Pete Stark

Mr. STARK

Mr. STARK. Mr. Chairman, I yield myself the balance of my time.

Mr. STARK. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Minnesota [Mr. Minge].

Mr. STARK. You take that tax cut for the very rich and invest it in the bedrock of the American economy, in students and farmers and in the growing economy of our country.

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

Mr. STARK. Mr. Chairman, I yield 2 minutes to the gentlewoman from Connecticut [Mrs. Kennelly].

Mr. STARK. Mr. Chairman, I yield 5 minutes to the distinguished gentleman from New York [Mr. Owens]. (Mr. OWENS asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Chairman, that sounds very good to me.

Mr. STARK. Mr. Chairman, I yield 3 minutes to the distinguished gentleman from Minnesota [Mr. Peterson]. (Mr. PETERSON of Minnesota asked and was given permission to revise and extend his remarks.)

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to share with my colleagues news of a special gathering that will take place on Thursday, May 18, in Castro Valley, CA. Over 50 senior citizens, each over 100 years old, will join together at Eden Medical Center for the sixth annual 100+ celebration. As best I can calculate it, 5715 years of experience and memories will be shared by 56 people at this unique gathering. Every one of us has looked to an elder, perhaps a grandparent or great-grandparent, at different times during our lives for the wise counsel that only experience can provide. Their wit and wisdom speak of lessons learned; their knowing smiles are a reflection on decades of experience. I know my own mother, who is just 86 years old, has taught this incorrigible son an encyclopedia of lessons! While I cannot be there on Thursday, I want to join Eden Hospital in honoring our local centenarians. The most senior of these senior citizens are 106, including Vera Sherman and Anna Simons. There are also five 105 year- [[Page E1058]] olds, including Abdul Khaliqi, Antonio Nieto, Marie Sobieski, Mary Souza, and Ethel Stenson. Nicolasa Alcon, Elizabeth Denny, Etta Osborn, Epifania Saldana, Eva Thornton, Catherine Walker, and Lily Wilkinson are 104 this year. The 103 year-olds who will be there on Thursday are: Giorgina Angeli, Michael Branden, Lillian Garfais, Mamie McGriff, and Antonio Nava. The presence of the 102 year-olds will be filled by Anna Galvin, Jim Hendricks, Hinda Jackson, Helen Leandro, Eugenia Liorentzevitch, Erminia Oberti, Fred Vonbrethorst, Frances Wayne, and Grace Zoellner. Marion Boone, Olga Cherepanoff, Josephine Corona, Hazel Garad, Olive Gurney, Marianne Hill, Dale Kune, Kristina Langas, Helen Minore, Marian Morken, Eva Ortiz, Irene Pearson, Liilie Seay, Mary Silva, Ernestine Smedman, Leo Valentine, and Marguerite Zugnoni, at 101, are the sophomores of this class. The freshmen, young at only 100, are: Jane Barkley, Augusta Burlingame, Alice ``Pete'' Clark, Althea Cummings, Leone Gardelius, Ollie Holmes, Clara Moreland, Sumako Oka, Mamie Person, Edith Irene Wasley, and Elizabeth Wershkull. Mr. Speaker, I hope my colleagues will join me in honoring these centenarians, especially during Older Americans Months, 1995. Their long and full lives have been a source of inspiration to their friends, family, and us all. I wish them all good health and good cheer.

Mr. STARK

Mr. STARK. Mr. Speaker, I want to thank the distinguished ranking member for that eloquent introduction. It is obvious that there are some people on the other side of the aisle who think they know more about this bill and about the Medicare program, but if this bill were not such a cheap, cynical effort to manipulate public opinion, I would be tempted to ignore it. It is not needed, and it accomplishes nothing, and nothing that cannot be done now without legislation. It is technically flawed. It asks the wrong people to render opinions on issues that are not within their jurisdiction or their area of expertise or their mandate. At best, this is suggesting that the dog ate the homework. It is a prime example of Washington run amok, wasting everybody's time, money and creating unnecessary bureaucratic mishmaw when the majority is blindly casting about for someone else to fulfill its responsibility. They really have a responsibility to propose a budget along with the details that are necessary to meet the fairy tale requirements in their budget. No amount of effort to shift the responsibility to someone else is going to hide the basic fact that the Republican Party is intellectually bankrupt. It is offering us a flimsy outline of a radical fairy tale world populated by rich, white suburban lawyers and MBA's, a world without aging or poverty, with education by osmosis, and beggars on white stallions. Oh, to be a young Republican and naive.

