Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I am proud to join today with my colleagues to urge support for passing the Patients' Bill of Rights Act of 1998, a bill that would give millions of Americans enrolled in managed care plans a measure of control over the quality of care they receive. For consumers of mental health and substance abuse benefits--which are often arbitrarily capped at a particular dollar level--this bill contains key quality provisions. It provides for continuity of care, access to specialists, choice of specialist, enables exceptions from overly restrictive drug formularies, and provides for an independent external appeals process. The bill will guarantee that consumers can continue seeing their providers for 90 days after they change plans if they are in the middle of a course of treatment. For those with psychiatric disabilities, this continuity of care provision is critically important, since studies show that a sudden change of doctors for patients with serious psychiatric disorders can result in devastating setbacks. The abrupt termination of psychiatric services to thousands of Los Angeles County Medi-Cal beneficiaries last year illustrates this point well. Last year, the California State Department of Health contracted with Foundation Health to provide comprehensive medical services to its Medi-Cal population in Los Angeles. In turn, Foundation subcontracted out the provision of psychiatric services to MCC Behavioral Health Care. When MCC's contract ended, it notified 5,000 enrollees that their mental health services would be terminated in two weeks. All were undergoing a course of psychiatric treatment, and many suffered from severe psychiatric disorders, such as schizophrenia, bipolar disorder, or major depression. Most were not fully fluent in English. A full-blown crisis was averted when the Los Angeles County Department of Mental Health offered to care for the notified patients-- but the Department was not fully equipped to do the job. As a result, some of the most severely disabled fell through the cracks and were lost to treatment. Beyond continuity of care, the Patients' Bill of Rights would boost consumer confidence in HMOs with a simple requirement that health plans provide a list of contracted providers and their qualifications on request and that enrollees be able to choose among the providers who serve the plan members. This requirement would apply to mental health providers if the plan offers mental health and substance abuse services. Today, consumers in managed care plans are not commonly given a list of the mental health providers in their own plans. When enrollees call to seek psychiatric care, they are often required to reveal confidential information about themselves over the phone to a ``triage'' staffer whom they don't know--and who may have no formal mental health training. The staffer then generally gives the caller names of one or two mental health professionals who are selected on the basis of zip code--not based on an assessment of the individual's need for a particular type of care. In an article published on May 6, 1997, The Washington Post questions whether zip code referrals produce good patient care results. The article discusses the experience of Mark Hudson, who worked for a Blue Cross/Blue Shield plan as a telephone referral assistant in Massachusetts from 1992 to 1995. ``I did the diagnosis and approval'' for 80-100 calls a day for plan subscribers, Hudson is quoted as saying. He routinely made referrals to two therapists located in the town where the callers lived, regardless of the medical needs they described. Hudson has no mental health training, and says Blue Cross officials specifically instructed him not to provide enrollees with the names of other approved therapists. Mr. Speaker, this makes no sense at all. Consumers who need mental health services should have the same freedom to select from a full panel of providers just as those seeking physical care typically can. The Patient Bill of Rights would help equalize this unfair practice. Access to appropriate prescription drugs for psychiatric disorders is another paramount issue. In a 1997 survey, the National Alliance for the Mentally Ill found that five of the nation's largest behavioral health care companies failed to provide access to breakthrough antipsychotic medications. Yet for serious disorders such as schizophrenia, older medications may give only partial relief, and have far more serious side effects. There is a requirement in many managed care plans that psychiatrists must first document two failures of older medications before a new one can be approved. Such policies are penny wise and pound foolish, since patients suffering severe side effects from these sometimes-outdated drugs can easily wind up needing hospitalization. Obviously, this can also result in suboptimal psychiatric care. By requiring an exception process to the drug formularies often used by plans and by allowing access to the external appeals process, the bill will allow mental health patients to have stronger protection than they do today. The external appeals process required by this bill offers an additional important level of protection for consumers of mental health and substance abuse services. Without it, consumers are forced to receive final medical decisions from health plans that hold a financial interest in denying care. In an article published on March 3, 1998, U.S. News explores this risk in some details. The article discusses the experience of Dr. Linda Peeno, who worked as an HMO's medical director--the person who must ultimately approve or reject requests for care. ``The decision [to approve a voice machine for a plan beneficiary--a young woman who suffered a usually-fatal