Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, for the past 13 years, California's Alameda County has been blessed to have a tough, hard-working, straight-talking sheriff named Charles Plummer. The January 2, 2000 issue of The Argus carried an excellent profile of this outstanding public servant, that I would like to submit, in part, in the Record. It is a model for those interested in law enforcement and public service throughout the nation. I would like to especially commend Sheriff Plummer for his stance on gun control and the need for reasonable regulation. I am proud to note that this has been an issue that has moved him from the Republican party to the Democratic party. Controversial Alameda County Sheriff Charlie Plummer Often Talks Tough, But He Also Walks the Walk (By Josh Richman) A framed photo on Alameda County Sheriff Charles Plummer's office wall depicts him shouting at someone behind a police crowd-control line. The caption: `` `Cause I'm the sheriff, that's why. If you don't like it, get outta here!' '' That's Charles Clifford Plummer to a T. He'll hear your concerns, take suggestions and perhaps even follow them, but never forget he's the boss. The affable-but-tough-talking lawman has carried a badge for 37 years and, at age 69, shows little sign of slowing down. His department's main duties include policing the county's unincorporated areas, running the county jails and coroner's bureau, and protecting county courts. Plummer also is a sharp-dressed, number-crunching CEO who runs his 1,650-person-strong, $145.7 million agency like a business. He has a taste for pricey cigars, and he donned a tuxedo rather than a uniform for his swearing-in ceremony. He rules from a 12th-floor corner office choked with international police memorabilia and boasting panoramic vistas of Lake Merritt and the hills. Some of his deputies accuse him of tyrannical bullying, but most officials and fellow lawmen praise his bluntness. ``He is old-school in the sense that when he gives his word, he keeps it,'' California Attorney General Bill Lockyer said, adding that Plummer's post as president of the California Sheriff's Association ``is an indication of the high regard that other elected sheriffs have for his leadership and abilities.'' Values and work ethic Plummer was born Aug. 17, 1930, in Fort Bragg. His parents separated when he was six and he grew up in his maternal grandmother's home, where he said he learned ``values and a work ethic that have He was on high school football, track and basketball teams, performed in the band and drama club, and was senior class president. He took a job as a water well-digger at age 10; while in school, and at Santa Rosa Junior College, he worked as a gardener, shingle mill worker, lumber, camp rigger, apple picker, construction worker, vacuum cleaner salesman and hospital attendant. He planned to become a mortician, but a California Highway Patrol officer picked him up hitchhiking and talked him into using his gregarious nature and large size to advantage as an officer. The Berkeley Police Department was ``the best in the United States, and that's why I wanted to go there,'' Plummer said, adding that it seemed like ``the West Point of all police work.'' He joined in 1952 and served there for 24 years, acting as field commander during some of the fiercest student demonstrations and riots of the 1960s and early 1970s. He reached the rank of captain in 1969 and was appointed acting chief in 1973. He became chief of the Hayward Police Department in 1976. Ten years later he ran for sheriff, and his opponent's withdrawal from the race led to his uncontested election. He took the department's reins in January 1987, the first outsider to hold the job in more than 40 years. Changing the department Plummer promised to dismantle the department's ``old boy network'' by replacing favoritism with the work ethic, and by threatening dire consequences for deputies who lied, used racist or sexual slurs, accepted gratuities or took drugs. He also set about having the department accredited by as many agencies as possible, believing it would bring increased efficiency, better eligibility for state and federal grants and more protection from civil lawsuits. The Commission on Accreditation for Law Enforcement Agencies accredited his department. The American Correctional Association and the National Committee on Correctional Health Care accredited his jails. The American Society of Crime Laboratory Directors accredited his crime lab, and the U.S. Department of Justice accredited his bomb squad. The certificates hang in his office lobby, tokens of his proudest achievements. Earning accreditation is like ridding a home of termites, he said--it's expensive up front, but you do it to save money later. Even so, he often has had to go toe-to-toe with other county agencies to vie for dollars. Plummer has fought budget battles with the same intensity he brought to controlling riots on Berkeley's streets, He once threatened to close North County Jail rather than cut investigators, crime prevention and animal control. In 1996, asked to trim $6.9 million from his budget, he instead asked for $3 million more. ``I can't afford to cut one person, so why go through the charade?'' he asked at the time. He doesn't always win. The 1992-93 budget required 300 layoffs, and Plummer had to pink-slip a whole academy class-- his lowest moment, he said. ``That hurt me worse than the riots hurt me in Berkeley,'' he said. ``It just tore my heart out. We have warned them it could happen, but that doesn't make it any easier when you're having a graduation and you can't give them badges.'' After proclaiming it a ``chainsaw massacre,'' he mustered a crowd, hefted a The budget crunches spurred Plummer to view his department as a business. Assuming that a fully-staffed jail is an economically efficient jail, he sought more contracts to house other agencies' inmates in Alameda County. Plummer's jails have held San Francisco county inmates, state parole violators, federal prisoners from U.S. Marshals in California and Hawaii, and illegal immigrants from the federal Immigration and Naturalization Service. He acknowledges that those and other contracts, such as providing security for county hospitals and other facilities or events, create a lot of overtime. But his budget always covers it, he noted: ``I've never brought in a budget in the red in my life.'' He has positions for 920 sworn deputies, 37 of which are now vacant. He hired San Leandro Police Chief Robert Maginnis as an assistant sheriff last August specifically to recruit. Some said Maginnis was being groomed as a likely successor, but Plummer said Undersheriff Curtis Watson already has earned that mantle by paying his dues within the department. ``Also, I would never support anyone who would not agree to give at least two terms,'' he said, because he believes a sheriff needs at least eight years to be an effective leader. Republican no more Plummer ended his lifelong GOP membership in June, reregistering with a ``no party'' designation. Why? ``Guns,'' he said. As sheriff, he enacted new requirements for concealed firearm permits--a demonstrated need, a psychiatric exam, $1 million of liability insurance and qualification at the sheriff's shooting range. State Sen. Don Perata, D-Alameda, who earned a permit, wants to include such mandates in a plan for statewide licensing and registration for gun owners. Plummer approves, explaining, ``we're not really anti-gun, we're pro-gun-responsibility.'' But when he heard U.S. Rep. Bob Barr, R-Georgia, speak on the radio against gun control earlier this year, he had an epiphany. ``I thought, `I don't want my name associated with that crap,' ``Plummer said. He would rather associate with his wife of 51 years, Norma, their three children--two of whom followed him into law enforcement--and eight grandchildren. He also associates with the Boy Scouts, the Rotary and other groups, which he called ``great therapy for me''--talking to people outside his work helps him avoid ``burnout'' after so many years of policing, he said. His current term will expire in three years, when he's 72; whether he runs again ``will depend on how I feel.'' He admits he'll be ``a little long in the tooth,'' but a recent physical found him fit, and close aides have agreed to tell him if they think he's slowing down. ``If I think I'm taking anything away from this organization, I'm outta here,'' he said.

Mr. STARK

Mr. STARK. Mr. Speaker, today I join my colleague and good friend, Representative Karen Thurman, in support of House Concurrent Resolution 247, to honor National Donor Day and recognize the importance of organ, tissue, bone marrow & blood donation. With more than ten people dying every day and approximately 70,000 Americans currently awaiting organs, it is clear that our nation is facing a crisis. This resolution will help raise awareness and increase donations nationwide--it is a meaningful step toward bringing an end to our nation's current predicament. A number of businesses, foundations, health organizations, and the Department of Health and Human Services have previously designated February 12th as National Donor Day. The first two National Donor Days succeeded in raising a total of almost 17,000 units of blood, adding over 2,400 potential donors to the National Marrow Donor Program Registry, and included mass distribution of organ and tissue pledge cards. This Concurrent Resolution supports National Donor Day, encourages Americans to learn about and openly discuss donation, and calls on the President to issue a proclamation to demonstrate support for organ, tissue, blood and bone marrow donation. Research points to a clear need for public education and incentive programs to increase organ donation. This Congress, I also introduced legislation, H.R. 941, the ``Gift of Life Congressional Medal Act of 1999,'' to create a commemorative medal that honors organ donors and their families. This Act is intended to draw attention to this life- saving issue and to send a clear message that donating one's organs is a selfless act worth the profound respect of our Nation. I hope Members would also consider this effort to increase donations. This problem is clear--there are not enough organs to meet the needs of patients nationwide. Let's support initiatives such as H.R. 941, to create an organ donor medal, and H. Con. Res. 247, to honor National Donor Day and recognize the importance of organ, tissue, bone marrow & blood donation. Such initiatives will help raise awareness, increase donations nationwide, and both are meaningful steps toward bringing an end to the lack of available organs nationwide.

