Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to speak with fondness about the late Congressman George Brown. His death leaves us with one less person dedicated to the fight for America's future. When I came to Congress to try to end the Vietnam War, George was also fighting against that war. With his leadership, we brought our soldiers home and ended one of the lowest points in American morale and foreign policy. His fight for what was right didn't end with Vietnam. He fought for the environment, for education, and for the underprivileged throughout his career. One of Representative Brown's legacies is the Environmental Protection Agency. Before George Brown, there was no single entity in government designated to protect American air, water, land, and wildlife. His dedication to protecting our ecosystem helped improve the quality of life for all of us and future generations. George Brown raised environmental activism from a few dedicated scientists to the general public, making the environment an issue and assuring that the government protected it. Representative Brown interests went beyond preserving the environment for future generation; he cared deeply about the education of our children. George supported the establishment of educational loans. These loans have provided millions of Americans with the opportunity to go to college and contribute more to our society. Recently, he joined in support of building more schools, hiring more teachers, and improving the quality of our classes. He was committed to quality education for our children. George Brown fought to improve the lives of all Americans. He fought especially hard for those Americans who couldn't fight for themselves. Before coming to Congress, George worked to end anti-union laws and to ban discrimination. Once elected to Congress, he worked to enact the Civil Rights Act to address which discrimination against minorities. He also joined in the fight to improve health care, provide affordable prescription drugs, and even to protect our health care workers from accidental needlesticks. Congressman George Brown fought for so many things that we now take for granted. George stood up for what was right for our environment, education, and the underprivileged. Beyond all of these accomplishments, he was an example to all of us. He stood up for what he believed in regardless of the potential political fall out. He exemplified the ideals that this country was founded on. Although George is no longer with us, we will continue to fight to ensure that every American has the same rights, freedoms, and opportunities that some want to reserve for the elite few.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in support of H.R. 1660, the Public School Modernization Act. It is time for Congress to take action and make an investment in the future of America, our children. This legislation will provide significant help to local school districts in meeting their needs both to build new classrooms to keep up with skyrocketing school enrollments and to renovate and modernize their existing facilities. Overall, California alone projects a $20.1 billion five-year cost for school modernization, including $11 billion for modernization and technology upgrades of old facilities. These technology upgrades include very basic amenities such as additional electrical outlets, and telephone jacks for internet connection. Additionally, California will need $4 billion just to build new facilities to accommodate growing enrollment. California would get just over $3 billion under the Public School Modernization Act. This bill will provide $24 billion in interest-free funds for school modernization projects and deserves our support. According to the Committee for Education Funding, the Republican education agenda is projected to cut over $3 billion from the Department of Education's budget including a $1 billion cut from Title I funding, a program aimed at supporting children in poverty. Funding will also be slashed dramatically for Federal Pell Grants and the Head Start Program. It would be prudent to cut funding for wasteful defense programs, and unnecessary manned space exploration. It is time to make a significant improvement in the education of our children. I urge my colleagues to support HR 1606. Our children's future depends on it.

