Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, the Clinton administration is currently considering a $4 billion sale of attack helicopters to the Republic of Turkey. I am here tonight, Mr. Speaker, to express my strong opposition to this proposal. Providing these helicopters to Turkey will only serve to increase tensions and instability in a region of the world that is vital to U.S. interests and which is already plagued by conflicts and human rights violations. Put very simply, Mr. Speaker, I am concerned that the Turkish Armed Forces will use this advanced American military technology to threaten its neighbors and abuse its own citizens. Mr. Speaker, several organizations have called upon the Clinton administration to refuse an export license for the attack helicopters to the Turkish Army because Turkey has failed to make progress on human rights benchmarks set by the administration in 1998 as a condition for approval of the export license. Among those organizations working to block the export license is Amnesty International. Dr. William F. Schulz, Executive Director of Amnesty International USA, stated that, ``Based on the State Department's own annual human rights report, Turkey fails to meet the human rights benchmarks.'' Indeed, Mr. Speaker, the section on Turkey in the State Department's annual human rights report issued just a few weeks ago states that, ``The security forces continue to torture, beat, and otherwise abuse persons regularly. Torture, beatings, and other abuses by security forces remained widespread, at times resulting in deaths. Security forces at times beat journalists.'' Mr. Speaker, in a particularly relevant issue with regard to the helicopters, both the State Department and Amnesty International have reported the use of helicopters to attack Kurdish villages in Turkey and to transport troops to regions where they have tortured and killed civilians. Do we really want to see American advanced technology used by Turkey to accomplish these operations against the Kurdish people with even more ruthless efficiency? Mr. Speaker, this helicopter deal is also a danger to regional stability in the Eastern Mediterranean and the Caucasus. Recently there has been a thawing in Greek-Turkish relations, a trend which we all welcome. The sale of these helicopters to Turkey has the potential to upset this recent progress in the relations between these neighbors. It could well be seen by Greece as a destabilizing step at a time when we are seeking renewed efforts to resolve the Cyprus conflict, an issue that the administration considers a major priority. In terms of Turkey's legitimate defense needs, it was hard to see any justification for these advanced attack helicopters. Indeed, Mr. Speaker, it is apparent that Turkey is already overarmed. The neighboring country that has suffered the most from the Turkish Government's aggressive militaristic and nationalistic posture is Armenia. In the years between 1915 and 1923, Turkey perpetrated genocide against the Armenian people resulting in 1.5 million innocent Armenian civilians being murdered. In the year 2000, Turkey continues to maintain an illegal blockade of its border with Armenia, which has prevented the delivery of vitally needed supplies to Armenia. Even Turkish business people would like to see the opening of corridors of trade and transport with Armenia. Turkey has also backed Azerbaijan in the conflict over Nagorno Karabagh. Given this pattern of hostility, the people of Armenia have every reason to fear the acquisition of these helicopters by Turkey. Mr. Speaker, the Government of Turkey knows how the game is played here in Washington. They have recently signed a $1.8 million year contract for the lobbying services of several former Members of this Congress to push for the helicopter deal. I urge the administration to resist this type of pressure, and I call on my colleagues in Congress to join me in using our position as elected officials to prevent this helicopter deal. Providing these helicopters to Turkey does nothing to promote American interests or values, does nothing to promote stability, and does nothing to advance the cause of human rights.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise to commend the efforts of Chairman Bliley, Mr. Dingell, Mr. Markey, Mr. Tauzin, Mr. Oxley and our friends in the other body for reaching a consensus on legislation to promote more competition in the satellite communication industry. The conference agreement on S. 376 is landmark legislation that will finally update our nation's satellite communication laws for the 21st century. I am pleased that the conference agreement is a bipartisan bill that will encourage the privatization of INTELSAT without imposing unreasonable restrictions or penalties that will hurt consumers. Of course, if INTELSAT thumbs its nose at the standards set forth in this bill for a pro-competitive privatization, its ability to offer services in the United States could be hindered dramatically. However, this leverage is necessary to ensure that INTELSAT truly privatizes, and to ensure that we finally have a level playing field in the satellite services market. I am also pleased that the conferees made several necessary changes to the conference agreement to ensure that the Department of Defense and other agencies that protect our national security would not be harmed by any limitations imposed upon INTELSAT if it were to fail to privatize in a timely manner. This bill is explicit in its protection of our national security interests, and I especially want to thank Mr. Dingell, the Ranking Member of the Commerce Committee, for including this language in the bill. It is also important to note that this bill eliminates several antiquated statutes that have hindered the growth and expansion of satellite communications companies. In particular, this bill will enable Lockheed Martin to complete its acquisition of COMSAT Corporation. I am confident that this merger will enhance competition in the satellite services market, and I urge the FCC to act on this merger as soon as possible. American companies like Lockheed Martin and COMSAT deserve the right to compete in the global satellite market now without any further delay. I want to thank all of the members and staff who worked so hard on this important legislation. I urge its immediate adoption.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, in a little more than a week, President Clinton will embark on an historic trip to South Asia. It will mark the first time a U.S. President has traveled to this vitally important part of the world since President Jimmy Carter went to India in 1978. Mr. Speaker, yesterday, President Clinton announced that Pakistan would be part of his South Asian itinerary. Although I had previously opposed including Pakistan on the itinerary, in light of yesterday's announcement, I hope the Presidential visit will provide an opportunity for candid, productive discussion between our President and the generals in Pakistan now with regard to the need to dramatically change Pakistan's course in a number of key areas. It is important that President Clinton express to Pakistani General Musharraf that the United States is very concerned about Pakistan's role in fomenting instability in Kashmir, about the links between Pakistan and terrorist organizations, and about Pakistan's role in the proliferation of nuclear weapons and missile technology. I think that General Musharraf and the other leaders of the Pakistani ruling junta must hear the message that the United States does not consider last year's military coup to be acceptable, and that the overthrow of a civilian government cannot be allowed to stand as a permanent condition in Pakistan. Mr. Speaker, I include for the Record an editorial that appeared in today's New York Times called ``Troubled Trip to Pakistan'' as follows: [From the New York Times, Mar. 8, 2000] Troubled Trip to Pakistan President Clinton's decision to include a stop in Pakistan in his visit to South Asia later this month should not be seen as an American endorsement of Gen. Pervez Musharraf, that country's military ruler. Since seizing power last October, General Musharraf has ignored Washington's concerns in three vital areas. He refuses to cut links with international terrorist groups, resists treaty commitments to curb Pakistan's nuclear weapons program and declines to take steps toward restoring democratic rule. For these reasons, Mr. Clinton would have done better to skip Pakistan, limiting his visit to India and Bangladesh. But since he has chosen to add a stop in Islamabad, he should use his time there to encourage constructive changes in Pakistani behavior. Administration officials concluded that a snub of Pakistan might drive the country toward even more belligerent conduct. With only 10 months remaining in Mr. Clinton's term, this is probably his last chance to visit Pakistan as president. He enjoyed some success interceding with General Musharraf's deposed predecessor, Nawaz Sharif, getting him to pull back from a dangerous military confrontation with Indian in Kashmir last summer. That border remains dangerous, with Pakistani-backed militants regularly attacking Indian positions. Since both countries became independent a half-century ago, Pakistan has been challenging India's control over this restive Muslim-majority state. Mr. Clinton now seems eager to offer American help in resolving the longstanding dispute. But India remains opposed to any form of international mediation on Kashmir, and without New Delhi's cooperation any American effort would be doomed. For now, America should limit its role to trying to prevent further armed clashes. Mr. Clinton should also press General Musharraf to sever ties with Harakat ul-Mujahedeen, a Kashmiri terrorist group backed by the Pakistani Army. He ought to insist that Pakistan use its close links with the Taliban government in Afghanistan to press for the expulsion of Osama bin Laden, the international terrorist implicated in the deadly bombings of two American embassies in Africa. Another goal should be to persuade Pakistan, as well as India, to sign the nuclear test ban treaty. South Asia is home to more than a sixth of the world's population and is of growing economic importance. For too long it has been neglected by American presidents. This is not the ideal moment for Mr. Clinton to visit Pakistan. He should keep his visit as brief as possible and not flinch from telling General Musharraf what he must do to win American and world respect. Mr. Speaker, this editorial basically expresses my sentiments in regard to the fact that Pakistan should not have been included on the itinerary, but now that it is, what positive steps need to be taken by Pakistan and what the President could hopefully accomplish in that regard. I want to say, Mr. Speaker, that despite my initial reservations, I hope that the President's visit to Pakistan will offer an opportunity for some straight talk on these important issues. On the issue of the Pakistani coup, Mr. Speaker, I believe that this Congress must make a firm statement of our opposition and displeasure with the seizure of power by means of a coup d'etat and that civilian, democratically-elected government be restored. Last October, right after the coup, legislation was introduced in this House by the gentleman from Connecticut (Mr. Gejdenson), the ranking member of the House Committee on International Relations. Unfortunately, that resolution has not yet been acted upon by this House. Today I am sending a letter to the distinguished Speaker of the House, Mr. Hastert, urging that this important resolution be scheduled for a vote as soon as possible. I urge my colleagues in joining me on this initiative.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, in the latter part of March, President Clinton is scheduled to travel to India. His trip will mark the first visit by an American President to the world's largest democracy since 1978. I would say that a visit to India by the leader of the free world is long overdue, and I want to express my appreciation to the President for making this historic trip. Mr. Speaker, my purpose this evening is to suggest that the President devote significant time during the trip to developing closer bilateral cooperation on defense and security issues to respond to common threats and challenges. This is an area where the need for a U.S.-India partnership is growing increasingly urgent. For years we have seen how many of the same forces of international terrorism that threaten American interests also pose a direct threat to India's security. Another common threat faced by India and the United States emanates from the People's Republic of China. In the last week, we have seen China threatening Taiwan with military force, belying Beijing's claims to favor peaceful reunification. This is, unfortunately, a familiar pattern. U.S. naval officials in the Pacific are currently trying to defuse the situation, and the administration is obviously concerned about the implications that Beijing's saber-rattling will have in a variety of areas. In this House just a few weeks ago, we passed the Taiwan Security Enhancement Act, which I supported. Mr. Speaker, I believe it is time for the United States to stop basing so much of our Asia policy on the hope of achieving a strategic partnership with China. Instead, I believe we should recognize the benefits of closer defense ties with India, a country which, unlike China, is a democracy and which, also in contrast to China, does not threaten its neighbors with the kinds of rhetoric and actions that Beijing has most recently demonstrated with regard to Taiwan. Toward this end, President Clinton's upcoming trip to India offers an opportunity to embark upon a new direction in U.S. policy in Asia. It is an opportunity to confront the threat posed by China to regional and independent national security and to make responses to this threat a higher priority. Mr. Speaker, India faces a very serious threat from China. The two countries share a border of approximately a thousand miles. In the 1960s, China initiated a border war against India and continues to occupy Indian territory. More recently, we have seen China providing missile development and nuclear technology assistance to Pakistan as well as other unstable regimes. Pakistan, a country currently ruled by military dictatorship, launched a border conflict against India last year in Kashmir and continues to threaten India in a number of ways, including by providing support and a base for terrorist movements active in Kashmir. By aiding Pakistan, China is indirectly, but in a very real sense, threatening its neighbor India. India, on the other hand, Mr. Speaker, does not engage in proliferation activities. India has developed its own indigenous nuclear weapon and missile systems, but it does not share the sensitive technology with other nations, much less with unstable regimes that support international terrorism. India does not seek to promote tensions among neighboring countries, as China has cynically done in the India-Pakistan dispute. Given Chinese behavior and the common threat it poses to the United States and India, I believe that President Clinton should use his trip to India as the occasion to launch a new Indo-U.S. defense partnership. I will be calling on the President to take this much-needed action. While this is a bold new step, I believe we can lay the groundwork now for a far-reaching alliance between the United States and India, including greatly expanded International Military Education and Training, joint exercises and other military and political links that the U.S. currently maintains with our key democratic allies around the world. Such a partnership may take some time to fully develop, but now is the time for launching it and also pondering the details. Finally, Mr. Speaker, I maintain my view that the President should not go to Pakistan on his trip to South Asia. It is important that the administration continue to send the message to Islamabad that we are very concerned about Pakistan's role in promoting instability in Kashmir, about the links between Pakistan and terrorist organizations, and the crushing of civilian government by the military junta now in power. Currently, Pakistan is not on the President's South Asia itinerary. Mr. Speaker, Pakistan has done nothing to deserve a visit by the President of the United States.