Pete Stark

Mr. STARK

Mr. STARK. Mr. Chairman, this week, the House considers the Republican Leadership's Budget Resolution for FY '99 (H. Con. Res. 284). The Budget Committee approved a resolution on May 20, 1998 by a margin of 22-16 with every Democratic Member opposing the measure. While I could not have come to this floor to support the Committee- passed resolution, what is before the House today is even worse than the product that the Republicans voted out of Committee. Today's Budget resolution is a cruel and direct attack on the least advantaged Americans. It shows the majority party's true colors. They are willing to make our children pay the price for their politics in three significant ways: The government infrastructure that benefits the common good and each individual family--our schools, our environment, our park systems, our crime fighting programs--is cut to the bone. Programs providing a safety net for the neediest families with children are gutted. A $10 billion cut in the Budget category 600 translates into a 25% cut in budget authority for Temporary Assistance for Needy Families. The proposal to spend $100 billion today on tax breaks for the wealthy to please voters at November's polls instead of investing it for Medicare and Social Security solvency will only devastate our future federal budgets--and our children will pay the price. My colleagues on the other side of the aisle say that it is not the role of government to help the downtrodden, the disabled, the children who happened to be born into families without means. But is it the role of government to hurt them? That's just what this resolution would do. This budget must be viewed in the context of the economy. We know that this era of prosperity has passed many Americans by. Although we have had a long period of economic recovery, our economy has not been that robust until the last year or two. In fact, during the first three years of the recovery (1991 to 1993), 80% of Americans experienced declines in income. As the economy grew more robust during the Clinton administration, workers experienced some income gains but, in spite of these more recent gains, the gap between the rich and the poor continues to widen. Improvements in wages were just not enough to erase 20 years of falling and stagnating wages. Census Bureau data analyzed by the Center on Budget and Policy Priorities dramatically demonstrates this growing income inequality in 48 out of 50 states: Between the late 1970s and the mid-1990s, the incomes of upper-income families with children increased in every state. On average, incomes of the richest fifth of families increased by 30%, or nearly $27,000, after adjusting for inflation. In sharp contrast, incomes of the poorest families with children decreased in 44 states in this period. The decline in the real incomes of the poorest families with children averaged 21 percent, or $2,500. In the U.S. as a whole, Census data shows that the poorest 20% of families with children had an average family income of $9,250 in the mid-1990s, while the average income of families in the top 20% of income distribution was $117,500, or 13 times as large. The income gap is not just between rich and poor. The gap has also increased between middle class and high income families between the late 1970s and the mid-1990s. By the mid-1990s, there were 40 states where the gap between the highest income 20 percent of families and the middle 20 percent of families with children was larger than it had been for any state during the 1970s. This data is clear: economic prosperity has not been broadly shared in America. The poverty rate for children has not declined. More than one in five children lives in poverty. Although children represent one- fourth of the population, they comprise nearly 40% of the people living in poverty. Nor has the pain of budget choices been broadly shared. Under this Budget plan, the young and the poor bear the pain, and the rich share the gain. The Leadership's Budget cuts domestic spending by $101 billion over the next five years--a 19% reduction below the amount needed to keep up with inflation by the year 2003. This is a huge cut below the already tight spending levels approved in last year's budget agreement. And, since the Republican budget does not include funding for the highway bill, the actual cuts would be even deeper. More than 40% of the cuts fall on low-income families, even though these programs make up only 23% of all mandatory spending. The Republican budget cuts Medicaid and children's health by $12 billion, and cuts education by $5.7 billion over five years. The most insidious cut of all is the cut in the budget category 600. This category includes the Temporary Assistance for Needy Families program (TANF). The TANF block grant replaced AFDC, the JOBS program, and Emergency Assistance. Cutting TANF reduces the funds states have to spend on providing basic supports for children. It also reduces state funds to pay for caseworkers to assist families making the transition from welfare to work. It reduces the funds to assure needy families with children obtain the education, training and employment assistance they need to help them become self-sufficient and avoid long-term welfare dependence. If the TANF block grant budget authority is cut from $16.4 billion to $12.4 billion each year to achieve $2 billion in outlay savings, as CBO estimates, and all the cuts came from TANF assistance: Benefits for all TANF families could be reduced by about 25% which would require the ``average'' welfare family of 3 to live on about $275 a month; benefits for about one-quarter of TANF families could be eliminated ending assistance for approximately 1.5 million children; and basic education and job skills training needed for parents to become employable could be reduced or eliminated for up to 2.9 million parents trying to get back to work. States would have $10.2 billion less over 5 years to make the promote job preparation to get families off of public assistance, to prevent and reduce the incidence of out-of-wedlock pregnancies, and to provide child care for needy children. In spite of our budget surplus and beyond our targets agreed to in the Balanced Budget Act, this resolution cuts to the quick every way our government works to make life better for Americans. Why? So we can give $100 billion in tax cuts and still have a balanced budget? The Chairman of Ways and Means has floated various tax cuts but they all disproportionately help the upper bracket folks: estate tax relief, deeper capital gains cuts, exclusions for interest and dividends, reductions in the alternative minimum tax and marriage penalty relief. Even the accelerated deductions for health insurance provide more relief for those in the upper brackets than for taxpayers with lower wages. The tax cuts are unfair and unwise when we know we must address solvency issues in both Medicare and Social Security. In keeping with our vote today on school prayer, I hope I can reach the hearts and minds of my colleagues with a story about Moses. About 3000 years ago, Moses interpreted the Pharaoh's dream of 7 fat cattle and 7 starving cattle as a prediction that Egypt would have 7 years of feast, and then 7 years of famine. Like a wise ruler, the Pharaoh saved some of the surplus of the 7 good years, so that the people of Egypt could survive the 7 years of famine. That was a pretty big gamble the Pharaoh took, relying on someone else's interpretation of a dream. He could have made everyone happy for 7 years and seen his approval ratings reach deity levels. He could have abolished the tax code and built and built a few extra pyramids for his best friends. Instead of the 3 pyramids of Egypt, he could have had 4 or 5. He could have built a dozen sphinxes. But no, he was wise, and saved for a possible disaster--and the disaster came. We don't need Moses to analyze the demographics in America. We know that our current surpluses are temporary and will turn to deficits. We know that Medicare and Social Security will either have to be cut or taxes raised in the next 10 years. We also know that we can make the problem infinitely easier to solve if we save today's surpluses for tomorrow's shortfalls. God doesn't have to give us a dream for us to figure out the right policy here. If we don't pass a budget that saves for future needs, our children will wonder if we were so dumb that we could not to see the obvious coming--or just too foolish not to prepare for it. Mr. Speaker, I cannot support this budget that guts safety net programs for our children so that it can give tax breaks to the wealthy. I urge my colleagues to reject it as well.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to oppose House Joint Resolution 78, the so-called ``Religious Freedom Amendment.'' This proposed constitutional amendment would obliterate the separation of church and state and would result in government-sanctioned worship, taxation to benefit religion, and majoritarian oppression. In order to serve its own interests, the radical right is overlooking what is already current law. Religious expression is protected by the First Amendment, and private religious expression is legal everywhere, including public schools. Under the First Amendment, students can pray silently at any time and even aloud in groups so long as they are not disruptive. Student-led religious clubs can meet on school property to pray and study Scripture. Religious speech in the public square already abounds. We learned at the beginning of this Republican-led Congress that the government does not hand out money without strings attached. This proposed Amendment to our Constitution goes much further by permitting a wide array of government-sponsored religious expression. It would allow state endorsement and financial support for religious activity not only in schools, but on all public property, including government offices, court houses, and military bases. It is coercive and vain to impose religion, to require our government to recognize or single-out one faith from another when it is one of thousands of beliefs, faiths, doctrines, and creeds. Allowing government to endorse religion in this way turns religion into a political tool and sends the message that those who do not hold a certain faith are outsiders--and not full members of the political community. Nearly every mainstream religious group, including the Baptists, the Presbyterians, the Muslims, the Unitarians, the Episcopalians, the Lutherans, and the entire Jewish community oppose this amendment. It is clearly supported by a radical religious minority who seek public endorsement of what should be a private affair. Rather than promoting religious liberty, the ``religious freedom'' amendment presents a grave peril to the crucial principles protecting religious liberty that are part of the framework of American law. What is not broken needs no repair.

