Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, reclaiming my time, in response to the question of the gentleman from Texas, this legislation will have no effect. The Gingrich-Thomas legislation will so destroy nursing home regulations that even if it did have an effect, it would not make any difference, because the nursing home regulations would be tossed out the window by the Republicans and it would be moot as to whether this does. But the legislation does not.

Mr. STARK. I yield to the gentleman from New Jersey.

Mr. STARK. Mr. Speaker, reclaiming my time, quite frankly, the committee that deals with this topic has not met, and it is responsible for Medicare, and it does nothing except worry and tell us that Medicare is going to go broke. It is in fact fiddling with this type of data bank, when the major data bank, which is the trust fund, is not being corrected. So there is a great deal of blame to justly be placed on the administration of the health committee under its current leadership.

Mr. STARK. The other issue of data banks, Mr. Speaker, is in the field of insurance regulation. This data bank was designed to find a correlation between private insurance that an employee might have and Medicare. We have further need for a data bank that would deal with the question of selling insurance that is duplicative. This is a rule that we have had to protect seniors, and it is being eliminated by the Republican Medicare bill. The sales rules are also being eliminated. Now, without keeping a data bank on the unscrupulous sales practices of health insurers who sell Medigap, and allowing these duplicative policies to reappear, we will have no way of knowing how much harm is being done to the seniors. We estimate that several billions of dollars were paid prior to our passing the bill which eliminated duplicative Medigap sales to seniors, but we have not kept that data bank, assuming that those rules would be affected. Without any prejudice to the ability to reinstate a data bank, I think it is necessary to point out that these seniors will need protection from the unscrupulous insurance agency and this bill---- point of order

Mr. STARK. Mr. Speaker, I certainly would, only to suggest to the Chair that in whichever way the Chair sees fit to rule, the Chair certainly understands the issues and has been extremely fair, and I would have no quarrel with him in any event.

Mr. STARK. The Speaker's admonition is well received. Mr. Speaker, I would like to return to the issue of the data banks collected by employers. Part of the reasoning behind repealing this data bank was the feeling that it was overly intrusive; that the Federal Government requiring an employer to do something for the common good is something that the Republicans find antithetical, requiring employers to obey OSHA rules or good labor relations is somehow overburdening them. Thusly, this data bank was considered as intrusive and something difficult for the employers to maintain. By the same token, there has been a resistance to say a COBRA extension. I would submit, Mr. Speaker, that the issue of collecting this health data in the data banks in H.R. 2685 was probably three or four times more expensive than keeping data for COBRA extensions for workers who have been laid off or disabled. It is difficult for this gentleman to be enthusiastic about moving limited amounts of restrictions on employers when, as under COBRA, we have over 30 million Americans who have had their health insurance extended because we did that, and we have perhaps as many as 4 million, as we speak today, who have their health insurance under COBRA because we required those employers to maintain a small data bank. Now, it escapes reason, or it does to this gentleman, why the Republicans should oppose extending COBRA. it costs no one anything. No Federal cost; no cost to the employer; no cost to the insurance company. It has been offered at 110 percent of the previous premium instead of the 102, and the data bank collection for that is so much simpler. I do not want to see this correction take on a life of its own and be considered as a policy to remove any responsibility from employers when they are required by minor Federal regulations to do something that is in the public interest, something that would be for the good of all people. Now, with these layoffs that are coming left and right, American Telephone laying off 40,000 people or whatever, and I am not about to suggest that the Republicans are responsible for that. I imagine the CEO's are Republicans but I do not blame that on the party. But what I am suggesting is that underlying this bill, the unsung agenda is that there is something wrong with the Federal Government requiring an employer, or anybody, to do the right thing. That is wrong, Mr. Speaker. The Federal Government, for example, provides Social Security. It has provided, happily, Medicare, and we do require some businesses or employers to keep records for that to make sure they are not stealing from us. That is a data bank. Under no circumstances would I like to have this bill considered as a precursor for removing other restrictions on collecting data. For example, we are finally starting, this was a bipartisan bill when we used to have bipartisan Medicare bills, to collect outcomes research, a data bank. We are requiring hospitals, even profit hospitals, and physicians to begin to build a data bank about how health policy or health procedures work after 5 or 10 years. That is a vital part of health research, and in no way should that get mixed up with this kind of a data bank, which was not well conceived in the beginning. We have data banks that are useful. There are other areas that, if I just might mention, as I suggested, the Medigap rules, the question of block granting seniors without knowing if we do not have data banks, and somebody says, gee, this is intrusive, we may miss a chance to protect those seniors and those poorer citizens who do not have the option of being covered under major policies by their employers. What I am suggesting is that this correction is worthy of taking care of. I am not sure it is worthy of spending as much money as we have assumed here today in printing costs. But I do think that it is a potential danger, that we ought not to let it set a standard that says just because we are asking private citizens or private businesses to collect information, do we feel that that is not something that could be useful.