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, the northeast States are experiencing--and suffering from--escalating home heating oil prices. I have heard from numerous constituents, including the Fuel Merchants Association of New Jersey, small fuel oil dealers, the New Jersey Motor Truck Association, and oilheat consumers affected by this crisis. I commend the administration for releasing $175 million in emergency LIHEAP funds to date and for working with northeast Congressmembers on this issue. I had written to President Clinton after he released an initial $45 million in emergency funds, urging him to release additional funds, and I was pleased to learn that an additional $130 million were subsequently released. I also have urged the administration to press OPEC and our major foreign suppliers to increase their production of both crude oil and home heating oil exported to the United States in order to address this problem. In addition, I asked that the administration conduct an immediate investigation of alleged price gouging by the oil industry, or at least, that the administration investigate whether or not there was some deliberate attempt by the oil industry to join forces and illegally jack up prices. I also asked the administration to convene an emergency meeting as soon as possible with the major integrated oil companies and with other refiners in order to encourage an immediate increase in refining utilization to produce additional supplies of home heating oil. I understand that crude oil production is down and that there has been a 22-percent reduction in the stocks of distillate fuel oil from last year. But, more must be done. To this end, I also am organizing, along with my colleague, Representative Fossella, a bipartisan educational briefing, which is being held this Thursday at 3:30 in room HC-8 of the Capitol for Members and staff. The briefing will enable us to discuss longer-term options to prevent these types of crises in the future and methods for creating greater market certainty. As the cold weather continues, we must act immediately to combat this crisis facing many American families.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, this week the president of the Republican of Azerbaijan, Heydar Aliyev, is visiting our Nation's Capital. President Aliyev is scheduled to meet with President Clinton this morning at the White House. He will also be holding meetings with Secretary of State Albright and Energy Secretary Richardson. I would like to take this opportunity, Mr. Speaker, to express my hope that President Clinton and the other officials in his administration will use these meetings to urge President Aliyev to work in good faith for Azerbaijan for an Azerbaijan-negotiated settlement to the Nagorno Karabagh conflict. In particular, it is imperative that Mr. Aliyev be urged to accept the direct participation of representatives from Nagorno Karabagh in the negotiations. In the minds of many, the Nagorno Karabagh conflict is viewed as a bilateral dispute between Armenia and Azerbaijan. While these two countries must obviously be part of the negotiations in the final settlement, the people of Karabagh who have their own democratically elected government must have a seat at that table. After all, it is their homeland and their lives that are at stake in this peace process. No one else should be allowed to make these life and death decisions for them. Mr. Speaker, the United States is one of the cochairs of the Minsk Group, the body under the Organization for Security and Cooperation in Europe, the OSCE, charged with facilitating a negotiated settlement to this dispute. More than a year ago, the U.S. and our Minsk Group partners put forth a plan for resolving this conflict known as the common state approach. Despite their serious reservations, both Armenia and Nagorno Karabagh previously accepted this framework as the basis for negotiations while Azerbaijan rejected it. We do not necessarily need to be wedded to this one approach for jump starting the negotiations, but we should use occasions like this week's visit by President Aliyev to call for all sides to get back to the negotiating table with no preconditions. I expect that President Aliyev will use this occasion, this meeting with the President, to call for the lifting of section 907 of the Freedom Support Act, a provision of U.S. law that prohibits direct American government aid to Azerbaijan until that country lifts its blockades of Armenia and Nagorno Karabagh. President Aliyev, backed up by the support of major oil companies, has been lobbying American officials to repeal section 907. In 1998, this Congress rejected an amendment to the foreign operations bill that would have repealed section 907 and we must hold the line. Azerbaijan has failed to meet the basic condition for lifting section 907, namely, that it take demonstrable steps to lift the blockades it has imposed on its neighbors, and such intransigence should not be rewarded. I call on our administration to use this occasion to stress to the Azerbaijani president that the ball is in his court and that the only way to lift the ban on U.S. aid is for Azerbaijan to lift the blockade. Mr. Speaker, Presidents Aliyev and Kocharian, President Kocharian of Armenia, have been meeting on a number of occasions at multilateral meetings where both countries are represented, and I welcome these direct talks and hope that they will continue. Azerbaijan and Armenia must normalize their relations with one another. They have to work for greater economic integration, development of infrastructure, and cooperation in other areas. This is the path that President Aliyev must be encouraged to follow. Indeed, the benefits to his country would be significant by opening up trade investment and assistance, that these benefits cannot begin to flow to Azerbaijan until Azerbaijan lifts its blockades against Armenia and Karabagh. I truly hope Mr. Aliyev will hear this message and not continue to believe he can play the oil card, trying to use Azerbaijan's presumed oil reserves as a way of getting the U.S. to sell out the principle behind section 907. Mr. Speaker, last week at a White House ceremony to accept the credentials of Armenia's new ambassador to the United States, President Clinton pledged to aid Armenia to achieve a durable and mutually acceptable resolution to the conflict over Nagorno Karabagh. President Clinton also praised President Kocharian and President Aliyev for their willingness to act boldly for peace. He stressed America's commitment to helping Armenia-established democratic institutions and a market economy, and noted that the progress made by the Armenian people means that the U.S. can shift our assistance from humanitarian aid to development projects. Unfortunately, the President's fiscal year 2001 budget proposal actually calls for a 27 percent reduction in assistance to Armenia. Congress will have an opportunity to reverse this, and I intend to work hard to make sure that the assistance is actually increased. Finally, Mr. Speaker, I want to renew my call for Armenia's President Robert Kocharian to be extended an invitation for a state visit to Washington. Last November 25, my colleagues in the House joined me in a bipartisan call on President Clinton to extend the invitation to President Kocharian. I see one of my colleagues on the Republican side, the gentlewoman from Maryland (Mrs. Morella), is here and she was one of those. While President Aliyev's current visit is not an official State visit, President Aliyev has been here on a State visit. President Kocharian, who was elected nearly 2 years ago, has yet to be accorded this honor. To solidify the growing bonds between the U.S. and Armenia, I believe it is time for a State visit for President Kocharian.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I move that the House do now adjourn.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I have spoken over the last couple of weeks during our special orders in the evening a number of times on various health care issues because I do believe that this new session of Congress that began a few weeks ago must focus attention and try to pass legislation that would address three major health care concerns. First and in many ways most important because it has moved the furthest and has the best chance I think of getting passed before the Congress adjourns this coming fall is HMO reform, the need to pass the Patients' Bill of Rights which is the House version of HMO reform that passed this fall that is now in conference with the Senate. The conferees have been appointed, and we understand that the conference is scheduled to meet at some time towards the end of this month, but I cannot stress enough how important it is to move quickly on the Patients' Bill of Rights. I am going to devote my time this evening to that. I did want to also mention the two other major health care initiatives that were outlined by the President in his State of the Union address and which are at the top of the Democrats' agenda and the second issue after the Patients' Bill of Rights, after the HMO reform, is the need for a prescription drug package, benefit package, under the auspices of the Medicare program. Any one of us, any Member of Congress, any of my colleagues, either Democrat or Republican, knows that when they go back home, if they have a town meeting or they stay in their office and they hear from their constituents they will hear over and over again about the problems with seniors who do not have access to prescription drugs, either because Medicare does not provide it as a basic benefit or because they cannot find an HMO or pay privately for a medigap policy or some other kind of insurance that will cover prescription drugs. They do not find either the insurance policy affordable or they do not have enough money to pay for the prescriptions on a daily or weekly basis that they need, and I should mention that tomorrow night during special orders we intend to take up that issue. The third issue, of course, is access to health insurance for the uninsured. The bottom line is that we now have about 45 million Americans that have no health insurance, and the numbers continue to grow. The President again outlined in his State of the Union address, and as one of the priorities of the Democratic agenda, the fact that we now have articulated a way to try to cover a significant number of those uninsured Americans, first by expanding the CHIPS, the kids' health care initiative, second by enrolling patients of those children who are eligible for the CHIPS, for the kids' care initiative and, third and just as important, addressing the problems of the near elderly, those between 55 and 65 who are not now eligible for Medicare because they are not old enough but who perhaps can buy into Medicare or could buy into Medicare with a little bit of help either through a tax credit or some kind of subsidy from the Federal Government. I do not think there is any question that all three of these health care initiatives need to be addressed and can be addressed in a bipartisan way in this Congress if we sit down and put our minds to it. So far, the Republicans have not moved on any of these initiatives, any of the three; and I want to concentrate tonight on the Patients' Bill of Rights because I think that has the best chance of getting passed and getting to the President's desk. I have been basically critical of the Republican leadership in the House because they dragged their feet so long on true HMO reform, and the Patients' Bill of Rights was a piece of legislation that was put together by Democrats but with the help of some Republicans, the gentleman from Georgia (Mr. Norwood) and the gentleman from Iowa (Mr. Ganske). These were physicians and health care professionals who worked with the Democrats, a small group of Republicans, in trying to put together the Patients' Bill of Rights. We had a very hard time getting a hearing, getting anything out of committee, getting it brought up on the floor. The Republican leadership put up all kinds of roadblocks and alternatives, but finally we were able to pass the Patients' Bill of Rights in the House of Representatives. I would like to outline a little bit of the good points of the Patients' Bill of Rights and why we insist, as Democrats, that this be the bill that finally goes to the President. I say that by way of contrast because on the Senate side, the other body, I should say, the other body has passed a bill that is now in conference with the House version; but the version passed in the other body is far inferior and does not really constitute true HMO reform. Before I get to the contrast, let me, Mr. Speaker, talk about what is in the House bill in the Patients' Bill of Rights and why it is so important for the average American that this legislation pass pretty much intact. I think a lot of people are aware of the abuses and excesses within the HMO system. What happens frequently, when I talk to my constituents, is they complain to me about the fact that they need a certain procedure, a certain operation, or they need to stay in the hospital a certain number of days or they need certain kinds of medical equipment and the insurance company says, no, we will not pay for it. We do not think it is necessary. The problem is that too often that is the case. Something, whether it is an operation or procedure or some kind of service or equipment, that your physician feels is necessary, medically necessary, the insurance company says is not. Well, we know traditionally that the doctors who were sworn to the Hippocratic oath and went to school to learn what is good for you should be, with you, should be making the decisions about what kind of medical care you need. That is why they went to school. That is why they became doctors. They are now hamstrung. They do not have the ability to decide what kind of medical care you get because if the insurance company will not pay for it and you cannot afford it, you are simply out. So what we really need to do, and I think the two most basic aspects of the Patients' Bill of Rights that are really crucial is, one, the decision about what is medically necessary needs to be taken from the insurance company, from the HMO, and given to the physician and you, the patient, and that decision about what is medically necessary then is once again made by the physician and the patient, not by the insurance company. The second thing is that if you are denied care, if you are told that this is not medically necessary by the insurance company, then you should have some way to redress that grievance, either by some sort of external review that is not influenced and decided or determined by the insurance company, or ultimately be able to go to court and sue the HMO for your rights or for any damages that are inflicted upon you because you were not able to have the medical procedure that you and your physician deem medically necessary. Well, unfortunately, that is not the case right now. Right now, many times the insurance company has an internal appeal procedure but they control the procedure, and they simply say we made the right decision and that individual cannot sue. Because under Federal law, in many, many cases, an employee that works for an employer who is self-insured, which most of the larger ones are, then under Federal law, what we call ERISA, there is a Federal preemption that says an individual cannot bring suit against the HMO, against the insurance company. Well, the Patient's Bill of Rights reverses all that. Basically it says the decision about what is medically necessary is made by the physician and the patient, not by the insurance company. And in order to enforce that definition about who decides what is medically necessary, there is both an internal review and an external appeal that is devoid of the influence of the insurance company because it is a panel that does not have the insurance company on it. And then, failing that, you have the right to go to sue and for the court to make a determination that that particular operation or procedure should be granted; or, alternatively, if the procedure or operation was denied and someone has suffered, that damages can be obtained from the HMO because they denied what was legally entitled. Those are the basic tenets of the Patient's Bill of Rights. There are a lot more specific items, which I would like, Mr. Speaker, to basically outline, if I could, for a few minutes this evening. And I am only going to cover the ones that I hear the most about