Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I rise with a group of colleagues to introduce the Medicare+Choice Consumer Protection Act of 2001. Congress should enact this bill immediately to ensure overdue protections for Medicare+Choice enrollees who are seeing increasing costs, decreasing benefits, and fewer options to obtain affordable supplemental coverage for Medicare. The Medicare+Choice program is an option that many seniors appreciate and it is an option that should remain viable in Medicare. Unfortunately, the problem of plan pullouts, benefit reductions, and cost increases, will never be solved by continuing to pour more money into HMOs. Even if their demands for ever higher payments are met, they will change yearly--just as our benefits do in the Federal Employee Health Benefits Program. This is because--unlike the rest of Medicare-- these plans are private companies that make annual changes to their benefit offerings based on costs and other business decisions. The bottom line is that they are in business to make money. That's understandable, but it undermines program stability, and confuses beneficiaries. The bill I am introducing today, along with a group of colleagues including Reps. Gephardt, Rangel, Dingell, Waxman, Brown, Kleczka, Cardin, Thurman and Tierney, will help senior citizens and other beneficiaries deal with the everchanging world of Medicare+Choice. It doesn't heap any new money on the HMO industry. Instead, it extends important consumer protection standards to Medicare beneficiaries who find themselves in a plan that no longer meets their needs. There are three major components to the bill: (1) Eliminate the Medicare+Choice lock-in scheduled to begin going into effect in January 2002. (2) Extend the existing Medigap protections that apply to people whose Medicare+Choice plan withdraws from the program to anyone whose Medicare+Choice plan changes benefits or whose doctor or hospital leaves the plan. (3) Prohibit Medicare+Choice plans from charging higher cost-sharing for a service than Medicare charges in the fee-for-service program. This provision is crafted to continue to allow reasonable flat-dollar copayments. The bill is endorsed by a host of senior and consumer advocacy organizations including: the National Committee to Preserve Social Security and Medicare, Alliance for Retired Americans, National Council on the Aging, Families USA, The Medicare Rights Center, California Congress of Seniors, and California Health Advocates. They've endorsed it because the three components are each important consumer protection improvements for beneficiaries in Medicare+Choice plans. Eliminating the lock-in means that no one will be forced to stay in a health plan that doesn't meet their needs. When seniors get marketing material from an HMO and choose to join, they don't know what illnesses will befall them or what injuries may occur. If they picked a plan that suddenly doesn't meet their specific needs, they need to be able to get out. The lock-in prohibits that flexibility. Especially with the volatility of the Medicare+Choice marketplace over the past several years, it is important that seniors know that if they test an HMO and don't like it, they'll be able to leave and choose a Medicare option that better suits them. This is a provision that is agreed upon and strongly supported by both consumer advocates and the managed care industry. Under current law, if your Medicare+Choice plan leaves your community or withdraws from Medicare all together, you can move into a select category of Medigap plans (A, B, C and F) without any individual health underwriting. This protection is obviously important because it makes more affordable Medigap options available to people who through no fault of their own can no longer remain members of the Medicare+Choice plan in which they had been enrolled. Unfortunately, these protections do not extend to seniors whose plans make drastic changes, but stop short of completely withdrawing from the program. Many Medicare beneficiaries are getting letters from their HMOs describing changes to their plan for next year that are so dramatic that the plan no longer meets their financial needs, health needs--or both. In my district, PacifiCare is pulling out of some parts of the county, but remaining in others. In the areas where they remain, they have instituted a new $400 hospital deductible for each covered admission (up from $100 last year), a new $50 copayment for dialysis where there had been none, and increased Medicare-covered inpatient injectible medication cost-sharing from $30 to $250 or the full cost of the drug, whichever is less. By any standard, these are dramatic increases. HealthNet, which also serves my district, will now have a hospital deductible of $750, and they have dropped all coverage of prescription drugs,, while more than doubling their premium from $30 to $85 a month. These changes may well affect the ability of current enrollees to afford to continue in the plan--and certainly could impact their ability to get needed care. It is very likely that a Medigap supplemental policy might make better sense for these beneficiaries. Therefore, it is critical to extend the current Medigap protections for when a plan terminates Medicare participation to participants of plans that have made changes to their benefits like those described above. Those same protections need to apply if a patient's doctor or hospital discontinues participation in the Medicare+Choice plan as well. There have never been any lock-in provisions for providers that require that they continue with a Medicare+Choice plan for the full contract year. Again, it is beyond a patient's control if their doctor or hospital withdraws from their HMO. They need to have the option to follow that doctor--and that likely means being able to join a Medigap supplemental plan and return to traditional fee-for-service Medicare. The third provision of the bill may be the most important. I am truly shocked by the level of gamesmanship going on with the cost-sharing proposals being put forth by many HMOs in their Medicare+Choice plan outlines this year. I believe that the Secretary has the latitude in current law to prohibit many of these schemes from being put in place-- and I encourage him to make ample use of that power. But, I think we need a change in law that makes it perfectly clear that Medicare+Choice plans cannot charge patients more for a service than the patient would face under the Medicare fee-for-service program. Medicare+Choice guarantees beneficiaries the same benefits they get from Medicare--plus more. If a Medicare HMO is charging $50 for dialysis services that a patient needs to stay alive and those same costs would be approximately $23 in fee-for-service Medicare, that is not meeting Medicare's level of benefit coverage. I can't understand why we would want to allow that. If Medicare covers home health care with no cost-sharing, why should we allow Medicare+Choice plans to diminish the value of that benefit by charging cost-sharing? The same is true with durable medical equipment, and the list goes on and on. On top of being unfair, the ability to charge higher cost-sharing for services like DME, home health, and dialysis perpetuates the cherry picking and risk avoidance that is well-documented in the Medicare HMO program. It has the obvious unfair consequence of allowing Medicare+Choice plans to avoid patients that know they will need those services. Patients with specific health needs read the benefit package carefully to see what is covered before they enroll. They won't even apply for the plan if their needed services are too costly or not covered at all. That keeps the Medicare+Choice plans from enrolling costly patients. They've already won at delaying risk adjustment which would help solve that problem. We shouldn't let them begin to use cost- sharing as another mechanism to avoid risk. These are common sense protections that would help beneficiaries feel more confident about their choices. Proponents of the Medicare+Choice program should support enactment of this legislation because it will reduce the uncertainty and fear factor that makes beneficiaries understandably skeptical about the Medicare+Choice program in the first place. The bottom line is that the Medicare+Choice Consumer Protection Act is a simple, incremental bill that will help protect Medicare beneficiaries who choose to enroll in a Medicare+Choice option. We've made this option available to seniors, and I think it is our responsibility to assure that they don't lose other options in Medicare because they've taken us up on the offer. I urge all of my colleagues to join us in enacting this small, but important bill this year.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise to introduce the Safe Nursing and Patient Act of 2001 which I am introducing with a group of colleagues today. There are some 500,000 trained nurses in this country who are not working in their profession. Of course, their reasons for leaving nursing are many. But consistently cited are concerns about the quality of care that nurses' feel able to provide in many health care settings today and increasing requirements to work mandatory overtime. Listen to these words of a nurse in the state of Washington: I have been a nurse for six years and most of the time I have worked in the hospital environment. It is difficult to tell you how terrible it is to ``work scared'' all the time. A mistake that I might make could easily cost someone their life and ruin mine. Every night at work we routinely ``face the clock.'' All of us do without lunch and breaks and work overtime, often without pay, to ensure continuity of care for our patients. Yet, we are constantly asked to do more. It has become the norm for us to have patient assignments two and a half times greater than the staffing guidelines established by the hospital itself. I cannot continue to participate in this unsafe and irresponsible practice. So I am leaving, not because I don't love being a nurse, but because hospitals are not safe places: not for patients and not for nurses. If we want to ensure quality patient care and a strong nurse work force today and in the future, we must make stories like this nurse's much less frequent. One way to do that is to enact legislation prohibiting hospitals and other health care providers from forcing nurses to work hours beyond what that professional nurse believes to be safe for patient care. That is the purpose of the Safe Nursing and Patient Care Act. The current practice of mandatory overtime is jeopardizing the quality of care patients receive. It is also contributing to the growing nurse shortage. Current projections are that the nurse workforce in 2020 will have fallen 20 percent below the level necessary to meet demand. A recent report by the General Accounting Office, Nursing Workforce: Emerging Nurse Shortage Due to Multiple Factors, concludes as follows: [T]he current high levels of job dissatisfaction among nurses may also play a critical role in determining the extent of current and future nurse shortages. Efforts undertaken to improve the workplace environment may both reduce the likelihood of nurses leaving the field and encourage more young people to enter the nursing profession . . . We have existing government standards that limit the hours that pilots, flight attendants, truck drivers, railroad engineers, and other professions can safely work before consumer safety could be impinged. However, no similar limitation currently exists for our nation's nurses who are caring for us at often the most vulnerable times in our lives. The Safe Nursing and Patient Care Act would set strict limits on the ability of health facilities to require mandatory overtime from nurses. While nurses would be allowed to continue to volunteer for overtime if and when they feel they can continue to provide safe, quality care, mandatory overtime would only be allowed when an official state of emergency was declared by the Federal, State or local government. These limits would be part of Medicare's provider agreements. They would not apply to nursing homes as there are alternative staffing and quality measures moving forward for those facilities. To assure compliance, the bill provides HHS with the authority to investigate complaints from nurses about violations. It also grants HHS the power to issue civil monetary penalties of up to $10,000 for violations of the act and to increase those fines for patterns of violations. Providers would be required to post notices explaining these new rights and to post nurse schedules in prominent workplace locations. Nurses would also obtain antidiscrimination protections against employers who continued to force work hours for nurses beyond what a nurse believes is safe for quality care. Providers found to have violated the law would be posted on Medicare's website. This legislation is not the final solution. I believe that standards must be developed to define timeframes for safe nursing care within the wide variety of health settings (whether such overtime is mandatory or voluntary). That is why the legislation also requires the Agency on Healthcare Research and Quality to report back to Congress with recommendations for developing overall standards to protect patient safety in nursing care. I know that our Nation's hospital trade associations will claim that my solution misses the mark because it is precisely the lack of nurses in the profession today that is necessitating their need to require mandatory overtime. Let me respond directly. Mandatory overtime is dangerous for patients plain and simple. It is also a driving force for nurses leaving the profession. These twin realities make mandatory overtime a dangerous short-term gamble at best. We should join together to end the practice. This bill takes the first step to address the problem by strictly limiting the ability of providers to force nurses to work beyond their professional opinion of what is safer for fear of losing their jobs. This is a very real problem facing the nursing profession and that is why my bill is endorsed by the American Nurses Association, AFSCME, AFT, SEIU, AFGE, UAW, and the AFL-CIO--organizations that speak for America's nearly 3 million nurses. I urge my colleagues to join with me in support of the Safe Nursing and Patient Care Act. Again, my bill is not the only solution. I also support efforts to increase the number of people entering the nursing profession and have cosponsored legislation to achieve that goal. But, we must also take steps to improve nursing now so that today's nurses will remain in the profession to care for those of us who need such care before new nurses can be trained and be there as mentors for the nurses of tomorrow. Mandatory nurse overtime is a very real quality of care issue for our health system and I look forward to working with my colleagues to enact the Safe Nursing and Patient Care Act which will start us down the right path toward protecting patients and encouraging people to remain in--and enter--the nursing profession.

