Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I am not willing to waste $30,000 a year per family to pay for it because the insurance is not worth that much. This is squandering the taxpayers' money. I will repeat what the Joint Committee on Taxes has said. That the total people benefiting from this bill, while there will be 12,400,000, all of them already have insurance. There are only 160,000 people who are eligible who are uninsured. So we are spending, I just want to repeat, we are spending $48 billion to help 160,000 people. They may each insure two people so to give my colleagues credit, I will say it is 320,000 people. That is a cost of $15,000 a head, $30,000 a family, for 10 years. My colleagues could buy them a hospital and a doctor for that kind of money. The Republicans just do not know what they are doing. They are squandering the taxpayers' money. I just want to remind everybody, $48 billion to help, according to the Committee on Ways and Means, Republicans-controlled Joint Committee on Taxation, there are only 160,000 people who are uninsured who qualify. That is ridiculous.

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

Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the gentleman from California (Mr. Becerra). (Mr. BECERRA asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, in the interest of explaining how we spend $48 billion to give 160,000 people access, I yield 1\1/2\ minutes to the gentleman from Texas (Mr. Stenholm), (Mr. STENHOLM asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, this is a very tough week for the House Republican leadership. In an attempt to get the spotlight off of bipartisan attempts to curb the power of big managed care companies, the Republican leadership is finally willing to talk about helping the uninsured get access to health care. Unfortunately, while their proposals are expensive, their talk is cheap. In a very cynical attempt change to the topic from managed care reform, we will see Republicans on the floor today in the House of Representatives claiming to be trying to expand health insurance to the uninsured. Don't be fooled. Their proposal will not help the population the most likely to lack health insurance and it isn't financed at all. It would cost the federal government more than $48 billion over ten years without solving the very problem it proclaims to address. A record 44.3 million uninsured Americans live in our country today, hoping and praying they do not get sick or injure themselves. More than 32 million of these families have income at or below the 15% income tax bracket. These are people who cannot afford to pay insurance premiums-- working families of modest means, people between jobs, students, unskilled workers who do not have the luxury of demanding employer coverage--or have a ``pre-existing condition'' that makes them persona non grata in the individual insurance market. The ``access'' provisions that the Republicans offer do little to nothing to help these people without insurance. Instead, they provide tax breaks to the wealthy and the healthy through a variety of tax changes that don't reach the uninsured. For example, one of their so-called access provisions would expand a demonstration project on medical savings accounts (MSAs) so that all employers could offer them. Generally, demonstration projects have to ``demonstrate'' some success to be expanded but, in this case, the big insurance companies that offer MSAs have much more political clout with the GOP than the millions of uninsured. Instead of admitting that MSAs have failed, the Republicans are throwing more money into them. With bigger tax breaks, more healthy and wealthy people will use them, but that doesn't do anything for people too poor to afford insurance or benefit from MSAs. Another provision would expand the deductibility of health insurance that employers and the self-employed receive to people who purchase their own insurance. It would not provide people with up front funds to help them purchase health insurance. Again, since more than 32 million uninsured families are at the 15% or 0% income tax bracket, this provision does nothing to make insurance affordable to them. The Republicans also do nothing to address the inequities of the individual insurance market. Anyone with a pre-existing condition, anyone who is older, anyone with a genetic history of potential health problems will continue to find it impossible to purchase affordable insurance. There are also other Republican provisions that would preempt state regulation of insurance in favor of new federal regulations. These so- called Association Health Plans and HealthMarts would undermine successful state-based small group market and individual insurance reforms. They are less comprehensive health insurance policies that would escape state consumer protections. The Republican proposal would let these plans ``cherry-pick'' the healthy, low-cost patients and result in higher health insurance premiums for people in traditional state-regulated insurance. If the Republicans were serious about providing access to the uninsured, there are a number of affordable, sensible solutions which they could be raising on the floor today, but aren't. Those provisions include items such as: Passing the Medicare Early Access Act. Introduced again this Congress as H.R. 2228, this bill would allow all people aged 62-64 to buy into Medicare program, people aged 55-64 who have lost their job to buy into Medicare, and would allow people whose employers' renege on retiree health coverage the option of staying in COBRA until they are Medicare- eligible. This bill has only a small cost that can be fully covered by a number of small Medicare fraud and abuse revisions. Yet, we have seen no action on this legislation that would provide a new, affordable option for health insurance coverage for early retirees--the people who are the hardest to insure in the private marketplace and a significant growing portion of the uninsured. Enacting provisions to protect children whose parents are leaving the welfare rolls for low-income jobs so that they aren't inappropriately dumped out of Medicaid and left without health insurance. The number of people with Medicaid coverage in 1998 was the lowest it's been since 1991, according to the Bureau's historical tables on insurance coverage. Improving the State Children's Health Insurance Program. This program was passed by Congress with great fanfare in 1997 as a means of extending health insurance to half of the then 10 million uninsured children. According to new census data, we now have 11 million uninsured children after that program has been in existence two years. Clearly, it isn't working as intended. Serious attention should be focused on making this program work or finding a new solution for covering these 11 million children. It's not rocket science to figure out who are low-income children. The Internal Revenue Service could run a match or we could utilize data from the free and reduced price school lunch program to presumptively enroll children. Passing H.R. 1180, the Work Incentives Improvement Act to allow the more than 8 million people receiving disability benefits return to work without fear of losing their health insurance. This bill has already unanimously passed the Senate and the Commerce Committee, but it has been stalled from reaching the House floor. These are real, concrete steps that would help the uninsured, but they are not part of the Republican bill. Instead, all of these Republican leadership provisions benefit the well-heeled rather than the uninsured. Essentially the Republican leadership has taken a tax break package for the wealthy and disguised it as a health access bill. But the Wolf's teeth show through the sheep's clothing when one looks at how the bill is financed. Instead of finding off-sets and living within tradition pay-go rules, the Republican leaders decided to tap the surplus needed to shore up Social Security and Medicare and pay down the debt. Not only are the Republican leaders not proposing a plan to help those who cannot afford health insurance, by using the surplus, they are putting the future of Social Security and Medicare in jeopardy and increasing the amount of debt we leave to future generations. H.R. 2990 is a poison pill to managed care reform and I urge my colleagues to join me in opposing this legislation. As further evidence of this point, I submit new data that we have received from the Joint Tax Committee. As you will see, the Joint Tax Committee has estimated how many people the Talent Access bill would help. The answer: Almost no one. The tax deduction for individuals paying for more than 50% of the cost of the health insurance will cost $31.2 billion over 10 years and result in 200,000 uninsured people getting insurance. That's $156,000 per new insured person--$15,600 per year. The acceleration of the 100% tax deduction for the self-employed will help 120,000 previously uninsured and cost about $3 billion over 4 years. That's $6,250 per person per year--a cadillac cost for sure. Joint Committee on Taxation, Washington, DC, October 6, 1999. Hon. Edward M. Kennedy, U.S. Senate, Washington, DC. Dear Senator Kennedy: This is in response to your letter of October 4, 1999, requesting revenue estimates and other information concerning several of the health care tax provisions in the conference agreement on H.R. 2488 and two of the health care tax provisions in S. 1344. The conference agreement on H.R. 2488 contains an above- the-line deduction for health insurance expenses and long- term care insurance expenses for which the taxpayer pays at least 50 percent of the premium. The deduction would be phased in at 25 percent for taxable years beginning in 2002 through 2004, 35 percent for taxable years beginning in 2005, 65 percent for taxable years beginning in 2006, and 100 percent for taxable years beginning in 2007 and thereafter. Taxpayers enrolled in Medicare, Medicaid, Champus, VA, the Indian Health Service, the Children's Health Insurance Program, and the Federal Employees Health Benefits Program would be ineligible for the deduction for health insurance expenses. The conference agreement on H.R. 2488 also contains a provision that would allow long-term care insurance to be offered as part of cafeteria plans, effective for taxable years beginning after December 31, 2001. For the purpose of preparing revenue estimates for these provisions in H.R. 2488, we have assumed that the provisions will be enacted during calendar year 1999. Estimates of changes in Federal fiscal year budget receipts are shown in the enclosed table. We estimate that in calendar year 2002 about 9.1 million taxpayers would claim the 25-percent deduction for health insurance expenses. About 100,000 of these 9 million taxpayers would be new purchasers of health insurance. Assuming an average of two persons covered by each policy, about 200,000 persons would be newly insured as a result of the 25-percent deduction for health insurance expenses. We estimate that in calendar year 2002 about 4.7 million taxpayers would claim the 25-percent deduction for long-term care insurance expenses, and an additional 300,000 taxpayers would use cafeteria plans to pay their share of premiums for employer-sponsored long-term care insurance. About 80,000 of these 5 million taxpayers would be new purchasers of long- term care insurance. S. 1344 contains a provision that would increase the deduction for health insurance expenses of self-employed individuals. Under present law, when certain requirements are satisfied, self-employed individuals are permitted to deduct 60 percent of their expenditures on health insurance and long-term care insurance. The deduction is scheduled to increase to 70 percent of such expenses for taxable years beginning in 2002 and 100 percent in all taxable years beginning thereafter. S. 1344 would increase the rate of deduction to 100 percent of health insurance and long-term care insurance expenses for taxable years beginning after December 31, 1999. S. 1344 also contains provisions that would eliminate certain restrictions on the availability of medical savings accounts, remove the limitation on the number of taxpayers that are permitted to have medical savings accounts, reduce the minimum annual deductibles for high-deductible health plans to $1,000 for plans providing single coverage and $2,000 for plans providing family coverage, increase the medical savings account contribution limit to 100 percent of the annual deductible for the associated high-deductible health plan, limit the additional tax on distributions not used for qualified medical expenses, and allow network-based manage care plans to be high-deductible plans. These provisions would be effective for taxable years beginning after December 31, 1999. For the purpose of preparing revenue estimates for these provisions in S. 1344, we have assumed that the provisions will be enacted during calendar year 1999. Estimates of changes in Federal fiscal year budget receipts are shown in the enclosed table. We estimate that in calendar year 2000, about 3.3 million taxpayers would claim the 100-percent deduction for health insurance expenses of self-employed individuals. About 60,000 of these taxpayers would be new purchasers of health insurance. Assuming an average of two persons covered by each policy, about 120,000 persons would be newly insured as a result of the 100-percent deduction for health insurance expenses. We do not have an estimate of the numbers of individuals who would be newly insured as a result of the medical savings account provisions of S. 1344. I hope this information is helpful to you. If we can be of further assistance, please let me know. Sincerely, Lindy L. Paull. Enclosure: Table #99-3 206

