Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to honor my dear friend, Commander Gregory Lawrence, a member of the Milpitas, California Police Department. I would like to congratulate Commander Lawrence on his retirement, September 8, 2000. Commander Lawrence attended high school at William C. Overfelt High School in San Jose, California. Between the years of 1966 and 1969 he served as a Tank Commander in the U.S. Army. He continued his education at San Jose City College and San Jose State University. In 1979 he graduated from San Jose State with a Bachelor of Arts degree in Administration of Justice. In 1995 he earned a Masters Degree in Management from California State Polytechnic University, Pomona. During his 29 year police career he attended the FBI National Academy, the POST sponsored Supervisory Leadership Institute and Command College. Commander Lawrence began his career with the Milpitas Police Department on June 18, 1971. Through hard work and dedication he rose through the ranks and was promoted to Senior Officer in September 1973, Sergeant in July 1980, Lieutenant in October 1991, and Commander on September 15, 1998. Commander Lawrence served as a supervisor in patrol, traffic, community relations, personnel, and investigations. He was instrumental in the development and implementation of the first Community Relations unit where he taught drug resistance classes at Ayer and Milpitas High Schools. He was also one of the department's first Crisis Negotiators. He was the first and only Sergeant to ride motorcycles as a duty assignment and researched, developed, and implemented the department's driver training and bicycle programs. Commander Lawrence served his community extremely well and I cannot thank him enough for his unselfish dedication to the city of Milpitas. He has accomplished a lot in his 29 years with the police department and has set a great example for dozens of other police officers, friends, and members of the community for years to come. Commander Lawrence deserves great commendation, and I would like to ask my fellow colleagues to join me in congratulating him on his retirement.

