Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, will the gentleman yield?

Mr. STARK. Mr. Speaker, I just wanted to ask the gentleman from [[Page H 6607]] Texas [Mr. Armey] the distinguished majority leader, I hate to forecast votes, but my suspicion is that the conference report on Medicare Select would pass. I think that everything that has to be said on it, I believe it has an hour of debate. And our champion, the gentleman from Michigan [Mr. Dingell] is ready to go. And I might respectfully suggest that we could accomplish some work if the gentleman wanted to begin with that at this point.

Mr. STARK

Mr. STARK. Mr. Speaker, Medical Savings Accounts--MSAs--are the latest fad sweeping Congress and are seen as an easy way to solve the health care insurance crisis. Wrong. They are a brilliant scheme by some profit-hungry insurers to skim healthy people out of the insurance pool and increase health care premiums for the sick, the disabled, and those planning to have a baby. The Washington Post editorial of June 29 entitled ``Not a Cure'' explains the problem: [From The Washington Post, June 29, 1995] Not a Cure In the name of health insurance reform, a proposal is being advanced in Congress whose effect could well be to weaken rather than strengthen the health insurance system. To some extent that's even its goal. It's an idea that should be approached with the greatest caution. The proposal is to change tax law to allow what are known as medical savings accounts. Instead of normal insurance, a person or his boss would buy a high-deductible policy that would kick in only after the first several thousand dollars a year of medical expenses. To help pay the uninsured expenses, the individual or employer would then also put some money in a special savings account. The savings account contributions, whether made by the employer or the beneficiary, wouldn't count as part of the beneficiary's taxable income. The new wrinkle here would be that part of the ``insurance'' would be in cash that the employee could keep in the account for future use if he didn't spend it all. Advocates say the great virtue is that the employees would have an incentive they currently lack to limit their health care spending while increasing national savings. They add that the health care costs of employers would likely decline under the plan, while the cost to the government would increase only marginally (in part because more people would be at least partially insured). The problem is that the savings accounts would likely split the insurance market. The healthy would be drawn to the new system. The others--those likely to face high costs--would not. Health insurance is supposed to be a system for spreading risk. You put as large a cross-section of premium payers as possible into a common pool, and the healthy at any given moment then support the sick, secure in the knowledge that when they become sick in turn, they too will be supported. To the extent that you take away the healthy, the sick are left to support themselves, and the system unravels. The American Academy of Actuaries commissioned a study of the savings account idea. ``Employees who have little or no health care expenditures stand to reap a real financial reward. The biggest losers will be employees with substantial health care expenditures,'' said the head of the study group. The head of Blue Cross and Blue Shield of Ohio calls the proposal ``the ultimate `cherry-picking' scheme invented by some insurers to guarantee themselves large profits by only insuring the healthiest among us.'' The risk is the greater if people can ultimately use the medical savings for non-medical purposes. A bill by Chairman Bill Archer of the House Ways and Means Committee, on which a hearing was held the other day, seeks to prevent that. Some people doubt that for all the debate it has stirred the bill would have the momentous effect that either side expects, and therefore that it's safe to enact. That's not much of a claim for it. Congress should look twice at this one.

Mr. STARK

Mr. STARK. Mr. Speaker, at the close of this month, Tom Elkin will be stepping down from his position as assistant executive officer for health benefits for the California Public Employees' Retirement System. I would like to take this opportunity to thank Tom for the great work he has done for CalPERS and the people of California. Tom's energy, knowledge, and enthusiasm are key reasons why the CalPERS board entrusted him to guide the system's health program. He has been instrumental in CalPERS' success in holding down health insurance costs for the nearly 1 million people who receive health benefits through CalPERS and actually obtaining cost reductions in the last 2 years through hard bargaining with providers. Under his management, the CalPERS health program has maintained quality and choice for its participants while keeping providers honest and focused on those who come to them for care. During the 103d Congress, CalPERS was used as a paradigm by many players in the health reform debate who sought to reproduce the system's savvy use of its market power to negotiate with health care providers. Tom Elkin's skill and diligence created this enviable record of quality and cost containment which has made CalPERS a model for health care management for the 21st century. California will miss the service of this distinguished public servant, who is moving on to new challenges. I wish Tom the best for the future.