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am pleased to help 160,000 Americans to the tune of $48 billion. That is real help to the average taxpayer. Mr. Speaker, I yield 2 minutes to the gentleman from Georgia (Mr. Lewis).

Mr. STARK. Mr. Speaker, I yield myself 3 minutes. (Mr. STARK asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I thank the ranking member for yielding this time to me, and I just want to bring to light some new information. The Joint Committee on Taxation has given us some estimates on what this wonderful access bill will do. It will provide access perhaps to 160,000 families; that is all. At a cost of $48 billion, and try this with your shoes and socks on, that is $300,000 per family or $30,000 a year to give 160,000 families, 320,000 people, coverage. That is all it does. The benefits go to those people who are currently insured, which means the Republicans are squandering $300,000 per family for 160,000 families who are uninsured, and my colleagues want to talk about wasting money? Trust the Republicans to do it. Mr. Speaker, the Joint Tax Committee has estimated how many people the Access bill would help. The answer: almost no one. The tax deduction for individuals paying for more than 50% of the cost of their health insurance will cost $31.2 billion over 10 years and result in 200,000 uninsured people getting insurance. That's $156,000 per new insured person--$15,600 per year! The acceleration of the 100% tax deduction for the self-employed will help 120,000 previously uninsured and cost about $3 billion over 4 years. That's $6,250 per person per year--a cadillac cost for sure! Just for comparison, an individual policy in the Federal Employee Health Benefit Plan costs about $2,500 to $2,800. The Republican plan is a massive waste of money. The Joint Tax's letter follows: Joint Committee on Taxation, Washington, DC, October 6, 1999. Hon. Edward M. Kennedy, U.S. Senate, Washington, DC. Dear Senator Kennedy: This is in response to your letter of October 4, 1999, requesting revenue estimates and other information concerning several of the health care tax provisions in the conference agreement on H.R. 2488 and two of the health care tax provisions in S. 1344. The conference agreement on H.R. 2488 contains an above- the-line deduction for health insurance expenses and long- term care insurance expenses for which the taxpayer pays at least 50 percent of the premium. The deduction would be phased in at 25 percent for taxable years beginning in 2002 through 2004, 35 percent for taxable years beginning in 2005, 65 percent for taxable years beginning in 2006, and 100 percent for taxable years beginning in 2007 and thereafter. Taxpayers enrolled in Medicare, Medicaid, Champus, VA, the Indian Health Service, the Children's Health Insurance Program, and the Federal Employees Health Benefits Program would be ineligible for the deduction for health insurance expenses. The conference agreement on H.R. 2488 also contains a provision that would allow long-term care insurance to be offered as part of cafeteria plans, effective for taxable years beginning after December 31, 2001. For the purpose of preparing revenue estimates for these provisions in H.R. 2488, we have assumed that the provisions will be enacted during calendar year 1999. Estimates of changes in Federal fiscal year budget receipts are shown in the enclosed table. We estimate that in calendar year 2002 about 9.1 million taxpayers would claim the 25-percent deduction for health insurance expenses. About 100,000 of these 9 million taxpayers would be new purchasers of health insurance. Assuming an average of two persons covered by each policy, about 200,000 persons would be newly insured as a result of the 25-percent deduction for health insurance expenses. We estimate that in calendar year 2002 about 4.7 million taxpayers would claim the 25-percent deduction for long-term care insurance expenses, and an additional 300,000 taxpayers would use cafeteria plans to pay their share of premiums for employer-sponsored long-term care insurance. About 80,000 of these 5 million taxpayers would be new purchasers of long- term care insurance. S. 1344 contains a provision that would increase the deduction for health insurance expenses of self-employed individuals. Under present law, when certain requirements are satisfied, self-employed individuals are permitted to deduct 60 percent of their expenditures on health insurance and long-term care insurance. The deduction is scheduled to increase to 70 percent of such expenses for taxable years beginning in 2002 and 100 percent in all taxable years beginning thereafter. S. 1344 would increase the rate of deduction to 100 percent of health insurance and long-term care insurance expenses for taxable years beginning after December 31, 1999. S. 1344 also contains provisions that would eliminate certain restrictions on the availability of medical savings accounts, remove the limitation on the number of taxpayers that are permitted to have medical savings accounts, reduce the minimum annual deductibles for high-deductible health plans to $1,000 for plans providing single coverage and $2,000 for plans providing family coverage, increase the medical savings account contribution limit to 100 percent of the annual deductible for the associated high-deductible health plan, limit the additional tax on distributions not used for qualified medical expenses, and allow network-based manage care plans to be high-deductible plans. These provisions would be effective for taxable years beginning after December 31, 1999. For the purpose of preparing revenue estimates for these provisions in S. 1344, we have assumed that the provisions will be enacted during calendar year 1999. Estimates of changes in Federal fiscal year budget receipts are shown in the enclosed table. We estimate that in calendar year 2000, about 3.3 million taxpayers would claim the 100-percent deduction for health insurance expenses of self-employed individuals. About 60,000 of these taxpayers would be new purchasers of health insurance. Assuming an average of two persons covered by each policy, about 120,000 persons would be newly insured as a result of the 100-percent deduction for health insurance expenses. We do not have an estimate of the numbers of individuals who would be newly insured as a result of the medical savings account provisions of S. 1344. I hope this information is helpful to you. If we can be of further assistance, please let me know. Sincerely, Lindy L. Paull. Enclosure: Table #99-3 206

