Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. STARK. Mr. Speaker, I am pleased to yield 3 minutes to the gentleman from Texas (Mr. Doggett), a member of the Committee on Ways and Means.

Mr. STARK. Mr. Speaker, I am pleased to yield 2 minutes to the gentleman from Texas (Mr. Stenholm). (Mr. STENHOLM asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield the balance of my time to the gentleman from South Carolina (Mr. Spratt), the distinguished ranking member of the Committee on the Budget, to close the debate.

Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Texas (Ms. Jackson-Lee). (Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from California (Mr. Filner).

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I do not know what the House rules say about wagering on the House floor, but if the rules were silent, I would be inclined to offer the Republican proponents and my opponents a wager. I would give them, whoever wanted to accept this wager, $1,000 every year that they meet their projected 10-year budget proposal if they would in turn be willing to give me $1,000 for every year in the next 10 years that they do not meet the budget proposal. I would like to have that memorialized in the Congressional Record and hope that I could collect every year for the next 10, and I think I might leave that open for a while. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished gentleman from Washington (Mr. Inslee). (Mr. INSLEE asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Maryland (Mr. Cardin) and see if he can explain what the Senate representation from Maryland did, without violating House rules.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today along with several of my Congressional colleagues to introduce ``The Medicare Critical Need GME Protection Act of 2001.'' This legislation seeks to protect our nation against the growing depletion of health care professionals fully trained to treat costly and deadly illnesses. Under current law, the Medicare program provides reimbursement to hospitals for the direct costs of graduate medical education training. That reimbursement is designed to cover the direct training costs of residents in their initial residency training period. If a resident decides to proceed with further training in a specialty or subspecialty, however, a hospital's reimbursement is cut to half, 50 percent, for that additional training. The rationale for this policy is strong. In general, we have an oversupply of specialty physicians in our country and a real need to increase the number of primary care providers. By reducing the reimbursement for specialty training, the Medicare program has promoted needed increases in primary care training rather than specialty positions. I agree with this policy. However, as is often the case, there are always exceptions to the rule. We do not want to hinder training of particular specialties or subspecialties if there is strong evidence that there is a serious shortage of those particular physicians. That is why I am introducing The Medicare Critical Need GME Protection Act. Child and adolescent psychiatry is a clear example of how certain subspecialties face critical professional shortages. The 2001 report of the Surgeon General's Conference on Children's Mental Health states that almost one in ten children suffer from mental illnesses severe enough to impair development, yet fewer than one in five get treatment. One huge barrier is the clear dearth of child and adolescent psychiatrists. Today there are roughly 7000 fully trained child and adolescent psychiatrists in the entire United States with only 300 additional psychiatrists completing specialty training each year. These numbers fall far short of what is needed to meet prevalence rates that identify nearly 15 million children and adolescents in need of mental health treatment. That means that many vulnerable young people will suffer needlessly, unable to access the help they desperately need. To provide another example of a current subspecialty facing serious professional shortages, we can look at nephrology. Between 1986-1995, the number of patients with End Stage Renal disease, ESRD, more than doubled, with over a quarter of a million people now on dialysis. Yet current data indicate that only 51.8 percent of today's nephrologists will still be in practice in the year 2010. Most primary care physicians are not trained to treat the complex multi-symptom medical problems typically seen in ESRD and are unfamiliar with specific medications and technology prescribed for such patients. The decreasing supply of nephrologists, coupled with an expanding population of renal patients, puts the health of our nation at risk. The Medicare Critical Need GME Protection Act provides a tool to help combat such shortages of qualified professionals. The bill would simply provide the Secretary of Health and Human Services with the flexibility to continue full funding for a specialty or subspecialty training program if there is evidence that the program has a current shortage, or faces an imminent shortage, or health care professionals to meet the needs of our health care system. The Secretary would grant this exception only for a limited number of years and would have complete control of the exception process. Programs would present evidence of the shortage and the Secretary could agree or disagree with the analysis. Nothing in this bill would require the Secretary to take any action whatsoever. The bill also includes protections for budget neutrality. If the Secretary approves a specialty or subspecialty training program for full funding under this bill, the Secretary must adjust direct GME payments to ensure that no additional funds are spent. Again, The Medical Critical Need GME Protection Act does nothing more than provide limited flexibility to the Secretary of Health and Human Services to ensure that we are training the health care professionals that meet our nation's needs. I encourage my colleagues to join me in support of this important legislation. By giving the Secretary the flexibility to allocate funds to attract and train professionals in certain `at risk' fields of medicine, we will significantly improve patient care and lower long- term health care costs.

