Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I wish to bring to the attention of my colleagues the endeavor of my good friend Paul Callens. Paul has gathered several of his friends to join him on a seven-month walk for national unity--an 11-state, 3,200-mile journey from Maryland's Eastern Shore to the city of San Francisco, to promote racial unity throughout the United States. Along the way, the Unity Walkers will pass the birth place of abolitionist and former slave Harriet Tubman, stop at the site of last year's Middle East Peace Talks, and arrive in Washington, D.C. for a weekend celebration on the National Mall on Sunday, April 4 to commemorate the anniversary of the assassination of the Rev. Dr. Martin Luther King, Jr. We would like to think that blatant racism is a thing of the past, but daily reports of police brutality, church burnings, hate crimes and acts of racially-motivated violence shatter the illusion that bigotry no longer exists in our country. The goal of the walkers and their supporters is to build a national unity movement that celebrates the differences among Americans and promotes appreciation of the racial and cultural blend that makes up the population of the United States. They hope to interest community leaders and local government officials in celebrating a National Unity Day, to be observed on October 10. In these next few months, Paul Callens will ask our communities to examine the attitudes we've inherited about race and to reevaluate our treatment of racial differences. Some who would promote intolerance and irrational prejudice have made an attempt to turn back the clock on the progress we've made in the fight for civil rights. Paul and his friends will spread the word that hostility based on racial or ethnic identity has no place in America. Please join me in congratulating Paul and the Unity Walkers and wish them success in their effort to heal the wounds of racial intolerance in our country. We make progress one step at a tim

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to join with Rep. Degette and our colleagues in introducing the Patient Freedom from Restraint Act of 1999. According to recent estimates, between 50 and 150 people die each year in psychiatric hospitals and other residential treatment centers while restrained or in seclusion. This legislation would extend much needed and long over due protections for people who rely on others for their care and safety. Specifically, our legislation will protect individuals living in residential facilities for adults and children who are developmentally delayed or suffer from a mental health disability. According to a 1996 GAO report on institutions for the mentally retarded, one of the most common problems of care was excessive or inappropriate use of restraints. Other reports indicate the deaths due to restraint result from inappropriate and reckless use of restraint techniques and neglect of the patient's well being. Even if there is no physical harm due to restraint, the violent act can have long-term implications for the patient's psychological health and recovery. Restraint and seclusion have no medical or therapeutic function. In fact, these techniques may do more to harm the individual than help. The only time that such measures are warranted occur when the person's behavior creates an immediate threat to the health and safety of self and others. Currently, there is no federal statute or uniform regulation that protects patients from the misuse of restraints and seclusion. Many years ago, the same problem existed in nursing homes. Patients were indiscriminately restrained and suffered terrible as a result. The Omnibus Budget Reconciliation Act of 1987 greatly changed how the nation's elderly are treated. In essence, we revised the Social Security Act to make clear that restraint and seclusion could be used only in extreme cases. The result of that legislation has been an incredible improvement in the treatment that seniors receive. The staff of nursing homes found that simple changes in the environment and procedures made restraints unnecessary. Our legislation would not prohibit the use of restraint or seclusion, it merely identifies the conditions when they may be used. The more important aspect of the legislation is that it would protect the health and safety of the patient. Our legislation would require that treatment facilities document the use of restraint and seclusion in the patient's treatment or medical record. In addition, to reporting the incident, the staff of the facility must document treatment a treatment plan to reduce the future risk of episodes requiring restraint or seclusion. The legislation would require that residential facilities train their staff in the appropriate use of restraint techniques and its alternatives. We believe that this is an essential feature of the bill. Many of the deaths and severe injuries that patients experience result from misuse of standard restraint procedures. Finally, the legislation would require that cases of severe injury and death be reported to the State's Protection and Advocacy Board, and the Secretary of Health and Human Services. Documentation of these cases is an essential mechanism for protecting the rights and liberties of the patients.