Mr. STARK

Mr. STARK. Mr. Speaker, as the conglomeration and monopolization of American health care continues, State Insurance regulators must do a better job of questioning the quality of plans entering their states. I thought the following article from the September 18, 1999 issue of the Delaware News Journal by former utilization review nurse Mary Ellen Gaspard and A.G. Newmyer, head of the Fair Care Foundation (an HMO watchdog group), made some excellent points about the ``quality danger'' facing Delaware. [From the News Journal, Sept. 18, 1999] Blue Cross Takeover Needs Skeptic's Eye (By Mary Ellen Gaspard and A.B. Newmyer III) Few Americans can name their state insurance regulator. The majority of regulators are appointed and remain largely invisible. By reputation, they care more about the health of insurers than the health of the public. Delaware may be different. We've never met Insurance Commissioner Donna Lee Williams. But like the minority of regulators who are elected rather than appointed, she has a reputation for caring about consumers rather than for genuflecting before insurance executives. Now she has a real opportunity. Hearings begin Tuesday on the plan by CareFirst--a Blue Cross plan based in Maryland--to take over the Delaware plan. The commissioner must determine, among other things, whether the deal would hurt Delaware policyholders. In our view, CareFirst has redefined predatory behavior by health insurers. Perhaps the company's claims handlers were trained to echo the mantra, ``Just say no.'' Cases handled by volunteers at the Fair Care Foundation, in helping patients in CareFirst's market, suggest that the delays and denials don't even pass the laugh test. Sadly, there is a mean- spiritedness evident in the treatment of the sick and their families that CareFirst management has taken to new heights. We can't imagine why Donna Lee Williams would want to put Delaware's 200,000 Blues subscribers under CareFirst's heel. Like their claims handlers, she should just say no. CareFirst, of course, disagrees. With a sensible regulatory structure in CareFirst's back yard, the facts would be apparent to Delaware regulators. But Steve Larsen, the appointed insurance commissioner in Maryland, has a reputation among consumer groups as being affable and ineffective. When CareFirst took over the Blue Cross plan in Washington, questions arose concerning whether Larsen had evaluated the Maryland plan's treatment of policyholders. His so-called market conduct study was reduced to one sentence. That's one more sentence of oversight than the D.C. regulator could muster. At hearings on the proposed merger, it became clear that the Washington insurance commissioner had never conducted a market study of the Blues during all the years that his office had jurisdiction. Delaware should just say no pending an investigation that is truly independent and thorough. We've seen no indication that Maryland or Washington regulators are capable of either. Their pre-merger hearings were a pro-forma joke. After consumers sued an appeals court ruled that the Blues had cozied up to the regulator in illegal ex-parte sessions, where they re-wrote conditions of the merger. The proposed Blues merger in Delaware is complicated. CareFirst has to call the merger an ``affiliation'' because under the law, a merger would be a ``conversion'' of the non- profit assets of the Delaware plan. That would require that the Delaware assets be set aside for health care of residents in the state. But CareFirst wants the money. So the architecture of the deal is intentionally opaque. Delaware will effectively lose all local control of its Blue Cross plan. We suspect the results won't be pretty. Donna Lee Williams has a vital opportunity. If the state chooses to wink at the predatory practices of CareFirst, then our hearts go out to the 200,000 Blue Cross subscribers in Delaware.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the gentleman from Texas for yielding me this time. Mr. Speaker, George W. Bush said it yesterday, that his party is putting too much emphasis on economic wealth and too little on social problems, and their candidate is not whistling Dixie. The gentleman from Oklahoma (Mr. Coburn), the previous speaker, said that we are going to break the payroll of this country. They are not going to break the payroll; they are going to break Social Security system. Because what the Republicans have done is the most dishonest, obscene attempt at almost fascist power to defeat a bill that they know would pass if they allowed the Members of the House to vote to pay for it. To force Members to be fiscally irresponsible as a Republican ploy to win what they cannot win through honest debate is shameful. To suggest that access is in their bill is sheer nonsense. Thirty-two million of the 45 million uninsured are in the 15 percent bracket or less, which means they get less than the $700 discount from a $5,000 bill, if they had $5,000 to buy insurance in the first place. Absolute nonsense and drivel.