Mr. STARK

Mr. STARK. Mr. Speaker, following is a letter I submit for the Record that was sent to Members of Congress by the Leadership Council of Aging Organizations signed by 32 groups, on the principles that Medicare prescription drug legislation should meet. If one compares the principles with the various bills that have been introduced, it is clear that the President's proposal; the Stark- Dingell-Kennedy proposal meet the criteria. All others bills that I am aware of do not meet the criteria--they are either means-tested, unaffordable, don't provide catastrophic protection, fail to improve quality, do not buy drugs cost-effectively, and so forth. The LCAO has performed a valuable service in laying out what good pharmaceutical health insurance policy should be. Congress should proceed accordingly. Leadership Council of Aging Organizations, Horace B. Deets, Chairman, February 7, 2000. U.S. House of Representatives, Washington, DC. Dear Representative: The undersigned members of the Leadership Council of Aging Organizations (LCAO) look forward to working with the Congress on the creation of a Medicare prescription drug benefit. As you consider current proposals and draft new prescription drug proposals, we would like you to consider the following issues that are of the highest priority to our organizations and the millions of Americans that we represent. Benefits Medicare should guarantee access to a voluntary prescription drug benefit as a part of its defined benefit package. Medicare's prescription drug benefit should provide comprehensive coverage, including the most current, effective, and individually appropriate drug therapies. Medicare's contribution toward the cost of the prescription drug benefit must keep pace with the increase in prescription drug costs and not be tied to budgetary caps. Adding a Medicare prescription drug benefit must not reduce access to other Medicare benefits. Coverage The Medicare prescription drug benefit should be available to all Medicare eligible older Americans and persons with disabilities, regardless of income or health status. The Medicare prescription drug benefit must be voluntary and must provide safeguards against the erosion of current prescription drug coverage provided by others. Affordability The financing of a new Medicare prescription drug benefit should protect all beneficiaries from burdensome out-of- pocket expenses and affordable cost sharing. particularly low-income beneficiaries. The new benefit must protect individuals from extraordinary expenses for prescriptions drugs. The government subsidy must be sufficient to guard against risk selection and to provide an attractive benefit design. Sufficient subsidies should be provided for low-income beneficiaries to ensure that they have access to the benefit. Administration The new prescription drug benefit should be efficiently managed, include appropriate cost-containment, and reflect the purchasing of the Medicare beneficiary pool. Quality The new Medicare prescription drug benefit must meet rigorous standards for quality of care, including appropriate monitoring and quality assurance activities. The Medicare program should work to prevent the overuse, underuse, and misuse of prescription drugs. We request that you carefully consider the issues presented above as you develop your Medicare prescription drug proposals. We look forward to working with you to ensure that the Medicare program is strengthened by your efforts. Sincerely, AARP; AFSCME Retiree Program, Alzheimer's Association, American Association for International Aging, American Association of Homes and Services for the Aging, American Federation of Teachers Program on Retirement and Retirees, American Society of Consultant Pharmacists, Asociacion Nacional Pro Personas Mayores, Association for Gerontology and Human Development in Historically Black Colleges and Universities, Association of Jewish Aging Services, B'nai B'rith Center for Senior Housing and Services, Eldercare America, Inc., Families, USA, The Gerontological Society of America, Gray Panthers, National Academy of Elder Law Attorneys, National Asian Pacific Center on Aging, National Association of Area Agencies on Aging, National Association of Foster Grandparent Program Directors, National Association of Nutrition and Aging Services Programs, National Association of Retired and Senior Volunteer Program Directors, Inc., National Association of Senior Companion Project Directors, National Association of State Long-Term Care Ombudsman Programs, National Association of State Units on Aging, National Caucus and Center on Black Aged, Inc., National Committee to Preserve Social Security and Medicare, National Council of Senior Citizens, National Council on the Aging, Inc., National Hispanic Council on Aging, National Indian Council on Aging, Inc., National Osteoporosis Foundation, National Senior Citizen Law Center, Older Women's League

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in opposition of H.R. 6, the Marriage Tax Penalty Relief Act of 2000. The Republicans will characterize those who oppose their bill as opposing tax relief for working families. This is not true. I support targeted tax relief for working families. However, any tax legislation must be enacted prudently and must be structured to target the right population. The bill before us today is far from prudent. I oppose H.R. 6 because of the process chosen by the GOP; the bill is misleading; and the Democrats have offered a better alternative. Targeted marriage tax penalty relief should be an issue that everyone can support. So it was surprising to learn that Ways & Means Democrats were left out of the whole process. The leadership developed this bill without any consultation from Democrats. If real legislation is going to pass the second session of the 106th Congress, then we must work in a bipartisan fashion. It seems that my colleagues on the other side of the aisle prefer to politicize legislation rather than produce policy that will actually help the citizens we serve. This bill puts the cart before the horse. There is no budget in place in which to examine this bill in an overall framework for this year's spending. To explain my point, the average American worker should not go out and purchase a brand new car without knowing how much is needed for their other expenses. The worker would end up with bounced checks and nothing left for food and medical expenses. This is exactly what the Republicans intend to do with this tax bill. Congress does not know how much is needed for our other spending priorities. It is fiscally irresponsible to spend money without an overall budget in place. Without a budget, last year's mantra to save Social Security and Medicare has been completely ignored. I am committed to saving Social Security for current and future retirees. I am also committed to saving Medicare--and enhancing its benefits--for current and future retirees. The American worker is entitled to both of these benefits in their golden years. I will not participate in a negligent Congress whose behavior could eliminate these two programs. A vote on H.R. 6 today does not allow Congress to prioritize our spending. So not only does this bill fail to ensure solvency for Medicare and Social Security, it prohibits us from other spending needs such as improving our schools, providing a Medicare prescription drug benefit, and making health care available to the 11 million children currently without it. This bill needs to 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. There are nearly as many families that receive ``marriage bonuses'' 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. The bill's title implies that it helps those who are faced with a marriage penalty when it truthfully benefits the wealthy. Finally, I cannot support this reckless tax cut when the Democrats have offered a safer, more responsible option. First and foremost, our bill uses the projected surplus to extend the solvency of Medicare to 2030 and the solvency of Social Security to 2050. The American worker has told us time and time again that extending these programs is a priority. I've listened to my constituents and I encourage my GOP colleagues to do the same. The Democratic substitute bill is not only more responsible than the Republican plan, it is also less costly and targeted to those who need it most. Our plan costs $89 billion over 10 years; one needn't be an economist to know that this is much more affordable than the $182 billion Republican price tag. 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. Again, the Democratic substitute would provide greater tax relief for these taxpayers than would the Republican bill. We shouldn't even be debating marriage tax penalty today. This is not the right time or the right product through which to achieve a reasonable tax cut. It is ludicrous to take a piecemeal approach to any tax reform package. Treasury Secretary Lawrence Summers has urged President Clinton to veto this bill. We need to oppose H.R. 6, go back to the drawing board, establish a budget and bring responsible tax relief legislation to the floor for a vote.

Mr. STARK

Mr. STARK. Mr. Speaker, I join today with Rep. Sherrod Brown, the ranking Democrat on the Commerce Health Subcommittee, and my California colleagues Representatives Henry Waxman, George Miller, Bob Matsui, Anna Eshoo, Tom Lantos, Xavier Becerra and Lynn Woolsey to introduce the State Children's Health Insurance Program Integrity Act of 2000. This legislation would prohibit any State Children's Health Insurance Program (S-CHIP) from allowing a health plan to simultaneously administer and participate in the state plan. While it is simply a technical correction to S-CHIP, it is important technical correction that would eliminate a very real potential for conflict of interest problems caused by health plans playing dual roles in state programs. The need for this legislation was first brought to our attention in 1998 when California initially granted a contract to a participating health plan to also administer the state CHIP plan. In fact, that health plan withdrew its application and the State went with a non- health plan alternative administrator. We are now reintroducing the bill and urging its swift passage because it may soon be an issue in California again and could easily become an issue elsewhere since there is nothing in federal law that prohibits states from granting such contracts. The second administrative vendor contract will be negotiated in California later this year. Without Congressional action on this issue, it is likely that there will once again be competition among participating health plans to obtain the vendor contract. To further describe the seriousness of this conflict of interest, under California's program the administrative vendor performs a wide variety of functions including: providing trained staff on the program's toll free telephone lines, making eligibility determinations and redeterminations, collecting premiums, enrolling and disenrolling members, transmitting enrollment information and updates to participating health plans, administering the annual open enrollment process, and the list goes on and on. These are clearly functions over which a participating health plan has tremendous interest and will certainly attempt to influence in any system. Clearly, allowing plans to play both roles creates an inherent bias. And, at a time when there are numerous alternatives to selecting a health plan with a financial interest in that market, it is a bias that can be easily avoided. Further evidence that our legislation has real merit can be found in another provision of the Balanced Budget Act of 1997 (BBA) which included the S-CHIP program. The BBA allows state Medicaid programs to choose private enrollment brokers to handle the day-to-day enrollment functions of their Medicaid programs. However, in allowing these enrollment brokers, the law clearly stipulates that the enrollment broker be free of any conflicts of interest. Specifically, the law requires that, ``The broker is independent of any such entity and of any health care providers (whether or not any such provider participates in the State plan under this title) that provide coverage of services in the same State in which the broker is conducting enrollment activities.'' Our legislation would apply the same conflict-of-interest standard that exists in the Medicaid enrollment broker law to the S-CHIP law. This is an important bill that would protect the integrity of S-CHIP programs across the country. We look forward to working with our colleagues for passage of the State Children's Health Insurance Program Integrity Act this year.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take a moment to remember a dear friend of the Hayward, California community who has recently passed on. Alwine Fenton was a great supporter of cultural awareness in the Hayward community. She was very involved in many local art programs, and was dedicated to introducing children to the arts, especially music, in various ways. From 1949 until 1986, Mrs. Fenton taught music in Hayward's elementary schools. In addition to teaching, Mrs. Fenton was the cofounder, officer and director of the Southern Alameda County Youth Orchestra, introducing children to orchestral and symphonic music. She also arranged concerts with the Classical Philharmonic Orchestra of San Leandro for thousands of Hayward area children. Not only was Mrs. Fenton committed to promoting musical awareness, but she also dedicated a great deal of her time to the visual arts in the Hayward area. She was a member of the Hayward Arts Council, which arranges art exhibits in downtown storefronts and throughout the community. Mrs. Fenton had arranged art exhibits in the City Hall since June of 1998. After her retirement, Mrs. Fenton continued to remain active in the Hayward community. She was a member of the California Retired Teachers Association as well as the Eden Garden Club. She was also a member of the Friends of the Hayward Library group and the Kaiser Hospital support group for heart patients. Mrs. Fenton's accomplishments have not gone unnoticed. During her time as an educator, Mrs. Fenton received several awards from the California Teachers Association. In 1998, the Hayward Lions Club recognized Mrs. Fenton with the Distinguished Citizen of the Year Award. I ask my colleagues to join with me in paying tribute to this great community leader. Mrs. Fenton will truly be missed by all members of the Hayward community. Her dedication to promoting cultural awareness, especially in the arts, will be remembered for many years to come.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to commend Taiwan for embracing democracy and striving for complete autonomy from the People's Republic of China (PRC). Taiwan has liberated itself from the oppressive Chiang Kai-shek regime only to be threatened by the current Chinese government. The PRC has a history of using coercion to get what it wants, and the recent missile tests are no different. We all know this is wrong and yet we continue a ``strategic partnership'' with this barbaric regime. Today's resolution, H.R. 1838, the Taiwan Security Enhancement Act, antagonizes the PRC. The title of the bill is misleading. Sure, it professes the sense of Congress that we should offer them the military might of the United States, but it will not make Taiwan any more secure. It only raises tensions in the region. To protect the free people of Taiwan and to help the process of democratization in the PRC, we need a coordinated, thoughtful, comprehensive China Policy. This Resolution is not such a policy! For example, China wants and needs integration into the world economy and the WTO. It needs the cooperation of the rest of the world to accomplish this goal. We need a concerted, comprehensive international effort to require that as a condition for the many objectives of the PRC, they give the world assurances of respect for international law, for the rights of the people of Taiwan, and indeed, for the rights of their own people. Therefore, I will not support the Taiwan Security Enhancement Act.