Mr. STARK

Mr. STARK. Mr. Speaker, today I am introducing H.R. 1912, the Health Care Fraud Prevention and Paperwork Reduction Act. This bill establishes an effective national program to control fraud, waste, and abuse in our health care system. When Willie Sutton was asked why he robbed banks, he responded: ``Because that's where the money is.'' Today's criminals continue to be attracted to where the money is--in health care. State officials in Florida report that drug traffickers are changing professions because the money is bigger in health care fraud and the risk is less. Fraudulent activities involve both Government programs and private payers. Federal outlays for Medicare along totaled $162.5 billion in fiscal year 1994, and are expected to exceed $177 billion in 1995 and $198 billion in 1996. GAO estimates that fraud and abuse in the health care industry accounts for an estimated 10 percent of our yearly private and public expenditures. In 1994, this would have approached $94 billion. That amounts to approximately $258 million a day or $11 million every single hour. The bill would establish an all-payer health care fraud and abuse program, coordinated by the Office of the Inspector General [OIG] of the Department of Health and Human Services. In fiscal year 1994, the OIG generated savings, fines, restitutions, penalties, and receivables of over $8 billion. This represents $80 in savings for every Federal dollar invested in their office, or $6.4 million in savings per OIG employee. H.R. 1912 would extend Medicare and Medicaid's proven enforcement remedies of civil monetary penalties and criminal penalties to private payers. The policies are proven and represent 25 years of experience in fighting fraud and abuse under Medicare. The bill is an improved version of the antifraud measures included in last year's health reform legislation. Equally important as preventing and detecting fraud and abuse in the health care system is the deletion of waste. Forms, other paperwork, and burdensome administrative requirements increase the patient costs and frustrate the provider. The bill would improve the efficiency and effectiveness of the health care system by establishing standards and requirements for electronic transmission of certain health information. H.R. 1912 would reduce the administrative cost of the current system and make health insurance documents easier for patients and providers to understand. A uniform health claims card would be distributed to each beneficiary of a health plan, and all medical records and reporting would be transmitted using a uniform electronic format. Hearing after hearing has outlined the heavy fraud, waste, and abuse in health care, yet little is done to remedy the problem. Ample evidence exists to show that this activity is costing us millions of wasted dollars each day. We must not wait to enact tougher penalties and enforcement procedures for health care fraud nor should we wait to simplify the administrative processes associated with our health care system. The wasted dollars are far too valuable. This bill should be passed this year. The following is a summary of the bill: Anti-Fraud and Abuse Initiative of 1995 title: fraud and abuse Subtitle A: Amendments to anti-fraud and abuse provisions applicable to Medicare, Medicaid, and State health care programs I. Amendments to anti-kickback statutory provisions A. An intermediate civil monetary penalty of up to $50,000 would be established for anti-kickback violations B. The current criminal fine would be increased to no more than $50,000 II. Amendments to exceptions to anti-kickback statutory provisions A. Current exception for discounts would be modified to prevent providers from giving discounts in the form of a cash payment B. Current exception for bona fide employment relationships would be modified to require that any remuneration be consistent with fair market value, and not be determined in a manner that takes into account the volume or value of any referral C. Current exception for waiver of coinsurance would be modified to allow for such arrangements if-- (1) A waiver or reduction of coinsurance is made pursuant to a public schedule of discounts which the person is obligated as a matter of law to apply; or (a) The person determines in good faith that the individual is indigent, or (b) The person fails to collect coinsurance or deductible amounts after making reasonable efforts, and D. An exception would be provided for certain arrangements where providers are paid wholly on a capitated basis III. Amendments to civil monetary penalty statutory provisions A. A civil monetary penalty would be established for the following improper conduct: (1) Offering inducements to individuals to receive from a particular provider an item or service (2) Engaging in a practice which has the effect of limiting or discouraging the utilization of health care services (3) Substantially fails to cooperate with a quality assurance program or a utilization review activity (4) Substantially fails to provide or authorize medically necessary items or services that are required to be provided under the health plan, if the failure has adversely affected (or had a substantial likelihood of adversely affecting) the individuals B. Civil monetary penalties would be increased to no more than $10,000 for each false or improper item or service C. The assessment would be increased to three times the amount claimed and interest shall accrue on the penalties and assessments after a final decision D. If within one year the Attorney General does not initiate a criminal or civil action the Secretary could initiate a civil monetary penalty proceeding IV. Private Right of Action A. Any person that suffers harm as a result of any activity of an individual or entity which makes the individual or entity subject to a civil monetary penalty may bring a civil action V. Amendments to exclusionary provisions in fraud and abuse program A. The Secretary would have the additional authority to exclude individuals and entities based on felony convictions relating to fraud, theft, embezzlement, breach of fiduciary responsibility or other financial misconduct in connection with the delivery of a health care item or service B. The Secretary's current discretionary exclusion authority would be extended to permit the Secretary to exclude individuals who retain an ownership or control interest in a sanctioned entity C. Minimum period of exclusion for certain violations already specified in statute would be established VI. Amendments to quality of care sanctions A. Practitioners or persons who violate quality of care obligations as determined by the Peer Review Organization would be subject to a civil monetary penalty of not more than $10,000 B. The additional requirement that the practitioner be shown to be ``unwilling or unable'' to meet PRO quality of care obligations before the Secretary may exclude the individual from participating in Medicare would be deleted. VII. Revision of criminal penalties A. For providers who violate specified fraud and abuse provisions, penalties would include fines, treble damages, and imprisonment VIII. Amendments to criminal and civil laws A. A criminal violation for health care fraud would be created for the following crimes (1) Whoever knowingly executes a scheme to defraud any health plan or person, in connection with the delivery of or payment for health care items or services (2) Penalties would include a fine and a prison term of not more than 5 years B. Forfeitures for violations of fraud statutes (1) If the court determines that a Federal health care offense is of a type that poses serious threat to a person's health, or has significant detrimental impact on the health care system, the court could order the person to forfeit property used in or derived from proceeds from the offense and is of value proportionate to the offense Subtitle B: Establishment of all-payer health care fraud and abuse control program I. The Secretary of Health and Human Services (acting through the Inspector General of HHS) and the Attorney General would establish and coordinate an all-payer national health care fraud and abuse control program II. The Attorney General and Inspector General would be authorized to conduct investigations, audits, evaluations and inspections relating to the delivery of and payment for health care and to have access to all records available to health plans relating to the program III. Coordination with law enforcement agencies and third party insurers A. The Secretary and the Attorney General would be required to consult with, and arrange for the sharing of resource data with State law enforcement agencies, State Medicaid fraud control units, State agencies responsible for the licensing and certification of health care providers, health plans, and public and private third party insurers IV. General provisions regarding all-payer fraud and abuse program A. All health plans, providers, and others would be required to cooperate with the national fraud control program and to provide [[Page E 1310]] such information as is necessary for the investigation of fraud and abuse (1) Procedures would be established to assure the confidentiality of the information required by the national fraud and abuse program and the privacy of individuals receiving health care services B. Health plans and providers would be required to disclose information that the Secretary deems appropriate, including information relating to the ownership, control and management of a health care entity IV. Establishment of fraud and abuse account A. Civil money penalties, fines, forfeitures and damages assessed in criminal, civil or administrative health care cases, along with any gifts and bequests would be deposited in an ``All Payer Health Care Fraud and Abuse Control account'' B. The assets in the Account would be used, in addition to such appropriated amounts, to meet the operating costs of the national health care fraud control program Subtitle C: Application of fraud and abuse authorities under the Social Security Act to other payers I. Application of civil monetary statutory penalties to all payers A. The provisions under the Medicare and Medicaid programs which provide for civil monetary penalties for specified fraud and abuse violations (as amended by this Act) would apply to similar violations with respect to all payers B. The following activity would be prohibited and subject to a civil monetary penalty not to exceed $10,000: (1) Expelling or refusing to re-enroll an individual in violation of federal standards for health plans or State law (2) Engaging in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment in a health plan on the basis of a medical condition (3) Engaging in any practice to induce enrollment in a health plan through representations which the person knows or should know are false Subtitle D: Advisory opinions on kickbacks and self-referral I. Issuance of Advisory Opinions A. The Secretary would require an individual requesting an advisory opinion to pay a fee equal to the costs incurred by the Secretary to issue the opinion. Subtitle E: Preemption of State corporate practice laws I. Preemption of State Laws Prohibiting Corporate Practice of Medicine A. No provision of State or local law would apply that prohibits a corporation from practicing medicine.

Mr. STARK

Mr. STARK. Mr. Speaker, advocates of sales taxes and value added taxes say that their proposals will eliminate the underground economy and tax avoidance by the criminal element and pretty much make the IRS unnecessary. Personally, I've been very skeptical of this argument, but the following letter, received by members of the Ways and Means Committee, indicates that the Republican tax revolution may indeed bring a revolution to criminal thinking. Robin, Gypum, & Steel, P.C., Springfield, VA, June 7, 1995. Chairman Bill Archer, Committee on Ways and Means, 1102 Longworth HOB, Washington,

Mr. STARK

Mr. STARK. Mr. Speaker, today I am reintroducing legislation to authorize the Environmental Protection Agency [EPA] to establish a California Urban Environmental Research and Education Center [CUEREC]. I am honored to be joined in this effort by 13 California colleagues: Mr. Dellums, Ms. Pelosi, Mr. Horn, Mr. Lantos, Mr. Matsui, Mr. Miller, Ms. Woolsey, Mr. Mineta, Ms. Eshoo, Ms. Roybal-Allard, Mr. Torres, Mr. Waxman, and Mr. Filner. Legislation to authorize EPA research programs was unfortunately not acted upon in the last Congress. However, CUEREC did receive a line item in the 1995 Department of VA, HUD, and Independent Agencies appropriations bill to cover start-up costs. This line item has allowed CUEREC to begin its first year of operation and the center was dedicated on October 21, 1994 at a tree planting ceremony on the Cal State Hayward campus. The bill requests $4.5 million for fiscal year 1996 because CUEREC is mandated to work with all 22 California State Universities in its 2nd year of operation and because CUEREC will need this level of support to carry out the activities set out for it in the legislation. Currently, CUEREC is in the process of linking California's major university systems--the Cal State University [CSU] campuses, the University of California [UC] campuses, as well as private universities and colleges--to deal with the employment and environmental challenges of California's military base closures and defense conversion. Among other activities CUEREC will: help remove market barriers for small environmental business enterprise development; help in military base conversion and utilization focused on increasing sustainable economic development and job creation throughout California; encourage the transfer of government developed and/or sponsored environmental technology to the private sector while working closely with such laboratories as Lawrence Livermore, Sandia, and Lawrence-Berkeley; encourage the funding of viable environmental projects throughout California; assist women and minority owned small businesses in complying with local, State, and Federal environmental regulations and taking advantage of opportunities in sustainable economic development; avoid duplication in environmental research and education programs by developing an on-line data base of such activities available to all California universities and colleges; help coordinate Cal State and UC environmental applied research and education programs; and advise local, State, and Federal officials on the economic and envionmetal implications of development programs throughout California. Prior to CUEREC, no EPA sponsored research center had been established in California. Seventeen such EPA sponsored research centers have already been established in other States. CUEREC would be the first to focus on urban environmental policy, base closures, and defense conversion environmental problems. CUEREC would also be the first to include all of the universities and colleges in a single State. Both Senators were very supportive of the legislation last year. CUEREC is a unique program, providing many important benefits for California and a cost effective model; university based program for the Nation and I urge my California colleagues to support it.