Mr. STARK

Mr. STARK. Mr. Speaker, in March, the Bipartisan Commission on the Future of Medicare voted 10 to 7 on a plan known as Premium Support. The law establishing the Commission required that for a formal report to be issued, 11 votes were needed. One of the 10 votes for Premium Support was by Samuel Howard of Nashville, Tennessee. Premium Support is a proposal to use higher premiums in traditional Medicare to push beneficiaries into private, managed care HMO-type plans. It is based on the theory that the private sector is more efficient and can do a better job--save money and offer extra benefits--than the traditional Medicare program. Mr. Howard was one of the leading proponents of the idea that the business sector is always better than the government sector, and that government is inept and stupid. His comments in the Commission's public meetings never varied from that theme. I submit for the Record an article from The Tennessean of September 4, 1999: State Blames Xantus Chief for Insolvency (By Keith Snider) Xantus Corp. Chairman Samuel H. Howard used TennCare money to finance other business deals, misled state regulators and presided over a health plan that routinely lost claims, a report filed yesterday alleges. State receivers who have been running insolvent Xantus HealthPlan of Tennessee blamed Howard for much of its demise, saying his business decisions left the TennCare plan disorganized and vulnerable. Xantus disregarded a state law that requires health maintenance organizations to maintain a minimum net worth, the report says, and used cash from the health plan to pay debts and expand its parent firm, Xantus Corp., into Mississippi and Arkansas. ``Xantus HealthPlan of Tennessee was not managed in a compliant, operationally sound, or financially sound manner for several years,'' leaving it unable to meet its obligations, the report concludes. Howard released a short statement challenging the report and saying he hasn't had time to read it in detail. ``I could not disagree more with its findings and conclusions,'' said Howard, former chairman of the Nashville Area Chamber of Commerce and one of the city's most prominent African-American businessmen. ``I am deeply disappointed that our voluntary entry into rehabilitation has resulted in a report of this nature.'' The Tennessee Bureau of Investigation said it is continuing a probe of possible wrongdoing at Xantus, but spokesman Mark Gwyn would not say whether the report will affect the investigation. Officials in the attorney general's office and in the state Department of Commerce and Insurance couldn't be reached late yesterday for comment. David Manning, a former state official who co-wrote the report with Manny Martins, would not say whether the receivers have shared information with the TBI. ``Obviously, we're making public filings and they're available for anybody who has an interest,'' he said. Xantus, the state's third-largest TennCare plan with 160,000 members, has been in the hands of receivers since March 31. On Thursday, Manning and Martins asked a Davidson County Chancery Court judge to approve a rehabilitation plan that would replace the health plan's management and begin paying creditors with $30 million in state funds. The new report, supported by a thick stack of documents, describes a business that gradually was run into the ground. Among other things, Howard used money from Xantus HealthPlan in 1994 to repay a $1 million start-up loan and used at least $2.8 million in 1996 to open a health plan in Mississippi, the report says. Howard explained the 1994 transaction as a ``management fee'' paid by Xantus HealthPlan to Xantus Corp., but the report says no management agreement existed at the time and would have required state approval. Xantus Corp. overcharged the health plan by millions of dollars in management fees to replace money it had originally invested in Xantus HealthPlan, the report says. That left the health plan relying only on TennCare payments to keep its net worth above state minimums. After the state warned Xantus in April 1998 that it was undercapitalized, Howard approved a $10 million transfer from the health plan to the parent company to pay the $9 million balance of a Nations-bank loan, the report says. And in September 1998, Xantus diverted an additional $350,000 from the health plan to its Mississippi business despite reporting a negative net worth of $3.4 million in the same quarter, the report says. Xantus misreported its net worth for that year, the report says, and financial reports for that year show ``a pattern of questionable financial `recovery' at the end of the first three calendar quarters'' and that the health plan ``recurrently `rallied' at the end of each quarter.'' Howard misled Commerce and Insurance officials on management fees, the source of loans, intercompany transfers, his salary, and about how he intended to finance the acquisition of Health Net's TennCare business two years ago, the report alleges. Xantus didn't properly investigate loss-plagued Health Net before buying it, the report says, and limped along with inexperienced managers and a clams processing system that paid claims to the wrong provider, paid the wrong amount, lost claims and denied claims that had been preauthorized. The receivers said earlier this week that their estimate of how much Xantus owes doctors and hospitals has grown from $50 million-$60 million to $80 million because the processing system hasn't been sorted out. Manning characterized the findings as ``a factual report that reaches reasonable conclusions.'' State Sen. Thelma Harper, who called a June news conference along with other prominent African-American leaders to express concern about the investigation of Xantus, couldn't be reached for comment. Howard, who has blamed flaws in the $4.3 billion TennCare program for Xantus' problems, said yesterday he's learned ``that the gap between the business world and government is deep and wide.'' But the report says Howard's contention that Xantus had an unfair share of very sick enrollees was contradicted by a state review and by data from Xantus itself. It concedes the state didn't allow Xantus to close its rolls to new members and also rejected a plan in August 1998 that would have cut management expenses from 17% to 11%. The state should shoulder some of the blame, said Craig Becker, Tennessee Hospital Association president, who represents hospitals that have unpaid Xantus claims. ``The ultimate responsibility belongs to the state,'' he said. ``It was their lack of oversight that allowed it to happen.''

Mr. STARK

Mr. STARK. Mr. Chairman, I rise in opposition to H.R. 2436, the Unborn Victims of Violence Act. This bill would give pregnancy from beginning to birth the same legal standing under federal law that we currently give a person. This legislation would establish a separate offense and punishment for federal crimes committed when death or bodily injury to the fetus occurs. Likewise, the bill establishes the same penalty for a violation under federal law if the injury or death occurred to the unborn fetus' mother. This bill is designed for one purpose: to undermine the decision in Roe v. Wade. This legislation is an effort to endow legal rights to fetuses--in fact a backdoor way of elevating the legal status of a fetus--which has been the cornerstone of the conservative anti-choice agenda. This is just another way of writing a Human Life Amendment, a decades-long effort to expand the meaning of the word ``person'' under the constitution to include unborn offspring at every state of their biological development. Anti-choice Members of Congress know that they are trying to fool the American people. They would also have us believe in their crusade to protect unborn victims of violence--but what about the born victims of violence? Every day in America, 13 children and youth under age 20 die from firearms. If this Congress is so concerned with the safety of children, why has it not passed the gun control provisions approved by the Senate that would eliminate gun show loopholes and require mandatory safety locks with firearms sales? The conference committee on H.R. 1501 and the Senate gun legislation has met only once publicly--and that was before we adjourned for the August recess--to read their opening statements. Every day in America, 1,353 babies are born without health insurance and 2,162 babies are born into poverty as a result of welfare reform legislation passed by many who remain in the majority of this Congress today. We know now that children are losing critical benefits like Medicaid and food stamps. The Urban Institute cites falling welfare rolls as the ``primary reason'' that an estimated 500,000 fewer adults and children nationwide participated in Medicaid in 1996 than in 1995. Loss of Medicaid and the absence of employer-sponsored health insurance coverage make it extremely difficult for former recipients to obtain health care for themselves and their children. In addition, the Children's Defense Fund's study entitled ``Welfare to What?'' cites troubling findings by NETWORK, a coalition of Catholic organizations, on 455 children in California, Florida, Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania and Texas during late 1997. The study found that 36% of children in families who had recently lost cash assistance were ``eating less or skipping meals due to cost.'' The bottom line is that families who lose welfare often lose food stamps, making it impossible to buy sufficient food. The same disregard for our children is evident in Congress' refusal to hold states accountable for maintaining high levels of quality in our child care centers. Today in America, more than 80% of child care services in the U.S. is thought to be of poor or average quality. Still, Congress turns its head and allocate billions of child care dollars a year with very little assurance of quality, allowing our children to be placed in substandard conditions. The crimes of domestic violence is a horrendous one, and should be punished, but this blatant attempt to placate the radical right belittles the severity of domestic violence by using women and their pregnancies as tools to elevate the legal status of a fetus. It is cowardly, and it dishonors the lives of women who have survived, and those who have succumbed to the terrible tragedy of domestic violence.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in support of the designation of a ``National Unity Day'' to celebrate our country's diversity as well as promote the need for harmony within our nation. Presently, my good friend Paul Callens and several of his colleagues are participating in the Unity Walk, a 3,200-mile trek across the United States. This Unity Walk is a means for sending the message to all Americans that we must create racial harmony within our communities at both the local and national levels. The walkers also hope to interest community leaders and local government officials in celebrating a National Unity Day. Their voyage is scheduled to end in San Francisco on October 10, 1999. The participants hope to engage fellow Americans in worthwhile discussion about the issue of racial harmony. Their ultimate goal, however, is the designation of a National Unity Day commemorating the importance of indivisibility among our diverse group of citizens here in the United States. This would also include an annual National Unity Day celebration to recognize National Unity Day on the second Sunday of October every year. In our land of great freedom, we must not tolerate racism or prejudice of any kind. We must work together for peace and unity among the citizens of the United States to whom liberty and justice are natural human rights. The Unity Walkers have asked communities to examine their attitudes toward racial differences and make strides toward ending those racial divisions that threaten the soul of our nation. I ask my colleagues to join with me today in support of the establishment of National Unity Day, as we work to celebrate the differences among us.