Mr. STARK

Mr. STARK. Mr. Speaker, earlier this year, President Clinton issued an Executive Memorandum directing all Federal health plans, which serve over 85 million Americans, to come into substantial compliance with the Consumer Bill of Rights recommended by the President's Quality Commission. The Advisory Commission on Consumer Protection and Quality in the Health Care Industry recommended: Consumer information disclosure; choice of providers and plans; access to emergency services; consumer participation in treatment decisions; nondiscrimination protections; confidentiality of health information; access to complaints and appeals processes; and, a recognition of consumer responsibilities. The Medicare program is already meeting most of these standards, but there are two specific components of the Consumer Bill of Rights that cannot be enforced in Medicare without a statutory fix. Both provisions affect the choice of plans and providers. The first would grant women direct access to obstetricians and gynecologists, the second would grant transitional care protections to patients who are undergoing a course of treatment and faced with an involuntary change in health plans or their doctor leaving the plan. Today, I rise with my Democratic colleagues from the Ways and Means Health Subcommittee to introduce ``The Medicare Consumer Bill of Rights Conforming Act'' which creates statutory authority for Medicare to fully enforce the President's Quality Commission's Consumer Bill of Rights. The Medicare Consumer Bill of Rights Conforming Act would require health plans to allow a Medicare beneficiary to select an OB-GYN as her primary care provider if she so chooses. It would also prohibit health plans from requiring women to obtain prior authorization before obtaining routine gynecological care. An issue of real concern to people in managed care plans, and those thinking of joining them, is that doctors come and go from health plans, resulting in a loss of continuity of care for patients during those transitional times. The Medicare Consumer Bill of Rights Conforming Act would create short-term protections for Medicare patients in such situations. Patients undergoing a course of treatment when a health care provider is terminated from the plan would be able to continue that care with the same provider for up to 90 days. Cases involving institutionalization, pregnancy or terminal illness could have longer periods of transitional coverage. In all instances, the provider would need to accept the payment rate of the patient's health plan in order to qualify for continued participation. The Medicare Consumer Bill of Rights Conforming Act is a small but important piece of legislation that would ensure Medicare beneficiaries of a basic set of consumer protections. These protections are not controversial. They were endorsed by the President's Quality Commission, which included representatives of big business, insurers, small business, labor, consumers, seniors, and the managed care industry. This is a very small step for Congress to take to provide Medicare with the authority to enact these protections for our nation's seniors and disabled population. I look forward to working with my colleagues to enact this sensible, non-controversial legislation.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to announce the introduction of important legislation that will benefit the people in Alameda County, California. I have introduced a bill that would authorize the construction of the Alameda County Brackish Water Desalination plant. This plant would treat the water from San Francisco Bay that has been creeping into the groundwater used by residents of my district in Alameda County. The water would either be directed for residential use or be put back into the ground. This project will decrease our dependability on water imported from the San Francisco Bay Delta and help us reclaim our groundwater basin. Additionally, this plant will improve the water quality and availability for almost 300,000 people in Fremont, California and the surrounding areas. This bill would authorize construction of the plant under the Reclamation Wastewater and Groundwater Studies Act and will cost $30 million. The bill makes specific provisions to exclude the U.S. Government from incurring any costs associated with the operation of the plant and limits the total federal expenditures to 25% of the total construction cost. This one-time appropriation for construction will go a long way to ensure water quality and accessibility for the people of Alameda County. I urge my colleagues to support this important project and to take action soon to allow the Bureau of Reclamation to proceed with the feasibility study.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to introduce the ``Medicare+Choice Mental Health Coverage Access Assurance Act of 1998.'' This important legislation seeks to provide Medicare beneficiaries with appropriate and medically necessary mental health coverage under managed care. Last year's Balanced Budget Act opened more managed care choices to Medicare beneficiaries through the establishment of the Medicare+Choice Program. In doing so, we enacted some patient protection measures for individuals enrolled or will be enrolled in Medicare managed care. However, because of managed care's history of putting more restrictive limits on mental health care compared to general health care, I believe that additional steps must be taken to ensure that Medicare patients with mental health needs will receive appropriate mental health care. The amendments to the Balanced Budget Act that I am introducing today would give Medicare consumers emergency care in the case of a suicide attempt, coordination of post-stabilization care, clear descriptions of mental health and substance abuse benefits, access to mental health specialists and to inpatient treatment. According to the Health Care Financing Administration, close to five million Medicare beneficiaries are mentally ill. Of these, 1.3 million are under age 65; they receive SSDI and Medicare due to a mental disability. The number of SSDI recipients diagnosed with a mental illness increased 17% between 1993 and 1995. And it is expected that the number of geriatric patients with mental disorders such as depression, anxiety, and Alzheimer's will grow rapidly in the coming years. To address these needs, Medicare spent close to four billion dollars on mental health services in calendar year 1994. Yet, the services presently received by Medicare beneficiaries are viewed by many as inadequate and fragmented. While one may expect capitated systems to better provide for a full continuum of mental health care and serve individuals with mental health needs better, experience with this sector to date has been mixed. In the public sector, states are struggling to address fundamental questions of coverage, access, quality, and mental health's coordination with the rest of health care as millions of mentally disabled Medicaid beneficiaries are moved into managed care systems. It is worth noting that many public purchasers are placing their mental health and addiction disorder treatment and prevention programs into the hands of private companies far more rapidly than their own contracting abilities or the capabilities of the managed care companies may warrant. Medicaid's transformation to managed care gives us reasons to proceed with caution. The federal government retains the ultimate responsibility of ensuring that taxpayers' money is well-spent and the mental health needs of Medicare beneficiaries are well-served if we are to turn their care over to private companies. This legislation that I am introducing today address these issues and requires the following minimum standards from health plans that wish to participate in Medicare. First, a patient should get the psychiatric emergency care he needs if he has made a suicidal attempt or has made serious threats to inflict harm to himself. It seems that some managed care companies do not take a suicidal attempt seriously enough. According to the report Stand and Deliver: Action Called to a Failing Industry, 1997 by the National Alliance for the Mentally Ill, five of the nine largest behavioral managed companies surveyed failed to provide a response that acknowledged a suicide attempt as a potentially deadly emergency requiring prompt attention. Second, should a patient show up in an emergency room in an emotional crisis and the managed care plan decides that he does not meet the criteria for an inpatient admission, the plan must still do what it takes to stabilize the patient. Treatment decisions should include a realistic assessment of the availability of community supports and other treatment setting options that would serve as an alternative to inpatient care such as partial hospitalization or acute diversion units. Third, Medicare beneficiaries are entitled to and should get a clear description of mental health and addictive disorder treatment benefits from health plans. This should include any front-end restrictions on utilization of mental health services such as premiums, co-insurance, deductibles, number of visits and days limits, and the range of services provided. In addition, plans should also disclose annual and lifetime limits on mental health spending. This would enable Medicare beneficiaries, and specifically those with mental disability, to make an informed choice of a plan that best serves their needs. Fourth, a Medicare+Choice plan should provide beneficiaries access to mental health and addiction specialists. This requirement is particularly important to the severely and persistently mentally ill geriatric patients, whose complex medical, psychiatric, and cognitive impairments are frequently left poorly attended to. Last of all, it must be emphasized that the treatment of serious brain disorders continues to require the availability of inpatient care. The decision to admit or to refuse a psychiatric hospital admission to a patient in distress can have grave and even life- threatening consequences. Thus, these decisions must be made in close consultation with the physician who wishes to admit a patient with serious symptoms to a hospital setting. I urge my colleagues to join me in co-sponsoring this important and straightforward legislation. For too long, discussions of mental health and addictive disorders have been lost in the Medicare debate. The elderly and disabled Medicare beneficiaries with mental health needs are a vulnerable population. They deserve our attention and our commitment to provide them with the best care we possibly can.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the dedication and accomplishments of Mr. John Hanley who represents the very best in public service and to thank him for his years of service to our joint constituency in the 13th Congressional District as he leaves to continue his career across the Bay. A graduate from Fordham University in New York, Mr. Hanley began his career with the Social Security Administration as a Claims Representative in New York in 1971. Since then, he has held increasingly responsible positions, including Operations Supervisor, Staff Specialist in the Regional Office, Area Administrative Assistant, Assistant District Manager, and District Manager in two Bay Area districts--meanwhile finding time in the evenings to complete his MPA at California State University Hayward. Mr. Hanley has been SSA District Manager for the Hayward, CA District for seven years where he displays an exceptional ability to balance operational and administrative responsibilities. He consistently demonstrates a personal involvement in all aspects of operations, and can be depended upon to be well informed on technical changes as well as on new policies and procedure that impact operations and service delivery. Due to his strong analytical skills, his suggestions for changes and improvements benefit not only his District but the entire Region. Under Mr. Hanley's exceptionally effective leadership, his District is a model for timeliness, accuracy and courteous service. John's blend of consistently efficient service without sacrificing compassion has earned him the respect of peers and community alike and has made my job easier! My office has observed his office as a hallmark of public service and has enjoyed many years of close cooperation and responsiveness. I join many in our community in thanking John for his strong leadership within the Administration and for having a caring heart for the claimants.

