Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, noting that the gentlewoman from Washington (Ms. Dunn), the previous speaker, had joined with Messrs. English, Shaw, and Hayworth in voting to deny seniors a free drug benefit reduction, I yield 1\1/2\ minutes to the gentleman from Maryland (Mr. Cardin).

Mr. STARK. Mr. Speaker, noting that the gentlewoman from Connecticut (Mrs. Johnson) did not respond to the question of why she voted to deny seniors a medical drug benefit, I yield 1\1/2\ minutes to the gentleman from Wisconsin (Mr. Kleczka).

Mr. STARK. Mr. Speaker, I yield myself 30 seconds. I do so just to challenge my Republican colleagues who are afraid today that they would have to vote on a drug benefit, but to remind the public that the gentleman form Pennsylvania (Mr. English), the gentlewoman from Connecticut (Mrs. Johnson), the gentleman from Arizona (Mr. Hayworth), and the gentleman from Florida (Mr. Shaw), who are all sitting here voted to deny seniors in their districts a discount on prescription drugs at no cost to the Federal Government. I hope that they will explain to the seniors whose benefits are being reduced why they did that and why they are afraid to see it come up today and vote for it or against it in an up forward manner.

Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Washington (Mr. McDermott). (Mr. McDERMOTT asked and was given permission to revise and extend his remarks.)