Mr. STARK

Mr. STARK. Mr. Chairman, it is unconscionable that more than seven weeks after this country lost more innocent lives than were lost in the American Revolution--and the means of attack was through sabotage of our aviation system--that we are only today debating this very urgent matter. The Senate unanimously passed a comprehensive aviation security bill three weeks ago. Meanwhile, the House of Representatives has been devising ways to provide tax relief to corporations and liability relief to the airlines--and ignoring airline safety altogether. We continue to hear stories of passengers who board airplanes with everything from knives to loaded guns. Two weeks ago, seven baggage screeners at Dulles International Airport failed a pop quiz that tested their skills. Currently, airlines are responsible for the screening of airline passengers and baggage. Airlines pass this responsibility on to the lowest-bid screening contractors who pay their employees minimum wage and have widely varying employment standards. The result, as documented by the General Accounting Office and the Department of Transportation's Investigator General, is high turnover in the screener workforce and a failure of the screening process to work effectively-- as witnessed by the attacks of September 11 and subsequent weapons allowed aboard aircraft across the U.S. We have given the airlines and private contractors plenty of opportunity to remedy the egregious problems with the baggage screening process and they have failed to do so. Now, it is time for the federal government to step in and ensure safety of our airports and skyways. The Democratic substitute will do just that and that's why I support its passage today. It is not a perfect bill either. If I had the opportunity, there are changes I would make. But, passing the Democratic substitute today will get this overdue airline security bill to the President for his signature today. That is of the utmost importance. Let's be clear. Baggage screeners are enforcement officers just like our Customs officers who are already federal employees. It simply makes sense to make them federal employees and ensure uniform employment standards are in place for all of them. That's what we've done with Customs Officers and no one is asking us to turn that duty over to private companies! This is an issue of national security and it requires a role for government to assure that our citizens are protected. This concept should not be controversial when we are talking about risking U.S. lives. It is incumbent upon the U.S. government to provide protection for all of its citizens from harm at airports and on airplanes--if the best way to do that is to federalize passenger and baggage screeners, let's do it and do it now. This very same bill was passed by the U.S. Senate by 100-0. Last time I looked, there were a significant number of conservative Republican Senators. If they were able to recognize this as an issue of national security, so should their colleagues in the House. It is obvious that the quality of the screening process will improve with federal employees doing the job. Government can pay salaries commensurate with the law enforcement responsibilities of screening. This job involves not only the ability to read x-rays, but also the ability to size up individuals and situations which require more thorough inspection in certain circumstances. These are skills required of Customs and Immigration inspectors and for which they are more appropriately paid than current baggage screeners in our nation's airports. The GOP bill allows the same inept agencies to train screeners. The only change is that all these poorly trained screeners would be wearing a uniform supplied by the U.S. Government. Slapping a U.S. badge and uniform on our baggage screeners isn't going to deter further terrorist attacks, nor will it improve the training and attrition of our baggage screeners. We need real reforms in the entire screening pay structure and process. The Democratic Substitute bill does that. Finally, the GOP bill includes further unwarranted liability protections. The bill expands liability relief to other unnamed parties beyond the two airlines protected from liability under the Airline Stabilization Act enacted last month. Under the Managers Amendment, with no showing of justifiable cause--indeed, with no showing of any cause at all--every potential defendant to a September 11-related action, whether that defendant is presently known or unknown, would be completely immunized from punitive damages regardless of its conduct. That means that Congress might even be protecting a private security company that knowingly hired a convicted felon or an illegal alien, or that deliberately failed to check for weapons. This provision is as ludicrous as the discussion of whether or not to federalize the baggage screening workforce. The evidence is clear. We must not waste another day in quarrelsome debate when security has been breached prior to, and subsequent to, the September 11 attacks at airports across the U.S. I urge my colleagues to vote no on the Manager's amendment and vote yes on the Democratic substitute bill.