brain stem stroke] is now mine, and I feel the pressure to find a way to say no'', Dr. Peeno is quoted as saying. She went on to add, ``If I cannot pronounce it medically unnecessary, then I have to find a different way to interpret our medical guidelines or the contract language in order to deny the request.'' Unhappy with her role as a medical care denier, Dr. Peeno left the industry in 1991. Mr. Speaker, mental health and substance abuse is probably the area where managed care has the most serious problems. We need an entire bill devoted to addressing these special problems--but the bill I am cosponsoring today is a good beginning on these problems. In the coming weeks, I will be introducing separate legislation to deal with the unaddressed mental health and substance abuse consumer issues. In the meantime, we should not delay in passing the important protections contained in the Dingell-Gephardt-Kennedy bill.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to introduce The Medicare Social Work Equity Act of 1998. The Balanced Budget Act of 1997 includes a provision that will discourage nursing homes from utilizing social workers. This unintended consequence occurs because the legislation requires social workers' services to be included in the consolidated billing of the nursing home while psychologist and psychiatrist services remain outside of the consolidated billing. Under this construction, if a nursing home utilizes social workers' services, those dollars come out of the nursing home payment. Psychologist and psychiatrist payments do not. The effect of such a policy will be to encourage nursing homes to avoid social workers and instead rely on the more expensive services of psychologists and psychiatrists. Several firms that provide mental health services to nursing homes across the country have already informed me that they will cease hiring social workers and replace them with psychiatrists and psychologists beginning July 1, 1998. Clinical social workers are the primary providers of mental health services to residents of nursing homes, particularly in underserved urban and rural areas. Without correcting legislation, mental health services to nursing home residents will be reduced and Medicare costs for these services will most likely increase. I do not believe that Congress intentionally crated this problem. The Medicare Social Work Equity Act of 1998 seeks to address these concerns by excluding clinical social workers from the consolidated billing provisions of the Balanced Budget Act of 1997 and treating them identically to other mental health providers. This bill has been endorsed by the National Association of Social Workers, the Clinical Social Work Federation, the American Health Care Association and the National Citizens' Coalition for nursing Home Reform. Several firms that provide mental health services to nursing homes across the country have also pledged their support. I am attaching a letter I received from one such firm, MHM/Bay Colony Counseling Services. I urge my fellow Members of Congress to join with me in passing this crucial piece of legislation. Together, we can ensure that social workers continue to provide essential mental health services to nursing home residents. MHM/Bay Colony Counseling Services, Cambridge, MA, March 10, 1998. Representative Fortney ``Pete'' Stark, House of Representatives, Cannon House Office Building, Washington, DC. Dear Representative Stark: I am contacting you to extend my enthusiastic support for your efforts in pursuing the Medicare Social Work Equity Act of 1998 which excludes social workers from the new consolidated billing requirement in skilled nursing facilities. I am the Clinical Director at MHM/Bay Colony Extended Care Service. We provide comprehensive mental health services to the residents of about 125 nursing home facilities in the state of Massachusetts, and we employ about 100 professional clinicians, 60% of which are licensed social workers. The social workers we employ are trained, and exceptionally skilled psychotherapists who have made a purposeful professional career choice to provide psychotherapeutic services to the medically and psychiatrically frail and compromised older population. In doing so, they also provide consultation and support to the nursing home staff who are extremely challenged in providing front line care to this needy population. If this consolidated billing requirement for skilled nursing facilities by Medicare includes social workers, the impact will have an enormously destructive effect on systems and services; i.e.: Our services to these residents will be decimated in terms of available and acceptable trained professionals. 60% of our case load of frail aging nursing home residents, most in their last years of life will lose services. (This is the population who are most intensely affected by severe emotional distress, or progressive dementia and in need of management consultation intervention). 60 to 70 social workers will be unemployed from our program. (I speculate about 200 to 400 additionally from other services in Massachusetts). The assumption for this Medicare consolidated billing requirement, I believe, is that it is a cost saving device. In all actuality, in terms of mental health services, the costs will ultimately increase for Medicare. Programs, like ours, will be forced to employ only doctorate level psychologists who are exempt from this consolidated billing. Medicare reimburses psychologists at a higher rate than social workers for the same billing code. In closing, I need to emphasis that our services are essential for the fundamental well-being of this population and that our social workers are the foundation of our services. My staff and I thank you for your leadership in expending this so rapidly. I am available for contact if further efforts are needed. Sincerely, Muriel Ellman, Clinical Director, Extended Care Service.