Mr. STARK

Mr. STARK. Madam Speaker, I rise in opposition to the conference report on S. 900, the Financial Services Modernization Act. It is badly flawed on several counts. Rather than strengthening the Community Reinvestment Act, the conference report actually weakens this landmark regulation. For example, the bill limits CRA's oversight of 80% of the nation's banks by decreasing the frequency of exams from once every two years to once every five years for banks with at least a ``satisfactory'' rating. This ill-advised provision will undoubtedly induce small banks to game the CRA process. In fact, the National Community Reinvestment Coalition predicts that small banks ``will relax their CRA lending in underserved communities for four years, and then hustle to make loans in the last year before a `twice in a decade' CRA exam.'' The overall impact of the CRA provisions, then, is to weaken protections against discrimination and redlining by constraining the Community Reinvestment Act in an era when financial conglomerates will become ever more powerful. The Gramm-Leach-Bliley bill also raises troubling questions about the basic relationship between federal and state law in key areas. Supporters claim that the bill leaves state insurance law undisturbed. But in an October 13 letter, the National Association of Insurance Commissioners warned that the bill's broad, loose language will effectively permit banks to ``engage in high-risk reinsurance, claims settlement, credit insurance, third-party management services and other insurance business activities without being subject to supervision by either the States or the Federal government.'' NAIC's concerns focus on Section 104 of the conference report, which says that no state can ``prevent or restrict'' a bank's business activities. This language ``attacks the heart of State insurance regulation,'' NAIC writes, ``because every action taken by a State to protect consumers restricts the business activities of insurance providers--including banks--to some degree. The letter concludes with a grim prediction that ``virtually all State insurance regulatory actions affecting banks would thus be subject to legal challenge and possible preemption.'' Among the categories of state laws that may be preempted by S. 900, according to NAIC, are fair claims settlement laws covering consumers who purchase health, auto, homeowners, life, annuities, and other types of insurance.'' Concerns have also been raised about whether more protective state medical confidentiality laws are saved. Supporters say they are, but state insurance commissioners say that's not clear. Litigation is sure to follow, which will cost consumers plenty. In addition, the bill's privacy rules governing sharing of information within affiliated entities are astonishingly weak. The bill allows affiliates--banks, securities firms and insurers--to freely share financial information without the consumer's consent. Affiliates have only to disclose their basic rules once a year. The problems that this could create are severe. Financial institutions, looking at the bottom line, will use all of the information available to them before making lending decisions. Why, for example, would a bank that has a health insurance subsidiary not want to weigh medical information gleaned from financial data in considering mortgage applications? Will young families now have to worry that, having supplied medical information to apply for life or casualty insurance, that this data will affect their application for a home loan? 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, Calfornia 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. 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 consumer ``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 much 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 vote no on the Gramm-Leach-Bliley conference report.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize California State University-Hayward Professor Julie Glass, who has been chosen by the Carnegie Foundation as California Professor of the Year. Dr. Glass hosts a cable television program devoted to college algebra, has authored math-oriented children's books, and is co-founder of a math and science day camp for school-age girls. The Carnegie Foundation, a policy center devoted to strengthening America's schools and colleges, and the Council for Advancement and Support of Education (CASE) which represents 2,900 colleges, universities and independent elementary and secondary schools recently joined to select 44 state winners. Dr. Glass was selected from among 20 nominees at universities throughout California. Among Dr. Glass' most visible contributions to Cal State-Hayward are the two programs she has developed for the university CableNet television station, which reaches 120,000 East Bay households. The first, Math on TV, was a video course that ran 2 years ago which targeted high school students preparing for mathematics placement exams. The second program developed by Dr. Glass is College Algebra, which can be viewed on CableNet, Channel 26 in the Hayward area. The course is offered for college credit, and has an Internet component that allows students to interact with the instructor. Among other projects, Dr. Glass has co-developed the Mathematical Explorations for Girls' Achievement Camp, a summer enrichment program to encourage girls ages 10-12 to pursue an advanced education in mathematics and science. Program participants have traveled to a wastewater treatment plant and the NASA Ames Center to learn more about career opportunities in these fields. Dr. Glass also has several children's books with mathematical themes to her credit, and helps to train Cal State-Hayward student interns to work with students from local high schools on their math skills. We thank Dr. Glass for all she has done to promote proficiency in mathematics and science, and for inspiring young people who would otherwise not consider a career in these fields. We are extremely fortunate for educators who encourage students to become independent thinkers, and help students build the skills they need to participate in the global, technological economy. We are very grateful for a professor who makes it her life's work to prepare our children to be productive adults. We send Julie Glass our warmest congratulations and thanks.