid says for that Medicare part B premium. Under the Medicaid bill that was passed out of the Committee on Commerce, my Committee on Commerce last Friday, there no longer is any guarantee that Medicaid will pay that part B premium for those elderly and poor Medicare senior recipients. Where are they going to get the money? Where are they going to get the money to pay for that part B insurance to cover their doctor bills? They are already so poor that they barely can make ends meet. Their Medicare part B premiums under Speaker Gingrich and the Republican leadership proposal are going to double over the next 7 years. So, if they were paying $40 now, they are going to be paying probably $100 within [[Page H 9726]] the next 7 years. Yet they do not have Medicaid paying for any part of it anymore. There is no way that they can afford to pay that. The end result is that, if some of the States decide not to take on that extra burden, they are simply going to be out on the street. They will not have any health care. Last, today at our alternative Medicare hearings, we had two senior citizen advocates from my district, one is Dave Sheehan, who is the director of the Edison Township Senior Center in Edison, NJ, and also Dave Keiserman, who is State chairman of the New Jersey Council on Senior Citizens. And what they pointed out and what I wanted to reiterate today is how unable, how difficult it is going to be, if not impossible, for seniors who now receive Medicare to pay these additional payments out of pocket that have been proposed in both the bill put forward by the Republican leadership in the House and the bill put forward by the Republican leadership in the Senate. I already mentioned some of the proposals in the House bill with regard to Medicare part B that pays for doctors' expenses for seniors, doubling of the part B premiums over the next 7 years. How can these seniors, most of whom make less than $25,000 a year, something like 75 percent of the seniors in the country make less than $25,000 per year, how are they going to be able to pay double their part B premiums? But if you look at the Senate bill, the one that is being considered on the other side of the Capitol, they go beyond the increase in the part B premiums. They talk about doubling the part B deductible from $100 today to $210 in 7 years. They talk about also delaying eligibility for Medicare from age 65 to age 67. We really do not know how far these additional out-of-pocket payments are going to go. We have heard now about increased deductibles, increased part B premiums, raising the age of eligibility for seniors for Medicare. Where do we go from here? Well, the bottom line is that increasingly what we are finding, when these Republican leadership proposals go to the Congressional Budget Office, is that there are huge gaps in how much money they can actually save. There is a real question about whether or not any of these proposals on the Senate side or the House side are going to be able to save $270 billion to achieve that level of cuts in Medicare. And so what I think is going to happen is that we are going to see more and more of an effort to try to find more and more of that money to pay for those cuts out of increased out-of-pocket costs to the beneficiaries, to the senior citizens. Do not be surprised to see larger deductibles. Do not be surprised to see copayments. Do not be surprised to see eligibility going from 65 to 67 or maybe even to 70. Do not be surprised to see even larger Medicare part B premiums than what has already been discussed. I just wanted to spend a little time, Mr. Speaker, if I could, on Medicaid, the program for poor people, which I would point out again, 70 percent of that money in New Jersey for Medicaid goes to pay for senior citizens and those who are primarily in nursing homes. The figure for the rest of the country is pretty much the same. A majority of the money that we now spend on Medicaid, even though it is a program for poor people, is for senior citizens, most of which pays for nursing home care. The bill that our Committee on Commerce reported out on Medicaid last Friday was a travesty. We had no hearings, again. Whatever they do on Ways and Means, we do not have any hearings in the Committee on Commerce. We get the bill and then the next day we have the markup, and we do not even have an opportunity to have a hearing at all. In the Committee on Commerce, the Medicaid bill that was reported out was indeed a travesty. The New York Times, in an editorial on September 26 called it a cruel revision of Medicaid. Just let me give you a sentence for two. They said, ``Congress shows no signs of slowing its assault on the social safety net stitched together over six decades. The House Commerce Committee tore another hole in the net on Friday by eliminating the Federal guarantee of Medicaid insurance.'' Essentially, what the Republicans did in this Medicaid bill was to eliminate the entitlement statute for Medicaid. So in effect, there is no guarantee that anyone gets Medicaid coverage anymore. They send the money in a block grant to the States, and they