in terms of abuses that come to me from my constituents. One is with regard to emergency services. In the Patient's Bill of Rights, individuals are assured that if they have an emergency the services will be covered by their insurance plan. The bill says that individuals must have access to emergency care without prior authorization in any situation that a prudent layperson would regard as an emergency. Now, that sounds a little bureaucratic, but basically it is saying that the insurance company cannot say, if an individual has an emergency and they think it is a legitimate health emergency, that they have to go to a particular hospital which may be much further away than the closest one, or that they have to call the insurance company and get a prior approval before they go to the emergency room. Some people say how can that be? How can they issue a call for approval if they are having a heart attack? Unfortunately, in many cases, that is the case. And in many cases they will not pay if a patient goes to the emergency room that is a few blocks away, because they say that individual should have gone to one that was 30 miles away. Well, this Patient's Bill of Rights, this bill, says that is not the case. If the average person would think, for example, that they are having a heart attack, they can go to the nearest emergency room and they do not have to call for prior approval, because it is a true emergency and there is no time for it. The second major area in terms of access to care under the Patient's Bill of Rights is specialty care. Patients with special conditions must have access to providers who have the requisite expertise to treat their problem. The bill allows for referrals, for enrollees to go out of the plan's network for specialty care at no extra cost if there is no appropriate provider in the network for covered services. So what it says is, if the HMO does not have a particular person who can handle that specialty care, and I will give an example, the HMO may have a number of pediatricians but they do not have a pediatrician who specializes in heart problems or one who specializes in kidney problems or whatever, then that individual would be able to go outside the plan's network and get a doctor who has that particular ability and there would be no extra charge to them. In addition, for individuals who are seriously ill or require continued care by a specialist, plans must have a process for selecting a specialist as a gatekeeper for their condition to access necessary specialty care without impediments. This is a situation where the HMO says an individual can go to a cardiologist, but every time they go, or maybe every other time, they have to get another referral from the primary care physician. Well, if this is a chronic illness where that individual needs the cardiologist on a regular basis, the cardiologist should be the person the patient sees regularly without having to go to their primary care physician for approval every time. That is very important for a lot of people. Because what happens is the primary care physician becomes the gatekeeper. And if he is under pressure, he or she is under pressure not to allow too many visits to the specialist, then that patient may not have access even though they have a chronic illness to the cardiologist, for example, on a regular basis. The Patient's Bill of Rights provides direct access to OB-GYN care and services for women. It ensures that the specialties of children are met, including access to pediatric specialists and the ability for children to have a pediatrician as their primary care provider. I could go on and list a number of other things that are provided and guaranteed as patient protections under the Patient's Bill of Rights, but I think I have covered enough of some of the major areas that people complain to me about where abuses exist. I do want to talk a little bit about information, though, because many people complain to me and say that their HMO, when they sign up, does not provide adequate disclosure of what benefits are provided and what is essentially in the insurance plan. That is a major problem because many times seniors sign up for HMOs and they do not necessarily know what they are getting into. They do not know the limits of it. We have in the Patient's Bill of Rights protections with regard to health plan information that says informed decisions about health care options can only be made by consumers who have access to information about their health plans and, therefore, we require managed care plans to provide important information so that consumers understand their health plan's policies, procedures, benefits, and other requirements. Now, that is a kind of a general broad statement, but I will give an example. In my home State of New Jersey, Mr. Speaker, there have been a number of situations over the last 6 months where HMOs have decided to drop seniors in a given area or for a given reason, and a lot of the seniors do not understand that that can happen. So that is the type of information that they certainly should have. I talked about the external appeals process; that individuals would have access to an external independent body with the capability and authority to resolve disputes for cases involving medical judgment. If a plan refuses to comply with the external reviewer's determination, the patient may go to Federal Court to enforce a decision about what is medically necessary. We have already discussed that. There are also a number of protections with regard to the doctor- patient relationship. Many of my constituents are surprised to learn that we have gag rulings with a lot of the HMOs today. In other words, if the HMO, or the insurer, figures that a particular operation or procedure is not going to be paid for, is not going to be covered, they will simply tell the physician that the physician cannot talk about that procedure because it is not covered. Well, it is bad enough if the doctor tells his patient that they need a particular operation and then the patient finds out the insurance company will not cover it. But imagine that the doctor cannot tell his or her patient about an operation, even though he or she feels that that patient needs it, because the HMO contract says he cannot talk about it if it is not covered. Well, that is in fact a reality for many Americans today with some of the HMOs. That is totally wrong. It violates every notion of freedom of information and free speech. I suppose it is questionable whether it is even constitutional. But we, in the Patient's Bill of Rights, specifically say that we prohibit plans from gagging doctors and from retaliating against physicians who advocate on behalf of their patients. We also prevent plans from providing inappropriate incentives to providers, to physicians, to limit medically necessary services. So, in other words, there cannot be any financial incentive, which is often the case to a physician if he cuts back on services or does not provide for a number of services and keeps costs down for the HMO, for the insurance company, in that way. There are a lot of other protections in the Patient's Bill of Rights, and I do not want to go through every one of them, but, Mr. Speaker, I do want to make the point that this is a very strong bill. And this problem is a problem, the abuses within HMOs, that Americans and all our constituents face. These abuses need some very strong medicine to make sure that they do not occur any more on a regular basis. That is why the Patient's Bill of Rights is a strong bill, and that is why Democrats, myself and other Democrats, keep insisting that it be the bill that comes back to the House from the Senate and goes to the President's desk. Because if we do not have good patient protections and strong patient protections then we will not accomplish anything in terms of this debate on the HMO reform. Now, I wanted to, if I could, just make some comparisons with the version of HMO reform that came from the other body, from the Senate, and is now in conference with the House Patient's Bill of Rights that I just described. The point I want to make here is that if the conferees, when they meet, were to accede to a version that is more like the Senate bill as opposed to the House Patient's Bill of Rights, we would have accomplished nothing, in my opinion, on this issue, and no reform that is meaningful would take place in this session of Congress. I will give some examples of how the Senate Republican bill differs from the House Patient's Bill of Rights. The Senate bill leaves more than 100 million Americans uncovered, because most substantive provisions or protections in the bill apply only to individuals enrolled in private employment-based self-funded plans. Now, this is what I talked about before where most of the larger employers, and even some smaller employers but certainly most of the larger employers, they have their own insurance fund. They are self- insured. Well, about 100 million Americans, the majority of Americans, do not fall into that category. What the Republican bill says is that the bill applies only to individuals who are enrolled in those self- funded plans. So most Americans would not even be covered by the patient protections because they are not in those self-insured plans that the Senate bill covers. Just an idea. There was a study done by Health Affairs, which is a publication, that found that only 2 percent of employers offer HMOs that would be covered by the standards in the Senate bill and only 9 percent of employees are in such HMOs. Self-funded coverage is typically offered only by large companies. Of the 161 million privately insured Americans, only 48 million are enrolled in such plans. Of those 48 million only a small number, at most 10 percent, are in HMOs. So that is an interesting statistic. Because what it says is that of all the Americans out there who are covered by health insurance, only 48 million are in these self-insured plans that are covered by the Senate bill. But even of those 48 million, about 10 percent are in HMOs because most of the people who are in those plans are not in HMOs. They are probably in some kind of traditional insurance policy on a pay-as- you-go basis as opposed to an HMO. The Senate bill does not allow designation of an OB-GYN, or obstetrician gynecologist, as a primary care physician. With regard to the specialty care that we talked about, it provides no ability to go outside the HMO network at no extra cost if the HMO's network is inadequate. So what I said before, about the House version of the Patient's Bill of Rights, it says that an individual can get a specialist outside the network at no extra cost if they do not provide it in the network. We do not have that language in the Senate bill. It allows the HMO to write contracts rendering the protection meaningless, e.g., specialty care is covered only when authorized by a gatekeeper. There are all kinds of gimmicks, if you will, in the Senate bill that basically make it difficult to really apply any of the patient protections in a significant way. I just wanted to mention a couple more things, just by way of contrast. With regard to continuity of care for patients, in other words, when a doctor is dropped from a network or an employer changes insurance plan, in the Senate bill it leaves out protection for all Americans who are not terminally ill, pregnant, or hospitalized. It provides only 90 days of continued care for terminally ill or hospitalized patients, forcing them to change doctors or hospitals even if they live longer or have not been discharged from the facility. Most important, though, and I think this really gets to the heart of the debate, in the Senate bill, and this goes back to what I said before, Mr. Speaker, the key really to this HMO reform is who is going to define what is medically necessary and how are they going to enforce their rights if they have been denied care that they and their physician think is medically necessary. Well, in the Senate bill, in the Senate Republican bill, the HMO continues to define what is medically necessary. No matter how narrow or unfair to patients the HMO's definition is, their definition controls in any coverage decision, including decisions by the independent third-party reviewer. So what that says is that, if my physician and I feel that I need a particular operation and the HMO denies it, even if I go to an outside reviewer, they are only reviewing the HMO's definition of what is medically necessary; they cannot go beyond that definition. So if the HMO defines what is medically necessary in a way that would preclude that particular operation procedure, it does not matter whether they go to an outside panel or if they go to court, or whatever, because the bottom line is the HMO is going to decide what is medically necessary. I could go on and on and talk about so many other things in the Senate bill. It does not ensure doctors can talk about the HMO's financial incentives or its processes. It does not prohibit the gag clauses that I talked about before. In terms of information that is provided to patients when they sign up for their HMO, it is very limited in the Senate version. And so, again, the point that I am trying to make is that we can hear my colleagues on the other side of the aisle talk all they want about how they want to pass good HMO reform, but the only way that is going to happen is if this conference comes up with a bill that is very much like the House passed Patients' Bill of Rights. Without that, if the bill comes out similar to the Senate version, in effect, the Congress would have failed in its responsibility to enact true HMO reform. The one other thing that I wanted to mention in the context of the Patients' Bill of Rights and HMO reform, the Republican leadership in the House, when they passed the Patients' Bill of Rights, attached to it a number of provisions which I call poison pills. These are provisions that really have nothing to do with patient protections but which the Republican leadership claim also address some of the access problems for the uninsured. We do not have a consensus in the House or in the Senate at this point on how to deal with the problem of the uninsured. Obviously, as I mentioned before, the Democrats and myself feel very strongly that is what is needed is a major effort through legislation both monetary as well as a change in policy that would allow children, the parents of children who are not covered, and the near elderly, at a minimum those groups, to be insured. The President has talked about, as I mentioned before, a major new initiative that expands the kids' health insurance to sign up more kids, to sign up the parents of those kids that were uninsured and to make it possible for people who are 55 or 65 to buy into Medicare or to even have a subsidy or a tax credit so they could afford to do so. What the Republicans have done with the Patients' Bill of Rights, they have attached provisions which they claim are going to address the problems of the uninsured but do not effectively do so. They have attached provisions that would expand MSA, medical savings accounts. Medical savings accounts are a device whereby, under Medicare, for example, rather than buy an HMO or traditional fee-for-service policy, they could buy a policy whereby they get a lump sum; and if they do not use a certain amount of their care over the course of the year, that money is paid back to them in a check that they can use to go on a vacation or to by a car, whatever they want to do. Basically what it does is to create a situation where they are kind of gambling with their health, if you will. They assume that they will not have certain expenses; and they, basically, establish a threshold, if you will, for the level of care that if they do not meet they pay out of pocket up to that certain threshold. And it has not worked. I mean, basically, very few Americans have signed up for medical savings accounts. And the whole idea is, essentially, something that very few seniors or anybody is responding to. But the Republican leadership says, oh, this is a great idea. This is a great way of expanding health insurance. Well, I do not see how it accomplishes that at all. They also have HealthMarts and they have other devices that supposedly are going to make it possible for more people to have health insurance but, in fact, do not accomplish that at all. What I see happening here, without getting into the details of it, is, rather than addressing the Patients' Bill of Rights and trying to come to a consensus on the HMO reform that the majority of the people in the majority of this Congress have supported, they now are trying to muck up this whole issue by talking about these access issues for which there is no consensus and which will simply delay any action on the Patients' Bill of Rights and on HMO reform in this Congress. And so, what I have said to my colleagues, and I will say again, Mr. Speaker, is let us pass a good Patients' Bill of Rights; let us deal with the HMO reform issue, which is now ripe, which overwhelmingly the people and the Members of Congress have voted for in this House and support; let us go with the House version; let us send this to the President, because he says that he will sign it; and let us make this the first priority to show that that Congress can accomplish something that is important to the American people on a bipartisan basis. I know that I, as a Democrat, and my colleagues on the Democratic side, including those of us who are conferees, will continue to insist on that, insist that the conference meets, that we come up with a strong Patients' Bill of Rights similar to the House version, and that we get it to the President so that we can have a great accomplishment and a great victory for the American people. And we will be back here many times in the evening demanding that that happen. Because the Republicans are in the majority and they control the process, and it is up to them to make sure that this happens, with bipartisan support from the Democrats.