Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, before recognizing the gentleman from New York, the ranking member of the Committee on Ways and Means, I just want to point out to my colleagues that Julian had really two constituencies for almost 20 years. I served on the Subcommittee on the District of Columbia at the same time that Julian was chairing that subcommittee of the Committee on Appropriations, and the District of Columbia owes a great deal of gratitude over the years for the number of times that he came to the defense of home rule, to the aid of their schools, their health care, their police and fire departments, all at times where he was able to bring aid to a concern that was never, I hate to admit, the most popular committee in concern in this House, and that was dealing with some of the problems of the District of Columbia. But he felt a real responsibility, and he discharged that responsibility with great humanity. I think, in addition to his district in California, he had that added responsibility. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from New York (Mr. Rangel).

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentlewoman from California (Ms. Waters).

Mr. STARK. Mr. Speaker, I yield 30 minutes to control to my distinguished colleague, the gentleman from California (Mr. Horn). Mr. Speaker, I yield such time as he may consume to the gentleman from Missouri (Mr. Gephardt), the minority leader.

Mr. STARK. Mr. Speaker, I offer a privileged resolution (H. Res. 671) and ask for its immediate consideration.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased today to introduce legislation with Representative Henry Waxman that focuses clear attention on the critical role that staffing plays in delivering quality care to the 1.6 million people--our parents, grandparents, siblings and spouses--whose fragile health requires them to live in nursing homes. Policymakers and the public have heard stories for years about the high cost of poor care. And most of us intuitively know that understaffing is a causal or contributing factor in the hundreds of sad tales of neglect and abuse that are identified and publicized each year. The impetus for this legislation is both a recent HHS report on nursing facility staffing ratios and a local study conducted in my district that highlights the correlation between quality of care and staffing levels. The ``Nursing Facility Staffing Improvement Act of 2000'' proposed a remedy for chronic understaffing in nursing homes: It directs state surveyors to conduct special staffing assessments in instances where they identify quality of care deficiencies that either cause actual harm, or that pose a risk of immediate jeopardy to resident health or safety. If there is a finding that inadequate staffing has contributed to an actual harm or immediate jeopardy deficiency, the bill requires those facilities to submit corrective action plans within 30 days stipulating the number and type of additional nursing staff necessary to assure resident well-being. Facilities would then face tough scrutiny from state inspectors, who would check and enforce continued compliance during two interim staffing-only surveys that would occur before the next routine annual inspection. In the event that a facility was again found to have inadequate staffing during an interim survey, an additional two years of interim staffing surveys from that date forward would be triggered. As a separate disclosure requirement, the HHS Secretary would make facility-specific staffing data available on the ``Nursing Home Compare'' website. The data, which would include total hours of care provided per shift by both licensed and unlicensed nursing staff could be reviewed by family members before placing their loved ones in a facility and aid them in making informed choices. The legislation does not propose any new fines or penalties for inadequate staffing. Rather, it holds nursing homes responsible for providing consistently adequate levels of nurse staffing, which all experts tell us is the foundation of good medical and supportive care for medically complex, fragile people. It accomplishes this through a system of stepped-up scrutiny and public accountability. The remedy we are proposing today will improve enforcement of those staffing standards that currently apply, as well as standards that are developed in the future. This legislation will strengthen our federal oversight system. Under current law, many inspectors find it relatively difficult to document and defend appeals of citations of facility understaffing. This bill would change that by directing surveyors to analyze the role that staffing plays whenever there are serious quality deficiencies. And if will serve as a wake-up call for those facilities they try to control expenses by cutting back on the number and wages of nursing staff. Last July, phase one of an important HHS staffing study, titled ``Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes'' was released. It is an important analysis for many reasons, and the first federal study of its kind. Its central findings is that most facilities are failing to staff at levels that guarantee good care. In brief, HHS identified two levels of staffing--a ``preferred minimum'' staffing levels of 3.45 hours of nursing care for each resident each day, with 2 hours of this care providing by nursing assistants, 1 hour by a registered or licensed nurse, and 0.45 hours only by registered nurses. Quality of care in facilities that staffed above this level, the study concluded, was ``improved across the board.'' HHS also identified a lower ``minimum'' level of 2.95 hours of nursing care per resident day, with 2 hours of care provided by nursing assistants, 0.75 by registered or licensed nurses, and 0.20 hours only by registered nurses. Regrettably, more than 90% of facilities in the U.S. fall short of this standard today. The agency's phase one study also shows that many states are acutely aware of staffing shortages in nursing facilities. Many have already moved to impose more stringent staffing requirements under their licensure authority, and some are taking up State legislation to set quantitative minimum staffing standards. California, for example, has a new law requiring all nursing facilities to provide at least 3.2 hours of resident care per day. At the federal level, we are about a year away from having national recommendations on a minimum ratio requirements from phase two of HHS staffing analysis, which will help to shape future discussions and debate about how to go about establishing federal staffing standards. The staffing shortages documented in HHS' national study are also reflected in many homes in my district. At my request, the Democratic staff of the House Government Reform Committee prepared an analysis of staffing levels in homes in my district. Titled ``Nursing Home Staffing Levels in the 13th Congressional District,'' the report shows that 86%, or 25 facilities, did not meet HHS' preferred minimum staffing level of 3.45 hours of nursing care per resident day, while 55% did not meet the lower minimum level of 2.95 hours of nursing care. Equally important, this congressional study looks at the annual surveys of these homes during their most recent annual inspections. Among those facilities that did not staff at preferred minimum levels, 68% were cited for a violation causing actual harm to residents. In contract, homes that did not staff at preferred minimum levels had no violations causing actual harm. Clearly, staffing levels matter. The findings of this congressional study and others like it, plus the implied cost of bringing nearly 16,480 nursing facilities throughout the country up to appropriate levels, are already the subject of considerable debate and discussion. In the next Congress, policymakers and stakeholders will begin to seriously grapple with the mechanics of translating HHS' future staffing recommendations into quantitative federal standards. In the interim, it is simply wrong to stand by and allow the current national epidemic of inadequate staffing to continue without intervention. The status quo means that nursing home residents will keep suffering adverse consequences in the form of poor care, or--in the most severe cases--neglect so profound that untimely death is the result. For all of the reasons, I urge my colleagues to join me in support of the ``Nursing Facility Staffing Improvement Act.'' It is a bill that I hope will find its way into next year's discussions on nursing home quality and accountability, and I invite any and all interested parties to comment.