Mr. STARK

Mr. STARK. Mr. Speaker, many of us in Congress--and many of our constituents around the country--have serious concerns about the future of managed care and what it means for the quality of our nation's health care system. I recommend the attached article for my colleagues' attention. It is written by Dr. Ronald J. Glasser, a practicing pediatrician at Children's Hospital in Minneapolis, Minnesota. The article appeared in the May 2001 edition of Washington Monthly. As many of my colleagues know, I am a longtime champion of expanding Medicare to eventually provide health insurance coverage for everyone. The article below provides strong support for that proposal. [From the Washington Monthly, May, 2000] Flatlining, the Coming Collapse of Managed Care and the Only Way Out (By Ronald J. Glasser, M.D.) Everyone knows the horror stories of managed care; the denied treatment, the preauthorizations, refusals to allow subspecialty care, etc. So there is little reason to mention the motorized wheel chairs denied for patients with spina bifida--``our evaluation team has determined that your patient can walk assisted with braces or walker the prescribed twenty meters in under the approved ninety seconds.'' Nor is there need to remind of the termination of skilled nursing care for adolescents with cystic fibrosis-- ``home nursing care will be discontinued at the end of the month due to the plan's determination that there has been stabilization of your patient's clinical course.'' Even as I write this, my home state of Minnesota's largest HMO is refusing to approve a discharge order to transfer a quadriplegic 18-month-old girl to the city's most respected and accomplished rehabilitation medical center because it isn't on the HMO provider list. Try to justify that to your conscience or explain it to traumatized, desperate parents. But these are only the everyday skirmishes. As a pediatric nephrologist and rheumatologist in Minneapolis, I've been on the front line of these battles for 15 years, and I've experienced first-hand the insanity of managed care. Under managed care, physicians have fared no better than the patients. Despite what the managed-care industry would like you to believe, there is no real competition out there, no real choice. In any urban population of less than a million people, one dominant health plan usually covers more than 50 percent of the area's enrollees. In the larger cities, there are usually only four plans that cover more than 70 percent of the residents. These big plans run the show, shadow each others' prices, and do not easily tolerate criticism. Steve Benson, a well-respected pediatrician for over 20 years worked in a clinic recently taken over by a health plan. After questioning the appropriateness of the plan's insistence on scheduling patients every 10 minutes, he was told that he was not a team player. But he continued to complain that ten minutes per patient was not enough time to perform an adequate exam, much less counsel young mothers. More pointedly, after he complained that such a draconian patient-care policy was detrimental to the family and demeaning to the doctor, the medical director took Benson aside and told him that he was disruptive. If he wanted to continue at the clinic, he would have to seek counseling with the plan's psychiatrist. When Dr. Benson refused, he was fired. The plan was determined to make an example of the good doctor. The separation clause of his contract stated that if he left the clinic, he could not practice within two miles of the facility. The plan interpreted ``facility'' to mean anything owned by the health plan, including depots, warehouses, parking lots, machine shops, and administrative buildings. That meant virtually the whole metropolitan area and most of the rest of the state. Daunted by the prospect of endless lawsuits, Dr. Benson, at the age of 56, was forced to leave his practice as well as the state. There were not more complaints from the other physicians. Cherry Pickers The lunacy of managed care began with the passage of the 1973 HMO Act. Within a decade, that craziness had grown into a full-blown catastrophe. It is fair to say that, back in 1973, no one had a clear vision of exactly what these organizations were, how they were to be run, what precisely they were supposed to do, or how they were to become profitable and remain fiscally sound. The original idea was simple enough: Health-care costs were rising for employers and some method had to be devised to control them. What better way than to put together a whole new health-care delivery structure that would focus on keeping people healthy and that would place each patient into a health care ``network,'' based on sound medical and economic principles? Not surprisingly, though, patients wanted to stay with their own doctors and were reluctant to sign up with a health plan that wouldn't let them go to hospitals not in the plan. The imposition of whole new structures and delivery systems would have their own unique costs and unexpected problems. Still, the health-maintenance organizations had enormous built-in advantages that allowed them to quickly overcome patients' doubts while overwhelming both physician resistance and the skepticism of the business community. First of all, as the name implied, HMOs were never set up to care for the sick--a problem if you intend to be in the health-care business. In addition, HMOs only offered medical care through employers, which virtually guaranteed them a healthy population. The insurance industry calls this tactic ``cherry picking.'' Full-time employees are the perfect demographic for any health-care company. Eighteen-to-55-year-olds are universally the healthiest cohort in any society; but the real ``cherry picking'' lay in selling health insurance only to employers, because no one who has heart failure, severe asthma, or is crippled by arthritis can maintain full-time employment. You start with healthy people, and if workers become ill or injured on the job, there's always workers comp. But the HMOs' real advantage lay in their start-up costs. No one in America will ever see another new car company built from scratch because of the billions of dollars it would take to build the factories, set up the infrastructure, and establish distribution systems. But HMOs were, from the very beginning, given a pass on initial expenditures. The original HMOs were not viewed as insurance companies. In California and many other states, they were licensed under the department of corporations rather than with the state's insurance commissioner. At first they looked more like what were called ``independent contractors'' than insurance companies. In fact, that was precisely how the HMOs presented themselves-- nothing more than a group of doctors offering to supply health-care services to a defined group of people, similar both professionally and legally to carpenters or roofers offering their services. Amidst all this initial confusion, managed-care companies were exempted from the usual requirements of insurance, specifically the need for large cash reserves. In short, they could become insurance companies without having monies available to pay claims. One of the largest and most successful HMOs in Minnesota came into existence with nothing more than a $70,000 loan from a neighborhood bank to rent office space, hire two secretaries, and purchase a half-dozen phones. This reckless financing led to what soon became a corporate Ponzi scheme. Without adequate reserves, HMOs had to keep premiums ahead of claims, and since premiums had to be kept artificially low to gain market share, that meant what it has always meant in the insurance business: lower utilization, or in the new health speak, denial of care. Managed-care companies have always used certifications, pre-authorizations, form- ularies to restrict drug use, barriers to specialty care, limitations on high-tech diagnostic procedures, and the hiring of physicians willing to accept reduced fees to keep costs down and profits up. These restrictions were ignored when managed-care companies covered only a few hundred thousand people, but last year, over 140 million potential patients were enrolled in managed care. HMOs could no longer hide what they were doing. Drive-By Delivery Debacle Managed care's first great PR disaster was the early discharge of new mothers within 24 hours of delivery. Obstetrics was always a financial black hole for these companies. About four million babies are born in the United States every year, and managed care covers the cost for almost two-thirds of the deliveries. The average cost in the Midwest of a standard delivery and two-day stay in the hospital, not including physician and anesthesiologist fees, is $4,500 for the mother and $1,000 for the baby. For a cesarean section, the cost jumps to $10,000 for the mother and $4,500 for the baby--and the hospital stay goes to four days. And these are the costs if everything goes right. Do the math: Just assuming all the deliveries are standard ones, with two days in the hospital per delivery, the cost works out to nearly $22 billion a year. HMOs weren't financially equipped to handle those kind of costs year in and year out. They had become profitable by signing up only healthy people. Unfortunately, healthy people also have babies, and $22 billion a year was quite a hit on very narrow profit margins. So the managed-care managers got the bright idea that if they hustled mothers and babies out of the hospitals after one day, they'd recapture half to two-thirds of their costs. Beginning in the early 1990s, HMOs began demanding that their obstetricians discharge women who had uncomplicated vaginal deliveries within 24 hours of giving birth. The plans presented company data proving early discharge to be safe. Medical directors began to track which doctors followed this new guideline. Those who refused or balked were reprimanded or fired. But the data was nonsense. This year, a study on early discharge was published in the prestigious American Journal of Medicine entitled ``The Safety of Newborn Early Discharge.'' In the article, physicians from two university pediatric centers not only challenged the managed-care pronouncements of safety, but denounced them as fabrications: ``Newborns discharged early [less then 30 hours after birth] are at increased risk of re-hospitalization during the first month of life.'' Not only was the data erroneous, but so, it turns out, was the math. Delivery costs are front loaded, so most of the expenses are incurred during the first day in the hospital. Unless HMO administrators somehow managed to persuade women to give birth in taxis on the way to the hospital simply kicking them out of the hospital a day early didn't end up saving the HMOs much money. Nonetheless, by the mid-1990s, the health plans were in charge, pushing their own agendas and their own data. First, they encouraged and then demanded early discharges. But a funny thing happened on the way to the bank. These early discharges, unlike all the other cost shaving, affected a very large, unexpected and quite formidable group of consumers: husbands. These weren't just any old husbands, they were a very unique subset of husbands: state legislators. The average American state legislator is male, 38 to 53 years of age, usually four to seven years older than his wife, fiercely committed to family values--and usually, to his wife. All over the country, these men, unaware of the new 24-hour policy, went to the hospital following the birth of their child, and were met at the entrance to the maternity ward or, in some cases, at the doorway of the hospitals, by an exhausted spouse. In all probability, she was in a wheelchair, holding their new child, and accompanied by an aid or an OB nurse who explained to the bewildered husband that his wife and child were fine and that both had been cleared for discharge. More than likely, the nurse handed the husband a prescription or an anti-nausea medication, and advised him that a representative from their health plan's home-care division would probably be calling in a day or two to set up an in-house visit or make an appointment with a pediatrician. If anything went wrong, they were to call 911. The husbands clearly didn't like the early discharge policy, but had no idea where or how