Mr. STARK

Mr. STARK. Mr. Speaker, in our aging society, it is beginning to dawn on millions of Americans across the country that chronic illnesses are now America's number one health care problem. Yet because our health care system has been designed around meeting the needs of acute, not chronic illness, our system of services for those with Alzheimer's, diabetes, and other major conditions is both fragmented and inadequate. To be successful, 21st century health care must be reorganized to maximize the intelligent use of those protocols and procedures that can most effectively control and slow the rate of chronic illness progression. This can only be accomplished if treatment for chronic conditions is consciously and carefully integrated across a range of professional providers, caregivers and settings. This integration of services for chronic illness care is at the heart of the Chronic Illness Care Improvement Act of 2000 that I am introducing today. It is a major bill, designed to focus debate on the need to provide comprehensive and coordinated care for people with serious and disabling chronic illness. I am introducing this Medicare measure this summer to invite comments, ideas and suggestions for refining this bill so that it can be re-introduced at the beginning of the 107th Congress, with bipartisan sponsorship. The bill I am introducing today is the result of months of consultation and work with numerous senior, illness, and health policy groups. I hope that it will receive the endorsement of many groups in the days to come. The bill has four titles and is phased in over a number of years. Why? Because we know a lot about the management of chronic illness--but in truth, the comprehensive national program that is so desperately needed will require long range planning and implementation in phases. Therefore, Title I creates a temporary Commission to study and recommend solutions to the complex issues involved in coordinating and integrating the diversity of healthcare services for the chronically ill. Title II lays the groundwork for a full, comprehensive care program by establishing the databases and infrastructure we will need to provide high quality care to those with chronic illness. Title III launches two major prototype chronic disease management programs-one for diabetes and the other for Alzheimer's disease. Once we learn from the experience of these two prototypes, the Act calls for expansion to a high quality national program for management of other serious and disabling chronic illnesses. Title IV promotes coordination of care for dually eligible beneficiaries by streamlining the processes of obtaining waivers and determining budget neutrality of combined Medicare and Medicaid programs. Why a Program to Improve the Care of Chronic Illness is Needed Do you know someone who has diabetes, high blood pressure or a heart condition? Perhaps someone who is important to you suffers from arthritis, asthma or Alzheimer's disease. All of these problems have one thing in common-they are chronic illnesses. Once these problems begin, they stay with you and many of these problems inevitably progress over time. What most people don't know is that chronic illness is America's highest-cost and fastest growing healthcare problem accounting for 70 percent of our nation's personal healthcare expenditures, 90 percent of all morbidity and 80 percent of all deaths. Yet while chronic disease is America's number one healthcare problem, care for those with chronic illness is provided by a fragmented healthcare system that was designed to meet the needs of acute episodes of illness. We cannot deliver 21st century healthcare with a system that was designed a half century ago, before angioplasty or bypass surgery for heart disease and before L-dopa for Parkinson's disease. Medical discoveries like these have transformed many illnesses from rapidly disabling conditions to chronic conditions that people live with for a long time. But the healthcare system that works for a devastating heart attack does not work for chronic illnesses that need a totally different group of services, including long range planning, prevention, coordination of care, routine monitoring, education, and self-management. The acute care model is a mismatch for the needs of chronic disease and the result is that people with chronic conditions receive healthcare that responds to crises rather than preventing them. The fact is we know a lot about the natural course of chronic illnesses like diabetes and arthritis. We have learned the all-too-common scenarios that result in complications such as an amputation in the diabetic or a stroke in the person with uncontrolled hypertension. Delaying stroke by 5 years would yield an annual cost savings of 15 billion dollars, yet we continue to shortchange the ounce of prevention that is worth a pound of cure. The patients know what is wrong with the system--they tell us our healthcare system is disjointed and a nightmare to navigate. They want more information about their condition, more emotional support, and more control of their care. They deserve better communication and integration of care amongst their many healthcare providers who currently function to deliver separate and unrelated services, even though they are providing care to the same person. But none of this will happen in a medical system that does not reward quality of care for chronic illness. Our healthcare system does not reward preventive care or continuity of care. Neither do we reward early diagnosis, interdisciplinary care, emotional counseling or patient and caregiver education. The cornerstone of quality healthcare for chronic illness is long-range planning and prevention, yet the Congressional Budget Office currently has no mechanism to measure cost- effectiveness over extended periods of time. Unless we recognize that an upfront investment in the early and middle stages of chronic illness will pay dividends over the long term, we will continue to be caught in the vicious cycle of responding to crises rather than anticipating and preventing them. There is increasing recognition of the looming problem of providing long-term care to the growing number of senior citizens, but little awareness that better care of chronic illness beginning at the time of diagnosis is the most effective strategy to prevent the progression of disability and loss of independence. Join me in supporting The Chronic Illness Care Improvement Act of 2000 to bring excellence to the care of chronic illness, just as Medicare has already achieved for acute illness. This legislation will put our emphasis where it belongs--on proactive strategies that will prevent complications and disability before they happen. This is a systems problem that requires a systems solution. Disease management of chronic illness will only succeed if financial, administrative and information systems are developed to support it. Our current healthcare system locks into place fragmentation and duplication of services. We must strive to align financial incentives among healthcare providers to achieve common care, quality and cost objectives. We can improve the quality of care while reducing costs by reducing duplicative and unnecessary services and by preventing complications and loss of independence. The healthcare challenge of this new century is to design a Medicare system that meets the needs of persons with serious and potentially disabling chronic illness. The medical discoveries of the 20th century have dramatically prolonged the life expectancy of persons with all types of chronic conditions. In the 21st century, our challenge is to reduce the progression of disability and to improve the functional status and quality of life of persons with chronic illness. Invitation for Comments Mr. Speaker, reforming our health care delivery system to improve the care of chronic illness is a complex and major undertaking. Therefore, I want to repeat my comments that I am introducing this bill today to solicit comments and ideas from across the Nation. Today's bill is just the first round in a major initiative to improve this part of our health care system. I look forward to additional ideas and suggestions. Following is a section-by-section description of the proposal. The Chronic Illness Care Improvement Act of 2000 Bill Summary 1. The bill charges a congressionally-appointed National Commission with development of a Medicare policy agenda that provides for an integrated, comprehensive continuum of care for serious and disabling chronic illness. Among its responsibilities, the National Commission on Improving Chronic Illness Care will: Raise public awareness about how and why chronic illness care should be improved; Investigate the barriers preventing integration of care for the chronically ill and establish baseline data for benchmarking future progress in reducing the prevalence of chronic conditions and healthcare costs; Establish direction for integrating the delivery, administration and finances of chronic care services. III. The bill lays the groundwork for a national program of coordination and integration of care for serious and disabling chronic illness through initiatives addressing: Prevention of Disease and Progression of Disability: Preventive services under Medicare are expanded. Research is also expanded into risk factors associated with the progression of disability. A public awareness campaign on prevention of chronic illness is established and bonus payments are offered to reward plans and providers that meet targets for reducing disability. National Targets for Improving Chronic Care: HHS will develop a national database for long-term planning and measurement of outcomes; will set national goals to reduce the prevalence of chronic illness; and will develop outcomes measures for analysis of long-term effectiveness of interventions that prevent chronic illness, complications and disability. Coordination and integration of health services across different care settings: Common patient assessment instruments-are developed to integrate care across settings. Medicare and Medicaid-services for dually eligible beneficiaries are coordinated by streamlining the processes of obtaining waivers and determining budget neutrality for these programs. Adequate manpower, education and expertise in chronic illness: Expand training opportunities where shortages of physician's with chronic illness expertise exist and HHS- sponsored, Internet-based national resource centers are set up to serve chronic illness patients and providers. Managed care bonus programs for excellence in integration of chronic illness care:, Bonus payments are provided through Medicare for the development of comprehensive programs serving chronically ill beneficiaries. Specifically, disability prevention programs that achieve prevention goals, improve quality or perform research into delaying the progression of disability or preventing disease-related complications are funded. Development of methods of cost assessment that make sense for long goals and outcomes: Methodologies to measure long range costs of comprehensive disease management programs that prevent chronic illness, delay disability, and prolong independence are developed and implemented by HHS. III. The bill implements a nationally Phased-in program of comprehensive integration 'and coordination of care for serious and disabling chronic illness by: Establishing-Prototype models for comprehensive disease management of two chronic illnesses, diabetes and Alzheimer's disease in 2003, that will be used as the basis for expanding in 2007 to other serious and disabling chronic illnesses, including hypertension, heart disease, asthma, arthritis, multiple sclerosis and Parkinson's disease. These comprehensive disease management programs known as The National Initiative to Improve Chronic Illness Care include these key components: Best practices and evidence- based clinical guidelines, Interdisciplinary care, Case management, Disability prevention, Patient and caregiver education to foster self-management, Medication monitoring, Integrated administrative and financial services, Integrated information systems.