Mr. STARK. I yield to the gentleman from Texas.

Mr. STARK. May I be heard on the point of order Mr. Speaker?

Mr. STARK. I thank the Chair. The important issue is that if we were to even consider doing away with the data bank, we could not have the records to support the fact that we ought not to do away with nursing home regulations as the Republican Medicare bill would suggest.

Mr. STARK. Mr. Speaker, I reserve the balance of my time.

Mr. STARK. Mr. Speaker, reclaiming my time, the gentleman is quite correct in his presumption. That was the initial suggestion or intent created by the other body in establishing this legislation.

Mr. STARK. Certainly.

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. The gentleman from New York touched on an issue which I think it important. It is true that we will save employers a piddly little amount of money by doing away with this data. What the employer has to do is keep track of an employee's insurance other than Medicare. But if my colleagues want to talk about a cost to employers and a data bank that will choke the horse of business, talk about the data bank that the Republicans are requiring business to keep if they pass these silly MSA's. Under a medical savings account a business would be required in a data bank to keep track of every medical expenditure, it would be required---- point of order

Mr. STARK. If I may be heard? I am talking about data base requirements by an employer, an issue raised by the previous speaker, and I believe it is quite germane as it deals with the requirements that employers may be faced with in keeping medical data banks as required by the Federal Government.

Mr. STARK. Mr. Speaker, I will confine my remarks to employers collecting data for a data bank that relates to Government insurance and private insurance, which I believe is specifically what the bill and I am suggesting; that while we are eliminating this, we are on the other hand creating an even bigger data bank, and perhaps we should prohibit data banks for things like MSA's which, by the way, exist without any new legislation. MSA's are there today. It is, if we require the employer to keep track of who collects the money for an IRS exemption, he will then have to keep track of each specific payment to a doctor, and it has been estimated that it will cost the Government $4 billion to have these MSA's. Not only will it cost the employers, the gentleman from New York is concerned about more money, it is going to add $4 billion in costs. So, as the Republicans have done, on the one hand they say let us save a nickel here, but let us spend a million dollars if it helps our rich friends in business, and this is a perfect example of, I think, being penny-wise and pound-foolish dealing, Mr. Speaker, with a data bank which is minuscule, which requires almost no recordkeeping by business, while on the other hand ignoring those data banks that are being proposed to be imposed on business and private citizens, which increase the number of insured, increase the deficit and do no good to anyone. This, unfortunately, is the litany and the inheritance of the Republican leadership as they have shown this----