Mr. STARK

Mr. STARK. Mr. Speaker, as part of the Patients' Bill of Rights, the Republicans insisted on passing an unpaid-for set of tax deductions which they say will help improve access to health insurance. Their proposals will--but mostly for those in the upper income brackets who already have health insurance or who can afford it. Even in the area of long-term care insurance, the data shows that the Republican proposals disproportionately help those in the upper income brackets. Mr. Speaker, let's be fair. As we work on the access provision of the Patients' Bill of Rights, we should convert all of the tax deductions to credits, so that those who seek to use these tax incentives are all on a level playing field, and so that the Treasury's scarce resources go to those most in need of help. The following is data from a March, 1999 report to HHS prepared by LifePlans, Inc., entitled, ``A Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non- Privately Insured Disabled Elders Living in the Community.'' The data shows how LTC insurance is disproportionately held by those in the upper incomes and with the most assets--and how deductions will help those people far more than they will help the lower income. A credit would be a far fairer tool to help encourage the purchase of LTC insurance. ------------------------------------------------------------------------ All privately- insured All elders age Socio-demographic characteristics home care 65 and over claimants (in percent) (in \1\ \2\ percent) ------------------------------------------------------------------------ Race: White (not Hispanic)................... 97 85 Non-White.............................. 3 15 Living arrangement: (n=694) Alone.................................. 34 34 With spouse............................ 44 53 With relative.......................... 11 13 Other.................................. 11 .............. Total income: (n=492) $30,000................................ 52 65 >$30,000............................... 48 35 Total income: (n=432) Less than $10,500...................... 7 \3\ 19 $10,501--$19,999....................... 22 28 $20,000--$30,000....................... 28 19 $30,001--$39,999....................... 13 11 $40,000--$49,999....................... 9 8 $50,000--$74,999....................... 11 8 $75,000................................ 10 8 Estimated current value of home: (n=431) Less than $50,000...................... 7 \4\ 25 $50,000--$99,999....................... 28 37 $100,000--$149,999..................... 19 18 $150,000--$199,999..................... 13 10 $200,000--$249,999..................... 11 4 $250,000............................... 22 7 ------------------------------------------------------------------------ \1\ AOA (1998). Prolife of Older Americans. Washington, D.C. \2\ LifePlans, Inc. analysis of 1995 survey of 1,000 randomly selected individuals age 65 and over. \3\ Money Income in the United States: 1997 Current Population Reports, Consumer Income. Note that data from census table is interpolated to assure comparability of intervals. Also note that among claimants, 15% of the respondents who were willing to indicate whether their income was greater or less than $30,000 were not willing to answer the more detailed income questions. That is why there is a difference between the estimate for the proportion reporting incomes less than or equal to $30,000 (52%) and the estimate derived when summing answers for those answering the detailed income question. \4\ American Housing Survey for the U.S. in 1995. U.S. Census Bureau.

Mr. STARK

Mr. STARK. Mr. Speaker, the pharmaceutical industry constantly tells us they need every dollar for R&D, so they can invent wonderful new drugs, and that Congress must not do anything to question how they price drugs. A doctor sent me the following invitation he got from Bristol-Myers Squibb. As the doctor wrote: Since the enclosed invitation to a dinner plus $100 certificate continues to be commonplace, it makes me wonder how many go without needed medications that could be funded with these solicitations. I'm not sure whether it's the pharmaceutical executives or the physicians who are doing the soliciting . . . just like on the street. Bristol-Myers Squibb: why not put the money you spend in these solicitations into R&D--or lower drug prices? The U.S. pharmaceutical industry spends far more on marketing and overhead than it spends on R&D--despite what Flo and her front group friends say. This letter is just one small example of how the industry could, indeed, save money for R&D and/or lower prices. Bristol-Myers Squibb You are cordially invited to Participate in a dinner discussion on ``Treatment Modalities Throughout the Lifecycle of the Type 2 Diabetic Patient: A Focus on Monotherapy Approaches,'' on, Monday, November 29, 1999, Mr. Stox restaurant, 1105 East Katella Avenue, Anaheim, CA 92805, at 6:30 p.m. The program will last approximately one hour and a half. Each attendee will receive a certificate worth up to $100 towards the purchase of medically relevant items. Reservations are taken on a first come first serve basis. To make a reservation, please call 1-800-366-9034.