Mr. STARK

Mr. STARK. Mr. Speaker, Representative Markey and I have introduced the Omnibus Long-Term Health Care Act of 1999. We are joined by Representatives McGovern, McDermott, Moakley, Olver, Capuano, and Gordon. The following is a detailed outline of the provisions of this legislation. We invite members of the House to join us in cosponsoring this legislation. We invite the public to suggest refinements and additions to the legislation to make it more comprehensive, workable, and effective legislation to help the millions of Americans facing the problems of obtaining quality long-term health care.***HD***Title I: Long-Term Care Giver Tax Credit Title I of the bill provides a $1000 tax credit similar to the one described by the President in his State of the Union address. Our proposal has several notable differences. First, our tax credit is completely refundable, and there is no distinction between care for an adult or a child. If the credit is not refundable, it will fail to help those families in greatest need of help. To be honest, $1000 is not that much money for long-term care, but it does provide a family with modest relief that they can use as they see fit. That is why we have structured the bill to ensure that those who most need the support will receive the refund. Another important distinction between our proposal and the President's is the treatment of children with long term care needs. The President's proposal would limit the tax credit to $500 for children with long term care needs. We do not agree with this policy. The long- term care needs of a disabled child are just as expensive and emotionally and troubling as they are for an adult. Our legislation also has a broader definition of individuals with long-term care needs. The President's proposal includes individuals who require assistance in to perform activities of daily living (bathing, dressing, eating, continence, toileting, and transferring in and out of a bed or chair). This is a good start but does not include people with severe mental health disabilities or developmental disabilities who cannot live independently. Finally, our legislation limits the amount of the refund for the wealthy, not the poor. In our bill, reductions in the refund begin at the upper income levels, not the lower income levels. The full refund is available up to income of $110,000 for a joint return, $75,000 for an individual return, and $55,000 for a married individual filing a separate return. Above these levels, the refund is decreased by $50 by every $1,000 over the threshold level.***HD***Title II: Long-Term Care Medicare Improvements Title II of the legislation addresses a range of reforms and improvements to Medicare benefits. The goal of this title is to provide adequate long-term coverage to patients with chronic health care needs. We believe that we can adjust Medicare benefits so that people can continue to live in their homes and communities, and enjoy the contact with their families and friends. These proposals are cost effective as they rely on services in facilities other than hospitals and skilled nursing facilities, and allow people to continue to live in familiar surroundings with their family. 1. Long-Term Home Health Aide Benefits The first section extends Medicare Home Health Aid-Type services to chronically dependent individuals. This section establishes a new ``long-term'' home health benefit to maintain people with chronic conditions at home rather than in more expensive settings. Many people can no longer take care of themselves because physical or mental disabilities impair their ability to perform basic activities of daily living (ADLs), including eating, bathing, dressing, toileting, transferring in and out of a bed or chair, and continence. These are activities that we all take for granted. The inability to do any of these independently is distressing for the patient and a clear indication of the extent of the impairment. This provision allows individuals who suffer from a chronic physical or mental condition that impairs two or more ADLs to receive in-home care. To help contain costs, the provision would require competitive bidding of these services. 2. Adult Day Care The second section of this title's reforms is a provision for Medicare Substitute Adult Day Care Services. This provision would incorporate the adult day care setting into the current Medicare home health benefit. The provision allows beneficiaries to substitute any portion of their Medicare home health services for care in an adult day care center (ADC). Adult day care centers provide effective alternatives to complete confinement at home. Many States have used Medicaid funding to take advantage of ADCs for their patients. For many, the ADC setting is superior to traditional home health care. The ADC can provide skilled therapy like the home health provider. In addition, the ADC also provides rehabilitation activities and means for the patients. Similarly, the ADCs provide a social setting within a therapeutic environment to serve patients with a variety of needs. To achieve cost-savings, the ADC would be paid a flat rate of 95% of the rate that would have been paid for the service had it been delivered in the patient's home. The care would include the home health benefit and transportation, meals and supervised activities. As an added budget neutrality measure, the title allows the Secretary of Health and Human Services to lower the payment rate for ADC services if growth in those services is greater than current projections under the traditional home health program. This program is not an expansion of the home health benefit. It would not make any new people eligible for the Medicare home health benefit. Nor would it expand the definition of what qualifies for reimbursement by Medicare for home health services. This legislation recognizes that ADCs can provide the same services, at lower costs, than traditional home care. Futhermore, the legislation recognizes the benefits of social interaction, activities, meals, and a therapeutic environment in which trained professionals can treat, monitor, and support patients. The legislation also includes important quality and anti-fraud protections. In order to participate in the Medicare home care program, ADCs must meet the same standards set for home health agencies. The only exception is that the ADCs would not be required to be ``primarily'' involved in the provision of skilled nursing services and therapy services. The exception recognizes that ADCs provide services to an array of patients and that skilled nursing services and therapy services are not their primary activity. Here is an example of how the system would work. A physician prescribes home care for the patient. Next, the patient and his or her family decide how to arrange for the services. They could choose to receive all services through home care, or choose a mix of adult day care and home care services. Therefore, if the patient required three physical therapy visits and two home health aide visits, the patient could receive the physical therapy at the ADC while retaining the home health aide visits. When the patient goes to the ADC, he or she will receive the physical therapy and other benefits the ADC provides. All of these services would be incorporated into the payment rate of 95% of the home setting rate for the physical therapy service. This plan offers a savings for Medicare and an improved benefit to the patient. 