to complain. So they called their wives' obstetricians. The doctor would explain that she'd seen the wife in the morning and that, while she would have preferred to keep her in the hospital another day or so, their health plan's policy was to discharge within 24 hours after delivery. The husband then called the health plan, and after a dozen or so phone calls, reached a benefits coordinator sitting at a computer screen somewhere in another state. The husband, like every husband who called, was rather unceremoniously told that early discharge for uncomplicated deliveries was the accepted standard of medical practice in their community and that the wife's attending physician had clearly authorized the discharge. If the husband still felt concerned, he should write a letter or call their HMO's toll- free complaint number. It was a big mistake. Legislators and congressmen are not the kind of husbands who write letters or call 800-numbers. Instead, they went back to the state legislatures, and within weeks passed laws stipulating longer hospital stays for uncomplicated vaginal deliveries. Some states refused to allow discharge in less than two days; others gave new mothers a minimum of 72 hours. What was so astonishing about these laws, of which there were some 26 different versions, was not that they were passed so quickly and so unanimously, but that no health plan put up even a semblance of resistance, and none tried to have a single law repealed. More tellingly, not a single HMO offered up the safety data that they used so successfully to coerce physicians into sending new mothers home within a day of delivery. Faced for the first time with an advocacy group that could do them real harm, the health plans simply caved in and admitted by their silence that they had been wrong. One HMO apologist, the president of the California Association of Health Plans, did try to defend the early discharge policy, explaining that ``no one is looking at the big picture, at what will happen to monthly premiums.'' The HMO industry took a terrible beating on early discharge, but it continues to try to ration care by restricting both diagnosis and treatments, further limiting mental health coverage, sending stroke victims to nursing homes instead of rehabilitation hospitals, and simply refusing to pay for new, cutting edge prosthesis, while putting more and more bureaucratic hurdles in the way of physicians prescribing new drugs. It is, after all, what managed care does, what it has always done, and what it needs to continue to do to stay in business. The Answer Over the last decade, I have seen managed care harass and demean physicians and punish patients. Now, it is punishing the business community, once its staunchest supporter, with premium increases of 15 to 20 percent a year. Last month, the president of the University of Minnesota asked the state for a supplemental funding appropriation of $280 million, a third of which simply covered the year's increase in employee health insurance costs. Honeywell and Boeing have the same problem, only they can't go to the state for relief. They must eat the premium increases rather than decrease health- care coverage and risk losing employees in a tight labor market. All those original pronouncements of the managed-care industry in the late 1980s and early 1990s guaranteeing high- quality health care at low and affordable prices have been abandoned as these companies scramble to stay afloat as costs escalate and stock prices slip to new lows. This year, Aetna Health Care, in a letter to stockholders, stated that it planned over the next four quarters to drop 2.5 million members, raise premiums, and cut back on full-time staff. Not a very encouraging business plan, especially for a company insuring more than 19 million people. Years ago, a few people warned that this market-driven experience was bound to fail. The essence of sustainable insurance, whatever the product, is the size and diversity of the risk pool. The Royal Charter establishing Lloyd's of London, the world's first insurance company, made the point of their enterprise quite clear: ``So that the many can protect the few.'' The idea hasn't changed in over 300 years. A sustainable insurance plan demands a large risk pool so that it can offer low rates and cover future claims. Managed- care companies handled the problems of risk by ignoring the elderly, the poor, the indigent and the needy, but it was hardly a strategy for long-term fiscal health. Early skeptics of this new industry had watched the growth of Medicare, the government's insurance plan for the elderly, since its passage in 1965 and had no illusions that managed care could operate both efficiently and at a profit. Although an astonishing success, Medicare had also grown more and more expensive over the years. The increasing costs had nothing to do with greed on the part of physicians or hospitals, poor administrative controls, or excessive utilization of services, but plain old-fashioned need. The creators of Medicare were shocked at the unmet needs that Medicare had unleashed, the hundreds of thousand of seniors who had gone untreated because they could not afford to visit a doctor, much less be admitted to a hospital. The country had clearly underestimated the demographics of an aging population of people who simply refused to die, as well as the astonishing growth of medical technology now able to keep the elderly healthy. Vice President Cheney's multiple cardiac angiographies, balloon angioplasties, and coronary stints, along with his cholesterol-lowering drugs, beta-blockers and ACE inhibitors, not to mention his blood-thinning medications and anti- platelet drugs, are a testament to what can be done today that couldn't be done in the '60s and early '70s. Sooner or later, taking care of people gets costly. Managed care had a bit of a head start on controlling costs by only offering coverage to a healthy, employed population. But as that population aged, the demand for service increased and all bets were off. Indeed, despite the bizarre claim- denial schemes the industry has implemented, it continues to lose money. Many, if not all companies, have dropped their sickest members, raised premiums and cut services just to keep in business. How many more years of increased premiums, ever more complicated administrative hoops and decreasing services will it take to prove that private-sector health care doesn't work? Every survey, from the first nationwide study performed in 1935, has shown that most Americans want their government to support health care to those in need. That's a fact. It is also a fact that we already have a system in place that would provide an obvious solution: expanding Medicare. While managed care has faltered. Medicare has prospered. Throughout the whole history of Medicare, there has never been evidence that Medicare has ever denied treatment that a physician considered necessary. At a time when managed care routinely rations care, Medicare has simply paid for what is prescribed. While it isn't perfect--many seniors still need Medigap insurance to cover some of the things Medicare doesn't, such as prescription drugs--it still offers a good model of efficient health care administration that could be replicated for the rest of America if expanded. Medicare is administered by fewer than 4,000 full time employees to cover some 39 million people. Aetna Health Care, meanwhile, employs 40,000 administrators to handle roughly 19 million enrollees. Here in Minnesota, every health care dollar is funneled through eight HMOs and approximately 250 other health insurance companies. A recent audit by the state attorney general estimated that as much as 47 percent of that premium dollar is pocketed by these companies before distributing what is left to the doctors, patients, nursing homes, pharmacies, and hospitals. By contrast, Medicare doesn't have to screw around with manipulating patient claims. It doesn't need a provider network coordinator to explain why a claim hasn't been paid or a treatment refused. And more to the point, Medicare doesn't have to underwrite its own insurance, market its ``product,'' skim off profits, or spend a fortune on advertising and lobbying to keep the playing field tilted in their direction. There have been times when Medicare has been unresponsive, but it has never been as ruthless or intransigent as an insurance company executive or medical director hack working for an HMO. If there is going to be a so-called tyranny of Medicare, it will be our tyranny, rather than the dictates of some anonymous corporate executive deciding the meaning of ``medical necessity.'' There is no need under Medicare to refer an objection to ``the Complaint Procedure Section as designated in the booklet explaining the rules of benefits of your Group Health Plan Membership Contract.'' Just call your congressman. The nation's oncologists convinced Congress to have Medicare approve payments for outpatient intravenous chemotherapy rather than solely hospital-based treatments. Even more recently, physicians were able to get Medicare to reverse regulations that proved too foolish and time consuming to be practical in the real world. Last month, the nation's teaching hospitals had Congress place back monies that had been removed from Medicare under the 1997 Balanced Budget Act in order to fund ongoing teaching and patient-care projects. When was the last time a CEO of a managed-care company gave back anything? Rotting Corpses But a $1.2 trillion-a-year industry does not go away easily. Recently, Dr. George Lundberg, the former editor of the Journal of the American Medical Association, discussing managed care, put the whole issue in more prosaic terms. ``Managed care is basically over,'' he said. ``But like an unembalmed corpse decomposing, dismantling managed care is going to be very messy and very smelly.'' But managed care is determined to survive, and it is proposing a number of programs to shift the cost and risks of health care onto the consumer while lifting the burden of increasing premiums off the shoulders of the employers. One method is the ``Defined Contribution,'' where employers simply wash their hands of any increasing costs and give each employee a certain amount of money for health care. If the $2,000 or so lump sum doesn't cover the cost of a plan that allows employees to see their favorite doctors, or if they want say, dental coverage, they must pay for it themselves. A second concoction is the ``Medical Savings Account,'' modeled on individual retirement accounts to provide health care by allowing tax-free contributions to cover medical and surgical expenses. Again, there is general agreement among economists that these new programs will so fragment risk pools that those managed-care plans offering these programs but signing up the sickest members will slide into insolvency even faster than the current managed-care companies. But to hide these structural defects and obfuscate the issue, and to stifle debate of any other rational public- sector alternatives, the advocates of managed care always bring up Canada's health care system as an example of a failed Medicare-type program. What they don't say is that each year, Canadians pay a little less than $1,600 U.S. per person for health care coverage. We pay more than $4,000 per American, and the price tag is going up annually. Canada would be able to do everything they have to do and, more importantly, what they would like to do, with what we pay. In fact, we should be able to do everything we want to do right now with our $4,000. But the inefficiencies of a system with 2,500 different private health plans virtually guarantees the continued failure of our health-care system to provide high-quality, affordable health care for everyone. For flood insurance to work, it has to cover everyone, those who live on the hills and up in the mountains as well as those who live along the lakes and river banks. If all 280 million Americans are in the same risk pool; if the inefficiencies as well as the predatory behaviors of managed care can be eliminated, we can have the best health-care system in the world, and we can have it now. --------------------------------------------------------------------------- F ---------------------------------------------------------------------------