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, on Friday, February 18, 2000, a retirement party in honor of Ms. Ramona J. Young will be held at the Garden Manor in Aberdeen, NJ. Ms. young will be honored by her friends and family on the occasion of her retirement after a distinguished career as an Investigator with the New Jersey Office of the Public Defender. Ramona Young has devoted herself to helping others in many capacities. A registered nurse, she graduated from the Montefiore Hospital School of Nursing in the Bronx, New York, and worked as an operating room nurse. In January 1975, Ms. Young came to work with the Department of the Public Advocate as a Field Representative in the Division of Citizen Complaints. In this position, she handled all the problems presented to her by New Jersey residents, ranging from motor vehicle complaints to issues relating to heating problems, always responding in an effective and courteous manner. She remained with the Division of Citizen Complaints until July of 1986. At that time, Ms. Young was transferred to the Public Advocate's Division of Mental Health Advisory in Farmingdale, NJ, as a Field Representative covering Monmouth and Ocean counties, NJ. In this position, she called upon the use of her nurse's training to help those people who, as the saying goes, ``fall between the cracks.'' Ms. Young recognized that people are not just bureaucratic statistics. She worked tirelessly on behalf of people with legitimate grievances who need assistance from supportive, qualified professionals in a position to help. Guided by this philosophy, Ms. Young helped countless people through the bureaucratic maze for a fair and just resolution of their cases. In 1995, Ms. Young was transferred from Mental Health Advocacy to the Office of Public Defender, Criminal Division, as a Principal State Investigator. Her assignment was in the Union County, NJ, Trial Region. Once again, Ms. Young proved to be a dedicated and effective advocate for the disadvantaged. She always put her experience and training to work, combined with a strong measure of compassion and professionalism. The result was unfailingly accurate, impartial and professional investigations. Mr. Speaker, it is an honor to pay tribute to Ramona Young on the occasion of her retirement. While the Office of the Public Defender is losing a talented and dedicated professional, I hope and trust she will continue to contribute her energy and experience to the betterment of our community.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, on Saturday, February 12, 2000, a ribbon cutting ceremony will be held for the opening of the Armenian Educational, Art & Communication Center and the Nikit and Eleanora Ordjanian Library-Museum, including the Personal Library of Reverend Father and Arafelian and the ACYO Computer Karam Center. This event will be held at the Armenian Apostolic Church of Arizona in Scottsdale, AZ. This ceremony will be followed by a concert by George Mgrdichian, the world-renowned virtuoso of the oud, a traditional Armenian instrument. Mr. Mgrdichian is the writer and performer of the Broadway musical ``Nine Armenians.'' Mr. Speaker, it is always a matter of great pride for me to join with the Armenian-American community in welcoming a new center for the celebration and advancement of Armenian culture. The Armenian-American community, over one million strong, has contributed in countless ways to the economy and the culture of the United States. While embodying the American Dream, the sons and daughters of Armenia who have settled in the United States have for generations striven to maintain their links to one of the most ancient and enduring cultures in the human race. Next year, the Republic of Armenia will be the site of celebrations for the 1,700th anniversary of Christianity. Armenia is, in fact, the first nation to have embraced Christianity as its national religion. And the history of the Armenian nation, language and people goes back many centuries earlier. In the years since, despite terrible periods of war, conquest and oppression, the Armenian people have endured and preserved. Today, Armenians the world over can take pride in the tremendous strides made by the Republic of Armenia and the Republic of Nagorno Karabagh, emerging democracies that seek to establish their rightful place as members of the family of nations. The sense of pride in being Armenian can be felt in many parts of the world, from Yerevan to Stepanakert to Scottsdale, Arizona, to my hometown of Long Branch, New Jersey. Mr. Speaker, it is an honor and a privilege for me to congratulate the Armenian-American community of Scottsdale on the opening of this new facility, and to pay tribute to this important event in the pages of the Congressional Record.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, it is with profound sadness that I rise to mark the passing of Mr. Peter H. Maclearie of Spring Lake Heights, NJ, who died on Wednesday, December 8, 1999, at the age of 68. Mr. Maclearie was an outstanding leader in the Jersey Shore community, contributing his talents and energies in both the public and private sectors. He served as the Mayor of Spring Lake Heights for two terms, from 1970 to 1976, having previously been a Borough Councilman from 1963 to 1970. Mr. Maclearie also served as an incorporater and member of the Board of Directors of Allaire Community Bank in Wall, NJ. He was responsible for obtaining federal grants for the development of the Spring Lake Community Center. Among his other contributions to the betterment of our community, Mr. Maclearie was a founding member and past chairman of the South Monmouth Regional Sewerage Authority. He served on various committees of the New Jersey League of Municipalities and was a member of the New Jersey Conference of Mayors and an honorary member of the Municipal Clerks Association. Indeed, Mr. Speaker, it seems as though politics and community service must be in the Maclearie blood. Mr. Maclearie's father was the Mayor of Belmar, NJ, for 36 years, including a period of time when father and son were mayor simultaneously in adjoining boroughs. His sons, Peter and Paul, are currently municipal councilmen in Tinton Falls, NJ, and Spring Lake Heights, respectively. Mr. Maclearie was also the president of Coded Systems Corp., which he founded in 1971. His firm specialized in codifying municipal ordinances throughout New Jersey and many other states. He also was the founder and president of Maclearie Printing of Wall, NJ. A communicant of St. Catharine's Roman Catholic Church in Spring Lake, NJ, Mr. Maclearie also was a member of the church's Finance Committee. He was a member of the Wall Rotary Club, the Belmar Fishing Club, the Spring Lake Golf Club, the Manasquan River Marlin and Tuna Club, and the 200 Club of Monmouth County. He was a charter member of the Manasquan Elks Lodge and the Spring Lake Area Chapter of Deborah Heart and Lung Center. Born in Asbury Park, NJ, Mr. Maclearie lived in Belmar before moving to Spring Lake Heights 42 years ago. He was an Army veteran of the Korean War, serving as a combat photographer. He was a member of the Spring Lake Post of the American Legion, a life member of the Asbury Park Post Veterans of Foreign Wars and the Richard Skoluda Chapter of Disabled American Veterans, Spring Lake Heights. Despite his numerous commitments, Mr. Maclearie found time to enjoy life with his family, to dote on his grandchildren, to pursue such hobbies as fishing, boating, camping, practical jokes--and, of course, politics. He is survived by his wife of 44 years, Florence Yesville Maclearie; three sons and daughters-in-law, Peter and Ann of Tinton Falls, Paul and Eileen of Spring Lake Heights, and James and Nancye of Toms River, NJ; four daughters and three sons-in-law, Michelle and Christopher Wood of Spring Lake Heights, Nancy and Matt Hayduk, also of Spring Lake Heights, Cathleen of San Francisco, California, and Mary Beth and Drew Smith of Phoenix, Arizona; a brother, Timothy of Ocean Grove, NJ; two sisters, Jean Boda of Elizabethtown, Pennsylvania, and Judy Gray of Maine; and 10 grandchildren. In keeping with Mr. Maclearie's dedication to the cause of helping others, his family has asked that, in lieu of flowers, contributions be made to the Deborah Heart and Lung Center or the Peter H. Maclearie Scholarship Fund in Spring Lake Heights. Mr. Speaker, the Maclearie family is obviously devastated by his loss, as are his many, many friends. I hope that they will find comfort in the many good wishes from people all over, and from the knowledge that Mr. Maclearie did all that he could to make his community a better place.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, it is with profound sadness that I rise to mark the passing of Mr. Jerry W. West, Sr., of Neptune, NJ, who died on Saturday, December 4, 1999, at the age of 73. Jerry West was an outstanding leader in our community, dedicated to the effort to improve the quality of life for the residents of the Jersey Shore area. He was also a good friend whose support and advice I have always valued. Jerry also worked closely my predecessor, a great Member of this House, the late Representative James J. Howard of New Jersey. Born in Asbury Park, NJ, Jerry West lived in the Shore area for most of life. He served his country in the Navy during World War II. He received his bachelor's and master's degrees in business administration from Monmouth University in West Long Branch, NJ. He went on to earn his doctorate from Temple University, Philadelphia. He was an adjunct professor at his alma mater, Monmouth University. For 20 years, Jerry served as a contract specialist for the U.S. Army's Fort Monmouth in Eatontown, NJ, retiring in 1997. Jerry West made great contributions to the building and maintaining of a prosperous and healthy community along the Jersey Shore. He was a member of the Neptune Township Board of Adjustment and the Environmental Commission. He also served on the Fletcher Lake Committee, contributing his efforts to the restoration of this beautiful lake located between the Ocean Grove section of Neptune and Bradley Beach. In fact, in recognition of Jerry's devotion to the cause of protecting our environmental resources, the West family is asking that, in lieu of flowers, memorial donations be made to the Fletcher Lake Committee. As dedicated as he was to serving our community, Jerry was most devoted to his family. He is survived by his wife of 53 years, Edna Brand West, his son, Jerry West, Jr., his daughter, Linda W. Maxwell, his brother, John West, his sister, Ann Connelly, five grandchildren and two great-grandchildren. Mr. Speaker, the passing of Jerry West is a terrible loss for his family, his many friends and all those in our community who have benefited from his good work. It is, nevertheless, an honor for me to pay tribute to him in the pages of the Congressional Record.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise today to discuss the latest episode in a troubling, ongoing pattern by the military regime in Pakistan to provoke a crisis in Kashmir and to essentially pick a fight with India with results that could be destabilizing and devastating to the entire region and the entire world. The Pakistani government, a military junta that overthrew the civilian government in a coup last October, declared last Saturday, February 5, Kashmir Solidarity Day. Pakistan's military strongman leader, General Musharraf, visited the Pakistani-administered area of Kashmir and encouraged the terrorist forces there to continue their Jihad in the Indian states of Jammu and Kashmir. That same evening, according to an account from the Indo-American Kashmir Forum, a band of gun-wielding terrorists sought out Kashmiri Pandits or Hindus in the village of Telwani and opened fire on two families belonging to the minority Hindu community. Three Pandits, including a 9-year-old girl, were killed and many others were injured. Mr. Speaker, this is the true face of the so-called liberation campaign being waged by so-called freedom fighters for years in Kashmir. It is a violent terrorist campaign, pure and simple. Now Pakistan's support for this violent campaign has been laid bare for all the world to see. Pakistan has always acknowledged its political and moral support for the insurgency in Kashmir, but evidence clearly shows that Pakistan's support runs much deeper. Now General Musharraf has spelled it out. He publicly pledged his support for the terrorist groups fighting in India's state of Jammu and Kashmir. He was quoted in news accounts saying, ``All heads rise with pride when we hear of the struggle of Kashmiri freedom fighters.'' These are the same freedom fighters who carried out the atrocity against the Pandit villagers, including the little girl, that same night. Mr. Speaker, India and Pakistan have fought two wars over Kashmir. Last summer Pakistan initiated a border skirmish last year across the line of control that separates the two sides near the town of Kargil. Most news accounts indicate that General Musharraf and the other military coup leaders were behind the planning and execution of that disastrous campaign. Fortunately, the United States and the rest of the world community recognize Pakistan as the aggressor. President Clinton prevailed on the civilian leadership of Pakistan, and I stress, civilian leadership of Pakistan at the time, because the civilian government was still in place, to withdraw its forces. A few months later General Musharraf overthrew Pakistan's civilian government, and the government in Islamabad has been escalating the threatening rhetoric and destabilizing actions ever since. Mr. Speaker, the U.S. has not done enough, in my opinion, to show its opposition to the military takeover in Pakistan. A House resolution that condemns the coup has come out of committee. The problem is that the military government has no legitimacy, and can only stay in power as long as it whips up hatred against India by citing Kashmir. That is why the generals started the Kargil war, and that is why they encouraged the hijacking of the India Airlines plane last December. That is why they continue the campaign against a multi-ethnic and religious state in Kashmir, and contribute to the murder of innocent Kashmiri Pandits. The end result of the generals' provocation would be another war with India over Kashmir. The problem is that the generals now control nuclear weapons they could unleash in such a war. Mr. Speaker, the U.S. must send an unequivocal message that this continued provocation in Kashmir by the Pakistan military regime is unacceptable. At a minimum, the President should not visit Pakistan during his trip to South Asia in March. The State Department should declare Pakistan a terrorist state, and make it clear there will be no further contact with the Pakistani government until it stops its provocative actions in Kashmir and takes steps to restore democracy in Pakistan.