leave it up to the States to decide what they want to do with the money, with very few strings attached. I have to tell you, Mr. Speaker, I had a forum last Monday, actually it was Tuesday, in my district, after this Medicaid bill had passed out of the Committee on Commerce. And I told the senior citizens at a senior center in Long Branch, the town that I live in, about some of these cuts and what they will mean, and they were really outraged. And they had reason to be outraged. One of the things that we pointed out to the seniors and really to my constituents in general is the fact that all the protections that existed under the Medicaid Program in the past, when someone had to be placed in a nursing home, all the protections with regard to the nursing home, all the protections with regard to the family of the person who went to the nursing home, the family, the spouse that had to stay back in the home or the kids that were still in the community, all those were just eliminated completely by the Republican majority on the Committee on Commerce. There are no longer any nursing home standards. The money goes to the States in a block grant. The nursing homes can do what they want unless the States come in and start regulating them. So all the concerns about proper sanitation in nursing homes, code enforcement in nursing homes, proper care, that there are nurses that are visiting the patients in nursing homes, none of that has any Federal protection anymore. Just as bad was the fact that the protections for the spouse who has to stay at home were eliminated. Right now, under current law, if your husband goes to a nursing home and you are the woman who stays at home, you get to keep your home, you get to keep your car. And you get to keep about $14,000 in a savings account that they cannot go against you to pay for that nursing home care for your husband who is in the nursing home. That is all out the window now. If a State wants to, they can simply go after those assets or include those assets in calculating whether or not someone is eligible for Medicaid placement in nursing home. They also eliminated all the protections under current law for children. So there is nothing to prevent a State, if it wants to, to say, your dad is now in a nursing home and so we are going to go after your house, the children, or we are going to go after your assets to pay for his nursing home care. Again, all those protections were simply eliminated. The other thing that happened, which I found extremely disturbing, is that the Federal law right now with regard to Medicaid, links the actual reimbursement rate that is paid to nursing homes to a standard based on the amount of money that is necessary to pay for adequate care. In other words, the States, under current law, have to give the nursing homes enough money to pay for adequate care of the person who is in the nursing home. That was abolished. We had a vote on it. Again, it was voted down by the Republican majority. So what we are going to see increasingly is less money going to the States, no safeguards for the States, the States paying less and less money for nursing home care that is less than adequate, and no way to make sure that under Federal law that those nursing homes are adequate and provide proper care. The last thing that I wanted to mention, going back again to the fact that this is not at all a partisan issue, and I hate the fact that it keeps being characterized as such, is that in my home State of New Jersey, in a lot of the other States around the country, many of the Republican elected officials have been very critical of this Republican leadership Medicaid proposal because of the formula that is being used to decide how much the individual States are going to receive. I would point out that it really does not matter what the formula is because since there is going to be so much less money going to the States to pay for Medicaid, however you figure out the formula, the States are not going to have enough money to provide adequate care. But I want to commend my [[Page H 9727]] Governor, Governor Christine Whitman, and also the members of my State delegation, the Republicans in my State delegation, New Jersey, all of whom have protested to Speaker Gingrich and to the Republican leadership that the formula for Medicaid is inadequate and certainly unfair to the State of New Jersey. Now what the Governor of New Jersey pointed out is that in the next year, in 1996, there will be a 7.2-percent Medicaid grant increase to the States under the formula that Speaker Gingrich has put forward, but after that, for the fiscal years from 1997 to 2000, there is only a 2- percent annual increase in the amount of money the States get to provide for Medicaid expenses, and essentially what the Governors said, and I quote, is that ``we cannot achieve that level of savings, we cannot operate that program with the level of money that we are going to be getting from Medicaid.'' So, if I could just conclude by pointing out again, as much as most of the people opposing this Gingrich plan are Democrats, there are a lot of Republicans