Mr. STARK

Mr. STARK. Mr. Speaker, more and more people in this country are losing access to health insurance. A new study by the Urban Institutes that the percentage of people under 65 without health insurance in 1998 grew to a stunning 18.4 percent. And, as the study's authors highlight, the strong national economy is masking what would otherwise be an even greater problem. There are many approaches to solutions for decreasing the number of uninsured. As most of my colleagues are aware, I support the creation of a universal health care system in which each and every American would have health insurance coverage. That is the most fair, affordable, and sustainable solution to our national health care needs. However, that won't be accomplished overnight. In the meantime, there are steps that Congress can and should be taking to develop immediate, if smaller, solutions to providing people affordable health insurance coverage options. One such is to pass legislation that would provide certain groups of individuals the option of buying into Medicare. For two sessions of Congress, we have sponsored a bill endorsed by the President called the Medicare Early Access Act. The goal of this legislation is to expand access to Medicare's purchasing power to certain individuals below age 65. The Medicare Early Access Act is self-financed, through enrollees' premiums; it is not a publicly financed program. It simply would enable eligible individuals to harness Medicare's clout in the marketplace to get much more affordable health coverage than they are able to purchase in the private sector market that currently exists. The bill would provide a very vulnerable population (age 55-64) with three new options to obtain health insurance: Individuals 62-65 years old with no access to health insurance could buy into Medicare by paying a base premium (about $326 a month) during those pre-Medicare eligibility years and a deferred premium during their post-65 Medicare enrollment (about $4 per month in 2005 for an individual who participated in the full 3 years of the new program). The deferred premium is designed to reimburse Medicare for the extra costs due to the fact that sicker than average people are likely to enroll in the program. The deferred premium would be payable out of the enrollee's Social Security check between the ages of 65-85. Individuals 55-62 years old who have been laid off and have no access to health insurance, as well as their spouse, could buy into Medicare by paying a monthly premium (about $460 a month). There would be no deferred premium. Certain eligibility requirements would apply. Retirees aged 55 or older whose employer-sponsored coverage is terminated could buy into their employee's health insurance for active workers at 125 percent of the group rate. This would be a COBRA expansion, with no relationship to Medicare. Today, we are here to introduce a new, improved version of this legislation. As we are all aware, there are new projections of vast budget surpluses in our Nation's future. We want to take a small portion of those monies and finance a new component of the Medicare Early Access Act. Our new bill, the Medicare Early Access and Tax Credit Act of 2000 supplements our previous proposal by incorporating a new 25 percent tax credit that would be attached to each of the three programs. Thus, the actual cost to taxpayers would be 25 percent less than the cost under the proposals in the existing bill. I join today with more than 50 of my colleagues to reintroduce this new version of the legislation. Affordability is a key component of expanding health insurance coverage. Adding a tax credit to the programs increases their affordability so that more people age 55 and older can take advantage of the program. The latest analysis from the Congressional Budget Office and the Joint Committee on Taxation, indicate that more than 500,000 currently uninsured people would gain health insurance coverage by enactment of the Medicare Early Access and Tax Credit Act. The Medicare Early Access and Tax Credit Act isn't the total solution for people age 55-64 who lack access to health insurance coverage. However, if passed, it would make available health insurance options for these individuals at much less than the cost of what is available today. This is a meaningful step forward in expanding health insurance coverage to a segment of our population that is quickly losing coverage in the private sector. The Medicare Early Access and Tax Credit Act is legislation that we should be able to agree upon and to enact so that people aged 55-64 have a new, viable option for health insurance coverage. I submit a more detailed summary of the Medicare Early Access and Tax Credit Act as follows: Medicare Early Access and Tax Credit Act Title I: Help For People Aged 62 to 65 62-65 year olds without health insurance may buy into medicare by paying monthly premiums and repaying any extra costs to medicare through deferred premiums between ages 65 to 85 Starting July, 2001, the full range of Medicare benefits (Part A & B and Medicare+Choice plans) may be bought by an individual between 62-65 who has earned enough quarters of coverage to be eligible for Medicare at age 65 and who has no health insurance under a public plan or a group plan. (The individual does not need to have exhausted any employer COBRA eligibility). A person may continue to buy-into Medicare even if they subsequently become eligible for an employer group health plan or public plan. Individuals move into regular Medicare at age 65. Financing: Enrollees must pay premiums. Premiums are divided into two parts: (1) Base Premiums of about $326 a month payable during months of enrollment between 62 to 65, which will be adjusted for inflation and will vary a little by differences in the cost of health care in various geographic regions, and (2) Deferred Premiums which will be payable between age 65- 85, and which are estimated to be about $4 per month in 2005 for someone that participated for the full three years. The Deferred Premium will be paid like the current Part B premium, i.e., out of one's Social Security check. Note, the Base Premium will be adjusted from year to year to reflect changing costs (and individuals will be told that number each year before they choose to enroll), but the 20 year Deferred Premium will not change from the dollar figure that the beneficiary is told when they first enroll between 62-65--they will be able to count on a specific dollar deferred payment figure. The Base Premium equals the premium that would be necessary to cover all costs if all 62-65 year olds enrolled in the program. The Deferred Premium repays Medicare for the fact that not all will enroll, but that many sicker than average people are likely to voluntarily enroll. The Deferred Premiums ensure that the program is eventually fully financed over roughly 20 years. Savings from the anti-fraud proposals (introduced separately as HR 2229) finance the start-up of the program and protect the existing Medicare program against any loss (see Title IV). Title II: Help For 55 to 62 Year Olds Who Lose Their Jobs 55-62 YEAR OLDS WHO ARE ELIGIBLE FOR UNEMPLOYMENT INSURANCE (AND THEIR