Mr. STARK

Mr. STARK. Mr. Speaker, the HHS appropriations bill slashes Medicare's administrative budget. To quote from the Committee: ``The bill makes available $1,752,050,000 in trust funds for Federal administration of the Medicare and Medicaid programs, which is $390,785,000 below the fiscal year 1999 comparable level and $264,077,000 below the Administration request.'' The Administration had requested about $200 million worth of user fees, which have no hope of passing in this Congress. As a result, the Appropriations Committee action is a devastating blow to the Nation's seniors and disabled. If these figures were to become law, our ability to fight Medicare fraud, waste and abuse will be crippled. Our ability to visit nursing homes and other providers to check on quality and protect vulnerable seniors will be 40% of the amount requested by the Administration. It is no exaggeration to say that this budget will lead to the unnecessary death of older citizens. Speaker Gingrich must still be here. He is the one who said: ``HCFA will wither on the vine.'' This budget achieves that goal--it destroys our ability to administer a compassionate and effective Medicare program.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise in support of Representative Tierney's amendment to require the Agency for Health Research and Quality to conduct a study about the effect of universal health care and other access expansions on health quality and costs. The U.S. is the only industrialized nation that fails to provide universal health coverage for our citizens--and yet we continue to spend more on health than any of those nations. A key factor impacting our nation's health expenditures is that we have 43 million Americans left out of our system whom we are covering in the most expensive manner--through emergency rooms, late in their illnesses, and often without the benefit of appropriate prescription drugs since many of these people cannot afford them. It is time for Congress to return to the vitally important issue of expanding health insurance coverage. There are viable means to achieve that goal. The most direct routes to providing universal coverage would be to enact a single payer system or to expand Medicare coverage to everyone. There are other more incremental approaches which would also move us in the right direction: We could use a tax credit approach, like that I have authored in HR 2185, the Health Insurance for Americans Act. We could expand Medicare coverage to persons aged 55-64 under HR 2228, The Medicare Early Access Act, which is supported by many of my colleagues and the Administration. We could expand Medicare to children--creating a much more effective coverage policy than the State Children's Health Insurance Program, which continues to leave millions of our nation's children without coverage. That could become an avenue leading to Medicare for all. I urge support of the Tierney amendment which, if passed, would provide us with further evidence for moving forward to expand health insurance in our country. That is a debate to which Congress must return.

Mr. STARK

Mr. STARK. Mr. Speaker, poll after poll shows the American public strongly supports adding a drug benefit to Medicare. Unfortunately, the Pharmaceutical Research and Manufacturers of America has mounted a silly, sleazy $20-$30 million campaign featuring an actress named Flo to oppose comprehensive prescription drug coverage for America's seniors. They use a phony front name, Citizens for Better Medicare. Perhaps a better name for this campaign-to-deceive-seniors would be: Corporations for Beaucoup Money . . . or Companies for Bundling Money (to trick the public into thinking that the Rx debate is about big government instead of comprehensive Medicare drug coverage) . . . or Corporations for Bigger (Profit) Margins. PhRMA is apparently convinced that if Congress adds a prescription drug benefit to Medicare, their member companies won't be able to continue pricing drugs at the stratospheric levels many do today. Those pricing strategies are so distorted that Medicare beneficiaries who have no drug insurance are being charged more than twice as much, on average, as prices paid by enrollees of large group health plans. And for the limited number of drugs that Medicare currently covers-- generally those administered by physicians--Medicare is being overcharged by billions of dollars. This was made painfully clear in a report issued last year by the HHS Inspector General, which found that Medicare paid $1 billion more in 1997 than the VA did for the same 34 drugs. Individual seniors are being harmed by artificially inflated drug prices, too. Last year's stunning 18% growth in drug spending means that fewer elderly people--who need and use pharmaceutical medications more than any other age cohort--will be able to fill the prescriptions their doctors order this year. After all, the median annual income of seniors in this country was about $21,000 in 1997. In contrast, the average compensation for CEOs among PhRMA's top 12 companies last year was nearly $28 million. Stock options for U.S. pharmaceutical pharaohs were worth far more: $103 million on average in 1998. Major drug companies also spend billions every year on campaigns to influence which drugs doctors prescribe. This spring, a Florida physician mailed me a sample of the invitations he received from pharmaceutical companies for the week of April 25. Here they are: Sunday: The doctor and his colleagues are invited to a Niaspan- sponsored Afternoon-at-the-Races event at Tampa Day Downs, which includes use of a private suite, plus an expensive lunch and open bar from noon to 3 p.m.; Wednesday: The doctor and his colleagues are invited to a Pfizer- sponsored complementary dinner at Landry's Seafood, an upscale restaurant where no entree is under $25 per person; Thursday: It's a tough choice: Hoechst Marion Roussel is picking up dinner at Charley's Steak House . . . but across town, Pfizer is paying for dinner at Alfano's; Friday: What a bonanza! Free tickets for the docs, their spouses and children to watch the Tampa Bay Devil Rays play the Seattle Mariners. That's not all. ``In addition to these free meals,'' the physician writes, ``I have been invited to a second baseball game at Tropicana Field, plus our office has been served three lunches for 25 people this week by the pharmaceutical companies.'' In 1998, pharmaceutical companies spent an amazing $7 billion in these and other promotions designed to influence which drugs doctors prescribe to their patients. Advertising to consumers is climbing too: spending on direct-to-consumer advertising last year rose to $1.3 billion. It is important to remember that ``Flo'' is just another advertising gimmick created by PhRMA. Her ads oppose big government when it comes to discussion of a Medicare drug benefit. What they don't say is that PhRMA vigorously supports big government R&D tax credits, barriers against cheap imports, patent extensions and generous funding of medical research. The fictitious ``Flo'' will soon fade from the public's memory. But the plight of real seniors in America who desperately need access to prescription drug coverage will not. It is those seniors we are trying to help by adding a prescription drug benefit to Medicare.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise today in opposition to H.R. 1875, the Interstate Class Action Jurisdiction Act of 1999. This so-called ``tort reform'' measure proposes to create a huge new roadblock to justice for class action litigants. If enacted, H.R. 1875 will harm consumers and benefit corporate defendants--among them managed care plans, gun manufacturers and tobacco companies. Although ERISA does not permit injured enrollees to sue their HMO under state malpractice laws, recently some class actions have been successfully filed alleging violations of state consumer fraud and unfair trade practice laws. These class actions are being used to require HMOs to provide needed treatments, access to specialists, and continuity of care. Yet H.R. 1875 would reverse these gains by making it far easier for managed care plans to force removal of cases filed under state consumer fraud laws to federal court--where outcomes could be inconsistent and unfair. Currently, most class actions are brought under state law with state court judges interpreting and applying the standards litigants must meet. H.R. 1875 would divest state courts of many of these cases, requiring federal judges to interpret and apply state law. This opens the door to inconsistent interpretation by judges not familiar with state law. Our current class action system is a win-win-win--for the courts, for litigants, and for society. Class actions are now heard by judges knowledgeable in the area and familiar with the law. The federal bench lacks the resources to handle these cases in its already overburdened docket. Under present guidelines, class actions may be heard by federal judges when the damage amount involved is more than $75,000 per plaintiff and other requirements are met. In state courts, class actions can be brought when the amount of damage per plaintiff is modest. H.R. 1875 eliminates the $75,000 figure and the other requirements. Thus, corporate defendants could easily request removal of many state class actions to federal court--over the objections of all plaintiffs or co-defendants. If this bill is enacted, it will essentially deny a forum to thousands who have been injured by exposure to tobacco products, asbestos and other unsafe products, and thwart reforms that benefit society as a whole. In effect, the class action device itself would be destroyed. If H.R. 1875 becomes law, dozens of class action lawsuits that could help thousands will simply never be heard. Consumers will again become victims--this time, of a massive federal judicial logjam. Tobacco companies, asbestos makers, drug manufacturers, and HMOs are lobbying strongly for H.R. 1875. The Interstate Class Action Jurisdiction Act of 1999 gives them relief at the expense of justice that consumers deserve. A ``yes'' vote for H.R. 1875 is fundamentally a vote against consumers' rights. It should be quickly rejected.