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in opposition to the DC/Labor- HHS bill's 3-month moratorium on the Secretary of Health and Human Services (HHS) organ allocation regulations which the President yesterday cited in his veto message as a highly objectionable provision. I also rise today in objection to the Organ Procurement and Transplantation Network Amendments of 1999 (H.R. 2418)--a bill to amend and reauthorize the National Organ Transplant Act of 1984. Over 63,000 Americans are currently awaiting an organ transplant. Almost 5,000 people die each year in this country waiting for an organ transplant. Unfortunately, the current system is based on geographic boundaries--so that while a patient in one State may wait 21 days for an organ transplant, a patient in another State may wait an average of over 300 days. The HHS organ allocation regulation attempts to move to a system based on medical necessity instead of geography. As the President stated yesterday: ``This rule, which was strongly validated by an Institute of Medicine (IoM) report, provides a more equitable system of treatment . . . its implementation would likely prevent the deaths of hundreds of Americans.'' The HHS regulation incorporates comments from the transplant community, patients, and the general public to ensure the neediest patients receive organs first--regardless of where they live. However, the DC/Labor-HHS bill delays the HHS Secretary's organ allocation rules. The current 90-day moratorium may not sound like a lot of time--but to patients awaiting transplants, every day counts. Furthermore, during those 3 months, much can be accomplished by those who oppose the Secretary's regulation. For example, the Organ Procurement and Transplantation Network Amendments of 1999 (H.R. 2418) could reach the House floor. H.R. 2418 would render moot the recently revised HHS organ allocation regulations. Further, the bill would remove the Secretary's legitimate authority to oversee the program, provide unreasonable protections for the current contractor, while it simultaneously makes data less available to the public. The United Network for Organ Sharing (UNOS) is the current private contractor in charge of distributing organs procured for transplant. H.R. 2418 essentially gives UNOS a monopoly on the contract. I am submitting the following article from the most recent issue of Forbes magazine as further evidence of the need to oppose legislation which protects the current contractor and of the imperative need to oppose any delay of the HHS organ allocation regulation: [ From Forbes Magazine, Nov. 1, 1999] The Organ King (By Brigid McMenamin) Ever since Forbes exposed the federal monopoly that's chilling the supply of transplantable organs and letting Americans who need them die needlessly (Forbes, Mar. 11, 1996), Health & Human Services Secretary Donna Shalala has been trying to challenge the way United Network for Organ Sharing operates. But the Richmond, Va.-based cartel will have none of it. Using a heavy-handed mix of litigation, lobbying and bullying of its opponents, UNOS has solidified its position as the federal contractor in charge of deciding which people get new kidneys, livers or hearts. Under the UNOS system, most organs are shared only within 62 regional territories. A potential recipient in, say, New York, where donations are low, can expect to wait months for an organ to show up, even though there may be so many donors across the river in New Jersey that New Jersey patients are getting transplants after short waits or when they are far from desperate. Though UNOS has begun to relax the locals-first policy, still, last year 4,855 Americans died while waiting for transplants. (This doesn't even count people pulled off the list after they became too sick to handle a transplant.) It is a matter of debate how much lower the number of deaths would be if the system for obtaining and allocating organs were more rational. But Consad, a research outfit in Pittsburgh, estimates that at least 1,000 people die needlessly each year. When Shalala urged that organs be shared over wider regions, UNOS Executive Director Walter K. Graham refused. He decreed, in a memo to his member hospitals and organ banks, that UNOS doesn't have to take direction from the federal government on this point. UNOS' main source of funding is the $375 registration fee potential organ recipients must pay to get on the waiting list. That amounts to some $13 million a year, money that is supposed to be spent mostly to match organs with suitable recipients. In reality, at best half of the money goes to that. What about the rest? Graham and his 40 board members spend some $1 million each year on jetting around and on meetings and conferences. A new $7 million headquarters building is planned. In 1997, some $1.6 million went for items network officials refuse to explain. ``They really never tell you what they're spending money on,'' says veteran board member John Fung, a liver surgeon at the University of Pittsburgh. When Shalala tried to exert more control over the rising registration fees, Graham challenged her in a proceeding before the U.S. General Accounting Office, claiming she had no right even to know how he spent the fees. The suit was settled; Shalala backed down. Why not simply bring in another contractor to ration organs? Good luck. The congressional committee in charge of such matters is headed by Representative Thomas Bliley, from UNOS' home city of Richmond. His cousin Paul S. Bliley is a law partner of UNOS lawyer Malcolm E. (Dick) Ritsch. Last fall, then-Louisiana Congressman Robert Livingston, whose home state includes eight profitable transplant centers, pushed through a bill halting further attempts by Shalala to control the contractor. After the Senate rejected this moratorium, Livingston got it tacked onto another bill behind closed doors by threatening to hold up funding for the International Monetary Fund. The moratorium ends Oct. 21. But UNOS has already had Wisconsin Congressman David Obey tack another one-year extension onto a bill that was set to go to the full House for a vote in October. His state's four transplant centers stand to lose organs if UNOS loses its grip. Craig Howe, executive director of the National Marrow Donor Program, recently expressed interest in having his organization bid on the organ contract. After UNOS found out he was interested, his board members, who include 14 physicians, axed him. Although some powerful and prominent surgeons like Fung are an exception, most doctors involved in the business fear offending UNOS lest their organ supply be affected. In another instance FORBES is aware of, UNOS threatened to retaliate against an outfit it perceived as a rival bidder for the organ allocation job. Tax-exempt groups like UNOS are supposed to make their financial statements available for public perusal. But UNOS hides significant activity behind two little-known affiliates that aren't