Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, might I inquire as to the time remaining.

Mr. STARK. Mr. Speaker, I yield 7 minutes to the distinguished gentleman from Oregon (Mr. Wu).

Mr. STARK. Mr. Speaker, I ask unanimous consent that I be allowed to yield half of my time in support of the joint resolution to the gentleman from California (Mr. Rohrabacher), and that in turn, he be allowed to yield blocks of that time so yielded.

Mr. STARK. Mr. Speaker, I am pleased to yield such time as he may consume to the gentleman from Missouri (Mr. Gephardt), the distinguished minority leader, to close debate for our side. (Mr. GEPHARDT asked and was given permission to revise and extend his remarks.)

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in strong support of H.R. 457, the ``Organ Donor Leave Act.'' This legislation will assure that federal employees will be granted an adequate amount of leave if they choose to undertake organ or bone marrow donation. Over 50,000 people are currently awaiting an organ transplant, but because of a national shortage, over 4,000 people die each year for lack of a suitable organ. Research points to a clear need for incentive programs and public education concerning organ donation. We need to use every possible option to increase the number of donated organs. This legislation is one way to meet this goal. Currently, federal employees may use up to 7 days of leave to serve as an organ or bone marrow donor. However, experience indicates the need for additional time for organ transplant operation and post- operative recovery for living donors--up to six or eight weeks in many cases. The ``Organ Donor Leave Act'' increases the amount of leave that federal employees may use to serve as an organ donor to 30 days. This legislation also goes hand-in-hand with the ``Gift of Life Congressional Medal Act of 1999'' which Senator Frist and I introduced this past March. This non- controversial, non-partisan legislation creates a commemorative medal to honor organ donors and their survivors. I ask that our colleagues act to support both the Gift of Life Congressional Medal Act as well as the Organ Donor Leave Act to increase organ donation and to bring an end to transplant waiting lists. Today's vote in an important step toward increasing organ donation, but there are many additional steps that we should also be making to improve our national organ donation rate. I look forward to working with my colleagues in implementing additional future improvements.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise today in opposition to the proposed $266 billion for the Defense Appropriations for FY 2000. This bill appropriates $2.8 billion more than the administration's request. This includes hundreds of millions of dollars needed to build new F-15s and F-16s--both Cold War fossils--and $3.9 billion for a national missile defense system. What is the threat that we need such elaborate and expensive items to add to the U.S. defense? What is the threat that we are willing to forsake health care for our children, smaller classrooms for our children and prescription drug coverage for our seniors? Times are changing. The $3.9 billion that is to be spent on missile defense is an example of money invested in a non-existent threat. The proposed National Missile Defense (NMD) program would have been much more useful fifteen years ago, during the Cold War. Biological and chemical warfare is the foreseen threat these days, and an NMD program will soon be obsolete. Defense spending should be decreasing, yet it is costing more and more each year to defend ourselves from an invisible enemy. The Pentagon is the largest source of bureaucratic waste, fraud and abuse in the federal government. Military contractors and their champions in Congress fuel wasteful military spending by promoting weapons as jobs programs and stuffing pork projects into districts and states. When in reality, the jobs gained in the U.S. pales in comparison to those sent overseas to complete the majority of weapons development. Congress should hold military projects to the same ``pork accountability standard'' as other government projects. The worst part of it all is that in order to fund these ridiculous increases, programs designed for community and regional development programs will suffer the most. Massive cuts in domestic programs will equal a massive loss in jobs for teachers, construction workers, civil service workers, and others. This money could also be directed to improve the quality of childcare for working families, improving Medicare, and increased funding for medical research. Remember to keep in mind the $13 billion wasted in Kosovo--a situation that could have been settled through peace talks and negotiations. Now, NATO wants our support to rebuild the bridges, roads, and towns that were destroyed. I strongly urge my colleagues to join me in opposing this wasteful and misdirected use of $266 billion. Please oppose H.R. 2561, the Defense Appropriations for Fiscal Year 2000.

Mr. STARK. Mr. Chairman, I offer an amendment.

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

Mr. STARK. I appreciate the gentleman.

Mr. STARK. I yield to the distinguished gentleman from California.

Mr. STARK. The gentleman's record is well known in that regard, and I deeply appreciate his support of this amendment.