Mr. STARK

Mr. STARK. Mr. Speaker, Santa Clara County in California has just made history by approving a plan to provide health coverage for all of the estimated 70,000 uninsured children in the county. Unwilling to wait for national and state officials to respond to the problem, the county has obtained funding from a variety of diverse sources to ensure that children receive the health care coverage they need, starting January 2, 2001. The county will streamline application forms, aggressively conduct outreach, and enroll the approximately 50,000 children who qualify for state and federally funded programs. For the other 20,000 children who don't qualify for existing government assistance, the county will pay the majority of their health insurance premiums. Not only will Santa Clara County's children be guaranteed health coverage, but also they will be guaranteed comprehensive coverage. Currently, children can obtain access to health care through Medicaid, State Children's Health Insurance Program (SCHIP), and the private sector. Often, the health coverage varies widely. Under Santa Clara County's program though, all children up to the age 19 will be guaranteed comprehensive coverage of a range of services, including vision, dental, and medical care. I want to commend Santa Clara County for being the first in the nation to set its sights on covering all children with health insurance. The county has proactively found a solution to our nation's pressing problem of the uninsured and has built partnerships with diverse groups to achieve coverage for all children. I hope that other counties, states, and the federal government will follow Santa Clara County's lead. With over 10 million uninsured children in this country, the problem faced by Santa Clara County is one that is faced by numerous counties across America. This year, I introduced H.R. 4390, the MediKids Health Insurance Act to provide health coverage for every child in the country. It would provide a health care safety net for uninsured children by guaranteeing access to comprehensive medical care. MediKids, which builds on our successful experience with Medicare, is one approach to ensuring coverage for all children in the nation. There are alternative approaches that build on other existing programs, similar to the new effort being undertaken by Santa Clara County. I hope everyone in Congress can join in continuing our efforts to expand coverage to our nation's uninsured children. Passage of the SCHIP program in 1997 has certainly moved us forward, but much more needs to be done. All of our nation's children deserve a healthy start in life. For the children living in Santa Clara County, they should now get precisely that.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to commend the Fremont Police Department for receiving the 2000 Community Policing Award for highly populated cities awarded by the International Association of Chiefs of Police and ITT Industries Night Vision. The Fremont Police Department was one of five winners out of over 100 entries from communities and agencies across the United States and Canada. The city of Fremont and Fremont Police Department have shown a strong commitment to crime prevention that should be used as a shining example for other communities across America. Currently, Fremont has shown its strong commitment to crime prevention by making sure that there are enough police officers to respond to the issues of crime prevention in the city. Fremont has a staffing ratio of one officer per 1,000 residents, much better than the State and national averages. In a nationally published study, Fremont had the 8th lowest population to officer ratios of the Nation's 289 largest police forces. This low ratio has been maintained even though Fremont has experienced a large growth in population. This low staffing provides the Fremont Police Department the manpower to carry out innovative approaches to law enforcement. For instance, Fremont as part of their increased use of Community Policing techniques has encouraged leadership building in the neighborhoods. This strategy encourages a stronger partnership between the community and the police department in preventing crime. Again, I want to extend the highest commendation and congratulations to the Fremont Police Department for its outstanding service to its community.