Mr. PALLONE

Mr. PALLONE. Madam Speaker, I thank the gentleman from Texas for what he said. And, particularly, because he pointed out how HMO reform, or something very similar to the Patients' Bill of Rights, has been, in fact, law in Texas now for some time and is working very well. And that they have had very few lawsuits. And as he mentioned, and I think it is so important, the reason there are so few lawsuits is because basically the patient protections that we are advocating here at the federal level are preventive measures. In other words, the HMOs, when they know they have to provide these protections, take more precautions, do the right thing; therefore, it is not necessary for them to be sued, except in very few cases. I think that sort of belies the critics of the Patients' Bill of Rights who say it is going to be litigious and there are going to be so many lawsuits and that costs will go up. In fact, just the opposite has happened in Texas. But the problem, as my colleague has pointed out, we need this at the federal level because of the federal preemption of those people who come under ERISA; those who, through their employer, are in self-insured plans, which is millions and millions of Americans that come under that federal preemption, so they are not allowed to sue their HMO. I do not want to stress the suit aspect, however, because I do not think that is as crucial as the fact that an individual needs an independent ability to appeal a denial of care. And that can be done under the Patients' Bill of Rights through a very good internal review, or internal appeal, as well as an external administrative appeal where an individual goes before a board that is not influenced by the HMO. And that board can overturn the decision of the HMO to deny care without having to go to court. So there are a lot of ways that we achieve accountability in the Patients' Bill of Rights without actually having to bring suit. And as the Texas case points out, those situations where suits are brought are very, very few indeed. Now, Mr. Speaker, the reason why the gentleman from Texas (Mr. Green) and myself are here today is because earlier today, maybe within the last half hour or hour, we passed in the House, by a considerable margin, a motion to instruct the conferees so that we go to conference on the Patients' Bill of Rights. And we also directed those conferees to stick with the House version of the bill, which is really the only true Patients' Bill of Rights. What the Senate passed, in my opinion, is really sham reform that does not add up to anything in terms of actually dealing with the excesses and the abuses that we have seen so many times with HMOs. So I wanted to react to some of the comments that were made on the other side of the aisle by the Republicans in the leadership who said this motion to instruct was not necessary. Well, let me say this motion to instruct was necessary, and the majority of Members on both sides of the aisle voted for it because it is necessary. And it is necessary because 4 months have passed since this House took up and passed the Patients' Bill of Rights, a very strong HMO reform bill. And yet in those 4 months, even though the Senate had passed another bill, I think last July or so, we still have not seen any action to bring the House and the Senate together, represented by their conferees, to try to come up with a bill that both houses can agree on and send to the President. So when the Republican leadership says give us more time, I think one of my colleagues said on the Republican side, well, we will get to this by the end of the month, meaning the end of February, my reaction is, well, they have already had 4 months and time is running out. There will not be many days left in this Congress. Certainly we are going to be out of here by October if not sooner. And if we do not start meeting and having the conferees meet and talk about the differences between these bills and what can be done to achieve a consensus, we will never get a good Patients' Bill of Rights passed. The other thing I would point out is the reason we insisted on sticking with the House version, so that the House version should be the one, or something close to it should be the one that the conference adopts, is simply because there is such a disparity between the House bill, which basically is true HMO reform and protects against these abuses, as opposed to the Senate bill that really does not cover anybody. My colleague from Texas was pointing to some of these things, but I just wanted to point out some of the gross disparities between the two bills. The Republican Senate bill leaves more than 100 million Americans uncovered, because most substantive protections in the bill apply only to individuals enrolled in private employment-based self- funded plans. Now, a self-funded plan is one in which the employer pays medical bills directly, rather than buying coverage from an HMO or insurance company. These are the ones that come under the ERISA exemption, or the ERISA preemption I should say. There was a recent study in Health Affairs that found that only 2 percent of employers offer HMOs that would be covered by the standards in the Republican Senate bill and only 9 percent of employees are in such HMOs. Self-funded coverage is typically offered only by large companies. Of 161 million privately insured Americans, only 48 million are enrolled in such plans. And of these 48 million, only a small number, at most 10 percent, are in HMOs. So when I say that the Senate Republican bill is sham HMO reform, I am not just making that up. We have data to show that because of the exclusions and because so many insurance plans, so many people covered by their insurance would not come under this bill and have the patient protections we are talking about, in effect the Senate bill is meaningless. It does not have any teeth to it at all because it does not even apply to most people with health insurance. The list could go on. By contrast, I should point out, of course, the Democratic bill would apply to all those plans. And I should say it is not even the Democratic bill. It is the House-passed bill that was a Democratic bill that was passed on a bipartisan basis versus a Senate bill. All we are saying in this motion to instruct is that we must stick with the House version, because if we do not, we will not have a true Patients' Bill of Rights. I wanted to give a few other examples. And I am not looking to beat a dead horse here, but I want to give a few more examples of the contrasts between this Republican Senate bill and this essentially Democratic House bill that we keep insisting on. With regard to care for women in the Republican Senate bill, it does not allow designation of OB-GYN as a primary care physician. It does not require a plan to allow direct access to OB-GYN except for routine care. On the other hand, the Democratic bill, the House bill that we insisted on today in the motion to instruct, allows patients to designate OB-GYN as a primary care physician and provides direct access to OB-GYN for all OB-GYN services. Specialty care. How many of our constituents have come to us and told us that some of the problems they have had with HMOs is they do not have access to the specialty care that they need. Well, in the Republican Senate bill there is no ability to go outside the HMO network at no extra cost if the HMO's network is inadequate with regard to a particular specialist or specialty care. Basically, what the Republican Senate bill does is to allow HMOs to write contracts rendering the patient protections meaningless. In other words, specialty care is covered under the contract only when authorized by a gatekeeper. Well, what good is that? That is the problem that our constituents are complaining about, how they cannot go to a specialty doctor unless they get a referral each time; and a lot of times the specialty care is not even available within the network. This is all meaningless under the Republican Senate bill. The Democratic, the House passed bill, provides the right to specialty care if specialty care is medically indicated. And it ensures no extra charge for use of non-network specialists if the HMO has no specialist in network appropriate to treat the condition. Just a couple of other things. Probably the most important thing, and I know my colleague from Texas would agree, is not only the ability to go for some kind of external review if someone has been denied care that is not biased against them, or ultimately the ability to bring suit, but also the whole definition of what is medically necessary. In other words, the problem that we face with so many of our constituents is that the decision of what kind of care they need, the decision of what is medically necessary, which is essentially the same thing, right now is basically made by the insurance company or the HMO. What my constituents say to me is, I do not want the decision about what kind of operation I get or how long I stay in the hospital or what kind of equipment I am eligible to use; I do not want that to be made by the insurance company. I want it to be made by my physician, with me, because my physician knows what is best for me. He is the medical adviser. He is the doctor. He is the one that knows, not the nameless bureaucrat working for the insurance company. Well, under the Republican Senate bill they allow the HMOs to define medically necessary, what is medically necessary. No matter how narrow or unfair to patients the HMO's definition, their definition controls in any coverage decision, including decisions by an independent third- party reviewer. So even if someone had the external review or had the right to bring suit, what good is it if all the external reviewer is going to go over or what the court looks at is how the HMO defines what is medically necessary? That just kills the whole thing. That makes the whole HMO reform meaningless, if that decision about how to define what is medically necessary is essentially made by the HMO. What we say, and most importantly in the House-passed bill, the one that we have been insisting on today in the motion to instruct, is that that definition is made by the physician with the patient, and basically is a definition based on what the standard of care is within that specialty group, by the diplomates, the people that have the diploma in cardiac care or the people that have the expertise in other kinds of specialty care. Those are the people who should be defining what is medically necessary. I could go on and on, and we will talk a little more about why this Democratic House bill is so much better than the Senate bill and why we need to insist on that in the conference; but the other thing that I wanted to mention, and then I will yield back to my colleague, and this came up again during the debate today on the motion to instruct, is that what I see happening here on the Republican side of the aisle with the Republican leadership is that they realize that the Patients' Bill of Rights has majority support in this House, and I think also in the Senate as well, and amongst the American people, and so they cannot really fight it any more by saying it is a bad bill. So what they are now trying to do is to change the subject. Instead of talking about the Patients' Bill of Rights today, so many of my colleagues on the Republican side of the aisle tried to bring up other issues. One of my Republican colleagues talked about why we do not deal with the issue of medical mistakes, because that has become a major issue now. I am not saying it should not be addressed, but why are we mucking up the Patients' Bill of Rights when we know where we stand and we know we can pass that and send it to the President to sign? Why would we want to muck that up by dealing with the issue of medical mistakes, which will probably take another year or two to get that resolved and we can finally get a consensus on that. Another Republican colleague talked about access for the uninsured. And I am totally in favor of more access for the uninsured. The President in his State of the Union address the other day, and my colleague from Texas, talked about how we have proposals now on the Democratic side that would expand health insurance coverage for more children, taking the parents of the kids that are part of the Kids' Care Initiative; address the problems of the near elderly so they can buy into Medicare. Sure, all these other access issues for the uninsured need to be resolved, but, again, we do not have a census on that. They are now in the formative stage in terms of the debate and where we are going to go. They have to have committee hearings, they have to be voted on the floor, they have to be addressed in both houses, and there is no consensus. So, again, why would we want to muck up the issue of the Patients' Bill of Rights, which has the consensus and can get the votes and can pass and be signed by the President? Why would we want to throw in all these other things? Basically, it comes back to what the Republican leadership was doing all along with the Patients' Bill of Rights. They tried their darnedest to try to throw all kinds of poison pills into that debate and add all these amendments with the MSAs, the medical savings accounts, the health marts, and all these other things, even the issue of medical malpractice at one point. All these things they tried to throw in as poison pills so that we could not get to the heart of the issue where there was a consensus. I simply say once again, based on that motion to instruct, do not fool around any more. Let us go to conference. We know we can deal with these HMO reform issues, these patient protections. Let us deal with them and resolve them in a way that protects the American people and not try all these other gimmicks to try to make it so we never get to what is really important here and what we can pass. With that, I would yield back to my colleague.