Mr. STARK. Mr. Chairman, this is a simple amendment, and it does not save much money, but we learned from years ago from H. R. Gross that we save a little bit at a time and it adds up to a big amount. But we have been subsidizing defense contractors at air shows designed to sell our weapons to foreign governments. I have no quarrel, and I am not here to debate the value or the validity of air shows, but I am suggesting that we have had a long history with this, and it culminated in 1992 when a U.S. Marine aircraft crashed on its way back from the Singapore airport, and in response to that misuse of taxpayers' money, because we had subsidized that air show by sending our planes, our men to basically be demonstrators or sales people----

Mr. STARK

Mr. STARK. Mr. Speaker, I rise in opposition to H.R. 2488, the Financial Freedom Act which has been brought to us for consideration by the Republican leadership. After the hard choices made in the 1993 tax bill to restore our nation's economic health after the debacle of ``Reagonomics'', we are in better shape than in the last 15 years. Now Republicans want to pass a $3 trillion tax cut premised on budget cuts that will never materialize. This whole exercise is a hoax. The Republicans have created the illusion of paying back their wealthy supporters and corporate special interests in a bill that will never become law. Contrary to its title, this bill with its reckless spending of close to a trillion in the next decade and more than $2.8 trillion by the following decade, will rob our nation and future generations of any chance of financial freedom. By spending more than we have in real surpluses, we will restrict our ability to bolster our Social Security trust funds to accommodate changes in demographics and also to protect and improve Medicare. There is no financial freedom for the majority of seniors without Social Security. There is no financial freedom for seniors and their children saddled by prescription drug and long-term care expenses. Yet passing massive, unfunded tax cuts threatens the ability to bolster both Medicare and Social Security. There is no financial freedom for most families under this bill that allocates close to half of the total tax benefits to the richest one percent whose incomes exceed $301,000. The richest one percent would get an average tax cut of $54,000 a year. The bottom 60% of taxpayers-- those with incomes less than $38,200--would get an average cut of $174 a year. The bill buys the rich quite a bit more financial freedom than the rest of us. This bill targets the benefits to the rich in the way they structure the 10% tax cut, and by the size of the capital gains cut and the virtual elimination of the estate taxes. Only the wealthiest 2% of estates even pay estate tax now because current law exemptions; there is no such thing as a ``death tax'' for most American taxpayers. This bill lets everybody out the door--Warren Buffet, Bill Gates, Malcolm Forbes--not just the small businessman and farmers in search of a relief to pass on a small business to their children. The average benefit of the capital gains cut for the top 1% of taxpayers is $8,319 while 80% of the taxpayers--those with incomes under $62,800--would get a cut of $17 or less from the capital gains reduction. Seventeen dollars a year doesn't buy much financial freedom for working family by any objective measure. There are also over $100 billion in corporate tax breaks including some for arms merchants, oil, gas and timber investors, and folks who can enjoy three martini lunches. Even the guise of providing relief for long-term care expense is just a tool to expand the market for insurance industry. The tax credit in the Republican package can only be used to buy insurance, not to pay long-term care expenses themselves. This bill just reinforces skepticism by voters that they won't get any tax relief because it will go to rich individuals and corporate freeloaders. I urge a no vote on H.R. 2488: The tax breaks are tilted toward the rich. This tax cut is too big for this country to bear before the surplus even materializes. A yes vote tonight is a reckless vote that gambles away funds needed to preserve Medicare and Social Security. A yes vote guarantees an increase in public debt.

Mr. STARK. Mr. Speaker, I opposed the Republican tax bill in Committee and I oppose it today because it will force, in the near future, massive, destructive cuts in Medicare, and it prevents us from improving Medicare with a modest prescription drug benefit. By reducing the tax cut by about 40%, we can extend the life of the Medicare Trust Fund well into the retirement of the Baby Boom generation, from 2015 to 2027. We can also make Medicare a modern health care program by covering pharmaceuticals which reduce the need for hospitalizations and which provide quality, preventive care. If we don't use these resources to extend the life of Medicare, but instead pass this tax cut, we are voting for future massive cuts in benefits to seniors and the disabled, or for massive, crippling cuts to hospitals, nursing homes, and home health agencies--or for a massive future tax increase at a time when the economy may not be able to handle such an increase. The choice seems obvious: save resources for Medicare today, or face impossible choices in the future. When we know with absolute certainty that Medicare will need major new resources in the near future, do we want to give away revenues in a tax cut, largely to the rich, that could prevent this future crisis? Workers per Medicare Beneficiary will fall from 1998's 3.9 to 2.3 workers per beneficiary in 2030. We must make it easier now for those fewer workers of the year 2030 to pay taxes to support retirees and the disabled. That means dedicating revenues now (by retiring debt). Other options for extending the life of the Hospital Trust Fund are unacceptable. The Medicare Hospital Trust Fund runs out of money in 2015. ``To bring the HI program into actuarial balance, over just the next 25 years under the Trustees' intermediate assumptions, would require either that outlays be further reduced by 11% or that income [payroll taxes] be increased by 12 percent.'' By voting not to save 15% of the surplus to HI, thus extending the Trust Fund to 2027, Members are in effect voting for additional major hospital cuts or future tax increases. Republican Members of Ways and Means have sponsored or cosponsored many Medicare spending bills that will cost tens of billions over the next 10 years. If they don't support saving some money for Medicare, supporting these Medicare bills isn't real--it is hypocrisy. Mr. Foley is on 9 bills including a major hospital outpatient payment relief bill. Mr. Hayworth has 4, Mr. Watkins has gone to bat for the chiropractors and would spend billions more. Mr. McInnis would spend billions more. Mr. Ramstad is supporting 6 bills that would spend billions, Mr. English 11, Mr. Camp 6, and Mr. Nussle, leader of the rural caucus, has 7 spending bills that would cost billions. You all are basically saying you don't really want to do any of those spending bills or those bills to undo the BBA, you just want tax cuts. Can't shift more costs to seniors and disabled. Medicare is already one of the lowest retiree benefit plans in the industrialized world and worth less than the value of the average private insurance/employer plan. (That's why we need to add a prescription drug benefit.) Costs are already being shifted to seniors because of that Balanced Budget Act. We can't shift more.