Mr. STARK

Mr. STARK. Mr. Speaker, medical savings accounts are a brilliant scheme to skim the healthiest people out of the insurance pool--and leave the rest of us to face sky-rocketing insurance rates. MSA's are a bad idea that has spread like wildfire. Following is a portion of the testimony of the Consortium for Citizens With Disabilities before the Ways and Means Subcommittee on Health on May 25. I hope the CCD's insights will help stop this lemming-like pursuit of MSA legislation. Medical Savings Accounts Many Members of Congress believe that Medical Savings Accounts (MSAs) have the potential to reduce health care costs and increase the number of Americans with insurance. There have been suggestions that MSAs be implemented not only in the private sector but in the Medicare program as well. The Consortium for Citizens with Disabilities Health Task Force has major concerns with the emphasis presently being placed on Medical Savings Accounts as a solution to our health system's problems of access and affordability. The use of MSAs is not only untested, but also has the very strong potential for making comprehensive health insurance less affordable for persons with disabilities and serious chronic illnesses. Because of our many concerns, which are discussed below, and in the absence of other reforms, the CCD Health Task Force does not support the establishment of MSAs as either an incremental reform or as a solution to the health care problems facing millions of uninsured and underinsured individuals in the U.S. Supporters of MSAs state that: MSAs will allow the marketplace, not the government to address the cost and access issue. By giving responsibility for paying for health care to consumers, it is assumed that MSAs will reduce unnecessary health care expenditures because individuals who are spending their own money will be more prudent purchasers. It is also assumed that the lower cost of catastrophic health insurance will lead more employers to offer the health insurance. MSAs will lead to lower administrative costs because insurance companies will only be involved with claims higher than the deductible amount. However, MSAs are untested, and it is not clear that they will either lower costs or improve access to services. What are MSAs and How do they Work? Medical Savings Accounts are tax-exempt savings accounts modeled on Individual Retirement Accounts that employed individuals can use to pay for health-related expenditures. State MSA laws generally create incentives for people to set up these accounts by exempting from state taxes the money contributed to these accounts. MSAs work like this: Employers can purchase a standard health insurance plan with a low deductible ($250-$500 annually per person) or a catastrophic health insurance plan with a high deductible ($3000-$5000 annually per person). Because most people will not have health care costs higher than several thousand dollars, the premiums for high deductible catastrophic health insurance plans are much lower than for plans with low deductibles. An employer sets up a MSA for employees who want to participate in this type of plan and deposits, in pre-tax dollars, an amount equal to the difference between the cost of a standard low deductible plan and a catastrophic high deductible plan. The self-employed can also set up a MSA. Employees can use the money in their individual account for health care expenses. When the high deductible is met, the insurance company then pays the bills. If money is left in the account at the end of the year, it can be withdrawn and used for other purposes or carried over with accrued interest into the next year. The CCD has several major concerns about MSAs: The catastrophic health plans that are purchased in conjunction with MSAs can impose pre-existing condition limitations and can refuse to cover persons with certain health conditions or disabilities. Catastrophic health plans with high deductibles often do not provide the comprehensive coverage needed by persons with serious illnesses or conditions. Some of these plans have lifetime or per condition limits of only $100,000. The American Academy of Actuaries has estimated that persons with high health expenses will experience major increases in out-of-pocket costs with MSAs. MSAs may also increase out-of-pocket costs if the amount employers contribute to the MSA is not sufficient to cover the annual catastrophic deductible. Additionally, the combined cost to the employer of an MSA contribution and the catastrophic health plan premium may not be less than the cost of a standard health plan. If large numbers of individuals choose MSAs plus catastrophic health plans, the health insurance market will be further segmented, reducing the size of the population pool needed to spread risk adequately. MSA will likely lead to adverse selection because they will be utilized primarily by younger, healthier people who do not anticipate a need for health care. Persons who anticipate health care expenditures, those who need comprehensive coverage, and those who are older and at higher risk for needing health care are likely to remain in standard low deductible health insurance plans. Individuals with MSAs could also change to a low-deductible plan when they become sick or anticipate medical bills (e.g., childbirth expenses), thus exacerbating the problem of adverse selection. Adverse selection will lead to higher premiums for persons in standard, low deductible health insurance plans. It has been estimated that if MSAs are widely adopted, the cost of a standard, low deductible health insurance policy would rise by as much as 26%. Increases of this magnitude will make comprehensive, low deductible insurance unaffordable both for employers and individuals who want to purchase these policies. There is no evidence that MSAs will make consumers more cost conscious when they are seriously ill. Physicians--not consumers--determine what treatment is needed. If surgery is recommended, consumers don't look for the cheapest surgeon, they look for the best surgeon. Some individuals may forgo preventive and early intervention services if they are allowed to use money left in their MSAs at the end of the year for personal expenses other than health care. This concern also raises the question of whether it is appropriate to allow pre-tax dollars to be used for non-health expenses. It is likely that catastrophic health plans will restrict the type of health care expenditures that will count towards the deductible. For example, if an individual spends $3000 on mental health services, there is no guarantee that all of these expenses will be counted towards the deductible, particularly if the insurance has limited coverage for these services. A majority of Americans are enrolled in some form of managed health care plan. It is unclear whether MSAs can be coordinated with these plans. Those opposed to managed care view MSAs as a means to maintain the market for indemnity insurance and fee-for-service health care delivery. Experience with MSAs is very limited. It is not clear whether they will result in savings. Some analysts predict that any potential system cost savings will be eliminated by the additional costs required to administer MSAs. Most importantly, the CCD Health Task Force believes that allowing employers and the self-employed the option of establishing tax deductible MSAs in conjunction with coverage is not the solution to our nation's health system problems because: MSAs do not address the need for insurance by millions of working Americans whose employers will not contribute to the cost of health insurance; and MSAs do not address the need for insurance by millions of low-income individuals who are self-employed or unemployed and who cannot afford to buy health insurance.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to mark the 12th annual observance of National Missing Children's Day and to recognize Child Quest International, Inc., a San Jose based nonprofit organization, for all of their tireless efforts on behalf of missing children. As of this year, Child Quest International has assisted in the recovery of 1,016 missing children. More than 1,000,000 children are reported missing in the United States each year and between 20,000 and 50,000 of those remain missing for more than 1 year. Child Quest International was founded in 1990 and formed to protect and recover missing, abused, and exploited children. Child Quest International works to successfully reunite missing children with their families and to provide support and referral services to children who have been abused and exploited. Child Quest International assists families 24 hours a day, 365 days a year through a nationwide toll-free number. Its caseworkers all have criminal justice backgrounds with the expertise to investigate cases and provide technical assistance and counseling to families. They have a worldwide photo distribution network over which they can distribute posters and flyers. They are able to do mass and direct mailings and utilize mass media such as television, radio, newspapers, billboards, and bus signs. Child Quest International differs from other nonprofit organizations, in that it also utilizes new technologies such as computer information networks and computer digitized photographs. Child Quest International also provides support and referral services for families worldwide in the following areas: abused and exploited children, Grandparents' rights, and missing adults. They provide mediation services for parents and children and referrals for counseling and therapy. Child Quest International is also very active in education and prevention through TV and radio programs, public service announcements, presentations at schools, service clubs, and community events, and such services as the S.T.O.P. kidnapping program. Mr. Speaker, I would like to commend Child Quest International for its dedication to the protection and recovery of missing, abused, and exploited children on this 12th annual observance of National Missing Children's Day.