Mr. STARK

Mr. STARK. Mr. Speaker, I have introduced legislation for Medicare to encourage patients to use certain hospitals that provide better outcomes for sophisticated surgical operations-- i.e., fewer people die in surgery or in recovery. In exchange for saving lives, and giving certain hospitals higher volume of patients, the hospitals will give Medicare, the taxpayer, and the beneficiary some savings. It is truly a win-win proposal. But some--mostly those who stand to lose business--oppose the idea. To be blunt, that puts them on the side of killing people in order to help their bottom line. It is, Mr. Speaker, a truly immoral position for so-called health care providers to take. And don't take my word for it. Following is a memo from a physician on my staff that reviews some of the academic literature on the subject: Is Quality of Care Affected by Hospital and Physician Volumes? It is a mark of the advancement of medicine that we have come to nearly take for granted the availability of highly specialized and technical diagnostic investigations, medical therapies, and surgical interventions. However, when we individually confront health problems we justifiably want to know that our physician or hospital has adequate experience to make an accurate diagnosis, to make the most informed decision about what should be done and to carry out sophisticated surgical procedures. The question is, do high volume centers really have superior outcomes? Fortunately, a large body of medical literature exists on the relationship between hospital volume, physician volume and outcomes. Optimal results clearly require physicians with specialized expertise and well-trained staff. High volume centers are more likely to offer a wider range of therapeutic options that result in more targeted therapy. For example, the patient with angina due to narrowing of the coronary arteries may be treated with medication alone, angioplasty, a stenting procedure or a coronary bypass and each of these options would be the optimal decision under the right conditions. The cardiologist or cardiovascular surgeon who has extensive experience with all of these options is likely to make the bets therapeutic decision. Sophisticated surgical procedures demand highly-trained, close-working health teams drawing upon the expertise of many health professionals including anesthesiologists, nurses, rehabilitation therapists, respiratory therapists, and dietitians. Stable health care teams promote better collaboration, communication, and continuous quality improvement based upon experiential learning. A massive study by Hughes and colleagues in 1987 analyzed 503,662 case records from 757 hospitals and demonstrated a statistically significant correlation between greater hospital volume and better patient outcome for 8 of 10 surgical procedures evaluated: coronary artery bypass graft, cardiac catheterization, appendectomy, hernia repair, hysterectomy intestinal operations, total hip replacement, and transurethral prostatectomy. Twenty years ago (1979) in the New England Journal of Medicine, Luft and colleagues reported that mortality following open-heart surgery, vascular surgery, and transurethral resection of the prostate, is reduced in high volume hospitals, with hospitals in which 200 or more of these operations performed annually having death rates 25-41 percent lower than low volume hospitals. Two decades ago, the authors concluded that the data supports the value of regionalization for these operations. Numerous studies have specifically focused upon volume/ outcome relationships in both medical and surgical interventions for cardiac conditions: Jollis and colleagues (1994) evaluated 217,836 Medicare beneficiaries who underwent coronary angioplasty. Both in-hospital mortality and the rate of coronary bypass surgery following angioplasty were higher in low volume hospitals. These results indicated that if all study patients had received care in high volume hospitals, there would have been 381 fewer bypass operations and 300 fewer in-hospital deaths. These results were reproduced in papers by Cameron et al (1990) and Ellis et al (1997). Hannan and colleagues (1997) reported that both high hospital volume and high cardiologist volume were independently correlated with lower mortality following coronary angioplasty. Showstack and colleagues (1987) analyzed the outcomes following 18,986 coronary bypass operations at 7 hospitals in California. They also found that higher volume hospitals had lower in-hospital mortality and concluded that the greatest improvement in average outcomes following bypass surgery would be achieved by closing low volume surgical units. The significance of high physician volumes in determining outcome is highlighted by a series of papers examining patient outcomes following myocardial infarction: Jollis and colleagues (1996) examined mortality following MI for 220,535 Medicare patients and reported that patients treated by cardiologists were 12 percent less likely to die within one year than those treated by a primary care physician. Similarly, Casale and colleagues (1998) reported that following MI, treatment by a cardiologist resulted in a 17 percent reduction in hospital mortality. In addition, patients of all physicians who treated high volumes of patients with MI, had an 11 percent reduction in mortality. Nash and colleagues (1997) reported that not only mortality following MI was reduced by cardiologist's care, but also that these patients had a shorter length of hospital stay than those receiving care by primary care physicians. Both Thiemann et al and Chen et al in this year's New England Journal of Medicine also reported lower mortality following MI in higher volume hospitals or following admission to one of ``America's Best Hospitals'' for cardiology (as determined by U.S. News and World Report). Children requiring surgical repair of congenital heart defects face a much lower risk of death when operated on in a hospital that performs more than 300 similar surgical procedures annually (Jinkins et al, 1995). Hannan and colleagues (1992) reported the identical relationship between hospital volume and mortality following abdominal aortic aneurysm surgery. Cancer surgery frequently involves complex procedures which require special expertise. Accordingly, a number of studies have examined volume-outcome relationships following complex surgical oncologic procedures. Begg and colleagues (1998) analyzed the case reports of 5013 patients in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database including patients who underwent pancreatectomy, esophagectomy, pneumonectomy, liver resection or pelvic exenteration for cancers of the pancreas, esophagus, lung, colon, rectum and genitourinary tract. Higher hospital volume was associated with lower mortality for all surgical procedures except for pneumonectomy. The most striking results were for esophagectomy and for pancreatectomy where operative mortality rose from 3.4% to 17.3% and 5.8% to 12.9% respectively in low-volume vs. high- volume hospitals. The pancreatectomy results were reproduced this year by Simunovic et al. (1999). It has been suggested that national referral centers be developed for pancreaticoduodenectomy, also known as the Whipple procedure. Hospital volume was found to strongly influence both perioperative risk and long-term survival following the Whipple procedure as reported by Birkmeyer and colleagues (1999). The relationship between hospital volume and outcome of hepatic resection for hepatocellular carcinoma were analyzed by Choti et al (1998) and Glasgow et al (1999). The mortality rate rose from 1.5% to 7.9% in procedures performed in high volume vs. low volume hospitals. Moreover, Glasgow reported that three quarters of patients with liver cancer were treated at low volume hospitals with a record of 3 or fewer hepatic resections per year. The identical volume-outcome relationships have been reported for renal diseases. The Agency of Health Care Policy and Research recently sponsored a study regarding referrals and specialty care within the Medicare system. Avon (1999), reported that when patients with renal failure received late referral to a kidney specialist (nephrologist), their risk of death was 33% higher. Pediatric renal transplantation has also been scrutinized for volume-outcome relationships. Schurman and colleagues (1999) reported superior survival of the transplanted kidney in high volume centers performing more than 100 transplants annually. Research supporting a strong relationship between high hospital/physician volumes and improved patient outcomes spans two decades and multiple medical specialties. Both medical and surgical care at institutions with lower levels of experience clearly increases the risk of poorer outcomes including death, in a diverse range of medical conditions. A review of the literature demonstrates that there is strong evidence to support the development and implementation of Centers of Excellence for a range of medical and surgical conditions. Reference List Avon J, Impact of Specialty Care on Mortality in End-Stage Renal Disease. Presented at Primary Care Referrals and Specialty Care: New Findings on September 13, 1999, Agency for Health Care Policy and Research. Begg CB, Cramer LD, Hoskins WJ, Brennan MF, Impact of Hospital Volume on Operative Mortality for Major Cancer Surgery, JAMA 1998; 280:1747-51. Birkmeyer JD, Finlayson SR, Tosteson AN, Sharp SM, Warshaw AL, Fisher ES, Effect of Hospital Volume on In-hospital Mortality with Pancreaticoduodenectomy, Surgery 1999; 125:205-6. Birkmeyer JD, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN, Relationship between Hospital Volume and Late Survival after Pancreaticoduodenectomy, Surgery 1999; 126:178-83. Cameron DE, Stinson DC, Greene PS, Gardner TJ, Surgical Standby for Percutaneous Transluminal Coronary Angioplasty: a Survey of Patterns of Practice, Ann Thorac Surg 1990; 50:35- 9. Casale PN, Jones JL, Wolf FE, Pei Y, Eby LM, Patients Treated by Cardiologists have a Lower In-hospital Mortality for Acute Myocardial Infarction, J Am Coll Cardiol 1998; 32:885-9. Chen J, Radford MJ, Wang Y, Marciniak TA, Krumholz HM, Do ``America's Best Hospitals'' Perform Better for Acute Myocardial Infarction? N Engl J Med 1999; 340:286-92. Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzman JV, Cameron JL, Gordon TA, Should Hepatic Resections be Performed at High-Volume Referral Centers?, J Gastrointest Surg 1998; 2:11-20. Ellis SG, Weintraub W, Holmes D, Shaw R, Block PC, King SB, Relation of Operator Volume and Experience to Procedural Outcome of Percutaneous Coronary Revascularization at Hospitals with High Interventional Volumes, Circulation 1997; 95:2479-84. Glasgow RE, Showstack JA, Katz PP, Corvera CU, Warren RS, Mulvihill SJ, The Relationship between Hospital Volume and Outcomes of Hepatic Resection for Hepatocellular Carcinoma, Arch Surg 1999; 134:30-5. Hannan EL, Kilburn H, O'Donnell JF, Bernard HR, Shields EP, Lindsey ML, Yazici A, A Longitudinal Analysis of the Relationship between In-hospital Mortality in New York State and the Volume of Abdominal Aortic Aneurysm Surgeries Performed, Health Serv Res 1992, 27:517-42. Hannan EL, Racz M, Ryan TJ, McCallister BD, Johnson LW, Arani DT, Guerci AD, Sosa J, Topol EJ, Coronary Angioplasty Volume-Outcome Relationships for Hospitals and Cardiologists,

Mr. STARK

Mr. STARK. Mr. Speaker, I rise to address the issue of quality improvements in our nation's child care centers. As a member of the House Ways and Means Subcommittee on Human Resources with jurisdiction over the federal welfare system, I voted against the 1996 overhaul of our welfare system because of the dangerous effect it would have on the health and well-being of children and families in our country. Congress was warned by advocates for low-income and poor families that without the proper work supports--health care, food assistance, and child care services--welfare reform's efforts to push mothers into low-paying, low-skill jobs could not succeed. Now as more and more families with children are forced to send both parents (or the only parent) to work, the absence of child care hampers the ability of mothers to successfully make that move. Families are stuck between a rock and a hard place. Child care is in short supply, is too expensive for many families to afford, and often is of poor quality. When families try to get child care, they encounter long waiting lists--even for crummy programs--or the care available is unaffordable. The message to low-income families is that they must take any care they can get. More often than not, parents end up patching together a number of child care arrangements and go through the day anxious that part of the child care chain will fail. Many mothers are reporting that the child care assigned to them by welfare caseworkers would place their children in a low-quality setting that would make them susceptible to physical harm and do little to prepare children for school. Working parents need to feel secure about the arrangements they've made for their children during work hours, because the quality of care children receive can make a difference in parents' ability to work. Evaluations of GAIN, the job-training program for welfare recipients in California, found that mothers on welfare who were worried about the safety of their children and who did not trust their providers were twice as likely to subsequently drop out of the job-training program. We must increase both the quantity and the quality of the care offered. My bill, the Child Care Quality Improvement Act (H.R. 2175), promotes quality child care by providing incentive grants to states to help them set and meet long-term child care quality goals. My bill would base a state's eligibility for future funding on the progress made in increasing training for staff, enhancing licensing standards, reducing the number of unlicensed facilities, increasing monitoring and enforcement, reducing caregiver turnover, and promoting higher levels of accreditation. Congress has wrongly refused to require significant quality standards for the billions in child care dollars we allocate each year. The federal government should give states the resources to improve child care quality at the local level, but only through a system of measurable indicators of desired outcomes. As the father of a young son, I know the difficulty families face when searching for a caregiver for their children. I believe we must give families peace of mind by helping states provide the high quality of care every child deserves. We must not threaten a parent's chance at succeeding on the job and achieving self-sufficiency.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the gentleman for yielding me the time. Mr. Speaker, I would like to talk about the calendar and explain that Thanksgiving does not come until Thursday, a week, and the ``turkey'' that we are about to consider today is stuffed with a lot of horrendous gifts and failures. For example, stuffed away in this bill, unknown to many of my colleagues, is a gift of over $500 million a year to drug companies who have their pharmaceutical drugs exempted from certain protections under the Medicare bill. But at the same time we are giving $500 million a year to these pharmaceutical companies, members of the Committee on Ways and Means, all of them, all of the Republicans who were there voted to deny seniors a discount on their prescription drugs. That means that the gentleman from Arizona (Mr. Hayworth), the gentleman from Pennsylvania (Mr. English), the gentleman from Florida (Mr. Shaw), the gentleman from Florida (Mr. Foley), and the gentlewoman from Connecticut (Mrs. Johnson) all voted to deny the seniors in their district a discount on their prescription drugs, which would have cost the Federal Government not one penny. Yet, grandly, they are going to vote to give $500 million a year to the pharmaceutical companies. Now, this bill is not paid for. There is a $4 billion gift to the medical providers. Yet it shortens Medicare solvency and raises the Part B premium on all of our seniors by $12. At the same time, this bill has failed to give Medicaid to children of legal immigrants. Young children are denied medical care if they came to this country after 1996. Yet, we had a great gift to the Blue Cross/Blue Shield company by weakening quality control standards for managed care under Medicare. We weakened the standards when this same Congress has been unable to finalize the managed care bill of rights. We are doing nothing under the Republican leadership except giving big dollars to the pharmaceutical companies in exchange for their donations, giving big gifts to Blue Cross and for-profit managed care plans who are reaming our seniors. And yet, in the next bill to be considered, if this turkey that we will consider in the extenders happens to have a bowel movement, we are going to spend $40 million or $30 million a year turning the results of that activity into energy. I would suggest, if we are going to put up with all this Republican alchemy, why do we not ask these same poultry producers to turn that by-product into gold; and then they might find the $17 billion they cannot find to pay for in this bill and, so, it is going to come out of the Social Security trust fund. All in all, the gentleman from Texas (Mr. Frost) is correct. It is a bill we should not be voting on in the dark. Vote ``no'' on the rule and the bill.