Mr. STARK

Mr. STARK. Mr. Speaker, among the greatest advances of medicine in this century has been the development and professionalization of radiology. Therefore, I rise today to congratulate the American College of Radiology and its 31,000 members on its 75th anniversary. While the numbers of diagnostic radiologists, radiation oncologists and medical physicists comprising the college have changed dramatically, the ACR's main objective has not. Through the years, working with Members of Congress, key Federal, State, and local agencies and a wide variety of health care and consumer organizations, the college has worked tirelessly to improve the quality of patient care. The American College of Radiology has met this objective through numerous programs. Beginning with mammography, ACR has initiated several national accreditation programs designed to assure high quality performance from both health care professionals and imaging equipment. In addition to mammography, accreditation programs are in place for ultrasound, radiation oncology, stereotactic needle breast biopsy, magnetic resonance imaging, ultrasound-guided breast biopsy. ACR's groundbreaking mammography accreditation program, which began as a voluntary effort in 1987, now has become a nationally mandated program. In part, as a result of this program and other breast cancer early detection promotion efforts, the National Cancer Institute has recorded, for the past few years, the first declines in mortality from breast cancer. In addition to accreditation, the ACR has improved the quality of care through its Performance Standards \TM\, Appropriateness Criteria \TM\, life-saving research through clinical trials and medical continuing education programs for members. The performance standards are principles for delivering high quality radiological care. They are revised and expanded every year. The standards cover a wide variety of procedures. The Appropriateness Criteria \TM\ ensure that the most appropriate examination is done in the most appropriate setting at the most appropriate time. More than 500 medical experts have assisted in developing these criteria. The college also offers numerous continuing education seminars each year. ACR manages the federally funded Radiation Therapy Oncology Group (RTOG). This organization carries out multidisciplinary cancer trials nationwide. RTOG has gathered numerous medical facilities in providing state-of-the-art treatment for a wide variety of cancers. As a complement to RTOG, the college also operates the Radiological Diagnostic Oncology Group (RDOG). This program evaluates current and emerging imaging technologies used in the management of patients with malignant disease. NCI funds RDOG so that the group may provide a timely approach for the cost-effective use of new technologies. Even before the ACR initiated its quality improvement and research programs, radiologists were deeply involved in working to improve patient care. World War I, for example, presented a great need and a great opportunity for radiology. One of the founders of the college, Dr. Edwin Ernst, recalls how using a table built by German prisoners, and a rolling floor fluoroscopic gas tube, he pinpointed the location of bullet fragments. And radiologists in general played a major role in treating and diagnosing patients in those rugged field hospitals. Later, in the 1920's the International Radiological Congress helped to standardize measurement. The ACR also worked to secure financing of the x-ray equipment at the Bureau of Standards. It was also in the 1920's that the American College of Radiology was born as two dozen radiologists gathered for the first time officially to transact the business of the college: to plan ways to improve their profession's expertise. When the United States entered World War II, radiologists mobilized to serve their country. The college volunteered to handle radiology manpower issues for the Army. The growth and development of radiology after World War paralled post-war growth of the Nation. In the early 1950's, three dedicated members of the college--Drs. Eddie Ernst, Wally Wasson and Ben Orndoff--began to cajole, badger and convince their fellow radiologists into preserving the history of their profession. In 1955 they gathered for the first time as the Gas Tube Gang. The gas tube was the symbol of the early imaging technology. Through their efforts the college's archive's was created and today it is filled with gas tubes, other early radiological devices, mementos from Dr. Roentgen, Madame Curie and other pioneers, and pages and pages of rich history of the ACR and the field of radiology. So it is with all of this history in mind and the great contributions the ACR has made to the practice of medicine that I wish the American College of Radiology well on its 75th and continued success in the years to come.

Mr. STARK

Mr. STARK. Mr. Speaker, my staff recently conducted an analysis of eight industrialized nations and found that the United States is the only country lacking government-sponsored prescription drug coverage for its senior citizens. The chart I am submitting today clearly illustrates our Government's failure to provide pharmaceutical coverage for seniors who need it most. Canada, the United Kingdom, Germany, Japan, France, Sweden, and the Netherlands all provide universal prescription drug coverage for the elderly. The UK and France fully exempt the elderly from copayments for certain prescription drugs. Sweden provides a similar exception, but in no case charges seniors more than a $10 copayment for prescription drugs or more than $200 in annual out-of-pocket expenses. The findings clearly show that elderly Americans are being denied a fair system of drug coverage. Further, recent analyses show that drug prices in the United States are surging by 18 percent per year, with the result that more seniors will be unable to purchase needed medications. Yet the elderly have a particular need for prescription drug coverage, as seniors purchase one-third of all prescription drugs while they only comprise 12 percent of our population. As employer-sponsored retiree health coverage in the United States rapidly erodes and Medicare HMO's pull out of many markets and lower existing drug benefits, it is time to recognize that the private sector will never be able to guarantee drug coverage for all seniors. In contrast, adding an outpatient drug benefit to Medicare would do exactly that. If so many other industrialized nations can provide prescription drug coverage for their senior citizens, why can't we? I urge you to support legislation to add a prescription drug benefit to Medicare. If we do not, we will do great harm to millions of seniors who lack any drug insurance to pay for medications their doctors prescribe. Contrary to what the pharmaceutical industry would have you believe, the debate is not about price controls. The debate is about coverage.