Mr. STARK

Mr. STARK. Mr. Speaker, I am proud to join with my colleagues to introduce the National Mental Health Parity Act of 1999. The goal of this legislation is to provide parity in insurance coverage of mental illness and improve mental health services available to Medicare beneficiaries. This legislation will end the systematic discrimination against those with mental illness and reflect the many improvements in mental health treatment. My legislation would prohibit health plans from imposing treatment limitations or financial requirements on coverage of mental illness, if they do not have similar limitations or requirements for the coverage of other health conditions. The bill also expands Medicare mental health and substance abuse benefits to include a wider array of settings in which services may be delivered. Specifically, the legislation would eliminate the current bias in the law toward delivering services in general hospitals by allowing patients to receive treatment in a variety of residential and community-based settings. This transition saves money for the simple reason that community-based services are far less expensive than hospital services. In addition, community-based providers can better meet the patient's personal needs. Providing access to mental health treatment offers many benefits because of the significant social costs resulting from mental health and substance abuse disorders. Treatable mental and addictive disorders exact enormous social and economic costs, individual suffering, breakup of families, suicide, crime, violence, homelessness, impaired performance at work and partial or total disability. Recent estimates indicate that mental and addictive disorders cost the economy well over $300 billion annually. This includes productivity losses of $150 billion, health care costs of $70 billion and other costs (e.g. criminal justice) of $80 billion. Two to three percent of the population experience severe mental illness disorders. As many as 25 percent suffer from milder forms of mental illness, and approximately one out of ten Americans suffers from alcohol abuse. One out of thirty Americans suffer from drug abuse. Alcohol and drug dependence is not the result of a weak will or a poor character. In many cases, the dependence results from chemical abnormalities in the person's brain that makes them prone to dependence. In other cases, the dependence represents a reaction to unhealthy social and environmental conditions that perpetuate abuse of alcohol and drugs. Regardless of the cause of the abuse, alcohol and drug abuse can be treated and allow the person to live a normal and productive life. Mental health disorders are like other health disorders. With appropriate treatment, some mental health problems can be resolved. Other mental health conditions, like physical health conditions can persist for decades. Indeed, there are those who battle mental illness their entire life just as there are those who suffer from diabetes, congenital birth defects, or long-term conditions like multiple sclerosis. Whereas insurance policies cover the chronic health problems, they do not offer the same support for mental health conditions. During the last 104th Congressional session, parity in the treatment of mental illness was a widely and hotly debated issue. Although parity legislation was finally developed, insurance carriers found gaping loopholes and created mental health insurance policies that provide less access to mental health services. Furthermore, the current parity legislation includes many exemptions in coverage requirements for small employers. if an employer has at least 2 but not more than 50 employees, they can be exempt from the coverage requirement. Finally, if a group health plan experiences an increase in costs of at least 1 percent, they can be exempted in subsequent years. We can and must do more for our constituents. My proposed legislation addresses two fundamental problems in both public and private health care coverage of mental illness. First, despite the prevalence and cost of untreated mental illness, we still lack full parity for treatment. The availability of treatment, as well as the limits imposed, are linked to coverage for all medical and surgical benefits. Whatever limitations exist for those benefits will also apply to mental health benefits. Let us not forget the small employers either. If a company qualifies for the small employer exemption, the insurance companies will be able to set different, lower limits on the scope and duration of care for mental illness compared to other illnesses. This means that people suffering from depression may get less care and coverage than those suffering a heart attack. This disparity is indefensible. Access to equitable mental health treatment is essential and can be offered at a reasonable price. Recent estimates indicate that true parity for mental health services will increase insurance rates by a mere one percent, a trivial price to pay for the well being of all Americans. Second, the diagnoses and treatment of mental illness and substance abuse has changed dramatically since the start of Medicare. Treatment options are no longer limited to large public psychiatric hospitals. The great majority of people receive treatment on an outpatient basis, recover quickly, and return to productive lives. Even those who once would have been banished to the back wards of large institutions can now live successfully in the community. Unfortunately, the current Medicare benefit package does not reflect the many changes that have occurred in mental health care. This bill would permit Medicare to pay for a number of intensive community-based services. These services are far less expensive than inpatient hospitalization. For those who cannot be treated while living in their own homes, this bill would make several residential treatment alternatives available. These alternatives include residential detoxification centers, crisis residential programs, therapeutic family or group treatment homes and residential centers for substance abuse. Clinicians will no longer be limited to sending their patients to inpatient hospitals. Treatment can be provided in the specialized setting best suited to addressing the person's specific problem. Currently there is a 190-day lifetime limit for psychiatric hospital treatment. This limit was originally established primarily in order to contain costs. in fact, CBO estimates that under modern treatment methods, only about 1.6% of Medicare enrollees hospitalized for mental disorders or substance abuse used more than 190 days of service over a five year period. Under the provisions of this bill, beneficiaries who need inpatient hospitalization would be admitted to the type of hospital that can best provide treatment for his or her needs. Inpatient hospitalization would be covered for up to 60 days per year. The average length of hospital stay for mental illness in 1995 for all populations was 11.5 days. Adolescents averaged 12.2 days; 14.6 for children; 16.6 days for older adolescents; 8.6 days for the aged and disabled; 9.9 days for adults. A stay of 30 days or fewer is found in 93.5% of the cases. The 60-day limit, therefore, would adequately cover inpatient hospitalization for the vast majority of Medicare beneficiaries, while still providing some modest cost containment. Restructuring the benefit in this manner will level the playing field for psychiatric and general hospitals. In summary, my legislation is an important step toward providing comprehensive coverage for mental health. Further leveling the health care coverage playing field to include mental illness and timely treatment in appropriate settings will lessen health care costs in the long run. These provisions will also lessen the social costs of crime, welfare, and lost productivity to society. This bill will assure that the mental health needs of all Americans are no longer ignored. I urge my colleagues to join me in support of this bill.