Mr. PALLONE. Mr. Speaker, I appreciate the comments of the gentleman. If I could just add one thing before we conclude, one of the things that I found in the 2 months that we had the recess and we were back in our districts and I had a lot of forums on health care on seniors or just in general with my constituents in the various towns that I represent, we are living in very good economic times and the economy is good and generally most people are doing fairly well, but there is a tremendous frustration that the Government does not work. And it is I think, for whatever reason, Congress seems to be the main focus of that, the notion that somehow all we do down here is talk and we never get anything done. The reason I was so frustrated today when I heard some of the arguments from the Republican side is because I know that this issue, the Patients' Bill of Rights issue, the HMO reform issue, is something that we can get done. Because the public wants it done. And we had Republicans join us on this Patients' Bill of Rights, and I know that the President will sign it. So I do not want this to be another issue that is important that falls by the wayside because the Congress and the President could not get their act together. If there is anything that we can pass this year, this is the issue. And I think we just have an obligation to our constituents to show that, on something so important as this, that we can actually accomplish something and not just sit here and argue back and forth. Obviously, we need to argue, otherwise my colleague and I would not be up here. But we also need to pass something. And that is what we are all about.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to thank my colleague from Arkansas for those kind remarks. And let me just say, I listened to the previous Republican speaker on the other side of the aisle, and after I listened to what he said, I am more than ever convinced why we need this motion to instruct. He said, well, we are going to schedule the conference. It will be scheduled sometime in February or early March. Well, the bottom line is it has not been scheduled. The bottom line is that it has not been scheduled. It is 4 months since we passed this bill. I am tired of hearing about it is going to be scheduled, it is going to happen. I hope he is right. But I think that we must insist that we move to the conference straight with. The other thing is there is a tremendous amount of frustration on the part of Democrats and myself on this side of the aisle because so many efforts have been made by the Republican leadership over the last 2 or 3 years to sabotage the effort to pass the Patients' Bill of Rights. For 2 years, we saw both Houses of Congress pass what I considered bad bills, it did not really do any reform. And now the gentleman suggested somehow we have to wait on the access provisions and the larger issues of dealing with the uninsured or other health-care issues have to be brought into this. Again, I think that is nothing more than an effort to try to delay and delay and delay the Patients' Bill of Rights. We know that there is almost unanimous support amongst the American people for this legislation the way the House passed it. We must insist on the House version. Because that is the only thing that is going to be signed into law. That is the only thing that will pass both Houses overwhelmingly, go to the President and be signed into law. If they mess up this legislation with the Senate version that has the MSAs, even one of my Republican colleagues talked about how bad that is, the health marts and all these other poison pills that have been placed in this legislation and get to those other issues, all that means is that they are going to ruin any possibility of passing the Patients' Bill of Rights in the way it was passed in the House, the way the American people want it passed. So I would maintain, after listening to my colleagues, I feel all the more we need this motion to instruct. We need to go to conference forthwith. We need to insist on the House version because that is the only thing that is going to pass. Let us get passed what we can get passed and show the American people that we can accomplish something that helps them rather than dillydallying for the rest of this year and the rest of this Congress.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I would mention that I do not plan to use all of the time this evening that is allotted to me, but I do want to spend some time talking about the Democratic health care initiatives, particularly by reference to the President's State of the Union address last Thursday night where he outlined many of the Democratic health care initiatives, some of which have already had debate and been discussed extensively by me and by other Members of this House, others of which are somewhat new. I would start out by pointing out that the Democrats and myself, we feel very strongly that the time has come to deal with three key health care issues. I do not say this because it is the Democratic agenda; I say it because I think it is America's agenda. These are the concerns and the problems that need to be dealt with, that I hear from my constituents in New Jersey in my congressional district, as well as from my colleagues here in Washington, D.C. on both sides of the aisle, when they come back, particularly from this 2-month period, this district work period or recess that we were in, and a lot of us had forums, a lot of us got input from our seniors, from our senior citizens, as well as from a lot of other people, and we are here back fresh for the second session of this Congress but we need to address these health care concerns. Let me detail the three concerns that I have. First of all, it is time to pass the Patients' Bill of Rights, the HMO reform. We went for a year, the last session in 1999, trying to push the Patients' Bill of Rights, and we finally did get it passed in the House of Representatives, but it still has not passed, or a strong bill, I should say, has not passed in the Senate. It is now in conference between the two Houses, between the House of Representatives and the Senate, but we still have not had a meeting of the conference so that we can move forward in trying to adopt good HMO reform to deal with abuses of HMOs that are basically set forth in the Patients' Bill of Rights. We need to pass that. That is number one, and I will talk a little bit more about it later. Number two, we need to address the problem of prescription drugs for seniors. Concerns about health care cross all generational lines and all class and income lines, but for seniors in particular the lack of a benefit under Medicare for prescription drugs, and the majority of the seniors do not have that kind of a benefit, is a particular problem because when I am in my district, or the forums in my district office, so many seniors call me or will come up to me and some of them will say they have prescription drug benefits but it is not sufficient, and the costs continue to escalate and they simply cannot afford it. So they either go without the drug or they take less than they are supposed to or they try to spread it out in some way. This is not the way we should operate. Prescription drugs are a preventive benefit that should be provided under Medicare. Of course, the President talked about that as well and I will talk a little bit about it tonight. The third health care issue, though, and concern that needs to be addressed is access for the uninsured. Since I have been a Member of Congress, and particularly in the last 5 years, the number of Americans who are uninsured who have no health insurance continues to skyrocket. It is about 45 million Americans now that have no health insurance, and keep in mind that these are pretty much middle class working people, because if you are poor enough to fall below a certain income you are eligible for medicaid. If you are a senior, regardless of income, you are over 65, you are eligible for Medicare, but if you are a working person whose income is just above the line for medicaid and you are not a senior citizen then you do not have any guarantee of health insurance. What is happening increasingly is a lot of people simply do not get health insurance as part of their employment. Years ago, most Americans, if they were working, their employer provided some sort of health insurance where the employer would pay part of it and the employee would pay part of it, but increasingly that is not the case. So we have about 45 million uninsured Americans, mostly working Americans, who simply do not have the ability through their job to get access to health insurance and we need to do something about it. The President has addressed that as well, and it is part of our Democratic agenda. Now, let me take these in order and spend some time on each of these issues, if I can tonight, Mr. Speaker. First of all, I want to go back to HMO reform and the Patients' Bill of Rights. No one is suggesting that HMOs are a bad thing. We know that in many cases HMOs have actually helped to bring down the costs of health insurance. The bottom line is that there are many cases where there have been excesses or abuses within HMO networks, and oftentimes that manifests itself in that a physician will say to a particular patient that they need a particular operation or a length of stay in the hospital, or have to go to a particular provider or particular hospital or specialist for care. The HMO does not allow it, either because there are certain types of operations that the HMO just will not pay for or they will say that you can only stay in the hospital a certain number of days for a certain procedure even though your physician thinks that you need to stay longer, and we have had people actually become very ill, even die, because of the denial of care in those abusive situations. Well, we as Democrats put together a bill called the Patients' Bill of Rights. I am not saying that it is strictly a Democratic bill. We had some Republicans that cosponsored the bill and certainly some Republicans that voted for the bill when it was passed here in the House of Representatives, but unfortunately the Republican leadership in the House did not support the Patients' Bill of Rights and they continue to create problems in terms of its going to conference. We heard from the Republican leadership I think a week or two ago that they say now that they will hold a conference, but it has not been held yet and the problem is that the conferees that the Republican leadership have appointed to this conference, even if it is held, are not people that support the Patients' Bill of Rights. They are specifically those who said that they would not support the Patients' Bill of Rights. Well, what does the Patients' Bill of Rights do? Let me just give some indication of what this is all about and how it corrects some of the excesses or abuses with regard to HMOs. I am going to mention a few things with regard to access. One is emergency services. Individuals are assured under the Patients' Bill of Rights that if they have an emergency those services will be covered by their plan. The bill says that individuals must have access to emergency care without prior authorization in any situation that a prudent layperson would regard as an emergency. So if you are the average guy and you feel that you have chest pains and that you need to go to the hospital and the emergency room because you think you might be having a heart attack, well, that is the average or prudent layperson. If you have to go to the nearest emergency room, even if the HMO says that that is not where you go and that is not one of the hospitals that are covered, they have to pay because it was an emergency. That is what the bill says. Specialty care, Mr. Speaker, under this bill patients with special conditions must have access to providers who have the requisite expertise to treat their problem. The bill allows for referrals for enrollees to go out of the plan's network for specialty care at no extra cost to the enrollee if there is no appropriate provider available in the network for covered services. For individuals who are seriously ill or require continued care by a specialist, plans must have a process for selecting a specialist as a gatekeeper for their condition to access necessary specialty care without impediments. So what we are saying here is if the HMO does not have a specialist that you need to handle your particular situation, then they have to pay for you to go to another specialist, and if you have the type of condition where you need to go to a specialist on a regular basis, you do not have to go to the primary care physician for a referral to that specialist every time. You just get basically registered with a specialty doctor and you continue to go to her or him. Now those are some of the examples. I mean, there are a lot of others. I think one of the worst abuses that I know of is what they call the gag rule, where HMOs will write into their contract that if they do not provide a particular operation or service your physician cannot talk to you about it. In effect, he or she, your physician, is gagged from telling you what kind of procedure or operation you really need because the HMO will not cover it. Well, that obviously needs to be eliminated. One of the provisions in our Patients' Bill of Rights says there cannot be any gag rules. Let me go into some of the other areas. I had a number of senior forums in my district during the recess in December and January and a lot of them complained about not having adequate information provided by the HMO, that they do not even know what is covered, they do not know what physicians are in the network, they do not know basically what their insurance provides. Well, in the Patients' Bill of Rights, we say that managed care plans have to provide information so the consumers understand their health plan's policies, procedures, benefits and other requirements. That may seem like it's not important, but I think it is very important. Also important, and I want to stress, is the grievance and appeals procedure. Right now if an HMO turns you down for a particular operation, how do you appeal that decision if you feel that that decision by the HMO was a wrong one? Well, with great difficulty, I should add. Oftentimes the HMO will have you go to an internal review board with members appointed from their own staff and so when you appeal you have no chance. Well, what we say in the Patients' Bill of Rights is that there has to be an internal appeal that basically is not influenced by the HMO, and then there has to also be an opportunity to go outside the internal review process within the HMO to an outside board that can make a decision to overturn the HMO's decision independent of the HMO, an external appeal. Beyond that, though, there is also the opportunity to sue. One of the complaints that we hear from some of the opponents of the Patients' Bill of Rights is that it allows people to sue because right now if you fall under the Federal preemption under ERISA because your health plan is provided by an employer who is self-insured, which there are a lot in this country, you cannot sue the HMO. The Federal law prohibits you from suing the HMO. We eliminate that provision and say that if the reviews that I mentioned, internal and external, fail, that you have the option to go to court and sue to overturn the HMO's decision, which I think is a very valuable reform and protection, patient protection, under the Patients' Bill of Rights. I do not want to continue to go on about the Patients' Bill of Rights and provide more details because I know that we have done that many times. I have talked about it many times. I think the time now is for action. The Republicans are in the majority. They control the agenda. They need to have a conference on the Patients' Bill of Rights. They need to have the conference include both Democrats and Republicans, and mostly including the people that supported the House version that actually passed here in the House of Representatives, and they need to act expeditiously so that we can get a bill out of conference and to the President that is actually a strong bill that protects patients' rights. We will continue as Democrats to say over and over again that this must be done over the next few weeks, as we begin this new session of the Congress. Now, let me, Mr. Speaker, if I can, move on to the second health care issue that I said earlier this evening is so important and again that the President addressed in his State of the Union address, and that is the issue of prescription drug benefits under Medicare. When Medicare was started in the 1960s, when President Lyndon Johnson proposed it, prescription drugs were not that important. Medicare was started in the sixties primarily because of the huge costs of hospital care, and people did not rely on medication or prescription drugs so much as a preventive measure the way they do today, but yet now 30 years later we all understand why prescription drugs are needed and they are such a big part of our health care, not only in terms of our condition and whether we are going to be well and be active and not get sick, but even more so they take a big bite out of your budget if you have to pay for them privately. We know that some people do get prescription drugs as part of Medicare. If they are in an HMO, the HMO might provide some coverage, but what we find is that increasingly more and more of the HMOs that were providing coverage for prescription drugs are cutting back, charging more in terms of copayments or even a premium, to the seniors that are enrolled in the HMO. We still have a lot of seniors who are in the fee-for-service program, not part of an HMO. Some of them may have what we call Medigap, supplemental coverage that they pay for privately, that would include prescription drugs but again that is becoming increasingly prohibitive. The costs keep rising, the coverage keeps diminishing. So even if you have a prescription drug benefit as part of Medicare or because you have a Medigap policy, you find yourself increasingly paying more and more money out of pocket. Some people, if they have no benefits, are paying $1,500, $2,000, $2,500 a year for prescription drugs, and they simply cannot afford it. The easiest way to deal with this problem is to include it under Medicare as part of the basic benefit package and pass legislation that would accomplish that. I also think that it is important, though, that when we pass that legislation and that when we consider that legislation, that we put in some provision that allows for a better price negotiation, because right now what we find is that seniors that are not part of an HMO and who have to go buy a prescription at the drugstore themselves, even if they have some coverage under MediGap or whatever, they are paying exorbitant prices for the prescription drugs, way out of