Mr. STARK

Mr. STARK. Mr. Speaker, today I join with several colleagues to introduce the Medicare Chronic Care Improvement Act of 2001. This comprehensive piece of legislation would update and improve the Medicare healthcare delivery system to better meet the needs of people with serious and disabling chronic health conditions. Individuals with chronic illnesses represent the highest-cost, fastest-growing sector in healthcare, accounting for 90% of morbidity, 80% of deaths, and over 75% of national direct medical expenditures. For a person who is seriously disabled by their chronic condition, annual medical expenditures can be nearly 15 times that of a healthy person. Furthermore approximately 100 million Americans have chronic conditions and this number is expected to increase to 157 million--or half the population--by 2020. Although chronic conditions are America's number one healthcare problem, we have a healthcare system that is designed around acute care needs. A recent IOM report, Crossing the Quality Chasm, appropriately concludes, ``chronic conditions should serve as a starting point for the restructuring of health care delivery because chronic conditions are now the leading cause of illness, disability, and death in the United States, affecting almost half of the population and accounting for the majority of health care resources used.'' This statement is particularly true with respect to Medicare beneficiaries--about 80% of those aged 65 and older have one chronic condition and two thirds have two or more. For women, the numbers are even higher--90% have one or more chronic diseases. Chronic illnesses are physical and mental conditions that are persistent, recurring, and can range from mild to severely disabling. Some have acute periods that require hospitalization, while others can be successfully managed to prevent costly hospitalizations. Conditions like arthritis, depression, and hypertension are particularly common among older Americans. Others, such as schizophrenia and multiple sclerosis, can lead to profound impairment and disability in Americans under 65. We cannot deliver 21st century healthcare with a system that was designed a half-century ago, before angioplasty or bypass surgery for heart disease and before L-dopa for Parkinson's disease. Medical discoveries like these have transformed many illnesses from rapidly disabling conditions to chronic conditions that people live with for a long time. But the healthcare system that works for devastating heart attack does not work for chronic illnesses, which benefit from a completely different group of services. For example, Medicare data show that people with chronic conditions see eight different physicians on average. Yet Medicare does not compensate physicians for time spent communicating with each other around complex patient needs, monitoring for harmful drug interactions, or teaching patients and caregivers how to better manage their conditions. As a result, these crucial care coordination services are rarely provided. To effectively meet the needs of individuals with chronic conditions, our healthcare system must reward care coordination as well as prevention and health promotion. We must promote early diagnosis, interdisciplinary care, and counseling and education for patients and their caregivers. Furthermore, we must develop more effective national policies on chronic condition care by studying chronic condition trends, including utilization, quality, and costs of services for patients with chronic conditions. The medical discoveries of the 20th century have dramatically prolonged the life expectancy of persons with all types of chronic conditions. In the 21st century, our challenge is to reduce the progression of disability and improve the functional status and quality of life of persons with chronic illness. The Medicare Chronic Care Improvement Act of 2001 strives to achieve these goals by: Improving access to preventive and wellness services for Medicare beneficiaries; Covering assessment and care coordination services for Medicare beneficiaries with serious and disabling chronic conditions; Refining fee-for-service payments for physician and post-acute services and M+C risk adjustment methodologies to more accurately account for the costs of chronic illnesses and disabilities; Studying chronic condition trends and costs to serve as the basis for improved Medicare policies on chronic care; and Commissioning an Institute of Medicine study to identify barriers and facilitators to effective chronic illness care, with a report and recommendations to Congress. For more detail, I am also entering a section-by-section bill summary into the Congressional Record following this statement. This legislation has been endorsed by a variety of health organizations representing consumers and providers: Chronic Care Coalition: American Association of Homes and Services for the Aging; American Geriatrics Society, Catholic Health Association of the United States, Elderplan Social HMO, National Chronic Care Consortium, National Council on the Aging, National Family Caregivers Association. National Depressive and Manic-Depressive Association. Association for Ambulatory Behavioral Healthcare. American Lung Association. American Academy of Neurology. United Seniors Health Cooperative. American Neurological Association. Let us not forget--Medicare is the major source of health coverage for seniors with chronic conditions. As Congress considers modernization strategies, we must take action to protect Medicare and ensure that its benefit, financing and oversight structures are able to better meet the needs of persons with chronic conditions. I urge my colleagues to join me in taking a major step forward in improving the quality of care for Medicare beneficiaries with chronic health conditions. Medicare Chronic Care Improvement Act of 2001 TITLE I--Expansion of Benefits to Prevent, Delay, and Minimize the Progresssion of Chronic Conditions Improve access to preventive services Eliminate deductibles and co-insurance for Medicare covered preventive services. Streamline process of approving preventive benefits by directing the Secretary of Health and Human Services to contract with the Institute of Medicine (IOM) to investigate and recommend new preventive benefits every 3 years. Grant the Secretary the authority to implement these recommendations, and fast-track the recommendations through Congress if the Secretary chooses not to act upon this authority. Expand access to health promotion services Establish demonstration projects to promote disease self- management. Implement a Medicare health education and risk appraisal program no later than 18 months after a series of demonstration projects conclude. Expand coverage for care coordination and assessment services Create a new benefit that covers assessment, care coordination, counseling, and education assistance for individuals with serious and disabling chronic conditions. Services could be provided by health care professionals, including physicians, social workers, and nurses. Examples of items and services to be covered include: initial and periodic health screening and assessments; management and referral for medical and other health services; medication management; and patient and family caregiver education and counseling. Title II--Establish Payment Incentives for Furnishing Quality Services to Individuals with serious and disabling chronic conditions Improve Medicare financing methods Direct the Secretary to refine Medicare prospective payment systems for skilled nursing facility (SNF), home health, therapy, partial hospitalization, end stage renal dialysis (ESRD), and outpatient hospital services and refine resource- based relative value scale (RBRVS) payment methods for physicians to ensure appropriate payment for serving individuals with serious and disabling chronic conditions. Direct the Secretary to refine Medicare+Choice risk adjustment methodology to provide adequate payment for plans with specialized programs for frail elderly and at-risk beneficiaries. Until the refined risk adjustment methodology is implemented, direct the Secretary to continue current payment methodologies for existing specialized programs for frail elderly and at-risk beneficiaries. Create a demonstration program to provide additional payments to Medicare+Choice plans that provide a specialized program of care for beneficiaries with serious and disabling chronic conditions. These plans must exclusively serve such beneficiaries or serve a disproportionate share of such beneficiaries. The demonstration program would expire one year after the refined risk adjustment methodology is implemented. title iii--study and report on effective chronic condition care Evaluate Medicare policies regarding chronic condition care Direct the Secretary to study chronic condition trends and associated service utilization, cumulative costs, and quality indicators in Medicare. Direct the Secretary to report the study results to Congress every 3 years. The report must include recommendations on improving care for Medicare beneficiaries with chronic conditions, reducing chronic conditions, and reducing related medical expenses. Identify improvements in Medicare to ensure effective chronic condition care Direct the Secretary to contract with the IOM to investigate and identify barriers and facilitators to effective care for Medicare beneficiaries with chronic conditions, including inconsistent clinical, financial, or administrative requirements across care settings. The IOM's report must include recommendations to improve access to effective care. Definitions ``Chronic condition'' means one or more physical or mental conditions which are likely to last for an unspecified period of time, or for the duration of an individual's life, for which there is no known cure, and which may affect an individual's ability to carry out basic activities of daily living (ADLs), instrumental activities of daily living (IADLs), or both. ``Serious and disabling chronic condition(s)'' means the individual has one or more physical or mental conditions and has been certified by a licensed health care practitioner within the preceding 12 months as having a level of disability such that the individual for at least 90 days, is unable to perform at least 2 ADLs or a number of IADLs or other measure indicating an equivalent level of disability or requiring substantial supervision due to severe cognitive impairment.