Mr. STARK

Mr. STARK. Mr. Speaker, for those of my colleagues who served with John Burton in this House or have known him otherwise, there's no need for me to say that John is a one and only. The brother of the late Phil Burton, John is now an Assemblyman in the California legislature representing the city of San Francisco. Sunday, April 9, 1995, the San Francisco Examiner Magazine published a feature that catches the essence of the John Burton I know and love. John tells it the way it is and he doesn't spare himself. His commitment to [[Page E1132]] his constituents, especially those that can use a helping hand, comes through loud and clear, as does his love for his city. Some might ask why, in these days of penny-pinching stewardship, I devote limited resources to spreading the John Burton story over a few lines of this Record. Anyone with an ounce of compassion will know after reading what follows. Serving the public involves more than a green eye shade and a sharp pencil. John Burton has that extra ingredient. Maybe by putting these words before my colleagues some of what John Burton has will rub off. I hope so. [From the San Francisco Examiner Magazine, Sunday, April 9, 1995] The Last Tangle (By Edvins Beitiks) Caught up in the memory of Jimmy Durante's how's-by-you scene from The Man Who Came to Dinner, Assemblyman John Burton swung around in his chair, imaginary fedora tipped back on his head, imaginary nose groaning under the weight of a Hollywood gone by, ran his fingers across an invisible piano on the desktop in his office and sang, ``Didju ever have the feeling that you wanted to go and still have the feeling that you wanted to stay. . .'' Burton laughed. ``Saw Durante in Vegas once,'' he said. ``What a show. I goddamn tingled.'' There are other names that get Burton smiling: Burl Ives, doing his version of ``Big Rock Candy Mountain.'' Louis Prima and Keely Smith. Phil Harris and ``That's What I Like About the South.'' June Christy singing ``Something Cool.'' Burton remembered listening to Christy on the hi-fi in the mid-'50s, when he pulled a tour with the 2nd Armored in Germany. ```Midnight Sun' `I'll Take Romance,''' he said. ``That got me through the Army.'' When California's term limit kicks in on the veteran Democrat, forcing him to leave office in 1996, he'll be going back to Ives, Harris and Christy for some soothing words. Not that he needs to be soothed--politics these days isn't what it used to be, said Burton, and leaving the Assembly won't be that hard. ``It's tougher to do the public's business, every day,'' he said. ``You're fighting a battle against people who want to cut off a whole hand. I've never been one to take any satisfaction in being able to say, `We saved two fingers.' I've never been happy with saying, `Well, we got them to cut only $10 instead of $20 from the old people's pension.' That's no thrill for me.'' These are miserly times, said Burton, who publicly underlined his disgust by introducing legislation at the end of last year to ``criminalize'' poverty. His Swiftian bill, AB44, suggested that if a family of four ``intentionally or maliciously'' falls below the federal poverty guideline of $14,763, the parents should go to jail. Republicans brushed the bill off as another piece of windmill-tilting by Burton, but the longtime liberal said he just wanted some honest debate on the issue. At the time, he explained: ``Maybe during the hearings it might come out that . . . you can't make it a crime for someone to be poor because a lot of people don't want to be poor.'' Sitting behind the desk at his Sacramento office, Burton said, ``It was something I felt like doing. The idea is to let somebody have a reasonable chance at a decent job and a good standard of living. You know, people don't want to be poor. They don't want to live that way. ``I'm very pessimistic at the way things are going,'' he said. ``Your basic Republican comes goddamn near to being an anarchist. They accuse the Democratic party of steamrolling, but they did something Democrats haven't done--threatening their moderates that if they don't go along with this b.s. they won't get committee chairs, they won't get anything.'' Republicans have also pushed for a constitutional amendment on a balanced budget--a concept Burton has always opposed. ``It's government by minority,'' he said. ``Businesses are allowed to go into debt, individuals are allowed to go into debt, individuals are allowed to go into debt to buy a home or a car. But to say the entity responsible for providing for the common defense and promoting the general welfare . . . isn't allowed to go into debt? That's crazy.'' After 30 years of political give and take, said the 62- year-old Burton, ``The thing I miss most is . . . your word is your bond. A guy gave you a handshake and that was it. No more.'' Although he didn't see eye to eye with former governor George Deukmejian, Burton acknowledged that ``Duke at least stood up for what he said. And Ronald Reagan, for all his faults, was much more human than Pete Wilson.'' Burton dismissed the current governor as ``this p-- --. He's not reactionary. He's not moderate. He's nothing. He was for affirmative action when it was popular, now he's against it. It was OK to bring in Mexican farmworkers, now he's against immigration. I don't like people like that.'' He hasn't changed much since his first election to the Assembly in 1964, Burton said, ``except that I'm more tolerant of viewpoints different than mine. I don't consider that members who are conservatives are, on the face of it, fascists, although some right-wingers would put on brownshirts in a minute if they could.'' Burton learned to distrust conservatives on his daddy's knee. His father, Thomas, was a traveling salesman who decided to go to medical school when he was 36 years old and brought his family west to set up shop in San Francisco-- making house calls in Hunters Point, not charging patients who couldn't pay. ``The guy always had a social conscience,'' said Burton. ``He was always very color-blind. . . . I can remember driving once down Golden Gate with him and we saw these kids playing, 6 to 7 years old, black and white, and he said, `Kids that age don't have a problem, but when they grow up they're told, `You can't play with those people.''' Thomas Burton, a native of Indiana, was an early supporter of Franklin Roosevelt and the liberal wing of the Democratic party. ``In 1956, he sent a $1,000 check to Adlai Stevenson, which was a lot of money for anybody, much less our family,'' Burton said. Their father's liberal leanings were passed on to his three sons, starting with Phillip Burton. ``He ran the first time in 1954,'' John Burton said of his legendary older brother. ``Challenged an incumbent who died two weeks before the election and the guy still won. ``In `56, just after I got out of the army, he went against Tommy Maloney, who'd been in city politics forever. I told my brother, `You're f--------g nuts! If you lost to a dead man, how are you going to beat this guy?' But he did, and when he won it, it was a great tonic for me. The beginning of my political career, really.'' In 1964, John Burton was elected to the Assembly from the old 20th District, a district so Democratic he couldn't lose. ``It was different in Sacramento back then,'' he remembered. ``I was calling the sergeant-at-arms `Sir.' Jesse Unruh was speaker, I voted against him and he started to s-- ---- on me a little bit. That kind of stuff happened all the time.'' Unruh, son of a Texas sharecropper who boasted of not wearing socks until he was 12 years old, was of the old school, said Burton. ``People like Unruh and my brother ate, slept and breathed politics. Not many people up here are into it like that anymore.'' His longtime friend Speaker Willie Brown belongs to the old school, too, and it made Burton grin to see the way Brown out-maneuvered Republicans to win back his spot after the last elections. ``Some Republicans objected to even calling him `co-speaker.' They didn't want to even give him a share, and now he's the speaker. The kind of tickles me.'' Calling back faces from the past, Burton remembered San Francisco Supervisor Bill Blake, who once arrived late to a restaurant, threw the keys to his car to a man standing at the curb, thinking he was a valet, and came out after dinner to find his car stolen. And then there was Congressman Eddie Patton, who ``used to talk out of the side of his mouth like this,'' Burton said, tossing frogtones out of his lower lip. ``Eddie was a piece of work.'' The phone rang and Burton talked a little, chuckled a little, then offered the three golden rules for a man getting old: ``Never pass a urinal, never ignore an erection and never trust a fart.'' He leaned back in his chair and smiled, nodding his head to the laughter that came bursting from the other end of the phone. Burton turned to talk about his growing-up years, when he lived at the edge of West Portal and the whole city was his playground. ``I went to Jefferson Grammar School, played behind Colonial Creamery on Irving Street. When I was at Lincoln High, we used to go out to McCoppin