Mr. STARK. Reclaiming my time, the gentleman raises a very good question. Last year we had a health reform bill. We laid out specific Medicare savings. It would have reduced Medicare spending by about $168 billion over 7 years and improved the status of the trust fund, and we did not wait for the President's proposals, nor did we rely on alarming statements about the status of the trust fund, nor did we try and scare the seniors. We worked, and we came up with a balanced, fair, health reform plan that provided coverage for all Americans, and every one of the Republicans on the subcommittee and the full committee voted against those cuts. They turned their back on the medical trust fund last year when they had a chance to help seniors and other Americans who did not have health care. Where were they then? They took a walk. And now they are still taking a walk. They still have not figured out what to do, and they are asking us to buy into this cockamammie plan. The gentleman rises a great issue. Every Republican on the committee voted against bringing these savings. Ironically, the only action taken thus far by the other side for the solvency of the trust fund is to give seniors, rich seniors, a tax cut, and take it out of the trust fund, to take $87 billion over 10 years and give it to the richest seniors and cut the money out of the Medicare part A trust fund. That is the only thing they have come up with so far. Why not do what the chairman of the Committee on the Budget has done and let the committee work its will, come out with details, show us what they are planning to do, as our minority leader and as our distinguished whip showed us in their comments just a moment ago, that they plan to cut the poorest of the Medicare beneficiaries, to increase their co-pays, to deny them choice of doctors and plans, to give them vouchers that will not work? I urge you to show the emperor-Speaker has no clothes and vote ``no'' on this silly bill.

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

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize Mrs. Margaret Montero, the supreme president of the Associacao Protectora Uniao Madeirence do Estado da California [APUMEC] a fraternal organization in California's 13th Congressional District. On June 20, 1995, she will finish her term in office. The APUMEC is a fraternal benefit society which was started in Oakland, CA, in 1913, by several men from the island of Madeira, Portugal. The purpose of the society is to assist any member who might be ill or in need. If a member passes away, the society provides assistance to the member's family. Since 1913, the society has grown in membership to [[Page E1046]] nearly 2,000 members in several States. The APUMEC continues to provide these services and has expanded to provide others, such as the scholarship program which awards scholarships each year to qualified students. Margaret Montero is currently the 70th supreme president of the APUMEC. She joined APUMEC Council No. 4 ``Progresso'' on February 4, 1967, and has served as an officer since 1970. She is the third member of her family to hold the office of supreme president. Margaret's late brother-in-law, Jose (Joe) J. Montero was supreme president from 1930 to 1932. Her daughter, Jackie Montero Flynn, served as supreme president from 1973 to 1974. She and her daughter are the first mother and daughter supreme presidents of the APUMEC. Ms. Montero was born on May 28, 1915, in Honolulu, HA. She has been a resident of the bay area for over 60 years. She owned a business with her now deceased husband, Mr. Joaquim (Harry) Montero, to whom she was married for 45 years, and she still resides in the city of San Leandro, CA. She has one daughter, Jackie Montero Flynn, one stepson, John Lewis Montero; three grandson; and two great grandchildren. Ms. Montero has also served as a member of many other community organizations, including the IDES, ISMM, SES, SPRSI, UPPEC, UPEC, the Brotherhood of St. Anthony, the Cabrillo Civic Clubs of California, and the ICDES. She is also a representative to the Portuguese Fraternal Benefit Societies of California. Ms. Montero will finish her term on June 20, 1995. During her tenure as supreme president, she brought in a total of $575,000 in policies and over 85 new members to the society. This is a significant contribution to the organization. But perhaps even more significant is the tireless dedication she has brought to the APUMEC for the 28 years that she has participated in the organization. Today, I want to congratulate Margaret Montero on her successful term as supreme president and recognize her for her commitment to the APUMEC and to the entire Portuguese community, I wish her much happiness in the years to come.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the achievements of Ms. Lorraine Hurley who is retiring after 40 years of dedicated service to the school children of the 13th Congressional District. Ms. Hurley was born and raised in San Lorenzo. She graduated at age 15 from Hayward High School and dedicated the rest of her life to teaching. She taught in the Oakland School District for 10 years and then returned to the San Lorenzo Unified School District to teach for the next 31 years. She has been the recipient of many awards, including the Alameda/ Contra Costa Teacher of the Year. She was a member of Delta Kappa Gamma, the Teachers' Honor Society. Ms. Hurley is also an advocate for and supporter of her fellow teachers. She was very active in the San Lorenzo Teachers' Association and an officeholder in the National Education Association. She was chosen to be a mentor/teacher. Mr. Speaker, I am proud to recognize Ms. Lorraine Hurley for her commitment to our children and am certain that she will be sorely missed.