Mr. STARK

Mr. STARK. Mr. Speaker, on July 31, 1999, Union City, California will celebrate its 40th Anniversary and its recent designation by the National Civic League as an All-American City, one of only ten in the United States for 1999. Although the City of Union City will be celebrating its 40th Anniversary in 1999, the year 1850 marks the date that settlers John and William Horner visited an oasis by the Bay and laid out a small settlement town eight square blocks which they called ``Union City.'' It is said that the name originates from the Horners' Sacramento River steamer call ``The Union.'' In the early 1850's, Union City had a total population of just three families. This is in stark contrast to the nearly 64,000 residents who inhabit the City today. Many of Union City's early settlers were disappointed gold miners who found that growing potatoes, fruits, and vegetables could also be quite profitable and rewarding. Most of the vegetables grown in California were shipped from Union City as this area was considered to be the most fertile agricultural land in the state. By 1852, Union City had developed into a town that had several hotels, numerous boarding houses, livery stables, general stores, a blacksmith shop, and a men's furnishing store among others. The coming years saw major industries start to settle in the area, such as Pacific Coast Sugar Company and Gold Medal Flower. Much of the area that is now Union City was spared with little damage during the earthquake of 1906. However, Union City faced a new challenge in the 1950's when several adjacent cities targeted Union City for possible annexation. To prevent this from happening, Union City residents decided to successfully incorporate the city in 1959. Present day Union City is known as the Gateway to the Silicon Valley. With a diverse population of almost every imaginable ethnicity, Union City exemplifies the true American spirit. Civic-minded communities continue to work tirelessly for safe neighborhoods, quality housing and exemplary schools. I am proud to represent Union City in my 13th Congressional District, and I ask my colleagues to join me in congratulating this outstanding city on its 40th birthday and designation as All-American City for 1999.