Mr. STARK

Mr. STARK. Mr. Chairman, I yield myself 7 minutes. Mr. Chairman, I come before us this afternoon as the ranking Democratic member on the Joint Economic Committee, fulfilling a requirement outlined in the Full Employment and Balanced Growth Act of 1978 attributed to several of our great colleagues, Mr. Gus Hawkins and Senator Hubert Humphrey, who put the long-term goal of raising U.S. living standards far ahead of any of their short-term political aims. And I rise in strong opposition to the budget resolution before us. Before I go into details as to how harmful that is, I would like to put this debate in some context, as my senior Republican from the Joint Economic Committee on the House side did just a moment ago. We have had growth in 1998 close to 4 percent, and the economists are raising their projections for this year every day. Our economy is the envy of the world. The United States is growing two to three times faster than Japan or Germany. The unemployment rate is 4\1/2\ percent, the lowest unemployment since 1969. And the unemployment rate has been below 5 percent for almost 2 years. This is all building up and it is continuing good news. Who would have believed we would have seen us move ahead of Japan in these measurements in our lifetime? Inflation was 1.6 percent in 1998. We would have to go back to the early 1960s to find inflation that low. Furthermore, it has remained low despite falling unemployment, which confounds many of the economists. The once famous and now forgotten misery index, the combination of unemployment and inflation, the lowest point in 40 years. That is before the gentleman from New Jersey (Mr. Saxton) and I even got to this place. The economy has generated 15 million new jobs net since 1992 and 2.8 million jobs were added in 1998 alone. The average weekly take-home pay after inflation has increased by 2 percent in 1997 and 1998 after almost 20 years of stagnation. The current expansion is not just a statistical phenomena. It has improved the standard of living for many Americans. Let us not celebrate, because this economic expansion is not yet shared by all Americans and that is not acceptable to the Democratic Party. One in seven counties in this country have twice the unemployment rate of the rest of the Nation. Some research shows that although there are fewer numbers of people receiving welfare, there is no definition as to what has happened to them. Are they working, or have they merely dropped off our statistical radar screen? And what has happened to their children? There is still more that we need to know in order to ensure that all Americans can enjoy the quality of life they deserve. When things go well, everybody is taking credit. Somebody said, ``success has a thousand parents and failure is an orphan.'' But it is easy to be entangled in the cause and effect. And one thing is clear: Eliminating the budget deficit has enabled interest rates to fall, which, in turn, is considered one of the major stimulants for our economy. Our first goal in fiscal 2000 should be to ensure that Social Security and Medicare are financially secure in order to provide health care to those who need it. The Republicans agree to wall off the Social Security Trust Fund, but their budget proposal does not do anything to address the solvency of either Social Security or Medicare. Their proposal calls for a freeze in Medicare's administrative budget over the next 10 years. We have hearing after hearing about how we have satisfied the Medicare operators so that they can go after fraud and abuse and put these egregious profit-hungry private HMOs and hospital chains that are stealing from the Government out of business. We have the lowest administrative overhead in Medicare of any program in the country, about 2 percent, compared to 10 to 30 percent for private insurers and managed care plans. The latter figure includes overhead and profit. But we cannot continue this good work if we are unwilling in a budget to support the administrators who make it work so well. Former Speaker Gingrich once said that Medicare's administrative agencies should ``wither on the vine,'' as should the program. Although no longer here, Mr. Gingrich's wishes seem to be with us, as the Republicans attempt to destroy Medicare and its ability to serve the need of America's seniors and disabled. Let us talk about budget surplus. There is a lot of talk about it, but I did not see one. Once we take Social Security off of the table, as the Republicans suggest, we are left with about $125 billion over the next 5 years. And without touching the Social Security Trust Fund, I do not think we find a surplus until 2002. So if we are going to make policy based on the surplus, why do we not wait until we know there is one around and then debate it? During 1999, defense expenditures were 13 percent greater than all nondefense discretionary spending. I wonder if this really reflects our country's priorities. Republicans go further and add billions to defense, and it calls for a cut in discretionary spending. Now, I do not happen to think the Pentagon is optional. It certainly is not. But if the Pentagon is not optional, neither is Head Start, public health programs, education, job training, housing, veterans' hospitals, law enforcement, environmental programs, the national parks, community and economic development, rural programs, highways, energy, among a few which are being eliminated or cut severely, if the Republicans do not intend to shove us into the greatest deficit we have had since Ronald Reagan forced us into a deficit by reckless tax cuts and even more reckless military spending on things like Star Wars and other things, which produced nothing but welfare for otherwise unemployable scientists and would-be soldiers of fortune. I predicted that we would strike a deal to kick people off welfare, and we have. But what we have done is harm the children and the helpless in this country in the Republican effort to grab more tax cuts for 1 or 2 percent of the very rich, and that is not again what the Democratic Party is about. My Republican colleagues did not vote for the 1993 act. Not one of them voted. They are taking credit for it. But it has not stopped them from bragging about it. Eliminating the deficit was the single largest explanation for the current health of this economy, and we must not jeopardize it again. I urge my colleagues to oppose this budget resolution, send them back to the table to bring one that will help the economy for the long run and help all Americans. Mr. Chairman, I include the following for the Record: Crisis Facing HCFA & Millions Of Americans The signatories to this statement believe that many of the difficulties that threaten to cripple the Health care Financing Administration (HCFA) stem from an unwillingness of both Congress and the Clinton administration to provide the agency the resources and administrative flexibility necessary to carry out its mammoth assignment. This is not a partisan issue, because both Democrats and Republicans are culpable for the failure to equip HCFA with the human and financial resources it needs to address what threatens to become a management crisis for the agency and thus for millions of Americans who rely on it. This is also not an endorsement of the present or past administrative activities of the agency. Congress and the administration should insist on an agency that operates efficiently and in the public interest. Over the past decade Congress has directed the agency to implement, administer, and regulate an increasing number of programs that derive from highly complex legislation. While vast new responsibilities have been added to its heavy workload, some of its most capable administrative talent has departed or retired: other employees have been reassigned as a consequence of reductions in force. At the same time, neither Democratic nor Republican administrations have requested administrative budgets of a size that were in any way commensurate with HCFA's growing challenge. The latest report of the Medicare trustees points out that HCFA's administrative expenses represented only 1 percent of the outlays of the Hospital Insurance trust fund and less than 2 percent of the Supplementary Medical Insurance trust fund. In part, these low percentages reflect the rapid growth of the denominator--Medicare expenditures. But, even accounting for Medicare's growth, no private health insurer, after subtracting its marketing costs and profit, would ever attempt to manage such large and complex insurance programs with so small an administrative budget. Without prompt attention to these issues, HCFA will fall further behind in its implementation of the many significant reforms mandated by the Balanced Budget Act (BBA) of 1997. In the future the agency also has to cope with a demographic revolution that it is ill equipped to accommodate and with changes in medical technology that will increase fiscal pressures on the programs it administers. As the Bipartisan Commission on the Future of Medicare grapples with the problem of reshaping the Medicare program for the next millennium, it would do well to consider two important reforms concerning HCFA's administration. First, the commission should recommend that Congress and the Clinton administration endow the agency with an administrative capacity that is similar to that found in the private sector. Second, the commission should consider ways in which the micromanagement of the agency by Congress and the Office of Management and Budget could be reduced. Congress and the public would be better served by measuring the agency's efficiency in terms of its administrative outcomes (such as accuracy and speed of reimbursement of various providers), rather than by tightly controlling its administrative processes. Only if HCFA has more administrative resources and greater management flexibility will it be able to cope with the challenges that lie ahead. The mismatch between the agency's administrative capacity and its political mandate has grown enormously over the 1990s. As the number of beneficiaries, claims, and participating provider organizations; quality and utilization review; and oversight responsibilities have increased geometrically. HCFA has been downsized. When HCFA was created in 1977, Medicare spending totaled $21.5 billion, the number of beneficiaries served was twenty-six million, and the agency had a staff of about 4,000 full-time-equivalent workers. By 1997 Medicare spending had increased almost tenfold to $207 billion, the number of beneficiaries served had grown to thirty-nine million, but the agency's workforce was actually smaller than it had been two decades earlier. The sheer technical complexity of its new policy directives is mind-boggling and requires a new generation of employees with the requisite skills. HCFA's ability to provide assistance to beneficiaries, monitor the quality of provider services, and protect against fraud and abuse has been increasingly compromised by the failure to provide the agency with adequate administrative resources. Even with the addition of $154 million to its administrative budget that Congress included in its latest budget bill, the likelihood that HCFA can effectively implement all of its varied assignments is remote. The Health Insurance Portability and Accountability Act of 1996 assigns many new regulatory responsibilities to HCFA, but a far larger task is implementing the BBA of 1997. The BBA has more than 300 provisions affecting HCFA programs, including the Medicare+Choice option, which will require complex institutional changes and ambitious efforts to educate beneficiaries. Medicare spending accounts for more than 11 percent of the U.S. budget. Workable, effective administration has to be a primary consideration in any restructuring proposal. Whether Medicare reform centers on improving the current system, designing a system that relies on market forces to promote efficiency through competition, or moving toward an even more individualized approach to paying for health insurance, Congress and the administration must reexamine the organization, funding, management, and oversight of the Medicare program. During anything less is short-changing the public and leaving HCFA in a state of disrepair. Stuart M. Butler, Heritage Foundation; Patricia M. Danzon, University of Pennsylvania; Bill Gradison, Health Insurance Association of America; Robert Helms, American Enterprise Institute; Marilyn Moon, Urban Institute; Joseph P. Newhouse, Harvard University; Mark V. Pauly, University of Pennsylvania; Martha Phillips, Concord Coalition; Uwe E. Reinhardt, Princeton University; Robert D. Reischauer, Brookings Institution; William L. Roper, University of North Carolina at Chapel Hill; John Rother, AARP; Leonard D. Schaeffer, Well-Point Health Networks, Inc.; Gail R. Wilensky, Project HOPE. Mr. Chairman, I reserve the balance of my time.

Mr. STARK. Mr. Chairman, I yield 2 minutes to the gentleman from New York (Mr. Hinchey) one of the leading members of the Joint Economic Committee, pending which I yield such time as he may consume to the gentleman from South Carolina, ranking member of the Committee on the Budget.