Mr. STARK

Mr. STARK. Mr. Speaker, Republicans talking about saving Medicare remind me of the man who murdered his parents and begged for mercy as an orphan. They are making a blatant attempt to distract the public from a tax bill that takes $87 billion out of the Medicare Part A Trust Fund over the next 10 years and gives it to the rich. And Republicans are crying crocodile tears about the trust fund being in danger? ``Hello, Earth to Republicans: Your hypocrisy is showing.'' I urge Republicans to reread their views on last year's health reform bill. In that bill, Democrats saved the Medicare Trust Fund by getting all health spending under control. The billions we saved in Medicare helped the uninsured, expanded Medicare benefits and provided a prescription drug benefit for everyone. Democrats used Medicare savings to improve the entire health care system. Where were the Republicans? They voted against any and all Medicare savings. In their dissent 10 months ago, they said ``reimbursement levels * * * have reached potentially disastrous levels'' and ``additional massive cuts in reimbursement to providers * * * will reduce the quality of care for the Nation's elderly.'' Now the militant radical right wants to cut three or four times more than we did. How can they now say it will not hurt quality? Newt can't reform the system with more managed care and vouchers. I rather resent Republicans suggesting that my mother and the Nation's seniors are either senile or so stupid that they will not see through his double-talk. My mother knows that managed care costs more and means less choice of doctors and hospitals. My mother knows that Republican vouchers to buy private insurance will never be worth enough to pay for her health care. Newt's plan to push America's seniors into plans with less choice--all the while saying he gives them more choice--is a dog that just will not hunt. Republicans intend to disrupt people's health plans, force them into managed care, and they know it will save little or nothing. Last week, CBO said that Medicare spends more for HOMO enrollees than had they remained in the fee-for-service sector--about 5.7 percent more. Until you Republicans know more about how to pay for seniors in managed care, you are just whistling in the dark, and playing fast and loose with a sacred trust. We Democrats have always worked with responsible Republicans on ways to improve Medicare and reform the entire health care system. But $300 billion in Medicare cuts for the sake of tax cuts for the rich will destroy not only Medicare, but the entire U.S. health care system. We must not only preserve Medicare, but we must provide coverage to 47 million Americans who are today without coverage. You Republicans proved your political dominance over the House in the past 4 months. Now, why not show us you stand for something besides insurance company profits and tax cuts for the very rich. You are in complete control of this Congress and must be judged by your ability to legislate in the best interests of all Americans--not just white, rich, suburban radicals. So let us get together and fix the ``break'' the way it ought to be fixed, with universal coverage and reform for all Americans.

Mr. STARK

Mr. STARK. Mr. Speaker, today, I would like to pay tribute to city attorney Allen E. Sprague for his dedicated years of service to the city of Fremont. During his tenure, Mr. Sprague has provided strong leadership to a city which has risen to new heights. After graduating from University of California Boalt Law School, Mr. Sprague was hired as the city of Freemont's assistant city attorney in 1963. Six years later, he was appointed as their city attorney, thus attaining the title of ``Dean of California City Attorneys,'' as the longest serving, continuous, and surviving city attorney in northern California. Mr. Sprague served as counsel to 18 separate city councils, and as a mentor to numerous staff members who have gone on to serve other California cities as city attorneys. During a difficult transitional period, Mr. Sprague also acted as interim city manager in 1980 and 1981. Mr. Sprague's community commitment goes well beyond his years with the city. He was an active participant with the Kiwanis International Club for 20 years, where he served as local chapter president, regional and national officer. Mr. Sprague also shared his fellowship as a lay Eucharist minister at St. Anne's Episcopal Church in Fremont and by raising the spirits and bringing comfort to those in need as a volunteer with the Vespers Hospice. Mr. Speaker, I come before you today to recognize Mr. Allen E. Sprague for all his achievements and commitment to our community. I hope you and my colleagues will join me in congratulating this leader for his illustrious career and wish him and his family well in their future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to call attention to the Members and the general public of the opening of an exhibit entitled ``Defending Religious Liberty,'' on view in the rotunda of the Cannon House Office Building, U.S. House of Representatives, May 2-5, 1995. The focus of the exhibit is on repression of the Bahai community and portrays America's concern for religious freedom and the response of the United States and other nations to the persecution of members of Iran's largest religious minority. Those who practice the Bahai faith number 6 million in more than 205 countries with more than 100,000 worshipers in the United States. The Islamic regime calls the Bahai faith a conspiracy and heresy. Followers have no legal rights and secret documents show official Government policy is suppression of the Bahai community. Bahai students have been expelled from schools, followers have been denied food ration cards, dismissed from jobs and denied pensions. Many have disappeared, been kidnapped, jailed, tortured, and executed on account of their religion. Congress has acknowledged that the abusive treatment of the Bahais is a critical human rights concern. Although diplomatic pressure and critical publicity has elicited a positive response from the Iranian Government the Bahai community remains an oppressed minority, denied the right to elect leaders, conduct religious schools, and pursue other organized religious activities. Bahai members are composed of the mainstream of people, from different races, nationalities, and social and economic backgrounds. They believe that all people are meant to live in peace and unity and should be supported in their continuing efforts to protest against the Iranian Government's persecution of Bahais. Mr. Speaker, I hope this exhibit will remind us of the oppression of our fellow human beings. We must continue to direct our efforts toward resolving these crimes against humanity. Therefore, I propose we should never resume trade or diplomatic relations until the Islamic Revolutionary regime reverses their policy.