Mr. STARK

Mr. STARK. Mr. Speaker, in response to a number of questions I submitted last fall, I have received the following memo from the Office of the Chief Actuary of the Medicare agency.***STRPGFIT*** I asked what effect various options for spending restraints or increased revenues would have on the long-term outlook for the Medicare Trust Fund. The Actuary's memo makes it clear that we can solve Medicare's long-term problems without radical change. A lot of politicians and editorial writers cry that the sky is falling because of the coming retirement of the Baby Boom generation. The Actuaries show that with a variety of reasonable changes, Medicare will be there for our children and grandchildren. The memo shows that with reasonable controls on hospitals and doctor inflation and very small tax changes, we can easily solve Medicare's financial problems between now and 2022, and solve more than half the 1998--2072 problem. For example, a three year freeze on hospital payment inflation would cut the short-term problem in half and the 75 year budget shortfall by one-quarter. A freeze is doable, because the Medicare Payment Advisory Committee (MedPAC) reports that at current rates, in 2003 hospital Medicare payment profits are likely to be about 15%--far more than we should be paying. As another alternative, if we donated half the tobacco settlement to the Medicare Trust Fund and saved the next decade's budget surpluses for Medicare, we would keep the Hospital Trust Fund solvent way past 2020. We don't need tax increases. If we just save the pending surpluses for Medicare, instead of dribbling them away, we can solve Medicare's problems over the next twenty years. A proposal to hold Hospital Trust Fund spending to the growth in the Medicare population plus the per capita growth in Gross Domestic Product, would solve half the long-term financial problems of the Trust Fund. Holding health inflation to this level will be tough, unless private sector health inflation is held to similar levels--but we should try. The fat and waste in the health care system is extraordinary, and we should make this our goal. The Office of Actuary estimates also show that the Stark-Moynihan Medicare Early Access bill (HR 3470, 3471) allowing people to buy into Medicare as early as age 55 would be revenue neutral over the next 25 years and then actually improve the Trust Fund because of the bill's anti-fraud provisions. People who want to abolish Medicare and privatize all government programs are trying to scare Americans into believing Medicare can't be saved. Take a look at these budget estimates: these are reasonable changes that we can and should make. With additional savings we should even be able to improve the existing program to provide a pharmaceutical benefit. ***STRPGFIT***Memorandum, May 15, 1998. From: Sol Mussey, Director, Medicare and Medicaid Cost Estimates Group, Office of the Actuary, HCFA Subject: Estimated Long-Range Financial Impact of Selected HI Proposals The attached table provides estimates for several proposals designed to help reduce the Hospital Insurance (HI) program's long-range actuarial deficit. The attached table provides the 25-year, 50-year, and 75-year impacts on the actuarial balance, together with the resulting balances themselves. The attached is based on the 1998 Trustees Report, intermediate assumptions, and consequently include the effects of the Balanced Budget Act of 1997. Each line of the table represents the actuarial balances under current law modified for that particular proposed only. No request was made at this time for any combination of proposals. In practice, the financial impact of a legislative package made up of several of these proposals would not necessarily equal the sum of the individual impacts, due to potential interactions among provisions. The estimates shown for the age 62 buy-in proposal are based on the proposal in the President's 1999 Budget. Since the proposal in the short run is to be financed by other savings proposals in the budget, we included the effects of these other proposals. Hence, the 25-year effect on the actuarial balance is zero. However, the buy-in proposal becomes self-financing after about 20 years and the savings from the other proposals in the budget are assumed to continue. Therefore, there is some positive effect on the actuarial balance for the 50- and 75-year projection periods. The center of excellence proposal is also included in the President's 1999 Budget. As is always the case with long-range financial estimates, the impacts shown for the attached proposals are subject to considerable uncertainty. Actual future effects could differ substantially from these estimates. Sol Mussey, ASA, Director, Medicare and Medicaid Cost Estimates Group.

Mr. STARK

Mr. STARK. Mr. Speaker, H.R. 2400, the ``Building Efficient Surface Transportation and Equity Act (BESTEA)'' bill is a highly needed piece of legislation. Every member of Congress wants to be able to go back to his or her district over the Memorial recess and give their constituents new roads and improved public transportation. I would be as proud as the next member to go back to California's 13th District and give them millions of dollars for road repairs and improvements--if it was not a deceptive form of Congressional pork and budget busting. This legislation authorizes approximately $216 billion in federal highway and transit assistance over a six-year period. This bill is too large and too complex to agree to when the whole process went awry. When Congress agrees to ``Save Social Security First'' but votes to spend a bloated highway bill--filled with various pork barrel projects--then Congress is deceiving the American people. The proposed funding in the BESTEA bill will deny states block grant funds for social services. Three billion dollars has been taken from programs that would have otherwise gone to services for children without health insurance, the disabled and the impoverished. The BESTEA legislation unjustly denies $15.5 billion in benefits to veterans for disabilities relating to tobacco use in the miltiary--a service-connected disability--to fund highway construction projects. I will not tell veterans that we would take away an earned benefit--that we would deny them of a healthy and productive lifestyle--to pay for potholes. Like every member of Congress, I realize the importance of safe roads and bridges and its impact on public health and safety. But unlike most members, I will not sacrifice children and welfare recipients to pave America's streets. I will not vote for H.R. 2400.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to introduce ``The Medicare Critical Need GME Protection Act of 1998.'' This important legislation seeks to protect our nation against the depletion of health care professionals that are trained to appropriately treat costly and deadly illnesses. Under current law, the Medicare program provides reimbursement to hospitals for the direct costs of graduate medical education training. That reimbursement is designed to cover the direct training costs of residents in their initial residency training period. However, if a resident decides to proceed with further training in a specialty or subspecialty, a hospital's reimbursement is cut to half (50%) for that additional training. The rationale for this policy is strong. In general, we have an oversupply of specialty physicians in our country and a real need to increase the number of primary care providers. By reducing the reimbursement for specialty training, the Medicare program has promoted increases in primary care training rather than specialty positions. I agree with this policy. However, as is often the case, there are always exceptions to the rule. We do not want to hinder training of particular specialties or subspecialties if there is strong evidence that there is a serious shortage of those particular physicians. That is why I am introducing The Medicare Critical Need GME Protection Act. To provide an example of a current subspecialty facing serious shortages of professionals, we can look at nephrology. Between 1986- 1995, the number of patients with End Stage Renal Disease (ESRD) has more than doubled. At present, more than 40 million Americans die from kidney failure or its complications each year. In 1998, the estimated cost to treat ESRD will exceed $12 billion. However, current data indicates that only 51.8% of today's nephrologists will still be in practice in the year 2010. Most primary care physicians are not trained to treat the complex multi-symptom medical problems typically seen in ESRD and are unfamiliar with particular medications and technology prescribed for such patients. The decreasing supply of nephrologists, coupled with an expanding population of renal patients, puts the health of our nation at risk. The Medicare Critical Need GME Protection Act provides a tool to help combat such shortages of qualified professionals. The bill would simply provide the Secretary of Health and Human Services with the flexibility to continue full-funding for a specialty or subspecialty training program if there is evidence that the program has a current shortage, or faces an imminent shortage, of physicians to meet the needs of our health care system. The Secretary would grant this exception only for a limited number of years. The Secretary would have complete control of the exception process. Programs would present evidence of the shortage and she could agree or disagree with the analysis. Nothing in this bill would require the Secretary to take any action whatsoever. The bill also includes protections for budget neutrality. If the Secretary approves a specialty or subspecialty training program for full-funding under this bill, the Secretary must adjust direct GME payments to ensure that no additional funds are spent. Again, The Medicare Critical Need GME Protection Act does nothing more than provide limited flexibility to the Secretary of Health and Human Services to ensure that we are training the health care professionals that meet our nation's needs. I would encourage my colleagues to join me in support of this important legislation. By giving the Secretary the flexibility to allocate funds to attract and train professionals in certain ``at risk'' fields of medicine, we will significantly improve patient care and lower long term health care costs.