Park, 24th and Taraval, regular. Drank some beer, played some basketball. ``I can remember, as a 12-year-old kid, working at the YMCA on Friday nights, getting out about 9:30 and walking down Leavenworth and up Market. You'd have all these hucksters out on the street, selling trick packs of cards, ducks with their heads dipping in water, and never thought for a minute anything could happen to you. ``Sometimes I'd walk all the way out to Sloat Boulevard, rights through the tunnel. If the streetcar came through, you had to step to one side, let it go past. Walk all that way, and never worry.'' Burton drew other pictures of San Francisco in the air, including the image of John D. Monaghan, bartender at No. 10 Sanchez. ``I used to take my daughter there on St. Patrick's Day--John standing behind the bar, answering the phone, `No. 10,' kind of rocking back and forth on his feet, talking to everybody, more full of s-- than a Christmas turkey. Oh, man, how could you not love it?'' But those days are gone, said Burton. ``Society's getting worse, therefore the city's getting worse. You had the `homeless' at Third and Howard, a few drunks sleeping at night in Union Square * * * but now `homeless' is a part of our society. Not since the Depression has there been the underclass we have now.'' Because the government flat gave up on the War on Poverty, said Burton, ``we're reaping a whirlwind of neglect.'' There has been plenty of speculation about Burton's options after he leaves the Assembly. He waves it away, saying, ``When I get out, there are two things I want to do--learn Italian and play some bocce ball.'' But he's not getting out anytime soon. Last month, he threw his fedora into the ring for state senate--the 3rd District seat [[Page E1133]] belonging to Sen. Milton Marks. Burton's ultimate decision, though, will take into account whether Willie Brown runs for mayor of San Francisco or Marks' seat. ``I think it's important for somebody to be doing battle with the right-wing Republicans, who are more and more taking over the Republican party in this state,'' said Burton. ``To thwart their efforts to cripple public education, cripple environmental protection and take away women's right to choose. These are tough times, and you should get in the fight and stay in the fight--not drop out and kind of bitch and moan.'' Burton's name has been mentioned for The City's mayoral race, but he doesn't see himself running. ``My mother didn't raise me to cut back on libraries or playgrounds or AIDS funding, or go after poor people on the street,'' he said. Lately, San Francisco has been ``penny wise and pound foolish,'' added Burton. ``But, to be fair, the city just doesn't have the resources.'' It doesn't seem that long ago that Burton's best friend, George Moscone, was assassinated at City Hall on Nov. 27, 1978. But it's been a long time, and--for Burton--a hard road. Moscone was his friend from the day they met in 1946 until the day the mayor was shot to death with Supervisor Harvey Milk, said Burton, who still can't understand the killings. ``It was such a f----g nutty thing,'' he said, looking down at his hands. ``I heard some political forces were egging (Dan White) on--`Somebody ought to kill that f----r,' things like that. I don't know. ``During that period I was, shall we say, involved in doing drugs, and I started doing more,'' Burton said. ``I don't know if what happened to George was the reason for it, but I guess I used it as a reason. I mean, George was as close to me as my brothers.'' Burton found himself hooked on ``what they call crack now, called it free-basing back then. I would get so depressed I couldn't move. I'd stop for a couple of days and had to start again, just to get energy. ``I got into nitrous oxide, too,'' said Burton. ``I'm a very addictive-compulsive person * * * went on a four-month run once, like you see on TV or in the movies, the guy's OK one day and the next he's in the gutter. ``I learned you can't quit for six months and go out and celebrate with a couple of toots or a couple of tokes and quit the next day. The only way to do it is not to do it at all.'' By the time of Moscone's death, Burton was already known for stream-of-consciousness speeches from the floor of the legislature that made no sense. In ``A Rage for Justice: The Passion and Politics of Phillip Burton,'' a biography due out this fall, Sacramento political columnist John Jacobs writes, ``John Burton was going downhill fast. Rumors surfaced that a dry cleaner found packets of cocaine in his coat pocket * * * friends feared they would find him dead somewhere.'' Burton got the message himself, calling an end to his brief Congressional career two days before the filing deadline for the 1982 elections. He remembers the date exactly: Sept. 30. ``I went back to vote against the balanced budget amendment. That was on Thursday. Sunday, I flew down to a hospital in Arizona and checked myself in. It was easy after I really decided to do it, after I acknowledged half-assed to myself that I've got a problem, instead of, `It's no big deal.' ``Haven't had a drink since then,'' he said. ``Not too long ago I was at a party where they had that Australian beer-- Foster's--I took a little sip and I could feel it going down. I knew I'd be in trouble if I took a good gulp. And nonalcoholic beer? I had some once and the guy says, `Tastes good, huh?' and I said, `Yeah, it does taste good. I better not have anymore.' ``I don't miss it,'' Burton said. ``I don't really like being around people who drink. Three drinks and they have a heat on, don't even know what they're saying. Women who take a drink and just get silly.'' Burton, who has been married twice and remains divorced, smiled and said, ``I'm sure it breaks their hearts, but I just have to pass.'' In Jacobs' book, one Republican argued it was worth keeping Burton in office because ``at least John Burton stood back in his stupor and didn't do much but vote wrong.'' But Burton's legislative record has been anything but passive. ``At one point, before the Republican governors got ahold of it, our aged, blind and handicapped had a better standard of living than the aged or blind anywhere else in the country,'' said Burton, who sponsored SSI bills for the handicapped. ``And our autistic children's program was the first in the nation.'' Burton was also proud of his ``asset forfeiture law-- keeping law enforcement officers from just coming in and grabbing property without cause.'' But he acknowledges his own political career doesn't compare to the record of his brother, Phillip. Some of Burton's best memories come from sharing the spotlight with his brother back in Washington. ``I kept thinking about what Phil and I together were doing to all those conservatives in the Old Guard. Driving them up the wall. I laughed my ass off. ``You look at what Phillip's done, it's awesome. There hasn't been a minimum-wage bill since he did it, and he's been dead 10 years. Redwood Park, Golden Gate National Park, miners' lung legislation, and on and on and on. He just brought me along for some of it.'' And Burton enjoyed the ride, every minute of it. He remembered walking down the steps of the Capitol with his brother, making up words to a song about angry Republicans, then making them angrier with new legislation. ``Nowadays, there are so many intrusions into people's rights to live decently,'' said Burton. ``If I did something for the quality of life for people, just helped a little, who gives a s-- whether they erect a statue to you or not?'' Having his political life wrapped up in the wonder of California has made it all worthwhile, Burton said. ``California's got so much, you know? Like Pat Brown used to say--`When I fly over this great, big beautiful state of ours. . .''' Burton, whose desk holds a glass ball that beams, ``God Made the Irish #1'' and a nameplate with shamrocks on either side, reminisced about the power of Irish districts when he first started out, when ``the Mission was Irish, Noe Valley was Irish, the Sunset. Around the Castro it was the Scandinavians, the Excelsior was Italian, Potrero Hill-- Russians and Slavs, the Richmond was kind of Irish, kind of Russian, there was Manila Town off Kearny, and the Haight was a mixture. ``The mix has changed, but it's still a melting pot, and it's wonderful. You can't beat it,'' said Burton, grinning all at once. ``San Francisco. You've got to f____ love San Francisco,'' he said. ``I remember once when I went out to eat at a restaurant, must have been down around Westlake, and there's all this fog. I got out there, wound up just walking around the parking lot for 10 minutes, maybe more, taking it all in. ``The woman I was with must have thought I was nuts, but being away from San Francisco and coming back to the fog . . . you've got to love it.'' Burton looked around his office, filled with photos from three decades of political hand-shaking and head-shaking and hand-wringing and loud singing in the front room with people from the Mission and Sunset and Bayview. He smiled to himself, hummed a bit of ``Big Rock Candy Mountain,'' and said once more ``You've got to love it.''