Mr. STARK. I yield to the gentleman from New York.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to recognize the exceptional achievement of Ms. Alberta ``Peppy'' Mayer, a resident of Fremont in California's 13th Congressional District. Peppy was recently awarded the California Distinguished Realtor Award, which is the highest honor that the California Association of Realtors [CAR] can bestow upon one of its members. To receive this award, one must have been a California realtor for at least 20 years, demonstrated outstanding service to the CAR for at least 15 of those 20 years, be a CAR honorary director for life, and be a current, active CAR member in good standing. Peppy is all these things and more--she is one of the most committed, talented, tenacious, and energetic people I know. Peppy Mayer was born in Chicago and lived in both San Francisco and Alameda before settling in Fremont with her husband, Edward Mayer, and their three young daughters. Although she had studied to be a teacher at San Francisco State University, when the family moved to Fremont, she began to look for another career and enrolled in a course in Real Estate. There were few women real estate agents at that time but she soon won a prize for closing the most escrows in the Tri-City area. She has not looked back since. Peppy has been a member of the California Association of Realtors since 1967 and has served the association in almost every capacity since then. She has been a director of the association for 29 years. In 1976, she became the first woman to serve as board president. In 1981, she became the first woman to chair the legislative committee, and in 1985, she became district 6 regional vice president. In 1980, she was appointed as honorary director for life. She has also been a director of the National Association of Relators for the last 12 years. Peppy is the author of numerous publications for both the California Association of Realtors and the National Association of Realtors. She has also received many awards including: Salesman of the Year in 1967, Relator of the Year in 1977, the CAR's 1980 designation as Honorary Director for Life, the Recognition Award for ``A Lifetime of Outstanding Dedication and Service to the Real Estate Industry'' in 1991, and she became a life member of the Million Dollar Club in 1973. As Peppy's business flourished, she still managed to find time to be an active member of the community. She has been the director of the Fremont Chamber of Commerce, making her the first woman to hold this position. She has been a long time member of the fund raising committee for the Fremont Boys Club, and a founding member of the Ohlone College Foundation. Mr. Speaker, I ask you and my colleagues to join me in recognizing Ms. Alberta ``Peppy'' Mayer for her exceptional professional accomplishments and to congratulate her on being the recipient of the 1995 California Distinguished Realtor Award.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to pay tribute to Lt. Drew David Helms, a man who touched the lives of thousands. Lieutenant Helms was a member of the Salvation Army corps in California's 13th Congressional District. He passed away on Sunday, February 11, 1996, as a result of injuries received in an automobile accident. Lt. Drew Helms grew up in Seattle where he learned the importance of service to his fellow man early in life. His parents, Gordon and Peggy Helms, were training to become Salvation Army officers and brought Drew and his older brother, Paul, along with them as they attended the School for Officers's Training. Drew grew up in the corps and credited his parents with teaching him early on to honor and respect all human life and to dedicate one's life to helping those less fortunate. While still in Seattle, Drew met Nancy Newbould. After years of friendship and service together in the Salvation Army, they were married in 1987 while Drew was a student at Simpson College in San Francisco. In June in 1988, Drew graduated from Simpson with a bachelor of arts degree in Christian education. In 1990 Drew and Nancy, along with their 1-year-old son, Nicholas Andrew, entered the School for Officers' Training as members of the Followers of Jesus Session. In 1992, Drew and Nancy moved to Honolulu, HI, after receiving their commissions as lieutenants in the Salvation Army. Once there, Drew was appointed commanding officer of the Leeward Corps. In September of the same year, Drew and Nancy's second son, Cameron David was born. After only a year in Hawaii, the Helms family moved to Hayward, CA where Drew served as commander of the Hayward Corps. They served in Hayward together for the next 5 years and had a daughter, Katherine Leigh, in May of 1995. Lt. Drew Helms was on his way from Hayward to the corps to participate in a neighborhood feeding program when he was involved in a fatal automobile accident. He is survived by his wife, Nancy; their three children, Nicholas, Cameron, and Katherine; his parents, Majors Gordon and Peggy Helms; and his brothers Paul, Derek, and Craig. My thoughts and prayers are with them. Mr. Speaker, I ask that you and my colleagues join me in honoring the memory of Lt. Drew David Helms. His dedication and commitment to those less fortunate should serve as an example to us all.