Mr. STARK. Mr. Chairman, I rise today in opposition to both the GOP budget proposal as well as the Democratic alternative. Both budgets call for enormous increases in defense spending over the next six to ten years. I cannot vote for these exorbitant increases in defense spending--anywhere between $112-134 billion--when the fate of Social Security and Medicare remains questionable. The Democratic Budget Resolution, by using the President's plan for defense spending, endangers already vulnerable programs by needlessly puffing up the military. The Democratic resolution calls for over $9 billion in undistributed cuts by the year 2000. The question is--where do we find it? Shall we do away with the Department of Agriculture and the Department of Energy? Which severely underfunded federal program will we raid first? Come the year 2000, programs that are already suffering--like federal childcare and job training programs--will be sitting ducks. Proponents of increasing military spending claim that this money is needed to replace aging weapons systems, improve the military's readiness and training, and to attract and retain more people in the armed services through better pay benefits. Since 1996, the Congressional majority has added nearly $30 billion beyond the Pentagon's request to help with military readiness. Three-quarters of this went to pork projects in key members' districts. The proposals before us today would commit more than $1.8 trillion to the military over the next six years. There is no justification for increasing military spending by this amount. These budgets propose to squander scarce resources in order to appease the defense industry and procure weapons systems not seen since the Reagan era. The U.S. alone spends more than twice that of all of its potential aggressors combined. That means Russia, China, Iraq, North Korea, Syria, Libya and Cuba combined don't even spend half of what the U.S. spends for defense. The U.S. spends up to $35 billion per year maintaining 6,000 nuclear weapons on hair trigger alert. The Soviet Union is no longer a threat to the U.S. The U.S. is more threatened by the technicians and technology in Russia falling into the hands of rogue states. However, yesterday, in the Supplemental Appropriations bill, my colleagues chose to reduce the funding to purchase and store the enriched plutonium and uranium used to make nuclear weapons in Russia. The budgets before us include spending for a National Missile Defense (NMD) system on top of the billions already wasted on a futile deployment. Spending just a fraction of what the U.S. has spent, and plans to spend, on NMD could do far more to reduce the danger of missile attacks and weapons proliferation if used on verifiable arms control and disarmament. We are marching down the wrong path. Instead of making this a more livable and peaceful world for our children, we are proposing cuts in necessary programs for life while increasing spending on weapons of destruction. I urge my colleagues to join me in opposing these egregious budget proposals.

Mr. STARK. Mr. Chairman, I ask unanimous consent to yield the balance of my time and its control to the gentleman from South Carolina (Mr. Spratt), the ranking member of the Committee on the Budget.

Mr. STARK. Mr. Chairman, I yield 2 minutes to the gentleman from California (Mr. George Miller). (Mr. GEORGE MILLER of California asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Chairman, I yield 2 minutes to the gentleman from Minnesota (Mr. Minge), but pending that I yield 1 minute to the distinguished gentleman from South Carolina (Mr. Spratt), the ranking member of the Committee on the Budget.

Mr. STARK

Mr. STARK. Mr. Speaker, during rollcall vote No. 58 on the Allen motion to recommit with instructions, I was unavoidably detained. Had I been present, I would have voted ``yea.'' Stated against:

Mr. STARK. Mr. Speaker, during rollcall vote No. 59 on H.R. 4, I was unavoidably detained. Had I been present, I would have voted ``no.''