Mr. STARK

Mr. STARK. Mr. Chairman, will the gentleman yield?

Mr. STARK. Mr. Chairman, I am inclined to support the Watts-Moran- Thornberry amendment. I am a cosponsor of the legislation of the gentleman from Virginia (Mr. Moran), which does roughly the same thing. The amendment is revenue neutral. It does have an accounting problem as currently drafted. As drafted, the amendment would increase Medicare utilization undoubtedly as the retirees find it less expensive to seek medical care there. As we all know, we have a long-term financing problem in the Medicare Trust Fund, and if we increase Medicare spending, it is essential that we keep the trust fund neutral. This amendment needs an accounting fix to make sure that that money that the DOD raises gets into the Medicare Trust Fund and not into general revenues. It is my understanding that staff has not yet had time to work out the details of the language, and I am wondering if the gentleman from Texas (Mr. Thornberry) could give us a commitment to address this problem in conference?

Mr. STARK. Mr. Chairman, if the gentleman will yield further, I thank the authors of the amendment. I think you have a winner. I would suggest that if anybody is concerned, that you do not extend it at the end of three years. In the balanced budget amendment we made it the law that people had to be able to get the Medigap policy back. So if in the third year we decide the experiment will not work, we can write that into law and see that no one is disadvantaged by losing the Medigap policy.

Mr. STARK

Mr. STARK. Mr. Chairman, the Lowey-Harman amendment will restore the ability of our female service members and female dependents stationed overseas to exercise their constitutional right to choose safe abortion services, using their own funds to obtain services in military hospitals. This is an important access-to-health-care amendment. Military women depend on their base hospitals for all of their medical services. This amendment gives them access to the same range and quality of health care that they could obtain in the United States. This amendment has the strong support of organizations like the American Nurses Association, the American Public Health Association, the American Women's Association, the American College of Obstetricians and Gynecologists, and the Planned Parenthood Federation of America. This amendment also has the support of the Department of Defense. No surprise here, as the policy of denying women access to safe health care serves no military purpose. Still, anti-choice Members of Congress would endanger the lives of women in foreign countries where local health care facilities are inadequate--where quality care is not available. They would force women into the hands of untrained medical professionals, or into unsterilized facilities--increasing the danger and the risk to the health of these women. Make no mistake about it--their objective is the same as always: to make abortion services difficult to obtain, prohibitively expensive, and physically risky for physicians and women alike. True to form, the conservative majority have extended their reach to discriminate against women who have volunteered to serve their country by prohibiting them from exercising their legally protected right to choose. Women serving this country have lost a legal right. Vote for the Lowey-Harman amendment to end this blatant disregard for the health, safety and constitutional rights of women.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to congratulate Mission San Jose High School for winning the Blue Ribbon award from the Department of Education. Mission San Jose was one of six California schools to win this prestigious award and one of 166 schools nationwide. Mission San Jose proves that public schools can be effective advocates for all students to succeed in the 21st Century. Mission San Jose believes that all students can learn and all students will learn. The facts prove them correct. Mission San Jose High School has an attendance rate of over 95 percent and a dropout rate of .05 percent. The student average SAT scores are in the top 5 percent of the nation. 65 percent of the student body is on the honor roll and the most importantly to me is that 95 percent of students go on to post-secondary institutions. These numbers speak for themselves and for the faculty and administrators at Mission San Jose High. I congratulate Principal Mathog for her outstanding leadership and positive views. This success by one of our public schools is the best argument against some of the arguments of my colleagues. Eliminating the Department of Education and advocating public funds to be spent on scholarship vouchers for private schools is not the right step to providing opportunity and hope for all students. Public schools work and I can prove it. Mission San Jose deserves this award and I congratulate them.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to recognize The Washington Township Health Care District which has provided 50 years of service to the community of Fremont, California. Half century ago, a group of civic minded citizens created the Washington Township Health District in the belief that healthcare is just as much a matter of public duty and public financing as is public education. The District opened Washington Hospital, a 150 bed facility, within 10 years. Washington Hospital has been providing superior health care services for the past 40 years; the Hospital has grown right along side the community and has consistently been able to meet the needs of our community. The founding members of the Board had the foresight to envision that returning profits to the Township, in the form of services and programs, would benefit the community more than profits being distributed to shareholders outside the District. In addition, the creation of a publicly elected Board of Directors provided ongoing community access to the governance of the District. Mr. Speaker, please join me in recognizing Washington Township Health Care District for the service it provides to meet healthcare needs in our community.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to recognize the achievements of the Upward Bound Program at California State University, Hayward (CSUH), in the 13th Congressional District of California. On Saturday, May 16, 1998, twenty high school seniors will be honored for graduating from the program at the Eighth Annual Awards Recognition Banquet. In 1965, the Upward Bound Program was established at universities and colleges throughout the country. Upward Bound prepares low-income students who will be the first in their families to obtain a degree from a four year college or university. The program provides tutoring, instruction, counseling, career orientation, and an opportunity to experience educational development and personal growth within a college setting while students are still in high school. In 1990, the Program at CSUH became one of the over 550 Upward Bound Programs nationwide. At present there are 72 participants from Southern Alameda County in the Program. In order to be eligible for the Program a student must have the potential to succeed at the college level, even though his or her test scores and grades may not reflect it. The student must also come from a low income background as established by the U.S. Department of Education, or from a family whose parents or guardians have not graduated from a four year college. The Program at CSUH consists of an academic year component and a summer session component. During the academic year students attend Saturday instructional sessions at CSUH, tutorial sessions during the week, and field trips to educational, cultural, and recreational sites. The Program provides assistance in preparing applications for college admission and financial aid, and makes a coordinated effort to maximize students' educational development by maintaining close communication with the students' teachers, counselors, and parents. During the summer students spend an intensive 4 to 6 weeks living and studying on the CSUH campus. The students take high school level development and enrichment courses, and receive career, academic, and personal counseling. They also have access to all facilities, and sports, cultural, and recreational events, with the goal of giving them an opportunity to see what life will be like as a college student. This year there will be twenty seniors graduating from the program, and I would like to congratulate them by name. They are: Sonia Abrego, Noemi Arrieta, Michael Barrett, Gabriela Bressler, Ricshell Bunton Jr., Damali Burton, Oliver Chang, Eujenia Garcia, Ana Gutierrez, Darryl Hampton, Anthony James, Joshue Jones, Peng Lim, Bogdana Marchis, Feliza Montes de Oca, Reyna Nava, Phuong Nguyen, Vanessa Perez, Marion Thurmond, and Andrea Williams. Mr. Speaker, I ask that you and all my colleagues join me in congratulating these students on their achievements. CSUH's Upward Bound Program continues to be an effective vehicle for educational equity and opportunity through its efforts to help students progress along the path of academic success.