in my State and in other parts of the country at every level, whether it is the Senate, whether it is the Governors, whether it is the other members of our congressional delegation, or State legislators who are pointing out that there is absolutely no way that we can continue to provide adequate care under the Medicaid Program for our poor people and particularly for our elderly who are the main beneficiaries of the Medicaid Program, and the same concerns are now being expressed as well on the Medicare Program, that this level of cuts that are being proposed by Speaker Gingrich and the Republican leadership are simply inadequate to provide quality care for our seniors and for the people who are part of the Medicare and Medicaid Programs. Mr. Speaker, I am pleased to see that the cracks are starting to show, that we are seeing a slowdown in effect in the effort to try to move both of these bills through Congress. We have a week now, next week, and there will be no votes on the floor of the House of Representatives on any bills, and I am hopeful that the momentum will continue to build during this next week so that, when we come back around Columbus Day, there will be even more and more opposition on a bipartisan basis to these terrible changes that are being proposed in the Medicare and Medicaid Programs.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to report how more and more conservative Republicans at the Jersey shore, which I represent, are coming out against Speaker Gingrich's Medicare cuts. If I could read from the Asbury Park Press in my district yesterday: State Senator Leonard T. Connors and Assemblyman Jeffrey W. Moran and Christopher Connors, all Republicans from Ocean County have written to Bob Dole and Speaker Gingrich to ask them to back off on the proposed cuts because of the impact they could have on senior citizens, and I quote: ``Americans want Congress to cut the pork, but balancing the staggering Federal deficit or financing tax breaks for the rich on the backs of our elderly is morally bankrupt,'' the lawmakers stated in their letter. Mr. Speaker, they also said, ``Jacking up Medicare part B coverage from $552 annually to $1,100 under your announced plan is signing a death warrant for millions of senior citizens across America. To save electricity, the seniors live in darkness. Their diet is poor. They scrimp and save for goods and services middle-class Americans often take for granted. A $564 increase in their Medicare premium is a stake in the heart,'' the Republican legislators wrote.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, last week the other body, the Senate, approved a provision to the fiscal year 1996 Foreign Operations Appropriations bill that would permit the transfer to military equipment to the Government of Pakistan. This provision was not included in the House version of the bill, and it is my strong belief that the conferees should not adopt this provision in the conference report. The provision adopted last week, if enacted into law, amounts to a waiver of the Pressler amendment, named for the Senator who sponsored this provision which became law 10 years ago. This law prohibits U.S. military aid to Pakistan if the President cannot certify that Pakistan does not possess a nuclear explosive device. President Bush invoked the law in 1990 when it became abundantly clear that Pakistan was not in compliance with this provision of American law. Nothing has changed in the last 5 years. Indeed, supporters of this provision do not claim that Pakistan is now in compliance with U.S. conditions. Their argument, rather, seems to be that we should provide the arms in spite of Pakistan's flouting of the U.S. conditions. Mr. Speaker, this arms transfer would have the effect of undermining the ongoing commitment of the United States to nuclear nonproliferation. It would also heighten regional instability in South Asia. And it would send the message that countries that disregard clearly stated U.S. conditions for aid can simply ignore those conditions and ultimately be rewarded. Mr. Speaker, The New York Times on Saturday, September 21, 1995, published the following editorial, which very concisely sums up why this arms package should not be adopted as part of the fiscal year 1996 Foreign Operations Appropriations bill. The Wrong Message to Pakistan In an unfortunate reversal, the Senate voted on Thursday to lift some of the military sanctions that were imposed on Pakistan five years ago. Pakistan has made no concessions to American requests that it cap its secret nuclear weapons program, and until it does so, and allows verification, it should not be the beneficiary of American military aid or be allowed to buy American military hardware. South Asia has long been considered one of the most dangerous regions in the world for nuclear proliferation. India has tested a nuclear bomb and Pakistan wants to match its capability. The Clinton Administration has concluded that Pakistan's secular, relatively democratic government should be supported. That is fair enough. But the way to do so is not with the military