Mr. STARK

Mr. STARK. Mr. Speaker, we didn't pass health care reform last Congress, but the need for it didn't go away. I've just received a letter from a midwestern family, which shows how the Nation's insurance companies continue to behave in an irresponsible and capricious manner. This family of four, which says they have less than average health care expenses, had been using the COBRA health continuation provisions for 18 months at an annual rate of $5,556.97. With COBRA expiring, they wrote Connecticut General Life Insurance Co. to ask about converting to an individual rate policy. Following is their letter describing what happened. The company sent them a printed sheet in which they were invited to continue for the annual rate of $38,696. Mr. Speaker, Connecticut General obviously has no interest in writing policies for individuals. It met the letter of the law requiring that COBRA enrollees be offered a conversion policy--but their offer is a joke and an insult. When the Nation's insurance companies display this type of behavior, they are just refanning the flames for health care reform. The letter follows: April 21, 1995. Re health care cost reform. Hon. Pete Stark, Subcommittee on Health, Ways and Means Committee, Longworth House Office Building, Washington, DC. Dear Congressman Stark: I am writing to you because I believe you would want information like this to help you make informed judgments on health care issues that not only affect me and my family, but affect millions of other people. I believe it is federal law that requires insurance companies to offer group medical conversion policies to individuals when they are no longer eligible to be part of the group. Surely that legislation didn't intend to allow for an insurance company, in this case Connecticut General Life Insurance Company, to increase a family's premium from $5,556.97 per year to $38,696.00 (over 590% increase) with a higher deductible ($500) and lower R&B daily limit ($250). I paid a monthly premium of $463.08 for eighteen months after leaving my teaching position. When I was informed that I was no longer eligible for the group, I requested and received the enclosed conversion quotes. I am sure that Connecticut General Life Insurance Company's attorneys have assured them that they are within the law when they quoted such an unjust rate. I would hope that Congress would review and modify any legislation that requires health insurance companies to offer conversion policies, but allows them to do so in such an unconscionable way. Sincerely yours,