Mr. STARK

Mr. STARK. Mr. Speaker, Ms. Luisa Victoria Iglesias, affectionately known as ``L.V.'', is retiring after 37 years with the Federal Government. Although the number of years is not in itself remarkable, the fact that she is retiring at age 88 years and 9 months is truly remarkable. And equally remarkable is the importance of the work that she has performed in her career in the Federal Government. Ms. Iglesias graduated from high school in Albany, NY in 1929 and from New York State Teachers College in Albany in 1933. In 1934 she became an English teacher at a high school in Guayama, Puerto Rico. While she was teaching, she continued her college studies by attending the University of Puerto Rico, receiving a certificate in social work in 1936. In 1938, Ms. Iglesias held the position of Delegate to the Bureau of Women and Children in Industry in Mayaguez, Puerto Rico. She then moved to Caracas, Venezuela to become a Social Work Instructor, and shortly thereafter, she was promoted to Social Work Director in Maracaibo, Venezuela. Later, she returned to Puerto Rico to become a Medical Social Worker for the Crippled Children's Program in Santurce, Puerto Rico. In 1942, Ms. Iglesias returned to the United States to attend the University of Chicago, where she received a Master of Arts in Social Work in 1943. She then returned to Puerto Rico and was promoted to Medical Social Work Supervisor. In 1945, Ms. Iglesias became Chief of the Bureau Public Assistance. In 1958 she was promoted to the position of Chief of the Organization and Methods section in the Department of Health, Puerto Rico. During the years from 1952 through 1960, Ms. Iglesias continued to attend the University of Puerto Rico in the evening and attained another Masters degree in 1962. For several years during that time, she was a member of the Puerto Rico Social Work licensing board, and during the years 1957-58, she was a member of the Puerto Rico Parole Board. Ms. Iglesias' career with the Federal Government began in 1963 when she started working for the Social Rehabilitation Service (SRS) in the former Department of Health Education and Welfare (DHEW). She was hired as a Social Administration Advisor (also known as a Family Services Technician); she was later promoted to Social Work Program Specialist and then to Associate Policy Control Officer. Later, as the Policy Officer in the Office of the Associate Administrator for Policy Control and Coordination, SRS, Ms. Iglesias had final SRS approval authority on all Medicaid, welfare (aid to families with dependent children, AFDC), and social services regulations that were developed for the DHEW Secretary for publication in the Federal Register. When SRS was abolished in 1977 and HCFA was created, Ms. Iglesias was assigned to HCFA as a Policy Coordination Officer in the Office of the Administrator, Executive Secretariat. In 1978, Ms. Iglesias was reassigned to the position of Supervisory Regulations Analyst in the Bureau of Program Policy. In the last HCFA reorganization, she became a member of the Office of Communications and Operations Support. Mr. Speaker, listing the positions that Ms. Iglesias has held does not begin to describe the importance of the work that she has done. Long before the current effort to make Federal regulations more readable and understandable, Ms. Iglesias worked to achieve that end. Ms. Iglesias wrote the first regulations development manual in SRS-- ``the Policy Coordination Manual.'' Beginning with her work in SRS, she became known for her mandate that regulations must be written in a clear and comprehensible manner. She insisted that regulations should not simply repeat statutory language, and instead, charged her coworkers with providing interpretative rules and regulations that a layman could read and understand. A former English teacher who speaks Spanish fluently, Ms. Iglesias developed training materials and taught classes to ensure that staff develop clear, understandable regulations. After SRS was abolished and HCFA was established (combining the Medicaid and Medicare programs), Ms. Iglesias remained in the Washington Liaison Office of HCFA (HCFA's headquarters became Baltimore) and took on the task of rewriting Medicare regulations. Medicare regulations were then ``mixed'' with the Social Security regulations in Title 20 of the Code of Federal Regulations (CFR). She worked with the CFR office to establish a separate title 42, Chapter IV of the Code of Federal Regulations and spent several years rewriting and recodifying the Medicare regulations in plain English. In HCFA, Ms. Iglesias continued her efforts to make regulations--now Medicare regulations--clear and understandable. In 1978, Ms. Iglesias found further support for her cause that regulations must be ``clear and readable'' in the Deputy General Counsel for Regulation Review in the Department of Health and Human Services. She quickly began further efforts to indoctrinate staff not merely to restate the language of the law in regulations, but to apply all of the principles of the English language in developing comprehensible Federal Medicaid, welfare, and social services regulations for publication in the Federal Register. As an example of her work, Ms. Iglesias has for years tried to simplify the definitions used in Medicare regulations by insisting that HCFA staff refrain from using multiple definitions of the same terms. Similarly, she has instructed HCFA staff that definitions of terms not be used to establish conditions or parameters in regulations. At that time, Ms. Iglesias exerted such energies that no one would have guessed that she was then in her early 70's. Because of her work, many people in HCFA refer to Ms. Iglesias as ``Ms. CFR.'' Ms. Iglesias is known for her love of swimming each morning from June through October (which, in part, may contribute to her good health), her love of attending symphonies at the Kennedy Center, her love of cruising around the world, her love of solving crossword puzzles and playing scrabble, her ability to work hard and fast, and her expectation of others to do the same. Throughout the years, even after exerting such energies at work, Ms. Iglesias has kept up her extensive travels around the world. Even now, at her current age, she still takes at least one cruise each year, and sometimes two. She has visited such places as Spain, South America, Alaska, Russia, Greece, China, Africa, Iceland, Denmark, Scotland, England, Norway, New Zealand, Australia, Malaysia, Europe, Japan, Canada, Indonesia, the Canary Islands, and Hawaii. Ms. Iglesias' immediate family includes two sons, Victor (who lives in Malaysia) and Carlos, two daughers-in-law, Alby and Linda, 2\1/2\- year-old triplet grandsons and a granddaughter, as well as a great grandson, with whom she must keep pace. And I understand that if she follows the same family of legacy of longevity as her aunt of 111 years of age now residing in Puerto Rico, she will have plenty of time to do this in her retirement. Although they are happy for her, Ms. Iglesias' coworkers at the Health Care Financing Administration mourn their loss on her retirement. We can all be grateful for her efforts and her intense desire to make Medicare a better program by writing clear and understandable regulations. And I am sure that I join all Americans in wishing Ms. Iglesias much happiness and continued great cruising as she retires from the Health Care Financing Administration at age 88 after 37 years of Federal Government service.

Mr. STARK

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. In the efforts of the new Congress to be gentler, although I am adamantly opposed to this bill, I would like to give the two best shots they have to the gentleman from Texas (Mr. Archer), the distinguished chairman of the Committee on Ways and Means, and the gentleman from Michigan (Mr. Levin), the distinguished ranking member of the Subcommittee on Trade. I want to give him 4 minutes, and we will proceed to destroy their arguments in subsequent time. Mr. Speaker, I yield 5 minutes to the distinguished gentleman from Michigan (Mr. Levin).