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the gentleman for yielding me this time. I would point out to the gentleman on the other side, those with the least experience with corporations, those who have had their elbows furthest in the trough all of their lives, seem to know most about what corporations can do. I am always curious to see how this wisdom from these people who have never held a job outside the public sector is going to create jobs. But in this stimulus bill, one of the shameless things that the Republicans do, in contravention to the statement of the gentleman from California (Mr. Thomas) on September 21st, is fail to provide meaningful help with health insurance. He said, and I am quoting, ``That every American who was laid off should have the ability to get assistance on their health insurance if they are laid off. The way we do that is to go back to the bipartisan legislation which provided a window of opportunity, and it is true that under current law they have to pay the full cost, and that is what we are going to do, is mitigate that cost.'' The fact is that the gentleman from California (Mr. Thomas) did not perform as he said. They do not mitigate the cost for COBRA in this bill. If a lick and a promise is mitigation, that is fine. But under the substitute of the gentleman from New York (Mr. Rangel), we would provide 75 percent of the COBRA premium, equal to roughly $450 a month in 2002, as opposed to approximately a $90 contribution under the Republican bill. The Republican bill does nothing to help those people who would qualify for Medicaid in the States because it specifically prohibits their money from being used for anybody who qualifies for a Federal benefit. Our bill would provide that people who are not fortunate enough to be eligible for COBRA and the new subsidy under our substitute, could get Medicaid assistance from the States. Yes, our package of health care subsidies to these 7.8 million unemployed is $25 billion. That is a lot of money. But I just ask the Members, and this is the choice when we vote, would Members rather give the $25 billion to the unemployed to help them for a year to get decent health care in this country? I particularly ask those who all get free health care from the Federal Government every time they stub their toe, would they rather help the unemployed while they sit with their fat, free health benefits, or would Members rather give the $25 billion to their friends in the big corporations who we may hear from in pillow talk or from campaign contributions? Do Members want to go home and say, That is what I have done. I am a Republican, and I am proud I gave $25 billion back to some of the richest corporations with no strings attached, and a piddling little $3 billion to the people who have been laid off to protect their health care benefits? That is shameless. Mr. Speaker, I urge my colleagues to oppose the Republican so-called ``economic stimulus package'' presented to us today. Their plan will do little to stimulate the economy and even less to aid displaced workers who have lost both their incomes and their health insurance. Their bill lavishes billions of dollars on special interests, while shortchanging recently laid-off American workers and others hurt by the terrorist attacks on September 11. Their bill offers 14 large U.S. corporations more than $6.3 billion in tax breaks in one provision alone. That is more than double the $3 billion they provide in block grants to the States as their so-called solution to helping displaced workers obtain health insurance. In contrast, the Democratic Alternative would provide approximately $25 billion in health insurance assistance. If that comparison isn't stunning enough, look at this way. The part of our proposal that helps with COBRA coverage would finance 75 percent of a family premium per month, about $450 out of $600 premium, while the Republican proposal--if States even choose to use it--could only pay $90 of that same premium. It's the equivalent of throwing a 10-foot rope down a 30-foot hole. Adding insult to injury, if this bill becomes law, it could bankrupt many people before they retire by encouraging people to use their IRA savings to pay for the health care they've lost due to the economic downturn. Yes, you heard me correctly. At the very time that Republicans are trying to privatize Social Security and undermine the stability of that program, they are urging people to spend their private savings on health care before reaching retirement age. It makes no sense. The Republican plan is nothing more than another tax bill for their wealthy contributors--be it corporations or individuals. It may be cloaked in the sheepskin of ``economic recovery,'' but this package is the same old Republican special interest tax breaks they've been pushing forever. In contrast, the Rangel substitute is a sensible, targeted package that includes urgently needed, temporary health insurance assistance for millions of dislocated workers and their families during this difficult time. We are all painfully aware of the families who have lost loved ones in the horrific terrorist attacks on September 11, and of the workers who have lost their jobs during the economic downturn that began even before September 11. Among the many difficulties these families and individuals face is the very real danger that they will also lose their health insurance and join the ranks of the nearly 40 million uninsured Americans. More than 15 years ago, we created ``COBRA'' continuation coverage, which enables displaced workers and their family members, as well as family members of workers who have died, to retain their employer- sponsored health insurance for a limited time after separating from the workplace. But people have to pay 102 percent of the premium for this continuation coverage. In 2002, that's projected to average $600 per month, or $7,200 per year, for family coverage. Workers and family members who are already suffering from a loss of income thus face a Hobson's choice between making ends meet and protecting the health of their families. As a result, just 7 percent of unemployed adults participate in COBRA under current law. Not surprisingly, participation among high-income households is more than double that of low-income--11 percent versus 5 percent, respectively. In addition, COBRA isn't even an option for many displaced workers. A recent study estimates that only 57 percent of all workers are even eligible for COBRA. That is because COBRA doesn't generally apply to firms with 20 or fewer employees and many employers don't provide health insurance, or workers are not eligible for or can't afford to participate in the plan, or they get their insurance elsewhere. The Democratic substitute answers the health insurance needs of dislocated workers and their families by first building on the existing COBRA continuation law. Our bill would pay for 75 percent of the cost of COBRA coverage for those eligible for COBRA, and it would create an optional Medicaid expansion to offer temporary coverage for those who are not eligible for COBRA. These new temporary programs would be in place for only 1 year--long enough to provide a cushion of support to working families as we lift ourselves out of this economic downturn. This is an ``economic stimulus'' of the most basic, compassionate kind. It provides the kind of health and financial security that people need right now. It ensures that some families can continue with their same health care providers, which is vitally important for someone undergoing a course of treatment. And it builds on existing programs that work. The Rangel substitute recognizes that people will more quickly get back on their feet and back into the workforce when their health needs are met. Importantly, this legislation would provide peace of mind to millions of Americans by saying that you don't need to worry about losing your house or your car due to high health care costs--when you have already lost your job. Mr. Speaker, what Ways and Means Chairman Bill Thomas said on September 21 holds true today. Unfortunately, he seems to have forgotten his recent advocacy for our approach. Now is the time to take Mr. Thomas at his earlier word and to vote for the Rangel substitute to assist unemployed Americans with their health insurance needs. I hope you will join me in supporting this amendment, and supporting families across the Nation in their time of need.