Mr. STARK

Mr. STARK. Mr. Speaker, today I am introducing the Long-Term Care Insurance Tax Treatment and Consumer Protection Act of 1995. This bill establishes critically needed standards for long-term care insurance policies. It makes changes that will protect elderly consumers from the misleading practices that leave them without adequate insurance coverage for nursing home and home care. The bill establishes minimum standards that long-term care insurance policies must meet. The standards include requirements for standardized outlines of coverage and terminology that will enable consumers to make intelligent choices about which policy to purchase. The standards will prevent discrimination in regard to certain disabling conditions. They assure that benefits will be delivered in the full range of settings available for the care of the elderly. The Ways and Means Committee recently passed H.R. 1215. That bill includes provisions that allow individuals to include long-term care insurance premiums as a part of their itemized expenses for medical care, to the extent that those expenses exceed 7.5 percent of adjusted gross income. In effect, H.R. 1215 encourages people to purchase long- term care insurance by permitting favorable tax treatment of the premiums. My bill contains the same long-term care insurance provisions as in H.R. 1215, but with an important difference: my bill contains the standards that are needed to prevent consumer abuse. Abuses of consumers in the long-term care insurance market are severe--so severe that a past president of the National Association of Insurance Commissioners [NAIC] has said that the very viability of this product is in question. The NAIC has developed model standards that each State may adopt in order to regulate long-term care insurance. States vary widely, however, in their application of the standards. For example, Washington, DC enforces none of the recommended standards, while Connecticut has adopted 24 of the 28. This bill would require the States to certify that long-term care insurance policies being sold in the State meet the consumer protection standards. The premiums for policies that do not meet the standards could not be used as an itemized tax deduction. This structure would provide incentives to States to enforce consumer protection standards. It would also care insurance policies, not only because they could get a tax deduction but also because they would be assured that the policies are good products. When a consumer decides to purchase a policy, there is a dizzying array of policies and riders available. Benefits and terminology vary greatly. It is almost an impossible task for a consumer to make an effective choice of policy. This bill would require the insurance company to provide the consumer with an outline of coverage. The outline of coverage would be in a standard format, contain specific information and use standardized terminology. The outline of coverage would enable a consumer to compare plans and to choose the policy that best meets his or her needs. The outline of coverage would also assure that the consumer knows in advance the criteria for receiving benefits under the policy. Policies currently are so confusing, that it is often unclear when and where benefits can be used. A senior may think that, when she becomes unable to care for herself, she can get assistance with activities of daily living in her own home, and later find out that benefits are only available in a certified nursing home or when she needs skilled nursing care. By clearly defining the threshold conditions for receiving benefits, there will be no doubt about exactly what services an individual can receive and where they can be delivered. Currently, long-term care insurance policies often do not provide for an examination period. When a consumer is dissatisfied with a policy, there is no way to return it without forfeiting the premium already paid. This bill allows a 30-day examination period during which the policy can be returned for a full refund. If a person purchased long- term care insurance through a health plan at work, the bill would assure that the person was given the opportunity to continue coverage when he or she leaves that job. Right now insurance companies can cancel or refuse to renew a policy because the policyholder has developed an illness that the company thinks is too big a risk. This bill would prohibit companies from canceling a long-term care insurance policy unless the policyholder failed to pay the premiums, committed fraud, or did not disclose relevant information to the company. Another important feature that most policies now do not include is non-forfeiture benefits. Non-forfeiture benefits assure that, when a policy is dropped or canceled, the policyholder gets back at least a portion of the premiums paid. This is accomplished either through a refund of money or eligibility for services when they become needed. Up to 60 percent of policyholders drop their policies within 10 years of purchase. People who drop their coverage stand to lose significant amounts of money. They should not be penalized if they can no longer afford the policies as they get older. Policies are usually held for 10 to 20 years before the policyholder needs to use the benefits. Long-term care insurance is basically worthless unless it includes inflation protection. Inflation protection assures that most of the cost of care will continue to be covered after 10 or 20 years. Without inflation protection or with inadequate inflation protection, a policy held for 10 to 20 years, pays only a small fraction of the cost of nursing home care. By purchasing inflation protection, a policyholder is also protected from having to buy additional coverage at a later date. Some policies currently do allow a person to buy additional coverage. When bought later, however, additional coverage is more expensive. This is because the person pays the then-current price based on his attained age. This bill would require the insurer to offer the purchaser the option to purchase inflation protection. In addition the insurer would have to provide the consumer with a comparison of the benefits over 20 years with and without inflation protection. The consumer then can make an informed decision about whether the coverage under the policy will be adequate many years in the future. One of the ways in which insurance companies are able to avoid paying benefits to policyholders is to put restrictions on the diagnoses that will be covered. The protections in this bill would prevent discrimination against people with Alzheimer's disease and other disabling conditions. A policy could not use different criteria to receive benefits and could not pay different amounts of benefits for people with those disabling conditions. When a consumer has a policy that provides benefits for home care, he or she expects to be able to get assistance with things like bathing and dressing. Yet some policies that cover home care will cover only the services of a registered nurse in the person's home. This practice defeats the purpose of providing coverage for home care. Many people can remain in their own homes for a much longer period of time and avoid more costly nursing home care, if they receive needed assistance with activities of daily living. That does not necessarily mean, however, that they need a nurse to provide skilled care. This bill requires that policies covering home care include those services that are most beneficial to people in their own homes. It also allows services to be delivered in all types of residential facilities, such as assisted living facilities, rather than just in skilled nursing facilities. Last year, the Ways and Means Committee came to a bipartisan consensus on standards for long-term care insurance. Those consensus standards are embodied in this bill. In testimony on January 20, 1995 before the health subcommittee, 8 of the 14 witnesses testified as to the need for standards to protect consumers. Groups as diverse as the Health Insurance Association of America, the Partnership States of California, New York, and Connecticut, the Coalition on Long-term Care Financing and Consumers Union all firmly support appropriate consumer protection. Long-term care insurance has been promoted in this Congress as a way to reduce the rising costs of nursing home care under