Mr. STARK

Mr. STARK. Mr. Speaker, we have heard today about ideas and proposals being proposed. But these same proponents of these ideas have put forth a budget that destroys children in this country, destroys clean air, destroys safe water, reduces law enforcement, all in the name of providing tax cuts to the rich. All I can say is, please leave our seniors alone. The gentleman who preceded me a few speakers ago in the well, who chairs the Subcommittee on Health and the Environment of the Committee on Commerce, has already cut $84 billion out of the trust fund for Medicare just to give tax cuts to the very rich. Do not help us anymore, Mr. Chairman. You have done enough harm already. Medicare Select is nothing but a political payoff to big insurance companies. Prudential Life Insurance Co. has already been convicted of stealing billions of dollars from seniors. Golden Rule Insurance Co. is under more litigation with State insurance commissioners than any other insurance company in the country. The staff who drafted this silly bill was paid hundreds of thousands of dollars by the insurance industry last year, and they are telling you they are here to help seniors? Mr. Speaker, do not believe that. They have already cut $3,000 out of seniors' pockets by changing the taxes that they will pay, to pay for their silly budget which is designed only to give tax cuts to the rich. So, yes, let us balance the budget, let us help kids become healthy, let us have education and a clean environment, but do not louse up Medicare with silly ideas that are untried, that are just a payoff to the major insurance companies in this country, that will do nothing but deny medical benefits to the seniors who are already happy with their health care. This is free enterprise to pay off Republican campaign contributions run amok.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to introduce the Medicare Beneficiary Protection Amendments of 1995. I am joined by Mr. Waxman, Mr. Ackerman, Mr. Coyne, Mr. Dellums, Mr. Foglietta, Mr. Gonzalez, Mr. Kennedy of Rhode Island, Mr. McDermott, Mr. Olver, Mr. Palone, Ms. Pelosi, Mr. Rangel, and Ms. Woolsey. This legislation is designed to achieve what its title implies--to improve the protections provided to Medicare beneficiaries. This legislation is urgently and increasingly needed, for two chief reasons. First, proposals are appearing that have as their focus the movement of more and more Medicare beneficiaries into managed care insurance products. Some proposals would push beneficiaries into health maintenance organizations. I support a less coercive approach, one that allows beneficiaries to determine the pace at which they move into HMO's. But either way, HMO's will continue to play a growing role in Medicare. Second, an extensive survey of Medicare HMO enrollees and former enrollees, recently completed by the inspector general of the Department of Health and Human Services, documents several problem areas with Medicare HMO's. The inspector general's findings substantiate numerous complaints I have received from individual beneficiaries over the past few years. It is clear that before Congress flings the Medicare doors wide open to managed care plans, we ought to act to prohibit managed care practices that are known to jeopardize beneficiary care. And we ought to act swiftly, because this is an area where an ounce of prevention is worth more than a pound of the cure. The summary finding of the inspector general's report, I believe, captures very well the overall experience we are having with the service delivery of Medicare HMO's: Generally, beneficiary responses indicated Medicare risk HMOs provide adequate service access for most beneficiaries who have joined. However, our survey results also indicated some problem areas: beneficiaries' knowledge of appeal rights, access and service to [end stage renal disease]/ disabled beneficiaries, and inappropriate screening of beneficiaries health status at application. Overall, Medicare beneficiaries are receiving adequate services, but serious problems exist with a significant number of enrollees, particularly among those enrollees who have the greatest health care needs. Some of the specific findings of the inspector general are: [C]ompliance with Federal enrollment standards for health screening and informing beneficiaries of their rights appeared to be problematic. Most beneficiaries reported timely doctor appointments for primary and specialty care, but some enrollees and disenrollees experienced noteworthy delays. Perceived, unmet service needs and lock-in problems led 22% of disenrollees and 7% of enrollees to seek out-of-plan care. Disabled/ESRD [end stage renal disease] disenrollees . . . reported access problems in several crucial areas of their HMO care. In addition, the inspector general's survey found that: 16% [of enrollees] either planned to leave or wanted to leave [their HMO], but felt they could not, primarily for reasons of affordability. The most troubling of the inspector general's findings is that: 66% of disabled/ESRD enrollees wanted to leave their HMOs. I have no illusions that the ``Medicare Beneficiary Protection Amendments of 1995'' will completely alleviate all of these problems. In fact, I am hopeful that consumers, providers, and others will continue to offer suggestions as to how we can continue to improve the quality of care received by Medicare beneficiaries. Nonetheless, the remedies I am proposing today will take us a long way toward that goal. In addition to providing specific responses to managed care practices that have created beneficiary access problems, this legislation provides a framework through which Medicare beneficiaries can make informed choices about their Medicare coverage options. Too often today, while a beneficiary has the legal right to exit an HMO and return to traditional Medicare coverage, the inability to secure an affordable Medicare supplemental policy--a medigap plan-- makes this a hollow option. As proposed in this legislation, the institution of a coordinated open enrollment process for Medicare beneficiaries will guarantee that the options we claim to provide to beneficiaries are actually open to them. Central to the functioning of the coordinated open enrollment process--and to guaranteeing true choice for beneficiaries--is the beginning of attained-age pricing of medigap premiums. Attained-age pricing is the policy of raising medigap premiums as an enrollee gets older. In their report on medigap plans, Consumer Reports magazine described attained-age priced plans as hazardous to policyholders. I agree. A comparison of the least expensive attained-age rated medigap plan versus the only community-rated medigap plan in California--using plan E for the comparison--showed that a typical Medicare beneficiary will pay $3,360 more for the attained-age plan than the community-rated plan over his or her life. On top of being more expensive, this attained-age rated plan restricted access to a limited number of health care providers. The reason for the higher lifetime premium is that while the attained-age plan starts with a lower premium, the premium quickly rises as the beneficiary ages to well above the non-age-adjusted community rate. The premium comparison follows: medicare supplemental plan e (Premiums as of May, 1994 for the California counties of San Diego, Orange, Los Angeles, San Bernardino, Imperial, and Riverside)

Mr. STARK

Mr. STARK. Mr. Speaker, the May 17 radio commentary by Kevin Phillips on the Republican budget plan hit the nail on the head: In the guise of crisis legislation, deficit reduction . . . especially as put forward by the House of Representatives, also has major overtones of special interest favoritism and income distribution. Spending on government programs, . . . is to be reduced in ways that principally burden the poor and middle class while simultaneously taxes are to be cut in a way that predominantly benefit the top one or two percent of Americans. If the U.S. Budget deficit problem does represent the fiscal equivalent of war--and maybe it does--then what we are really looking at is one of the most flagrant examples of war profiteering this century has seen. And it deserves to be rejected with outrage. Mr. Phillips is right: The Republicans are practicing class warfare. They get upset when you use that term--but that's what they are doing. They doth protest too much about the term, and the proof is overwhelming that they are taking from the bottom half of our society to give to the top 1 percent.