3 Home Health Case Managers The third section of this title makes a number of improvements in the quality of services provided through home care. First it establishes a case manager who will oversee the provision of home health care. This section of the legislation will ensure that those in need of long-term health care will receive necessary and cost effective care. The Balanced Budget Act of 1997 (BBA) implemented a number of policies designed to slow the growth of a health benefit that was doubling in cost every three or four years. Prior to the BBA, the incentive to home health agencies was to over-use services to boost profits. In the BBA's prospective payment system (PPS), the incentive will be the opposite and there are real concerns about potential under- utilization of services. The Medicare Home Health Case Manager legislation would ensure that an independent case manager evaluates the patient's needs and service level. The case manager will be financially independent of the home health agency and would be paid through a Medicare fee-schedule, independent of the amount or type of care the patients receive. The legislation would also provide the Health Care Financing Administration (HCFA) with the flexibility to investigate the effectiveness of reimbursing home health case managers on a competitively bid basis. This type of case manager program is endorsed by the Medicare Payment Advisory Commission (MedPAC), a Commission appointed by Congress to provide expert advice on Medicare and Medicaid policy. In their March 1998 report to Congress they recommended that such a case manager be adopted for the home health benefit. Their report states: Such an assessment would help to minimize the provision of services of marginal clinical value, while ensuring that patients receive appropriate care. Requiring case management of long-term home health users could improve outcomes for individuals with long-term home health needs and at the same time slow the growth of Medicare home health expenditures. (Emphasis added). In addition, there are real-life examples of case management systems saving money and improving care. For example, Maryland's Medicaid program has a high cost user initiative which in FY 96 saved the state $3.30 for each $1 spent--a savings of 230%. The Health Insurance Association of America also commissioned a study of its member plans and found that rehabilitation/case management programs return an investment of $30 for every $1 spent. Therefore, this section would achieve two important goals. First, it saves money. Second, the program ensures that patient's needs are met. Patient's care should be determined based on an objective and independent evaluation of the patient's condition, not the bottom line of a health care corporation. 4. Coordinated Care Another section recognizes that there are many medical conditions, such as congestive heart failure, that create severe long-term care needs that need coordinated, comprehensive care. Many people suffer an acute condition that leaves them weakened and in need of health care long after the acute phase of the condition passes. Currently, Medicare does not adequately cover an expensive recuperation that can last for months. This section directs the Secretary to identify 10 medical conditions, clustered by diagnostic related groups (DRGs) that consistently require intense follow-up care. Along with the 10 DRGs, the Secretary would determine reasonable costs to cover comprehensive case management, caregiver education and training, and other general assistance. Our proposal requires the Secretary of Health and Human Services to identify those medical conditions, clustered into logical DRGs that represent the most expensive home health services, most consistently require home health services, and require the longest period of convalescence. Using these DRGs, the Secretary will be able to develop a better system of coordinating care and helping families. 5. Other Home Health Service Improvement Adopting a provision from Rep. Jim McGovern's bill, we propose an outlier policy. In brief, this provision requires that HCFA develop a home health agency outlier program, so that agencies do not avoid the money-losing, harder to care for cases. We also propose to strengthen the provisions in the BBA that require hospitals to give more objective information to patients about the full range of post-hospital services, and not just direct patients to their hospital-owned services. Finally, we give more flexibility to the ``homebound'' rule. 6. Hospice Improvements Another section provides broad revisions and improvements to the hospice care benefit. Hospice care includes interdisciplinary professional services for patients whose health condition will not benefit from cure-based treatments. Hospice care, which may be offered in the person's residence or a skilled facility, provides palliative care to reduce pain and enhance the patient's quality of life. For those patients in the terminal phase of their life, hospice care offers final comfort for the patient and the patient's family. The current rules governing hospice care offer physicians few incentives to recommend this alternative for their patients. In a 1999 report to Congress, MedPAC commented that, Another vulnerable population is the nearly 2 million Medicare beneficiaries who die each year. Too many of their physical, emotional, and other needs go unmet, although good care could minimize or eliminate this unnecessary suffering. Even hospices--which pioneered care for the dying--help only a fraction of patients and are often used far later than they should be. Ensuring that beneficiaries receive human, appropriate care at the end of their lives should be a priority for the Medicare program. The consequence of our current medical practice is that patients remain in more expensive treatment facilities and do not receive the palliative care they require. This section of the bill offers three specific improvements. First, the legislation would direct the Secretary to designate DRGs that indicate a chronic and terminal condition that are most likely to lead to death, and for which hospice care may provide assistance. These DRGs would then be used as a part of the patient's discharge planning. The intent of this section is to ensure that patients receive a complete review of their treatment and care options, including hospice options in the patient's community. A second solution is to ensure that information regarding hospice care becomes a part of physician training. This section does not require that physicians become proficient in the medical practice of hospice care, only that they become more aware of its services as an option for terminally ill patients. The legislation would also include hospice care within the federal employees health benefits program (FEHBP). We hope that by including this benefit for our nation's federal employees, we will set a standard for other insurance providers. The net result would be that more patients will obtain necessary hospice care during the final days of their lives. 7. Help for Low-Income Seniors and Disabled Another section of this title will help all lower-income Medicare beneficiaries--and the chronically ill, the disabled, and the frail `old-old' who tend to be those with the least income. This amendment is a repeat of a bill introduced by Rep. McDermott and Stark (HR 1455) which coordinates SSA and IRS data to presume that individuals who show income below the poverty level are eligible for the QMBy and SLMBy programs and presumptively enrolls them in those programs. Today about 40% to 50% of those who are eligible for these programs which pay Medicare's premiums, deductibles, and copays, fail to enroll. Presumptive enrollment will provide hundreds, even thousands of dollars of help per year to our nation's poorest, most vulnerable citizens.***HD***Title III: Nursing Home Improvements Title three of the legislation provides a number of reforms to laws and regulations governing skilled nursing facilities. Earlier this year, the General Accounting Office released a report that several members of Congress and Rep. Stark requested. That report, ``Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Quality Standards (GAO/HEHS-99-46)'' indicated that more than 40 percent of the skilled nursing facilities did not comply with fundamental quality standards. In many cases, these deviations from quality standards represent an egregious threat to the health of patients living in nursing homes. At least 25 percent of the homes reviewed violated standards that eventually created actual harm to the residents. Currently, 1.6 million elderly live in skilled nursing facilities. These people are among the sickest and most vulnerable segment of the population. A major portion of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) brought sweeping reforms to the nursing home industry. That legislation did much to improve and ensure the quality of health care provided in skilled nursing facilities. Fortunately, the majority of skilled nursing facilities responded well to these changes and continue of offer quality care for their patients. Unfortunately, a sizable minority of skilled nursing facilities continues to place profits ahead of quality care. Because of the continued failure of these providers, we must give the states and health care regulators the legal tools to bring these providers into line or remove them from the system. This title provides several important modifications and additions to the OBRA-87 legislation. First, all skilled nursing facilities will be required to conspicuously post in each ward of the facility a list of the names and credentials of the on-staff employees directly responsible for resident care and the current ratios of residents to staff. This simple requirement will allow families and the nursing home ombudsman program to determine whether the facility provides adequate staff to attend to the residents'' needs. In