Mr. STARK. Mr. Speaker, this is my time and I reclaim it. That is as silly as supply side economics. The gentleman ought to know better. Mr. Speaker, I reserve the balance of my time.

Mr. STARK. Some businesses do. The ones getting the subsidy for the most part do not. They have so many loopholes and subsidies, as in this, that they end up paying no taxes.

Mr. STARK. Mr. Speaker, I yield 7 minutes to the distinguished gentleman from Texas (Mr. Doggett). Mr. Speaker, this bill has a whopping cost to Americans of $42 billion in this decade. To be bipartisan about it, in the words of Senator John McCain, ``this legislation is an example of the costly corporate welfare that cripples our ability to respond to truly urgent social needs.'' Indeed it is. To make matters worse, despite all the proclamations about how urgent this bill is and how we will avoid a trade war and save all of these jobs, to make matters worse, this bill does not work. And even its supporters concede in private that it will not work and that we will be back here as soon as the World Trade Organization considers and rejects this bill, doing this all over again, because of the well justified criticism that has been levied against this very obvious straight subsidy. With good reason, the Europeans have already rejected this ill- conceived proposal. Not only does it not work in the world forum, it does not work, according to even Republican sources, like the Republican Congressional Budget Office. It announced in March of this year that ``export subsidies'' such as this bill ``reduce economic welfare and typically even reduce the welfare of the country granting the subsidy.'' The assistant director of the General Accounting Office in August of this year said ``most of the benefits are received by a small number of large corporations.'' He noted: ``Policymakers have available a number of tax and other government incentives that meet WTO standards, and that could be expanded to replace the prohibited direct tax subsidy provided by the FSC tax regime.'' And to those who say they want more free trade, this bill does not provide free trade. It provides distorted trade and chooses winners and losers. This legislation asks local stores that sell groceries and clothing to customers at a mall or along Main Street across this country to pay higher taxes than the multinationals that sell cigarettes and machine guns abroad. Mr. Speaker, $4 of every $5 in this bill go to companies that have assets exceeding $1 billion. It offers no significant benefit to smaller companies in this country. Indeed, I think the Congress ought to heed the words of commentator Paul Magnusson in ``Business Week'' on September 4 of this year who wrote that ``the larger problem with subsidies is that they invite countersubsidies and so accomplish little besides transferring money from consumers and taxpayers to politically powerful producers''; and that is exactly what is happening today. I agree with that commentary that ``it's time to call a halt to such waste by both sides; getting rid of subsidies for exports would be a good place to start. The Clinton administration should drop its plans to expand FSC and get back to the negotiating table and start proposing some real solutions such as eliminating all export subsidies.'' Indeed, the administration should have done just that. Now who is driving the corporate welfare Cadillacs that are lining up outside the Capitol to get more welfare under this proposal? Well, driver number one is Mr. Phillip Morris and the tobacco lobby. They get $100 million a year under this proposal to export death and disease to the rest of the world, to use the slick tactics that they developed here in America addicting our children to nicotine in order to encourage a global pandemic addicting the children of the world. And to my colleagues from the tobacco-producing States, the industry does not even have to use American tobacco. All they have to do is slip a little Marlboro label on the package and they can use exclusively foreign tobacco, and still be tax subsidized by American taxpayers to the tune of over $100 million a year to promote death and disease. The Clinton administration agreed to oppose this wrong. The administration were true to the last minute; and then they abandoned, in the face of the lobbying power of the tobacco industry, their stated willingness to end this promotion of death and disease. Who is the second big corporate welfare Cadillac driver? There has been the suggestion that we could not have any amendments to this bill. Well, there was an amendment that was done behind closed doors, and the effect was to double, absolutely double with an increase by $300 million every year the amount of money that those who make weapons in this country will get by selling them abroad. We already dominate the world scene in terms of the manufacture of weapons being sent to every arms race in every corner of the world. But under this bill, American tax payers will have to subsidize and offer more corporate welfare to those weapon manufacturers to keep up the good business they have that results in death and destruction all over this world. Instead of being a leader and trying to reduce the amount of those arms races around the world, we are subsidizing it to the tune of $300 million more, even though last year, the Treasury said it was not a good idea, and the Defense Department, in 1994, indicated it was not necessary. Even though Republican groups in this Congress said it was unwise, they could not, in an election year, resist the dominance and power of the arms manufacturers. And then another driver of this corporate welfare Cadillac is the pharmaceutical industry. It is an industry that today gets a reward for making prescriptions here in America and selling them for less abroad. They will get a tax subsidy, a bit of corporate welfare, for doing that at the same time they gouge consumers at home. This bill is wrong, that is why it was done behind closed doors, that is why they are fearful of amendments and discussion and it ought to be rejected.

Mr. STARK. Mr. Speaker, I am happy to yield 30 seconds to the gentleman from Guam (Mr. Underwood). (Mr. UNDERWOOD asked and was given permission to revise and extend his remarks.)

Mr. STARK. Most of these do not, no.