Mr. STARK

Mr. STARK. Mr. Speaker, the debate on reforming our health care system has begun to focus on the potential role of medical savings accounts. I would like to enter into the Record some comments from business, consumer, and health policy organizations regarding medical savings accounts [MSA's]. There comments are helpful in evaluating the likely costs and benefits to be derived from MSA's. In sum, these organizations find that the risks of MSA's are high and the rewards are, at best, overstated. The attached also sheds light on one particular company that is profiting handsomely from MSA's, and how this is so. The level of profits generated by this company, and how they have chosen to spend them, give us reason to take pause. These comments follow. February 1, 1995. Medical Savings Accounts--Not for Medicare! Dear Colleague: We have heard much about medical savings account (MSAs) recently. Companies that stand to benefit financially from MSAs--and those who have benefited from the profits of these MSA proponents--have been quick to push their merits. This week, Speaker Gingrich proposed to give Medicare recipients vouchers to enroll in medical savings accounts. More objective parties--business, consumer and health policy organizations across the potential spectrum--have concluded that the expansion of medical savings accounts will exacerbate problems in the health insurance market. ``While on the surface these proposals have some appeal . . . they pose serious problems . . . There does not appear to be a way to design an MSA that is not detrimental to the goal of achieving universal or near-universal coverage at a reasonable cost.''--Center on Budget and Policy Priorities ``To illustrate the current misunderstanding of how MSAs would generally operate, the [Academy] uses an example that appeared in a letter released by Senator Phil Gramm . . . The example seems clear enough. However, like many others, it misrepresents what is generally financially possible.''-- American Academy of Actuaries ``Our judgment is that the medical IRA is not going to bring about the kind of universal coverage and the stopping of cost shifting [[Page E1091]] that we would like to see . . . There are a number of other problems we have with a medical IRA that we think it will be found lacking in terms of where we would like to see health reform go.''--US Chamber of Commerce ``[The MSA] proposal does nothing for cost containment . . . Once fully implemented, [the MSA] proposal would have enormous negative effects on Federal revenue. It would create a huge new tax advantage/subsidy, going mostly to the non- poor . . . It could have deleterious effects on primary care.''--American Association of Retired Persons ``The likelihood that MSAs would be more attractive to healthy families indicates a potential adverse selection problem . . . In an unrestricted market, the difference in premiums [between traditional and MSA plans] would grow over time as the healthiest people in high-cost groups switch to lower-cost plans.''--Congressional Research Service, September 1994 Advancing MSAs may be in the financial interests of a few, but Medicare beneficiaries are not among them. Shown on the reverse is the chief proponent of MSAs and some information on this insurer's operations. Sincerely, Pete Stark, Member of Congress.

Mr. STARK

Mr. STARK. Mr. Chairman, I yield myself 1 minute. Mr. Chairman, could the gentleman from Minnesota [Mr. Peterson] explain to me the difference between the budget program that you are suggesting and the one that the Republicans are proposing?

Mr. STARK. Mr. Chairman, I yield 2 minutes to the gentleman from Vermont [Mr. Sanders]. (Mr. SANDERS asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Chairman, I yield 3 minutes to the gentleman from Indiana [Mr. Visclosky]. (Mr. VISCLOSKY asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Chairman, this is the hour allotted to the Joint Economic Committee. I thought it was train schedules for the Metro here. But I am going to explain that, as we learned in agricultural economics, that chicken droppings and chicken salad come from the same place, but there is, indeed, a world of difference between them. The budget resolution, as propounded by my Republican friends, really has nothing to do with economics. It has to do with a little accounting sleight-of-hand, perhaps some legislative legerdemain, but certainly not economics. It does represent massive redistribution from the elderly to the rich. Programs that benefit average Americans are cut, reduced, squeezed, whatever you want to call it, to provide huge tax breaks for the wealthiest people among us. Cuts to finance those breaks are made across the board, children's programs, Medicaid earned income tax credit, a whole host of credits, to given tax cuts to the rich. Today, however, I would like to focus on the proposed cuts in just one area. Guess what, Medicare. The resolution would require us to cut $283 billion out of the Medicare Program. That is a big chunk of cut. Now, the Republicans would like to pretend, and this is interesting, this is what economists do all the time, they pretend something is what it ain't. The Republicans would like to pretend that these are not really cuts, just reductions in the rate of growth. Now, that argument is, in economic language, specious, misleading, and hypocritical. For the Social Security recipients, these proposals increase out-of-pocket costs while reducing availability and quality of medical services. Now, the Republicans would make it sound as if Medicare costs rise over time because the program is growing, as if Congress is adding entitlements and new services, or paying higher reimbursement rates, or covering new categories of people. But none of those things are true. The truth is the Republican cuts would come out of the amount needed to keep benefits and rates at current levels. That is all. In 2002 alone, payments for each senior will increase by over $1,000. That is economics that the seniors in my district understand. The increases in the Medicare premiums and deductibles seniors would pay are not even the whole story. These cuts that the Republicans are talking about would reduce seniors' access to health care and require new copayments for services such as lab tests, home health care, and skilled nursing facilities. Seniors in California in my area would have to pay almost $1,500 more on the average for health care by the end of the 7th year. That is economics, ladies and gentlemen, that they can understand. Yet my Republican colleagues complain that the Government programs do not work. The distinguished vice chairman of the Joint Economic Committee, the ranking Republican member, just said this is about independence, responsibility, and hard work. Hogs on ice are independent. There are a lot of responsible people out there, and certainly we all know about hard work after Speaker Gingrich's 100 days. But, these proposals do not illustrate any of that. They illustrate how you can destroy Government, if that is really what you want to do, and I submit that is what the Republicans are about. And these proposals illustrate how. They take an effective program and cripple it. Last year much smaller Medicare cuts were proposed. The Republicans complained that any Medicare cuts, and that is the word you all used, you Republicans, you, would destroy the qualified and ability of care for seniors under the program. Given their objections to last year's proposed cuts, how can they possibly come back and justify larger cuts this year? They have tried to hide their intentions about Medicare by claiming they are just trying to save the trust fund. Well, now, here is an economic term. The seniors will recognize that claim as baloney. That is Economics 102. The proposed Medicare cuts are much larger than are needed. The only Republican proposal relating to Medicare so far that has passed this House actually makes the trust fund worse by repealing factions on [[Page H5128]] high income elderly that were dedicated to the trust fund. That hardly seems like a good way to save the trust fund. Last year, my colleagues on the Democratic side of the aisle proposed Medicare reforms that would have saved $168 billion over 7 years in the Medicare trust fund, and the Republicans, to the man and woman, voted against it. They argued that they wanted to support an amendment to strip the savings on the theory that they would ruin Medicare with the cuts. Now, if $168 billion was going to ruin it last year, $238 billion is going to knock the socks off it this year. You have been treating, you Republicans, you, the specific details of that Medicare plan like it was the Stealth bomber plans, top secret. Dornan could not have kept them more secret. They know that savings, you Republicans know, of the size that you are proposing, cannot be achieved without absolutely devastating the Medicare Program and placing new burdens on Social Security recipients. No wonder you are nervous about revealing what you intend to do. But let me tell you, my friends on the other side of the aisle, here is a hint of what they have up their sleeves. Medical insurance, part B, that covers doctors payments, which is by the way financially solvent and does not need any cuts to maintain its solvency, the Republicans are planning to double the deductible that beneficiaries pay before Medicare reimburses them for their doctors bills. After doubling it, that is not enough, they are going to index it so that their payments do not keep up, but their co-pays keep up with inflation, and they go up every year, just to remind these seniors how tough they are when they raise the cost of Medicare every year for the next 7 years and on into the future. They plan to increase the premiums that Medicare enrollees must pay. And if that is not enough, they make the patients pay a bigger share of laboratory tests, home health care services, skilled nursing facilities, all those things that the seniors are going to need. Here is the bottom line. Medicare patients will pay more upfront for their coverage, and if they get sick they are going to pay even more than that. No wonder you are not anxious to tell us what is hidden in that budget. These Medicare cuts will hurt. They will hurt beneficiaries, they will hurt the entire health care system, and ultimately hurt the economy. You knew I would get to it. Our economy and society as a whole will be devastated. Hard-working Americans who paid Medicare taxes for years will find themselves without medical insurance they had been counting on. Confidence in that portion of Social Security will be undermined, and rightly so. If you arbitrarily change a contract, renege on a deal, pull back on a promise to seniors that was made back in 1965, that we promised these workers, they will know you are reneging, they will know you are chintzy, they will know what your contract is. The health care system will suffer, especially in rural areas and inner cities. Hospitals will go bankrupt, rural health clinics and community health care centers will be forced to close, and medical care will be rationed and quality will decline. The overall economy will be harmed as those proposals slash Medicare and do nothing about rising health care costs, as the President has asked us to do. We cannot continue to spend an ever increasing share of our national income, and that is an economic term, on health care. But cutting health insurance for seniors and the poor without reforming the system is unfair and unwise. And making these cuts in order to finance tax breaks for the wealthy just compounds the folly and exacerbates the existing divisions. One more thing, just a word of advice. You are going to fix this by changing the CPI, aren't you? You are counting on that adjusting. Well, we have got a suggestion. If you really want to be tricky, and I see the good doctor sitting there, all we have to do is raise normal from 98.6 to 103 and we will save billions in Medicare. How would you like that? That makes about as much sense as the rest of this budget. So I urge you to defeat the budget, save the seniors from the destruction of Medicare, and get on about the business of seeing this country build and grow as it has over the past several years.