Mr. STARK

Mr. STARK. Mr. Speaker, the DC Appropriations bill is the shell in which the Republican leadership has chosen to place the legislative kitchen sink, so the speak. This bill includes a myriad of provisions that have nothing to do with the District of Columbia--Interior Appropriations; Labor-HHS Appropriations; a Satellite Home Viewers Act; certain dairy provisions and, the bill about which I am here to speak today: The Medicare BBA Refinement Act. The Medicare BBA Refinement Act is a sweet and sour bill--it is has good features and bad features. First, the good features. The move toward prospective payment systems is continued. The arbitrary $1500 caps on rehabilitation services have been lifted for two years while we develop a better payment system. Medicare's coverage of immuno-suppressive drugs for transplant patients has been extended 8 months. Patients in hospital outpatient departments are protected against ever having to pay more than a single day's hospital deductible for the cost of the outpatient procedure. Today, patients face out-of-pockets costs $2000 to $3000 for certain outpatient procedures. Now, their costs will be limited to about $776. And, I want to commend Chairman Thomas for a bill which did not give away the future of Medicare. The lobbying pressures have been enormous. It would have been easy to bring forth a $30 or $40 billion bill. The bill is limited and generally--with some exceptions--directs its spending to the areas where there is the most evidence that some adjustment is needed. Nevertheless, I voted against the bill when it first passed the House, because it was not paid for-and thus shortened the life of the Medicare Trust Fund about a year, and increased beneficiary Part B premiums by at least 50 cents a month. It still is not paid for--and now reduces solvency by more than a year, and increases beneficiaries' costs by several billion dollars over the next five years, increasing premiums about a dollar a month. It spends about $16 billion of the Social Security surplus over the next five years, and $27 billion over ten years. It didn't need to be this way. In the $212 billion a year Medicare program, there is fraud, waste, and abuse, and we could have saved several billion a year to pay for the relief that some providers needed. I am most disappointed about the budget games that were played on the 5.7 percent hospital outpatient department issue--which is a $4 billion gift to hospitals. When the BBA passed, we meant to reduce payments to hospitals which had been shifting overhead costs to outpatient departments. It is the rankest Orwellian revisionist history to claim otherwise. But revisionist history is what has happened. So that neither the White House nor the Congress would be charged for the $4 billion gift, there has been an exchange of letters in which no one is `scored' for the cost of spending $4 billion more. It is like manna from heaven, a miracle for which no one is responsible and no one has to pay. Mr. Speaker, it is all phony, it is all a distortion of the budget process. The give-away to hospitals does cost money; $1 billion will come from seniors. Therefore, we should have been honest and paid for it. It is money that will not be available to save Medicare. It is money that comes out of the Social Security surplus. And that is the truth. Mr. Speaker, this kind of dishonest budget game destroys faith and trust in government. Its true cost is much more than the $4 billion gift to hospitals. There are other bad features. There is absolutely no hard proof that some of these providers need more money. In many cases, the Congress has just been rolled by lobbyists and major contributors. Standards for Medicare managed care plans have been weakened. We continue to grossly overpay HMOs. The HMO industry that we beat in the Patient Bill of Rights has crept in the backdoor of this bill to weaken consumer protections and receive $4 billion dollars in overpayments. I would vote no if this were a free-standing bill based on is merits alone. That decision is made even easier by the process used here today which compiled all of these unrelated, important bills into one gaint package in order to try to force members of Congress to vote yes. Well, that theory doesn't work on everyone. I vote no.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise with regret to oppose what is being called the ``Ticket to Work and Work Incentives Improvement Act Conference Report.'' This title would never pass the ``Truth in Labeling'' test if it were on a box of food, but you can get still away with such falsehoods here in Congress--especially in the waning hours of the session. The reason for my regret is that I have worked much of the year to encourage passage of the Work Incentives Improvement Act here in the House. This legislation is vitally important for disabled individuals. Our current system--which actively discourages disabled people from returning to the workforce--simply makes no sense. Allowing disabled people to maintain their health insurance through Medicare when they return to work is something that should have always been law, not something we are finally doing today. I support that component of this bill which we are here considering today. I am unhappy that it has been weakened from the version that originally passed the House. In that bill, we would have given disabled individuals the ability to keep their Medicare health insurance for 10 years, while the bill before us today only extends that coverage for 8\1/2\ years. But, there is no question that this would be a significant improvement from the status quo. However, there is much more to this bill than the title would suggest. Through late night negotiations, this bill changed. In addition to the provisions relating to the Work Incentive Improvement Act, the bill includes two completely unrelated provisions. The first of these is a 90-day moratorium preventing the Secretary of Health and Human Services from implementing a regulation to improve our organ allocation program in the U.S. Also included is a package of tax extenders that is not fully paid for. The moratorium on the organ allocation regulation is especially egregious. The regulation is a product of negotiations with the transplant community, patients, and the general public and ensures the sickest patients get organs first--instead of basing life and death decisions on geography. Republicans included this same 90-day delay of the HHS organ allocation regulations in legislation earlier this year. The President vetoed that bill and cited the organ allocation moratorium as ``a highly objectionable provision.'' After that veto, Congressional budget negotiators and the White House agreed to permit the HHS organ allocation rule to go into effect after a 42-day consultation period. Yet only a few days later, they have decided to renege on that agreement. Congress has already delayed the HHS rules for over a year-- permitting the Institute of Medicine (IoM) to study the current system. The IoM report strongly validates the HHS regulations by calling for broader sharing of organs and for HHS to exercise its ``legitimate oversight responsibilities.'' Twelve patients die every day while awaiting an organ transplant under the current system. The fact of the matter is this moratorium is a pork barrel project for members of Congress who either represent the federal contractor, or small transplant centers with poorer outcomes who stand to lose under the new regulations. The Secretary's regulation will save lives. This moratorium will cause people to die. Which side do you think is right? Just like every other bill the Republicans have tried to push through this Congress, the tax extender provisions in the bill give big tax breaks to big business. It includes tens of millions of rifle-shot give-aways to GE--certainly not one of the neediest taxpayers in this country. It also spends $13 billion to give corporations money for research. Most companies would conduct research on their own regardless of whether or not taxpayers foot the bill. Do you really think that corporations like Schering-Plough would have halted research for their highly profitable drug Claritin if Congress had denied a research tax credit? Companies must conduct research in order to create profits. They don't need tax incentives from Congress to make a profit. In addition, this bill throws money to the wind through the highly unsuccessful windmill tax credit. There are windmills up and down the highways of California in hopes that they might produce effective forms of electricity. Once again, we're extending $3 billion in tax breaks to energy companies so that they can continue pouring money into a lofty goal. Coupled with this tax break is one that will provide tax incentives to energy companies who can produce energy from poultry droppings. Why stop at energy? We should give them tax incentives to produce gold from chicken droppings! Because of these unrelated provisions that were snuck into an otherwise very worthy bill, I am forced to vote against this bill today.