Mr. STARK

Mr. STARK. Mr. Speaker, the Republican Medicare bill will cost the Nation's seniors an extra $6.8 billion per year in doctor's bills. This is the same rate of balance billing we had before 1985, the year that Congress started to encourage doctors not to charge seniors extra. A return to this previous level of balance billing will cost the Nation's seniors at least $6.8 billion extra per year. The Republican Medicare bill allows doctors to set up fee-for-service plans with no limit on how much can be charged. It allows HMO's to extra bill for the basic package of Medicare services. It permits specialists outside of a beneficiary's managed care plan to charge unlimited amounts. Those who elect the Medical Savings Account option will also lose all protection against the-sky's-the-limit billings. The Republican plan reduces payments for traditional Medicare programs to the point doctors will switch to new systems that allow unlimited fees. Beginning in 1985, Congress passed a series of laws designed to encourage doctors to accept as payment in full the amount proposed by Medicare. As a result, Medicare beneficiary liability for excessive doctors' bills fell from $2.8 billion in 1985 to $1.3 billion in 1992. In current 1995 dollars, that is a decline from $5.5 billion to $1.5 billion. When you factor in the growth in Medicare and assume a return to the old ratio of balance billing, you get $8.3 billion in extra charges. Subtract the current $1.5 billion in extra billing, and you have an additional cost of $6.8 billion from the Republican plan. Seniors have been paying less out of pocket for medical bills in recent years, because assignment rates--the number of doctors who accept the Medicare fee as payment in full--has gone up, from 70 percent in 1986 to 92 percent in 1993. Balance billing--charging seniors more than the Medicare fee schedule--has also declined dramatically. When a senior goes to a doctor, he or she doesn't have to pay more than 20 percent--the coinsurance--of a set fee. There are no extra charges. The Republican bill changes all that. The GOP returns to the rate of extra charges existing in 1985. This will increase costs to seniors $6.8 billion per year, or an increase of $187 per senior in out of pocket expenses. The Republicans will also charge seniors $120 more per year in part B premiums. Put the two together, and seniors will see an increase over the Clinton budget of $614 a couple. Managed care should be encouraged. Medicare currently offers many choices of managed care plans to seniors. We should not return to wallet biopsies and price gouging. Whatever Medicare changes are made, we should preserve the limits on doctors' extra charges.