required to disclose anything. The first is the UNOS Foundation, a six-year-old shadow organization run by UNOS staffers. Spokesman Robert Spieldenner claims the foundation doesn't have to file tax returns because it brings in less than $25,000 a year. The UNOS Foundation owns something called the Transplant Informatics Institute, a for-profit company run by organ network staffers. Transplants Informatics is so secret that even some UNOS board members are unaware that it exists. What does the institute do? The government thinks it markets UNOS-developed software to organ network members. In an audit looking into the use of registration fees for lobbying, the Office of the Inspector General got just that impression. What the institute really does is analyze and sell organ network data to profit-making companies like Fujisawa, the Japanese firm that sells drugs for transplant patients. When the institute has not been able to cover its costs with such sales, UNOS has used its registration fee income to make up the difference. Prospective organ recipients are therefore effectively funding this hidden business. You'd think someone on UNOS' board would scream bloody murder about all this. After all, the 40-person board is almost half doctors, dedicated to saving lives. But the directors have little idea what's going on. ``The board is kind of in the dark,'' sighs patient advocate Charles Fiske, a former board member. ``We received an annual financial report and pretty much accepted it as written,'' says University of Oklahoma transplant doctor Larry R. Pennington, a board member from 1996 to 1998. They really don't know how to interpret the data. ``All I'm familiar with is hospital sort of activity,'' admits transplant physician William Harmon. Realizing that UNOS is out of control, Shalala has put out feelers for a replacement. ``I hope we have some bidders this time,'' sighs Claude Fox, a pediatrician who, as administrator of the Health Resources & Services Administration, oversees transplants for Shalala. The only prospect so far is Santa Monica-based Rand. Determined to see that Rand does not walk off with the contract, UNOS' lobbyists are pushing for a law that would insure that Graham's group will keep the contract forever. Last month Bliley's committee held hearings on a bill which would require the organ rationing contractor to have experience, something no group but UNOS has. It would also allow UNOS' members to vote on the choice. ``Anything that gives them more of a stranglehold isn't in the public interest,'' says Fox. ``It's like giving the EPA to some land-fill company,'' says Dr. Fung. It would be nice if UNOS didn't have a lock on this business. Better still if the federal government stepped out of the process altogether and let doctors come up with creative ways to increase the supply of organs. (How about giving people who sign up as potential donors when they are young some priority in getting organs when they are older?) Once there are enough hearts and livers to go around, there won't be unaccountable arbiters holding sway over our lives.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased that we will finally be going to conference for managed care reform. We passed this bill nearly a month ago and I don't understand why it has taken so long to get to this point. My hunch is that the main reason is that by holding this motion to go to conference until this late date, the Republican leadership will be able to delay any actual convening of the conference until the next Congress. Nonetheless, this action is an important step forward in our continued effort to protect consumers in managed care plans. Last month, the U.S. House of Representatives passed H.R. 2723, The Bipartisan Consensus Managed Care Reform Act, by a decisive bipartisan margin of 275-151. That same day, the House soundly rejected three other more limited approaches to managed care reform. The House bill is much stronger than its Senate counterpart. It applies to all private health plans unlike the Senate bill which is mostly limited to the 40 million Americans in self-insured plans. The external appeal provisions in the House bill are much stronger. And, most importantly, the House bill also includes health plan liability--a provision sorely lacking in the Senate version of the legislation. Health plan liability is a vital component of meaningful managed care reform. Only the threat of legal consequences will be strong enough to ensure the enforcement of these managed care consumer protections. It must be included in the final bill approved by Congress or we will have failed in our duty to protect consumers in managed care plans. To that end, the Conference should report a bill that closely mirrors that passed by the House in the form of H.R. 2723, The Bipartisan Consensus Managed Care Reform Act. It is also important that the final product be paid for. During the House consideration of the legislation, the sponsors of H.R. 2723 went to the Rules Committee to bring the bill to the House floor fully financed. We were forbidden by the Republican leadership from bringing our bill to the floor fully paid for--and likewise prevented from offering an amendment on the floor that provided such funding. The conference must rectify that problem. We have offsets for the costs-- they must be included in the final product. The Republican leadership also played games by adding a number of costly tax provisions to the package which they billed as new ``access'' provisions. In fact, there is precious little evidence that those provisions would expand insurance coverage. Instead, there is definite Congressional Budget Office evidence that those provisions would cost the taxpayers some $48 billion over the next ten years. The Conference should drop these provisions which do nothing to expand coverage and therefore needlessly increase the federal price tag of this otherwise very affordable, sensible legislation. As a Conferee, you can be sure that this will be my agenda: the final product should closely mirror H.R. 2723, it should be fully financed, and the costly, ineffective provisions of H.R. 2990 should be dropped. I hope that is an agenda we can all pursue. Managed care reform should no longer be a partisan issue. The bill passed by this House was a consensus package with broad-based bipartisan support within the House and the support of more than 300 organizations representing consumers, doctors, nurses, other health care providers, public health advocates. Let's take our consensus bill and make it law. I look forward to working with my colleagues to achieve this important goal. Let's get to work. General Leave