Mr. STARK

Mr. STARK. Mr. Speaker, it is a national disgrace that 11.1 million children in the United States still do not have health insurance as we enter a new millennium. What we have done so far has not worked. Since 1996, the numbers and percentages of children without insurance have actually crept upward. They have not yet reached a statistically significant degree of increase, but we are moving in the wrong direction. The web of programs we pieced together in 1997, CHIP/Medicaid/ transitional Medicaid, are failing to get health insurance coverage to more children. We need to come back to this question, and find something that will work. America's children deserve health insurance. I have begun to develop a bill to address this problem, currently in a rough draft form, which is based on the idea that we need a simple and comprehensive solution: We want every child in America to have health insurance. Every child in America is issued a birth certificate and social security number at birth. Let's automatically enroll every child at birth into a Medicare-type program; call it ``MediKids.'' MedKids will be both an umbrella and a safety net for all of the other programs insuring our children, so that no child will ever fall through the enrollment cracks again, much less 11.1 million children. Our current approach places the burden on already disadvantaged parents. State and local enrollment and welfare workers are unable to determine which families match various programs--much less process pages of forms and documentation in order to enroll children in health insurance. Instead, I propose we do what's right, sensible, and directly accomplishes the goal of health insurance for all of our children: (1) Enroll every child in MediKids automatically at birth; and (2) allow parents who do have other choices for a child's health insurance to attach evidence of coverage to their tax forms, thus exempting themselves from the premiums used to finance MediKids. Children are relatively inexpensive to insure, but this program will have a budget impact. I am developing a plan for covering the costs of this program. Ultimately, however we pay for it, we must make the stand that some things are wotrh spending money on, particularly in this time of unprecedented, record-breaking economic growth. My staff and I will be refining this bill over the holiday recess. For example, we will want to adjust the MediKids program to cover the specific services which children need. As our work progresses, we will be posting our drafts on our website, http://www.house.gov/stark and we invite everyone to visit the site and offer their input. We plan to introduce this bill at the start of the next Congressional session--the first of the new millennium. I invited all of my colleagues, and everyone in America who cares about the health of our children, to join us in developing this idea, and to co-sponsor this important effort to get every millennium baby off to a good start.

Mr. STARK

Mr. STARK. Mr. Speaker, one of the good services in Medicare is the CORF (Comprehensive Outpatient Rehabilitation Facility) program, where beneficiaries recovering from an illness or operation can get a wide range of quality rehab services. Unfortunately, there appears to be a loophole in the law allowing the establishment of ``satellite'' CORFs. In this scheme, doctors are getting letters offering to rent part of their office for the placement of a therapist. The rent offered is often sight-unseen and is far above what is a reasonable rental rate. It is, in my opinion, a violation of the anti-kickback laws and is a way to get referrals that greatly drives up utilization and costs for Medicare. To stop this proliferation of services we never knew we needed, I am introducing a bill, with an effective date of today, to require that all CORF services be provided at one site. I submit a letter from the HCFA Deputy Administrator on this issue and on the steps Medicare is taking to avoid fraudulent utilization in this area. The Administration is to be commended for its efforts to prevent abuse in this area--but clarifying the law will also be helpful. Department of Health and Human Services, Health Care Financing Administration, Deputy Administrator Washington, DC, Oct. 27, 1999. Hon. Pete Stark, House of Representatives, Washington, DC. Dear Mr. Stark: Thank you for your letter to the Administrator regarding contracts being mailed to doctors to open uncertified mini-Comprehensive Outpatient Rehabilitation Facilities (CORFs) in physicians' offices. I am responding on her behalf, and I apologize for the delay in this response. You also stated that you earlier copied the Administrator on a letter you sent to the Department of Health and Human Services' (DHHS') Office of the Inspector General regarding this matter. You are requesting that the Administrator immediately put a halt to the proliferation of these ``satellite'' CORFs. I share your concern with the apparent proliferation of satellite CORFs. Based on the information furnished, the establishment of satellite facilities is consistent with section 1861(cc) of the Social Security Act (the Act). Section 1861(cc)(1) of the Act states that in the case of physical therapy (PT), occupational therapy (OT), and speech pathology (SP) services there shall be no requirement that the item or service be furnished at any single, fixed location. All other CORF services must be provided at the site of the CORF approved for Medicare participation. It should be noted that although the Act exempts these services from the single, fixed location requirement, it does not exempt them from any of the other CORF requirements. Since the CORF must make documentation available to the state survey agency surveyor demonstrating that it furnishes all services in compliance with the CORF requirements, we would expect the documentation at the CORF for services furnished off-site would not be unlike that for services furnished at the CORF. Also, state survey agencies are not precluded from making visits to the off-site locations as necessary, to ensure that the CORF requirements are met. Recently, a briefing on CORFs and outpatient rehabilitation facilities was held for Kevin Thurm, Deputy Secretary of DHHS. I presented the Health Care Financing Administration' (HCFA's) program integrity action plan based on analysis we had initiated with the HCFA Miami Satellite Office. The plan includes intensified medical review in targeted areas, education of providers and fiscal intermediaries, and increased reviews of off-site locations. I believe these interventions and the increased oversight will curb inappropriate growth of the providers until HCFA is granted statutory authority to require that PT, OT, or SP be furnished at a single, fixed location. Thank you for your interest in this matter. Sincerely, Michael M. Hash, Deputy Administrator.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to pay tribute to my good friend I. Michael Heyman. As his friends and colleagues gather to honor his retirement from the Smithsonian Institute and his years of service to the University of California Berkeley, I would like to share with the House some of the highlights of Secretary Heyman's distinguished career. I. Michael Heyman became the 10th secretary of the Smithsonian Institution on Sept. 19, 1994. He heads a complex of 16 museums and galleries and the National Zoological Park, as well as scientific and cultural research facilities in 10 states and the Republic of Panama. Secretary Heyman served as chancellor of the University of California at Berkeley from 1980 to 1990. He began his career at Berkeley in 1959 as an acting professor of law and became a full professor in 1961. His distinguished teaching career has included service as a visiting professor of law at Yale (1963-1964) and at Stanford (1971-1972). A strong leader and active fundraiser, he strengthened Berkeley's biosciences departments and successfully promoted ethnic diversification of the undergraduate student body while maintaining high academic standards. The university maintains several large museums and, as chancellor, he actively participated in their supervision. His distinguished career includes serving as counselor to Secretary of the Interior Bruce Babbit and as deputy assistant secretary for policy at the Department of the Interior from 1993 to 1994. He is also a member of the state bars of California and New York. Born on May 30, 1930, in New York City, I. Michael Heyman was educated at Dartmouth College, earning a bachelor's degree in government in 1951. After a year in Washington as a legislative assistant to Senator Irving M. Ives of New York, he served in the United States Marines as a first lieutenant on active duty from 1951 to 1953, and as a captain in the reserves from 1953 to 1958. Secretary Heyman received his juris doctor in 1956 from Yale University Law School, where he was editor of the Yale Law Journal. He was an associate with the firm of Carter, Ledyard and Milburn in New York City from 1956 to 1957. He was chief law clerk to Chief Justice Earl Warren from 1958 to 1959. Over the years, Secretary Heyman has served on and chaired numerous boards and commissions, including almost four years as a member of the Smithsonian's Board of Regents (1990-1994). He has dedicated more than a decade of service to Dartmouth, his alma mater, as a member of its board of trustees from 1982 to 1993 and as chairman of the board from 1991 to 1993. Heyman has also been a member of the board of trustees of the Lawyers' Committee for Civil Rights under Law since 1977. He is married to Therese Thau Heyman, senior curator on leave from the Oakland Museum in California. Their son, James, is a physicist and teacher. I join my California colleagues in gratitude and appreciation for Secretary Heyman's contributions to education, law, culture, and above all, public service. His is a career we can only hope others will emulate. We congratulate him on a successful and fulfilling professional life, and we wish him well.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to introduce a rule for a discharge petition to force Congress to consider a Medicare prescription drug benefit. The rule would bring H.R. 1495, the ``Access to Prescription Medications in Medicare Act of 1999,'' to the floor for debate and open amendments. My bill provides a new Medicare benefit for prescription drugs--with a $200 deductible, $1700 in new benefits, with a 20 percent co-pay and stop loss protection for beneficiaries who would otherwise spend more than $3000 out of pocket on prescription drugs. This attempt to get a bill considered in the House is a way to force Republicans to finally address the issue of access to affordable comprehensive prescription drugs for seniors. A number of my colleagues and I have offered proposals for a way out of the current predicament which is particularly unfair to seniors lacking prescription drug coverage. The President has put forth his own Medicare prescription drug proposal which has no new deductible, requires a 50 percent co-pay of $2000 in 2002, rising to $5000 in 2008, and no stop loss protection. The ``Prescription Drug Fairness for Seniors Act'' (H.R. 664) introduced by Representatives Allen et. al. also has tremendous support. While this legislation would not create a new Medicare drug benefit, it would extend discounts to seniors equivalent to the discounts obtained by other large purchasers. As a recent Families USA study makes painfully clear, the cost of prescription drugs has become unbearable for America's more than 14 million Medicare beneficiaries who cannot afford prescription drug coverage. The Families USA study finds that seniors, the last major insured consumer group without a prescription drug benefit, are paying prices that are rising four times faster than the rate of inflation. According to this well-researched study, these drug prices support profit margins for the makers of those drugs that averaged 20 percent, while the median margin for Fortune 500 companies is only 4.4 percent. These high prices are supplementing the already-inflated paychecks of those who work for the drug industry. Likewise, the minority staff of the House Government Reform Committee recently conducted a comparison of prescription drug prices in my district and dozens of other districts and found that seniors buying their drugs out-of-pocket are paying about twice as much as the drug companies' favored customers (such as large insurance companies and HMOs). For Zocor, a cholesterol-lowering medication taken by millions by Americans--myself included--the price differential between what a consumer would pay who has no drug insurance relative to the rate for large group health plans is a staggering 229 percent--$114.62 versus $34.80 for a bottle of 60 pills. At the same time, an article in last Sunday's Washington Post reported that the four area HMOs serving Medicare recipients in Washington, D.C. will limit prescription drug benefits beginning January 1st. This appears to be reflective of a national trend as many managed care companies sharply raise co-payments and cap drug coverage. For example, next year UnitedHealthcare will raise prescription drug co-payments from $20 to $90 for a 90-day mail order supply of a brand- name drug and Cigna plans to reduce its annual benefit for brand-name prescription drugs from $600 to $400, with a new limit of $100 per each quarter of the year. The public overwhelmingly recognizes the need to provide seniors with access to affordable drugs. According to a recent Harris poll, 90 percent of Democrats, 87 percent of liberals, and 80 percent of Republicans and conservatives support a Medicare drug benefit. In addition, 70 percent of those participating in a recent Discovery/ Newsweek poll ranked the high cost of prescription drugs as ``the most important problem with the health-care system.'' And in a survey undertaken to better understand the American public's concerns, last Sunday's Washington Post reported the fear that ``Elderly Americans won't be able to afford the prescription drugs they need'' as one of the top issues that worries Americans. So why, in light of the public's priorities, has there been a real reluctance for Republicans to move forward on the issue of Medicare prescription drug coverage this Congress? Last week, Republicans decided to bring the BBA Refinement Act to the House floor under suspension so that amendments could not be introduced--such as the one based on Representative Allen's drug discount proposal. This legislation would have given seniors a price discount on their prescription drugs and permitted beneficiaries to finally purchase medicines at a fair price--bringing an end to the drug companies' price discrimination. And recently, the Ways and Means Republicans all voted against that same amendment offered by my colleague, Representative Karen Thurman, to include a discounting provision in the BBA Refinement legislation. It is this lack of Republican responsiveness that is leading me to file the rule for a discharge petition to bring H.R. 1495 to the floor. There are a number of good proposals out there. Any and all of them would improve the current, deplorable state we are now in. I think we can all agree that the current situation is not working and that the most important step we can now take is to increase access to affordable prescription drugs for our nation's seniors.