assistance program advanced by the White House and approved by the Senate. It would allow delivery of $368 million in military equipment to the Government of Prime Minister Benazir Bhutto. Relations between Washington and Islamabad have been tense since 1990 after Pakistan violated its promises and began stockpiling nuclear materials and the United States refused to deliver 28 F-16A fighter planes that Pakistan paid for in 1988. That decision was part of a ban on military assistance to Pakistan imposed to discourage its development of nuclear weapons. The Senate would now allow reimbursement to Pakistan for the planes, which is a reasonable compromise. But the loosening of sanctions should have stopped there. To resume military aid to a country that is secretly developing nuclear weapons and defying American nonproliferation policy makes no sense. American intelligence agencies have concluded that Pakistan possesses M-11 missiles acquired from China that can carry nuclear warheads. The Clinton Administration could have improved relations with Pakistan by simply removing the barriers to economic aid. A poor country, Pakistan already directs too many of its resources towards the military, at the expense of its citizens. The Senate measure was passed as part of the foreign aid bill. No similar provision exists in the House version. The House should not accept the Senate measure when it comes time to reconcile the bills. The United States should not be contributing to an arms race on the subcontinent.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, today is Wednesday, and the House is back in session. I was told that today in the Committee on Commerce, which I am a member of, that we were going to have a Medicare bill from the Republican leadership and that we would begin marking up the Medicare bill today. Of course, we did not receive a bill. We do not know when we are going to receive a bill. The latest information is that apparently a bill may be forthcoming either Friday or sometime over the weekend, or maybe not for another week or so. So the clock keeps ticking and still Speaker Gingrich and the Republican leadership have not given us a Medicare bill. I think it is very unfortunate. We really do not know what the Republican leadership is proposing with these vast changes in Medicare that have gradually been leaked out, and we certainly have not had any opportunity for any real hearings. As some may know, the House Committee on Ways and Means had one day of hearings last week. That obviously was not acceptable. We think the Democrats feel, and I feel very strongly, that we should have about a month worth of hearings and debate on something so important as Medicare. As a result, we have decided to have alternative hearings, and today was the second day of those alternative hearings out on the lawn in front of the Capitol where we heard from people from various parts of the community about the problems with the Republican leadership's proposal to change Medicare and take some $270 billion in cuts in Medicare in order to fund tax cuts primarily for the rich. Mr. Speaker, I just wanted to say, I was very pleased today, because I have noticed now that not only on Medicare, but also on Medicaid, the health care program for poor people, that this is no longer a partisan issue in my home State of New Jersey. Increasingly, Republican legislators have come out, both on the State and the Federal level, and criticized their own party for what is happening to Medicare and Medicaid. On the Medicare program for the seniors, today, or I guess it was yesterday, in Ocean County, which is the county that I used to represent, three State legislators, including Senator Conners and also Assemblyman Moran, both of whom have been in the State legislature for a long time, came out and had a press conference, sent a letter to Senator Dole and to Speaker Gingrich saying that they should scrap the Medicare proposal as it is, said that it was not fair to take away the money from Medicare to the tune of $270 billion and use it to finance a tax cut for wealthy Americans. They asked the Speaker and Senator Dole to simply throw the thing away. They pointed out, which I thought was very significant, that the proposal by Speaker Gingrich to double the Medicare Part B premium for doctor bills over the next 7 years was totally unacceptable and that seniors in their part of New Jersey, in Ocean County, would not be able to pay that Part B premium. This is something that myself and other Democrats have been complaining about now for several weeks but now we are also seeing Republicans in New Jersey coming out very strongly against these proposals. One of the worst things that happened, not only with regard to Medicare but also with regard to Medicaid is that my own committee, the Committee on Commerce, last Friday reported out the Medicaid bill that essentially the Republican leadership had put together. I have rarely seen such a travesty committed against the American people, particularly poor people, particularly elderly people. The New York Times in an editorial today called it a