Mr. STARK

Mr. STARK. Mr. Speaker, members constantly decry the problem of fraud, waste, and abuse in Medicare--and constantly underfund the agency that is responsible for administering Medicare. It is Congressional hypocrisy at its height. No one should criticize the administration of Medicare who does not support more resources for the beleaguered Health Care Financing Administration. Following is an excellent article by Julie Rovner of the National Journal's Congress Daily, entitled Congress v. HCFA: Bureaucracy Bashing 101. I would just add to Ms. Rovner's article that when HCFA sought $16 million this spring it paid for it by offering to slash $16 million from another Medicare-related account--but even that was denied by the micro-managing Congress. Medicare beneficiaries should know who to blame when they are unable to get their questions answered from HCFA: it is the Congress that should be blamed. [From the National Journal's Congress Daily, Apr. 23, 1998] Congress v. HCFA: Bureaucracy Bashing 101 (By Julie Rovner) Frustrated politicians like to point out how hard it can be to please constituents who simultaneously demand contradictory things--like those voters who all at once want increased spending, tax cuts, and no new additions to the deficit. But sometimes, the politicians themselves behave just as inconsistently. Take the Health Care Financing Administration, known--and almost universally derided--as HCFA (pronounced Hickfa). The HHS subunit that oversees Medicare, Medicaid, and, since last year, the new children's health insurance program, HCFA is the agency politicians most love to hate. In 1992, when he was running for president, candidate Clinton in his ``Putting People First'' manifesto vowed to ``scrap [HCFA] and replace it with a health standards board made up of consumers, providers, business, labor and government.'' In short, anybody except bureaucrats. During the heated Medicare debate of 1995, Speaker Gingrich claimed he never meant to suggest Medicare would ``wither on the vine'' under the GOP's budget plan, merely HCFA. But Congress' second favorite pastime, after beating up on HCFA, seems to be giving the agency even more work to do. Since 1996, three different bills have increased HCFA's responsibilities exponentially. ``It's the greatest workload in the history of the agency,'' said Harvard Professor Joseph Newhouse, vice chairman of the Medicare Payment Advisory Commission. And it is not like HCFA was a sleepy bureaucratic backwater: Running Medicare and Medicaid already required it to supervise the healthcare programs that will serve nearly 75 million Americans in 1998 and cost the federal government $300 billion in 1997, 18 percent of the entire federal budget. HCFA's latest onslaught began in 1996, with passage of the Health Insurance Portability and Accountability Act. Not only did HIPAA give the agency broad new responsibility to root out fraud and abuse in Medicare (the accountability part), it also made HCFA the fallback enforcement agency for states that failed to pass their own laws to implement the portability part. As of now, that includes five states: Rhode Island, Massachusetts, Missouri, Michigan, and California. Later that fall, Congress ordered HCFA to implement provisions tacked onto the VA-HUD appropriations bill barring ``drive through'' baby deliveries and requiring limited parity for mental health coverage. But that was only an appetizer. Last year's Balanced Budget Act, according to HCFA Administrator Nancy-Ann Min DeParle, gave the agency about 300 new tasks. In Medicare alone, the agency is expected to devise new payment systems for home health, hospital outpatient, and nursing home care; a new ``risk adjuster'' and new payment methodologies for managed care plans; and rules for new ``provider-sponsored organizations.'' And that is not to mention devising how to inform Medicare's 39 million beneficiaries about a vast array of new ``choices'' available to them this fall. At the same time, HCFA is responsible for approving each state's new children's health insurance program, and for helping states locate and enroll the millions of children eligible but not yet signed up for Medicaid. With that much more to do, you might think Congress would also give HCFA more money to do it with. But it is so easy to bash the bureaucracy that the Senate could not resist striking HCFA's request for an additional $16 million for FY98 during consideration of the supplemental appropriations bill last month. HCFA officials said $6 million of that request was to hire workers to enforce HIPAA in states that have yet to pass their own legislation. The states in question contain a total of 54 million citizens. ``The work requires knowledge and expertise in the area of health insurance regulation at the state level,'' said the agency in its supplemental request. ``The nature of this work is totally unlike that performed by HCFA's workforce.'' But that plea fell on deaf ears. ``Do we want to turn that much additional bureaucracy over to HCFA, that much more money, or can't they borrow some more of those employees that they now have who are probably reading through reports that are obsolete and maybe not doing so much good?'' asked Senate Majority Whip Nickles on the floor March 25. Evidently they can, according to the Senate. Members adopted Nickles' amendment to strip the funding from the bill after defeating, 51-49, an attempt by Senate Labor and Human Resources ranking member Edward Kennedy, D-Mass., to keep only half the money. The result of all this, says former CBO Director Reischauer, is ``setting HCFA up'' for failure. ``It's classic Congress,'' he said. ``There's no way HCFA can accomplish the changes Congress has asked [it] to do. Then [Congress] will be back in two years having oversight hearings about how HCFA failed to do its job.'' Mark your calendars now.

Mr. STARK

Mr. STARK. Mr. Speaker, there is a move afoot to re-open Medicare and other federal health care programs to gross waste, fraud and abuse. The legislative Trojan Horse in question is the ``Health Care Claims Guidance Act,'' (H.R. 3523) which would erect huge new barriers to federal prosecution of cases that target claims submitted with reckless disregard, deliberate ignorance or actual knowledge that the claim is false. I strongly urge my colleagues not to support--or to withdraw their support--for this pernicious legislation. The False Claims Act is the primary mechanism used by the Department of Justice to recover money paid out for services that Medicare doesn't cover, or that have no medical record to back them up. It's a civil, not a criminal statute, and has been used since Abraham Lincoln's administration to punish contractors who defraud the government. In the 1980's, the False Claims Act was used against defense contractors who overbilled the government by millions of dollars for items like those infamous toilet seats. Last year, the Department of Justice used the law to recover about $100 million in health care actions. Measured against the roughly $100 billion that Medicare pays out every year in hospital claims, that's a relatively modest amount. But that figure may rise in the future, because the False Claims Act is now being used more effectively to crack down on providers who deliberately overcharge Medicare through upcoding, unbundling, and other rip-off schemes. An alarming book by Harvard economist Malcolm Sparrow, ``License to Steal,'' documents how unscrupulous providers can devise billing strategies that pass muster under Medicare's claims processing system. It is precisely these kind of over-aggressive, sophisticated billing practices that the federal government is trying to stop using the False Claims Act. That's why the effort by the American Hospital Association to create a ``free fraud zone'' for providers who wished to overbill Medicare by as much as $11.4 billion every year is so offensive. The kind of cases that are brought under the False Claims Act are NOT innocent billing mistakes. I like to call H.R. 3523 the Columbia/HCA Protection Act, since even AHA admits that if the bill were enacted, it could be used to get the poster child for health care fraud off the hook! In addition to dismissing pending cases, the bill includes a ``material amount'' provision that Justice Department officials say would effectively shut down most False Claims Act cases. Simply put, the bill's proposed threshold of 10% would prohibit the government from bringing suit at all--unless the disputed amount exceeded 10% of the hospital's billing to Medicare or Medicaid for the entire year. So in effect, a large provider like Columbia could submit hundreds of millions of dollars in false claims every year--no questions asked. That's a form of immunity that the tobacco industry might well envy. We must not go down that route. We must not enact legislation like the Health Care Claims Guidance Act that raises the government's burden of proof and makes hospital compliance plans into escape hatches for providers who fraudulently bill. I strongly believe, and I know the Administration does too, that providers who deliberately scam the system must be punished. On the American Hospital Association's web page is an announcement that AHA is ``working with state metropolitan associations to identify a hospital that would be willing to be a plaintiff in a court case against the Justice Department.'' Let 'em sue. Any decent court will throw out a case that attempts to roll back the legal and proper use of the False Claims Act in recovering taxpayer's money that was inappropriately paid to hospitals for services that have no medical record to back them up. Congress should also throw out H.R. 3523, which Senator Grassley has called a ``misguided missile in the war against fraud.'' I'd like to make a point about how the False Claims Act is being used to stop patient abuse. In 1996, the law was successfully used to bring suit against three Philadelphia-area nursing homes that were found to be denying wound care and nutrition to three residents. In plain English, the nursing homes were starving the residents and ignoring their very serious skin ulcers, while continuing to submit false claims to Medicare and Medicaid. The amount of claims money involved was not large. But the statute was effectively used to stop the horrendous abuse of helpless, frail people, and to severely punish the nursing home. Experts say that the Philadelphia nursing home settlements are helping to establish a clear precedent for use of the False Claims Act in poor quality of care cases. But if H.R. 3523 is enacted, the law's present deterrent value against patient abuse would be nullified. The sheer toll that fraud and overpayment exacts on federal health programs each year makes it imperative that the federal government use every means available to fight back. The False Claims Act is a critical part of our current legislative arsenal, since it harnesses the energies of whistleblowers who are in a position to observe bad billing practices that the best computers can never detect. After all, if a claim looks okay, Medicare requires intermediaries and carriers to pay it within 14 days. It is perhaps not surprising that just as the federal government steps up its anti-fraud efforts, doctors and hospitals are beginning to complain loudly that they are somehow being ``unfairly targeted.'' This response from providers may even signal a certain level of fear that the federal government's no-questions-asked payment policy is changing. As it must: The latest report from the HHS Inspector General shows hospitals were paid $6 billion too much last year. Physicians were also paid $6 billion too much, and overpayments to home health agencies reached $2.5 billion. Fraud costs Medicare billions every year that it can ill afford to lose, and it must be stopped. A back-of-the-envelope calculation shows that if fraud ceased today, the five-year savings would amount to more than $100 billion. That's enough to extend the life of the hospital insurance trust fund by an additional seven years, and is nearly equal to what the Balanced Budget Act saved last year! The government's war against Medicare fraud has only begun, and the IG's audit makes it clear that no one who supports a ``zero tolerance for fraud'' policy can support H.R. 3523. I've probably introduced more legislation in this area than any other member of Congress--13 bills in the 105th Congress alone. A bill that I will shortly propose would give back to HCFA an authority it used to have--the ability to adjust base payments to Medicare HMOs every year, based on the previous year's documented overpayment or underpayment. Right now, the Congressional Budget Office says Medicare will overpay HMOs by $31 billion over the next 10 years! HCFA has always had the flexibility to adjust payments for Medicare managed care plans--until the Balanced Budget Act took it away last year. That's a legislative mistake that must be fixed soon, or taxpayers will be outraged.