Mr. STARK

Mr. STARK. Madam Speaker, the glaring absence of any financial privacy provisions for affiliated entities in the financial modernization bill before us today is a sorry mistake. It is wrong and inappropriate for Congress to, on the one hand, enact legislation that explicitly allows mergers between banks, insurers and securities firms--but which on the other hand denies consumers any say in how their personal financial information can be used and disclosed. I thought we learned this lesson 21 years ago, when Congress enacted the Right to Financial Privacy Act. That 1978 law, which I authored, put in place standards governing access and sharing of financial information for federal agencies. It stemmed from a Supreme Court decision that ruled the fourth amendment does not apply to banking records. As a former California banker, I had been a party in that 1974 suit, California Bankers Association v. Schultz. And here we are today, throwing open the door for financial institutions to create huge new holding companies--without giving consumers any ability to say how their sensitive personal financial information can be shared. In effect, we are creating a financial privacy vacuum. This runs counter to what we are trying to achieve in the area of medical confidentiality, where we are aiming to put the strongest possible safeguards in place at the Federal level, while preserving what is best about State privacy laws. In the next week or so, HHS will issue proposed regulations for medical privacy, which on balance are expected to be strong. If we can give consumers rights over their medical data, why can't we also give them a measure of control over how their financial data is used, marketed, and sold? Defenders of the conference agreement say that the bill limits sharing of personal financial data with non-affiliated, third-party entities. Nonsense. All that companies that don't formally affiliate have to do to escape the bill's consumers opt-out provision is enter into a joint agreement. Then, presto, they are free to manipulate personal financial data in any way they like. Nobody likes getting annoying calls from pesky telemarketers at dinnertime. Well, once this bill passes, the telemarketing business will go through the roof. Mergers between banks, securities firms and insurers will produce data amalgamation like we've never seen before. Before long, your health insurer will be able to get information on how money you make and what investment strategies you favor--making underwriting that much easier. Your bank will be able to easily look up how many checks you've written to your psychiatrist--and use that information to help decide whether you're an acceptable loan risk. This is the dawning of a new Orwellian Age of Information. I urge my colleagues to oppose this ill-conceived legislation.

Mr. STARK

Mr. STARK. Mr. Speaker, last Friday, the House passed an okay Medicare improvements bill. But it could have been much better; it could have helped seniors get a better price for pharmaceuticals; it could have helped low-income women fight cancer; it could have provided more help to providers hurt by excessive cuts in the 1997 Balanced Budget Act. But Republicans blocked any amendments to the bill--they did not want to be embrassed by having to vote against helping seniors with the high costs of drugs. Following is a letter which 119 Democrats (many more would have signed if we had had more time) sent to the Speaker, outlining our request for amendments to H.R. 3075. Mr. Speaker, the majority should be ashamed for a legislative gag rule that prevented us from improving this legislation. Congress of the United States, House of Representatives, Washington, DC, November 4, 1999. Hon. Dennis Hastert, Speaker of the U.S. House of Representatives, The Capital, Washington, DC. Dear Mr. Speaker: We are writing to ask that you not bring the Medicare Balanced Budget Act legislation (HR 3075 as amended in negotiations with Commerce Committee Republicans) to the floor under suspension of the rules, but instead provide a rule permitting Democratic amendments and a motion to recommit. Because Democrats were not included in the negotiations between the Ways and Means and Commerce Committee Republican members, it is particularly important that we be offered the opportunity for floor amendments. While the Republican bills that have been introduced provide a great deal of needed relief, we believe that (1) some additional relief to providers, (2) some beneficiary improvements (in particular help with the high cost of pharmaceuticals), and (3) some alternative policies are desperately needed. The amendments we propose would provide an additional $2.4 billion in paid-for relief, with some going to beneficiaries in lower pharmaceutical prices and other program improvements. Our amendments would also eliminate several policies in the Republican bill which the Administration has identified as unworkable or which would hurt Medicare beneficiaries. As fiscally responsible Democrats, we are concerned that the Republican bill is not paid for, and we urge you to find a way to pay for it, rather than further spending Social Security surpluses. For example, because it is not currently paid for, the Ways and Means bill (HR 3075) shortens the solvency of the Medicare Part A Trust Fund by at least a year, and increases Part B premiums for seniors. Therefore, to avoid this problem, we pay for the additional relief offered by our amendments. Thus we do not hurt Medicare's solvency. The $2.4 billion in relief over five years is paid for by $2.4 billion in Medicare savings from the President's budget proposal of last January. These savings come from Medicare anti-fraud, waste, and abuse proposals. Providing Needed Additional Relief The $2.4 billion provides important, much needed additional relief to --beneficiaries to meet the cost of fighting cancer and the high costs of pharmaceutical insurance \1\ --------------------------------------------------------------------------- \1\ We assume that the bill the Majority brings to the floor will include an expansion of Medicare's coverage of immuno- suppressive drugs, so that transplant patients do not suffer organ rejection. If this provision is not included, we ask permission to include it and pay for it with additional anti- fraud and abuse provisions. --------------------------------------------------------------------------- --teaching hospitals, --safety net hospitals, which have the lowest overall operating margins, --rural hospitals, which have the lowest Medicare margins, --skilled nursing homes, --home health agencies which are serving the sickest patients, --a more rational rehabilitation cap program that will help our most severely disabled stroke patients and amputees, --help for hospice agencies facing sky-rocketing pharmaceutical costs for end-of-life painkillers, and --the Medicaid and Children's Health Insurance Program, to help the providers serving the low income and to help Puerto Rico and the Possessions with more adequate payment rates. This additional relief will further ensure that Medicare beneficiaries are buffered from the cuts in the 1997 BBA and will allow Medicare beneficiaries to continue to receive high quality care. The attached memo describes these amendments in more detail. Help Seniors with the High Cost of Pharmaceuticals We believe we need to help all Medicare beneficiaries with a prescription drug insurance benefit, but that is a larger issue that cannot be addressed in this limited BBA corrections legislation. We hope, Mr. Speaker, that you will make this a priority issue for the Second Session of this Congress. In the meantime, we do believe that this bill gives us the one opportunity this year to help seniors with the exorbitant cost of prescription drugs. We propose an amendment which was offered in the Ways and Means Committee by Rep. Karen Thurman (and supported by all the Democratic members of the Committee) that makes the Allen-Turner-Waxman-Berry pharmaceutical discount bill (HR 664) germane to Medicare. Basically, the amendment says that if a drug manufacturer wants to sell pharmaceuticals to a hospital participating in Medicare, it must also make available to pharmacies for sale to seniors drugs at the best available price for which they offer that drug. By some estimates, this type of program could lower drug costs to seniors by as much as 40%. If we can't pass a major Medicare drug reform bill this fall, we can at least give seniors a chance for the discounts available to large buyers. Preventing Bad Policies If the Majority bill includes certain provisions, we ask that the rule governing debate permits us to strike those anti-beneficiary and anti-consumer provisions: Specifically, we are concerned that the Administration has warned that the hospital out-patient department (HOPD) provisions of the Ways and Means bill are so complicated that they will delay the start of HOPD Prospective Payment (PPS) by at least a year. Such a delay in the PPS will cost beneficiaries about $1.4 billion, with patients' share of total HOPD payments running about 50%. We would move to strike the House HOPD provisions in favor of the Senate's more administrable proposals, but keep the amount of relief to hospitals and patients at the House level. Second, if the Majority bill includes the `Commerce Republicans' provision giving ``deemed status'' to HMOs, we would strike that provision. An overwhelming number of House members have just voted in favor of higher quality in managed care plans. Therefore, we find it incredible that the majority may be proposing an amendment to the BBA which would weaken our ability to ensure quality by turning over approval of these plans to participate in Medicare to private groups which are often dominated by the very industry they are supposed to be regulating. If such `deemed status' language is included, we will seek to strike it in order to protect beneficiaries. Third, as mentioned above, we propose to strike the unworkable $1500 limit on rehabilitation caps for two years while the Secretary develops a rational therapy payment plan. This is the same approach as taken by the Senate Finance Committee. In conclusion, our beneficiaries and providers need the improvements made by the Democratic amendment. We urge you to make it in order. Thank you for your consideration. Sincerely, Neil Abercrombie, Gary Ackerman, Tom Allen, Robert Andrews, Tammy Baldwin, Tom Barrett, Jim Barcia, Xavier Becerra, Shelly Berkley, Howard Berman, Marion Berry, Bob Borski, Rick Boucher, Corrine Brown, Sherrod Brown, Lois Capps, Michael Capuano, John Conyers, Ben Cardin, Julia Carson, Bob Clement, Bill Coyne, Elijah Cummings, Danny Davis, Jim Davis. Peter DeFazio, Diane DeGette, Rosa DeLauro, Peter Deutsch, John D. Dingell, Julian Dixon, Lloyd Doggett, Eliot Engel, Anna G. Eshoo, Lane Evans, Eni Faleomavaega, Sam Farr, Michael Forbes, Bart Gordon, Gene Greene, Ralph Hall, Earl Hilliard, Maurice Hinchey, Darlene Hooley, Steny Hoyer, Paul Kanjorski, Carolyn Kilpatrick, Ron Klink, Dennis J. Kucinich, John LaFalce, Tom Lantos. Barbara Lee, Sandy Levin, John Lewis, Nita M. Lowey, Bill Luther, Karen McCarthy, Jim McDermott, Jim McGovern, Mike McNulty, Carolyn B. Maloney, Jim Maloney, Ed Markey, Matthew Martinez, Robert T. Matsui, Carrie Meek, Robert Menendez, George Miller, Joe Moakley, Jerry Nadler, Richard Neal, Eleanor Holmes Norton, Jim Oberstar, John Olver, Major Owens. Frank Pallone, Donald Payne, Nancy Pelosi, David Phelps, Earl Pomeroy, Nick Rahall, Charles Rangel, Lynn Rivers, Ciro Rodriguez, Carols Romero-Barcello, Lucille Roybal-Allard, Bobby Rush, Martin Sabo, Bernie Sanders, Tom Sawyer, Jan Schakowsky, Louise Slaughter, Vic Snyder. Debbie Stabenow, Peter Stark, Ted Strickland, Bart Stupak, Ellen Tauscher. Mike Thompson, Karen Thurman, John Tierney, Edolphus Towns, Jim Traficant, Peter Visclosky, Maxine Waters, Melvin Watt, Henry Waxman, Robert Wexler, Robert Weygand, Bob Wise, Lynn Woolsey, Al Wynn.