cruel revision of Medicaid. They said, ``Congress shows no signs of slowing its assault on the social safety net stitched together over 6 decades. The House Commerce Committee tore another hole in the net on Friday by eliminating the Federal guarantee of Medicaid insurance for millions of poor families. At the same time it voted to slash Federal Medicaid spending, virtually forcing States to kick millions of poor children out of the program.'' Let me tell just briefly some of the things that the Committee on Commerce did on Friday by a strictly partisan vote, all the Republicans voting for it and most except I think for one Democrat voting against it. First of all they eliminated all standards for nursing homes. They are giving money under Medicaid to the States for the [[Page H 9571]] Medicaid program which primarily pays for nursing home care in this country and they are eliminating all nursing home standards. Basically unless the State steps in, the nursing homes can do whatever they want. The other thing they did was to eliminate any protection for seniors, the spouse who stays back at home when the other spouse goes to a nursing home. Right now if your spouse has to go to a nursing home and pay for it by Medicaid, you can keep your home, you can keep your car, you can keep something like $14,000 in assets. That is gone. The assault on senior citizens both with the changes in Medicare and Medicaid continues. It is very unfortunate. I think it is incumbent upon us to continue to speak out against it.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, today is Thursday, September 21, and we still have no Medicare plan from Speaker Gingrich and the House Republican leadership. As you know, we were supposed to have it yesterday, and today was supposed to be 1 day of hearings before the House Committee on Ways and Means on the plan. Instead, the meeting was delayed. It is now scheduled for tomorrow, and we still have no Medicare plan to outline how the Republican leadership is going to cut $270 billion from Medicare over the next 7 years. The Democrats feel very strongly there should be at least 4 weeks of hearings on Medicare and Medicaid. We tried to bring that up in the House yesterday and were denied that by the Republican majority. Instead, we are going to have to have our own alternative hearings starting tomorrow and going into next week just so that the [[Page H 9366]] American people can find out what the Republican plan is for cutting Medicare and Medicaid, how they are going to implement it, and how they are going to figure out what they are going to do to prevent the fact, to prevent all the tax cuts for Medicare cuts.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I just wanted to thank the gentleman from Texas again for doing this special order tonight. I really will say once again that that chart that he has up there that says ``the GOP Medicare plan, pay more and get less,'' really says it all. This is what the seniors are increasingly telling me in my district and throughout the State of New Jersey. They understand that this is nothing more than a tax increase and a reduction in services. You cannot take the amount of money that we are talking about here, a $270 billion cut in Medicare--and I also notice that the rest of my colleagues talked about the cuts which are, I think, $180 billion in Medicaid as well--you cannot take that level of cuts in these programs without either reducing the quality of service or charging senior citizens more for what they are getting for health care. The reality is that what the Republicans are talking about essentially are doing both, because they have already told us. I know my friend, the gentleman from Michigan [Mr. Bonior], mentioned some of these things before. We have already heard about at least three possible implementations of this Medicare cut that would increase costs to seniors and in effect amount to a tax increase. One is on the Senate side, the increased co-payment, I believe, for Part A for hospital care from $100 to $150. We have heard about the Gingrich proposal with regard to Part B that pays for physician services, that in essence doubles you premium for Part B over the next 5 to 7 years; and we have also talked about means testing. I know that there has not been a lot of discussion in general about means testing, but this idea that we are going to charge wealthier people more for their Medicare premiums, for their Part B premiums, to the point where at some point they would not have any subsidy, would have to pay the whole cost of their Medicare premiums, well, right now the Republican leadership is talking about a $75,000 threshold for that. In other words, you would have to be making at least $75,000 before they start charging you that tax. But the bottom line is, I know from my own experience and I have seen it in the State legislature and here in Congress, those thresholds start to go down very quickly when the Republican leadership of the Congress is looking for extra money. So do not be surprised, New Jersey residents or Americans, if next year it is 65 and the following