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

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, there is an old rule of tax law which started with actually then Secretary of the Treasury Baker when we reformed the Tax Code under President Reagan. It was, if it quacks like a subsidy and walks like a subsidy and looks like a subsidy, it is a subsidy. The distinguished chairman of the Subcommittee on Trade would discuss the overburden of taxation. When the pharmaceutical companies charge our people, our seniors, our young people, two to four times more for the same drug that they charge people in Europe, and yet they have the lowest tax rate of any industry group in this country, why should we give them hundreds of millions of dollars of subsidy, gift, reduction? Members may call it what they want, but we are rewarding the pharmaceutical industry for charging less in Europe and more in this country. Tell me what it is, Mr. Speaker. I call it disgraceful, I call it obscene, $750 million a year to General Electric and Boeing to sell weapons, which they do not even sell, the State Department and the Defense Department arrange the sale of weapons. Yet, we give them a reduction of $750 million a year? That is a subsidy, pure and simple. Now, software was mentioned. Those poor folks in Seattle. Software? Do Members know how much Microsoft paid in taxes last year? Zero, Mr. Speaker, a goose egg. This big or this big, zero is still zero. Yet, they get a subsidy which gets them down to zero for all the software they sell overseas. Is that a gift? And this poor overtaxed Bill Gates is walking around, so we subsidize his sales overseas. Mr. Speaker, we have been doing this for generations. For 25 years, we have been giving $5 billion a year away in subsidies to corporations who would do the same thing whether or not they got this subsidy. And they do not set their prices based on their taxes. As any distinguished economist, like my friend, the gentleman from Illinois (Mr. Crane), the distinguished chair of the Subcommittee on Trade, knows, corporations do not price their products based on taxes, they price their products based on competitive and manufacturing costs, all the other things, as he so well knows. So all we are doing is giving a break, a tax break, a subsidy, to the richest corporations in this country, rewarding those corporations who gyp our senior citizens by overcharging in this country, by rewarding them. And my distinguished friend, the gentleman from Texas, will tell us about tobacco, subsidizing the sale of tobacco to hook little kids in other parts of the world while we are trying to spend money here at home. Just think, if we had some of this $5 billion a year to spend to train our children not to smoke, how much healthier and safer they would be. Think if we had some of this $5 billion a year to spend on education to hire teachers, which the gentleman could not find the money to do on the Republican side. Think if we had this $5 billion a year to provide a drug benefit to the senior citizens. No, we are going to continue this charade and give this money away in unconscionable subsidies to the corporations who least need it for doing what they would do anyway. It is the silliest kind of gift to the people who need it least, when we have people in this country who need help. We are turning our backs on the people in this country and helping the richest corporations in this country. End this charade now and vote against this bill.

Mr. STARK. Mr. Speaker, on that I demand the yeas and nays.

Mr. STARK. Mr. Speaker, I rise today in adamant opposition to H.R. 4986, the Foreign Sales Corporation replacement bill. This bill is a blatant form of corporate welfare, ruled illegal under international trade laws by the World Trade Organization (WTO). The U.S. has already missed two deadlines imposed by the WTO and the European Union for repealing the FSC. I don't know which is worse--that the current leadership is so incapable of governing that they can't meet an extended deadline, or that they have failed to comply with the WTO ruling by attempting to replace one export subsidy with something remarkably similar. Then the Senate Finance Committee made some minor changes to the bill that appears to bring the U.S. closer to WTO compliance than the House version without sacrificing the current tax benefit received by Caterpillar Inc. This version came back to the House and was voted on in H.R. 2614, the $240 billion GOP tax package. The House leadership thought they were doing their corporate constituents a favor by attaching the FSC to a bloated tax package. Now we're here once again because the majority leadership thought they could bait Clinton into signing a bad tax bill if they attached the FSC to it. No such luck! Clinton has threatened to veto the tax bill and the Senate has no intentions of acting on it. The bill before us today is nothing more than corporate welfare for some of the nation's most profitable industries. The European Union has filed a complaint with the World Trade Organization (WTO) that the FSC is an export tax subsidy and therefore illegal under international trade laws. I completely agree. Yet instead of repealing the tax subsidy and complying with our international trade obligations, this bill seeks to remedy the FSC with a near exact replacement. The Institute on Taxation and Economic Policy recently released a report that shows a rise in pretax corporate profits by a total of 23.5 percent from 1996 through 1998. At the same time, U.S. Treasury corporate income tax revenues only rose by a mere 7.7 percent. In addition to the myriad of corporate tax deductions this Congress insists on expanding, programs such as the FSC can help explain the disparity in corporate profits and corporate income tax rates. The FSC helps subsidize some of the most profitable industries such as the pharmaceutical, tobacco and weapons export industries. Why should Congress help out the pharmaceutical industry if the industry insists on charging U.S. consumers more for prescription drugs than they charge in Europe? We shouldn't! The pharmaceutical industry sells prescription drugs in the U.S. at prices that are 190-400 percent higher than what they charge in Europe. The U.S. subsidizes the pharmaceutical industry by approximately $123 million per year through the FSC. This is unfair to the American taxpayer and must not be allowed to happen. The top 20 percent of FSC beneficiaries obtained 87 percent of the FSC benefit in 1998. The two largest FSC beneficiaries, General Electric and Boeing, received almost $750 million and $686 million in FSC benefits over 8 years, respectively. RJ Reynolds' FSC benefit represents nearly six percent of its net income while Boeing's FSC benefit represents twelve percent of its earnings! It is high time we stop allowing corporate interests to dictate U.S. spending. We didn't pass a prescription drug benefit for seniors in the 106th Congress so we shouldn't be rushing through a piece of legislation that gives corporations a $5 billion per year tax break. I urge my colleagues to put working families, children and our seniors first, and oppose H.R. 4986.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Massachusetts (Mr. Tierney).

Mr. STARK. Mr. Speaker, I yield such time as he may consume to the gentleman from Oregon (Mr. DeFazio). (Mr. DeFAZIO asked and was given permission to revise and extend his remarks.)