Mr. STARK

Mr. STARK. Mr. Speaker, the Chairman of the Ways and Means Committee recently wrote to the U.S. International Trade Commission requesting a section 332 study relating to the pricing of prescription drugs by certain U.S. trading partners. The questions asked--if one reads between the lines--seem to be designed by the pharmaceutical lobby to study whether countries that control drug prices are being unfair to the drug companies; whether such price controls have caused U.S. prescription medication prices to be higher than they would otherwise have been. Implicit in the phrasing of the questions, is the assumption that other countries should be paying more. Other sources of information suggest another approach. Perhaps Americans should be paying less. The pharmaceutical industry is in an enviable financial position. Drug firms enjoy, on average, three times the profitability (28 percent) of the other 36 industry groups in the Fortune 500. While maintaining the present level of research and development, they were able to invest, last year, about $14 billion in direct-to-consumer advertising, public relations, lobbying and promotion to doctors. Taxpayers paid more than 30 percent of the costs of R&D through government grants, in addition to the millions in benefits from the government from R&D tax credits. The industry reaps huge benefits, while poor Americans choose between needed medications and paying the rent or for food; or they cut prescriptions in half to try and prolong their pharmaceutical supplies. The U.S. spends far more than any other country on health care (14 percent of GDP) yet it ranks 37th in the world in the quality of health systems; we rank in the lowest 25 percent of industrialized nation's in life-expectancy and infant mortality. Our system is inefficient and wasteful. American health care has an over-emphasis on state-of-the-art cure instead of preventive care; relatively, we are overwhelmed by MRIs, CAT scanners and high priced drugs. Why have drug costs increased at more than twice the general inflation rate, leading to prescription drug spending growing at twice the rate of all other health expenditures, accounting for 10 percent of total health expenditures? Perhaps, the chairman's requested study could be extended to include the increased productivity our economy might enjoy if drug prices were lower and the resources used instead on repairing the country's infrastructure, on education or even to lower taxes. How does the high cost of health care impact our trade balance? How much of the ``extra'' cost of an American car is attributable to the inflated cost of providing health care to workers, driven by such factors as rapidly rising pharmaceutical prices? We may be able to coerce our trading partners into allowing prices to be raised for their citizens. However, I doubt that Americans will be overjoyed to discover that the efforts of the International Trade Commission resulted in poor Mexicans being deprived of their life- saving medications, to further enrich the pharmaceutical industry (which will not be passed on to American consumers, in any case). The answer is obvious, we should be concentrating not on forcing others to pay more, but on convincing the prescription drug manufacturers to be a little less aggressive in maximizing profits here at home.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take a moment to remember a dear friend of the Oakland, California community who has recently passed on. Melvin Lee Thomas, a great friend, father, and grandfather, was a remarkable member of the Oakland community. A veteran of the United States Marine Corp, he served his country with tremendous loyalty. Melvin attended several schools in the Oakland area, including John Muir School in Alameda, Clawson Elementary School, Golden Gate Junior High School, and Oakland Technical High School. Mel, as he was fondly called, served with distinction in the United States Marine Corp from 1958 to 1964. He served with a marine assault battalion in Guantanamo Bay in Cuba during the Cuban Missile Crisis. His family and friends were never so proud or relieved when he returned home unscathed from his service to our nation. Mr. Thomas was a lover of nature, the outdoors, and the sea. Some of his favorite pastimes were spent on the ocean enjoying its wonders. He loved watching beautiful sunsets from the ocean. Mel enjoyed listening to good music and Jazz was his favorite. He also was an avid reader. He enjoyed the exploration of the world of the mind. Mel is survived by his only daughter, Nerissa Thomas; his granddaughter, Jordan Mykaela Bess; his three brothers James Keith, Andrew Rodgers, and Anthony Rodgers; and his uncle, John Elsie Byrd. I ask my fellow colleagues to join me in paying tribute to this great man. Mr. Thomas will truly be missed by all members of the Oakland community. His dedication to his country, family, and friends will not soon be forgotten.

Mr. STARK

Mr. STARK. Mr. Speaker, prescription drug prices are too high for the uninsured and the average retail customer who has to buy prescriptions on their own. How much too high? For generics at least 57 percent too high. For single source brand name drugs, about 32 percent too high, and for multi-source drugs, about 39 percent too high. Says who? A new Medicare survey of what hospitals actually pay for drugs compared to what the so-called Average Wholesale Price is. HCFA is issuing a new regulation on how to pay hospitals under the Hospital Outpatient Department (HOPD) prospective payment system. As part of that new regulation, they had to figure out what the beneficiaries' 20 percent co-payment should be. Instead of foolishly taking the Average Wholesale Price as a gauge of what to apply the 20 percent co-pay against, HCFA wisely sampled what the actual acquisition cost of drugs are, then developed an average formula to calculate the 20 percent the seniors and disabled would owe. Following is the discussion from the Federal Register of April 7th. This is all more proof that the uninsured and those who are buying drugs at retail need help getting the purchasing power of large groups. The Democratic Prescription drug bill, H.R. 4770, would help seniors get the kind of discounts we know that hospitals are getting. The savings to seniors will be phenomenal! A one-time exception to the general methodology described above pertains to current drugs and biologicals that will be eligible for transitional pass-throughs when the PPS is implemented. For this final rule, we revised many APC groups by removing, to the extent possible, many of these drugs and radiopharmaceuticals. Therefore, the payment rates for the APC groups with which these drugs are associated exclude the costs of these drugs and the total amount paid to hospitals for the drugs will be 95 percent of the applicable AWP. In order to be able to determine a coinsurance amount for these drugs, we needed to estimate what portion of this payment would have been included as part of the APC payment amount associated with these drugs and what portion would be the pass-through amount. Using an external survey of hospitals' drug acquisition costs, we determined the APC payment amount for many of these drugs as their average acquisition cost adjusted to year 2000 dollars. Where valid cost data were not available for individual drugs, we applied the following average ratios of acquisition cost to AWP calculated from the survey to determine the fee schedule amount: .68 for drugs with one manufacturer, .61 for multi-source drugs, and .43 multi-source drugs with generic competitors. In either case, the coinsurance amounts were determined as 20 percent of these fee schedule amounts. It is important to note that these estimates do not affect the total payment to hospitals for these drugs (95 percent of AWP).