Mr. STARK

Mr. STARK. Mr. Speaker, I am opposed to the Republican District of Columbia School Vouchers Act. It was brought to the floor on false logic and ignores the real problems in public education. Let's take the Republican argument at face value for a minute. If public schools in the District of Columbia are unable to educate our children, as my colleagues claim, is the solution to remove 2,000 of them and place them in private schools? What do we do for the 76,000 students left behind? In fact, these 75,000 will have to do with less funds available to help their education. It will cost $7 million to educate these 2,000 students in private schools--but this bill does not allow for additional funds to help the remaining children. How else could this $7 million be spent? The money could pay for after-school programs in each and every D.C. public school, 368 new boilers, could rewire 65 schools, upgrade plumbing in 102 schools, or buy 460,000 new textbooks. The people who live in the District of Columbia do not want this bill. The people of the District of Columbia did get the chance to vote on vouchers when the issue was placed on the ballot. It was defeated by a margin of eight to one. The residents of our host city do not deserve to be experiments for right-wing think tanks that promote ideas favored by the Christian Coalition and the religious right. If my colleagues on the other side are truly interested in helping students enrolled in public schools, I offer some suggestions for them. Why don't we increase the funds available for teacher salaries? How about holding teachers to educational standards of their own to make sure that those who teach our children are actually qualified to do so? What about providing a textbook in every core subject for every school child in America? What about adopting the President's plan to improve our educational infrastructure? We need to make sure that school classrooms are not falling apart and students have the resources they need, whether they be textbooks or access to the Internet, to be able to succeed in today's world. My Republican friends could make a strong stand for education by adopting these policies. Instead they shower us with rhetoric about helping children, when this is really an attack on public education across the country. The schoolchildren of the District of Columbia deserve our help and need our assistance. This is the wrong move, the wrong idea, and the wrong time and place. I urge my colleagues to take a real and meaningful stand for children and education.

Mr. STARK

Mr. STARK. Mr. Speaker, the other side of the aisle today will present this bill for debate to assure the public that this Congress is working in the spirit of our limited floor schedule on long-term policies such as saving Social Security for our children. I rather suspect that the children they talk about preserving Social Security for are being used as a shield in this debate because of a frontal assault that Republicans have been using on so many will not work. It is a good idea to have a dialogue. I think we should start opening the dialogue with the majority leader's remarks, and I quote the majority leader's remarks, in saying that Social Security ``should be phased out. Eventually we will be able to phase the government programs out and phase private programs in.'' The Speaker's think tank, the Progressive and Freedom Foundation, that preserves I do not know what for all Americans, says, ``There is an even more important moral question raised by the government's role as chief provider in old age. It sends an un-American message that it is not your responsibility to take care of yourself.'' Basically, the Speaker is suggesting that Social Security is un-American. That is a good place to start this dialogue. It is time for the public, quotes the Speaker's think tank, to take back from government responsibility for their futures, including their retirements. What will we do about the hard-working Americans who happen to become disabled or those who die early leaving their children with no means of support? And what about the 30 percent of Social Security beneficiaries who are elderly women whose wages never were at a livable level and never enabled them to save for their retirement years? Let us enter into a dialogue with that and see what my Republican colleagues would do. It is a long-range problem. It could be solved with a 1 percent increase in taxes for all time. I applaud efforts to work on long-term solutions that would really apply and benefit our children, but I am cynical that this Republican leadership will do the right thing on Social Security, even for kids. Look at their track record. They have repeatedly failed to face the tough issues that threaten our children because of their refusal to ruffle the feathers of the rich political constituencies that they serve. Where is the Republican leadership on providing managed care safeguards that our children will get the health care from HMOs that their parents have paid for, except denial for reasonable claims? Where is the Republican leadership when they have realized that 230 Members of this House support the managed care reform bill, but the leadership fails to bring it to this body? Are they going to appoint a commission for that? What about global warming? That is a long-range problem. We have not heard a peep out of the Republicans on that. Protecting our world environment is as crucial an effort for our children as saving Social Security. There may not be an environment for these children to live in. What about rules to assure that Congress is no longer tainted by illegal campaign contributions? The Republicans have amongst them a criminal, a convicted criminal who has been sentenced to serve in this House in the Republican Party. Now, that is creative judicial sentencing. It may be the worst sentence that anybody has ever been dealt in the history of the Federal judiciary. But what are the Republicans doing to clean up the criminals in their own ranks and lead us to an improved campaign finance reform? Nothing. Is that not a long-range problem that we ought to be concerned about? The leadership says they want to preserve all kinds of things for the future, but they ignore them. Is this just one more issue of benign neglect? Are they for cutting funds, as we sit here, for housing the poor? Yes, they are in a proposed supplemental. Are they refusing food stamps for legal immigrants? Yes, they are. Are they refusing to provide the funds necessary to enforce the Kennedy-Kassebaum health insurance bill? They are indeed. If there was ever an industry that needs oversight, it is the insurance industry. And what are they doing to look at Prudential's $3 billion of restitution to its customers for fraudulent sales practices? Is it that same Prudential that they want to take over and manage Social Security under privatization? I certainly hope not. I surmise the leadership is up to more of the same pattern. Their attempts to preserve Social Security are merely an attempt to dissuade the public from our facing the tough issues of the future. Has the responsibility and self-reliance mantra erased any trace of human kindness and of responsibility for the less fortunate in our society? I think that the opening dialogue of the Republicans says that that is their position. I challenge the Republicans to face up to all the issues that affect our children, including Social Security, and let us work to resolve them. Let us see this Congress produce some legislation that does some good for the Americans instead of deflecting the real true issues by referring them to a commission. My colleagues on the other side of the aisle present this bill today for debate to assure the public that this Congress is working--in spite of our limited floor schedule this year--on long-term problems such as saving Social Security for our children. Are the children being used as a shield in this debate because a frontal assault on Social Security won't work? As you all remember, the Speaker's comments on Medicare didn't go over very well. Who could forget the Speaker's comments that Medicare should wither on the vine? And the Majority Leader's remarks that Medicare was ``a program he would have no part of in a free world.'' Let's just hope that Americans do become involved in the Social Security debate because, left to this leadership, there would be no Social Security program left. The Majority Leader's position on Social Security is clear. He's been consistent since his first campaign for the House in 1984 in the position that Social Security ``should be phased out . . . eventually we would be able to phase the government programs out and phase the private programs in.'' The Speaker's think tank, the Progressive and Freedom Foundation, also promotes some unequivocal views on Social Security. According to a February, 1995 newsletter, the Speaker's foundation is advocating for the complete and immediate elimination of Social Security on moral grounds that it is un-American: There is an even more important moral question raised by the government's role as chief provider in old-age. It sends the unAmerican message that is not your responsibility to take care of yourself. It is time for the public to take back from government responsibility for their futures, including their retirements. And public policy should encourage the historic American virtues of hard work and frugality. Now, not in several decades, is the time to make this change. What of those hard-working Americans who happen to become disabled, or those who die early leaving their children with no means of support? What about the elderly women whose wages never were at a livable rate to enable them to save for their retirement years? What would become of them under the leadership's plan to privatize Social Security? The leadership would have the public believe that Social Security is in perilous condition and in need of being totally redesigned. We know better. Social Security will be solvent through the year 2032. A payroll tax increase of 1% could alleviate the demographic strain that we predict for that time. But rather than talk about this or any other option to strengthen the program, we debate today another commission to do the work of this Congress. And the leadership claims it promotes this bill for the children. I applaud all efforts to work on long-term solutions that would really benefit our children. But I am cynical that this leadership will do the right thing on Social Security, even for the kids. Just look at their track record. They have repeatedly failed to face the tough issues that threaten our children because of their refusal to ruffle the feathers of their political constituencies to get the job done. For example, where has this leadership done to provide healthcare for all children. What better example of a current need with long-term implications for both individuals and our economy than finding a way to cover the 45 million Americans--many millions of them children--who have no insurance and are not receiving the care they need. Millions of kids have no preventive healthcare or treatment of small problems, like ear infections, before they grow to major problems, like hearing loss. Is this House leadership willing to face their NFIB supporters and the insurance industry on that one--for the kids? Where is this leadership on providing managed care safeguards so that our children will get the healthcare from HMOs that their parents have paid for instead of denial after denial for reasonable claims made? The leadership is aware that 230 Members of this House support the lead managed care reform bill but the leadership fails to bring the measure up for a vote because of objections from business and the insurance lobbyists. Kids matter, but not as much as campaign contributions. How about global warming? Protecting our world environment is a critical concern for today's children and their children but is this House leadership willing to buck their major corporate supporters to do the right thing on the environment? Experience tells us they won't--not even for our children. What about this leadership taking action on rules to assure this Congress is not totally tainted by money? Isn't preserving a clean U.S. Congress key to assuring a ``government of the people by the people for the people'' for our children? Yet this House leadership has made a mockery of House consideration of campaign finance reform and has not even censured their colleague who plead guilty to criminal campaign violations. His sentence requires that he stay in Washington so that he can vote instead of serving time in a federal penitentiary. What message does this send to our kids about public service in Washington, DC? The leadership says they want to take this bill up today to preserve Social Security for our kids but they ignore our children's need for quality education. This leadership's action is not just benign neglect--they are promoting policies right now that will hurt our children in our emergency supplemental: cutting funds to provide housing for poor families; refusing to provide food stamp benefits to legal immigrants families; refusing to provide the funds needed to enforce Kennedy-Kassebaum health insurance bill which passed this House by vote of 421 to 2. If ever there is an industry that needs oversight, it is the insurance industry. Prudential's $3 billion restitution to its customers for fraudulent sales practices is proof of that! This leadership won't even provide the funds to pay our UN debt to work for world peace for all children. In light of this pattern, I surmise that what the leadership is up to is more of the same pattern. Their attempts to ``preserve'' Social Security by establishing individual accounts are nothing more than a gift of hundreds of billions of dollars in business to Wall Street. That even tops the $50 billion tax break for the tobacco companies that the leadership attempted last year. Just as the public wouldn't let them get away with the tobacco tax break, I'm counting on the public to see through their rhetoric this time because the facts on Social Security are clear: it's been a resounding success. Although privatization of Social Security is the topic de jour in America, we have an example of an safety net that has worked--and worked well--for over 60 years. We should focus on maintaining it's solvency past 2032, not dismantling the program. Social Security replaces about 40 percent of pre-retirement wages for average earner, 57 percent for low-earner and 27 percent for a high- earner. By design, it cushions those who have fewer resources to save. In 1996, Social Security lifted 11.7 million elderly people out of poverty. Two-thirds of elderly receive most of their income from Social Security. Without Social Security, one-half of older Americans would live in poverty. In addition to the elderly, 3.5 million non-elderly adults and 800,000 children were lifted out of poverty by Social Security in 1996. Its mandatory nature assures that all workers start their retirement nest egg with their first paycheck and increase their savings amounts automatically as their wages increase. Its social insurance component shields families from a wage earner's untimely death or disability, and subsidizes the lowest paid wage earners with the earnings of others. Social Security works because it is more than a savings account for individuals--it is a commitment that our society make to its members that there will be a safety net for workers and their families in the event of their disability or death during wage earnings years. Individual accounts take care of those who are sophisticated enough to invest their funds well; they leave the low wage folks, the unsophisticated, the disabled, the widows with young children out in the cold. Is that what America is about? Has the ``responsibility and self-reliance'' mantra erased any trace of collective responsibility for the less fortunate in our society? I think not. I challenge the leadership to face up to all the issues that effect our children, including Social Security, and to work to resolve these issues.