addition, the legislation would direct the Secretary of Health and Human Services to issue guidelines for adequate staffing for skilled nursing facilities. The second provision of this title gives states alternative punitive measures to use with repeatedly noncompliant nursing facilities. One of the distressing trends identified in the GAO report is a phenomenon they describe as a ``yo-yo'' effect. A nursing facility will correct the problem and avoid the fines or penalties. Once found to be in compliance, the facility will slip back and provide substandard services until cited again by regulators. Our proposed legislation offers two fixes. First, the legislation would allow states to recover the expense of resurveying and reinspecting the skilled nursing facility where there has been a substantial violation of the regulations. Second, the legislation would prohibit the facility from including the costs of the resurveying and reinspection in its reasonable costs figures. In other words, they cannot pass the bill of rectification onto Medicare or Medicaid. This proposal is a clear financial disincentive for homes to practice a yo- yo management and adds an important regulatory tool for the states. The third major initiative in our legislation is the requirement of criminal background checks. Skilled nursing facilities would be required to conduct a criminal background check of all employees and would be prohibited from hiring any person who has been convicted of patient or residence abuse. This portion of the legislation makes clear that we do not want felons who have a history of abusing others working with one of the most vulnerable groups of people in the nation. Finally, the legislation requires skilled nursing facilities to report cases when an employee has harmed a patient or resident. The legislation calls for revising the current Nursing Aide Registry. Under our legislation, the new name of the data base will be the Nursing Facility Employee Registry and will list any nursing facility employee who has been convicted or had a finding of abuse or neglect of a patient.***HD***Title IV: Long-Term Care Insurance Title four of the legislation addresses long-term care insurance. The first chapter encourages long-term health care policies for federal and nongovernmental employees. The second chapter extends the consumer protection standards contained within the Health Insurance Portability and Accountability Act to all long-term care policies. First, it directs the Office of Personnel Management to provide for the sale to the general public of group long-term care insurance policies that are offered to federal employees. The legislation keeps separate the premiums and costs of nongovernmental employees from governmental employees, thus protecting the federal employees from potential adverse cost impacts. In other words, nongovernment employees could pay a higher premium if the cost of underwriting that population is higher than the cost of underwriting federal employees. It is our hope, however, that by helping create a group market and offering economies of scale, this provision will help nonfederal employees obtain lower cost policies. The next section extends the consumer protection standards contained within the Health Insurance Portability and Accountability Act to all long-term care policies. Currently, these standards apply to only tax- qualified policies. Without these protections, some insurance providers may be tempted to provide long- term care policies that do not provide the level of financial protection that consumers need. Because of the expense of these policies, the consequences of purchasing inadequate insurance, and the difficulty of understanding these policies, we need to ensure that reasonable quality standards protect consumers from buying inadequate and inappropriate long-term care policies.***HD***Title V: Reauthorization of the Older Americans Act of 1965 Title five of the legislation is an extension of the Older Americans Act of 1965, as proposed by the President to include grants for care giver assistance.***HD***Title VI: Early Buy-in For Medicare Title six of the legislation would provide caregivers an early option to join Medicare. This important portion of the bill would provide increased access to health coverage for Americans who are the primary caregivers for family member with long-term care needs. Many Americans must quit job or retire early to care for a family member who has long care needs. In addition, they tend to range in age from 55 to 64. Consequently, health insurance companies refuse to insure them or charge huge premiums. Our proposal would cover nearly five million early caregivers who face the prospect of being uninsured and who are helping all of us by keeping other individuals out of taxpayer-subsidized institutions. This provision allows qualifying individuals to receive Medicare coverage when they leave their employment to provide long-term care for a spouse or relative.***HD***Title VII: Long-Term Care Giver Social Security Credit Protection Title seven also protects the future retirement income of caregivers who leave their employment to offer long-term care. This title does two things. First, it ensures that caregivers will continue to receive their Social Security credits while they are caregivers. Second, while the caregiver is unemployed he or she will be credited with the arithmetic average of his or her previous three years of employment as a contribution to income.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to honor Sergeant James Suk, a dedicated member of the Union City Police Department. Sergeant Suk recently retired from service after twenty- eight years of service, and will be honored by the Union City Police Department at a dinner on August 20, 1999. Officer Suk began his law enforcement career in Union City as a Patrol Officer in 1968, just two years after the Union City Police Department was formed. For the first six years of his career, Jim worked as a regular beat officer handling calls for service. During this time, he also worked in the Traffic Section and as a detective in the Investigations Section. In 1974, Jim was promoted to the rank of Police Sergeant and was assigned to the Patrol Division as a Watch Commander. He was the first director of the Youth Services Bureau. He also supervised the Investigations and Juvenile Sections. Jim's many assignments have included supervision of the Reserve Police Officer Program, the Prisoner Transportation Section, and the Crime Scene Technicians. During his long tenure at the Union City Police Department, Jim worked for every Chief of Police the department has had, and is one of the first Police Officers to retire. Each year, members of the Union City Police Officer's Association vote one outstanding officer as Officer of the Year. In 1996, the honor was awarded to Sergeant James Suk. It was an appropriate recognition for a career of exemplary performance. James genuinely cares about the people with whom he works. He has taken many new officers under his wing and help guide them in their careers. He is well respected by both his peers and the officers he supervises. The city will be honoring Sergeant Suk at a retirement dinner on August 20, 1999. I would like to join them in applauding his hard work and dedication. He has a fine record of accomplishments and is an inspiring example of citizenship. I wish Sergeant Suk the best in all his future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to honor and congratulate Patrol Officer Joan Honebein on her retirement from twenty-five years of service to the residents of the 13th Congressional District. Officer Honebein began her career with the Union City Police Department in 1974 when she was assigned to the patrol division. She was one of the first female patrol officers in South County. Joan, like every other officer, was responsible for handling a beat within Union City. In 1977, Joan was selected to be the director of the Youth Services Bureau. She supervised two youth and family counselors at Y.S.B. and served as the Union City Police Department's Juvenile Officer until 1984. In 1984, Officer Honebein returned to the patrol division to resume the duties of patrol officer and the responsibility of a beat. Joan remained a patrol officer until 1992 when she was selected to be the Court Liaison and Juvenile Detective. As a Court Liaison it was Joan's responsibility to take all pending court cases to the District Attorney's officer for review by the District Attorney. As the Juvenile Detective, she handled all juvenile cases referred to her by the patrol division. In 1997, Joan returned to the patrol division once again as a patrol officer responsible