Mr. STARK

Mr. STARK. Mr. Speaker, I am honored to co-sponsor the Work Incentives Improvement Act of 1999. This bill would remove the barriers to health insurance and employment inherent in the current disability insurance (DI) system, and enable many Americans to return to work. Disabled people have much to offer. It is time that we recognize and encourage them to participate as contributing members of society. I am especially pleased to support the Medicare and Medicaid provisions of this bill. Without these programs, many people living with disabilities would not have access to the care that is so vital to their health and well-being. Because private health insurance is not affordable or available to them, even after returning to work, we must keep Medicare and Medicaid available to the working disabled. There is one segment to the disabled population that I urge my colleagues to give special consideration: End Stage Renal Disease patients. As you know, there are about 260,000 Americans on dialysis and another 80,000 who are dependent on a kidney transplant (with about 11,500 kidney transplants performed annually). About 120,000 dialysis patients are of working age (between 20 and 64), yet fewer than 28,000 are working. The ``USRDS Abstract of Medical Evidence Reports, June 1, 1996 to June 1, 1997,'' reveals that 38.1% of all dialysis patients 18-60 years of age were employed full time, part time, or were students before onset of ESRD. But only 22.9% of ESRD patients in the same age group were employed full time, part time, or were students after the start of dialysis. This 15% (38.1% minus 22.9%) differential is the prime hope for return to work efforts. Of the transplant patients, most (88%) are of working age, but only about half of them are working. Section 102 of your bill provides Medicare coverage for working individuals with disabilities--but ESRD dialysis patients already have this protection. For transplant patients, Medicare does not cover their major health need--coverage of $8,000-$10,000 per year for immunosuppressive drugs--after 36 months. Clearly, we should tailor some special provisions to this population. I would like to suggest a series of ESRD return-to-work amendments that would save total government revenues in the long run. While these proposals may increase Medicare spending, they would reduce Social Security disability and Medicaid spending. There are just preliminary ideas, and I hope that you and the renal community could refine these ideas prior to mark-up. (1) A huge percentage of ESRD patients quality for Medicaid. The disease is so expensive ($40,000-$60,000 per patient per year) and the out-of-pocket costs so high that it impoverishes many. For transplant patients, the cost of life-saving immuno-suppressive drugs alone can be $8,000, $10,000 or more per year. No wonder many are tempted to avoid actions which would disqualify them for help. As part of general Medicare policy, I have always through that we should cover pharmaceuticals and, in particular, indefinitely cover immuno-suppressive. It is madding to hear the stories of $80,000- $100,000 kidney transplants lost, because a patient couldn't afford the $10,000 per year of medicine. I think a good case can be made to add to this bill coverage of immuno-suppressives indefinitely, to encourage people to leave Medicaid/Disability and return to work. (2) Some ESRD facilities do a good social work job helping patients return to work. Others don't seem to even try. We should honor and reward those centers which, on a risk adjusted basis, are doing the best job of rehab in their renal network area. The honor could be as simple as a Secretarial award of excellence and public recognition. The reward could be something more tangible--a cash payment to the facility to each patients of working age who does not have severe co- morbidities which the center is able to help return to work (above a baseline--perhaps 5% of eligible patients). For example, if a center had 100 working age patients, it could receive a $1000 payment for each patient above 5 who had lost employment and is helped to return to work. This would be a phenomenally successful investment and would particularly compensate the dialysis center for the cost of vocational rehab and social work. (3) Renal dialysis networks, which are designed to help ensure ESRD center quality, should be able to apply for designation as rehab agencies and for demonstration grants under this legislation. The law spelling out the duties of Networks has a heavy emphasis on rehabilitation. Indeed, it is the first duty listed: ``. . . encouraging, consistent with sound medical practice, the use of those treatment settings most compatible with the successful rehabilitation of the patient and the participation of patients, providers of services, and renal disease facilities in vocational rehabilitation programs;'' \1\ --------------------------------------------------------------------------- \1\ Sec. 1881(c)(2)(A); see also (B) and (H). I suspect that the 17 Networks vary widely in their emphasis on rehabilitation. Again, the Network(s) that do the best should receive recognition and share their success with the others. (4) Kidney failure remains a medical mystery. It often happens very quickly, with no warning. But for thousands of others, there is a gradual decline of kidney function. I am told by medical experts that in many cases the descent to terminal or end-stage renal disease can be showed by (1) nutrition counseling, or (2) medical treatment by nephrology specialists. I hope that you will make it clear that the Medicaid (or Medicare) funds provided in this program to prevent disability could be used to delay the on-set of the devastatingly disruptive and expensive ESRD. Monies spent in this area would return savings many times over. Also in the ``preventive area,'' some of the leaders in the renal community are reporting exciting results from more frequent, almost nightly dialysis. Like frequent testing by diabetics for blood sugar levels, it may be that more frequent dialysis can result in a less disrupted life and better chance to contribute to the workforce. We should watch these medical developments and if there is a chance that some additional spending on more frequent, but less disruptive dialysis would encourage return to work, we should be supportive. (5) Finally, I urge you to coordinate this bill with another proposal of the Administrative--skilled nursing facility employment of aides to help with feeding. As you know, last summer we received a GAO report on the horror of malnutrition and death by starvation in some nursing homes, due to a lack of staffing to take the time to help patients who have trouble eating and swallowing and who take a long, long time to eat (e.g., many stroke patients). A coordinated effort by the nursing home industry and ESRD centers to fill this minimum wage type position would help nursing home patients while starting many long-out-of-work ESRD patients back on the road to work. Mr. Speaker, these are just a few, quick ideas. I am sure that experts in this field could suggest other steps to ensure that the ESRD program not only saves lives, but helps people have a good and productive life.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to honor Officer Daniel Alday, a dedicated member of the Milpitas Police Department for over two decades. Officer Alday retired on February 14, 1999 and will be honored later this month by the Milpitas Police Department. Office Alday joined the Department on January 31, 1977, after four years of experience as a County Animal Control Officer. Officer Alday's bilingual abilities were a great asset to the Department over the years. His ready assistance was much appreciated by other officers and the Hispanic community. Office Alday was a K-9 officer from 1980 to 1983. During this time, he and his dog were productive in locating and apprehending suspects; they received numerous commendations from the community, and neighboring police agencies. From 1983 to 1992, Officer Alday served in the traffic division as a Motorcycle Traffic Officer. He attended the California Highway Patrol Academy for motorcycle training, and surpassed their rigorous requirements. During his tenure as a traffic officer, Officer Alday was certified by the courts as an expert in DUI cases. He advanced to accident reconstructionist after completion of accident reconstruction school and certification by the State of California. From 1989 to 1996, Officer Alday served as a hostage negotiator. He assisted in many difficult situations that ended peacefully. Officer Alday returned to patrol in 1992 and was selected for the position of DARE Officer. In 1994, Dan was assigned to the Public Relations Unit as a DARE Officer. He taught the DARE curriculum each year to four elementary schools, where he was instrumental in bringing new ideas to the DARE program. DARE activities included Skate Night for DARE students, lunch with the DARE Officer, and slide presentations of Student DARE activities that promoted parent participation to DARE graduations. Officer Alday's duties also included giving safety presentations to women's groups, businesses, and the community-at-large. He also conducted Mock Robbery Training courses for bank employees. Officer Alday continued to receive commendations from the community during his time with the Public Relations Unit. Regretfully, Officer Alday's police career is ending early because of a job-related injury. He has been an asset to the Milpitas Police Department because of his long-term service to the community. His contributions are numerous and his example is an inspiration. I join the Milpitas community in applauding Officer Alday's dedication, expertise and achievements. I wish him continued success in his future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, nursing home residents and their advocates welcomes speedy passage of this bill, which is designed to prevent facilities that prospectively withdraw from Mediciaid from kicking out frail elderly people whose care is paid for through that program. Last April, the Wall Street Journal brought national attention to evictions of Medicaid residents from a nursing home in Indiana run by the chain Vencor, Inc. Subsequently, Florida fined a Vencor facility in Tampa $270,000 for doing the same thing. The legislation before us today is only a first step. Congress can and should enact additional legislation to confirm the Health Care Financing Administration's authority to prevent nursing homes that are reimbursed by Medicaid from arbitrarily changing the number of beds allocated for residents who are enrolled in this program. If we fail to do this, facilities will continue dumping elderly people who are admitted as private-pay residents, and later told that they must leave once they have ``spent down'' because `` no Medicaid beds are available.'' Similarly, we should ensure that seniors are protected who are Medicaid-eligible at the time they seek admission to nursing homes. Too often, facilities tell these folks that their Medicaid beds are full, in hopes that a patient who can afford to pay a higher private rate will soon apply. Such discriminatory practices, which are unfortunately all too common today, deny needed care and services to vulnerable elderly individuals who deserve our help. Yet under current law, seniors and their families have very limited ability to seek redress. The legislation we are considering today will protect some residents now living in facilities that choose to withdraw from Medicaid. However, few nursing homes voluntarily withdraw from Medicaid. And for those who are denied admission in the first instance as Medicaid enrollees, or who are asked to leave after they have exhausted their resources, this proposal is not an answer. In the coming weeks, I will introduce legislation designed to add protections to Medicare and Medicaid to bolster enforcement efforts and improve residents' rights. I hope my colleagues will join me in supporting additional efforts to improve the quality of care in our nation's nursing facilities.