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the distinguished ranking member. I like the introduction by the gentleman from Colorado (Mr. McInnis). As one of the most conservative Members of the House, as ranked by the Concord Coalition and other groups, I am proud to answer the question of the gentleman from Colorado, because it is true that Democrats have been concerned about spending. We would like to spend money to see that our parents' Medicare is safe. We would like to spend money to make sure that the checks for Social Security go out each month to those beneficiaries. We would like to spend money to see that teachers can have a reasonable salary. All of those things are purposely being denied in the Republican budget which is driven by this tax cut. This is not Broadway. These are facts. The Republicans, for example, ran out of money for next year's Medicare payments and had to go through some blue smoke and mirror accounting tricks to find an extra $20 billion yesterday in the Senate bill because, otherwise, they would have had to dip into 2002's Medicare trust fund by 20 billion bucks to balance the budget. That is how bad this bill is. There is no money left for a pharmaceutical benefit unless, of course, we choose to take it out of Medicare and thereby dismantle the Medicare system which, under the former leadership of Speaker Gingrich, was the Republican plan and still remains the operative policy today. Privatize Social Security as the Republicans try to have us do, so that we can save that money and give the tax cuts back to the rich. So make no mistake about it, we conservatives would like to save money. But those of us who have ever run a business and not inherited it from our fathers, or worked all our lives in the public trough would like to see that the poorest of Americans get taken care of. That is the American way. We would like to see that the children's health care is taken care of. We would like to see that Medicare survives. That takes tax dollars. The fairest way to tax the American people is to let those who are very rich and very wealthy pay a larger percentage. That has been the American way for a long time. We hope, as Democrats, that that continues to be the American way, not the Republican way to give the money back to the rich donors to their campaigns, the huge corporate officers and the beneficiaries of huge stock options, support the people in Aspen who are living the life of luxury, and let the people on Main Street go broke. That is not the Democratic way. That is the Republican way, and we should oppose it.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise in opposition to H.R. 1646 the Foreign Relations Authorization. When this bill was placed on the floor of this House, I was surprised to see such a reasonable piece of legislation. For several years now this bill has been used to advance a conservative agenda including restrictions on international family planning activities, refusals to pay our commitments to international organizations, and fund totaling billions of dollars in direct military and economic aid to other countries. I am encouraged that there is not a multi-billion dollar package of military and economic aid to other countries in this bill. It is foolish to help train and equip other countries for war when there are so many people here at home who need help to obtain prescription drugs, lift their families out of poverty, and educate our children. Unfortunately, the amendment process has overridden my earlier support. This bill now restricts international organizations, cuts funding to these organizations, and re-implements draconian restrictions on international family planning activities abroad. The first amendment passed by the House provided special protections from international prosecution to U.S. forces engaged in human rights abuses. The International Criminal Court (ICC) was created to ensure that those people who violate internationally recognized human rights would suffer consequences for doing so. By providing special protection from prosecution to U.S. forces we are telling the world community that Human Rights are not important to the United States and that we should not have to abide by the same rules as the rest of the world. This is wrong and I am disappointed that so many of my colleagues supported this language. The second amendment passed by the House halted repayment of our back dues to the United Nations until we are given a seat on the UN Human Rights Commission (UNHRC). I disagree fundamentally with this decision and was dismayed that a majority of my colleagues supported this amendment too. This body has passed numerous bills and resolutions supporting democracy throughout the world. Unfortunately, when three other countries were democratically elected to the UNHRC rather than the United States, a majority of this House voted against democracy because we didn't win the election. It's an infantile reaction and I oppose it. The third amendment passed by the House re-affirms President Bush's implementation of the Mexico City provisions which prohibit U.S. funding to organizations who mention abortion in their counseling of people seeking family planning services. Existing law has prohibited these groups from using U.S. dollars to conduct abortions. This bill does nothing more than eliminate important services to people around the world, including access to contraception and other family planning services which reduce the number of abortions by decreasing the number of unwanted pregnancies. I strongly oppose its inclusion in this bill. I am disappointed in the bill as amended. It has gone back to advancing a conservative agenda when it should advance a free and democratic agenda. I oppose this bill and the principles it now supports.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise today in support of the provision added to the Foreign Relations Authorization Act (H.R. 1646) that would reverse the Bush administration's policy known as the global gag rule, and in opposition to the Hyde-Barcia-Smith-Oberstar amendment that would enforce the global gag rule. The rule prohibits international family planning organizations that receive U.S. funds from counseling on or conducting abortions with their own funds--not U.S. government dollars. Many international family planning organizations in developing nations offer comprehensive reproductive health services including contraceptive counseling, sexually transmitted disease prevention, rape counseling, and abortions. Women often enter the patchwork healthcare systems of developing nations through such international family planning organizations. By qualifying the use of U.S. funds according to the gag rule, we are rendering these comprehensive programs ineligible for valuable resources and limiting their effectiveness in providing health services overall. Furthermore, the gag rule could have the perverse effect of increasing the number of abortions, because those organizations that are ineligible for funds may no longer be able to provide a broad range of family services such as contraceptive counseling. In African countries where HIV/AIDS has reached epidemic proportions, every chance to counsel on disease prevention must be taken. Life expectancies are plummeting and drug prices are soaring, leaving a grim picture for the future of African children. Thus far, 17 million Africans, including 3.7 million children, have died of AIDS and over 12 million African children have been orphaned. Once a person is at a clinic, the door is open to provide information such as STD prevention. Integrating reproductive health services maximizes the effectiveness of these programs. We cannot stand by and watch this tragedy unfold without exploring every avenue possible to slow the growth of this disease that is devastating the spirits and economies of the developing world. On another note, how can we justify imposing restrictions on the rights of people in other countries that are constitutionally protected in the United States? In this country, the Constitution does not permit the government to restrict how organizations spend their own, non- federal funds. In this country, our right to free speech allows us to assemble peacefully and petition our government. In this country, we expect full disclosure of all our medical options when we week treatment from a physician. Yet, the global gag rule prohibits all of these legal activities in other countries in exchange for U.S. funds. We would not stand for such restrictions in the United States, and we cannot allow international family planning organizations to be prevented from discussing and performing services that are legal in their countries. Let's be clear, even if the Hyde-Barcia-Smith-Oberstar amendment fails here today, the United States Agency for International Development (U.S.A.I.D.) cannot promote abortion, nor can it fund abortions except in the cases of rape, incest, or if the life of a woman is in danger. I urge my fellow colleagues to oppose the Hyde-Barcia-Smith-Oberstar amendment. Reproductive health services are not solely the responsibility of developing nations. We are all affected by the growing population and the spread of HIV/AIDS. Furthermore, we should not impose restrictions on the citizens of other countries that citizens in the United States would not tolerate.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise to recognize the Central Labor Council of Alameda County, AFL-CIO on the occasion of its 100th anniversary. The Central Labor Council of Alameda County has a long history of organizing, advocacy, activism and progressive leadership over the past century. I would like to highlight some of their many accomplishments and contributions. The Central Labor Council was one of the first labor organizations in the country to take a high profile position in support of the Civil Rights Movement. Executive Secretary-Treasurer, Richard Groulx joined Martin Luther King, Jr. in the march in Selma, Alabama in 1964. The Central Labor Council was in the forefront in the demand for divestiture in apartheid South Africa. Long before the issue captured national attention, the Central Labor Council of Alameda County joined with religious, community and student groups to demand divestiture by the University of California. Secretary-Treasurer Groulx spoke to a rally of over 20,000, vowing labor's support for the divestiture. The Central Labor Council of Alameda County was one of the first labor bodies to recognize the United Farm Workers Organizing Committee and Cesar Chavez by lending money and physical support to the fledgling organization. When the Port of Oakland was locked in a year-long bureaucratic quagmire in its attempts to dredge the shipping lanes to accommodate the new larger container ships, it was the Central Labor Council of Alameda County and its Secretary-Treasurer Owen Marron who brought the stalemate to an end. He brought business, labor, elected officials and the Port together in a coalition. As a result, the impasse was broken and dredging within an acceptable environmental plan is underway. Thanks to the political clout of the Central Labor Council in partnership with a coalition of local unions, community and religious organizations, Living Wage ordinances have been passed by the cities of Oakland, Berkeley and Hayward as well as a major employer, the Port of Oakland. A collaboration of the Central Labor Council, under the leadership of the present Secretary Judy Goff, and the Labor Immigrant Organizing Network, has lead to the passage of a resolution of immigrant's rights. The immigrant rights resolution was sent to the California Labor Federation and the AFL-CIO leading to a change in the AFL-CIO's position on immigrant worker's rights. Congratulations Central Labor Council of Alameda County, AFL-CIO on your centennial birthday and best wishes in your continued successful efforts to organize for justice in our community.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise to pay tribute to Maria Ochoa, Ph.D. Dr. Ochoa has been director of the Sun Gallery in Hayward, California, for five successful years and is leaving to conduct art history research. Her exemplary leadership at Sun Gallery will be missed. Sun Gallery is a community based gallery that obtains its funding through foundation grants and community support. Through Dr. Ochoa's numerous programs and outreach activities Sun Gallery has become a true community based art gallery in which individuals feel invested and point to Sun Gallery with pride of ownership. Dr. Ochoa was hired in April 1996 to serve as the Director of Sun Gallery. During her tenure, the growth at Sun Gallery has been remarkable. She developed a comprehensive educational program for children, increased the Gallery's funding base, brought a wide range of internationally and nationally regarded artists to exhibit at the gallery, and most importantly, brought the community to Sun Gallery. She tripled the number of school children served annually by the gallery. Sun Gallery's classroom field trip program is now regarded as one of the premiere art education programs in the region. Dr. Ochoa also developed, in tandem with local artists and teachers, a bronze-casting curriculum that is now offered in high schools in Hayward, California. Dr. Ochoa has stated that she is quite honored to have been selected to bring Sun Gallery into the 21st Century and is deeply humbled to have been able to serve the community, while working in a visual arts setting. We are honored that Dr. Ochoa chose to lead Sun Gallery with her energy, commitment and talent. She leaves a legacy and her indelible mark on Sun Gallery. I join her friends and admirers in thanking her for a job well done.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise in strong opposition to the Budget Resolution Conference Report presented to us today. That opposition is based on the substance of the budget as well as the tactics used by the Republican majority to force this bill to the floor of the House of Representatives with no input from those of us on the Democratic side of the aisle. I guess it doesn't matter that Democrats have not had real input into the budget process because the overall document is a sham anyway. It does not reflect the total cost of the tax cuts that Republicans plan to pursue this year. Nor does it reflect the total defense spending increases that will become law before this year is over. And, this budget resolution still fails to account for additional cuts that will have to occur in many domestic programs in order to make room for the bloated tax cut and defense spending increases. Finally, it fails to protect Medicare and Social Security and falls far short of guaranteeing the funds necessary to add a prescription drug benefit to Medicare. On the tax cut front, the House has already passed tax cut legislation totaling more than $1.54 trillion. That is more than this budget resolution would even allow. Yet, the House-passed bills and this budget resolution still fail to address many tax issues that we know will be included before the year is over. Such tax changes include: a business tax package that will ultimately be part of any proposal to increase the minimum wage, tax extenders like the Research and Development Tax Credit, adjustments to the Alternative Minimum Tax, and various tax incentives for health care and education. I applaud my Senate colleagues for fighting to lower the amount of dollars dedicated to tax cuts in this budget resolution conference report from the $1.6 trillion requested by the President to approximately $1.215 trillion (and the $100 billion stimulus package for fiscal years 2001 and 2002). However, that appreciation is strongly dampened by the reality that even $1.25 trillion is too high and the tax cut number in this budget resolution is going to grow still larger. We will surpass these dollar limitations for tax cuts; in fact, we already have. And we will pay the price in more ways than one when we are forced to reduce expenditures in vital domestic programs that mean much more to a wider array of Americans than the tax cuts ever will. We can and should be increasing our investment in education. President Bush has made education one of his highest rhetorical priorities, but rhetoric alone won't fund education improvements. This budget fails to follow through with the resources necessary to make great strides on education. My colleagues in the Senate were able to dramatically increase funding for education by $294 billion in their version of the budget resolution. This conference report strips those increases from the package. The total funding level for education in this budget conference report is even less than the amount the President requested and the House approved this past March! That's moving backward on education--not forward. This budget puts at risk the Medicare and Social Security Trust Funds to finance other expensive components of this package. In 2011, the baby boom generation will start to become eligible for Medicare benefits. That begins a major demographic shift with far fewer workers supporting far greater numbers of seniors on Medicare. Today the ratio is approximately 3.4 workers per Medicare beneficiary. According to the Medicare actuary, that number is predicted to drop to about 2.1 workers per beneficiary by 2029. All of this cries out for protecting every cent that we have in the Medicare Trust Fund and making changes to law to ensure that more funds go into the Trust Fund in the future. But, the budget before us does the opposite. It raids the Medicare Trust Fund to fund an inadequate prescription drug benefit and makes the Medicare Trust Fund vulnerable for raiding for other purposes as well. Make no mistake about it. The dollars diverted from the Medicare Trust Fund in the budget before us today will never be returned to the Trust Fund. They are being spent elsewhere. That means that there are fewer resources dedicated to Medicare's future. We are robbing Peter to pay Paul. No ifs, ands, or buts about it. It is past time for us to add a prescription drug benefit to Medicare. None of us would join a health insurance plan that didn't include prescription drug coverage, but Medicare does not cover these necessary medical costs. The Congressional Budget Office estimates that Medicare beneficiaries will spend $1.5 trillion on prescription drugs over the next ten years. Instead of using a portion of the surplus to assure meaningful coverage, this budget resolution presents a Hobson's choice between covering prescription drugs or assuring available funds for future hospital, home health and nursing home services that are already covered. It diverts needed dollars from the Medicare surplus into an account that is labeled by the Majority for use on prescription drug coverage and so-called ``modernization.'' I opposed the earlier House-passed budget for the same reasons that I am opposing this budget resolution conference report before us today. This version still fails to appropriately prioritize the needs of our nation. It could put us back in the economic ditch that the Reagan tax package created in the 1980s, and from which we only recently emerged. During this time of unprecedented surplus, we should be shoring up the federal programs on which people rely, we should be increasing our investment in education, we should be improving the quality and availability of child care in our nation, we should be covering prescription drugs through Medicare, and doing much, much more. Instead, this budget squanders projected resources on tax cuts that disproportionately benefit the most well-off and puts at risk our ability to finance important government priorities now and in the future. I urge my colleagues to vote no on the budget resolution conference report before us.