for a beat. Joan has been a member of several Union City Police Officers Association Executive Boards, rising to the rank of Vice-President. She was also a member of the Union City Lions Club for many years and is a past President. She has volunteered for many of the projects sponsored by the Lions Club in Union City. In 1998, Joan was voted Officer of the Year by the members of the Union City Police Officers Association in recognition of her willingness to go the extra mile when providing service to the citizens of the community. It was a fitting tribute to an excellent career. On August 20, 1999 the Union City Police Officer's Association will honor Officer Honebein at a recognition dinner. I would like to join them in expressing my appreciation for her hard work and dedication. I wish her success in all her future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, today, Representative Ed Markey, I and others are introducing legislation that will affect the qualify of life for all Americans with long-term health care needs. Each day, millions of families struggle as they care for their loved ones who suffer from chronic and debilitative diseases. Alzheimer's disease, Parkinson's disease, multiple sclerosis, and the ravages of old age make many people dependent on others for their basic care. We legislators have a fundamental obligation to act decisively to ensure the quality of life for all citizens, especially those who can no longer care for themselves. The simple fact is that we need to act now to avoid the ``baby boomer'' crisis in long-term health care. As Professor Ken Thorpe testified before the Senate Finance Committee on May 26, 1999, The number of persons requiring assistance due to physical, cognitive or other disabilities is expected to rise from 7 million today to over 15 million by the year 2030. Our current patchwork of programs funded through Medicare and Medicaid are not well positioned to meet the demographic challenges that await us. There are no ``good-old'' days we can turn to and proclaim as the golden age of care for the elderly. The simple fact is that old age and the need for long-term care is a modern phenomenon. In the 1930s, the life expectancy of most people was around 65 years. Consequently, previous generations did not have to confront the prospect of tens of millions of citizens needing long-term care. Current estimates greatly expand the life expectancy of Americans. A man born in 1957, the height of the baby boom, can expect to live to 78. A woman born the same year will live to 85, an additional 7 years. Improvements in general public health and medical practice, and changes in life style will continue to extend the average age that people can expect to live. The practice of medicine has witnessed monumental changes during recent decades. What was once considered medically impossible is now common place. Lifestyles have changed as well. Our constituents are learning to ignore the lies spread by cigarette manufacturers and are turning away from this deadly habit. Similarly, more Americans now understand how diet and exercise can improve their health and extend their lives. A common urban legend we must avoid is the belief that families gladly dump their parents into nursing homes as a ready convenience. The truth is that families want to look after each other and use nursing homes only as a last resort when the burden of care is beyond their control. The majority of the persons with long term health care needs continue to live in their home. Of the extreme elderly, those 85 and older, only 21 percent live in nursing homes. Most of those residents are not there by choice, but because they require skilled nursing services. We need to focus on the facts and plan for the future. The end of World War II was the beginning of the baby boom. By 2010, those children born in 1945 will begin to retire. According to a recent CBO report, in the year 2010 there will be 40.6 million people over the age of 65--a 14 percent increase from the year 2000. The trend will continue. By 2040, there will be 77.9 million people over the age of 65, 118 percent more than in 2000. Indeed, the 85 and older age group is the fastest growing segment of the population. As the average age of Americans increases, the proportion of citizens with disabilities will also increase. According to the CBO, by 2040 over 12% of the elderly will be disabled by a physical or mental condition. The growth in the number of persons with Alzheimer's disease illustrates the need to develop a comprehensive long-term care program. As many as 4 million of the nation's elderly currently suffer Alzheimer's disease. Unless someone finds a cure for this condition, the numbers are sure to grow. Within the next 20 to 30 years there may well be over 14 million persons with this terrible disease that slowly destroys the brain. According to recent surveys, over 50 percent of persons with Alzheimer's disease continue to live with a relative or spouse who sees to their day-to-day care. This personal care may last for many years and represents the equivalent of a full-time job. Most Americans neither understand nor have prepared for their long- term care needs. Many of our constituents do not understand the difference between Medicare and Medicaid. They also have many misperceptions of the benefits available from Medicare. The general public does not understand that Medicare does not provide for long-term care. This error is compounded by the fact that most people mistakenly believe that their health care will cover their long-term care needs. For these reasons, and many others, Americans do not have sufficient financial resources to pay for long-term care. Women are especially hard hit by the lack of planning for long-term care. In general, women live longer, earn less money, and are often required to be the primary care giver. The consequence is that they do not have sufficient resources to meet their own health care needs. Take as an example a young woman who decides to take time from her career, stay at home, and raise a family. The time out of the job market means that she is not earning an income and contributing to a retirement plan. In addition, she is not contributing to social security. Finally, she is not keeping pace with her career and her salary will be less than those who remained in the work force. When this women retires, her Social Security benefits will be far less than a man the same age who worked uninterrupted his adult life. Moreover, this women will not have comparable financial assets including pensions and health care insurance. All too often, women then deplete their retirement savings and assets paying for the ailing husband's long-term care needs. Anyone who believes that women now enjoy equal opportunity is woefully ill- informed. These facts and trends lead to a clear conclusion: We must plan for the future and act decisively now. If we do not, millions of our fellow citizens will face catastrophic health care problems without ample financial and social support. We cannot depend on single simple-minded solutions. Neither private insurance nor Medicaid can cover long-term care to any meaningful extent. Long-term care insurance is a shell game of dollar trading. Those who can afford these policies are usually better off investing their money in other ventures that produce better financial yields. Those who need long-term care typically cannot afford the insurance. Those who are young enough to afford the policies typically have other pressing financial obligations including raising a family, mortgages, and college tuition. Any mandate to require folks to buy long-term insurance is a regressive tax hidden behind a fancy name. We cannot count on Medicaid as it is the resource of last resort. Patients cannot use this benefit until they have exhausted all their personal resources. Do we really intend to demand that people face financial ruin to maintain health care? Suffering a severe physical or mental health problem is stressful enough, we should not further burden patients with the anxiety surrounding financial disaster. Mr. Speaker, my colleagues, we have the opportunity to create the golden era for long-term care, but we must start now. The legislation that we offer today sets the stage for better long-term care. Our legislation recognizes that there is no single quick fix for long-term care. For this reason, we propose a range of legislative initiatives that, when combined, offer a comprehensive package. We describe the details of the Comprehensive Long Term Health Care Act elsewhere in today's Record. We hope that our colleagues and advocacy groups will join in support and in recommending refinements and improvements.