Mr. STARK

Mr. STARK. Mr. Speaker, United Wisconsin Services, Inc., describes itself as a ``leading provider of managed health care products and services'' offering HMOs, small group preferred provider organizations, and specialty managed care products. For the latest 3 months ending September 30, 1995, as reported in their 10-Q to the SEC, profits were down from the previous year's quarter and for the first 9 months of the year compared to last year. On $267,921,000 in revenues for the third quarter, United Wisconsin Services provided $202,233,000 in health services--or 75.4 cents on the dollar of premium went to health care. The rest went to commissions, administrative expenses, taxes, and profits. The 10-Q then lists a number of steps the company is taking to deal with the falling profit levels. The steps include ``* * * a review of underwriting practices to improve risk identification * * *'' That says it, Mr. Speaker. When the going gets tough, the tough find new ways not to insure sick people. This is why we need national health insurance reform. As price competition intensifies--which it should and which is good--the private sector will spend more and more time and energy uninsuring people. We need guaranteed issue, open enrollment everywhere for everyone.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to congratulate President Odell Johnson. He is retiring after 22 years of service with the Peralta Community College District, the last 15 years as president of Laney College in Oakland, CA. President Johnson is a long time resident of the bay area. He received his bachelor's degree from Saint Mary's College in Moraga and then moved to Fresno to receive his teaching credential. He returned to the bay area to receive his master's from Cal State Hayward and then moved back to Fresno to begin his teaching career. From 1958 to 1965, he was an instructor in the Fresno Unified School District. He then served as executive director of the Trinity Street Community Center for 2 years before becoming the deputy director of the Fresno County Economics Opportunities Commission in 1967. In 1968, President Johnson returned to the bay area where he became the dean of men at Saint Mary's College. In 1970, he was promoted to dean of students at St. Mary and in 1973, he moved to the College of Alemeda where he became the coordinator of special services and veterans affairs. In 1975, he became the assistant dean of instruction and in 1979, he was promoted to dean of instruction. In 1981, he went to Laney College where he served as president for the last 15 years. President Johnson has been a member of a number of community organizations including the Cultural and Ethnic Affairs Guild of the Oakland Museum, the Oakland Public Library Association, the National Association of Black Psychologists, and a member of the Cultural Plan Steering Committee for the city of Oakland. He also served on the board of directors of a number of organizations including, Oak Center Towers Senior Citizens' Housing, Oakland Ensemble Theater, Oakland Youthworks, Patrons of the Arts and Humanities, West Oakland Health Center, San Francisco Bay Area Youth Excellence Initiative Executive Committee. He has won numerous awards over the years including the Outstanding College Administrator Award, which was presented by the Associated Students of the College of Alameda. He received the Urban Services Award for Outstanding Community Service, the Outstanding Educator Award and the Basketball Player of the Century, and the Basketball Hall of Fame honor from St. Mary's College. Mr. Speaker, I ask you and my colleagues to join me in honoring President Odell Johnson for his dedication and commitment to the young people of the community for the last 22 years. He will be sorely missed.

Mr. STARK

Mr. STARK. Mr. Speaker, the Headwaters Forest in Humbolt County, CA, is one of the world's largest stands of privately owned ancient redwoods; however, this beautiful forest is in imminent danger of destruction. The Pacific Lumber Co., directed by Charles Hurwitz, has already logged thousands of acres and has indicated a desire to log some of the forest's last remaining 2,000-year-old giant redwoods. Presently, Mr. Hurwitz, is the subject of two Federal lawsuits totaling approximately $650 million, resulting from the failure in the late 1980's of a Texas savings and loan. The best chance to save the Headwaters Forest is through a debt-for-nature swap in which the Government would acquire the headwaters and in return would relieve all or part of Mr. Hurwit's outstanding debts. A debt-for-nature settlement negotiated with the help of the Clinton administration would allow the taxpayers to recover some of their losses from the savings and loan scandal while preserving one of the true treasures of nature--the Headwaters Forest. Less than 4 percent remain of the ancient, old-growth redwoods that once covered more than 2 million acres from Big Sur to the Oregon border. These majestic redwoods, such an important part of our California and national heritage, need to be preserved for future generations.