Mr. STARK

Mr. STARK. Mr. Speaker, I join my colleagues Representatives Charlie Rangel, George Miller, Jim McDermott, John Conyers, Barney Frank, Sherrod Brown, John Tierney, Sheila Jackson-Lee, Dennis Kucinich, William Coyne, Karen Thurman, and John LaFalce today to introduce the MediKids Health Insurance Act of 2001, which would provide universal health for our nation's children through a new Medicare-like national program with benefits tailored toward children. Senator Rockefeller is introducing a companion bill in the Senate. Children are the least expensive segment of our population to insure, and maintaining their health is integral to the future of our society. We can not allow children to go without basic health care because they are uninsured. They will be more likely to require both avoidable hospitalizations and emergency care. In addition, lack of health care as a child can lead to the need for more intensive and unnecessarily costly care later in life. Providing health care coverage to children impacts much more than just their health--it impacts their ability to learn, their ability to thrive, and their ability to become productive members of our society. In the past several years, we have achieved a remarkable consensus to address the millions of children without health insurance in America. The result has been the expansion of Medicaid and the implementation of S-CHIP. But, despite these efforts, there are still over 10 million uninsured children. Clearly, much more can and should be done to guarantee the coverage of all children in the United States. It is unconscionable for our society to allow children to go without health care coverage because the are stuck in the gap between being eligible for public programs like Medicaid and their parents' being able to afford reliable coverage. MediKids will provide health insurance for all children in the United States regardless of family income. The program is modeled after Medicare, but the benefits are tailored toward children. MediKids is financed like the Medicare Part B program with families paying a premium of 25% of the value of the program and the rest financed through general revenues. Premiums for MediKids would be collected each year when their parents' file their taxes. There is also a generous low-income subsidy for families phasing out at 300% of poverty. Parents who have other coverage for their children--employer sponsored, individual marketplace, S-CHIP, Medicaid or whatever, could maintain that coverage. But, if something happens and that coverage is no longer available, their children could always rely on MediKids for coverage. If the family moves, MediKids follows the children across state lines. And, no longer would kids get caught with no health insurance coverage if their parents are climbing out of welfare. Enrollment in MediKids is simple with no complicated paperwork or re- determination hoops to jump through. When children are born or immigrate to this country, the parents are automatically given a MediKids insurance card and information on the benefits. For those children who are already born, the bill authorizes presumptive eligibility and enrollment at outstationed sites such as Disproportionate Share Hospitals and Federally Qualified Health Centers to simplify outreach efforts. Once the program is fully phased in no outreach will be needed because enrollment into the program will be automatic. Our legislation is supported by both children's advocates and the doctors who care for children. Groups that support the legislation include: the American Academy of Pediatrics, the Children's Defense Fund, the American Academy of Child and Adolescent Psychiatry, Consumers Union, Families USA, the March of Dimes, the National Association of Community Health Centers, the National Association of Public Hospitals and Health Systems, the National Health Law Program, and NETWORK: a Catholic Social Justice Lobby. These providers and children's advocacy groups are united around the concept that children deserve access to continuous health insurance. MediKids meets that goal. It's time we make this investment in the future of America by guaranteeing to all children the health coverage they need to make a healthy start in life. In a country awash in surplus, there is no excuse for any of our children to grow up without health care coverage. A small investment in our children's health will go much further than a huge tax break for those who are already well off. I look forward to working with my colleagues and supporting organizations for the passage of the MediKids Health Insurance Act of 2001. Below is a short summary of the legislation:

Mr. STARK

Mr. STARK. Mr. Speaker, half of the American workforce lacks pension coverage. The majority of those who lack pension coverage are low- to moderate-income workers and employees in small businesses. Therefore, pension reform should be aimed at providing coverage for those who currently lack it. Any pension reform package should be judged primarily in terms of how much additional coverage for moderate and low-income workers the legislation provides and at what cost in terms of lost revenue. The biggest problem with the overall bill is that the bulk of it is spent to help relatively few workers who already have pensions and save for retirement. The biggest potential problem with the bill is that it could actually provide a disincentive for small business owners to provide any pension coverage at all. Increasing the IRA contribution limits to $5,000 is likely to hurt some low and mid-income workers by inducing small businesses not to offer an employer-sponsored pension plan. Under H.R. 10, the small business owner will be able to contribute $10,000 to an IRA combined for himself and his spouse. This additional contribution may be sufficient enough for the owner's retirement savings that he may not perceive a need, nor want to incur the cost, to set-up an employer- sponsored pension plan. Over three-fourths of the pension and IRA tax benefits in H.R. 10 would accrue to the 20 percent of Americans with the highest incomes. In addition to increasing IRA contribution limits, this bill helps executives and those employees who already earn the most lucrative salaries and already contribute to some type of tax-preferred retirement plan. The bill increases the $135,000 annual benefit limit for defined benefit plans to $160,000. Clearly this only helps those who currently earn the maximum defined benefit plan limit of $135,000. The rank and file workers don't earn pension benefits in excess of $135,000 so they don't need an increase on the annual limit on defined benefit plans. This is exclusively designed for those at the top. Currently, there is an employee limit of $10,500 on deposits to 401(k)s, and the combined employer-employee contribution may not exceed the lesser of $30,000 or 25 percent of pay. The bill before us raises the maximum combined contribution to $40,000 and eliminates the requirement that it not exceed 25 percent of pay. This is yet another example of a provision that is purely intended for high-income workers who already contribute greatly to their pensions. Under current law, tax-preferred pension plans must not discriminate in favor of highly compensated employees. For example, employers must not discriminate between executives and the rank-and-file workers in the formulas used to calculate employer contributions. This ensures that tax preferences for pension plans serve the public purpose of boosting pensions among a wide array of workers. Instead of strengthening these rules, the pension reform bill loosens the nondiscrimination rules. The bill also seeks to relax the ``top heavy'' protections that serve a similar purpose in ensuring that the pension wealth is not concentrated amongst the top tier income-earners. These safeguards apply to plans in which 60 percent or more of the pension contributions or benefits accrue to company officers and owners (``key'' employees). The protections require firms to take additional steps to protect the rank-and-file workers through accelerated vesting and certain minimum contributions or benefits than would otherwise be required under the general rules. H.R. 10 relaxes these safeguards to the detriment of employees working for these firms. There are a few relatively miniscule provisions that would actually be good policy changes for a broad range of workers if they were pulled out from the bill and addressed in separate legislation. The legislation would allow rollovers across defined contribution plan types so that, for example, 401(k) assets could be rolled over into 403(b) accounts. This will allow employees to move from public, private and non-profit jobs with fewer pension constraints. This amounts to .004 percent of the bill's total cost. The legislation also allows for faster vesting under employer-matching contribution plans. The bill accelerates the schedule for cliff vesting from 5 years to 3 years, and from 7 years to 6 years under graded vesting, reflecting the shorter commitments employees make to any one employer. This provision has a negligible revenue effect. Section 415(b), Multi-Employer Pensions limits are increased allowing those in the construction industry to earn the pensions negotiated for in their contracts. Although this provision may only effect a small group of workers, it accounts for just one percent of the overall bill. It is unfortunate that a little over 1 percent of today's bill actually provides for sound policy changes to help those who really need it. This bill does nothing to induce those who currently don't save for retirement to do so, and it gives those who do save more ways to shift funds. The Washington Post Editorial Department recognizes this fact, and I would like to submit the following Op-Ed for the Record. I urge my colleagues to vote no on H.R. 10. [From the Washington Post, Apr. 29, 2001] A Miserable Pension Bill The House Ways and Means Committee has approved still another tax cut bill, the third this year. Unlike the first two, this one is relatively small, was not proposed by President Bush and has strong bipartisan support. The House is expected to pass it overwhelmingly this week. But that's unfortunate, because the bill would not produce the healthy result its sponsors suggest. The bill, whose principal sponsors are Reps. Rob Portman and Benjamin Cardin, is presented as a way of increasing the retirement savings of the middle class. But in fact the tax savings, an estimated $52 billion over 10 years--would go mainly to people whose incomes already permit them to save a great deal. The committee rightly observes that too many workers approach retirement with insufficient savings; half of all private-sector workers lack pension coverage. But most of them will continue to lack it if this bill is passed. Those who already have the most coverage will be eligible for more; that will be the main effect. The bill would significantly increase the amounts of money that can be set aside each year in tax-favored individual retirement and 401(k) accounts. An estimated three-fourths of the benefit of the bill would go to taxpayers in the highest income quintile, and two-fifths would go to the highest income 5 percent. Democratic efforts to broaden the bill to benefit lower-income taxpayers failed. This bill also contains provisions that critics think would induce small employers to reduce pension coverage rather than expand it, as the sponsors suggest. This one won't break the bank, but neither is it likely to increase savings that much. For the most part, it will confer in the name of savings a tidy tax break on people who were going to save anyway. It ought not to pass.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to join with my colleague Shelley Berkley to support this concurrent resolution that honors National Children's Memorial Flag Day. This concurrent resolution supports the commemoration of the 4th Friday of each April as National Children's Memorial Flag Day. In addition this resolution encourages national, State, and local agencies and private organizations to fly the Children's Memorial Flag to remember the children lost to violence and to raise public awareness about the continuing problem of violence against children. I support this resolution nationally because of its successful observance in my Congressional district. In 1996, the Alameda County Board of Supervisors adopted the Children's Memorial Flag Project, and established a National Children's Memorial Day on the fourth Friday in the month of April to remember children who have died by violence. I want to commend Supervisor Gail Steele of Alameda County for her tireless work and dedication to get this resolution adopted. In addition, the California Assembly formally declared the fourth Friday in April as a statewide annual observance day. The Child Welfare League of America has adopted Alameda County's Children's Memorial Flag and promotes it nationally. This Congressional resolution is particularly timely in the wake of the two school shootings in California at Granite Hills High School in El Cajon, California and Santana High School in Santee, California. Unfortunately, acts of violence against children happen far too often. According to the Child Welfare League of America, three infants and children die from abuse and neglect in the U.S. each day, and ten children die a day as a result of gun violence. In fact, more children lose their lives to criminal violence in the U.S. than in any of the 26 industrialized nations of the world. We have lost far too many children in violent, preventable deaths. I encourage my colleagues in Congress to work with renewed resolve to ensure that our children have a full opportunity to become healthy and productive adults. Even one child lost is one child too many. I urge my fellow members to support the National Children's Memorial Flag Day concurrent resolution through unanimous consent.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in opposition to H.R. 503, the Unborn Victims of Violence Act. I oppose this legislation because of its implications for the future of a woman's right to lawfully terminate a pregnancy, not because I oppose punishing crimes against pregnant women--or anyone else--to the full extent of the law. Don't be fooled, this bill is an attack on the fundamental principles of Roe v. Wade. H.R. 503 would establish a zygote, blastocyst, embryo, and fetus as a person under federal law. Although the Supreme Court has held that fetuses are not persons under the 14th amendment, this bill would bestow separate rights to the fetus equal to that of the mother. The Lofgren substitute, on the other hand, creates a separate criminal offense for harm to a pregnant woman, while maintaining the woman as the primary victim of the crime. It also creates an offense for violence resulting in the injury or termination of a pregnancy. I urge my fellow colleagues to oppose H.R. 503 and to support the Lofgren substitute. H.R. 503 dislodges the cornerstone underpinning Roe v. Wade. In contrast, the Lofgren substitute strengthens punishments for crimes against pregnant women without weakening a woman's right to choose.