Mr. STARK. Mr. Speaker, I thank the distinguished gentleman for yielding me time. Mr. Speaker, I am pleased that we are going to conference for the managed care reform bill. It is clearly the wish of the majority that the House bill as passed be enacted into law. Under the rules of the House, the Speaker is directed to appoint Members, and no less than a majority who generally supported the House position, as determined by the Speaker. It is quite clear what the House position was. The conferees have not been appointed according, to my understanding, to that rule, and that does in fact necessitate our insisting that we hold to the position of the House. That is what you do in a democracy. The winner's position is the law and people should obey it. The public wants this. They have spoken. Whatever the Senate or the other body may have or have not done is not our issue. We are here to see that we fulfill the wishes of the vast majority of this body representing the vast majority of Americans, I believe it is close to 80 percent, who favor the strongest possible managed care control bill. The distinguished authors of this bill have done that, the House has worked its will, and it is our job to carry it out. It is my hope that the leadership will not frustrate this by slowing down, stalling, postponing the conference in other procedural moves, which is their prerogative. But I suggest they do so and they will incur the wrath of many Americans who are denied adequate and fair treatment from many managed care plans. They are the people who will be the losers if we do not insist on the House position and see that it prevails.

Mr. STARK

Mr. STARK. Mr. Speaker, the circumstances under which we are considering this bill are rotten: Because other appropriators have raided Labor/HHS for money to pad their proposals, this D.C./Labor HHS bill contains a variety of budget gimmicks that shift billions in spending into fiscal year 2001. Such gimmicks will negatively impact many worthy programs, including delays in critical biomedical research projects funded by the National Institutes of Health. But these forward funding gimmicks are not even the bill's biggest flaw. The Labor/HHS proposal deserves to fail because it harms programs that are critical to the well-being of Americans across the country. Simply stated, it's a rotten bill. Look at what we're being asked to approve: A 1-percent across-the- board cut in every program in the federal budget. Such crude, desperate budgetary tactics will result in decreasing vital federal funding for new community police officers, after-school services to children, worker protection programs funded by the Department of Labor, and childhood immunization programs. All of these and many more programs will be damaged. For seniors, the impact will be particularly severe. This bill cuts funding for nursing home survey and certification programs--reversing the increases of last year. It proposes to cut the operating budget for the Health Care Financing Administration, which needs far more then it is slated to receive to do an effective job in administering Medicare and Medicaid. If we continue to slash HCFA's administrative budget--which today stands at only 2 percent of the entire agency's budget--then we will have only ourselves to blame when HHS comes back next year to report that they are months behind in implementing initiatives that we directed them to accomplish. It is particularly sad and ironic that House appropriators are proposing to reduce spending for nursing home surveys. Have they not heard about the many General Accounting Office reports that detail appalling conditions in our long-term care facilities? In California, which I represent, GAO found that one in three nursing homes between 1995 and 1998 were cited by state surveyors for having serious or potentially life threatening care problems. The year-old federal/state initiative spearheaded by the HCFA to stem nursing home abuse has just begun to yield important findings. These findings didn't appear magically. They came about because last year, we voted to approve increased funding for additional state inspectors, who are now visiting more facilities more often--and on an unscheduled basis. This stepped-up scrutiny is showing where the worst quality flaws are in nursing homes generally, and which individual homes are actually harming people. The bill before us proposes to reverse these gains--and to put frail nursing home residents at serious risk again. As one frustrated HCFA official said to me: `You can't possibly give states money one year to hire more inspectors, and then take it away the next year and expect to make any progress.' It is equally wrongheaded to bleed funds from the government's primary health care fraud-fighting initiative, the Medicare Integrity Program. Congress crafted this program in 1996 so that it would be funded from mandatory spending accounts, precisely so that it would not be subject to the appropriations process. The whole notion was to try to create a secure, stable source of funding. This bill effectively proposes to unravel the Medicare Integrity Program, which the Congressional Budget Office has credited with producing an actual drop in Medicare spending of 2.5 percent last year. There is another huge problem with this bill--and that is that it delays HHS regulations that would reform our current organ allocation system to better serve the neediest--regardless of where they live. At present, our locally based systems mean that patients with terminal diseases in some parts of the country have a good chance of getting an organ transplant, while equally--and sometimes more--needy and deserving people in other states, where allocation systems are poorly developed, have no chance at all. The Institute of Medicine has issued a report that criticizes our current unfair system of organ allocation, and which recommends policy that is very similar to what the Secretary's regulations would do. I urge my colleagues to listen to these medical experts, to patients and to transplant advocates, and to support reform of our current skewed system. For all of these reasons, I urge my colleagues to vote ``no'' on the Labor/HHS bill.

Mr. STARK

Mr. STARK. Mr. Speaker, this Congressional Resolution is stupid. It is a truly a type of ``con''--designed to make a political statement without any real thought for the future. Between now and 2030, the number of Americans on Medicare will double, from 39 million to about 80 million. How will we pay for the retirement and health of the Baby Boomers. We can cut benefits in half as the number of enrollees doubles, thus holding spending fairly steady. But that would mean just transferring costs to people in their old age and when they are sick. We can cut what we pay doctors and hospitals in half, but who would then provide quality care to seniors? Or we could consider some tax increases. Actually, to save Medicare will take a combination of the three options I have just listed. To pass a Resolution like this to take one of those options off the table. Do we really want to do that? Instead of having an intelligent debate on how to provide for our citizens in the future, this Congress is just passing solgans--solgans which if taken literally would destroy our ability to meet the future needs of the Nation. That's why I'm voting ``no'' today.