Mr. STARK

Mr. STARK. Mr. Speaker, my colleagues and I are proud to introduce the ``Gift of Life Congressional Medal Act of 1999.'' This legislation creates a commemorative medal to honor organ donors and their survivors. There is a serious shortage of available and suitable organ donors. Over 50,000 people are currently waiting for an organ transplant. Because of low donor rates, over 4,000 people die each year for lack of a suitable organ. Some patients also wait significantly longer for a transplant depending on where they live. In some parts of the country, the typical wait for an organ transplant is close to 100 days. In other parts of the country, the wait is closer to 1,000 days. We need to use every possible option to increase the number of donated organs for all Americans. The Gift of Life Congressional Medal Act draws attention to this life-saving issue, and sends a clear message that donating one's organs is a self-less act that should receive the profound respect of the Nation. The legislation allows the Health and Human Service's Organ Procurement Organization (OPO) and the Organ Procurement and Transplantation Network to establish a nonprofit fund to design, produce, and distribute the medals. Funding would come solely from charitable donations. The donor or family member would have the option of receiving the Congressional Gift of Life Medal. Families would also request that a Member of Congress, state or local official, or community leader award the medal to the donor or donor's survivors. According to the United Network for Organ Sharing (UNOS), an average of 5300 donations per year were made between 1994 and 1996. Research points to a clear need for incentive programs and public education on organ donation. These efforts can increase the number of organ donations by more than 80 percent. Physicians can now transplant kidneys, lungs, pancreas, liver, and heart with considerable success. The demand for organs will continue to grow with the improvement of medical technologies. Without expanded efforts to increase the supply of organ donation, the supply of suitable organs will continue to lag behind the need. This is a non-controversial, non-partisan legislation to increase organ donation. I ask that our colleagues help bring an end to transplant waiting lists and recognize the enormous faith and courage displayed by organ donors and their families. A copy of the legislaiton follows.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today in support of HR 396 to designate the Ronald V. Dellums Federal Building in Oakland, CA. Ron Dellums spent his 27 years in Congress as an advocate for special justice. Throughout most of his career in Congress, I had the privilege to serve with Ron Dellums as he fought to bring home our troops in Vietnam, championed civil rights, and worked to end apartheid in South Africa. As a member and then Chairman of the Armed Services Committee, he argued powerfully and persuasively for cuts in wasteful defense spending. The Ronald V. Dellums Federal Building will be a lasting tribute to my East Bay neighbor and friend for the legacy he leaves our nation.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to introduce the Medicare Home Health Case Manager Act of 1999. The Medicare home health benefit has received much attention in recent years. The reason for that attention has been the dramatic growth of home health services over the past decade. The Balanced Budget Act of 1997 (BBA) made a number of changes to the home health benefit to help stem that growth. However, much more needs to be done. The Medicare Home Health Case Manager Act is a double winner. It would simultaneously reduce Medicare spending on home health while improving the quality of the benefit. It does this by introducing a new component to the benefit: an independent case manager. Today, home health care is prescribed by a patient's physician, but then the actual plan of care is executed by the home health agency treating the patient. This creates incentives that have nothing to do with quality or appropriateness of care. Under the cost-based reimbursement system that existed before passage of BBA, the incentive to home health agencies was to over-utilize services for patients because that is how the agency made more money. In the BBA's prospective payment system (PPS) of the future, the incentive will be the opposite and there are real concerns about potential under- utilization of services. The Medicare Home Health Case Manager Act would ensure that home health care decisions for long-stay patients were being made by an independent case manager who in no way financially benefited by the length or type of home care provided to a patient. They would be paid by a Medicare fee-schedule that would in no way be influenced by the amount or type of care they recommend. 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 in certain regions where that would prove appropriate. The creation of a home health case manager for long-stay patients 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). There is also a new Massachusetts Medical Society study in which two- thirds of the physicians who participated in the study stated that ``on occasion, they thought their patients didn't have enough home health coverage,'' even as 90% of them said that they routinely prescribe home health. They also expressed concern about ``the difficulty of getting information about the condition of patients receiving home care,'' noting that some information does not reach the doctors until ``it's well out of date.'' A home health case manager would remedy those concerns. 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. History has shown us that simply throwing more money into home health is not the answer for assuring that patients receive appropriate care. Let's use this opportunity to make a real, tangible improvement in the quality of care obtained by Medicare patients and simultaneously save Medicare spending by reducing inappropriate visits. I look forward to working with my colleagues for passage of this important legislation.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to rise with a number of my colleagues to introduce The Medicare Substitute Adult Day Care Services Act. This bill would improve home health rehabilitation options for Medicare beneficiaries and simultaneously assist family caregivers with the very real difficulties in caring for a homebound family member. As Congress turns needed attention to modernizing the Medicare program, this bill is an important step in that direction. It would update the Medicare home health benefit by allowing beneficiaries the option of choosing an adult day care setting for the provision of home health benefits rather than confining the provision of those benefits solely to the home. More specifically, the Medicare Substitute Adult Day Care Services Act would incorporate the adult day care setting into the current Medicare home health benefit. It would do so by allowing beneficiaries to substitute some, or all, of their Medicare home health services in the home for care in an adult day care center (ADC). To achieve cost-savings, the ADC would be paid a flat rate of 95 percent of the rate that would have been paid for the service had it been delivered in the patient's home. The ADC would be required, with that one payment, to provide a full day care to the patient. That care would include the home health benefit AND transportation, meals and supervised activities. Above the 95 percent reimbursement limitation there are additional inherent cost savings in the ADC setting. In the home care arena, a skilled nurse, a physical therapist, or any home health provider must travel from home to home providing services to one patient per site. There are significant transportation costs and time costs associated with that method of care. In an ADC, the patients are brought to the providers so that a provider can see a larger number of patients in a shorter period of time. That means that payments per patient for skilled therapies can be reduced in the ADC setting compared to the home health setting. As an added budget neutrality measure, the bill includes a provision that would allow the Secretary of Health and Human Services to change the percentage of the payment rate for ADC services if growth in those services were to be greater than current projections under the traditional home health program. This bill 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. In order to qualify for the ADC option, a patient would still need to qualify for Medicare home health benefits just like they do today. They would need to be homebound and they would need to have a certification from a doctor for skilled therapy in the home. All the bill would do is recognize that ADC's can provide the same services, at lower costs, and include the benefits of social interaction, activities, meals, and a therapeutic environment in which trained professionals can treat, monitor and support Medicare beneficiaries who would otherwise be at home without professional help. All of these things aid the rehabilitation process of patients. The bill includes important quality and anti-fraud protections. In order to participate in the Medicare home care program, adult day care centers would be required to meet the same standards that are required of home health agencies. The only exception to this rule is that the ADC's would not be required to be ``primarily'' involved in the provision skilled nursing services and therapy services. They would have to provide those services, but because ADC's provide services to an array of patients, skilled nursing services and therapy services may not always be their primary activity. Otherwise, all the home health requirements would apply to ADC's. Here is an example of how the system would work if this bill were law. A patient is prescribed home care by his or her doctor. At that time the patient and his or her family decide how to arrange for the services. They could choose to receive all services through the home, or could choose to substitute some adult day care services. So, if the patient had 3 physical therapy visits and 2 home health aide visits, they could decide to take the home health aide visits at home, but substitute 3 days of ADC services for the physical therapy visits. On those days, the patient would be picked up from home, taken to the ADC, receive the physical therapy, and receive the additional benefits of the ADC setting (group therapy, meals, socialization, and transportation). All of these services would be incorporated into the payment rate of 95 percent of the home setting rate for the physical therapy service. It is a savings for Medicare and an improved benefit to the patient--a winning solution for everyone. Adult day care centers (ADC's) are proving to be effective, and often preferable, alternatives to complete confinement in the home. States are taking advantage of their services for Medicaid patients today. Homebound people can utilize these centers because they provide door- to-door services for their patients. ADC's send special vehicles and trained personnel to a patient's home and will go so far as to get the patient out of bed and transport them to the ADC site in specially equipped vehicles. Without this transportation component, homebound patients would not be able to utilize such a service. For certain patients, the ADC setting is far preferable to traditional home health care. The ADC can provide skilled therapy like the home health provider, but also provide therapeutic activities and meals for the patients. These centers provide a social setting within a therapeutic environment to serve patients with a variety of needs. Thus, patients have the opportunity to interact with a broad array of people and to participate in organized group activities that promote better physical and mental health. Rehabilitation can be enhanced in such a setting. Again, it is important to note that ADC care provides an added benefit to the caregivers for frail seniors or disabled individuals. When a Medicare beneficiary receives home health services in the home, these providers are not in the home all day. They provide the service they are paid for and then leave. Many frail seniors cannot be left alone for long periods of time and this restriction prevents their caregivers from being able to maintain employment outside of the home. If the senior were receiving ADC services, they would receive supervised care for the whole day and the primary caregiver would be able to maintain a job and/or be able to leave the home for longer periods of time. This is a small step forward for rehabilitation therapy for seniors and disabled individuals. Eligibility for the home health benefit is not changed so it is not an expansion of the benefit. Patients would greatly benefit from the option of an adult daycare setting for the provision of home health services. I look forward to working with my colleagues to enact this incremental, important Medicare improvement.