Mr. STARK

Mr. STARK. Mr. Speaker, this bill will hamstring Congress in an unprecedented manner. Requiring a two-thirds majority essentially renders Congress unable to increase revenues, as demonstrated by the five major deficit reduction measures enacted between 1982 and 1993. None of these bills passed by a two-thirds majority, yet a majority of this representative body found them necessary to reduce the federal debt and balance the federal budget. This bill will hurt federal programs when the baby boom generation begins to retire. This could lead to steep reductions in Medicare and Social Security benefits, not to mention other needed federal programs. Congress needs to impose balance in its budgets but this would be made impossible by requiring a two-thirds majority. Everybody likes the benefits that the federal government provides but nobody likes to pay for them. So it's always easy for a Member of Congress to reduce taxes, yet very difficult to increase taxes--even under a bill that requires a simple majority vote. A two-thirds majority would be required of any bill seeking to raise federal tax revenues. This includes taxes on corporations that find loopholes to lower their effective tax rates. This also includes businesses that we find pollute the environment. Just last year, the Institute on Taxation and Economic Policy found that forty-one of Fortune's top 250 U.S. companies paid less than zero in federal income taxes at some point between 1996 and 1998. This means that rather than paying the $9 billion in federal income tax, as required by the 35 percent statutory corporate tax rate, these companies generated so many excess tax breaks that they received rebate checks from the U.S. Treasury totaling $3.2 billion. One astute University of Miami Law School professor accurately depicted today's bill as the ``Tax Loophole Preservation Amendment to the Constitution.'' The legislation before us today would mean that corporate welfare could continue to flourish at the expense of American seniors who risk decreased Social Security and Medicare benefits with passage of this devastating bill. This is too big a gift to give to corporate America when we need more money for our children's education, and we need a Medicare prescription drug benefit for our seniors. I urge my colleagues to allow Congress to continue its prescribed work in devising and enacting an annual budget that includes increasing revenues in the same manner as it decreases revenues--by a simple majority vote. I urge a ``not'' vote on H.J. Res. 41.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to join with my colleague Shelley Berkley to introduce this concurrent resolution supporting National Children's Memorial Flag Day. This concurrent resolution supports the commemoration of the 4th Friday of each April as National Children's Memorial Flag Day. In addition this resolution encourages national, State, and local agencies and private organizations to fly the Children's Memorial Flag to remember the children lost to violence and to raise public awareness about the continuing problem of violence against children. I support this bill nationally because of its successful observance in my Congressional district. In 1996, the Alameda County Board of Supervisors adopted the Children's Memorial Flag Project, and established a National Children's Memorial Day on the fourth Friday in the month of April to remember children who have died by violence. I want to commend Supervisor Gail Steele of Alameda County for her tireless work and dedication to get this resolution adopted. In addition, the California Assembly formally declared the fourth Friday in April as a statewide annual observance day. The Child Welfare League of America has adopted Alameda County's Children's Memorial Flag and promotes it nationally. This Congressional resolution is particularly timely in the wake of the two school shootings in California at Granite Hills High School in El Cajon, California and Santana High School in Santee, California. Unfortunately, acts of violence against children happen far too often. According to the Child Welfare League of America, three infants and children die from abuse and neglect in the U.S. each day, and ten children die a day as a result of gun violence. In fact, more children lose their lives to criminal violence in the U.S. than in any of the 26 industrialized nations of the world. We have lost far too many children in violent, preventable deaths. I encourage my colleagues in Congress to work with renewed resolve to ensure that our children have a full opportunity to become healthy and productive adults. Even one child lost is one child too many. I urge my fellow members to support the National Children's Memorial Flag Day concurrent resolution.

Mr. STARK

Mr. STARK. I thank the distinguished ranking member for yielding me this time. Mr. Speaker, I would like to point out, to my children and to anybody who is paying attention to this debate, that the Republican leadership is doing it once again. They would rather give a substantial tax break to America's wealthiest than provide a Medicare drug benefit for all seniors. This is a package of irresponsible, excessive tax breaks. Worse than that, it is a hoax. Little happens for 10 years. Actually, we gave the Republicans on the Committee on Ways and Means a chance to put their votes where their mouths are and vote to make this effective this year. The gentlewoman from Washington (Ms. Dunn), the gentleman from California (Mr. Thomas), the gentleman from Florida (Mr. Shaw), the gentlewoman from Connecticut (Mrs. Johnson), the gentleman from Pennsylvania (Mr. English), and all of the Republicans voted no. They had a chance to make this effective right now. Instead, they wait for 10 years and then the cost clocks in just at a time when we will have baby boomers needing Medicare and Social Security and just at a time when that money will not be available. It is interesting, and I have got to warn those who expect that next year their estates will be exempted, because they are in for a big surprise. Forty-three thousand Americans, less than 1 percent of all the taxpayers, will benefit from this Republican hoax. Forty million elderly and disabled are not going to get a drug benefit under Medicare because of this wasteful bill. Ninety percent of the beneficiaries of the estate tax cut make over $190,000 a year and our typical Medicare beneficiary has an annual income of less than $15,000 a year. A thousand times more people would be helped under this plan if Members vote for the Democratic alternative.