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in support of the resolution to disapprove annual normal trade relations (NTR) with China. Unfortunately, we should have debated the one year extension in May, instead of the harmful bill that will give permanent normal trade relations (PNTR) trade status to China's barbaric regime, and will ensure that multinational corporations have the investment protection they need to exploit China's cheap labor. China doesn't deserve annual normal trade relations status and it definitely doesn't deserve the permanent normal trade relations status the House approved in May. Regardless of how the House voted on PNTR, I will take this opportunity to tell my colleagues and the American people why the People's Republic of China (PRC) does not deserve normal trade privileges with the United States--for the next year or permanently. Just one month after the House voted to give China PNTR, the New York Times reported that China continues to aid Pakistan in its efforts to build long-range missiles that could carry nuclear weapons. China plays by its own rules and doesn't adhere to the rules of the international community. The United States wouldn't need to monitor the regional tension between India and Pakistan if China worked toward a mutual goal of nonproliferation. Instead, China provokes Pakistan with transfers of nuclear technology and exacerbates tensions between the two countries. Senator Thompson is trying to force a vote on his bill to monitor China's nuclear proliferation activities with greater scrutiny and applies sanctions if China is found proliferating weapons of mass destruction. Unfortunately, Senator Thompson is finding resistance from his own party that does not link PNTR with a nonproliferation bill. We saw what happened when the Administration decided to de-link trade and human rights for China. Human rights abuses in China worsened yet China has been allowed to export their cheap sneakers to the United States. Tens of thousands of Falun Gong practitioners have been detained, tortured and now are being committed to Chinese mental institutions for the mere expression of their faith. The Chinese government claims that Falun Gong is a religious cult not approved by the state. The state does not approve peaceful meditation, but it does approve torture and forced abortions. The Chinese government does not approve Roman Catholicism, but the sale of executed prisoner's kidneys is perfectly acceptable to the PRC. The United States cannot allow this barbaric government to harm its own people without facing some sort of punishment. Withholding annual normal trade relations should be that punishment. China is the biggest producer of ozone layer-destroying chlorofluorocarbons (CFCs) and will soon surpass the United States as the leading emitter of greenhouse gases. The United States suffers from China's earth-destroying practices. The United States spends $3 billion annually on cataract operations and billions more on treating skin cancer cases due to the destruction of the earth's protective ozone layer. China's irreverence for environmental standards is reflective of its irreverence for human life. This is unacceptable in the 21st Century. China must be held accountable for its actions--human rights violations, labor rights violations, trade violations, weapons proliferation and environmental violations must be scrutinized and the annual NTR debate is the forum for scrutiny. Withholding annual NTR will send a clear signal to Beijing that the United States does not condone its inhumane actions. Opposing the annual NTR extensions will tell China that the United States is willing to hold the PRC accountable. China must pay a price for its actions, and that price should be United States trade. I urge my colleagues to support disapproval of extending NTR status to China yet again.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise in support of the motion to recommit the bill. I oppose the Republican so-called Marriage Penalty Relief Act because it fails to appropriately address the problem for which it is named. Instead of addressing the needs of families who pay an actual tax penalty for being married, this bill provides broad tax relief to a host of families who are actually already enjoying a marriage bonus. It makes no sense to squander $182 billion of our limited federal resources throwing money away in this manner. There are far more important federal priorities. It is because of these other priorities that I rise in support of the Democratic motion to recommit. Under our motion to recommit, we would begrudgingly accept the Republican Marriage Penalty legislation, but the tax reductions would be prohibited from going into effect until a real Medicare prescription drug benefit was enacted. Seniors are in vital need of a Medicare prescription drug benefit and the Republican sham bill passed here in the House of Representatives last month is no solution. Seniors aren't looking for the opportunity to be overcharged and under-provided for in another private insurance plan as would happen under the Republican bill. Seniors want a drug benefit that is treated just like all of the rest of their benefits--as part of the Medicare program. They want a benefit that cannot be taken away, that will not vary if you live in a rural or urban area, that will not change if you live on the West Coast or in the mid-Atlantic states. It must offer a guaranteed benefit package and have an affordable premium and cost-sharing structure. In order to achieve the standard of a real drug benefit, the Medicare bill must include: A voluntary outpatient prescription drug benefit; a premium of not more that $25 (adjusted for cost increases), with low- income assistance; no deductible for those benefits; the benefit must cover 50% of the cost up to $2,000 growing to $5,000 over time; a $4,000 out-of-pocket spending limit after which all costs would be covered by the government, and all Medicare beneficiaries would receive volume discounts. Because providing seniors with a Medicare prescription drug benefit is such a vital national priority and because the Republican-led Congress clearly has no interest in passing a bill that meets the standards described above, we are willing to go along with this bloated marriage penalty tax bill. Unfortunatley, I know that our motion to recommit will fail. Republicans would much rather continue pouring money into the pockets of their wealthy benefactors than address the real needs of America's seniors and their families.