Mr. STARK. Mr. Speaker, most Americans living today were born well after the Great Depression. They are not marked by the fear of economic loss because--as a society--they have not experienced it. It may well be that those who have not lived through the Depression do not appreciate the need for a social safety net. Today's adults almost assume that a good economy will last forever. In such a climate, more people may be less appreciative of safety nets, like Social Security, and more convinced that self-reliance will suffice. But economic self-reliance is only workable for those who are reasonably well off and who understand the value of savings. Nobel prize winning economist Modigliani, my economics professor at Massachusetts Institute of Technology, taught me this lesson: people save only when they have money to save and perceive the need to save. With our national savings rate at an all time low of 3.8% of disposable income. I cannot help but conclude that Americans today do not perceive the need to save for the future. Self-reliance also assumes a certain level of sophistication to ensure that invested savings will grow. That requires knowledge about how to balance investment opportunities and risks. Americans have a ways to go in this regard as well. Social Security was never intended to meet all the requirement needs of Americans. The three-legged stool of secure retirement also requires worker pensions and private savings. We have a voluntary, employment-based pension system. Sadly, only about half of all Americans have an employer-based pension; small businesses tend not to cover workers at all. The erosion of pension security in the United States has been dramatic. Thirty years ago, most large employers structured pensions to look like our Social Security system with an employer and employee contribution and a guaranteed benefit payment related to the workers wages. More and more today, Americans have voluntary savings plans with a percentage of salary saved with each paycheck. These savings plans allow us to see how much workers are saving in voluntary, tax- subsidized plans, how sophisticated they are about their retirement investments, and whether workers actually use their retirement savings for other purposes. Early results are troubling. Workers often withdraw their persion funds when they leave a job and do not redeposit their pension into another savings plan. And some withdraw their pension funds even though they do not change their place of work. 1996 data on pension withdrawals show 60% of the distributions (in terms of the number of withdrawals, not dollars) from pension plans were not redeposited into another retirement savings plan. 79% of all the dollars distributed from pensions were redeposited in a pension savings plan. Overall, affluent people with large pensions tended to redeposit their pension funds; lower-income people with smaller pensions often withdrew pension funds for consumption. Put another way, 95% of the distributions over $100,000 were redeposited into a new pension savings plan. Only 20% of the distributions under $2,500 were redeposited into a new pension savings plan. In addition to size of the pension, age and sex are factors in whether pensions will be reserved for retirement needs: young workers and women tend to withdraw all their pension funds more often than other workers. A recent General Accounting Office (GAO) report studies the implications for women in particular, should the United States move toward a privatized retirement system. The report points out that women's Social Security benefits are lower than men's benefits, due to their lower earning levels. Proponents of privatization argue that individuals might take on more risk in the management of individual accounts to achieve a higher rate of return. But privatization could exacerbate the gender differences now found in retirement income for men and women. Men's pensions funds, on average, are twice the size of women's pension funds. Women make more conservative investments than men when they direct their retirement savings investments themselves, according to GAO and other economic studies. The GAO found that women ages 51 to 61 had a lower percentage of their total assets in stocks, mutual funds, and investment trusts than men did. These assets are riskier, but have higher yields than others, such as certificates of deposits, savings accounts, or government bonds. With very conservative investments, the investment return may not be adequate to see many women through their retirement years. Before we enter down the path of privatization, we should be mindful the current savings rates and practices of Americans. We should not assume that voluntary private savings will ever replace the benefits of Social Security.