Mr. STARK

Mr. STARK. Mr. Speaker, the Republicans are busy talking about flat taxes and sales taxes and reducing the tax on interest and dividends. What we should all be talking about is lowering the tax on labor and job skills and increasing it on pollutants. Global warming is happening. Those who lived through the snow storms of early January may want to laugh. Do not. The following article from the January 10, 1996, New York Times by two environmental experts points out that the recent blizzards are what we should come to expect as the environment changes. I have introduced legislation to remove tax subsidies on the extraction of polluting fuels and minerals. I am preparing legislation to move to the next step and gradually increase taxes on pollutants that contribute to global warming and the degradation of the environment. The money raised from these taxes can be used to fund lower taxes on wages and incomes, so that the average citizen is not hurt by these environmental taxes and so that our whole economy can begin to work for the long-term health of the world environment. [From the New York Times, Jan. 10, 1996] Bad Weather? Just Wait (By John Harte and Daniel Lashof) As the Northeast bowed before an extraordinary blizzard, southern Californians basked in record-breaking heat. Some speculated that this freakish weather was further evidence of long-term global climate change. But focusing on individual events would be a mistake. Unusual weather conditions have always been normal. This does not mean that global climate change is not occurring. A United Nations scientific panel recently concluded for the first time that global warming had begun and would intensify because of rising levels of heat-trapping gases emitted by burning coal, oil and natural gas. The magnitude of the change is uncertain, but over the next 100 years, the panel estimated, the planet's average surface temperature is expected to rise by 1.4 to 6.3 degrees Fahrenheit. The important news about this projected rise is not going to break the way it does for dramatic weather. Continued warming is likely to result in a gradual parching of soil in many regions of the world, possibly leading to declining crop yields even as the global population rises. When does this trend become ``news''? Sea levels will also rise, slowly inundating Asian farmland, entire islands in the South Pacific and coastal cities and harbors throughout the world. Coral reefs will die in the warmer oceans, and grasslands will give way to desert shrubs that can survive on less water, reducing food for grazing animals. Producers of coal and oil, as well as some economists, say that we should learn to live with these changes because doing so will be far cheaper than reducing carbon dioxide emissions enough to halt global warming. Leaving aside the fact that such conclusions ignore potential social and ecological disruption that is difficult to put in monetary terms, a growing body of research and experience indicates that reducing emissions sufficiently is not only possible but makes economic sense. Although the challenge is greater in rapidly developing countries where energy demands are rising most, industrialized nations can lead the way in reducing dependence on fossil fuels. The cost of solving environmental problems has routinely been overestimated. Take the ozone-destroying chlorofluorocarbons. Ten years ago, the chemical industry and other ``experts'' said that finding an economic alternative to these substances would be impossible. Yet once the industry was forced to find substitutes for them, under international agreements beginning in 1987, it managed to phase them out completely in two-thirds the time allowed for just a 50 percent cut, in many cases at a profit. Or consider the shift in fuel economy standards. Before minimum standards were established in 1975, the automobile industry claimed that doubling fuel efficiency, as required, would force everyone to drive compact cars. Ten years later, the standard had been achieved, while the average size of a car had hardly changed. Why were these estimates so far off? In part, opponents of the new regulations wanted to stimulate political opposition. But independent economists often made similar projections, apparently forgetting that political pressure spurs technological innovation. For this reason, some economists believe that the costs of stemming global warming will continue to fall--but only if the pressure to change exists. So far, the United States, with all its wealth and technology, has not made a serious commitment to reduce emissions. Only if we unleash our ingenuity to find solutions can we expect poorer countries to follow suit.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to congratulate the National Association of Women in Construction [NAWIC]. NAWIC is celebrating its 35th anniversary this year and the celebration will be hosted by the Greater Alameda County Chapter of NAWIC in Oakland, CA. The NAWIC is an international association of women employed in the construction industry. Its mission is to promote the construction industry and support the advancement of women within it. NAWIC does this by uniting women who are actively employed in the various phases of the construction industry, by promoting cooperation, fellowship, and a better understanding among members of the association, by encouraging women to pursue and establish careers in the construction industry, and by providing members with an awareness of the legislative process and legislation as it relates to the construction industry. In 1953, 16 women organized Women In Construction [WIC] in Forth Worth, TX, to support women who were employed in the construction industry, a traditionally male-dominated field. In 1955, WIC gained its national charter and became NAWIC. Since its founding, NAWIC has grown to a membership of more than 200 chapters in 47 States and three Canadian provinces. The NAWIC is made up of women who hold jobs in architecture, general construction, subcontracting, material supplying, construction engineering, construction news services, and construction trade associations. NAWIC is the organization that ties the women who work in all of these phases of the construction industry together. NAWIC offers programs and seminars to its members to keep them up to date on issues of importance to the industry. They share the latest industry trends and information through meetings, the monthly bulletin, roundtable discussions, and networking. They also provide a no-charge occupational referral placement which places 30 to 40 people in construction and construction-related jobs each year and a clearinghouse for bidding and employment information issued by other associations, public work agencies, and unions. NAWIC also has a strong commitment to the community. In 1972, the NAWIC Education Foundation was established to educate the community about the importance of the construction industry. Each year, the foundation sponsors competitions that are created to foster and promote construction as a viable career choice among young adults. In 1963, NAWIC established its Founders Scholarship Foundation, and in the past 5 years alone, has awarded more than $250,000 in scholarships to both male and female students pursuing construction-related studies. In its nearly 40 years of service to its members, NAWIC has advanced the causes of all women in construction, women whose careers range from the skilled trades to architecture to business ownership. Mr. Speaker, I hope you and my colleagues will join me in recognizing the 35th anniversary of the National Association of Women in Construction and congratulating the membership on their achievements.