Mr. STARK

Mr. STARK. Mr. Speaker, this bill is a vitally important for disabled people in our country. It will finally make changes to the disability system that will assist beneficiaries' desires to return to or enter the workforce. This should have been done years ago--and we should be doing more now. That being said, there is no question that this bill is a tremendous improvement from the status quo. The most significant component of this legislation is that it will provide disabled people with the ability to maintain their Medicare coverage for ten years after returning to work. Under current law, a disabled beneficiary who returns to work loses Medicare coverage after 4 years. That reality keeps people from even thinking about entering the workforce because losing disability status is not an easy thing to reverse. Maintaining health insurance is a priority for anyone, but for someone who is disabled, health insurance coverage is a lifeline they cannot afford to mess around with. Stretching that Medicare eligibility time period to 10 years is a giant step forward. Of course, the real solution is making Medicare coverage permanent for a disabled person regardless of work status. I wish we were voting on that full provision today and I will certainly continue working toward that goal. It is also worth noting that the process for this bill reaching the House floor has been horrendous. The Republicans have continued to play political games with this legislation every step of the way. Until just before this debate began, we weren't even sure if this bill would contain important Medicaid components that were in both the Senate-passed version of the legislation and the House Commerce Committee bill. Those two provisions directly appropriate funds for grants to states to establish support services for working individuals with disabilities and funds for demonstration projects to the states to extend Medicaid coverage to a wider group of workers with potentially severe disabilities. Those two Medicaid improvements are very important--they expand the number of people helped by this legislation and they are both strongly supported by the disability community. I am pleased that the bill before us today does now include those key provisions, but it has been a struggle to make sure that was the case. The Senate passed their version of this legislation unanimously more than 4 months ago. I don't understand why it's taken 4 months for the House to act, but I am glad this day is finally here. Let's pass this bill, get to conference, and enact this law which will finally correct a serious problem in our disability system by empowering disabled people to enter the workforce without fear of losing their health coverage.

Mr. STARK

Mr. STARK. Mr. Speaker, this bill is nothing more than a cheap shot attempt to embarrass the President by getting Congress to vote against provisions included in his budget. If that were all it was, that would be bad enough. But, the effect of the legislation is far worse. This bill puts Congress on record voting against user fees as a source for funding Medicare's administrative costs. At the very same time, the Republican's Labor-HHS bill guts Medicare's administrative budget by cutting more than 18 percent--or $400 million--out of it. Medicare needs to have its administrative budget funded in order to carry out vital tasks that impact people's lives. The Republican's Labor-HHS bill would cut in half the budget needed to inspect nursing homes and hospitals. That means that people will die--literally die--in poor quality nursing homes and hospitals across the country. So, the message delivered by this bill today is that we will not support user fees. The next message from Labor-HHS will be that Congress will not fund Medicare's administrative budget through any other means. And the result will be that people will die due to poor quality care, that Medicare will not be able to continue to improve its ability to root out fraud and abuse (which returns 9 dollars to every dollar spent) and that Medicare improvements will not be implemented because there will not be the work force to do the job. This vote is another political game by people uninterested in good government. It does not deserve to be on the floor of the House of Representatives today or any other day. There is much we need to be doing to improve Medicare--this takes us the absolutely wrong direction. I urge my colleagues to join me in opposition to this senseless, spiteful legislation. reauthorization of the superfund taxes (sec. 511)