proportion to what they would pay if they were in an HMO or had some other way to negotiate a price on a large volume basis. So the bill, when passed, needs to address that price discrimination issue as well. I just wanted to mention the President's proposal. The President has a very good Medicare prescription drug proposal. It is not the only one out there. I have one myself. There are other Members of the House on the Democratic side that have different proposals out there. But Democrats are united in saying that we want to have this benefit, that we support the President, that we need a prescription drug benefit under Medicare, and we need it now because of the crisis that we see out there. Let me just talk a little bit, if I can, about the President's initiative in this regard. What he does, what he proposes, is establishing a new voluntary Medicare part D prescription drug benefit that is affordable and available to all beneficiaries. This is voluntary. This is like Part B. Part A is your hospitalization, Part B takes care of your doctor bills. This would be a new part D, again voluntary, where you pay so much of a premium per month and you get a certain prescription drug benefit. You do not have to do it if you think you have other options that are better for you. What the President's drug benefit would provide is that there would be no deductible, but you would pay for half of the drug costs from the first prescription. So basically what the government would do is they would pay for half of the prescription drug, and that would begin with the first prescription that is filled. This would be up to $5,000 a year in spending when it is fully in place. In other words, if you incur drug bills up to $5,000, half of it would be paid by Medicare, and it could be as little as $10 or $20, if that is all it costs over the course of the year, and half of that would be paid by Medicare. The President's proposal would also ensure beneficiaries a price discount similar to that offered by many employer-sponsored plans for each prescription purchased, even after the $5,000 limit is reached. Again, there is going to be a price discount because you are going to be part of this Medicare program where the government or the intermediary can actually negotiate a better price for you. The cost is about $24 per month beginning in 2002 when the coverage is capped at $2,000, and would rise to about $44 per month when fully phased in in about 6 to 7 years when the total benefit can go up to $5,000 in prescription drugs, which is about comparable to what we pay now for Part B for the doctor bills in terms of the premium. Just like now in Part B for doctor bills, people who are at lower incomes at a certain level pay no premium. People who are a little above that lowest level pay part of that $44 a month premium. So we would ensure that beneficiaries with incomes below 135 percent of poverty, $11,000 for a single individual, $15,000 for a couple, would not pay anything for cost-sharing. People who are a little above that income would phase in and pay some of the premium but not all of it. I do not want to go into more detail about this, Mr. Speaker. I just think it is a very good proposal. As I said, it is not the only proposal out there. But as Democrats, we are united in the idea that we need to have a Medicare prescription drug plan, because the crisis in terms of constituents and Americans being able to pay the bill and foot the bill is way out of line. I just do not want to want to see more people not take prescription drugs when they need them because they cannot afford to pay for them. Let me go to the third issue I want to mention this evening with regard to health care, and again, part of the Democrats' agenda with regard to health care, and also something that the President talked about in his State of the Union again last Thursday night. This is the problem with access for the uninsured. The number of uninsured continues to rise. I think I gave the figure of about 45 million Americans now that have no health insurance; working families, people that go out every day and work one, two, or sometimes more jobs, but do not have any coverage through their employer and cannot afford to pay for it privately. Mr. Speaker, we know that when President Clinton was first elected to office going back I guess 7 years now he had put forward a comprehensive universal health care plan. That was shot down. I do not want to go into tonight whether it was a good or a bad plan or how people felt about it. Frankly, I thought it was a very good plan. I would have supported it. I think if it had been put into place, we would not have this 45 million uninsured and the number of uninsured continuing to rise every day if this had been put in place 6 or 7 years ago the way the President wanted it. But politically it was not possible to do so. The insurance companies attacked the President's proposal. The Harry and Louise ads were on TV. Basically, the proposal died. It never even came up on the House floor, on the Senate floor. Ever since then, those of us who have been concerned about the problems of the uninsured on the Democratic side have been trying to sort of look at the target groups, the key groups within that 45 million uninsured people that perhaps we can help without moving into a universal coverage system which politically is simply not saleable at this point. We started out targeting a number of different groups, most notably a couple of years ago children, because a big percentage of that uninsured group were children. We put in place the Kids Care initiative. We came out of the Health Care Task Force, which I co- chair. We convinced enough Republicans to go along with it, and almost all, I think every Democrat voted for it, and enough Republicans to get the majority, so we passed the Kids Care initiative. What we find is that, although we have addressed the problems of some of the children, we still have a lot of children that remain uninsured. Then we have a lot of parents of those children who are uninsured, because usually if a person is working and they get health care on the job, they can get their children covered as part of that policy. But the bottom line is that those parents that have uninsured children who have signed up for the Kid Care program, it is called CHIP, are usually uninsured themselves. What the President has said is that initially what he wants to do, and this is part of the Democratic agenda, is try to expand the coverage for as many children as possible by expanding the eligibility for the Kids Care initiative, and also going out and trying to reach kids that may be even eligible for Medicare, which is at a lower-income bracket than Kids Care, and make sure that they get signed up, because we know that so many of them have not signed up for Medicaid or for the Kids Care initiative, even though they are eligible for it. So there is an outreach component here among the Democrats' agenda, and there is also the component to raise the income level so that more children who are uninsured would be eligible for the Kids Care initiative. Then the President and the Democratic agenda goes one step further. It says that a big part of this 45 million people who are uninsured is not only the children but their parents, as I mentioned before. Let us allow parents also to opt into the CHIP program. If they have children who are uninsured and are now signed up for it, let them sign up for it as well. The President provides in his State of the Union message and will provide in his budget for exactly that. Just to give an idea, some statistics, over 80 percent of parents of uninsured children with incomes below 200 percent of poverty, which is about $33,000 for a family of four, and I want to stress that, we are not talking here about people that are on Medicaid, we are talking about a family of four making $33,000 a year. Some people would not consider that poor, but the bottom line is that a great percentage of those families do not have access to health insurance, even though they are working, because they cannot get it on the job and they cannot afford to buy it privately. There are about they estimate 6.5 million uninsured parents with incomes in the Medicaid and the CHIP, which is the Kids Care, eligibility range for children, and what the administration does, what the President does in his budget is he creates a new family care program. It basically provides higher Federal matching payments for State coverage of parents of children eligible for Medicaid or the CHIP program. Under family care, parents would be covered in the same plan as their children. States would use the same systems and follow most of the rules as they do in Medicaid and CHIP today, and the program would be overseen by the same State agency. There would be a match that is provided here. States would have to cover a certain percent and the Federal government would provide a certain percent. I just think this is so important, because again, I was listening to my colleague earlier on the Republican side who was talking about the marriage tax penalty. I agree that the marriage tax penalty should be eliminated, and hopefully we will do that over the next couple of months here. The bottom line, however, is that more important, really, to a family which has parents who are working, a working family, is the fact that they need health insurance, because if they do not have health insurance and they get sick, then they are basically dependent upon going to the emergency room, incurring huge bills that they probably can never pay, and this is not the way we should operate in this country today with the economy being the way it is and with the people that are working and trying to make a living. I think that the President's initiative not only for expanding it for children but also for parents is really so important. The other thing that I have not mentioned but I want to with regard to access to health care for the uninsured is that if we look at this 45 million people who are uninsured, I mentioned the kids initially, then I mentioned the parents of those children who are uninsured, another huge block of people are what we call the near elderly. These are people probably between the ages of 55 and 65 who are not eligible yet for Medicare but who basically are uninsured, either because maybe they were married to a spouse who had health insurance on the job but then that spouse died, so they do not have any health insurance themselves, or they were laid off, or they took an early retirement that did not provide health benefits. What we find is that there are just a huge number of people between that 55 and 65 age range for whatever reason that are still not eligible for Medicare because they are not old enough, but find themselves without health insurance, either because they are not working or because their spouse died and they do not have it, and they have no way of buying health insurance privately because it is too expensive and they do not make enough money. A couple of years ago, I think it was not this year but in the previous State of the Union Address, or maybe even prior to that, President Clinton proposed a Medicare buy-in for those individuals. In other words, we would figure out what the cost per month for the Medicare program is to the Federal government, and they would be able to simply purchase Medicare at that cost, which I think the President has estimated is somewhere between $300 and $400 a month. I always thought that was a great idea, but the problem is for a lot of these people $300 to $400 is prohibitive. They cannot afford it. There are different ways of trying to deal with that. I had advocated some kind of sliding scale subsidy for those individuals. The President in his State of the Union Address last week talked about using a tax credit as a way of helping these people so they could address and buy into Medicare. What he basically says is that in order to make this buy-in more affordable, the President proposes a tax credit equal to 25 percent of the premium for participants in the Medicare buy-in. I think that is good. Let me say this, the Congress has not addressed this at all. The House of Representatives has not considered this in committee, it has not come to the floor of the House. So once again I call on my Republican colleagues who are in the majority to bring up the Medicare buy-in for the near-elderly and allow it to come to the floor, because I think it will pass if it comes to the floor. Number one, we have to allow the buy-in, which is not the law; and number two, we have to find a way through either a tax credit, as the President has proposed, or some subsidy to make it possible for more people to afford that buy-in. But right now, we do not have it at all. So, again, access to health insurance coverage. What do we do? Address the problem with kids more extensively, address the problems of the parents of the kids, and the problem of the near-elderly. But the President and the Democrats have gone even further. We have 45 million Americans uninsured. If we are not able to cover all of them through some universal system, then we have to address it piecemeal. Again, how have most Americans been covered traditionally? Through their employer. Unfortunately, the number of employers percentage wise that offer health insurance has decreased. But if we can create some sort of incentive so that those employers once again will offer health insurance, particularly the small businesspeople that have the most difficult time buying the policy and making it available to their employees, then we can also make, I think, a significant dent in this group of 45 million Americans who are uninsured. Mr. Speaker, what the President has proposed, again, is to give small firms, those with fewer than 25 employees that have not previously offered health insurance, a tax credit equal to 20 percent of their contributions. And there are a number of other things here: Making COBRA continuation coverage more affordable; expanding State options to provide health insurance. There are a number of initiatives here that the President has put forward and that are part of the Democratic agenda. I am not going to go into all of them because I did promise that I would not take up all the time that was allotted. But, Mr. Speaker, I want to stress again the importance of these three issues: HMO reform, pass the Patients' Bill of Rights; two, Medicare prescription drug coverage; and, lastly, trying to address the problem of access for the uninsured, those 45 million Americans who do not have health insurance. I cannot think of anything that is more important for this House of Representatives to take up over the next 10 months or so between now and the November election, and I call upon my colleagues on the Republican side who are in the majority, the Speaker, the Majority Leader, to take up these issues and to pass legislation that addresses these concerns in a strong and effective manner. We will be here as Democrats. I promise that I will be here. My colleagues will be here every night if we have to demanding action on these three health care issues because this is what our constituents talk to us about, this is what needs to be done. And it is not that difficult to do if only the Republicans would join with the Democrats in addressing these concerns.

Mr. PALLONE

Mr. PALLONE. Madam Speaker, I want to thank the gentleman from Texas. I think we are running out of time so I want to kind of summarize and say that and I see that some of our colleagues are getting ready already for the State of the Union Address here tonight. But the bottom line is, with the State of the Union, is there is a real opportunity for us to work on a bipartisan basis on some of these issues. I just hope that this year, unlike last year, we see the cooperation of the Republican majority in the Congress working with the President and with the Democrats to get some of these things done. Because if we do not, I think that the American people are going to be very disappointed. They clearly want HMO reform. They want a prescription drug benefit for Medicare. They want the Federal Government to do more to help those who do not have health insurance. They want us to work on some of these education initiatives. If we do not come through, we only have ourselves to blame. I am just really doing nothing more, as I am sure the President will do tonight, but to call on the Republicans and the majority in the Congress to work with us this year and not have the negative attitude towards the President's proposals that, unfortunately, we had in the last year.

Mr. PALLONE. The answer, obviously, is yes, we need to do it. I am trying today not to start out with a partisan statement, but the bottom line, we know that when the President has tried over the last 2 years to come up with some kind of way to help with school modernization, the different bond proposals, the different ways of helping the local municipalities, the Republicans have just opposed all these things. So he just keeps coming up with innovative ways of trying to get this across. I think this is a great idea, and I have to say, I was listening to what the gentlewoman said about the need for smaller schools, modernization. Every district has this problem with either crumbling schools or overcrowded classrooms and the need for money to build new schools. I have the combination. My district is one where we have some smaller urban areas where I have seen crumbling schools that need new roofs and new gyms and all that, and other, more suburban towns that I represent where they are in trailers and they talk about how they may have to go to split sessions because there has been so much of an influx of new people, and they have not been able to keep up with it. I think the school modernization program is crucial. Of course, we have not mentioned the fact that the president has been and we have been somewhat successful in getting the Republicans to provide funding to reduce class size at the lower levels, because the gentlewoman talked about smaller schools. Smaller schools to me means not only smaller schools physically, but also smaller classes, so there is more individual attention. Even that was opposed by the Republicans. We had to go tooth and nail until we finally got more money to reduce class size and hire more teachers. The other idea that the President came up with with regard to higher education is so crucial. Again, when people talk to me about education, their biggest concern is the ability, whether they are going to be able to send their kids off to college. The costs are just skyrocketing. In New Jersey, where we send most of our students out of State because we do not have enough slots in-State for them, it is a particular crisis. So what the President has proposed in terms of helping parents and students to pay for higher education I think is crucial. The gentlewoman is right on point.