Mr. STARK

Mr. STARK. Mr. Speaker, we all know the problems that the high cost of health care causes for Americans. What is surprising is how hard it is for a patient/consumer to shop around for the price of a medical procedure. Shopping for the best price on a standard medical procedure is extremely difficult when one is healthy. It becomes nearly impossible when one is sick. Medicare should lead the way in helping establish pricing information that could help consumer/patients make their health care dollar stretch. Over the last few weeks, my staff has made calls to various hospitals and doctors' offices to find the cost of an Extracorporal Shock Wave Lithotripsy (ESWL) procedure. A lithotripsy procedure is one of the best ways to treat kidney stones, one of the more painful types of medical conditions that forces at least 100,000 Americans to require medical attention a year. Lithotripsy, an outpatient procedure which takes about an hour, uses a high energy machine to deliver shock waves to the kidney stone, smashing it to smaller pieces which then gradually pass out of the kidney, and then the body. The data from these calls about the cost of lithotripsy were eye opening. Not only was the price difference between hospitals and facilities notable, but so was the difficulty in gathering the information, especially the cost of this procedure for Medicare enrollees. For example, in the Greater Washington area, total cost of lithotripsy varied from approximately $5,400 at Johns Hopkins USA hospital to approximately $9,000 at George Washington University Hospital. The following chart lists other hospitals' and doctors' responses to the questions of cost for (1) someone without insurance and (2) someone with Medicare. What was as upsetting as the price differences was the difficulty in finding the cost to Medicare enrollees of this standard procedure. Staff was often told that hospital-using patients would be charged the 20% approved Medicare rate. In fact, patients often pay up to 50% of the Medicare Hospital Outpatient Department (HOPD) approved rate, which is a huge burden to the patient. Along with the underquoting of a patients' future bill, staff at many hospitals were not able to supply information about what was the approved rate that Medicare would pay, which would make it impossible for patients to plan ahead for their future bill. Mr. Speaker, Medicare is moving to a Prospective Payment System for Hospital Outpatient Department procedures. Under this new system, over time (unfortunately in many cases 20-30 years) the patient's share of the total bill will return from today's average of 50-50 to the normal Medicare co-payment of 20%. The establishment of this system will also make it easier for consumers to know what the price for a procedure at a particular institution really is. The calls by my staff show that, if one has a non-emergency medical need, some calling around can save literally thousands of dollars. But this information comparing costs between hospitals and other settings where the procedure can be done (such as an ambulatory surgical center where it is being proposed to allow lithotripsy to be done) should be more easily available. I hope that in this age of the Internet and other easier information gathering sources that we will find ways to make this type of basic shopping less of a mystery. Other data will be able to tell us the quality of different providers. Together, this information can help us choose both the quality and the price of the service we seek. This type of information can help reduce some of the outrageous costs of the American health care system and push the overall system toward higher quality. ---------------------------------------------------------------------------------------------------------------- Approximate cost of Approximate doctors Name of provider facility fees cost Approximate totals ---------------------------------------------------------------------------------------------------------------- 1. Johns Hopkins USA (at Bayview): A. Self-Pay...................... $2200.................. $2100.................. Procedure $5300 B. Medicare...................... ....................... ....................... Price changed from call made previously--now is $5400. Medicare would cover 80% so patients pay $1080. Anesthesia is separate and very hard to determine--`can't answer,' because cost depends on individual procedure. 2. Bethesda, Maryland Urologist Group Practice: A. Self-Pay...................... ....................... Initially, office ....................... policy to not give price, but then quoted about $3000. B. Medicare...................... ....................... Medicare pays 80% of ....................... approved cost. 3. A Maryland Urologist.............. N/A.................... $3500.................. ....................... 4. University of VA Medical Center: A. Self-Pay...................... UVA is State hospital; ....................... Estimate from $7000 to one can get help/ $10,000. discounts eligible for financial assistance. B. Medicare...................... Patient charged 20% of Said Medicare won't Was ``impossible'' for what is approved by approve all of $10,000. hospital to get this Medicare. information; patient must talk to Medicare about what is approved. 5. George Washington University Hospital: A. Self-Pay...................... ....................... ....................... $9000, 25% discount for payment up front--[25% discount is $2250, which lowers facility fee to $6750]. This is a flat fee-paid up front and there should be no additional fees, but doesn't include anesthesia. Anesthesia is approximately $409 an hour for this procedure. The non- prepaid rate is $630. B. Medicare...................... ....................... ....................... Was directed to talk to Medicare about what they cover. 6. Georgetown University Medicare Depends on hospital Fee during procedure is Despite repeated calls, Center. fees. It varies, but $3800. could not get in touch assume $2000 for each with insurance/billing half-hour--so assume department to find out $4000-$5000 for the cost for Medicare hospital fees. enrollees. 7. Urologic Surgeons of Washington: A. Self-Pay...................... N/A.................... Doctors cost: $3482.... ....................... B. Medicare...................... ....................... Medicare fee schedule ....................... brings down amount so patient ends up paying approximately $160. 8. Duke University Medical Center: A. Self-Pay...................... Facility fees are Doctors fees are ....................... approximately $6500. approximately $2500. B. Medicare...................... Hospital accepts what Need to file claim ....................... Medicare pays outside first; then can tell of deductible ($768). cost of doctors' fee. 9. Midwest Stone Institution ....................... ....................... Total costs run from (Missouri). $8000-12,000. Could not find out what Medicare approves. 10. American Kidney Stone Management, Cannot give cost ....................... ....................... Ltd. without knowing which hospital is performing operation because there is ``great difference between hospital costs.''. ----------------------------------------------------------------------------------------------------------------

Mr. STARK

Mr. STARK. Mr. Speaker, important health care legislation to provide work incentives for the disabled was unanimously passed by the Senate on June 16, 1999 (S. 331) and approved by the House Commerce Committee on July 1st (H.R. 1180) this year. Since then, this bill which was jointly referred to the Ways and Means Committee has been stalled and blocked. The Ways and Means Committee has done nothing to move this legislation forward despite the fact that this bill is good policy and has widespread support (229 cosponsors in the House and 79 cosponsors in the Senate). According to the Social Security Administration, 8 million people of working age now collect disability benefits under Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). While America's unemployment rate is the lowest in decades, the unemployment rate among working age adults with disability is nearly 75%. H.R. 1180 will help the disabled re-enter the workplace, yet Ways and Means refuses to act. The current SSDI and SSI legislation forces the disabled to choose between work and health insurance coverage. The choice between being unproductive or uninsured is inherent to SSDI's and SSI's definition of disability which equates disability with unemployability. This is a distorted view in a world where individual worth and accomplishment are measured in the workplace. Surveys show that most people of working age with disabilities want to work; however, they are fearful of losing health care coverage if they seek employment and then lose their job. The result is that less than half of one percent of SSDI beneficiaries and only about one percent of SSI beneficiaries ever actually leave the SSA disability rolls to return to work. It is difficult to overstate the benefits associated with holding a job when you suffer from physical or mental impairment. The restoration of emotional wellbeing associated with feelings of self-worth and accomplishment causes a domino effect with a cascade of benefits that goes well beyond the monetary value of employment. It is well recognized that depression is endemic among the disabled and that depression frequently contributes to a downward spiral of hopelessness, helplessness and amplified symptoms. Doctors understand that there is no prescription in their medical bag that will remedy this vicious cycle; in the absence of a cure, what the patient really needs are the tools to adjust to chronic impairment. Today's challenge in health care is to empower each individual to live productively in the face of impairment. We cannot delude ourselves that medicine through research and clinical excellence will master the problems of death and disability. We cannot look to new miracles to prevent, cure and effectively treat every ailment. The reality is that improving clinical practice is likely to increase, not reduce the ranks of the disabled. We bear the responsibility to integrate individuals with impairments as fully as possible into the fabric of our society. Indeed, we cannot afford to squander the skills and talents of these individuals. The fact is we should not confuse the difference between impairment and disability. Unfortunately, impairment is common and frequently permanent. Disability occurs when impairment has serious functional consequences. Our governmental programs should promote the realization of the full potential of the impaired individual, thereby minimizing disability. Health-promoting legislation provides incentives to return to the marketplace, providing a secure safety net for those who require it. The Work Incentive Improvement Act is one step in the right direction--empowering individuals with impairments by emphasizing new possibilities rather than lost potential. The Ways and Means Social Security and Health Subcommittees have lost their way if we do not grasp this important opportunity to acknowledge the value of disabled Americans.