Mr. STARK. Mr. Speaker, there has been a lot of rhetoric about motives. There are 7.8 million unemployed people, and this bill will give them less than $6 billion while it gives $25 billion to the largest corporations in this country. Ford and General Motors alone will get more money than all of the money spent on health care to those 7.8 million people. Chrysler and IBM alone will get more money than the unemployment increase, the increase in unemployment benefits, to those 7.8 million people. The entire bill gives more money to 100 corporations, over $25 billion, than it gives in rebates to 30 million people in unemployment benefits and health care to 7.8 million people. It gives less than $20 billion, less than 20 percent to all middle and lower class Americans, and it gives 25 percent to just these 100 corporations. Mr. Speaker, Members must make their choice. Do Members think that Chrysler and General Motors and IBM will do more for the unemployment, or will increasing the health care benefits for the unemployed do more?

Mr. STARK. Mr. Speaker, I ask the gentleman, is that not correct? This money will all come out of the Social Security Trust Fund. Not only will people get very little, but they will pay payroll taxes to bail out Chrysler and General Motors.

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

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in opposition to H.R. 2975, the anti-terrorism bill. I do so reluctantly because we were supposed to have had a bill on the Floor today that I could have supported. The House Judiciary Committee unanimously passed a bipartisan bill that adroitly found the right balance between giving federal authorities the tools they need to fight terrorism, while still protecting the civil liberties that our citizens hold so dear. Unfortunately, a few members of the Republican leadership rejected this bipartisan legislation and created a new bill. This bill loses the balance that the previous legislation had achieved. The bill gives broad new powers to federal law enforcement officials while putting civil liberties at risk. Even worse, the bill prevents the Congress from reviewing these provisions in two years to ensure that the government is using its new powers in an appropriate manner. In addition, this bill has not received proper consideration by the House of Representatives. Most members, in fact, don't even know what the bill contains. This may be the most sweeping, comprehensive piece of legislation dealing with law enforcement practices and civil liberties that this Congress will ever consider. Such important legislation demands careful scrutiny and deserves bipartisan agreement. This bill fails in both respects. There is no question that the United States government must do everything in its power to protect our citizens. Our laws do need to be adjusted to properly reflect modern technology and to effectively respond to modern threats. The bill we consider today, however, is not the answer. I urge my colleagues to oppose this bill and to return to a bipartisan approach to improving our nation's security.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to pay tribute to Gordon Galvan's many years of dedicated service on the San Leandro City Council. A lifelong San Leandro resident, Gordon is a third generation San Leandran and grandson of Spanish immigrants. He is a graduate of St. Leander's School and San Leandro High School. Gordon began his service to the local community in 1992 as co-founder and President of the Bancroft Area Neighborhood Association. He went on to be elected in 1994 to the San Leandro City council, representing District One and was re-elected by a mandate in 1998. During his two terms on the Council, Galvan was recognized as a champion of small and large businesses and a passionate advocate for revitalization of Downtown San Leandro. He led the way for public/ private partner investments in the area resulting in over $2.5 million of improvements to downtown San Leandro. Local and regional civic and community leaders recognized Gordon's leadership on the Council. His colleagues on the San Leandro City Council elected Galvan for an unprecedented two terms as Vice Mayor. He served as vice chair of the City of San Leandro's Disaster Preparedness Council, and worked on San Leandro's FEMA award-winning Disaster Preparedness Campaign. After seven years of service to the city of San Leandro, Gordon has stepped aside to devote more time to his business. Still devoted to serving his community, he is overseeing the management of the San Leandro Shuttle Program and the San Leandro Industrial Industrial Roundtable. The Mayor, the San Leandro City Council and the Chamber are hosting a tribute to Gordon on September 27. I join in expressing appreciation for his many years of dedicated service on the San Leandro City Council.

Mr. STARK

Mr. STARK. Madam Chairman, I rise in support of our armed forces that are preparing to deliver justice to the organizations who initiated the attack on the United States on September 11, 2001. However, I must still oppose the Defense Department Authorization bill before us today. This legislation simply fails to meet the mark for what is needed to defend our nation today. It does have several measures that I support including: pay raises for the average soldier and increased funding for medical benefits. However, all that's bad in this bill outweighs these positive components. Like previous defense authorization bills, it wastes billions of dollars on attack submarines, advanced destroyers, a National Missile Defense (NMD) System, and continues to fund the outdated F-22 program. The investment of hundreds of billions of dollars in aircraft carriers and ships has done little to protect American citizens from attack. It has only been used to line the pockets of big defense contractors who are more interested in profit margins than defending the United States. We continue to waste billions of dollars to build these ships at the cost of truly effective military investments like training in counter-terrorism, anti-guerrilla warfare tactics, and intelligence gathering--all of which would yield far greater benefits than the big ticket items currently included in the bill. The F-22 program is another wasteful program. We continue to fund this program despite its consistent cost overruns and failures to meet performance and production guidelines. This program made sense in the late 1990's when we were still preparing to defend against advanced Soviet technology, but today that is no longer the case. Our potential enemies are flying old Soviet fighters Su-22's and MiG-21's. These planes are on par with our old F-4 Phantoms which were the premier fighter when we were fighting in Vietnam. Finally it provides over $8 billion to continue to develop the National Missile Defense system. The attack on September 11th proves that any potential enemy would be far wiser to invest a couple million dollars to train people to fly a plane into the US to delivery weapons of mass destruction, rather than hundreds of billions of dollars to develop an Inter-Continental Ballistic Missile. In light of this reality, it seems foolish, wasteful and completely inappropriate to direct huge sums of money at a national missile defense system that has never been proven to work and is probably irrelevant to the dangers we face today. It is for these reasons that I must oppose this authorization bill.