Mr. PALLONE. I totally agree. It is interesting because I remember 6 years ago when President Clinton first talked about his universal health care plan, he had a very important proposal in there to expand programs for veterans as well. Again, we have not been able to fulfill that, and we need to. We need to make sure that the veterans' health care system is adequately funded and that we look at new technologies and new ways to do things for the next millennium because otherwise we are not meeting the commitment to them. So I want to thank the gentleman again. I yield now to the gentlewoman from the District of Columbia (Ms. Norton). I have not been back here for some time now, but I am glad to be back and hear from the gentlewoman.

Mr. PALLONE. Well, again, I appreciate the gentleman bringing that up. The gentleman says that Texas has the largest percentage of uninsured, but this is a problem that is national. Six years ago, when President Clinton first proposed the universal health care plan, which I think was a good idea and if we did not have all the opposition from the insurance industry and the Republicans that we probably could have worked something out that provided universal coverage, but now over the last few years we have been trying in some of these areas, as you mentioned, with the kids' health care initiative in particular, to try to plug up the holes and cover some of the uninsured in sort of a piecemeal fashion. It has been working, but even with that, even with the Kennedy- Kassebaum bill to deal with the problem of people having preexisting medical conditions not being able to get insurance and a lot of them can even with the kids' care insurance, we still have the number of uninsured growing nationally. We have to do more. One of the things that the President is going to announce tonight is a major new initiative to try to expand on some of these health care Federal programs to provide more coverage for the uninsured. If I could just mention a couple of things that I think are very significant, with regard to the kids' care initiative as well as Medicare, he has major proposals to spend money and to do outreach so we can get more kids signed up both for medicaid as well as the kids' care program. Because we have had a problem getting kids signed up, I think that one of the major reasons why they do not sign up is because, many times, those are the same parents of those children who are uninsured, and what the President is proposing now is to expand the kids' care initiative so that the parents of those uninsured kids can also sign up for insurance using the State and the Federal subsidy that is provided with additional funds that he is going to include in his budget. I think that is a great idea. We need to make sure that we get all the kids, but if we can get those parents in that will help. Then the other thing the gentleman talked about is to try to build on the private sector. Because the main way people traditionally obtained health insurance and still do in this country was through their employer, and if we can create financial incentives for employers when they hire people to make sure that they provide a health insurance option, that will go a long way as well. This is a major issue. The other thing, too, is I am sure the gentleman heard that during the break a lot of the States are really worried about this now and they do not know what to do. I know New York and Wisconsin and other States are trying to come up with ways that the States can provide for the uninsured, but they are never going to be able to do it effectively without some Federal initiative. I think it is important to have that Federal initiative.

Mr. PALLONE. Mr. Speaker, let me say that I am glad to be back. I think my colleagues know and I am sure most of the American people or many of the American people know that the House of Representatives has been in recess, has not had a session, for approximately 2 months since we adopted the budget at the end of November for the next fiscal year. Tonight, of course, the President will give his State of the Union Address, which represents really a new opportunity. This is the second session of the 2-year Congress. And when we come back today, we know that although we perhaps only have about 10 months before the House adjourns and the Congress adjourns there is this 10-month period when we can pass legislation and get things done that will positively impact the American people. Of course, the President will give his speech tonight and we will not know exactly what is in it until we hear it from him. But we know that he is going to talk about how the state of the Union is strong, how the country is strong economically, record new surpluses, overall crime rate down 25 percent, welfare rolls deeply cut. A lot of progress has been made under President Clinton, certainly in the 6 or 7 years now that he has been in office. But part of the problem particularly in the last year is that many times when the President suggests a positive agenda, progressive agenda to the American people as he did in his last State of the Union address, the Congress, which of course is dominated by the Republican majority, the Republicans are in the majority, resists his recommendations and do not pass the legislation or provide the resources so that we can move his agenda. And so I hope that this year that will not be the case again. If we look at what happened last year in the Congress, particularly in the House, there really was a resistance and most of the President's agenda was not adopted. I hope that is not the case this year. I hope that this year the Republican majority in the Congress will go along with the President's programs. If they differ slightly, fine, we can come to accommodations, but let us try to work together to come up with an agenda to pass legislation that helps the people and that moves this country quickly in a positive way into the next millennium. I wanted to talk a little bit about President Clinton and the Democratic congressional leaders' agenda for a few minutes if I could. What we want to do is to get the job done, if you will, for the American people in the year 2000. I am going to talk about a few specific points. Basically our Democratic agenda for progress in 2000 includes, first, repairing, renovating and renewing our schools. Second, cutting taxes while maintaining fiscal discipline because obviously we want to maintain the balanced budget that we have had and the surpluses that we continue to generate. Third, the Democrats want to modernize Medicare and include a voluntary prescription drug benefit. I would say, Mr. Speaker, during the 2 months that we were not in session I had many forums, some forums with senior citizens in my district, some with just people in general, constituents in general in my district. The number one concern that they had was with regard to health care. If it was seniors, they were concerned about the lack of access and the affordability of prescription drugs. Generally people expressed concern about the need for reform of HMOs because of the difficulties that they were having with HMOs in getting the health care that they thought that they needed. Then, of course, I had a lot of my constituents who simply have no health insurance whatsoever and want to see what we are going to do as a Congress and as a country to provide more options for health insurance. But let me continue with the Democratic agenda. I am going to go back to some of those health care issues a little later. The Democrats' agenda for progress in 2000 also includes strengthening Social Security. The President in his last State of the Union address stressed that whatever surplus was created as a result of the Balanced Budget Act, that that primarily, overwhelmingly, should go to shore up Social Security. Now, again when I had my forums in the district over the last couple of months, many of the seniors expressed concern over Social Security. I explained to them that Social Security was not bankrupt and that Social Security was sound but that the problem would come in, say, another 20 years, in another generation and that we needed to prepare now to make sure that for the next generation, Social Security was there. The President says the easiest way to do that is to certainly put a down payment down for the future by using the surplus primarily that is generated over the next 5 or 10 years. The other very important, perhaps the most important part of our Democratic agenda for progress in 2000 is to enact a real Patients' Bill of Rights. Some of my colleagues know that for the last 2 years, I have been pushing for this. We have yet to have a conference on the Patients' Bill of Rights, on HMO reform. I was pleased to see, I believe, today that the Republican leadership indicated that they were going to have a conference between the House and the Senate to try to work out differences on the Patients' Bill of Rights, on HMO reform, at some time next week or very soon. I applaud them for that but I think it is crucial that we have a good, strong Patients' Bill of Rights and I will insist on that as one of the conferees, because this is an important issue and if all we do is put together some makeshift reform that really does not do anything, some Band-Aid approach, the American people are going to hold us responsible and say, ``You didn't get the job done,'' so we need a strong Patients' Bill of Rights. The other important part of our Democratic agenda for progress in 2000 is to raise the minimum wage. We all know that the economy is strong. We know that this economy has generated hundreds of thousands of new jobs. But the bottom line is there are a lot of people who work and who basically do not make enough money, even though they are working full time or have two or three jobs, because their salaries, their wages are so low. We need to enact legislation that was primarily sponsored here in the House by our minority whip the gentleman from Michigan (Mr. Bonior) to raise the minimum wage. Finally, we also need to pass legislation to fight hate crimes, another important part of our agenda. What I would like to do, Mr. Speaker, if I could, is to go through some of these items individually. I see my colleague here from Texas. I do not know if he wants to join me now. If he would like to I would certainly yield to him.

Mr. PALLONE. I want to thank the gentleman again. I was just going to say there was one very positive development, I think, with regard to this prescription drug issue. That is, that a few weeks ago, I am sure the gentleman noticed that the major pharmaceutical companies, a lot of which are based in my State of New Jersey, announced that they were going to stop opposing a prescription drug benefit and speaking out against the President's proposed Medicare prescription drug benefit and were going to try to work with him to come up with a solution. I took that as a very positive development and contacted some of the pharmaceuticals in New Jersey which have their corporate headquarters in New Jersey in trying to work with them to accomplish that. On a somewhat negative note, though, I noticed that my colleague, the gentleman from California (Mr. Waxman), revealed some documents that had been circulated by some of the pharmaceuticals last week where they indicated that they were still going to be spending money and doing ads and doing things to try to oppose some of the efforts to keep the costs down. I would say that there are two things here. We need the Medicare benefit, but we also need to have affordable drugs. It is also important for the pharmaceuticals, as I know the gentleman from California (Mr. Waxman) has said, that whatever benefit we provide has to be an affordable benefit as well in terms of buying drugs. Because if there is some kind of benefit but the costs keep going up and ultimately people cannot afford it, the benefit does not do them any good. So we need to have the benefit, but we also have to have affordability and I think kind of empower people to be able to act together so that they can keep prices down.

Mr. PALLONE. Madam Speaker, one of the things that I want to mention, because sometimes I think that when we talk about these national education initiatives, that some of our constituents worry and say, well, education traditionally has been locally based, and the Federal Government has not really taken that much of a role, and what does all this mean if the Federal Government gets involved. I just want to stress we are really not changing anything in terms of local control of education. I mean, we are not suggesting in any way that the Federal Government dictate what teachers are hired or what textbooks are used in the classroom or what their curriculum is. All we are really doing with this school modernization initiative, the school safety initiative, the gentleman from Texas mentioned the effort to provide more money to hire teachers so that class sizes can be reduced, all we are really doing is helping the local towns afford some of these things because they cannot afford them now. I am sure the gentleman has the same situation in Texas that I face in New Jersey, where the funding for education is primarily locally based. The towns just cannot afford these things anymore. Believe me, it does not matter if they are an urban area or if they are a suburban area. They cannot keep raising the local property taxes to put up the new school, to put in to hire people to monitor the hallways for safety reasons, to hire extra teachers, to reduce the class size. By providing funding for these types of things, which is what the Democrats want to do, all we are really doing is helping the local taxpayer. Because either they are going to have to bond for these things and will not have the money to do it or going to have to raise taxes, which is very difficult and creates more problems. So all we are really saying is we want to take some of the Federal dollars and send it back to the towns for these purposes. We are not dictating to them what they do. They have to apply for these things. But we are making it easier for them to fund it. I do not know a town, no matter how affluent in my district, that is not in favor of that. Every mayor, every board of education tells me that they would love to see some of this happen.

Mr. PALLONE. Madam Speaker, I agree with the gentleman from Texas. I was thinking when I saw the gentlewoman from Washington, D.C. (Ms. Norton) there that I remember, I do not know if it was 6 months or a year ago, the memory fades now, but there was an occasion when she asked us, and we marched from the Capitol to a nearby school, it was within walking distance of the Capitol, and I cannot remember the name of the school, and we had a march. When we went there, she showed us this very innovative public school within the District of Columbia. I could not believe the enthusiasm that existed in that school. One of the things that they had, which I think is somewhat unique, is that all the kids were wearing school uniforms, which is something that I know that the President has proposed. I do not mean to just dwell on that. But there was just a lot of excitement in that place. But one of the things I kept thinking about is we keep talking about innovation, and one can put school uniforms in schools and one can come up with other things, but one cannot function, one cannot be very innovative if the place is falling apart literally. I think it is incumbent upon us to provide the resources so that schools are modernized. Modernization and the President's program for modernization is not just bricks and mortar, it is also for the Internet and for the electronic and the technologically innovative things that the infrastructure for those kinds of things are included in that modernization program as well. As my colleague says, what good is it? We cannot expect kids to use the Internet if they do not have the computers. They are not going to be able to have the money to do it at home, so we need to make sure that it is available in the schools. The school modernization program deals with that as well as providing the funding so that the town can build it, put a new roof on the school as well. I was amazed. I went to a school district, a school a few years ago in New Brunswick, which is one of the urban towns that I represent. Their roof was leaking. The walls were crumbling. It was unbelievable. I think a lot of people think that the school buildings generally are in good shape. But if they take a look and they go to some of the schools where these kids are being educated, they would be surprised, even the parents sometimes, to learn how bad it is. Madam Speaker, I yield to the gentleman from Texas (Mr. Rodriguez).