Mr. STARK. Mr. Speaker, I rise today in opposition of H.R. 4810, the Marriage Tax Penalty Relief Reconciliation Act of 2000. This is yet another bill in a series of legislation brought to the floor to help America's wealthy. Yes, we have entered an era of budget surpluses, but the surpluses must not be squandered on those who don't need it--the wealthiest U.S. income-earners. I support targeted marriage tax relief such as the Democrats have provided in our substitute amendment today. I also support increasing the earned income tax credit for the working poor who really do need the tax break. The Democrats have provided for this in the substitute bill as well. And the Democratic substitute makes sure that nobody will be denied the relief because of the AMT. The Republican bill does not. The Republicans have brought the estate tax, marriage penalty tax, medical savings accounts, and the telephone excise tax to the floor for consideration, and next week they plan to bring pension reform to the floor as well. Not a single one of these provisions will provide relief for middle and lower income working families. This Congress has already spent $471 billion on tax cuts for the wealthy and plans to spend another $54 billion on increasing pensions for the wealthy next week. This Congress can be charged with recklessly spending half a trillion dollars on the wealthiest Americans and there may be more to come. This is an irresponsible use of the hard-earned tax funds lower and middle-income earners contribute to their federal government. I. Marriage Penalty Tax This bill should target tax relief for those who need it most. Unfortunately, the GOP proposal actually helps wealthy Americans, not simply those facing a tax penalty due to marriage by implementing a tax bracket change favorable to those in the top brackets. There are nearly as many families that receive ``marriage bonus'' as receive marriage penalties in the U.S. As much as half of the $182 billion in tax relief in the GOP bill will go to families who receive the bonus and are not hurt by the marriage penalty. This bill's costliest provision, expanding the 15% tax bracket, only benefits taxpayers in the top quarter of the income distribution. This accounts for 65% of the plan's total cost, or nearly $100 billion. This bill's title implies that it helps those who are faced with a marriage penalty when it truthfully benefits the wealthy. ii. estate tax The estate tax repeal--and the numerous other tax measures passed by the House--should be scrutinized with a measure of fairness. It hardly seems fair to come to the floor of the House week after week to provide hand over fist full of tax break dollars to the wealthiest U.S. taxpayers, when we haven't even addressed Medicare's solvency. The estate tax bill is the most egregious of all of the tax bills that have come before the House for a vote. It spends the most amount of money-- $105 billion--on not just the wealthy, but the very wealthy. Ninety percent of the tax cut benefits will to go to those in the top 1% income group--those earning $319,000 per year and with estates over $20 million. Clearly this is a tax break for the rich. iii. pension reform The Ways and Means Committee is scheduled to markup the pension reform bill tomorrow and it's expected to be on the floor sometime next week. While many of my colleagues would like to believe that this package of reforms will help to increase pension coverage for working Americans it will do exactly the opposite. Trickle down economics didn't work for Reagan and it won't work for pensions. This bill will directly help those executives who earn $200,000 per year. This bill will purely benefit the rich when not one provision is included to help increase pension coverage for low and middle-income workers. iv. medical savings accounts The Republicans want to appear as though they are helping the average American worker so they decided to include medical savings accounts (MSAs) in the Patients Bill of Rights. The greatest savings from MSAs will help workers who have little or no health care expenditures. It allows people with low health costs to avoid taxes through essentially a new form of an IRA. And the Republicans go even further by allowing people to withdraw money from their MSA without any tax penalty if they maintain the deductible of $1,000 for individuals and $2,000 for families. This isn't a health proposal at all--it's just more money for the rich. v. telephone excise tax While this isn't a bill to directly help wealthy Americans, its primary purpose is to help wealthy corporations. This is just another fiscally irresponsible way for the Republicans to reduce federal revenues for the vital programs that the working families of this country rely on. The leadership of the 106th Congress doesn't care if it squanders another $20 billion in tax revenues by repealing the telephone excise tax. The GOP doesn't care if we have enough money to save Social Security and Medicare for future generations or to give our seniors a Medicare prescription drug benefit. The Democratic substitute bill targets those workers who need it most. The Democratic substitute addresses the marriage penalty by giving married couples a standard deduction twice that of single people. In addition, low-income married couples face a marriage penalty in the earned income tax credit. The Democratic substitute would reduce those penalties by increasing the income level at which the credit begins to phase out by $2,000 in 2001 and by $2,500 in 2002 and thereafter. It would also repeal the current reduction in the EITC and refundable child credit by the amount of the minimum tax. The Democratic substitute is the responsible way to address the marriage penalty tax without pandering to the wealthiest 2% of U.S. earners. I urge my colleagues to support the Democratic substitute and oppose H.R. 4810.

Mr. STARK

Mr. STARK. Mr. Speaker, today I rise in opposition to H. Con. Res. 253. This bill may very well be unconstitutional, is inappropriate, and is counter to the fundamentals I have supported since coming to Congress. The writers of the Constitution understood the importance of the separation of church and state. While religion plays an important role in our society, ``Congress shall make no law respecting the establishment of religion.'' This resolution recognizes the establishment of the government of a religious institution, the Roman Catholic Church, as a sovereign state. Thus this bill is unconstitutional and should not have even appeared on the floor of the House. This bill is also grossly inappropriate. The Majority party has consistently refused to pay our dues to the United Nations and has even called for its dissolution, while at the same time trying to tell the UN how to operate. this bill opposes a movement not to remove the Vatican from the United Nations but merely to put the Catholic Church in the same position that all the other non-governmental organizations have in the UN. This movement, if successful, would simply remove voting privileges from the Vatican, a right not enjoyed by any other non-governmental UN member today. And finally, this bill ``commends the Holy See for its strong commitment to fundamental human rights, including the protection of innocent human life both before and after birth.'' (emphasis added) I cannot vote for a bill that contains such language as I believe that it is a fundamental human right that a woman have the right to decide what happens to her body. I have fought for many years to ensure a woman's right to choose and I will not vote for any bill that suggests that a woman choosing to have an abortion is a person who violates human rights. For these reasons I urge my fellow members of Congress to vote against this inappropriate campaign check written to make the Republican Party seem even more anti-choice.