Mr. STARK

Mr. STARK. Mr. Speaker, I had hoped that the bipartisan, level-headed leadership that charted our legislative agenda last week would continue to prevail this week. The commercial airline industry is asking American taxpayers for a $20 billion bailout. I don't want to see the airline industry dissolve, and I don't want to see thousands of hard- working Americans lose their jobs. But the bill before us today provides a bailout for corporations and their highly compensated executive officers that would have faced insolvency despite the current crisis. Furthermore, the bill does very little for the thousands of employees who are about to lose their jobs over this crisis. It is unconscionable to provide a bailout for the airline industry without simultaneously addressing the more pressing needs of U.S. airline workers. The package does not include health insurance benefits or job retraining assistance for workers who have been laid off as a result of the loss. With this bill, Congress writes a fat check to the airline industry without any protections for airline workers. I am particularly concerned that we have done nothing to ensure that these workers' and their families' health needs will be met during this difficult time. On top of losing their jobs, their income and their livelihood, these hard working Americans are in danger of losing their health benefits and joining the already-massive ranks of the uninsured. Fifteen years ago we passed a bill that enabled displaced workers to retain their health insurance for a limited time while they look for other work. But there's a catch--employers may charge employees the full premium, plus an additional 2 percent. Laid-off airline workers thus face a Hobson's choice between making ends meet and protecting their families against the risks of high healthcare bills. This legislation does nothing to save them from having to make that awful choice. At a minimum, we should ensure that part of this generous gift to the industry go toward guaranteeing these workers and their families continued health insurance coverage. I wish that my colleagues would develop the kind of compassion for working people that they have for corporations. The Joint Economic Committee reports that the airline industry has lost $1 billion since this national crisis began. Yet, Congress plans to give the industry $5 billion to cover the incremental losses. This is an extra $4 billion in taxpayer funds that don't need to be repaid and that don't cover losses from last Tuesday's catastrophe. We must also hold airlines accountable for any mismanagement they engaged in prior to these attacks. The bill before us does not ensure U.S. taxpayers that this is the case. Instead, it allows the General Accounting Office to look at the funding allocation after Congress has already given them $20 billion. It will take a subsequent act of Congress to recover any overpayments to the airline industry. We must act responsibly now. We must hold the airlines accountable for their own shortcomings. More importantly, however, we must address the needs of airline employees first. These employees provide the foundation of the airline industry and must be taken into consideration before any CEO walks away with more than his fair share. Vote no on the Air Transportation System Stabilization Act.

Mr. STARK

Mr. STARK. Mr. Speaker, in the aftermath of the recent terrorist attacks on the United States, Americans have responded to the cries of their fellow citizens. From the many emergency personnel who arrived moments after the first impact, to the volunteers from all over the country arriving to help or donate blood, to the United States Congress, who has appropriated $40 billion help pay for recovery efforts, we have responded. Now it is time to plan the next part of our response: how to punish the perpetrators of this attack and how to protect ourselves in the future. Our country has come together to get through this time of great tragedy. Members on both sides of the aisle have appropriately put aside partisan politics and present a unified front against terrorism. Most Americans feel that we should strike back at the individuals, groups, or nations that were involved in these atrocities. I, too, think we should respond to this heinous attack, bring those involved to justice, and put an end to global terrorism. That said, however, I do not believe--even in times of extreme crisis--that the Congress should turn over our constitutional responsibilities to the President. The resolution we are debating today, I fear, begins to do just that. When writing the Constitution, our Founding Fathers created a balance of powers between the three branches of government to prevent one branch from inappropriately dominating another. Although the Constitution empowers the President as Commander in Chief, it gives the Congress the sole power of declaring war. This resolution gives the President the power to conduct a war without reporting to or consulting with Congress. Frankly stated, it cedes congressional authority to the President. I have real reservations about the resolution we are considering today. It should contain explicit language ensuring that the President reports to Congress and consults with us in planning and executing a military response. But it does not. That being said, this resolution is better than earlier versions that were considered. It now makes clear that nothing supersedes the War Powers Act, which requires the President to report and consult with Congress. Given those facts, I will support the resolution before us today. However, I will continue to insist that the President make Congress an integral part of our nation's response to these attacks. To do otherwise goes against the best interest of the people we represent and the democracy we seek to protect.

Mr. STARK

Mr. STARK. Mr. Speaker, La Clinica de La Raza, one of the largest community-based healthcare facilities in the East Bay, will celebrate 30 years of exemplary service to the residents of Alameda and Contra Costa Counties with an anniversary ceremony on September 13, 2001. Under the leadership of its CEO, Jane Garcia, La Clinica De La Raza's innovative community-based health clinic philosophy has earned the healthcare provider a national reputation. Community activists, healthcare professionals and volunteers established La Clinica in 1971. From its modest beginnings on Oakland's Fruitvale Avenue, La Clinica has evolved into a $22 million multiple- service healthcare institution and is the sixth largest nonprofit employer in the East Bay. The founders of La Clinica believed that quality healthcare should be available to all people regardless of their ability to pay. They also believe healthcare resources should be close to the community, controlled by the consumers who use them and services should be sensitive and culturally appropriate. Staff and volunteers provide services in English, Spanish, Cantonese, Vietnamese, Tagalog, Tigrinya, Arabic and other languages. La Clinica's success has made it a model healthcare facility. It is considered by many to be one of the best community-based clinics in the country serving low-income neighborhoods. With a staff of more than 300 individuals including 25 primary physicians, La Clinica de La Raza serves more than 13,000 families a year. Last year the clinic provided primary care visits to more than 100,000 East Bay residents. It administers the largest prenatal and pediatric program of any community-based clinic in Alameda County and is the only licensed outpatient mental health clinic servicing the Spanish-speaking population of northern Alameda County. As community needs have grown, La Clinica has grown to meet them. La Clinica's comprehensive medical program now includes dental, eye and mental healthcare, as well as pharmacy and laboratory services, social services support, and a progressive program of health and nutritional education. More than three decades ago, out of concern about the lack of healthcare access to the poor, La Clinica was established as a community-based free healthcare facility. Since then, La Clinica has evolved as a major asset to Alameda County's healthcare system. Congratulations La Clinica on your success. I join your community of clients, friends and supporters in thanking you for providing exemplary healthcare services.