Mr. STARK

Mr. STARK. Mr. Speaker, in recent weeks, Aetna has sent Members' offices criticisms of a recent California court case in which a jury has awarded $120 million to a widow for the economic loss and pain and suffering caused by the Aetna HMO's treatment of her husband, David Goodrich. Aetna is saying the facts do not support--and argue against-- allowing HMO members to sue their HMO. Ex parte communications about a lawsuit--and Aetna says it is appealing--are always questionable. Aetna, of course, has a ton of money to lobby Congress. The Goodrich family has no Washington lobbyist. Therefore, I asked the Goodrich attorney to comment on Aetna's mailing to us. Guess what? There is another side to the story. Following is a side-by-side prepared by the plaintiffs. Also, I am including in the Record a press release from California's Consumers for Quality Care, which makes the excellent point that the CEO of Aetna, who loves to write long editorials about quality, has thrown a temper tantrum, blaming the ``not intelligent enough'' jurors. It would be far better for him to look within to the quality of his operations. Is this really the kind of CEO we would want as head of the nation's largest health insurance company? Aetna Misled Congress About Facts of Goodrich Case: Investigations, Withdrawal of Federal Contracts Called for board of aetna also asked to fire c.e.o. huber over remarks Consumers For Quality Care, the national health care watchdog group, today called upon Congress to convene hearings and suspend Aetna's government contracts over the HMO's attempts to mislead Congress about the facts of the landmark Goodrich vs. Aetna case in order to prevent HMO reform. Aetna recently sent a statement to Congress distorting the facts of the case, in which a San Bernardino jury issued a $120 million rebuke of the HMO's conduct toward District Attorney David Goodrich. Goodrich died of stomach cancer after a two and one half year ordeal trying to get Aetna to approve cancer treatment recommended by his Aetna doctors. In a letter to members of the United States House of Representatives and Senate today, Consumers For Quality Care urged action against Aetna because ``Aetna's conduct . . . shows a contempt both for the Court, the American justice system and for Congress.'' A point-by-point refutation of Aetna's statement to Congress about the case, based on the court record, was also released. (Available upon request) ``We intend to make a federal case out of Aetna's misrepresentations and remorseless defiance of the civil jury and their authority,'' said Jamie Court, director of Consumers For Quality Care, a health care project of the Foundation for Taxpayer and Consumer Rights. ``It should be federal case when the nation's largest HMO misleads Congress and thumbs its nose at the civil justice system. Aetna's defiance of civil society's dictates should bolster the case for giving to all patients the right to sue that Mrs. Goodrich has.'' The Goodrich case exposed the disparity in federal law between government workers, like the Goodrich family, who can sue their HMO and private sector workers, who are prevented from suing for damages unless Congress changes the Employee Retirement Income Security Act of 1974 or ERISA. Huber Should Be Fired Consumers For Quality Care also wrote Aetna's Board of Directors asking it to fire Chief Executive Officer Richard Huber over his remarks attacking Goodrich's widow. Huber responded in the Hartford Court to the verdict. ``This is a travesty of justice. You had a skillful ambulance-chasing lawyer, a politically motivated judge and a weeping widow.'' Later, a Los Angeles Times columnist reported, ``he [Huber] expanded his complaints, telling me that juries are customarily not intelligent enough to consider complicated contractual issues and that this one in particular was too ill-informed, as a result of the judge's evidentiary rulings, to render a sound verdict.'' ``We have been astounded at your Chief Executive Officer's lack of remorse over the handling of David Goodrich's care and ask you to act immediately to remove him,'' wrote Court. ``If Aetna is dedicated to making things better for patients, Mr. Huber does not belong as your C.E.O. The true travesty of justice would be if Mr. Huber remains at the helm of Aetna and company policy continues to be indifference to its dying patients and to juries that condemn such policies.'' The Foundation for Taxpayer and Consumer Rights is a tax- exempt, nonprofit, nonpartisan organization dedicated to advancing and protecting the interests of consumers and taxpayers.

Mr. STARK

Mr. STARK. Mr. Speaker, I join with Representative Leach (R-Iowa) and 22 of our colleagues to introduce the Medicare Social Work Equity Act of 1999 to ensure that clinical social workers can continue to receive reimbursement under Part B of Medicare. Due to changes in the Balanced Budget Act of 1997, clinical social workers can no longer bill Medicare under Part B for counseling and other professional mental health services. Under current law, clinical social workers must now seek reimbursement under the consolidated payment system. Unfortunately, the prospective payment system was not designed to cover ancillary services such as psychotherapy. If Congress does not amend the laws to allow separate billing for psychotherapy service, clinical social workers will not be able to provide much-needed mental health services to long-term care facility residents. Doing so will needlessly harm seniors because clinical social workers have the professional training and expertise to work with seniors as do psychologists and psychiatrists. If we fail to fix this problem, Medicate will pay more. The services of psychologists and psychiatrists cost more than the services of a clinical social worker. Currently, clinical social workers receive from Medicare only 75% of what would be paid to a psychologist or psychiatrist. In addition, many skilled nursing facilities operate in communities where psychologists and psychiatrists are not available to treat seniors in skilled nursing facilities. Our legislation excludes clinical social workers from the prospective payment system. This small fix corrects what we believe to be a serious error created by the Balanced Budget Act. It is time to act quickly and decisively to preserve access to needed counseling services for residents in thousands of our nation's long-term care facilities.

Mr. STARK

Mr. STARK. Mr. Speaker, Friday January 22nd 1999 marked the twenty- sixth anniversary of the Supreme Court decision in Roe v. Wade, which ensured the right of all women to make decision concerning their reproductive health. For millions of women, Roe v. Wade has secured the constitutional right to seek access to safe and legal family planning and abortion services. Its impact on the health and safety of the lives of women cannot be overstated. It is an outrage that despite the Supreme Court's ruling, women still face barriers to seeking abortion without danger. States continue to find ways to restrict access by law, and even more troubling is the recent trend of clinic violence and the harassment of doctors and workers by anti-choice activists. I would like to highlight some cases from this past year of violence and threatening behavior in my home state of California: In February, a bombing attempt was made on a family planning clinic in Vallejo. The briefcase that contained the alleged bomb was later discovered to be empty. In April a firebomb was thrown at a Planned Parenthood family planning clinic in San Diego, causing $5,000 in damages. A door was broken in El Monte when a rock was thrown at the Family Planning Medical Center. In July, a San Mateo family planning clinic worker was accused of physical assault by three anti-choice protesters. The protestor's injuries were not found by the police to warrant charges. In San Diego, a clinic was vandalized, the buildings covered with the words ``baby killer.'' In September the new Planned Parenthood headquarters in Orange County face over thirty chanting anti-choice protesters. In Fairfield, a physician was harassed by anti-choice protesters as he arrived for work one morning. These events are mirrored by others across the country, and show that the fight for productive choice did not end with the Roe v. Wade decision. Twenty-six years ago the Supreme Court held up the right to reproductive choice for women, yet it is still debated on the floor of the House of Representatives on a near daily basis. We must keep up the fight for a women's right to choose. I remain committed to do all I can to preserve that choice.