Medicare and Medicaid. For the 10 percent to 15 percent of seniors who can afford to buy this insurance, it is likely to provide some modest cost savings several years in the future. More importantly, it is our responsibility to assure that the consumer abuses that have occurred in the past do not continue. I urge my colleagues to join me in support of this bill. A summary of the bill follows: in general The bill would provide that long-term care insurance contracts that meet the requirements of the bill received the tax treatment set forth in the bill. Similarly, the bill would provide a safe harbor with respect to the deductibility of certain expenses for long-term care services. Expenses for premiums and services that satisfy the requirements of the bill would be deductible as medical expenses. qualified long-term care insurance contracts In order to receive the tax treatment set forth in the bill, a long-term care insurance contract would have to meet certain requirements. A qualified long-term care insurance contract would be defined as one that meets the following requirements: the only insurance protection provided under such contract is coverage of qualified long-term care services; if Medicare is the primary payer, the contract does not cover expenses that are reimbursable under Medicare; the contract is guaranteed renewable; the contract has no cash surrender value; all refunds of premiums (other than on surrender or cancellation of the contract), any dividends, or similar amounts are applied toward future reduction in premiums or to increase future benefits; and the contract has been certified under the State regulatory program that has been approved by the Secretary of Health and Human Services. qualified long-term care services The bill would define qualified long-term care services as necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative, and maintenance or personal care services that are required by a chronically ill individual, pursuant to a plan of care prescribed by a licensed health care practitioner. A chronically ill individual would be defined as one who is unable to perform at least 2 activities of daily living for a period of at least 90 days due to a loss of functional capacity or due to cognitive impairment or having a similar level of disability (as determined by the Secretary of the Treasury in consultation with the Secretary of Health and Human Services). The activities of daily living would be defined as eating, toileting, transferring, bathing, dressing, and continence. exclusion for benefits and for employer provided coverage The bill would provide that benefits paid under a qualified long-term care insurance contract are excludable from gross income to the extent that benefits do not exceed $200 per day (indexed for inflation after 1996). An employer's contributions for qualified long-term care insurance would be excludable from gross income. The bill would not permit qualified long-term care insurance to be provided through a cafeteria plan or flexible spending arrangement. The bill would provide that distributions from individual retirement arrangements and 401K plans are excludable from gross income to the extent that they are used to pay premiums on qualified long-term care insurance contracts. federal standards for long-term care insurance Standard formats Each long-term care insurance policy would be required to contain an outline of coverage under the policy, using a uniform format and standard terminology, that accurately reflects the contents of the policy, reflecting specific elements. The format and standard terminology would be defined by the Secretary of Health and Human Services, in consultation with the National Association of Insurance Commissioners. include: a description of the benefits covered; the principal exclusions from and limitations on coverage; the conditions, if any, upon which the insured can obtain upgraded benefits; the threshold conditions for entitlement to receive benefits; a statement of the circumstances in which a policy may be terminated and the refund or non-forfeiture benefits, if any, applicable to each circumstance including death, nonpayment of premiums, non-renewal by the insured, any other circumstance; a statement of the total annual premium and the portion of premium attributable to each covered benefit; any reservation of the insurer of a right to change premiums any limits on annual premium increases; any expected premium increases associated with automatic or optional benefit increases, including inflation protection; circumstances under which the payment of premium would be waived; information on average costs and variation in such costs for nursing facility care and other covered benefits; comparison of benefits over 20 years for policies with and without inflation protection; a declaration as to whether the amount of benefits will increase over time and, if so, the type and amount of any limitations on, and any premium increases for, such benefit increases. Benefit standards Benefits under long-term care insurance policies could not be conditioned upon any of the following: the need for another type of service, such as prior hospitalization or a higher level of care; a particular medical diagnosis; compliance by the providers with conditions not required by Federal or State law; the provision of such service by a provider or in a setting providing a higher level of care than required by an insured individual. A long-term care insurance policy that provides benefits for home care or community-based services: may not limit benefits to services provided by registered nurses or licensed practical nurses; may not limit benefits to services furnished by persons or entities participating in programs under title XVIII and XIX of the Social Security Act; must provide, at minimum, benefits for personal assistance with activities of daily living, home health care, adult day care and respite care. A long-term care insurance policy that provides benefits for nursing facility services must provide benefits for services in all types of nursing facilities licensed by the State and may provide benefits for care in other residential facilities. A long-term care insurance policy may not discriminate in the treatment of Alzheimer's disease or any other dementia of organic origin, any organic or inorganic mental illness, mental retardation or any other cognitive or mental impairment, or HIV infection or AIDS from the treatment of any other medical condition, for purposes of determining whether the threshold conditions for the receipt of benefits have been met, or the amount of benefits under the policy. Inflation protection A long-term care insurance policy would be required to offer the consumer the option to purchase inflation protection. The inflation benefits shall not be less than 5 percent per year of the full value of benefits for the previous year or such other rate of increase as the Secretary may determine adequate to offset increases in the costs of long-term care services covered under the policy. Non-forfeiture benefits A long-term care insurance policy would have to include a non- forfeiture benefit after being in effect for a specified period. Right to cancel A long-term care policy would have to provide that the insured has 40 days to cancel and obtain a full refund of any premium paid. Guaranteed renewal In order to be certified, a long-term care policy could not be canceled or refused to be renewed (or replaced with a substantial equivalent) except for non-payment of premium or for fraud or non-disclosure on the part of the insured. Continuation and conversion rights of group policies A group long-term care insurance policy would be required to provide the opportunity to continue coverage when the policy would otherwise terminate. Approval of State Long-Term Care Insurance Certification Programs The Secretary of Health and Human Services would be required to review and approve State long-term care insurance certification programs meeting the following requirements: The State certification program would be required to assure compliance with the standards for long term-care insurance policies as specified in this bill. State programs would be required to provide administrative procedures under which an insured individual may seek reconsideration of any denial or partial payment of a claim.