Mr. STARK

Mr. STARK. Mr. Speaker, yesterday's horrific, cowardly attack on the United States was a senseless act of terrorism by enemies who abhor America's principles of freedom and justice. The terrorists who perpetrated this attack, however, have a miscalculated view of America: they believe we are weak, but we are strong; they believe we will cower in fear, but we will stand tall in solidarity; they believe they can break our resolve, but our unity will only be strengthened. First and foremost, my heart goes out to the victims and the victims' families of this terrible, horrific attack. The Congress of the United States, along with all Americans, stands with you in this time of sorrow and tragedy. Our thoughts and prayers also go to the firefighters, police officers, doctors, nurses, ambulance teams, hospital workers and all public servants who are working to rescue survivors and to care for the injured. Your heroic efforts will be long remembered. Even as we care for our citizens who have been victimized by this horrible crime, the resources of our government must now be directed toward finding those who caused these acts of violence and bringing them to justice. We must also examine the ways in which we protect ourselves, and we, as leaders, must critically review how we allocate our resources to defend this nation from terrorist attack. In the meantime, our nation stands resolute in the face of this crisis. We are confident in the foundations of our democracy and united through out strength of spirit, which has withstood civil war, world war, the Cold War and encounted acts of discrimination and prejudice in our journey to becoming the strongest, most powerful, freedom-loving country in the world. No despicable act of terrorism can diminish this spirit or take it away.

Mr. STARK

Mr. STARK. Mr. Speaker, today I am pleased to join Chairman Nancy Johnson (R-CT) in introducing legislation that will improve Medicare's administrative functions. Our bill addresses two very important problems in Medicare. First, it takes important steps to improve outreach and assistance to beneficiaries and providers, and to respond to certain other legitimate concerns raised by physicians and other providers. And second, it includes long overdue contracting reforms that will improve beneficiary and provider services and permit the consolidation of Medicare claims processing. Importantly, however, our legislation does not compromise the government's ability to protect taxpayer dollars from being inappropriately spent under Medicare. Mr. Speaker, no public program can continue without strong public support, and I suggest that Medicare needs both public support and provider support. The Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), is constantly criticized for burdensome regulations and paperwork. Yet polls of physicians and other providers have shown that providers prefer Medicare over other payers because Medicare pays faster and does less second-guessing than other payers. We need to improve the education and information processes for providers. It is hard for even the most seasoned Medicare analyst to keep track of all the payment and policy changes that have occurred in Medicare in the last few years. How can we expect providers to keep track of all of these changes while continuing to provide services? We need to do a much better job of educating and assisting physicians and other providers about these changes, and this legislation will help the CMS/HCFA do so. Mr. Speaker, throughout the history of Medicare, we have relied on Medicare contractors--carriers and fiscal intermediaries--to provide information to beneficiaries and providers, but that process is outdated in the face of all of the changes. Although that approach worked well for many years, I think most stakeholders would agree that we need major improvements in the Medicare contracting processes. Every President since President Carter has proposed reforms to the administrative contracting provisions in Medicare, yet they have never been enacted. I hope we succeed this time. Mr. Speaker, our legislation takes important steps to improve outreach and assistance to providers. It would also create a Medicare Provider Ombudsman to help physicians and other providers to address confusion, lack of coordination, and other problems or concerns they may have with Medicare policies. Our bill reforms the Medicare contracting processes by consolidating the contracting functions for Part A and Part B of Medicare, permitting the Secretary to contract with separate Medicare Administrative Contractors to perform discrete functions, making use of the Federal Acquisition Rules in contracting, eliminating the requirements for cost contracting, and expanding the kinds of entities eligible for contracting. Our bill would permit consolidation of claims processing with fewer contractors, and it would permit separate contracting along functional lines--for beneficiary services, provider services, and claims processing. Mr. Speaker, my support for combining the administrative contracting functions of Part A and Part B in no way implies my support for combining the Part A and Part B trust funds or otherwise combining the financing or benefits. I strongly oppose such a consolidation. Mr. Speaker, I have tried for years to get CMS/HCFA to institute a single toll-free phone number for Medicare beneficiaries like the single toll-free phone number that Social Security has operated for years. Finally, in the BBA, the Congress mandated the establishment of a toll-free number, 1-800-MEDICARE. By all accounts, it has been a great success, and even CMS/HCFA now touts its success. However, CMS/ HCFA has still been unwilling to permit Medicare beneficiaries to use this number as a single entry point to Medicare. The latest national Medicare handbook includes 14 pages of telephone numbers for beneficiaries to call with specific questions! Surely, if a beneficiary calls the 1-800-MEDICARE number, their call could be transferred to the appropriate number, rather than asking them to try to locate the correct number themselves from among 14 pages of numbers! In addition to not having a single place to call for Medicare problems, beneficiaries also have no casework office whose responsibility is to help them with their Medicare problems. In the past, CMS/HCFA has relied on the contractors, but many of the problems beneficiaries face are with the contractors themselves. In addition, CMS/HCFA now relies on State Health Insurance Counseling and Assistance Programs (HICAP) organizations to help beneficiaries. I am a strong supporter of these organizations; however, these agencies are staffed with volunteers. It is absurd for a huge public program the size of Medicare to rely on volunteers to be the main source of assistance for its beneficiaries. We should look to the Social Security Administration to identify ways to provide assistance for Medicare beneficiaries. For example, Social Security not only has regional teleservice centers to staff their national toll-free line and help beneficiaries with their questions, SSA also has Program Service Centers to perform casework for Social Security beneficiaries with specific problems. We need similar offices for Medicare beneficiaries to perform casework for them. Currently, Medicare casework is handled primarily by Congressional offices, since no casework office exists in Medicare. I have proposed that Medicare staff be stationed in Social Security field offices to help answer questions and provide assistance for Medicare beneficiaries. There are 1291 SSA field offices around the world, and I would like to see Medicare staff in many, if not all of them in the near future. I am pleased that the legislation we are introducing today authorizes a demonstration program to examine the value of placing Medicare staff in SSA field offices, and I hope it will be expanded if it is found to aid beneficiaries. Finally, Mr. Speaker, let me address Medicare administrative resources. Two years ago, in the January/February 1999 issue of Health Affairs, fourteen of our nation's leading Medicare policy analysts-- ranging from conservative to liberal--published an open letter titled, ``Crisis Facing HCFA & Millions of Americans.'' The crisis they spoke about was the lack of resources to administer Medicare. Their letter is even more relevant today. As its administrative workload has increased, CMS/HCFA resources have not kept pace. The changes that we propose in our legislation today are important, but by themselves, they are not sufficient. We simply must get more resources into Medicare administration.