Mr. STARK

Mr. STARK. Mr. Speaker, as the National Abortion and Reproductive Rights Action League (NARAL) celebrates 30 years of pro-choice advocacy, those of us dedicated to preserving a woman's right to choose know that the need for pro-choice advocacy and activism is greater than ever. America recently commemorated the 25th anniversary of Roe v. Wade, the Supreme Court decision that recognized the freedom to choose as a fundamental right, while opponents of choice worked to put the private decision about abortion into the hands of government. The anti-choice Congress has pushed a wave of legislation requiring women to endure increasing obstacles in order to exercise a right that should be non- negotiable. Reproductive choice continues to be debated on the floor of the House on a near-daily basis. NARAL has long been a fierce defender against infringements on the right to choose. For thirty years, NARAL has worked to increase Title X funding for federal family planning programs, promote contraceptive research and the development of contraceptive options for women and men, to protect the right of Medicaid-eligible women to make choices about their reproductive health, and to ensure that women have safe access to reproductive health facilities by condemning clinic violence and harassment. Pro-choice Members of Congress have never underestimated the powerful impact of NARAL's message, that we all want to see abortion made less necessary. NARAL tirelessly exposes the irony of the abortion debate-- that the strongest opponents of the right to choose also oppose programs promoting comprehensive sex education and birth control, which actually reduce unplanned pregnancies. Instead, anti-choice politicians would make access to family planning options more difficult, more dangerous, more expensive and more humiliating. We must continue to support legislation to help reduce the number of unplanned pregnancies. Specifically, we must rededicate our efforts to require that health insurance plans provide coverage for contraceptives to the same extent that they provide coverage for other prescription drugs. Our job in Congress is to move our nation toward a reproductive health care policy that promises to make abortion less necessary and protects the right of Americans to do what they believe is best for their families. We congratulate you on thirty years of advocacy, and look to NARAL for leadership as the 106th Congress prepares to defend a woman's right to choose.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today with a number of my colleagues to introduce The Medicare+Choice Improvement Act. I don't need to tell you that the large number of Medicare+Choice plan terminations this past year was a real shock to many of our Medicare beneficiaries. In a number of communities, beneficiaries are left with fewer affordable coverage options in Medicare. We should take immediate steps to make changes to the Medicare+Choice program that will protect beneficiaries when health plans leave the program, and we should make certain improvements that will aid health plans' abilities to project costs and continue as Medicare providers. I disagree with assertions that the only way to do this is to throw more money into the Medicare+Choice program and will oppose efforts of that nature. History always has had a way of getting distorted and the Medicare+Choice program is a fine example of that happening. Let us remember, the Medicare+Choice program was created as part of the Balanced Budget Act. In other words, the purpose of creating the Medicare+Choice program was to save money in the Medicare program. We have known for years that our payment system for Medicare managed care plans overcompensated them for the risk of the patients they were insuring. Medicare HMOs have historically insured younger, healthier seniors. Because Medicare's payment to managed care plans was based on the average fee for service payment in the county, the HMO payments were higher than appropriate. We also know that there are a number of other ways in which we are still overcompensating Medicare managed care plans. A chart highlighting these current overpayments is attached. So, rather than rewrite historical evidence to advocate increased funding of the Medicare+Choice program, I have put together The Medicare+Choice Improvement Act to make important consumer protection improvements in the Medicare+Choice Program. The bill would: Broaden consumer protections so that beneficiaries can leave health plans that have announced that they are terminating Medicare participation and join another Medicare+Choice plan to purchase a Medigap policy; Provide new protections for Medicare's disabled and ESRD patients. Prohibit door-to-door cold-call marketing of Medicare+Choice plans to seniors; Protect state efforts to provide comprehensive prescription drug benefits to their seniors; End Medicare+Choice plans' abilities to gerrymander their Medicare service areas in comparison to their commercial business; Require HCFA to calculate the portion of beneficiaries in a region receiving services through VA or DOD; Require the NAIC to reconfigure the Medigap policies so that they better meet the needs of today's Medicare beneficiaries. On the health plan side of the equation, my legislation would take care of one of their most pressing concerns: it would move the ACR submission date (the date that health plans must submit their pricing and benefit data for the following year to HCFA) from the current date of May 1 to July 1. This would give health plans two additional months to compile necessary data for the upcoming year. This might not move the date as far as health plans would like, but there are serious costs to move the date further in the year. As one example, moving the date any later would seriously jeopardize the ability of HCFA to prepare the ``Medicare&You'' beneficiary handbook which is mailed to seniors each year. On the topic of risk adjustment, I think that HCFA's proposal to phase-in risk adjustment over the next five years is just too long. We have solid evidence that Medicare managed care plans have been enrolling healthier patients and making more money off of them because of that fact (again, see the attached chart). The hospital-based risk adjustment proposed by HCFA is a first step toward fixing this inequity. It would finally put in place a financial incentive to enroll less healthy beneficiaries. We need to be moving forward as quickly as possible with this mechanism. I do concede that a phase-in approach is appropriate, but my legislation would have that phase-in occur over three years rather than five. We have an opportunity this year to make improvements to the Medicare+Choice program that will protect beneficiaries when health plans make business decisions about whether to continue participating in Medicare. This bill makes those improvements without senselessly increasing Medicare expenditures on a program that already costs more than traditional Medicare. I look forward to working with my colleagues to make these important, reasonable, and necessary fixes to the Medicare+Choice program.

Mr. STARK

Mr. STARK. Mr. Speaker, today I wish to pay tribute to Tracey Toomey, a firefighter from San Leandro, California, who died in the line of duty on January 10, 1999. He leaves a wife, Renee, and two children, Daniel and Shannon. Mr. Toomey died while on voluntary overtime, trying to put out a six- alarm fire which consumed a nightclub in Oakland. He was a dedicated and talented firefighter. He was born and raised in Oakland, graduating from Castlemont High School in Oakland in 1964, and went on to study at Laney Junior College. He served for two years in the United States Marine Corps, from 1965 to 1967, during which time he served in the Vietnam war. He became a firefighter in 1972, working in Oakland for several stations, including Station 23 and 6, and was volunteering for a further station at the time of his death. Toomey was as active in his personal life as he was in his professional life. He could often be found hiking, biking and hunting with his son. He also ran a welding business, and was skilled in the production of detailed pieces. He was a member of the California Artistic Blacksmiths' Association. He was a committed family man and was weeks from celebrating his twenty-ninth wedding anniversary. All those who had lived and worked with him will miss him greatly. He will be remembered as one whose commitment to his job went far beyond most and for that reason I wish to pay tribute to him today, and send our deepest sympathies to his family.