Mr. STARK

Mr. STARK. Mr. Chairman, I oppose H.R. 987, the Workplace Preservation Act. This legislation would prevent the Occupational Safety and Health Administration (OSHA) from promulgating a desperately needed rule on ergonomics. H.R. 987 will needlessly subject hundreds of thousands of workers to occupational injuries while yet another study is completed. Repetitive injuries are one of the leading causes of work-related illness. More than 647,000 Americans suffer serious injuries and illnesses due to musculoskeletal disorders, costing businesses $15 to $20 billion annually in workers' compensation costs. Total costs of these injuries are estimated at $60 billion a year. Ergonomics is the science of fitting the job physically to a worker-- for example, by altering chairs, adjusting the speed of an assembly line, or using special braces to ease back strain from lifting heavy loads. A federal ergonomics standard is needed to protect American workers from those organizations who refuse to protect their employees. Unfortunately, the majority leadership would rather kowtow to industry and delay promulgation of an inevitable standard. For the past several years, OSHA has been working toward the implementation of a regulation designed to reduce workplace injuries attributable to ergonomic factors in the workplace. OSHA has advanced a draft proposal that would provide an urgently needed health and safety standard for working Americans. The proposal draws from the businesses that have successfully prevented ergonomic injuries or reduced their severity in the workplace. The issue of ergonomics and its impact on workplace injuries has been studied. It has been documented that ergonomics prevent workplace injuries. For example, in 1997, the National Institute of Occupational Safety and Health produced a study demonstrating the validity of the science underlying an ergonomics standard. A 1998 review by the National Academy of Sciences also found that musculoskeletal disorders in workers are caused by ergonomic hazards in the workplace. A nursing home in Maine implemented ergonomics changes in the workplace. The nursing home cut their number of lost workdays from 573 in 1991 to 12 in 1996 by investing $60,000 on patient lifting devices and instituting a policy banning the lifting of patients unless there was more than one worker present to assist. This saved the employer more than $730,000 annually in workers' compensation premiums as a result of this policy. This nursing home provides a clear example of the potential benefits of a uniform ergonomics standard. Despite the multiple studies already completed, the FY 1999 Labor, Health and Human Services Appropriations Act provided $890,000 for the National Academy of Sciences (NAS) to review the scientific literature on the issue of work-related musculoskeletal disorders. The study was expected to take at least 24 months to complete. However, on October 19, 19998, Appropriations Chairman Bob Livingston and Ranking Democrat David Obey assured Labor Secretary Alexis Herman in a letter that ``by funding the NAS study, it is in no way our intent to block or delay issuance by OSHA of a proposed rule on ergonomics.'' Unfortunately, nine months later, the Republicans have broken their promise. This bill requires OSHA to delay its work until yet another government study is concluded. The facts are clear--providing guidance to employers and employees on ergonomics will prevent tens of thousands of injuries, alleviate considerable human suffering, and save billions of dollars. We should not have to wait for completion of yet another study to tell us what we already know. We must defeat H.R. 987. I urge my colleagues to join me in opposing H.R. 987.