Mr. STARK

Mr. STARK. Mr. Chairman, H.R. 4 does very little to help the average U.S. consumers who need to put fuel in their cars to get to work, or who need to cool their homes in the summertime. It does even less for the state of California that has been gouged by energy generators while the Federal Energy Regulatory Commission (FERC)--the federal body responsible for regulating the transmission and sale of wholesale electricity--has sat idle. The bill does however provide an enormous windfall for some of the planet's greatest polluters seeking to make even bigger profits at the expense of the U.S. taxpayer, and at the expense of a cleaner environment. This bill is too expensive, spending nearly $37 billion in new tax breaks without providing offsets, and it dips further into the Medicare and Social Security Trust Funds which Members of both sides of the aisle have agreed to protect. The nuclear power industry alone will receive $2.7 billion in tax breaks and spending subsidies on what amounts to nothing more than pork barrel spending. $1.9 billion of this tax break, originally reserved for state-regulated utilities with nuclear assets, will now be conferred to unregulated private nuclear entities seeking to increase their profit margin. Although the General Accounting Office (GAO) has reported waste and mismanagement of the $2.4 billion Clean Coal Technology Program (CCTP), this Congress wants to squander another $3.3 billion in tax benefits for a very similar program. Add this to the various research and development tax breaks in the bill and the coal industry will see a $6 billion Christmas gift in August. The biggest beneficiaries of the energy bill are the oil and gas industries, which will receive $24 billion in tax breaks. The oil and gas industries are experiencing a period of tremendous profits. Instead of regulating these industries to ensure that they don't take advantage of flawed de-regulated electricity states such as California, we are giving them further tax breaks to increase profits without imposing any additional federal oversight. This bill rewards the Texas oil producers for gouging California's electricity consumers but does nothing to guarantee that the price gouging will cease. This bill further rewards companies with a particularly egregious provision that allows royalty-free oil drilling on federal lands. Currently, oil companies pay royalty fees to the federal government on the oil derived from the Outer Continental Shelf (OCS). However, H.R. 4 will change that. The bill provides royalty relief to major oil and gas companies seeking new leases on the Outer Continental Shelf in the Gulf of Mexico. Under the royalty exemption, the Interior Secretary would be required to give as much as 52.5 million barrels of oil royalty-free, costing Americans at least $7.4 billion that the government would have received in those fees. Although proponents of this provision will tell you that it will encourage domestic oil exploration, there is no evidence that these companies would suspend drilling in the Gulf without such relief. This provision is nothing more than another handout to an industry that gets more than its fair share of tax relief. Finally, this bill doesn't do nearly enough to protect our environment. We have an opportunity to slow domestic fuel consumption, increase conservation and improve our environment by increasing the corporate average fuel economy (CAFE) standards. The CAFE program dictates the average miles per gallon (mpg) that passenger cars and light-duty trucks sold in the United States must meet. Unfortunately, the ``compromise'' that was reached on the CAFE standards was nothing more than an insincere fig leaf. The compromise calls for five billion gallons in gasoline savings over a six-year period. While this might sound like a genuine attempt to decrease fuel consumption, it translates to a mere six days worth of oil consumption for the U.S. To achieve that would require an increase in the fuel economy of cars and trucks of only about I mile per gallon--an increase that, considering how far fuel economy has fallen in recent years due to increased sales of SUVs and pickups, would improve efficiency only to the level we achieved in the early 1980's. The National Academy of Sciences just this week reported that fuel economy improvements could further reduce U.S. dependence on foreign oil. Our fuel economy standards should reflect a developed nation, leading in technological advances in the 21st century. But the meager CAFE increase proposed in H.R. 4 reflects a nation unwilling--not unable-- to provide global leadership for fossil fuel conservation and a cleaner environment. Regrettably, my colleagues did not seek a truly bipartisan energy bill that would encourage conservation and renewable energy generation; and contain manipulation of the energy spot market by the electricity generators. Instead, they chose to take a shortsighted approach to help some of their leading campaign contributors at the expense of our environment. I urge my colleagues to protect the environment, and protect the Social Security and Medicare Trust Funds. Vote no on H.R. 4.

Mr. STARK

Mr. STARK. Mr. Chairman, I am happy to yield 2\1/2\ minutes to the distinguished gentleman from Wisconsin (Mr. Kleczka).

Mr. STARK

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

Mr. STARK. Mr. Chairman, I am happy to yield 2\1/2\ minutes to the gentleman from North Dakota (Mr. Pomeroy), a former insurance commissioner of that fine State.

Mr. STARK. Mr. Chairman, I yield myself such time as I may consume. I ask the gentlewoman from New York if she would care to respond to a question and answer for me if she knows of any women's group in the United States that endorses this outside of perhaps the Eagle Forum.

Mr. STARK. Mr. Chairman, I yield 2 minutes to myself. Mr. Chairman, this is an old dead horse which for some reason has been revived again. Medical savings accounts have not worked in the private market and did not work when they were offered to Medicare beneficiaries. They did not sell one policy under Medicare. This provision comes with a price tag of nearly $5 billion over 10 years, and all that can be said is, ``There they go again, the Republicans giving a tax cut to the very rich.'' Mr. Chairman, the American Academy of Actuaries said the greatest savings from MSAs will be for the employees who have little or no health expenditures; and the greatest losses will be for those employees with substantial health care expenditures. Those with high expenditures are primarily older employees and pregnant women. The Wall Street Journal article explaining the lack of demand for MSAs stated that consumers using MSAs must generally pay full price for medical services, while managed care plans get discounts of 30 to 60 percent. MSAs discourage preventive care, which leads to more serious health costs. MSAs do not work. Mr. Chairman, why we should be increasing the ability of very rich people to have a second IRA and deny health care or raise the cost of health care for other workers escapes me. This is an amendment, laughable at best, proposed by people who think that they can buy some more votes by pandering to the very rich by giving away more tax deductions. I might say that in the previous debate today, people talked about raising the cost of health insurance. There is not one credible, independent study ever conducted that shows the number of uninsured Americans would go up if we passed the Patients' Bill of Rights. I challenge the Republicans to show me such a study.

Mr. STARK. Mr. Chairman, I yield myself the balance of my time. Mr. Chairman, I will conclude by saying that we are in a sad state of affairs when we have dentists writing law and lawyers practicing medicine, and Congressmen trying to run HMOs. I have a list of 704 organizations that support the original Ganske-Dingell bill without the poison pill amendments. There is not a health care professional organization in this country that does not support this bill, and the dental organization of the gentleman from Georgia (Mr. Norwood) supports the original bill. Why should we vote against those people that give us medical care? Do we know better? Is there somebody in this audience who would tell me of any medical profession that does not support the original bill and oppose the Norwood amendment? If we are going to legislate to protect patients, let us make sure that we do it right and support the original Ganske-Dingell bill.

Mr. STARK. Mr. Chairman, I yield 30 seconds to the gentleman from Iowa (Mr. Ganske).

Mr. STARK. Mr. Chairman, I yield 45 seconds to the gentleman from Wisconsin (Mr. Kind). (Mr. KIND asked and was given permission to revise and extend his remarks.)