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in opposition to H.R. 2561, the Defense Appropriations bill for Fiscal Year 2000. Spending on the F-22 is only a small portion of an already bloated Defense Appropriations bill. The House of Representatives will vote today on spending $267.8 billion for the Department of Defense. The GOP is unable to come up with adequate funding for Labor-HHS, yet they have mysteriously come up with $267.8 billion for defense spending. I have a suggestion for the leadership--cut wasteful defense programs. The Air Force can expect to receive approximately $1 billion to develop ``test'' F-22 aircraft and $1.2 billion for research and development on the plane. Lockheed Martin's K Street lobbyists are certain to get a bonus in their stocking at Christmas. Thanks to Lockheed's relentless lobbying efforts and shrewd production prowess, the company was able to convince House and Senate conferees that the program really is worthwhile. The Department of Defense has spent $18 billion on the F-22 since the mid-1980's. The project is too expensive and simply not needed. The program was initiated in 1981 to meet the threat of next generation Soviet aircraft. However, that threat no longer exists. The war in Kosovo is the perfect example of why the U.S. does not need the F-22. The current fleet of F-15s and F-16s demonstrated U.S. dominance in the air in Kosovo. Proponents of the F-22 claim that the aircraft is far superior than the F-15 in air to air combat. This may be true, but we never had air to air combat in Kosovo and we don't need anything superior. The Yugoslav Air Force never engaged the U.s. in air to air combat because they would have faced defeat much sooner. No nation in the world comes close to challenging U.S. air dominance. But there are many nations whose children's elementary and secondary school aptitude tests far exceed those of the U.S. We must ask ourselves, where are our priorities? When is classroom size reduction, providing health insurance to 11 million children and full prescription drug coverage to 40 million elderly going to be a priority for this Congress? It is deplorable and shameful that the wealthiest industrial nation cannot afford quality health care or adequate education. Yet at the same time, our nation is able to boast of its air dominance and insist on more. I urge my colleagues to join me in saying, ``enough is enough.'' I urge a no vote on H.R. 2561.

Mr. STARK

Mr. STARK. Mr. Speaker, kidney failure, and the need for dialysis 3 times weekly, is a devastating disease that grinds many people down. One of the most remarkable people I know is Dr. A. Peter Lundin, who experienced kidney failure as a young man 33 years ago, but who entered the world of medicine, became a nephrologist, and has had a remarkable and successful medical practice since then. He has been President of the American Association of Kidney Patients and a tireless advocate for the Nation's quarter million renal patients. He is truly a role model, a figure of courage and determination, to thousands. I would like to include in the Record at this point an article he recently wrote for RenaLIFE entitled ``Dialysis at the Beginning.'' Thank you, Dr. Lundin, for the great help and inspiration you have given to so many. Dialysis at the Beginning (By A. Peter Lundin, MD) Patients starting on dialysis today do not realize how easy and routine it has become. Since the 1960s when it began, dialysis therapy has grown into a well-organized, efficiently run, multi-billion dollar industry. From the perspective of the doctor and provider, it is no big deal to start a patient on dialysis today. Everybody who needs it, can get it. Patients really cannot be blamed for their ignorance of how relatively easy they have it because the emotional trauma of losing your kidneys and beginning a new and restricted life with dialysis has not changed. What has changed in this regard is much less attention today is paid to emotional adjustment. Patients are told when they need an access placed and when to start dialysis, often with little consideration of the impact of this new and dramatic event on their lives. Dialysis units are often compared with factory assembly lines where patients come, get their treatment and leave without so much as a word of concern. It was not like this when I began on hemodialysis in 1966. Then it was available in only a few centers scattered across the country. You had to have a willing insurance company or pay for it yourself. Because there were very few slots available you were chosen by a committee based on your social worth. Only breadwinners or housewives caring for working husbands and children were eligible. You were expected to continue working after you started dialysis. If you had another complicating disease such as diabetes or were over 50 years of age, dialysis was not even offered to you. The therapy itself was cumbersome and took a long time. It was done in settings where lots of nurses and doctors were available because of the uncertainty of how stable patients would be. Everybody was carefully observed by a psychiatrist for signs of distress. Everything was being measured because there was much to learn about this new therapy. How much time to spend on the machine and how often during the week to dialyze were still being developed. The few medications available for high blood pressure had powerful side effects and were rarely effective. There were no replacements for the erythropoietin and active vitamin D, which the dying kidneys had stopped making, therefore we were all constantly anemic. To get my hematocrit (amount of red cells in the blood) above 20 percent I needed frequent blood transfusions. The only way to control phosphorous in the blood was to eat a diet without phosphorous containing foods and to take Amphogel, an aluminum containing antacid. In those days Amphogel tasted like chalk. It came only as large unswallowable tablets or in liquid form and was extremely constipating. Due in part to the unpalatability of this therapy, some patients already had severe crippling bone disease. Others were already running out of areas for new accesses, their arteries and veins having been used up by multiple external catheters. In those days we did not have grafts or fistulas. We dialyzed through an external shunt in the arm or leg. In my case it was in my leg so I had more independence in putting myself on and off the machine. While I did not have to worry about getting stuck with needles, the shunts caused serious concerns of their own. They easily got infected, damaged the veins and arteries, and often clotted. All of these problems led to a shunt life expectancy of about six months. One of mine was chronically leaking from the arterial side, forcing me to walk on crutches from class to class. After getting heparin for dialysis it might take several hours with pressure to stop bleeding. When it clotted I had my own declotting kits. Sometimes it would take several hours to open the shunt up again. I was an undergraduate student at Santa Clara University in California when my kidneys failed. I was not a candidate for transplant, and as a student I was not a dialysis candidate either because I would have to become dependent on my family again. Nevertheless by a series of fortunate events the future came about and I am here 33 years later to tell about it. I learned how to dialyze myself at the University of Washington in Seattle in their Remote Home Dialysis Program. After three months of training I returned to Northern California and to school. I had the hope and expectation of becoming a medical doctor, and I transferred to Stanford University, feeling it would be easier to get into medical school from there. While taking a full course load of physics, chemistry, biology and mathematics I dialyzed at home. The treatments were done, then as now, three times per week, but they lasted for 10 hours. Clearly, to be able to go to school the dialysis sessions had to occur overnight. After setting up the machine I would get on about 7 p.m. and off at 5 a.m. Of course, I had to sleep and did while the machine was washing the blood. When I started dialyzing at home, dialyzers and blood tubing did not yet come in clean packages out of a box. They had to be put together by hand. At first, I had specially made glass drip chambers and long roles of plastic tubing. Dialysis membranes came in a large flat box. The open end of the tubing had to be softened by sticking it in acetone and was then attached to both ends of the glass drip chamber. The dialysis membranes were soaked and sanitized for several hours in a container filled with acetic acid. Carefully removed, they had to be stretched over long plastic boards. There were four membranes divided into two layers each between three boards. Then this construction was filled with formaldehyde overnight before the next dialysis. With practice I was able to put it all together in a bit less than an hour. Taking it apart when the dialysis was over took less time, but before the next dialysis it had to be put together again. My break came in 1968 when I was accepted to medical school in Brooklyn. It was my salvation. I was put on dialysis for 14 hours overnight, three times per week. I felt much better. I was learning to become a doctor. I got my first and only fistula which works well to this day. It was from that period of my life I learned some very important lessons about how to survive with dialysis: the importance of good dialysis and a reliable blood access. Getting dialysis treatments today is, in many ways, very much easier on the patient, who is on average older and having many more medical problems. Supplies, equipment, medications and ways to treat other medical problems have greatly improved over the years. While having one's access fail is no less traumatic today than it was back then, the future promises to bring additional advances to improve the lives of patients with kidney failure.