Mr. STARK

Mr. STARK. Mr. Speaker, the physician self-referral law has successfully prevented billions of dollars worth of business deals that would have abused patients through overtesting and provision of unnecessary services and wasted Medicare funds. That's why the legislation that is sponsored by Representative Bill Thomas--which effectively guts the statute by eliminating the Federal Government's authority to regulate providers' compensation relationships--should be summarily rejected. Instead, I hope that my colleagues will take a careful look at the legislation that I am introducing, which makes certain responsible changes in the law to streamline and simplify it. The principal provision in the Medicare Physician Self-Referral Improvement Act of 1999 creates a fair market value exception, or safe harbor, for providers who enter into compensation relationships with entities to which they refer Medicare and Medicaid beneficiaries for health services. All that is required under the fair-market value exception is that providers set down the terms of their arrangement in writing, that it is for a specified period of time and is signed by all parties; that it is not based on the volume or value of referrals; and that rates paid are commercially reasonable. What honest doctor can't meet those standards? The bill that I am introducing also makes changes in the ``direct supervision'' requirement that governs the in-office ancillary services safe harbor; substantially narrows financial relationship reporting requirements for providers, who would only have to produce accounts of their financial relationships and those of immediate family members upon audit; modifies the law's ``direct supervision'' requirement for in-office ancillary services; expands the prepared plan exception to include Medicare and Medicaid coordinated capitated plans; creates an exception for areas in which the HHS Secretary finds there are no alternative providers; exempts ambulatory surgical centers and hospices; alters the definition of a group practice; and requires HCFA to issue advisory opinions within 60 days of receiving a request. If enacted, these changes would improve the law without undermining it--as the Thomas bill clearly would. Policymakers know that the self- referral law is uniquely effective in controlling overutilization, and that it works well precisely because providers scrub their arrangements before finalizing contracts. In effect, the self-referral law is self- enforcing. To further substantiate that point, at a May 13 Ways & Means Health Subcommittee hearing on the physician self-referral law, the HHS Inspector General's chief counsel, D. McCarty Thornton, testified that the phony joint ventures on the 1980's have decreased significantly. That is good news. The result is that compliance with the law is standard practice in the health industry today. Even Columbia-HCA, which I have long criticized, now has a system in place that carefully screens financial relationships with physicians in order to stay in compliance with the law. This demonstrates that even without final regulations, the law is effectively controlling overutilization in Medicare's fee-for-service program--which still comprises 82 percent of all enrollees. Absent the law's curbs, Medicare would be highly vulnerable to overutilization again. Indeed, in 1995, when Representative Thomas introduced similar legislation, the Congressional Budget Office estimated the bill would cost Medicare $400 million over 7 years. It is particularly hypocritical that the American Medical Association is lobbying for repeal of the law's compensation provisions. Last time I checked, AMA's Code of Medical Ethics bars members from entering into self-referral arrangements. The Health Care Financing Administration has promised to issue final regulations for the physician self-referral law by next spring. At this juncture, it would be deeply irresponsible to enact legislation that effectively repeals the heart of the law--which is the Federal Government's ability to require fair-market value parameters for compensation arrangements between providers. If the law is repealed, taxpayers will again be forced to foot the bill for billions of dollars in provision of unnecessary services. Enactment of the Thomas proposal would shorten Medicare's life and return us to the days of the 1980's, when physicians created sham joint ventures to which they steered their patients for unnecessary, expensive, and even painful tests. I hope that we will not go down that road. The Medicare Physician Self-Referral Improvement Act bill summary The Medicare Physician Self-Referral Improvement Act of 1999 introduced by Rep. Stark refines the self-referral laws in a number of ways. Below is a summary of the bill that highlights major provisions in current law and major changes that this legislation makes to those provisions. Current law bans compensation between doctors and providers in certain designated health services areas. It is designed to provide a ``bright line'' in the law and to avoid requiring the government to investigate difficult ``kickback'' cases. The current law includes many complex exceptions to the total ban. The Medicare Physician Self-Referral Improvement Act of 1999 would replace most of the compensation exceptions with a single ``Fair Market Value'' test. It would maintain the exceptions to the ban for physician recruitment and de minimis gifts. Under the fair market value test, an agreement must be in writing, for a definite period of time, and not be dependent on the volume or value of referrals. The compensation in the contract must be a reasonable ``fair market'' rate. Current law requires ``direct supervision'' by referring physicians of those providing designated health services to qualify for the in-office ancillary service exception. The Medicare Physician Self-Referral Improvement Act of 1999 would require general supervision which is a less stringent standard than current law, but it would require that generally the physician be on the premises. Current law provides a general managed care exemption. The Medicare Physician Self-Referral Improvement Act of 1999 would clarify that the managed care exemption extends to Medicaid managed care plans and Medicare+Choice organizations. Current law provides an exception from the law in instances where no alternative provider is available. The Medicare Physician Self-Referral Improvement Act of 1999 would change that exception so that the Secretary of Health and Human Services would determine whether an area is underserved and therefore needed such an exception. Current law requires reporting of provider financial relationships and those of their immediate families, and institutes civil monetary penalties for failure to comply with such reporting requirements. The Medicare Physician Self-Referral Improvement Act of 1999 would repeal that reporting requirement and replace it with a requirement that physicians have records available for audit purposes. It would also abolish the civil monetary penalties that go along with the current financial relationship reporting requirement. Current law provides a list of designated health services that are covered by the self-referral ban. The Medicare Physician Self-Referral Improvement Act of 1999 would remove eyeglasses and lenses from the list and would clarify that the law does not cover ambulatory surgical centers or hospices. Current law requires HCFA to provide advisory opinions upon request, but has no deadline for their completion. The Medicare Physician Self-Referral Improvement Act of 1999 would require that advisory opinions be answered by HCFA within 60 days. Current law forbids providers from providing DME and parenteral and enteral nutrients as part of the in-office ancillary exception. The Medicare Physician Self-Referral Improvement Act of 1999 would eliminate the ban.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today with my colleague Albert Wynn (D-MD) on behalf of the citizens of the United States and their requests for a much-needed Medicare prescription drug benefit plan. Some of the greatest financial difficulties faced by seniors today come as a result of increasingly exorbitant medication prices. As the price of prescription drugs continue to rise, access to these vital drugs decrease concurrently. Just this week, we received the following petition from the Homecrest House Resident Council of Silver Spring, Maryland. This petition was sent to various members of Congress as well as President Clinton urging us to work together for the institution of a Medicare prescription drug benefit plan Close to 300 of the residents signed this letter which stretches some seven feet long. It is an urgent plea that not only lays out their own concerns, but also those of seniors nationwide who are constantly restricted financially from obtaining vital prescription drugs. The petition notes that decreased access to vital medications only contributes to prolonged illness and more frequent hospitalization, which subsequently increases the government's costs of caring for these elderly and disabled citizens. We ask our colleagues to join with us today in protecting our seniors and in aiding them in gaining access to the prescription drugs to which they are entitled. This petition is yet another visible example of the need for Congress to actively improve and protect the Medicare program. All seniors deserve access to prescription drug medications. It is our duty today to guarantee that access through prompt enactment of legislation that adds a prescription drug benefit to Medicare. I am submitting a copy of the petition we received which clearly illustrates the Homecrest House residents' concerns and requests. Homecrest House Resident Council, Silver Spring, MD, July 8, 1999. Hon. Peter Stark, House of Representatives, Washington, DC. Dear Representative Stark: We are enclosing our petition signed by most of our 300 resident. All acknowledgment would be greatly appreciated. We are sure that we voice a concern of our friends around the nation, seniors and disabled, who do without other necessities in order to buy need medications. We are confident that you will help us and that you and your party will get our vote, because you recognize how critically important it is to make prescription drugs more affordable for senior and disabled persons. Thank you for your cooperation. Sincerely, Virginia Benson, President. Mary Rygler, Chair, Community Affairs Committee. Enclosure.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to introduce the ``Patient Abuse Prevention Act of 1999'', which is being simultaneously introduced in the Senate by Senator Herbert Kohl (D-Wis.). This bill is designed to ensure that all prospective employees in long-term care facilities undergo criminal background checks. The bill is similar to a proposal in the Administration's budget, also establishing a national registry of individuals with histories of patient abuse by utilizing data from existing state registries. The goal of the new national registry is to prevent workers with a history of abuse from being hired to provide care for the frail elderly. Previous legislation enacted in 1998 permits--but does not require-- nursing homes, skilled nursing facilities and home health agencies to conduct criminal background checks on applicants. This bill takes the next logical step by requiring that all long-term care facilities screen all applicants for employment. The bill is enthusiastically supported by the Secretary of Health and Human Services and the National Citizens' Coalition for Nursing Home Reform. Secretary Shalala believes that this is ``the toughest set of requirements ever proposed for long-term care workers.'' Both letters of endorsement are attached at the conclusion of this statement. In order to overcome industry resistance to this needed change, this bill allows long-term care facilities to include such costs on their reports submitted to the federal government for reimbursement purposes. It is clear from several General Accounting Office analyses and hundreds of media reports that in order to improve the quality of care provided in long-term care facilities and decrease fraud and abuse, the federal government must take a more active role in making certain that those who are hired to care for seniors are fully qualified to do so. Thus, in addition to the background check requirements, the bill imposes significant civil monetary penalties upon providers who hire workers who do not pass background checks. We have all heard the horror stories about convicted violent offenders obtaining jobs in long-term care facilities. Such occurrences are intolerable. This bill is an important step in guaranteeing the safety of our seniors who receive long-term care. I look forward to working with my colleagues in the House and Senate to pass this important quality improvement for Medicare and Medicaid patients. The Secretary of Health and Human Services, Washington, DC, July 21, 1999. Hon. Herbert H. Kohl, U.S. Senate, Washington, DC. Dear Senator Kohl: I want to commend you and Senator Reid for your leadership on the vitally important matter of assuring that our most vulnerable frail and sick elderly and disabled Medicare and Medicaid beneficiaries are protected from people with violent criminal backgrounds or a history of abuse. We in HHS appreciate working with you and your staffs to help ensure that seniors and persons with disabilities receive the safe, high quality care they deserve. Your ``Patient Abuse Prevention Act'' will require nursing homes and other long term care providers to initiate background checks of prospective workers. We have a few issues with the bill that we would like to continue to work with you to address. We recognize, however, that this set of requirements is the toughest ever proposed for long term care workers. It builds on earlier proposals by the current bill's sponsors and is similar in a number of respects to proposals made by the President last year. For the many competent, caring, professionals and facilities who provide safe, quality long term care, it sends a message that we respect and value their high standards and want to find new workers who will live up to them as well. However, for criminals and those with a history of abusing or neglecting those dependent on their care, and for those who may have allowed such individuals access to vulnerable beneficiaries, it says in a clear and unmistakable way that you will not find a job in long term care paid for by Medicare or Medicaid because we will not tolerate it. As President Clinton said when he called for such an approach, ``When families have to worry as much about a loved one in a nursing home as one living alone, then we are failing our parents and we must do more.'' This bill does do more. We applaud your efforts and look forward to continuing to work with you on this bill to improve the safety of sick and frail elderly and disabled people. Sincerely, Donna E. Shalala.