Mr. STARK

Mr. STARK. Mr. Speaker, I am today submitting for the Record a letter I sent to Mr. Miles White, Chief Executive Officer of Abbott Laboratories. Recent congressional investigations have collected evidence that Abbott has reported inflated prices and has engaged in other improper business practices in order to create windfall profits for providers submitting Medicare and Medicaid claims for certain Abbott drugs. Such drug company behavior overcharges taxpayers and jeopardizes the public health system. The letter follows: Congress of the United States, House of Representatives, Washington, DC, October 31, 2000. Mr. Miles White, Chief Executive Officer, Abbott Laboratories, Abbott Park,

Mr. STARK

Mr. STARK. Mr. Speaker, I am today submitting for the Record a letter I sent to Dr. Jane E. Henney, Food and Drug Administration Commissioner. This letter provides additional information recently discovered during ongoing Congressional investigations into drug company price manipulation and supplements my previous two letters to Dr. Henney. Recent congressional investigations have collected evidence that certain drug companies consistently inflate prices and engage in other improper business practices in order to create windfall profits from Medicare and Medicaid reimbursements. In response, drug companies have stated that such drug inflation has been consistent with, and perhaps even required by, flaws in the reimbursement system's reliance on Average Wholesale Price (AWP). Further, drug companies contend that AWPs are meaningless numbers. However, as the letter below and its accompanying exhibits demonstrate, drug companies do indeed rely upon AWPs to advertise their drugs. And, in fact, drug companies often advertise truthful drug prices when there is no Medicare reimbursement available. The evidence uncovered suggests that contrary to drug company statements, it is not a flawed reimbursement system that leads drug companies to inflate their prices. Instead, it is drug companies' dishonest pricing based on their desire to create a profit for prescribing physicians seeking Medicare or Medicaid reimbursements. My reading of the Federal Food, Drug and Cosmetic Act and its corresponding regulations suggests that the FDA should pay particular attention to these misleading drug company actions. And I again request that the FDA conduct a comprehensive investigation into such drug company business practices. My third letter to the FDA regarding this issue follows: Congress of the United States, House OF Representatives, Washington, DC, October 31, 2000 Dr. Jane E. Henney, Commissioner, Food and Drug Administration, Rockville, Maryland. Dear Dr. Henney: I write to provide essential, additional information to you about price manipulation by some drug companies arising from ongoing Congressional investigations. Such drug company price inflation exploits the Medicare and Medicaid programs. This is the second supplement to my letter to you of October 3, 2000. Recent media reports of statements by certain drug company executives reveal a concerted effort to continue to mislead the Congress and the public about the nature of their companies'actions. Specifically, the drug companies have represented that their conduct, including-their inflated price reports that have resulted in admittedly excessive Medicare reimbursements, has somehow been consistentwith, and perhaps even required by, flaws in the reimbursement system's reliance upon Average Wholesale Price (AWP). This logic is premised on the erroneous contention that the AWPs associated with their drugs are meaningless numbers that should not reasonably be relied upon as an indicator of wholesale prices. Such statements are in themselves deceptive. The evidence developed during the course of the Congressional investigation reveals that it is routine for the drug industry to advertise a drug product's price in the AWP format and to encourage the consideration of AWP as one factor when evaluating competing drug products. Indeed, the drug companies often compare their drug's AWP with that of a competitor in an effort to demonstrate their drug's superiority from a cost perspective and to influence physician prescribing decisions. Such advertisements are directed at prescribing physicians, pharmacists, and other health care professionals and take many forms, such as direct contacts, flyers, and trade publications such as the Red Book, Drug Topics and Medical Economics which are each published or updated monthly. When there is no inflated Medicare reimbursement available for the prescribing physician, companies often advertise truthful AWP prices. To illustrate this, I have attached, as Composite Exhibit ``1``, copies of advertisements by Rhone-Poulenc Rorer (``RPW') which accurately communicates its price of Dilacor XR in the form of AWP and compares the higher AWP price of the competing drug Cardizern. RPR then emphasizes that the physician should prescribe Dilacor over Cardizem in order to save the patient money: ``Now DILACOR XR provides potential cost savings when angina patients are prescribed diltiazem.'' Attached as Composite Exhibit ``2'' are examples of Bayer Pharmaceutical advertisements for its drug Cipro where the drug company again accurately describes its price in the form of AWP and touts the cost savings to the patient in comparison to five competing drugs. Bayer explained it as follows: ``New CIPRO Cystitis Pack reduces the cost of branded therapy'' It is important to note that both RPR and Bayer use accurate AWPs to urge physicians to consider the cost to the patient when exercising medical judgment in selecting from competing brand drug therapies. Price, as expressed in the industry standard format of ``AWP'', is clearly an important characteristic that is considered in evaluating drug products. Indeed, Bayer's AdalatCC advertisement attached as Exhibit ``3 ``, which features the popular ``Dragnet'' star Jack Web, drives home this point: ``Just the Facts Powerful blood pressure control Comparable to Procarida. XL or Norvasc At a more affordable price'' (footnotes omitted). Footnote 6 of the ad's accompanying materials cites the Red Book--indicating that the AWP is considered a relevant benchmark when evaluating the drug's price. Composite Exhibit ``4'' demonstrates that physicians seek the lowest drug prices when there is no financial incentive to utilize the highest price drugs. PDR Generics provides pricing information on prescription drugs in ``one comprehensive, authoritative volume.'' The accompanying documents state the following: ``PDR GENERICS is the drug reference designed to help you find the most cost-effective generic alternatives for any prescription medication. . . .'' Exhibit ``4'' also provides further evidence that AWP prices are widely used as a reference tool: ``All detailed NDC and AWP pricing information is drawn from the authoritative RED BOOK database, Pharmacy's Fundamental Reference.'' Ordinarily, drug companies ensure that their AWPs are an accurate reflection of price when engaging in such marketing and advertising activities. Clearly, such advertisements would be misleading if the drug company were aware that the published AWPs had no factual basis and could not be realistically considered as a benchmark for prices. I strongly believe that if any of the above ads used falsely manipulated AWPs to fraudulently indicate that the advertised drugs were less expensive when in fact the drug company was aware that it is more expensive, FDA or FTC enforcement would be warranted. Unfortunately, such AWP manipulation is at the heart of the misconduct that Congress has uncovered in its investigation. As I have noted previously, the acts are being committed by some drug companies who know that the drug will be reimbursed by Medicare and that a health care professional will profit if the price is inflated. Advertising an AWP in the Red Book that falsely overstates a drug's price is as misleading as advertising an AWP that falsely understates the price. One form of false advertising misleads third parties to pay more for a drug and induces doctors, who submit the claim themselves, to prescribe the most profitable drug. The other form misleads the doctor into believing that a drug, to be dispensed at a pharmacy and not claimed by the doctor, is cheaper for the patient when it is not. I believe both actions should be considered violations of the Federal Food, Drug, and Cosmetic Act. AWP information is created by drug manufacturers for the express purpose of influencing decisions about their drugs. Although it appears most AWP representations are accurate and are affirmatively used to inform about cost savings, some drug manufacturers have chosen to inflate AWPs to exploit the Medicare and Medicaid Programs and thereby expand sales. Medicare and Medicaid relies on AWPs because the drug industry employs AWP to communicate prices. Drug manufacturers must not now be permitted to misconstrue the facts revealed in Congressional investigations by contending that the reimbursement system is flawed when they themselves provided the misleading information. Following up on my last two letters on this same issue, I reiterate that my reading of the Federal Food, Drug, and Cosmetic Act and the corresponding regulations suggests that the FDA should pay particular attention to these misleading drug company actions. Accordingly, I request that the FDA conduct a comprehensive investigation into drug company business practices that includes the additional exhibits referenced above. Sincerely, Pete Stark, Member of Congress.