Mr. STARK

Mr. STARK. Mr. Speaker, in order to bring this bill up on the floor today, the rule had to waive all points of order that could be raised against it. Yesterday, we were on this same floor debating the creation of a Medicare Prescription drug benefit for seniors. Two-thirds of our seniors have no drug coverage whatsoever or have inadequate coverage--a Medicare drug benefit is a vital issue to them. Yet, the Republican leadership refused to grant us a waiver so that the Democratic bill--which created a real, defined Medicare drug benefit that would be dependable and available to all seniors across the country--could be equally debated with the Republican counterpart. Instead of allowing a real debate, they passed their sham bill that turns drug coverage for seniors over to the private insurance industry--the very same industry that refused to cover seniors in the past. It is a false promise to America's seniors. Here we are less than 24 hours later and we are waiving all points of order against a bill that won't do anything to help the millions of people who are lacking health insurance or prescription drug coverage. Not at all. This bill will help one profession with a very high income--doctors. Clearly, if you aren't among their monied friends, you don't get on to the floor of the House these days. If enacted, this bill would cost the Federal government some $1.7 billion over five years in new outlays, and lose $2.5 billion in federal revenues over that same period. At the same time, it would cost consumers some $2.4 billion in increased insurance premiums because the effect of the anti-trust exemption is predicted to increase doctors' fees by some 15%. While I am sympathetic to providers' frustration with managed care's ever-growing control over our health care system, granting anti-trust exemption to health care providers is not the solution needed. I urge my colleagues to oppose the rule and if the rule passes to vote against H.R. 1304.

Mr. STARK

Mr. STARK. Mr. Chairman, the fact that we are considering this legislation on the House floor today is a testament to the Republican leadership's lack of desire to deal with the real problems consumers are facing from managed care. We passed a bipartisan Patients' Bill of Rights last October, the conference was appointed nearly four months ago--but we have made precious little progress on that important legislation that is already so long overdue. That is what we should be debating on the House floor today. We should be debating extending patient protections to consumers to ensure that health plans cover emergency room care, that women have an unfettered right to ob/gyn care, that health plans are required to provide their members with access to specialists, that patients be guaranteed access to an independent external appeals, and that patients could hold health plans liable if their actions caused harm or death. Instead, we are faced with a bill that does absolutely nothing to protect consumers in managed care--but does wonders to protect doctors' incomes. I guess we shouldn't be surprised. This Republican Congress has shown us time and time again that they are far more interested in helping their monied friends and supporters than the general public. On its face, this legislation raises numerous concerns. A simple look at the exceptions in the bill makes it clear that anti-trust exemptions fraught with potential problems. It Exempts Federal Health Programs. In order to get the bill out of the Judiciary Committee the bill's supporters had to accept an amendment to exclude Medicare, Medicaid, the Federal Employees Health Benefits Plan, the State Children's Health Insurance Program, Veterans Health services, Indian Health Services and all other federal health programs from the law. The reason for this amendment was that Congressional Budget Office analysis showed that the bill would impact federal spending for these programs by increasing expenditures by some $11.3 billion over 10 years. Managed care plays a major role in most of these programs today. By allowing doctors to collectively bargain with managed care plans, CBO estimates that rates will increase by 15 percent. If the law applied to federal health programs it would obviously impact federal health spending. The supporters of the bill don't want to acknowledge the real costs associated with passage of this bill so they exempt federal programs from it. Even with federal health programs exempted, CBO found that passage of the bill would decrease federal tax revenues by some $3.6 billion over ten years. Those federal losses come about because employers would claim larger deductions for the increased expense of providing health benefits (because of the increased bargaining power of doctors). This would also result in employees receiving a greater share of compensation in tax-sheltered benefits. The law sunsets after three years. In another attempt to gain support, the bill has a provision that would automatically sunset the law after three years. This sunset provision is a direct acknowledgement of the concern that granting anti-trust exemptions is a dramatic move. The fact is that we don't know exactly how much strength doctors would exert through this new found ability to collectively bargain. It may be that they would exercise restraint and put the quality of care of their patients first. Then again, they might exercise united power by refusing to contract with health plans that won't meet their demands--whatever those demands might be. Should the latter occur, the impact on patient care could be devastating. Therefore, the authors are acknowledging that an escape hatch might be necessary. I'd rather not open such a risky door in the first place. After all of these strong statements, I must also acknowledge that I understand and empathize with the frustration of America's physicians and other health care providers. The growth of managed care has significantly altered their professions in ways in which we could not have imagined even 10 years ago. And, much of this change has not been good for patients or health care providers. Congress can and should take action to address those concerns, but this bill isn't the solution. Instead, I urge Congress to move forward with passage of the Patients' Bill of Rights which would limit health plans' abilities to use financial incentives, eliminate gag clauses, and finally extend liability already faced by doctors and hospitals to the health plans that are making many of today's medical decisions. Many of my colleagues may not know that I was voted the most fiscally conservative Democrat this year by the National Taxpayer's Union. In the spirit of maintaining my standing of strong fiscal responsibility-- and on the many additional grounds I've mentioned--I strongly oppose H.R. 1304 and urge my colleagues to join with me in opposition to this so-called managed care ``solution'' that is fraught with such serious flaws.

Mr. STARK

Mr. STARK. Mr. Speaker, today I am introducing the National Flood Insurance Program Fairness Act of 2000. This February many of my constituents were placed into a special hazard flood zone, a designation which necessitated the purchase of flood insurance. These residents were not notified that they would be required to purchase flood insurance until two months or less before the maps became effective, even though the law is supposed to give them six months notice. This exacerbated an already difficult situation, as residents who had not seen flooding in decades or a lifetime had little notice to purchase costly insurance. Several residents who did not believe they were in the flood zone hired a surveyor at their own expense. The data provided by this private surveyor resulted in their homes being removed from the special hazard flood zone. While these residents were not required to purchase flood insurance, they did spend over $200 each for the surveyor. They were told by FEMA that they were responsible for that expense, even though the mistaken flood zone classification was made by the county engineers. Clearly the national flood insurance program needs to be revised to give homeowners more notice and due process. That's why I am proposing this legislation. The National Flood Insurance Program Fairness Act of 2000 would do the following: Require the FEMA Director to notify by registered mail the Chief Executive Officer of each community affected by changes in Flood Insurance Rate Maps. The Director will be required to provide a copy of the revised map, along with a statement explaining the process of appeal. The director will also provide the affected community sufficient information to identify which homes are affected. Require the Director to notify by registered mail the Chief Executive Officer of each community of FEMA's response to the community's appeal of the flood insurance rate maps. Require the Director to notify by first class mail each owner of property affected by the changes in the flood insurance rate maps. Require FEMA to reimburse a resident for reasonable costs incurred in connection with a surveyor or engineer for an appeal to the Director which is successful. This does not include legal services incurred by the resident. It is my hope that the legislation will allow communities to better work with FEMA to ensure that residents are given sufficient, fair, and timely notice if they will be required to purchase flood insurance.