Mr. STARK

Mr. STARK. Mr. Speaker, reclaiming my time, but according to the Joint Tax Committee, only 160,000 people who are uninsured will receive any benefit.

Mr. STARK. Mr. Speaker, I yield the balance of my time to the gentleman from Georgia (Mr. Norwood).

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

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. I suspect, Mr. Speaker, that the gentleman from Arizona, like myself, gets his health insurance from the Federal Government, and I do not hear him complaining about that. Further, Mr. Speaker, I would just like to remind my colleagues that at a cost for these 200,000 uninsured people of 15,000 a year, the Speaker would have to have a breakfast to raise money from lobbyists several times to be able to get enough money to pay for the cost of this health plan. Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr. Levin). (Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I do want to remind my colleagues that this bill is the penultimate waste of taxpayers' money. The Joint Committee on Internal Revenue Taxes, a committee run by the Republican majority on the Committee on Ways and Means to estimate the cost and benefits of tax bills, has estimated that there will be a grand total of 160,000 uninsured individuals who could possibly benefit from this bill, 160,000 people, I say to the gentleman from Missouri (Mr. Talent), at a cost of $48 billion over 10 years. Mr. Speaker, would the gentleman from Missouri (Mr. Talent) like to respond to a question? Why does he think it is so important to spend $48 billion to help 160,000 people? Because that is all this bill does.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Maryland (Mr. Cardin).

Mr. STARK. I will be glad to share with the gentleman those figures, and perhaps we can discuss it later. Mr. Speaker, I yield 3 minutes to the gentleman from New York (Mr. Rangel), the ranking member of the Committee on Ways and Means.

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

Mr. STARK. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Washington (Mr. McDermott).

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I wonder if the gentleman from Texas (Mr. Archer) would indulge me and respond to a question. I had stated that over 10 years this bill would cost, just for the tax deduction, $31 billion. The gentleman is quite correct, for 5 years it would cost less, but in the outyears the cost goes up. Is it not correct that there would only be 200,000 uninsured people, or 100,000 insured individuals, policyholders, who would benefit from the tax, according to our own Joint Committee on Taxation?