Mr. STARK

Mr. STARK. Madam Speaker, I rise in support of House Resolution 94, in recognition of the generous gift made by each living person who has donated a kidney to save a life. Of those approximately 63,000 Americans currently awaiting an organ transplant, almost two-thirds are in need of a kidney. Since 1989, more than 250,000 patients with kidney failure have died. However, with today's medical advances, living kidney transplantation has become a feasible treatment option for patients with end stage renal disease. Unfortunately, the number of people on the waiting list continues to grow more quickly than the number of organ donors. Research points to a clear need for incentive programs and public education to increase organ donation. To help encourage donations and to increase the number of organs available for potential donation, I introduced legislation this Congress, H.R. 941, the ``Gift of Life Congressional Medal Act of 1999.'' This bill would create a commemorative medal that honors organ donors and their families. We need to use every possible opportunity to increase the number of donated organs. This Act is intended to draw attention to this life- saving issue, and to send a clear message that donating one's organs is a selfless act that should receive the profound respect of our Nation. I hope Members would also consider this effort to increase donations. In addition to increasing the number of organ donors, it is important that we ensure our nation's organ allocation system is fair. Unfortunately, the current system relies more on geography than medical urgency. As a result, organs are offered first to people in a local, regional area and only when there are no local patients available is the organ offered to sicker patients on a broader level. This means that some of the most deserving of patients will not receive an organ solely because of where they live or where they undergo treatment-- which often times is a health plan's decision. In fact, patient outcome data recently released by the Department of Health and Human Services (HHS) suggest a patient's chances of getting a new heart or liver and surviving at least a year greatly varies depending on where the patient goes for a transplant. For example, at the University of Kansas Medical Center, 89% of people waiting for liver transplants received them within a year in the mid- 1990s, while at the University of Maryland in Baltimore, only 21% of patients received livers within a year. Depending on the transplant center, a patient's likelihood of dying within a year of listing for a liver transplant can range from 7% to 22%. A system that offers a level playing field to all patients no matter where they live is in everyone's best interest--medical urgency rather than geography should be the determining standard. Today, as we recognize the generous contribution made by each living kidney donor, we here in Congress need to be consistent in our message. While we're encouraging people to serve as organ donors, we also have Members introducing legislation that would harm organ donations and would permit geography to continue to serve as a barrier to organ allocation and transplantation. For example, the ``Organ Procurement and Transplantation Network Amendments of 1999'' (H.R. 2418) would remove HHS' legitimate authority to oversee the organ allocation program and would require HHS to rewrite its recently revised organ allocation regulations, while it simultaneously makes data less available to the public. If enacted, the transplant center performance data recently released by HHS would be unavailable to the public. This harmful legislation would set different allocation policies than recommended by the Institute of Medicine (IoM) and is probably unconstitutional in its delegation of power to a private contractor. Perhaps most disturbing, H.R. 2418 would provide unreasonable protections for The United Network for Organ Sharing (UNOS), the current private contractor in charge of disturbing organs procured for transplant. A recent Forbes magazine article characterized UNOS as ``the organ king: an outfit with life-and-death power over patients waiting for transplants'' which has ``evolved into a heavy-handed private fiefdom.'' This bill essentially gives UNOS a monopoly on the contract and the Forbes article provides even further evidence of the need to oppose legislation which protects this contractor. We are also currently facing a 90-day moratorium effort in the Labor- HHS Appropriations bill and just last Friday, legislation was introduced to delay the effective date of the HHS rule. This delay of the Secretary's organ allocation rule would keep the Administration from implementing the important, new HHS regulations, strongly supported by evidence from the IoM, and would lead to hundreds more needless deaths. The HHS organ allocation regulation attempts to move to a system based on medical necessity instead of geography with medical professionals making medical decisions about the best way to allocate the limited number of donated organs. The rule incorporates comments from the IoM, transplant community, patients, and the general public to ensure the neediest patients receive organs first--regardless of where they live. Further efforts to delay this rule are only causing needless deaths. In vetoing the DC-Labor-HHS appropriations bill last week, the President called the appropriations rider that would delay the implementation of HHS' final Organ Procurement and Transplantation rule for 90 days ``a highly objectionable provision.'' As the President stated: the HHS rule ``provides a more equitable system of treatment . . . its implementation would likely prevent the deaths of hundreds of Americans.'' I would hope that the President's strong opposition to the Appropriations bill's moratorium on the HHS transplant regulation will be honored by Congress. Let's increase the number of organ donors, make our organ allocation system fair, and bring an end to all the needless deaths. And let's be consistent in our message--vote for H. Res. 94 to recognize those who so generously give the gift of life. Vote against any effort to remove or delay the Secretary's legitimate oversight authority and to give a private contractor a monopoly over the nation's organ allocation program. And support a fairer allocation system that bases transplant decisions on common medical criteria and pure professional medical opinion and medical need--not geography.

Mr. STARK

Mr. STARK. Mr. Speaker, I ask unanimous consent to have my name removed as a cosponsor from H.R. 3073.

Mr. STARK

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, the gentleman from Rhode Island (Mr. Kennedy) said it quite eloquently. This bill is not paid for. It spends Social Security surplus, shortens the life of the Medicare trust fund, and does not deal with, as the committee had an opportunity to deal with, providing a discount, a discount of 25 to 50 percent off prescription drugs. I would remind people in the Florida area that the gentleman from Florida (Mr. Shaw) voted against people getting that discount on their prescription drugs at a time when the managed care plans in his area are reducing the prescription drug benefits to seniors, as did the gentleman from Pennsylvania (Mr. English), as did the gentleman from Arizona (Mr. Hayworth). They voted to deny seniors a savings of 25 to 50 percent at no cost to the Federal Government. They intend to support the pharmaceutical industry, whose huge political contributions are funding the Republican campaigns. Make no doubt about it, they yield to the big men and they will not help the seniors who are struggling every day to pay for the prescription drug benefits which the Republicans have repeatedly denied. They refused to have hearings, and they refused to vote for reasonable legislation. They are on the record. Let them deny it. Let them go home and explain to their seniors why they are being destituted because they cannot get prescription drugs at a reasonable price. Vote against the bill in protest.

Mr. STARK. Mr. Speaker, I yield such time as he may consume to the gentleman from Rhode Island (Mr. Kennedy). (Mr. KENNEDY of Rhode Island asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Florida (Mrs. Thurman), the author of the amendment, that would have given free or discounted prescription drugs, not free, free to the government, but a deduction or a reduction in the cost to the seniors. I would note, Mr. Speaker, that the previous speaker, the gentleman from Louisiana (Mr. McCrery), also voted to deny the seniors in his district a discount on prescription drugs at no cost to the government.