Mr. STARK

Mr. STARK. Mr. Speaker, today, I am introducing a bill that, if adopted, would dramatically improve the quality of medical care received by our Nation's elderly. This legislation instructs the Secretary to implement an on-line, prescription drug information management program for Medicare beneficiaries. This system, referred to as the Medicare Medication Evaluation and Dispensing System [MMEDS], would provide the tools and information to beneficiaries and their health care providers that are necessary in order to reduce instances of adverse drug interactions, over-medication, and other problems related to prescription drug use that plague our elderly. background The inappropriate use of prescription drugs is a health problem that is particularly acute for the elderly. The elderly not only use more prescription drugs than any other age group, they are also more likely to be taking several drugs at once, increasing the probability of adverse drug reactions. The General Accounting Office reported in July 1995 that 17.5 percent of the almost 30 million noninstitutionalized Medicare recipients 65 or older used at least one drug identified as generally unsuitable for elderly patients. In a recent study published in the Journal of the American Medical Association [JAMA], researchers concluded that nearly one in four noninstitutionalized elderly patients take prescription drugs that experts regard as generally unsuitable for their age group. If other situations were taken into account, such as incorrect dosage levels, for example, the number of medicare patients affected by the inappropriate use of prescription drugs would far exceed 25 percent. The inappropriate use of prescription drugs has not only proven to be dangerous to the health of the elderly, it has also proven to be expensive. The Food and Drug Administration estimates that the annual cost of hospitalizations due to inappropriate prescription drug use is $20 billion. The concept of using computer-based systems to improve patient care is not a new one. Advanced on-line computer technology is currently available that permits prescriptions to be screened before they are filled in order to identify potential problems. Thirty States currently operate automated drug utilization review [DUR] information systems for their Medicaid populations. Much of the initial cost--up to 90 percent--incurred by States to implement these on-line drug utilization review systems has been covered by the Federal Government. is it cost effective? The General Accounting office has found that automated prospective drug utilization review, like that called for in MMEDS, is cost effective to implement and to operate. In the State of Tennessee, a reduction of over $4 million in Medicaid drug costs was seen in just a 6-month period, representing 3.9 percent of the total cost of claims processed. In Maryland, over 7,000 prescription doses considered excessive for elderly Medicaid patients were modified, resulting in $385,252 in savings in just 10 months, and a total of $6.7 million in claims were reversed as a result of their on-line MMEDS-like system, accounting for 7.1 percent of the cost of Medicaid claims processed overall. There is no doubt that if Congress acts to approve this bill, the taxpayer's investment will not be lost and Medicare beneficiaries will be healthier as a result. goals The goal of this legislation is to provide a comprehensive outpatient prescription drug information system available to all Medicare beneficiaries which educates physicians, patients, and pharmacists concerning: First, instances or patterns of unnecessary or inappropriate prescribing and dispensing practices; Second, instances or patterns of substandard care with respect to such drugs; Third, potential adverse reactions and interactions; and Fourth, appropriate use of generic products. program The Medicare Medication Evaluation and Dispensing System will build on the existing Medicaid infrastructure. MMEDS will give all Medicare beneficiaries and their health care providers the medication management tools they need to identify the direct threats posed by inappropriate medication. In the process, hospital and other medical costs otherwise picked-up by Medicare as a result of these adverse reactions will be reduced. The program would provide on-line, real-time prospective review of drug therapy before each prescription is filled or delivered to an individual receiving benefits under Medicare. The review by a pharmacist would include screening for potential drug therapy problems due to therapeutic duplication, drug-drug interactions, and incorrect drug dosage or duration of drug treatment. Assuring Appropriate Prescribing