Mr. STARK

Mr. STARK. Mr. Chairman. I rise today in support of the Exchange Stabilization Fund (ESF) amendment to the Treasury Dept. Appropriations bill. Congress is the only body of this government that is legally able to authorize the treasury to spend any money. That is why I support this amendment, it returns control of US funds to the Congress, where it belongs. Our Constitution states that the government spending is restricted in that ``No payment (shall be made) from the Treasury except under appropriations made by law''. The Constitution shows no concern whether the funds in the Treasury come from taxes, or sales of assets, or even investment and trading of foreign currency. Therefore Congress, not the Executive or some Agency of the Government, is the only body that can allocate funds from the Treasury for any purpose. I understand some concerns that this body may not be swift enough to react to the rapidly changing international economy, however some compromise weighing the importance of the Constitution with the rapidly changing nature of the economy must be made. This amendment does not stop the Treasury from reacting to an emerging financial crisis, it simply allows the Congress to live up to its Constitutional responsibility to make sure that America's money is spent in a manner that promotes American interests. In 1997 a provision similar to the amendment we are debating today expired. In the year following this expiration, the Treasury provided $3 billion to Indonesia, $5 billion to South Korea, and $5 billion to Brazil, through the ESF. Which means that $13 billion of the American citizen's money was spent at the discretion of the Treasury with no need to consult representatives of the American people. The Exchange Stabilization Fund was established in order to stabilize the US dollar. Some may argue that the stability of foreign governments is vital to the stability of the international economy, and therefore the American currency. That may even be true, but no member of Congress was able to make that argument. It was simply a decision handed down to us by some officials in the Department of the Treasury. Passing this amendment will restore the power of this body to control how the American citizen's dollars are spent. I urge all members who understand the Constitution and believe that they are responsible to their constituents, to vote for this amendment.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in strong support of enhancing the preventive benefits available in the Medicare program. The President's Medicare reform plan has taken a step in the right direction by eliminating cost sharing on preventive services. This will encourage more beneficiaries to seek out mammography and other valuable screening tests. Let's continue this work by encouraging outreach efforts targeting preventive care. The number don't lie. Prevention saves lives. The Centers for Disease Control and Prevention has stated that ``our country cannot decrease its enormous healthcare costs, much less its priority health problems, without addressing in a fundamentally more aggressive manner, the prevention of chronic disease.'' (Unrealized Prevention Opportunities; Reducing the Health and Economic Burden of Chronic Disease, CDC Publication March, 1997) The most preventable cause of death in our society is tobacco use. Although we hope to target new initiatives for preventing tobacco use primarily to children and adolescents, a lot can be accomplished with smoking cessation efforts in the senior population. The President's decision to include such programs in his reform plan makes good sense. Studies have shown that health risks attributable to smoking decrease significantly within a few years after quitting, regardless of age. Tobacco use costs the nation $50 billion annually, in medical expenses alone. Smoking cessation efforts can help to reduce this immense burden on the health care system. With most chronic diseases, early detection is the key to successful treatment. Early detection also has the potential to save money. For example, treatment costs for breast cancer diagnosed in the localized stage are as much as 32 percent lower than treatment costs for later state diagnosis. Regular screening can detect cancers of the breast, colon, cervix, among others, at early stages. Currently, about 66 percent of people with these cancers survive for more than 5 years. With improved early detection efforts, about 95 percent or an additional 115,000 people would survive for 5 years or more. You can't put a price tag on that. In the case of diabetes, the CDC has found that enhanced prevention could save the Medicare program nearly a billion dollars per year. For example, if all people with diabetes received recommended eye disease screening and followup, the annual savings to the federal budget could exceed $470 million. Second, over half of the 57,000 lower extremity amputations associated with diabetes could be prevented. These preventable amputations currently cost $285 million annually. Finally, at least half of the 19,000 new cases of diabetes related kidney disease could be prevented. These preventable cases cost over $350 million annually. Prevention makes good sense in terms of both human and monetary costs. To not support the prevention of chronic diseases is to turn our backs on addressing the major health issue of our time.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to honor and congratulate Sergeant Ronald Icely, for serving the residents of the City of Milpitas for more than 31 outstanding years. Sergeant Ronald Icely attended Mt. Whitney High School in Visalia, CA, and graduated in 1965. He then continued his education at College of the Sequoias and San Jose State University. He began his career in public service as a reserve officer with the San Jose Police Department while at San Jose State University in 1967. On August 1, 1968, Ronald Icely was appointed to the Milpitas Police Department. He was promoted to senior officer in 1973, and promoted to Sergeant in 1975. During his many years of service, Sergeant Icely has received numerous letters of appreciation and commendation from the citizens of Milpitas as well as from many government agencies. He has been praised by his past supervisors for the high quality of his work, his leadership skills and investigative experience. In his tenure as a police officer, Ronald Icely saw Milpitas grow from a small community to a thriving city of 65,000 people. As the city grew his charge became more demanding, but Sgt. Icely continued to serve commendably. Early in his career Sergeant Icely became a member of the department's K-9 squad. He served as K-9 officer for five years with his canines, ``Romell'' and ``Toma''. He also received advanced training in supervision, and homicide and sexual assault investigation. Sergeant Icely has served as a field training officer and field supervisor in the patrol and traffic sections. He was also a supervisor in the Investigation Division and the lead investigator in ``felony persons'' crimes that included high profile homicide, robbery and sexual assault cases. Sergeant Icely has been very active with the youth of the community throughout his career. He coached PAL basketball, PAL baseball, and little league baseball for nine years. Sergeant Icely was also a charter member of the Milpitas Police PAL Board of Directors. The city will be honoring Sgt. Ronald Icely at a retirement dinner on July 30, 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 Icely the best in all his future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, I am proud to join with Mr. Markey in introducing this important bill. 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, Down's syndrome, and the ravages of old age make many people dependent on others for their basic care. Many Americans depend on long-term health care due to a chronic illness or a permanent disability. For example, as many as four 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. We are currently working on a comprehensive bill that will broaden the scope of services families and patients can use to meet their long- term care needs. In the interim we offer this modest first step. Specifically, this bill provides a $1,000 tax credit for caregivers similar to the one described by the President in his State of the Union address. Unlike the President's proposal our tax credit is completely refundable and makes no distinction between care for an adult or a child. If the credit is not refundable, it will be of little or no use to many of the families most in need of caregiver help. The following table illustrates the consequences as simple tax credit that is not refundable. A single individual who makes less than $7,050 will receive no benefit. That same person would have to make $13,717 to receive the full $1,000 of assistance. Similarly, an elderly couple would need a combined annual income of $21,067 to realize the entire tax credit. ------------------------------------------------------------------------ Minimum income required to Income Filing status receive required to portion of tax receive full credit tax credit ------------------------------------------------------------------------ Single.................................. $7,050 $13,717 Head of Household With One dependent.... 11,850 18,571 Married Joint Filers.................... 12,700 19,367 Elderly Single Filer.................... 8,100 14,767 Elderly Married Joint Filers............ 14,400 21,067 ------------------------------------------------------------------------ The consequence of a simple tax credit is that those people who most need assistance will be the least likely to obtain the intended support. To be honest, $1,000 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 distressing as they are for an adult. Our fill also has a broader definition of individuals with long-term care needs. The President's proposal includes individuals who require assistance 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 may not include people with severe mental health disabilities or developmental disabilities who cannot live independently. Our bill does help the caregivers of these people. Finally, our bill limits the amount of the refund for those less in need of financial support. The full refund is available up to incomes 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, and is phased out above $130,000 for a joint return and $95,000 of an individual return. The need for long-term care will continue to grow as the average age of Americans increases. 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. This proposal will have significant effect on revenue, but given the size of the problem and in the spirit of compassionate government, it is a step that we can find a way to afford.