year it is 50 and then it drifts down to 40. I have heard some of my colleagues already talking about a $35,000 threshold. We know that there is a huge gaping hole here. On the one hand they have these various tax increases which I just mentioned. On the other hand they have cuts in providers' fees, cuts in the amount of reimbursement that is going to go to hospitals or other health care facilities. Those things are going to result in less quality care. The hospitals in New Jersey, we have already identified through the New Jersey Hospital Association 76 hospitals that are on the critical list, that if they have any significant, and I am not talking about the level of cuts that we are talking about here but any significant cuts in Medicare or Medicaid, some of them are going to close and a lot them are going to significantly reduce their services. But beyond that, beyond paying more for those taxes, as the gentleman from Texas said, beyond getting less because of the quality of care and because hospitals and other providers are going to reduce the services that are available, we still have this gaping hole which we know that the Republicans are saying, ``Well, if all this doesn't squeeze enough money out of this system, then in a few years if we find out that we haven't saved enough, then we're just going to have to go back to the drawing board and come up with either more tax increases or more cuts in services.'' What is that going to mean? Again, it is going to be more tax increases. You will see those premiums for part B going up even more. You will see that means-test threshold going down. You will see those co-payments or deductibles increasing, and at the same time you will see less and less money going to the hospitals and going to those who are providing the services. There is no way to provide this level of cuts, to make this level of cuts in Medicare and also Medicaid, without having to pay more and get less, just as the gentleman says. I think that the Republicans and the leadership should fess up and say, look, this is a major tax increase, this is a tax increase on seniors that is going to pay for a tax cut for a lot of well-to-do Americans. They might as well admit it because every day we see, as this unfolds, and it has not unfolded completely, there are still a lot of details that we have not gotten, but as it unfolds we see more and more that that is the bottom line and that is what we are getting. I just wanted to congratulate again the gentleman from Texas and the gentlewoman from Connecticut for putting this together, because we have got to bring that point home.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, on Friday, I met in New Jersey again with a number of senior citizens as part of an outreach that myself and some of the other Democratic Congressmen in New Jersey have been doing on a regular basis. This time we were in Gloucester Township in Congressman Andrews' district and we had about 200 or 300 senior citizens who were very concerned about the Republican proposals to cut Medicare by $270 billion. Mr. Speaker, the problem that the seniors had is that they feel very strongly that they are not getting enough information about exactly what the Republican plan is, and the fact of the matter is, they are right. We are still not provided with the details about what Speaker Gingrich and the Republican leadership intend to do with the Medicare Program. Last Thursday, the Speaker and Senator Dole released their so-called plan to reform Medicare, but unfortunately, once again, the plan falls far short in regards to any specific details, and the plain fact is that the Republicans have still not offered any substantive Medicare plan. We do know certain things though. We do know that the cut, the $270 billion, is the largest cut in the history of the Medicare Program, and we also know that there is no way to implement that level of cut, that magnitude of cuts in Medicare without at the same time charging seniors more for Medicare and providing them with less services. My friend from Texas had the sign that he was using before and I will hold it up again. It says, the GOP Medicare plan, pay more, get less. The bottom line is that no matter how we cut it, when we talk about a level of $270 billion in Medicare cuts, it is going to mean more out of pocket for the average American senior and it is going to mean less services. Mr. Speaker, I am glad to see that over the last few days that we are starting to see more and more media reports explaining that fact. Today in the Washington Times there is an article on the front page. It says: ``Medicare Solution Looks Like the Problem. GOP Fears Specter of a Tax Increase.'' Already, we have heard about several tax increases or proposals from either the Senate Republicans or the House Republicans that would result in more money coming out of pocket from America's seniors. We have heard Speaker Gingrich, who last week indicated that the part B premium, the premium that pays for physicians' bills, for doctors' bills, is likely to go up so that within the next 7 years it is doubled and seniors