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to honor and congratulate Captain Joseph D. Silva, a dedicated member of the Milpitas Police Department. After thirty-five years of outstanding service, Captain Silva will be retiring from the force. Joseph Silva joined the Milpitas Police Department on February 4, 1963. Since then he has served in several capacities, making many lasting contributions to the force and community along the way. Joseph was promoted to Sergeant in 1966, Lieutenant in 1973, and again to Captain shortly thereafter. Captain Silva played a major role in guiding the evolution of the department as Milpitas grew from a small farming town to a large urban community. He started the department's first inventory procedures for equipment and the first suspect identification system. For eight years Captain Silva was a K-9 officer, wearing out five dogs in that time. He has served as a supervisor in patrol, traffic, and investigations, and was the first of many Milpitas Police Supervisors to attend the FBI Academy. Captain Silva was pivotal in planning and establishing the modern police administration building and the new police car design. They will stand as tributes to his leadership and dedication. Over his many years of service, Joseph Silva has been commended numerous times by the citizens of Milpitas and the law enforcement community. On March 1, 1998 the city will thank him again upon his retirement. I would like to join them by expressing my appreciation for his efforts. His leadership and commitment are an example and an inspiration for all of us. I wish him much happiness and success in his future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, on behalf of the Democratic leadership and all committees of jurisdiction, and at the request of President Clinton, we are pleased to introduce the Medicare Early Access Act. This bill provides health insurance for 400,000 people at a vulnerable point in their lives. At the same time, it closes gaping loopholes in Medicare to recapture millions of dollars in fraud and abuse. Democrats created Social Security in 1935 when Franklin Delano Roosevelt was in the White House. We perfected Medicare in 1965 when Lyndon Johnson was President. And in 1985, I was privileged to draft the COBRA coverage law with the support of a Republican President, Ronald Reagan. This year, under the leadership of President Clinton, we plan to follow in this bipartisan tradition and enact legislation to open up Medicare to early retirees and displaced workers who can't buy adequate health care in the private market. We can do this at no cost to the taxpayer. The Medicare Early Access Act is fully paid for through premiums and anti-fraud savings. Insurance companies don't want to sell policies to people between the ages of 55 and 65. Employers are trying to stop covering them. States are not filling the gap. It's time for the federal government to step forward and solve the problem of diminishing access for early retirees and workers who have lost their jobs through no fault of their own. Early Medicare is also an option for workers age 55 to 62 who have lost their jobs and aren't eligible for COBRA. And despite gloomy predictions in some quarters, the Congressional Budget Office has given the Medicare buy-in bill a thumbs up. The fraud part of this package will close gaping loopholes that now permit some providers to abuse our country's largest health care system. We give Secretary Shalala the authority to take the necessary steps to save Medicare billions of dollars. The President's Medicare buy-in proposal sets the stage for a federal government that is fiscally conservative and socially responsible. With the support of progressive lawmakers, we will work toward enactment of this important bill this year.

Mr. STARK

Mr. STARK. Mr. Speaker, the Kyl-Archer Private Contracting legislation will cost the nation's seniors and disabled billions of dollars. Kyl-Archer will let any doctor charge any Medicare patient any amount the doctor wants at any time. Medicare will pay no part of the bill-- zero, zip, zilch. How much will this cost Medicare beneficiaries? It is hard to provide an exact estimate, but it will clearly be in the billions. Some doctors do not accept Medicare's fee schedule and ``balance bill'' by increasing their charges to beneficiaries by 15% above 95% of the Medicare fee schedule. In 1995 the bills these doctors submitted amounted to $1.236 billion. I think it is safe to assume that this is the minimum number of doctors (and level of billings) who will use Kyl- Archer. But balance billing is a virus. Once some doctors start charging more, you can bet it will spread. Over the past 12 years, one of Medicare's greatest success stories has been to encourage doctors to accept the Medicare fee-schedule and to discourage balance billing. Before we started encouraging doctors to accept ``assignment'' 34.5% of bills were submitted by nonparticipating doctors who charged extra. If Kyl-Archer passes, I believe it will be a major signal to doctors to return to the days of unassigned, balance-billed claims. If we were to return to the pattern of billings that existed before 1985, the cost to Medicare beneficiaries would be about $15.23 billion. I doubt that we will see a return to that level of extra charges: with 73% of seniors living on less than $25,000 a year, and with 4% actually trying to live on less than $5,000 a year, it would be nearly impossible for doctors to shift that much cost onto the backs of seniors and the disabled. But I predict there will be some increase in private contracting