Mr. STARK

Mr. STARK. Mr. Speaker, a number of Medicare provisions in the Balanced Budget Act have been delayed because of the Year 2000 computer ``bug'' problem. One delay involves postponing reforms in the way Medicare pays for beneficiaries who receive services in hospital outpatient departments (HOPDs). This is as complicated and Byzantine an area of payment policy as exists in Medicare--but the bottom line is that the delay will cost seniors and the disabled $460 million in 1999 compared to what they would have saved if the HOPD reform that Congress intended and enacted had proceeded on course. $460 million is a lot of money for seniors facing medical problems. Hopefully, HCFA's Y2K corrections will proceed on schedule and beneficiaries can begin saving money in 2001 when the HOPD changes are implemented. But in case there are problems, seniors could continue to see higher costs than they should well into year 2000. This is a relatively simple problem to fix. I am introducing a bill today that will deliver on the BBA's promise to seniors of nearly half a billion in savings in 1999. I urge the Ways and Means and Senate Finance Committees to consider this proposal on an emergency basis. It will have no cost of Medicare--but it will provide much needed relief from HOPD overcharges. It has the support of the Administration. Following is a technical explanation of the problem and the solution. Again, Mr. Speaker, we should not get lost in the turgidness of the issue--we should just keep our eyes on the fact that the half billion in promised savings can still be achieved. Proposal to Reduce Medicare Outpatient Department Coinsurance Current Law Coinsurance for hospital outpatient department (OPD) services is currently based on 20 percent of a hospital's charge. Under the prospective payment system (PPS) for hospital OPD services, coinsurance will no longer be based on charges. Instead, base copayment amounts will be established for each group of services based on the national median of charges for services in the group in 1996 and updated to 1999. These copayment amounts will be frozen until such time as coinsurance represents 20 percent of the total fee schedule amount. If the OPD PPS were implemented in 1999, calculation of the copayment amounts in such a fashion would result in coinsurance savings of $460 million for beneficiaries in 1999. HCFA, however, will not be able to implement the OPD PPS in 1999 due to the intensive efforts and resources that must be devoted to achieving year 2000 compliance. It will be implemented as soon as possible after January 1, 2000. In the absence of the OPD PPS, coinsurance will continue to be based on 20 percent of charges. Proposal Beginning on January 1, 1999 and until such time as the OPD PPS is implemented, coinsurance would be based on a specified percentage of charges, which will be lower than 20 percent. The specified percentage (e.g., 18% or 17.5%) would be calculated by the Secretary and specified in law so that the beneficiaries, in aggregate, would achieve coinsurance savings equal to $460 million in 1999. These savings are equal to the amount that would have been saved by beneficiaries in 1999 if the OPD PPS were implemented. The Medicare payment, however, would continue to be calculated as if coinsurance were still based on 20 percent of charges. In so doing, the beneficiary coinsurance savings are not passed on to the Medicare program as a cost. Instead, the loss will be absorbed by hospitals, which is the same outcome that would have occurred in 1999 under the OPD PPS. Under this proposal, hospitals would not be able to recoup their losses by increasing their charges. In fact, increasing their charges would result in a further loss. This is because higher charges cause an increase in coinsurance but an offsetting reduction in the Medicare payment since coinsurance is subtracted out in order to determine the Medicare payment. Furthermore, since the Medicare payment is calculated as if coinsurance is 20% (rather than 18%), the Medicare payment would go down by more than the increase in the coinsurance payment (which is based on a lower percentage).

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to join with my Democratic colleagues from both the House and Senate today to re-introduce the Patients' Bill of Rights. This legislation came within five votes of passage in the last Congress. We are anxious to work with our colleagues to pass this important legislation this year. Patient protection should not be a partisan issue. This is the health care issue that continues to top this list of my constituents' concerns--and I represent California which has the longest history of managed care in our country. The Patients' Bill of Rights is a bill whose time has come. It builds on bills that have previously been introduced, on recommendations from the President's Advisory Commission on Quality in the Health Care Industry that met last year, on legislative efforts of various states, and on consensus agreements among consumer groups, many providers, and certain health plans. As more and more of our population joins managed care plans, the need for federal oversight of plan quality grows greater. Patients deserve to know that their health plans are held accountable to a basic set of consumer protection standards. That is what the Patients' Bill of Rights will do. Though many states have enacted consumer protection bills, they cannot regulate many of the health plans within their borders due to our convoluted health care system. Federal action is required. The Patients' Bill of Rights creates a set of federal standards that assures patient access to covered benefits and that holds health plans accountable for their actions. The most important components of the bill are as follows: Health Plan Accountability: The Patients' Bill of Rights holds health plan administrators to the same level of accountability for making medical decisions as doctors. Under current law, if an individual receives health care benefits through his/her employer, and a health plan makes a medical decision to withhold treatment that harms a patient, that health plan's only responsibility is for the provision of benefits that had been denied. The estimates are that some 125 million Americans are in these types of health plans. So, if a health plan denies a woman a mammography and she later is found to have advanced breast cancer--which would have been detected much earlier with the screening exam--that plan's only liability is the cost of the mammogram that was not provided. The remedy for this is straightforward: if health care plans are going to be making medical decisions, they must be held accountable to the same standards for legal liability as health care providers. In the last Congress, I introduced a free-standing bill (HR 1749) to correct this glaring inequity. The Patients' Bill of Rights corrects it as well. Our legislation would allow states to determine whether or not a consumer can bring a state cause of action against health plan administrators whose medical decisions result in harm. There has been much ado about this provision and its potential impact on business. The fact of the matter is that few employers are making medical decisions regarding their employees' health care. And, the bill goes so far as to explicitly protect employers from any liability as long as they are not involved in any medical decision-making. There has also been much talk that the courts will soon resolve the issue of ERISA preemption. Unfortunately, we are years away from a point when such resolution will be found. Courts across the country are developing very different interpretations of ERISA preemption and, consequently, there is no clear direction from their decisions. This is too important an issue to wait any longer. A legislative solution is warranted. External Appeals: Guaranteeing consumers access to a strong, independent external appeals process is also one of the best ways to assure the provision of quality care. Unless there is an outside, independent decision-making body for which consumers can ultimately take their appeals, we will not obtain real consumer protection. Health plans that hold a financial interest in denying care simply cannot be the final arbitrators about whether care will be provided. The Patients' Bill of Rights calls for health plans to contract with independent external appeals entities certified by the State or the Department of Labor to provide timely analysis of the plan's actions with the help of neutral health care professionals. There are defined timelines in the legislation to ensure that consumers facing serious, time- sensitive health consequences will be able to have their appeals resolved and the appropriate care provided. For example, in the case of urgently needed care, the external appeal entity could take no more than 72 hours to issue a decision. Disclosure of Consumer Information: Today, consumers have no way of comparing health plans based on easily understood quality criteria. The collection of standardized data and the provision of standardized comparative information is a key component of the Democratic legislation. As an example of this lack of ability to compare plans, PacifiCare, the largest Medicare HMO contractor and an insurer in the Federal Employees Health Benefits Program, refused to release its NCQA data last year. NCQA data may not be perfect, but it is the only measure out there today by which consumers can compare health plans. PacifiCare should not have been allowed to get away with holding that data confidential. One of my principal concerns has always been that managed care plans are quick to sign people up and collect monthly premiums, but slow to see a large number of their patients. I think that every health plan should be required, upon enrollment, to conduct an examination of each new enrollee before the health plan can receive any premium dollars. The strongest argument in support of managed care is that when it is done well--and is truly coordinating the care of patients--it can produce superior health outcomes. The idea of a care coordinator helping a patient through the typical health care maze is a good one. But, how can a managed care plan fulfill that role if the patient is never seen, let alone evaluated? The Patients' Bill of Rights does not go so far as to require that a plan examine a patient before premiums can be collected. However, it does require that data by presented to consumers on the plan's preventive health care services. In this way, consumers and employers will be able to compare health plans as to how fare the plan really goes toward managing patient's health. This data is available for prospective as well as current plan enrollees. These are several of the key consumer protection and quality provisions in The Patients' Bill of Rights. I chose to highlight these points because I think they are fundamental components of meaningful managed care reform. But the bill contains many additional important protections. The Patients' Bill of Rights is the most consumer-oriented managed care reform bill that has been introduced. Instead of protecting providers, it aims to help consumers. It calls for: direct access to OB-GYNs; direct access to specialists for patients with chronic medical conditions; coverage of routine patient costs for approved clinical trials; participation by plan physicians and pharmacists in the development of drug formularies; access to an out-of-plan specialist if no appropriate in-plan specialist is available--at no extra cost to the patient; and the creation of a consumer ombudsman in each state to help consumers make health care choices that meet their needs. Again, I am pleased to join with my colleagues today to introduce this vitally important legislation. I look forward to working with members in both bodies and on both sides of the aisle--and with the President--to pass federally- enforced, consumer-oriented managed care legislation this year.