will be paying twice what they are now paying for their part B premiums. We have also heard about the means testing. That was another proposal that came out of the House Republican plan. So far, they are talking about means testing only people at higher income levels, but I would contend to you that once you start down that slippery slope of means testing and charging people with higher incomes more for their Medicare premiums, their part B premiums, you will see that in future years, Congress will move toward lowering the threshold and that more and more middle class seniors will end up not having any kind of subsidy or any significant subsidy for their Medicare part B premium. Mr. Speaker, it is mentioned again in today's Washington Times that in the Senate Republican plan, they are talking about increasing copayments. So now we are also hearing proposals with regard to part A that pays for hospital bills to increase the copayment from $100 to $150. The bottom line is no matter how you cut it, we are talking here about more money out of seniors' pockets, and what is it for? All to pay for a tax cut, most of which will go toward the wealthiest Americans. I was very pleased today to see that there was an article in the Washington Post by the commentator, E.J. Dionne, Jr. It says, ``Blue Smoke and Medicare,'' and if I could just read some relevant sections from it, Mr. Speaker. It says, and I quote: The Republicans should admit that the Medicare fight is not primarily about the threatened bankruptcy of the Medicare system. The Republicans did not get into these big Medicare cuts because they feared for the system's solvency. If that were true, they would have made a lot of noise last year when Medicare's trustees issued a slightly more gloomy report on its finances. We know that, in fact, Medicare has never really been in better shape, that the part A trust fund that pays for hospital bills right now has a 7-year life expectancy, which is significantly more than the 2 or 3 years that was reported by the trustees of Medicare in previous years, and Mr. Dionne goes on to say that: The Republicans also have to stop denying that there is a link between their tax cutting plans and the Medicare cuts. It is simply true that they need huge cuts in Medicare and also Medicaid to finance their budget balancing promises and their tax cuts. If the Republicans really believe that these tax cuts are as right and as important as they claim, they ought to be shouting from the rooftops that their excellent tax cuts would be impossible without Medicare and Medicaid cuts. The Republicans don't want to admit this for purely political reasons. Mr. Speaker, I just want to continue to point out on a daily basis how significant the level of these cuts are and what a dramatic impact they are going to have on America's seniors, both by increasing the cost to seniors and providing less quality service.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I thank the gentleman for yielding me this time. Mr. Speaker, perhaps the most important thing about the Texas low- level waste compact is the progress it represents. This will be the 10th compact to receive congressional approval, and will bring to 45 the number of States moving forward together to meet their disposal needs. I am very happy to support its passage. The compact system envisioned by the Low-Level Radioactive Waste Policy Act was developed with the strong support of the National Governors' Association. Under the law, the difficult task of selecting disposal sites is the States' responsibility. Congress' responsibility, on the other hand, is to act quickly on the compact's request and, if all is in order, to approve it promptly. The Texas compact meets the law's requirements, and I urge my colleagues to support it.

Mr. PALLONE

Mr. PALLONE. If I could say very quickly, I think the gentlewoman from Connecticut is absolutely right. What she is pointing out even more so in the general sense is that this does not just effect senior citizens. Obviously we are very concerned about seniors; otherwise we would not be here. This affects the entire health care system and impacts everyone, not only because the quality of care is going to go down and you will have hospital closures, but you will have less community service, and that means that people just will not have access to quality medical care the way they do now. In addition, you have so many other people, I know you were mentioning about Medicaid before and how something like 70 percent, I know in my home State of New Jersey, 71 percent of the money from Medicaid pays for nursing home care. If there are cuts in Medicaid, just as there are significant cuts in Medicare, then what is going to happen is a lot of the senior citizens are not going to be able to pay for the nursing home care, and you are going to see their own children or grandchildren having to kick in more. So the costs of all this are going to end up ultimately, and the downgrading of our health quality and health care system, is going to impact everyone. There is no way this is just a senior citizen issue.