Mr. STARK

Mr. STARK. Mr. Speaker, in the final days of the last session of Congress, I introduced legislation to strengthen the ability of consumers to purchase contact lenses at lower prices, without compromising the quality of the products or services received. It was my hope that interested consumers, providers, and regulators would review and provide comment on the bill prior to reintroduction of the bill in the 104th Congress. Over the past several months, I have received comments from constituents, consumers, providers and various other interested parties. The overwhelming message is that a Federal law requiring prescribers to release contact lens prescriptions will benefit consumers across American. Today I am introducing ``The Contact Lens Prescription Release Act of 1995.'' This legislation will require the Federal Trade Commission [FTC] to issue regulations mandating the release of contact lens prescriptions after the initial fitting process has been completed. While some who provided comments favor mandating the immediate release of prescriptions, and others favor no requirements at all, the balance struck in this legislation ensures that consumers will have enhanced bargaining power when purchasing replacement contact lens without putting the quality of patient care in jeopardy. Today, more than a dozen States require some form of contact lens prescription release. This experimentation by the States has allowed us to monitor whether unintended consequences have occurred--such as a reduction in the quality of patient care--as a result of mandatory release. To date, I have not seen reports that the quality of patient care has suffered as a result of requiring prescription release after the initial fitting process is complete. While this legislation provides a minimum standard regarding prescription release, it is likely that some States will experiment with additional ways, such as immediate release of prescriptions, to advance the ability of consumers to purchase high quality contact lens products at the most competitive prices. This legislation allows States to continue to undertake such efforts. We in Congress would serve our constituents well if we continue to monitor these State efforts and follow-up with additional Congressional action if appropriate. I'd like to take a moment to provide some background to ``The Contact Lens Prescription Release Act of 1995.'' In 1989, the Federal Trade Commission [FTC] restated their requirement that eyeglass lens prescriptions be released by ophthalmologists and optometrists. In the FTC's ruling on eyeglasses, their comments explaining why they did not require the release of contact lens prescriptions is instructive for why this legislation is necessary today. The Commission found the following: While the record suggests that it is not uncommon for practioners to refuse to give patients copies of their contact lens prescriptions, and that resulting costs to consumers could be significant, we do not believe that the record contains sufficient reliable evidence to permit a conclusion that the practice is prevalent.'' [Emphasis added, Federal Register, Vol. 54, No. 47, Monday, March 13, 1989.) One of the benefits and responsibilities of representing the 13th District of California is having constant contact with constituents. Over the past few years, I have had the opportunity to gather ``sufficient reliable evidence'' that nonrelease of contact lens prescriptions does result in higher costs for consumers and that this practice is sufficiently ``prevalent'' to warrant legislative action. This legislation, Mr. Speaker, is rather simple--to allow greater competition in the marketplace. It achieves this goal by calling upon the Federal Trade Commission to issue a regulation requiring the release of contact lens prescriptions after the initial fitting process is complete. While there is strong sentiment in this body to forgo calling for any additional Government regulations, it would be short- sighted to turn aside this legislation for that reason. In enacting this legislation, this bill would eliminate dozens of State regulations that, however well-intentioned and well-suited to the technology and market conditions at the time, have come to block consumer choice today. Mr. Speaker, I urge my colleagues to support this legislation. A copy of the legislation follows.