Mr. STARK

Mr. STARK. Madam Chairman, lawmakers casting a ``yea'' vote today on the Financial Services Act, H.R. 10, are making a fundamental error. They are effectively voting to strip millions of Americans of a basic right: the ability to exercise meaningful control over who sees their most sensitive information. Title III, Subtitle D, Section 351 of the bill gives insurers extensive ability to disclose medical information without a consumer's consent. If this provision is enacted into law, it will create legal chaos. As written, it appears to overlay myriad state medical privacy laws that regulate disclosure and access. Does it make you feel ill to know that under H.R. 10, a travel insurance agent could peruse your medical records? Does it make your blood pressure rise to know that under H.R. 10, auto insurance companies could use medical data to raise your family's rate? And that any insurer, as well as its affiliates and subsidiaries, would be legally authorized to share sensitive, personal information with credit reporting companies? Unless lawmakers appointed as conferees for H.R. 10 take action to strike the bill's medical privacy provisions, American consumers will wake up to find that the insurance industry--which makes most of its money through underwriting to reduce financial risk--can disclose their medical data without authorization in many, many circumstances. And that's plainly wrong. It's also disturbing that the majority leadership has done next to nothing to advance comprehensive medical privacy legislation in the House of Representatives. Title V of the 1998 GOP managed care bill, H.R. 4250, featured sorry medical privacy provisions that were roundly condemned by consumer groups and privacy advocates through the country. Now the August deadline for action set three years ago by the Health Insurance Portability and Accountability Act is fast approaching. It is my hope that a coalition of members to work together to produce medical confidentiality legislation that is at least as strong as the 1997 recommendations developed by the HHS Secretary--with one notable exception. The Secretary's recommendations proposed no additional restraints on access to medical data by law enforcement officials in the form of a subpoena or court order requirement. That is a position with which I strongly disagree. It is not too late to enact sound medical privacy legislation that puts federal protections in place for consumers across the country, while leaving stronger state laws in place and allowing states the flexibility to add additional protections for those customers of the future who find themselves afflicted with as-yet-unknown disorders, and who, as a result, also suffer discrimination. Enactment of H.R. 10's medical privacy provisions would not only eradicate many existing medical privacy protections, but also hinder the HHS Secretary's ability to promulgate regulations under HIPAA if Congress does not act by next month. Madam Chairman, we must not do this. The consequences for consumers are far too grave.