Mr. STARK

Mr. STARK. Mr. Speaker, I join today with Mr. Shaw and a broad bipartisan group of our colleagues from the House Ways and Means Committee in introducing the Structured Settlement Protection Act. I was the Chairman of the Ways and Means Subcommittee that considered the original bipartisan legislation in 1982 that enacted the structured settlement tax rules. The Ways and Means Committee, acting on a bipartisan basis, adopted the structured settlement tax rules that are in the Code today to provide long-term financial protection to seriously-injured victims and their families, so that these families would not have to turn to taxpayer-financed programs to meet their basic living and medical needs. As a long-time supporter of structured settlements, I have been gravely concerned about the impact of so-called ``factoring''--in which future damage payments are sold off for a discounted lump sum--on this long-term financial security that Congress intended to achieve for injured victims and their families. That is why I have worked actively with Mr. Shaw and our colleagues on the Ways and Means Committee over several years to put forward legislation to protect structured settlements and the injured victims and their families who depend upon them. The Structured Settlement Protection Act that we are introducing today with broad bipartisan support on the Ways and Means Committee will bring a final resolution to the factoring issue, protecting the hundreds of thousands of structured settlement recipients and the longstanding Congressional policy of almost two decades. The Act works in conjunction with complementary State structured settlement protection legislation that already has been enacted by 19 States and is under active consideration in an additional 20 States. The Act and the complementary State legislation rely upon a State court review process to ensure that the structured settlement fulfills its intended purpose of providing long-term financial protection for injured people, while enabling the victim to get access to future payments if the court determines that such access is in the best interests of the injured person, taking into account the welfare and support of his or her dependents, and determines that the sale of future payments does not violate any State or Federal statutes or existing court orders. This Federal legislation is necessary to ensure compliance with State regulation given the nationwide operation of the factoring industry, to encourage the remaining States to adopt the necessary regulatory legislation, and to put to rest tax uncertainties that factoring transactions have created for the other parties to the structured settlement. I understand that the Act has the support of both the National Structured Settlements Trade Association on behalf of the structured settlement industry and the National Association of Settlement Purchasers on behalf of the factoring industry. Given this joint support, the legislation should be non-controversial. We have worked hard on a bipartisan basis to resolve this issue. I strongly urge that we move forward to enact this bipartisan legislation as soon as possible.

Mr. STARK

Mr. STARK. Mr. Speaker, today I join with Senator Wellstone and my House colleagues to introduce legislation that is long overdue. The Medicare Mental Health Modernization Act of 2001 does just what its title says--it updates and improves Medicare mental health benefits, removing the many roadblocks to treatment faced by seniors and people with disabilities. This comprehensive legislation modernizes Medicare mental health coverage in three important areas: Parity for Mental Health Services. Current benefit structure discriminates against people seeking treatment for mental health and substance abuse conditions. In effect, Medicare imposes a ``mental health tax'' by requiring a 50 percent co-pay for outpatient mental health services instead of the 20 percent co-pay required for most other Part B medical services. In addition, there is a 190 day lifetime cap on psychiatric hospital services--even though no similar cap on inpatient services exists for any other health condition. These discrepancies perpetuate the stigma surrounding mental illness and must be eliminated. Our bill would eliminate the discriminatory 190 day lifetime cap and reduce the 50 percent co-pay for outpatient mental health services to the 20 percent level enjoyed for other Part B medical services. Coverage of Community-Based Mental Health Services. Not only does our nation's largest healthcare program impose discriminatory limits and copayments, its overall mental health benefit package is outdated and inadequate. The net result is that seniors and people with disabilities don't have access to the latest, most cost-effective mental health treatments. In the past few decades, there have been tremendous advances in mental health diagnosis and treatment. We know that mental health conditions are like other health conditions. With appropriate treatment, some conditions can be resolved entirely while others require lifelong management. The same is true for physical illnesses like diabetes or multiple sclerosis. Furthermore, as the 1999 Surgeon General's report concludes, ``a wide variety of community-based services are of proven value for even the most severe mental illnesses.'' Yet with few meager exceptions, Medicare mental health benefits have remained virtually unchanged since they were enacted in 1965. To correct these flaws, the Medicare Mental Health Modernization Act would allow beneficiaries to access a range of community-based residential and outpatient services that appropriately reflect the state-of-the-art in mental health treatment. For example, although inpatient psychiatric services remain important, community-based crisis programs provide an evidence-based alternative to institutional care. Recognizing that fact, our bill would create Medicare coverage for up to 120 days/year for intensive residential services, such as mental illness residential treatment programs and substance abuse treatment centers. In addition, for the relatively small percentage of Medicare beneficiaries with the most serious and disabling mental illnesses, this legislation would make available a range of intensive outpatient services. Research confirms that these innovative services provide necessary skill training and supports that help people with brain disorders, such as schizophrenia and bi-polar disorder, function better. In fact, costly inpatient hospitalizations can be reduced by as much as 60 percent. Examples of intensive outpatient services include Programs of Assertive Community Treatment (PACT), psychiatric rehabilitation, and intensive case-management. Improved Beneficiary Access to Medicare-Covered Services. The Medicare Mental Health Modernization Act would also address professional shortages and potentially discriminatory coverage criteria that can leave vulnerable beneficiaries unable to access care. According to the Surgeon General, the supply of well-trained mental health professionals also is inadequate in many areas of the country, especially in rural areas. Particularly keen shortages are found in the numbers of mental health professionals serving . . . older people.'' The Medicare Mental Health Modernization Act addresses these professional shortages by allowing marriage and family therapists and mental health counselors who are licensed or certified at the state level to provide Medicare-covered services. It also ensures that clinical social workers can continue to provide psychotherapy in nursing homes by allowing them to bill Medicare directly for these services as psychiatrists and clinical psychologists can do. Finally, because coverage criteria for therapy services require beneficiaries to demonstrate ``continuing clinical improvement,'' our bill would mandate a study to determine whether these criteria discriminate against people with Alzheimer's disease and related mental illnesses. There is no question that our country's senior citizens and people with disabilities have significant mental health and substance abuse needs. Consider data from the 1999 Surgeon General's report on mental health and the 2001 Robert Wood Johnson report on substance abuse: Major depression is strikingly prevalent among older people. In primary care settings, 37 percent of senior citizens demonstrate symptoms of depression and impaired social functioning. Furthermore, older people have the highest rate of suicide of any age group--accounting for 20 percent of all suicide deaths. About 20 percent of individuals age 55 and older experience specific mental disorders that are not part of normal aging. Unrecognized and untreated depression, Alzheimer's disease, anxiety, late-onset schizophrenia, and other mental conditions can lead to severe impairment and even death. Older Americans tend to underutilize mental health services--only 50 percent of those who acknowledge mental health problems receive treatment. Approximately 17 percent of adults over 65 suffer from addiction or substance abuse, particularly alcohol and prescription drug abuse. While addiction often goes undetected and untreated among older adults, aging and disability makes the body more vulnerable to the effects of alcohol and drugs, further exacerbating other age-related health problems. Nearly 1 out of every 4 Medicare dollars spent on inpatient hospital care is associated with substance abuse. About 5 percent of American adults experience a serious mental illness that is disabling with respect to employment, self-care, and interpersonal relationships. In fact, nearly 90 percent of people with serious mental illnesses are unemployed. Nearly one-third of non-elderly, disabled Medicare beneficiaries have a primary diagnosis of mental illness. Policymakers on both sides of the aisle agree that Medicare's mental health benefits are woefully inadequate and out-of-date--yet none of the current Medicare reform proposals specifically address mental health. As a country, will we continue to stigmatize mental illness and deny elderly and disabled individuals access to mental health services that can improve their health and well-being? To me, the bottom line is clear--mental health modernization must be part of any fundamental Medicare reform. On a national level, there is positive movement in this direction. On January 1, 2001, an executive order brought parity to 9 million Federal employees, retirees, and their dependents--providing them with improved mental health benefits equal to those for physical conditions. Most states and even many large corporations now recognize that unequal coverage for mental illnesses is not only discriminatory, but costs more money in the long run. That's because untreated mental illness can lead to high cost hospitalization and crime--not to mention personal and family suffering, suicide, homelessness, lost productivity, and partial or total disability. These comprise the ``indirect'' costs of untreated mental illness. Together, these direct and indirect costs are tremendous. Yet over the past decade, spending for mental health care has declined relative to overall health spending and accounts for a mere 7 percent of total health expenditures. The Medicare Mental Health Modernization Act is an important step forward in providing comprehensive mental health coverage for senior citizens and people with disabilities. It ends Medicare's longstanding discriminatory mental health benefits and recognizes that state-of-the- art mental health care takes place in the community. This bill will assure that the mental health needs of elderly and disabled Americans are more fully addressed. A range of mental health advocacy organizations representing consumers, family members, and professionals has endorsed this bill. These include: American Association of Geriatric Psychiatry; American Association of Marriage and Family Therapists; American Association of Pastoral Counselors; I urge my colleagues to join us in support of this important legislation.