Mr. STARK

Mr. STARK. Mr. Speaker, one of America's most important assets is the diversity of our residents, and this diversity is growing rapidly. Between 1991 and 2000, the population of Asians and Pacific Islanders increased by 46 percent, Latinos by 40 percent, American Indians by 16 percent, and African Americans by 14 percent. Unfortunately, vestiges of racism--both conscious and unconscious-- still exist, permeating our society and our institutions. Last month, I highlighted research findings that demonstrate people of color disproportionately lack access to health care, vital treatments, and preventive screening measures. In addition, a recent New England Journal of Medicine study found that unconscious perceptions and biases can be revealed in differential physician recommendations for minority individuals seeking heart disease treatment. Taken together, these findings underscore the urgency of supporting legislation to improve health care quality for diverse communities. So far, very little has been done to address these tremendous disparities. For example, people of color are disproportionately affected by certain types of cancers--Vietnamese American women are five times more likely to contract cervical cancer than white women and Africa Americans are 35 percent more likely to die from cancer than whites. Despite these alarming statistics, the Institute of Medicine concluded that federal funding for cancer research among communities of color remains insufficient. S. 1880, The Health Care Fairness Act is an opportunity to positively improve the health care of all Americans by working toward reducing these disparities. It is a bipartisan effort that contains many important provisions, including an increased commitment to research on health disparities, improved data systems, and enhanced quality of care for health disparity populations, including low-income, medically underserved, racial and ethnic minority, and rural individuals. This legislation ensures a prominent focus in our nation's premier research agencies--the National Institutes of Health and the Agency for Health Care Policy Research--in improving health outcomes for populations that have a significant disparity in the rate of disease incidence, prevalence, morbidity, mortality, or survival as compared to the general population. It also provides grants to our medical, public health, dental, nursing, and other health professional schools so that curricula to promote improved health care quality can be developed for these populations. Furthermore, it designates opportunities for training so that our current and future medical providers are equipped to join the fight against health disparities due to geography, the lack of medical services, race and ethnicity, and socioeconomic status. Our country has made phenomenal advancements in science and medicine. It is time to ensure that all of our communities share in these rewards. This is a chance to help ensure our health care system is just, equitable, and equal for all Americans. Support fairness in health care, and vote for S. 1880.