Mr. STARK

Mr. STARK. Mr. Speaker, on May 20 of this year I commented on the 1994 recall of Vicryl sutures produced by the Ethicon Corporation. In my comments, I noted that according to FDA records, only 2% of the sutures were recovered in the recall. The numbers given to me by the FDA were incorrect. In fact, approximately 25% of the sutures were recovered in the recall. I include a letter from Melinda K. Plaisier, Interim Associated Commissioner for Legislative Affairs, describing the cause of the error and the correct facts. Food and Drug Administration, Rockville, MD, May 28, 1999. Hon. Pete Stark, House of Representatives, Washington, DC. Dear Mr. Stark: In the Food and Drug Administration's (FDA) May 18, 1999 letter of response to your April 19, 1999 letter regarding the distribution and recall of Vicryl sutures manufactured by Ethicon, Inc., there was a mistake. This letter is intended to correct that mistake. A response has also been sent to your cosigner, Representative Henry A. Waxman. When Ethicon originally provided distribution information to FDA, the manner in which the figures were reported was misunderstood by FDA. The number of sutures understood by FDA to have been distributed was considerably larger than the actual quantity. The 2% recovery rate therefore was inaccurate. The correct recovery figure was approximately 25%. This is based on distribution of 293,452 dozens and recovery of 72,929 dozens of sutures. If you have any questions regarding this information, we would be happy to discuss it with you further. We trust this responds to your concerns. If we may be of further assistance, please let us know. Sincerely, Melinda K. Plaisier, Interim Associate Commissioner for Legislative Affairs.

Mr. STARK

Mr. STARK. Madam Speaker, I rise today in strong opposition to H.J. Res. 33, ``The Flag Desecration Constitutional Amendment.'' This constitutional amendment would undermine the very principles for which the flag stands--freedom and democracy. The First Amendment to the Constitution reads as follows: ``Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press, or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.'' Those who founded our nation recognized that the First Amendment to the Constitution must protect citizens from their objections to the workings of their government. Freedom of expression is what makes the United States of America strong and great--it is the bedrock of our nation and has kept our democracy strong for over 200 years. In an effort to overturn two Supreme Court decisions that upheld flag burning as symbolic speech protected by the Constitution, the Flag Desecration Amendment would be the first to amend the Bill of Rights and limit Americans' freedom of expression. It would also open the door to other ``well-intentioned'' limits on our free speech. Just last week this Congress debated an amendment that would have barred the sale of films, books, pictures, and sculptures that qualify as ``patently offensive'' or lack ``serious literacy, artistic, political or scientific value.'' Who is to decide what is offensive, what is desecration, and what is free expression? While the idea of someone burning or destroying an American flag is upsetting, the thought of police arresting peaceful protesters is even more so. Our government's toleration of criticism is one of America's greatest strengths. This is not an issue of patriotism, it is an issue of preserving every American's protected right to dissent. Our commitment to freedom can best be displayed with a vote against this misguided constitutional amendment.

Mr. STARK

Mr. STARK. Mr. Speaker, on behalf of Congresswoman Thurman and myself, I am today introducing legislation based on recommendations of the U.S. General Accounting Office to improve the operation of the Medicare home health agency, durable medical equipment, and certain rehabilitation providers' surety bond program. Enacted as part of the 1997 Balanced Budget Act, the surety bond program was one of a series of anti-fraud, waste, and abuse provisions designed to crack down on the outrageous proliferation and increased utilization of questionable Medicare providers. The General Accounting Office issued a report in January, 1999 (GAO/ HEHS-99-03) entitled, ``Medicare Home Health Agencies: Role of Surety Bonds in Increasing Scrutiny and Reducing Overpayments.'' The report focuses on problems in the surety bond provisions and makes a number of recommendations. Our bill addresses most of those recommendations. While the BBA has had a huge impact in controlling the growth of spending and weeding out questionable and fraudulent providers, the surety bond program has had severe administrative problems. It needs simplification and needs to be focused on the start-up providers who have no track record and who may be the source of program abuse. Once a provider has proven that they are a reliable and dependable provider, continuing to require a surety bond just increases program costs. Our bill, therefore requires one surety bond for Medicare and Medicaid (not a separate bond for each program) for the two years of a provider's operations, and limits the size of the bond to $50,000 (not the larger of $50,000 or 15% of an agency's Medicare revenues) and makes it clear that orthotic and prosthethic providers includng angioplastologists, are not meant to be covered by the surety bond requirement. Mr. Speaker, we hope that this legislation can be enacted. It will reduce hassle and paperwork, while still helping weed out questionale home health and DME providers from starting in the Medicare program.