Mr. STARK

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I oppose renewing normal trade relations with the People's Republic of China. Indeed, it may be among the world's oldest civilizations, but today those wonderful people are lead by barbarious fascists. The gentleman from Texas (Mr. Archer), chairman of the Committee on Ways and Means, asked: Who is hurt? I can give my colleagues a list of the people who are hurt now by our current relationships with China: Millions of Tibetans, 6 million having been killed since the Chinese occupation in 1949; 2,000 political prisoners, these are just religious dissidents; 30 to 40 million Muslims have suffered; women and children; women pregnant outside of family planning rules have been abducted and forced to have sterilization. The inhumane treatment of human beings in China is documented over and over and over again. As far as national security, it has been documented recently by the Cox committee that China is stealing military secrets from us in preparation for nuclear war and has violated the proliferation and nonproliferation agreements and does not deserve our trading partnership. Whatever help may go to Boeing and Hewlett-Packard and whoever wants to sell a bunch of roam phones and airplanes to China is paid for by the blood and sweat that makes the cheap T-shirts and cheap shoes that are sold by Wal-Mart and others who import the slave labor produced goods. We cannot continue this. This is just a matter of will Americans do business with murderers, with torturers, with child molesters, with people who are being lead by leaders who have no spark of humanity. This cannot go on. The only message they understand is profit. They care not one whit for decency. The only thing we can do is cut into our profit at some small risk to the richest manufacturing companies in this country. Let us do it. Let us make a statement for human rights. Let us make a statement for childhood suffrage. Let us make a statement for decency. Let us make a statement for all the American values and suggest that we are rich enough and strong enough in this country to support Boeing and Hewlett-Packard and all of those people, and McDonald's franchises, all of those people who would supposedly be hurt if we do not. Mr. Speaker, it is my pleasure and privilege to yield 5 minutes to the gentleman from Oregon (Mr. Wu), one of the leading Members of the freshman class of the House of Representatives in the Democratic Caucus who has much experience and knowledge in this area.

Mr. STARK. I am in favor of the joint resolution, Mr. Speaker. Parliamentary Inquiry

Mr. STARK. Mr. Speaker, I am honored to yield 3 minutes to the gentleman from Michigan (Mr. Bonior) the distinguished minority whip.

Mr. STARK. Mr. Speaker, I yield 3 minutes to the gentleman from Ohio (Mr. Brown).

Mr. STARK. Mr. Speaker, I would just like to suggest that while there were $14 billion of stuff that we exported to China, you figure 20,000 jobs per billion, that is 280,000 jobs. That is hardly as many as the Chinese have killed in Tibet since their horrid reign. It is how you decide you want to take care of people. Mr. Speaker, I yield 3 minutes to the distinguished gentlewoman from California (Ms. Pelosi), the leader in the fight for human rights in China, for sensible and reasonable trade negotiations that will lead to nonproliferation and workers' rights and human rights. I ask unanimous consent, Mr. Speaker, at the conclusion of her remarks that she be allowed temporarily to control my time.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Ohio (Mr. Kasich).

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from California (Ms. Lee) a leader in the fight for human rights and my neighbor.

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentleman from California (Mr. Lantos).

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentlewoman from Ohio (Ms. Kaptur).

Mr. STARK. Mr. Speaker, I yield 30 seconds to the gentleman from Vermont (Mr. Sanders).

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Ohio (Mr. Kucinich). (Mr. KUCINICH asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 30 seconds to the gentleman from Illinois (Mr. Lipinski). (Mr. LIPINSKI asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from California (Ms. Pelosi).

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

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