Mr. STARK

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

Mr. STARK. Mr. Speaker, I yield myself 10 seconds. Mr. Speaker, I would inform the House that the minority office of the Committee on Ways and Means just received a telephone call from the executive director of the National Alliance for the Mentally Ill, which one of the previous speakers on the Republican side said endorsed the Republican bill. They said they do not, that that was a misstatement. Mr. Speaker, I yield 1 minute to the gentleman from Massachusetts (Mr. Neal), who understands that the Network of National Catholic Social Justice Lobby does endorse the Democrat bill and oppose the Republican bill.

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Michigan (Mr. Levin), a member of the Committee on Ways and Means, who understands that the Older Women's League and the Alliance for Children and Families have endorsed the Democrat bill and violently oppose the Republican bill.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Georgia (Mr. Lewis), who understands that the Alzheimers' Association and Consumers Union both oppose the Republican plan and endorse the Democrats' plan. He understands the working group, who put this bill together for the Republicans, is mostly comprised of lobbyists for the pharmaceutical industry and the managed care industry.

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Wisconsin (Mr. Obey), the former chairman of the Committee on Appropriations, who understands that the National Council of Senior Citizens and the National Senior Citizens Law Center both oppose the Republican plan and wholeheartedly endorses the Democratic plan.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Wisconsin (Mr. Kleczka), a distinguished member of the Subcommittee on Health of the Committee on Ways and Means, who understands that Families USA and the Leadership Council of Aging organizations vehemently oppose the Republican bill and support the Democratic substitute.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Washington State (Mr. McDermott), who knows why the National Committee to Preserve Social Security and Medicare and National Council on Aging supports the Democrats' plan and opposes the Republicans' plan.

Mr. STARK. Mr. Speaker, I yield myself 3 minutes. Mr. Speaker, to the previous speaker in the well I would say things have not changed, or maybe they have. Now the lobbyists for the pharmacists get together with Members of Congress in the dead of night and draw a bill that will benefit only the pharmaceutical corporations and the managed care companies. So where we used to be able to consult with our local pharmacist about what is good for us, now we have to let the Republicans cozy up to the lobbyists in whose pocket they reside and get their campaign contributions and whatever other gifts they want to give them as they draft a bill which will only help the pharmaceutical industry and the HMOs in this country. I would like to say that the Democrats' bill, if it were allowed to be voted on by the Republicans, is a better bill. We will hear in the debate that there are some similarities, and there are. The principal difference is that the Democrats bill is dependable. It uses real resources, and it is an integral part of Medicare. The Republican bill will never come into law. We see before us the statement that was given to us this morning by the administration which opposes H.R. 4680 because its private insurance benefit does not meet the President's test of being a meaningful Medicare prescription drug benefit that is affordable and accessible for all beneficiaries; and if H.R. 4680 were presented to the President, he would veto it. So we are today debating something that will never come to pass, and we have been foreclosed from offering an option. Admittedly, the option would be much more expensive, and we are proud of that. We, in our limited bill, have half the number of uninsured seniors than the Republicans do. If the Republican bill were to pass, which is not likely, there would still be 10 million Medicare beneficiaries without any health care. Our bill would leave 4\1/2\ million Medicare beneficiaries, half as few, that would not have insurance. Yet we are begging to spend this surplus and not waste it on a relief from the inheritance tax, which will benefit 3,000 or 4,000 of the very richest Americans. With that money alone, we could provide an added benefit at a low enough premium and eliminate the copay so that we could include all the Medicare beneficiaries in a generous, dependable benefit with a reliable premium that would be the same across the country and allow the seniors to get their drugs from any provider in the country. This is not true under the Republican bill. We think that the government can do a better job than subsidizing managed care drug plans whose record has been to increase the premiums, leave the program, abandon their beneficiaries, kick up the premiums, cut benefits, where Medicare has done none of that, it has been dependable. I wish we could bring our bill to the public. Mr. Speaker, I reserve the balance of my time.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentlewoman from Florida (Mrs. Thurman), a member of the Subcommittee on Health of the Committee on Ways and Means, who twice offered an amendment to give seniors a discount on their pharmaceutical drugs at no cost to the Federal Government, only to see every Republican on the Committee on Ways and Means vote against her amendment.

Mr. STARK. Mr. Speaker, I am pleased to yield 1 minute to the distinguished gentleman from Tennessee (Mr. Tanner), a member of the Committee on Ways and Means, who knows that the Consortium for Citizens With Disabilities and the National Academy for Elder Law Attorneys both support the Democratic bill and oppose the Republican bill. (Mr. TANNER asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I am pleased to yield 1 minute to the gentleman from Maryland (Mr. Cardin), who knows that the National Association of Area Agencies and the Center for Medicare Advocacy, Incorporated, of the Health Care Rights Project both endorse the Democratic bill and oppose the Republican bill. (Mr. CARDIN asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I am privileged to yield 1 minute to the gentleman from California (Mr. Becerra), the next mayor of Los Angeles and a distinguished member of the Committee on Ways and Means, who knows that the American Federation of Teachers and the National Hispanic Council on Aging have both endorsed the Democratic bill and opposed the Republican bill.