Mr. STARK

Mr. STARK. Mr. Speaker, the July/August 1999 issue of Health Affairs contained an interesting article entitled, ``Hidden Assets: Health Insurance Reform in New Jersey,'' by Harvard professor, Katherine Swartz, and Brandeis professor, Deborah Garnick. The information in the article strongly supports passage of H.R. 2185--a bill which gives people a refundable tax credit to buy individual health insurance through a community-rated, guaranteed-issue insurance pool. The article describes how, because of the collapse of the major individual insurer in New Jersey in 1993, the State came up with an Individual Health Coverage Program (IHCP). The key reforms of the IHCP are described below. The article concludes with the observation that the reforms themselves have not done much to help reduce the number of uninsured, because the cost of insurance is still too high for the working poor who constitute the bulk of the uninsured. But, says the article, if the New Jersey reforms were accompanied by a refundable tax credit system, it could make a major difference. What they are describing, Mr. Speaker, is H.R. 2185. Overview Of The Reforms The IHCP reforms forced changes in five areas. (1) To broaden the size of the potential market, insurers are sharply limited in their ability to choose whom they will insure. The regulations, require guaranteed issue and renewal of policies, portability of coverage across carriers, and limited to preexisting condition exclusions. (2) To encourage indemnity insurance companies and managed care organizations (hereafter collectively referred to as carriers) to enter the market, all carriers selling health insurance in New Jersey must either offer policies in the individual market or share in the losses of carriers that do sell policies and incur losses. (3) To give consumers more leverage in the market, carriers in the market may only sell up to six types of policies with standardized benefit packages, a standardization that facilitates comparisons by consumers. (4) To extend access to higher-risk persons, the state required carriers to use pure community rating in setting premiums for the standardized policies; age-rating bands or variations in premiums based on where a person resides in the state are not permitted. In setting premiums, carriers also are required to meet a minimum loss ratio, so that at least 75 percent of premiums are used for provision of services. However, carriers do not have to seek approval from a state agency for any changes in premiums that they might want to implement, which we discuss in more detail below. (5) To implement the IHCP and monitor industry compliance with the regulations, the authorizing legislation called for oversight by a board, which runs the program independently of the New Jersey Department of Banking and Insurance. Four of the nine board members are representatives of carriers and elected by the companies. New Jersey's reforms are remarkable, particularly today, when states are assumed to have little power to bargain with corporations. In recent years mutual fund firms, automobile factories, professional baseball teams, and many other corporations have extracted large government concessions by threatening to move elsewhere. Yet New Jersey imposed major regulations and risk sharing on health insurers, with major carriers taking a leadership role in the process. Additional efforts are needed to increase coverage. Even a well-functioning individual health insurance market has limits on what it can accomplish. The IHCP did not dramatically raise the number of New Jersey residents with individual coverage. Surely one reason more people have not purchased policies is that the premiums are not affordable for those with low incomes. The various congressional proposals to provide tax deductions or credits might induce some people to purchase individual policies who otherwise would not, but for people with low incomes, other efforts will be needed. The federal Earned Income Tax Credit offers a model of how the federal government could issue a tax credit that provides money during the year for the purchase of insurance. Such an ``earned insurance tax credit'' also would help to bring in younger workers, who typically earn low salaries, and thereby increase the proportion of healthy persons in each carrier's individual plans. Similarly, if the tax code were revised and incentives for employer-sponsored coverage were replaced by tax credits for individuals purchasing insurance, large numbers of people would enter the individual markets. The result would be a sharp increase in the proportion of healthy persons in the individual markets. Either of these tax-induced increases in the proportion of healthy persons with individual coverage would lower the expected expenditures per insured person. Competition among carriers in this expanded market then would increase, keeping premiums close to costs. New Jersey's IHCP is a model for other states wishing to increase access to health insurance via market-oriented solutions that do not involve increased government financial obligations. States have assets they can trade upon to force competition in an expanded individual insurance market--a factor that should be of greater importance in states' strategies for increasing access to health insurance.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the distinguished ranking member for yielding me the time, and want to remind one of the previous speakers, who suggested that, I suppose he means Democrats who are working for wages, could buy a couple of shares of Kodak. That would cost them about $160 a month out of their paycheck. Or Coca-Cola, I guess he said. Now, the tax bill is going to give this worker $136 a year. The worker already is not able to pay his or her bills, buy long-term care insurance, pay the house mortgage and get the kids to college. So I suggest that it is very disingenuous to gratuitously say to that worker, go ahead and save 160 bucks a month, we will give you $136 a year towards it. As a matter of fact, this bill was really designed to help Dr. Kevorkian and the undertakers. Several of my colleagues have already heard from their adult children wondering how we intend to commit suicide so we can escape the inheritance tax. Everybody has been bleeding on the Republican side for these poor multimillionaires who are going to have to pay an inheritance tax. Talk about term limits. They have said to the owners of small businesses and the owners of family farms, ``Die baby. Die in the next 10 years, and you can give the farm away to your kids tax free. But if you live, it goes right back up, and we sock you for a big inheritance tax.'' They change the rules to make funny speeches. We argued here sometime ago about a 60 percent rule, screaming that only the irresponsible people in this House would vote to raise taxes and they needed a supermajority. Well, with this bill they are going to raise taxes, and they have had to waive their own rules. One of the more serious issues is that they have really decided to turn their back on Medicare, and they are going to let Medicare destruct. They voted in committee against their own bills.

Mr. STARK. Mr. Speaker, I just wanted to ask any of my Republican colleagues if they know how much they are really helping poor Americans? It is only the Republicans who can take a bill full of chicken manure and turn it into a turkey. As soon as the public finds out how to do that, we will solve the homeless-and-the-hungry problem.

Mr. STARK. Mr. Speaker, I rise in opposition to the conference report on HR 2488. Let me just highlight a few of this bill's flaws: The Republican tax bill would spend $792 billion over the next 10 years out of a budget surplus that will never occur. This tax cut is based on a false premise: without enacting spending cuts, the surplus simply won't occur. By spending what we don't really have on tax cuts, this bill raids the Social Security surplus and endangers Medicare. It pulls a fast one today's workers who's payroll dollars are creating the surplus that exists today. The bill is a hoax even on those it portends to help. The individual tax rate cuts are dependent on no increase in national debt from now until 2009. One slight increase in interest rates is all that it takes for the national debt to increase. When was the last time interest rates did not increase over a ten year period? This bill is a huge hoax because it claims to phase in all sorts of tax relief but all the tax changes end on October 1, 2009 as sure as Cinderella's coach turned back into a pumpkin. For example, the estate tax repeal is not fully phased in until January, 2009. By October 1, 2009, the tax law reverts back to today's rates and provisions. What kind of incentive does a nine month tax-free window for estates create for families? The Republican tax bill expands retirement savings incentives at the expense of average workers. How many working couples can afford to increase their IRA contributions from $2,000 to $5,000 per spouse? The Republican bill does nothing to help those who barely make enough to fund IRAs at current contribution levels. Rather than helpng lower and moderate income taxpayers to save, this bill helps those who have already made the maximum contribution under current IRAs and 401(k) plans save even more. Worse than just helping those in the upper brackets, this bill harms lower-wage workers depending on pensions. The Republican tax bill guts the ``top heavy'' rules enacted to assure that tax-favored pensions would be available to all workers and not skewed to help mainly those at the top. The ``top heavy'' rules are gutted just as the contribution amounts and benefits are increased. This bill does not bolster pension security; it increases pension insecurity for rank and file workers. There is a gesture to assist with health expenses but this, too, is flawed. The prescription drug benefit is what the Republicans call a ``place holder'', not a real benefit for real people who today are making hard choices about whether to fill their prescriptions or to buy food and pay their rent and utilities. Our seniors need prescription drug help now, not a promise to deal with drug costs in some undefined way at some later time. The Republican bill is flawed in the ways it throws money at special interests. Business tax breaks, unlike the rate reduction for individuals, will be in effect no matter how high the national debt soars. The Republican tax bill throws $24 billion in tax breaks at the multinational corporations. These are the same folks who move American jobs overseas. It throws about $650 million at the oil and gas industry which has a hand out in hard times but never gives credit due consumers in good times. There is even a tax break to produce power from chicken droppings, a real turkey of a provision if there ever was one. Timber growers get over $275 in taxpayer assistance for reforestation, something timber growers already do. Life insurance cmpanies get a billion dollar tax break which allows them to file consolidated returns with their affiliates to shelter income from tax. Another billion goes to nuclear power plant stockholders with the taxpayers picking up the tab for the decommissioning costs. The Republican tax bill spends close to $4 billion on raising business meal deductions but average workers won't be at the table for that perk. They don't get to take clients out for steak and martinis. The Republican sponsors boast that their bill returns money to American families but they don't even do that in a fair way. Sixty percent of the taxpayers in the middle income quintile (annual income of $23,800 to $38,200) would receive an average tax cut of $278 a year, less than 8% of the total money to be given back to families. Compare that to the best off one percent of taxpayers--those making more than $301,000--who would get an average tax reduction of more than $46,000 a year under the Republican bill. The bill does nothing to shore up Social Security or Medicare. It precludes paying down the debt with any surplus that occurs. Although the Republicans have the votes to pass this turkey of a bill, they won't have my support for it. I will vote NO on HR 2488.