Mr. STARK

Mr. STARK. Mr. Speaker, today my colleague from Utah, Mr. Hansen, and I are introducing the Tobacco Health Tax and Agricultural Conversion Act of 1995, a bill to increase the cigarette tax to $2 per pack and to increase taxes on other tobacco products. We are joined in this by Mr. Durbin, Mr. Coyne, Ms. Pelosi, Mr. Lewis of Georgia, Mr. Lipinski, Mr. Moran, Mr. Oberstar, Mrs. Collins of Illinois, and Mr. Evans, as original cosponsors. The revenues raised by this bill would finance health education and medical research efforts, help fund the health care costs of our Nation's elderly, and assist tobacco workers and agricultural regions that may be adversely affected by an increase in the tobacco tax. But most importantly, this bill creates a powerful disincentive for Americans--particularly youngsters--from taking up smoking. We all know of the scourge that tobacco brings to America's families. The American Cancer Society, the American Lung Association, and the American Heart Association have reported that ``tobacco is the single greatest cause of preventable death and disease.'' There are 419,000 deaths each and every year due to smoking. This equates to more than 1,100 Americans dying every day. Smoking-caused deaths exceed the number of deaths caused from alcohol, drug abuse, homicide, suicide, automobile and airplane accidents, and AIDS combined. Twenty-seven percent of all Americans who die between the ages of 35 and 64 die from tobacco-related disease. The scores of lives lost to tobacco provide sufficient reason to take the action I call for in this legislation. But lives lost is not the only cost fo smoking. Tobacco-caused illnesses tax our health care system, requiring more than $50 billion per year in direct health care expenditures, including $22 billion borne by the Federal Government. Losses in productivity suck tens of billions more out of our economy. But if there is an area where federal action can make a positive impact, it is with smoking. Tobacco is the single greatest cause of preventable death and disease--preventable! As proven by experiences in several States and in other countries, tobacco consumption--and the related costs--can be reduced. In my home State of California, through a modest campaign, a substantial reduction in smoking among California's teenagers resulted. The National Academy of Sciences' Institute of Medicine, a well-respected independent scientific organization, concluded that-- If tobacco is made less affordable . . . consumption will tend to decline, especially among children and youth, whose smoking habits are not fully established. Therefore, policymakers have an effective means available to them-- increasing the real price of tobacco by increasing excise taxes--to reduce the consumption of tobacco by youths and thereby to reduce the health toll of tobacco use in future years. Most people who smoke today--about 90 percent--bagan smoking when they were kids. If the cost of a pack of cigarettes were raised to the equivalent of two Big Macs rather than the equivalent of just one today, youngsters might think twice before putting down the money for the cigarettes. And without continued waves of new smokers, the 400,000 Americans who die each year from smoking will not be replaced. In order to prevent nicotine addiction in children and youth, the National Academy of Sciences recommends the following-- (1) Congress should enact a significant increase in the tobacco tax, (2) All tobacco products should be taxed on an equivalent basis, and (3) The real value of tobacco taxes should be maintained to account for inflation. The Tobacco Health Tax and Agricultural Conversion Act of 1995, if enacted, would accomplish each of these steps. In the past, concerns have been raised over the impact a tobacco tax hike would have on tobacco farmers. We believe this bill offers a solution, not a problem, for tobacco farmers. U.S. tobacco farming has been declining for more than a decade. This has not been caused by increased tobacco taxes in the United States. This is not a result of reduced cigarette manufacturing in the United States. The decline in U.S. tobacco farmers, from 179,000 in 1993 to 137,000 today, is because U.S. cigarette manufacturers like Philip Morris and R.J. Reynolds have more than doubled their imports of less expensive foreign-grown tobacco over the past decade. Today, more than one-third of tobacco used in U.S.- manufactured cigarettes is imported. This trend is anticipated to continue, leaving U.S. tobacco farmers and their farming communities devastated. The legislation we are introducing today would allocate 3 percent of the revenues raised to a Tobacco Conversion and Health Education Trust Fund. The purpose of this is to assist individuals and communities that today are reliant upon tobacco farming to convert to other crops and industries. These funds could be used to purchase tobacco allotments from farmers or to finance infrastructure construction and modernization for agricultural diversification. Affected communities would be able to use these funds to stimulate nontobacco related economic development. Under this legislation, literally hundreds of millions of dollars annually would become available to tobacco farmers and tobacco-growing regions. A portion of moneys in the Tobacco Conversion and Health Education Trust Fund would be allocated to support health education efforts. Rather than rely solely on the increase in the price of cigarettes to educate American consumers of the true costs of cigarettes, the Secretary of the Department of Health and Human Services would conduct campaigns--building on efforts already underway in several States--to educate Americans on health risks, including the risks from tobacco use. A larger portion of the funds raised would be used to fund expanded medical research efforts. A full 9 percent of the revenues raised, estimated at roughly $1.5 billion per year, would be placed in a newly created National Fund for Medical Research. These resources will augment the current effort underway at the National Institutes of Health and throughout the Nation to expand our understanding and ability to deal with complex medical problems. As we all know, only one-quarter of all worthwhile grant applications submitted to the NIH each year receive funding. The remainder of the revenues raised by this legislation would be deposited into the Medicare Part A Hospital Insurance Trust Fund. The reason for this is simple. As stated by a former HHS Secretary who held responsibility for the Medicare program, ``Smoking is the single largest drain on the Medicare trust fund, poised to take $800 billion over the next 20 years.'' The revenues from this bill may not cover Medicare's full smoking-related costs, but this bill provides a good start. In sum, this legislation is good for America--for America's youth, America's families, and the American economy. Lives will be saved, suffering from disease will be diminished, long-term health care costs will be reduced, diversification in farming communities will be supported, and revenues will be generated for the health care needs of our elders. Mr. Speaker, we could continue for hours to cite reason upon reason to support this legislation. Some may want me to do so, merely to delay taking action. But at some point we must take action. We must decide that this is a necessary step and that it can no longer be delayed. We believe that the time is now. We urge our colleagues to support this legislation. A summary of the bill follows-- Summary of ``The Tobacco Health Tax and Agricultural Conversion Act of 1995'' Increase in Tobacco Excise Taxes This legislation would increase the excise tax on cigarettes by $1.76 per pack (from $.24 per pack to $2.00 per pack) and increase the excise taxes on other tobacco products. The excise taxes would increase in future years by an amount equivalent to the rate of inflation. This legislation would become effective after September 30, 1995. Use of Revenues Medicare Part A Trust Fund--88% of revenues--to strengthen the solvency of the Medicare Part A Hospital Insurance Trust Fund. National Fund for Medical Research--9% of revenues--to augment the resources currently available to the National Institutes for Health for medical research. Tobacco Conversion Account--1.5% of revenues--to assist individuals and communities that today are reliant upon tobacco farming to convert to other crops and industries. Health Education Account--1.5% of revenues--to educate Americans on health risks, including tobacco use.

Mr. STARK

Mr. STARK. I am reliably informed they do not intend to take it up, but, other than that, it can lay over there as well as lay here. That could well be. We still have until the end of June, and, as I say, why are we bringing it up today? I mean, if it is such urgency, I do not know because it seems to me we are bringing it up without the responsible procedure of seeing whether the bill is indeed any good. A closed rule does not permit any changes, and, except in some of the tax bills, I do not know what this urge, this rush, to judgment. If it is so good, why would it not stand the scrutiny of some discussion? I really do not--have no understanding of that, and I have heard precious little response from the majority side as to what they are scared of. What is it they are afraid of that will be offered? I am puzzled. I begin to--I would not say smell a rat--but why we would rush to jam this down the throats of unsuspecting seniors? My mother is perfectly happy right now with Blue Cross, and she has got Aetna--or she has got AARP's MediGap. Why? She is happy.

Mr. STARK. If I could reclaim my time to just explain to the gentleman that those people who are in the plan cannot be canceled even if we do not pass this. They are guaranteed to stay in. The only thing it would prevent is those insurance salesmen from selling new plans for perhaps a day or a week, it we miss the goal.

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

Mr. STARK. Mr. Speaker, I am about to suggest, if the minority would be willing to accept unanimous consent, that the bill be considered today, so in a matter of comity we are prepared and would be happy to proceed, and I am sure we would make a lot of friends. Mr. Speaker, I do not believe unanimous consent is necessary, but I ask unanimous consent that the bill be considered today.