Mr. STARK

Mr. STARK. Mr. Speaker, for the Record, I submit a letter signed by 133 Members sent to Speaker Hastert in support of improvements to the Medicare/Medicaid amendments of 2000 and the need for an open, fair, democratic process. If the requests in this letter had been followed, the quality of the bill passed by the House on October 26, 2000 would undoubtedly have been better and the veto threat may have been avoided. Congress of the United States, House of Representatives, Washington, DC, October 11, 2000. Hon. Dennis Hastert, Speaker of the House of Representatives, Speaker's Office, The Capitol. Dear Mr. Speaker: As Democratic Members of the House of Representatives, we are deeply concerned about reports that the full House may not be given the opportunity to offer amendments to the Medicare legislation which has been reported by the full Commerce Committee and by the Ways and Means Health Subcommittee. We further understand that these two bills are being melded together without any involvement of Democratic Members or staff, and we are very concerned that the House will be asked to vote quickly on a final bill which we have not seen or been involved with. Therefore, we ask that you schedule this legislation (which spends roughly $25 billion dollars over the next five years) for at least several hours of debate and with a rule that allows a number of amendments. We note that the two Committees' bills have many excellent features, particularly those sections that directly help beneficiaries. In particular, the various bills speed relief from the high co-payment burdens of hospital outpatient department services, help legal immigrants and their children under Medicaid, cover glaucoma screening, permanently cover immuno-suppressive drugs for organ transplant patients, help the low-income receive Medicare premium and co-payment relief, and make many other important program improvements. We hope that these important improvements will not be squeezed out, and that the final bill will retain these excellent features. We are certain that the final bill will receive the strong support of a majority of our Caucus. Still, adequate and open floor debate is essential, because this is the last chance for this Congress to consider adding a real prescription drug program to Medicare. An open debate would allow Members to include the type of Medicare prescription medicine program the American people want. It is unconscionable for this Congress to adjourn without addressing the prescription medicine crisis facing so many of our senior and disabled citizens. If the House can meet many of the legitimate needs of health care providers, it can certainly also address the needs of Medicare beneficiaries. To adjourn giving billions to managed care plans, but failing to help all seniors with prescription drugs costs would be shameful. We would like to provide a completely voluntary prescription medicine benefit within the traditional Medicare program. Our plan has no deductible, covers half the cost of medicines up to $2000 in the first year, gradually rising to $5000 by 2009. Any beneficiary who has out-of-pocket costs greater than $4000 would be fully protected against further catastrophic pharmaceutical expenses. Premiums for this voluntary program are $25 a month in the first year, and will gradually increase as the benefit increases. All seniors would be assisted with price discounts on all of their medicine purchases and low-income seniors would be fully protected. According to the Congressional Budget Office, this proposal would cover almost all seniors, whereas the bill which passed the House this summer leaves 7.8 million Medicare beneficiaries (one-in-five) unprotected. It is particularly ironic that the Ways and Means Health Subcommittee bill does not include a prescription drug bill for seniors, but provides hundreds of millions of dollars in extra payments to pharmaceutical companies, by delaying the implementation of more accurate non-chemotherapy drug prices which have become available as a result of an extensive investigation by the Justice Department. In addition to the prescription drug amendment, various Members in the Democratic Caucus would like to offer amendments to provide more balance to the bill: by ensuring that it includes additional beneficiary protections and improvements; by ensuring that it includes additional beneficiary protections and improvements; by requiring HMOs to be more accountable to enrollees in exchange for the higher payments in the bill, and by doing more for hospitals, nursing homes and other traditional providers and less for HMOs. We believe the reported bills give a disproportionate amount of relief to HMOs. The Majority's decision to give HMOs so much should not prevent us from giving adequate relief to other deserving providers. We believe that more of the surpluses which allow such changes should go to traditional providers and the seniors and the disabled whom Medicare is designed to serve. Thank you for your consideration of these requests. This Congress must not adjourn without addressing the need to help health care providers with the unintended impacts of the Balanced Budget Act of 1997; the need for seniors and the disabled to afford necessary pharmaceuticals; and improvements in the Medicare and Medicaid program to fill gap in care for the disabled and homebound, in the cost of treatments, and in covering modern, preventive care services. Sincerely, John D. Dingell, Ranking Democrat Committee on Commerce, Richard A. Gephardt, Democratic Leader; Charles B. Rangel, Ranking Democrat Committee on Ways and Means; David E. Bonior, Democratic Whip; Ed Markey, and 124 others.

Mr. STARK

Mr. STARK. Mr. Speaker, this rule paves the way for the cruelest hoax that the Republicans have yet perpetrated on seniors, children, and the health care system in our country. Forty-seven percent of this bill over 10 years goes to managed care plans without asking the managed care plans to do a thing except raise their own profits and put the money in their pockets. Ninety-four percent of the tax cuts go to people who are already insured. What does that do? That just gives the employers an incentive to cut back on insurance benefits, as they are doing every day. Sure, it helps the rich employers while it penalizes the poor employees. Long-term care tax deductibility. Fifty percent of the seniors are living on incomes of less than $15,000 a year. What does that do for the seniors when we have ignored long-term care benefits that we should have. Children's benefits have been dropped out of this bill. Lou Gherig benefits. Eighty-two Republicans co-sponsored a bill, along with 200 Democrats, to give improved benefits to people with Lou Gherig's disease. It was dropped out. Cruel. Forty-seven percent going to managed care plans, where we do not have any control, where we need the Patients' Bill of Rights. What could we do with that money? We could expand the hospital aid for an additional year. We could expand hospice care for an additional year. We could withhold the 15 percent cut on home health care for an additional year. Why are we not doing that instead of giving this to the Republican friends in the managed care companies who will see nothing but their prices go up on Wall Street while they continue to deny care and deny drug benefits and fold up their tents and leave smaller communities? Nothing in this bill will change that. It will reward the managed care plans for basically harming the beneficiaries and our seniors. That is not the way to go about this. This is a bill constructed to help the small percentage of the rich. It is a bill purposely crafted to deny children's health benefits. Children cost $400 or $500 a year to insure. A child without health insurance is a child without health care. The Republicans take great joy in telling us we are going to deny children health benefits. That is not the kind of people we want to have running this country. We should protest this bill to show that the Republicans have no mercy for children, no mercy for the seniors. They care nothing except for the very richest. They will deny health care if it helps the employers at the cost of the employees. Call this bill what it is. It is an arrogant play of pandering to the rich, of pandering to the wealthy at the expense of the poor and the people without health insurance. They should be ashamed of themselves for this bill. The President will veto it, as well he should. I urge a ``no'' vote and a ``no'' on the rule.