Mr. STARK. Mr. Chairman, I yield myself 10 minutes. (Mr. STARK asked and was given permission to revise and extend his remarks.)

Mr. STARK. Reclaiming my time, the gentleman is close to being accurate as he usually is on economic matters, but when it comes to discussing the privatization of Medicare, he is wrong. The secret document wants to offer vouchers which will make it difficult for your parents and mine and the average elderly to purchase health care. it is a step toward privatization, perhaps dressed in some kind of economic clothes that neither of us understand if that is the case. I want to thank the gentleman from Mississippi for bringing out that privatization is not the end all and be all to economic growth. I would like to ask the distinguished gentleman from New York if the budget that is generally described as the Black Caucus budget is not a product of the same group that year after year has brought us a budget that has tried to be sensible about defense, has held back tax cuts to the very rich while concerning itself with children, with education, with investment and research for health care, with the things that have made this country great, indeed, the things that create wealth in this country only through Government. If you could tell me where Lockheed or Martin Marietta gets any money to create wealth except through Uncle Sam, I think I miss my guess. I ask the gentleman from New York [Mr. Owens], is your budget balanced in the long run and if so how long?

Mr. STARK. The gentleman is close to being correct as he usually is.

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

Mr. STARK. I yield to the gentleman from Mississippi, and perhaps I could engage my distinguished ranking senior vice chairman in this colloquy for the minute or two remaining on our side.

Mr. STARK

Mr. STARK. Mr. Speaker, the Supplemental Security Income [SSI] Program was begun to provide a safety net for our country's elderly, blind, and disabled persons with limited income and resources. Over the years I have followed the outreach efforts of the Social Security Administration to inform potential eligible people about the SSI Program. In 1989 a Health and Human Services study indicated that that 35 percent of potentially eligible recipients were not participating in the SSI Program. Congress mandated funds to the SSA in fiscal year 1990 and 1991 for outreach projects in an effort to enroll these potential recipients. Many outreach programs designed and carried out by local government and nonprofit organizations have been funded by these appropriated funds. Outreach programs inform the SSA staff of the most effective means of reaching potentially eligible recipients of the SSI Program and assist recipients through the complicated application process. Alameda County in California has been very effective in reaching Southeast Asian potential recipients through an outreach program that reaches into the community through mutual assistance groups. In Arizona third parties using a variety of outreach techniques, including language groups, successfully funded eligible recipients and streamlined their application process by completing the many necessary forms for them. These examples point to what maybe the most effective way of contacting these hard to reach people. The use of existing private nonprofit community groups. I suppose that one of the quickest and most economical ways of finding and signing up eligible people for the SSI Program would be to use the staffs of nonprofit organizations who already work with the poor. Many of these people are very knowledgeable about the program and have the trust of potential recipients. Help in filing out the forms and collection of the necessary documentation would greatly assist the overworked SSA staff. In return the nonprofit organizations would receive a fixed amount of money for each person they ``sign up'' that was actually eligible for the SSI Program. This idea is the basis for the legislation I am introducing today. My bill creates two demonstration projects, one in a poor urban area and one in a poor rural area, to test this idea of providing an award for successful outreach.

Mr. STARK

Mr. STARK. Mr. Speaker, today I am introducing legislation that incorporates the Supplemental Security Income's [SSI] presumptive disability system into the Social Security Disability Insurance [SSDI] Program. One of the largest continuing problems faced by the Social Security Administration [SSA] is the backlog of more than 1 million cases waiting for a disability determination. In 1995 President Clinton asked for disability investment funding in the amount of $280 million as part of the regular administrative budget. These funds were specifically earmarked for processing disability related workloads. Congress appropriated disability investment funding in the amount of $320 million for fiscal year 1995. I support this move but we need to do more and to act more quickly. Social Security expects to receive nearly 3 million applications for disability benefits through 1995, 70 percent more than it received 5 years ago. Social Security admits that its complicated decision process has changed little in 40 years and offers an ``unacceptable'' level of service to the public. An announced ``re-engineering'' of the increasingly complex disability determination system is expected to stabilize the workload but not to result in an appreciable reduction in the backlog. On the average, it now takes a disability applicant 5 months to get an initial decision. If benefits are denied, the applicant waits another 18 months to get an administrative law judge's decision on the appeal. Congress has heard complaints in recent years of deserving applicants waiting months for desperately needed funds and, in some cases, dying before they get a decision. For example, in Arizona a recent disability applicant was forced to leave her secretarial job due to injuries resulting from a serious auto accident. She applied to the Social Security Administration for disability benefits to offset the loss of her income. She did not realize that she was venturing into an understaffed, underfunded Federal program that often forces disabled people to wait months to learn whether they qualify for benefits. After a year wait, she was successful in obtaining the benefits to which she was entitled only after hiring an attorney who specializes in such cases. These kinds of long delays are repeated in anecdote after anecdote. For many severely disabled, there should be a faster way. The SSI program makes an initial determination that presumes a person to be disabled if they fit certain severe disability criteria. These people begin to receive SSI benefits immediately and the SSA has a 6 month period to make the final determination of eligibility using the SSA's definition of disability. Being able to receive SSI benefits on the basis of a presumptive disability determination provides the disabled person with much needed money immediately. However, for a worker who has paid into Social Security and becomes disabled, there is no comparable process to identify the people that would most likely qualify for DI benefits. My legislation would remedy this by providing for determinations of presumptive disability under title II of the Social Security Act in the same manner and to the same extent as is currently applicable under title XVI of such act. This means that if a person is found to be presumptively disabled under title II and meets the requirements for entitlement to benefits the person will begin to receive benefits, after the initial 5 month waiting period required before DI benefits can be paid, for up to 6 months while the final determination is being made. If the person is presumed eligible to receive DI benefits, then their dependents shall also begin to receive benefits. If, in the final determination, a claimant's impairment does not meet the Social Security Administration's definition of disability, they and their dependents shall not be responsible to return the money they received during the presumptive eligibility determination period. In some instances a person may be presumed eligible for SSI benefits before being found to be presumptively disabled under title only 6 months of presumptive disability benefits. In most States, while receiving SSI benefits, a person is eligible for Medicaid. Under this proposal, claimants who would have been eligible for SSI benefits, were it not for their receipt of DI presumptive disability benefits, would be deemed eligible for SSI, making them eligible for Medicaid in those States where SSI eligibility triggers Medicaid eligibility. When the final determination for DI benefits is made, the claimant loses the Medicaid eligibility. Medicare will be provided to disabled workers and their dependents after they have been receiving disability benefits for 24 months, including the time they were receiving presumptive disability payments.