and Dispensing Practices While the MMEDS system will be operated under contract with private entities, the Secretary of DHHS would be responsible for overseeing the development of the program to assure appropriate prescribing and dispensing practices for Medicare beneficiaries. The program would provide for prospective review of prescriptions, retrospective review of prescriptions filled, and standards for counseling individuals receiving prescription drugs. The program would include any elements of the State drug use review programs required under Section 1927 of the Social Security Act that the Secretary determines to be appropriate. As part of the prospective drug use review, any participating pharmacy that dispenses a prescription drug to a Medicare beneficiary would be required to offer to discuss with each individual receiving benefits, or the cargiver of such individual--in person, whenever practicable, or through access to a toll-free telephone service-- information regarding the appropriate use of a drug, potential interactions between the drug and other drugs dispensed to the individual, and other matters established by the Secretary. The Secretary would be required to study the feasibility and desirability of requiring patient diagnosis codes on prescriptions, and the feasibility of expanding prospective drug utilization review to include the identification of drug-disease contraindications, interactions with over-the-counter drugs, identification of drugs subject to misuse or inappropriate use, and drug-allergy interactions. The Secretary, directly or through subcontract, would provide for an educational outreach program to educate physicians and pharmacists on common drug therapy problems. The Secretary would provide written, oral or face-to-face communication which furnishes information and suggested changes in prescribing and dispensing practices. In addition, the Secretary is instructed to, directly or through contract, disseminate a consumer guide to assist beneficiaries in reducing their expenditures for outpatient drugs and to assist providers in determining the cost-effectiveness of such drugs. Pharmacy Participation Participation by pharmacies would be on a voluntary basis. Participating would be required to meet standards of participation including, but not limited to maintenance of patient records, information submission at point-of-sale, patient counseling, and performance of required drug utilization review activities. Participating pharmacies would be required to obtain supplier numbers from the Secretary. Such supplier numbers would only be provided to pharmacies that meet requirements specified by the Secretary. Beneficiaries would be notified of which pharmacies are designated Medicare participating pharmacies. payment of services Within a 2-year period after the initial operation of the MMEDS system, the Secretary would be required to submit to Congress an analysis of the effect of the MMEDS on expenditures under the Medicare Program and recommended, in consultation with actively practicing pharmacists, a payment methodology for professional services provided to Medicare beneficiaries. The payment methodology would be designed in a manner that generates no net additional costs to the Medicare Program, after accounting for the savings to Medicare as a result of demonstrable reductions in the inappropriate use of outpatient prescription services. The Secretary would submit a report to Congress regarding such recommendations as the Secretary determines appropriate. privacy of prescription information Standards would be established to maintain the privacy of protected health information. Protected health information means any information collected in any form under this provision that identifies an individual and is related to the physical or mental health of the individual, or is related to payment for the provision of health care to the individual. Conclusion As the number of elderly in our society increases, the number and proportion of drugs used by these older Americans will also increases. It is true that drugs, when used appropriately, can reduce or eliminate the need for surgical and hospital care, prevent premature deaths, and improve quality of life. Unfortunately, a good deal of drug use among older persons is inappropriate, often resulting in hospitalization. While some drug-related hospital admissions are unavoidable, many can be attributed to errors in prescribing. By implementing the Medicare Medication Evaluation and Dispensing System Act, we could greatly improve the quality of care received by our Nation's elderly. I look forward to receiving any comments and feedback from interested parties.