Mr. STARK

Mr. STARK. Mr. Speaker, on June 14, I introduced H.R. 2185, the Health Insurance for Americans Act, to provide refundable tax credits for the purchase of health insurance through a consumer co-op type of mechanism. We must act to revise America's health care system. The current system of employer-based coverage is dying, as the following quote from a May 1999 study for the Health Insurance Association of America by Dr. William Custer, makes clear: There were 31.8 million uninsured non-elderly Americans in 1987. In 1997, this number had risen to 43.1 million, which represents a 35.5 percent increase. From 1996 to 1997 alone, the number of non-elderly Americans without health insurance rose by 4.1 percent. And this report forecasts that the number of uninsured Americans will climb to 53 million during the next ten years and could, if the nation experiences an economic downturn and higher-than-predicted health-care cost inflation, reach 60 million by 2007. This would mean that almost one of every four non-elderly Americans would lack health coverage. The primary reason for the increase in the number of Americans without health coverage over the past 15 years has been the increase of health care costs relative to family income. Almost six of every ten uninsured Americans lives in families with incomes of less than 200% of the federal poverty level. And while public programs such as Medicaid provide health coverage to about half of those in families with incomes below the federal poverty level, these individuals account for nearly three out of every ten uninsured Americans. Is there hope that other proposals will noticeably reduce the number of uninsured? For example, various Republicans are pushing the idea of Health Marts and Association Health Plans as forums where small businessmen can buy cheaper health insurance policies for their workers. But we know from polling of many small businesses that they have no interest in being in the health insurance-providing business. Even if it didn't cost them a penny, a majority of small businesses have said they didn't want to be involved in this process! In addition, a May 1999 study by the National Coalition on Health Care entitled ``Small Employer Health Insurance Purchasing Arrangements: Can They Expand Coverage?'' reports: The central conclusion of this study is that while Health Marts and Association Health Plans will offer advantages to some small firms and may somewhat reduce the deterioration in health insurance coverage in the U.S., they will not by themselves solve the problem of the uninsured. That is primarily because, on balance, neither Health Marts nor Association Health Plans are likely to reduce health costs enough to significantly entice most small firms not now offering coverage to buy health insurance. In addition, benefit packages that are significantly less comprehensive than typical do not seem to have broad appeal, and may still be too costly for most small businesses . . . . Even the most optimistic estimates of the impact of eliminating state mandated benefits or implementing Association Health Plans suggest that between 80% and 80% of the 43 million Americans who are uninsured today would remain uninsured. Mr. Speaker, it is clear that we need to try new approaches to a problem which is growing evermore serious. Following is a summary of the tax credit bill I have introduced. I hope my colleagues will join me in exploring this approach. Summary of Health Insurance for Americans Act Refundable tax credit for purchase of qualified health insurance Amount: $1,200/adult; $600 per dependent child, $3,600 max per family. Dollar amounts adjusted by annual inflation in Federal Employee Health Benefits Program (FEHBP) average premium increase. Eligibility: Anyone not participating in subsidized employer plan or public plan, or eligible for Medicare. Qualified health insurance Is private sector insurance sold through new HHS Office of Health Insurance (OHI). Insurance must be guaranteed issue/no waiting period, no pre-existing condition, community rated policies. OHI may negotiate on price, ensure quality of providers and adequacy of benefit package (Like the Office of Personnel Management does for FEHBP now), and hold open enrollment periods to facilitate comparison pricing. Every insurer selling to FEHBP must offer to sell similar policies to OHI, but may also offer zero premium policies. OHI will serve as an administrative device to move tax credit from IRS to the insurer selected by the individual, thus providing `advance funding' and preventing fraud. Effective date: 2001. Financing: Not spelled out in bill. Can be surplus, business tax, VAT, insurer/provider surtax, savings from reduced subsidies to providers to provide for the uninsured.