Mr. STARK

Mr. STARK. Mr. Speaker, today's Washington Post article about Arkansas Governor Huckabee's flight from a group of welfare protesters confirms my greatest fear about the 1996 welfare law--welfare reform was about cutting caseloads, not about helping ex-welfare recipients become self-sufficient. In the first 13 months after welfare reform was signed into law in August 1996, welfare caseloads dropped 19 percent nationwide. Almost 2.4 million fewer people received welfare assistance in September 1997 than in August 1996. The rate of welfare recipiency in the United States has reached its lowest level since 1969. What's happening to these families and children? Olivia Golden, the Health and Human Services Assistant Secretary responsible for implementing the welfare reform law, told the Ways and Means Committee last month that ``one of the challenges we face is to get better information about what is happening to families who are leaving assistance.'' The protest's in Little Rock complained that they haven't been able to find jobs. Ms. Golden confirmed that, when she reported that research from several states suggests that 50 to 60 percent of families leaving welfare are employed at follow-up. That means 40 to 50 percent were not employed. The Manpower Demonstration Research Corporation recently released an interim report on its multi-year evaluation of Florida's Family Transition Program, one of the first programs to include a time limit on the receipt of cash assistance. Although claiming that longer-term follow-up is needed to track how people fare in the aftermath of reaching the time limits, MDRC found that only 52 percent of the FTP group were employed two years after entering the study despite an unusually generous array of support services and financial incentives. Nonetheless, almost everyone who reached the time limit had their benefits entirely canceled. In the almost two years since passage of the Republican welfare reform law, a period of sustained economic growth and low unemployment, we have learned two things about the effects of the law--nearly one million families are no longer receiving welfare assistance and only about one-half of the families who have left welfare are working. Unfortunately, my dire predictions about the impact of welfare reform are being borne out--imposing time limits and ending assistance to needy families leaves them out in the cold whether or not jobs are available. The article is as follows: Huckabee Flees Forum After Welfare Protest Little Rock, April 28.--Angry demonstrators pounded their fists on Gov. Mike Huckabee's vehicle today after he fled a conference that they crashed. About 250 protesters, complaining that ex-welfare recipients haven't been able to find jobs, stormed the hall where Huckabee was scheduled to talk, but the governor left the Southwest Regional Civil Rights Conference rather than speak with them. ``I'm disappointed for the people that came from other places and I would have loved to have been part of the conference, but that's life,'' Huckabee said. The protesters charge that former welfare recipients haven't been able to find jobs since being dropped from the rolls. The number of welfare recipients in Arkansas has fallen from more than 21,000 last June to fewer than 14,000 last month. The protest was organized by the Association of Community Organizations for Reform Now. Huckabee left the hotel as protesters called on him to speak on the welfare issue. Huckabee's office called the protest an insult to the civil rights workers at the conference. About 900 people from Arkansas, Louisiana, New Mexico, Oklahoma and Texas attended.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to recognize the Mission San Jose Rotary Club for its extensive contributions to the quality of life in the Fremont community. Over the last fifteen years, Mission San Jose Rotary has been actively involved in the community through more than 45 projects benefiting the Mission San Jose, Serra Center, Ardenwood Park, Fremont Senior Center, Mission San Jose Museum, and many other worthy recipients. In addition, in 1986 Mission San Jose Rotary became one of the first clubs to champion the admission of women members, well before Rotary International recognized full participation by females. The club has sponsored two new Rotary clubs, sponsored four foreign exchange students, and counts more than 60% Paul Harris Fellows among its members. Mission San Jose Rotary has also contributed substantially to the Polio Plus Campaign and the Mission San Jose restoration. I also commend Mission San Jose Rotary for having prepared and served many thousands of meals at the Centerville Free Dining Room, and for their internationally acclaimed chili and famous linguica burgers, which have raised nearly $300,000 for charity. Throughout its existence, Mission San Jose Rotary has been acclaimed many times for its excellent service. On May 1, 1998, the Mission San Jose Rotary Club will celebrate the 15th Anniversary of its founding, and I would like to express my sincere appreciation for the dedicated efforts that have produced so many civic achievements. Congratulations, and I look forward to another fifteen years of exceptional service.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to join today with my California colleagues, Representatives Henry Waxman, George Miller, Robert Matsui, Anna Eshoo and Tom Lantos; and with Representative Sherrod Brown, the ranking Democrat on the Commerce Health and Environment Subcommittee, to introduce the State Children's Health Insurance Program Integrity Act of 1998. This legislation is simply a technical correction to the Children's Health Insurance Program (CHIP) legislation passed by Congress last year--but it is an important technical correction. The bill would protect the integrity of state CHIP programs by eliminating the potential for direct conflict of interest problems caused by a health plan playing dual roles in a state CHIP program. Under this bill, a state would be prohibited from allowing a health plan to simultaneously administer and participate in the state CHIP program. This legislation was developed in direct response to events that occurred during the Health Care Financing Administration's (HCFA) review and approval process of California's CHIP program (called Healthy Families). Under California's program, the administrative vendor will perform a wide variety of functions including: providing trained staff on the program's toll free telephone lines, making eligibility determinations and redeterminations, collecting premiums, enrolling and disenrolling members, transmitting enrollment information and updates to participating health plans, administering the annual open enrollment process, and the list goes on and on. These are clearly functions over which a participating health plan has tremendous interest and will certainly attempt to influence in any system. California's CHIP program design would have permitted a private health plan to serve as both the administrative vendor and a participating health plan. Initially, California did select a private health plan to be the administrative vendor of the CHIP program. That plan would have run the program (and performed all of the above- mentioned functions) while also participating as a health plan option for low-income children. We firmly believe that a system of such a nature is inherently biased. And, at a time when there are numerous alternatives to selecting a health plan with a financial interest in that market, it is a bias that can be easily avoided. Our concern regarding California's choice of the administrative vendor was alleviated when the private health plan pulled out of the contract and the State selected a non-health plan entity as the new administrative vendor. We introduce our legislation today to be sure that no other states attempt to develop biased programs. Our reasoning for the need for such clarifying legislation is reinforced by looking at another provision in the Balanced Budget Act of 1997 (BBA). The BBA allows state Medicaid programs to choose private enrollment brokers to handle the day-to-day enrollment functions of their Medicaid programs. However, in allowing these enrollment brokers, the law clearly stipulates that the enrollment broker be free of any conflicts of interest. Specifically, the law requires that, ``The broker is independent of any such entity and of any health care providers (whether or not any such provider participates in the State plan under this title) that provide coverage of services in the same State in which the broker is conducting enrollment activities.'' Our new legislation would apply the same conflict-of-interest standard that exists in the Medicaid enrollment broker law to the CHIP law. This is an important bill that would protect the integrity of CHIP programs around the country. And, we look forward to working with our colleagues for passage of the State Children's Health Insurance Program Integrity Act this year.

Mr. STARK

Mr. STARK. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, I rise to praise the work that the committee has done on H.R. 2400 and to thank the gentleman from Texas (Mr. Archer), chairman, for the work that the Committee on Ways and Means did, be it ever such a small part of an otherwise Herculean undertaking. The 6-year extension of the Highway Trust Fund will provide much- needed infrastructure, maintenance, and expansion for this country's economic future. It does an important job. It will create jobs, ease bottlenecks, and will help the traffic flow in the Bay area of California, which is of particular local interest to me, as the gentleman from Texas (Mr. Archer) has explained. It is paid for in a variety of ways. But I have one small reservation with the bill. That redounds not to the leadership of the committee of jurisdiction, but I am afraid to the leadership, budget leadership on the other side of the aisle, and that is that the bill is not paid for. I would be a much happier and more enthusiastic supporter if I knew that other items were off the table. I am led to understand that the 24 or $25 billion shortfall in this bill is not going to be taken out of veterans programs. Well, great for old veterans like me. But I would like some assurance that that will not leave children at risk, and that will not mean that the $24 or 5 billion is going to come out of education, or that is not going to come out of programs to improve public safety or housing for the homeless. There are many programs in this country that will be competing for that $24 billion, and I would be much more comfortable and feel that we were doing the more responsible job if the leadership of this House had told us just exactly how they intend to come up with that shortfall. I do not like legislating in the blind, and it is very nice to tell my constituents that I am bringing home all kinds of worthy projects to the San Francisco Bay area and to the East Bay. I am afraid that perhaps later this summer I am going to have to deliver the bad news, which is how we are going to pay for this wonderful Easter present. Mr. Chairman, I ask unanimous consent to yield the balance of my time to the gentleman from Minnesota (Mr. Oberstar).