above the current level of doctors who balance bill. If one assumed that we returned just one-third of the way toward the pattern of practice in 1985, to then the cost Medicare beneficiaries would be about $5 billion per year. Kyl-Archer gives doctors the freedom to charge more. For the rest of the nation, it will be one of the biggest consumer rip-offs in history. Don't worry about your cable tv rates, people, worry about being held hostage in your hour of sickness. The following staff memo provides background on the estimates of the $1,000,000,000 plus cost of Kyl-Archer. I've also included a chart prepared from data provided by the Health Care Financing Administration estimating some of the impact of the Kyl-Archer amendment. For the calendar year 1996 participation period, the physician participation rate (including limited licensed practitioners) had risen to 77.5 percent, accounting for 94.3 percent of allowed charges for physician services during that period. The physician participation rate rose to 80.2 percent in 1997. In contrast, 30.4 percent of physicians participated in FY 85, and they accounted for 36.0 percent of allowed charges. billings by nonparticipating physicians As the physician participation rate has increased over the years, total allowed charges billed by nonparticipating physicians have declined. For example, total allowed charges billed by nonparticipating physicians in FY 85 totaled 64.0 percent, as compared to 5.7 percent in 1996. unassigned claims by nonparticipating physicians In addition, the number of unassigned claims submitted by nonparticipating physicians has declined. Total covered charges represented by unassigned claims declined from 34.5 to 2.0 percent over the 1984-96 period. participating physicians' claims in 1995 For the calendar year 1995 participation period, the physician participation rate (including limited licensed practitioners) was 72.3 percent, accounting for 92.6 percent of all covered charges for physician services during that period. 2.8 percent of allowed charges were unassigned claims submitted by nonparticipating physicians. In 1995, 76.7 percent of allowed charges under the fee schedule were for physicians' services, and another 3.2 percent were for the services of limited license practitioners. During that time period, the allowed amounts for claims by physicians totaled $42.369 billion, and for limited license practitioners the total allowed amounts were $1.784 billion. Allowed amounts for claims by both physicians and limited license practitioners totaled $44.153 billion. The 92.6 percent of covered charges for physician services submitted by participating physicians (and limited license practitioners) during 1995 totaled $40.886 billion. unassigned claims by nonparticipating physicians For the calendar year 1995 participation period, 2.8 percent of allowed charges represented unassigned claims, totaling $1.236 billion. This represents total Medicare billings by physicians who do not accept assignment, and could be assumed to be costs that would be directly shifted to seniors if private contracting is allowed. If one were to assume that physicians would revert to their practices and behavior in 1985 with respect to billings for unassigned claims, it is estimated that charges totaling $15.233 billion would be shifted to seniors. (2.8% : $1.236 billion=34.5% : $15.233 billion). ------------------------------------------------------------------------ 1997 1996 1995 1985 ------------------------------------------------------------------------ Percent of physicians \1\ 80.2 77.5 72.3............ 30.4 participating. Percent of physicians \1\ not 19.8 22.5 27.7............ 69.6 participating. Allowed amounts for claims by ...... ...... $44.153 \2\..... ...... physicians \1\. Percent of allowed charges for n/a 94.3 92.6............ 36.0 physician services billed by participating physicians \1\. Percent of unassigned claims n/a 2.0 2.8............. 34.5 by nonparticipating physicians \1\. Total amount billed by ...... ...... $1.236 \3\...... ...... nonparticipating physicians \1\ on a non-assignment basis. Estimated annual charges that ...... ...... $15.233 \4\..... ...... would be shifted to seniors. ------------------------------------------------------------------------ \1\ Including limited licensed practitioners \2\ In 1995 a total of $55.217 billion in claims were allowed for all providers. This total included $42.369 billion for physicians and $1.784 for limited license practitioners, or $44.153 billion. \3\ This figure represents the 2.8 percent of allowed charges by physicians and limited license practitioners that represented unassigned claims in 1995, multiplied by the $44.153 billion in allowed amounts for claims by both physicians and limited license practitioners. \4\ Assumes that physicians would revert to practices and behavior in 1985 with respect to billings for unassigned claims--that the total amount of unassigned claims from nonparticipating physicians would increase from 2.8 percent to 34.5 percent. That factor (2.8 percent : 34.5 percent) is multiplied by the dollar value of allowed unassigned claims by nonparticipating physicians and limited license practitioners in 1995. Impact of Kyl/Archer in Dollars and Cents prepared from data provided by the health care finaning administration The Kyl/Archer bill allows doctors to require private contracts for Medicare-covered benefits, service by service and patient by patient, effectively removing Medicare's cost protections. Doctors would be able to charge more, while seniors would be left with outrageous bills to pay totally out of pocket. Here's what the Kyl/Archer bill means in dollars and cents. Today, under Medicare's rules, doctors can charge between $2,514 and $2,747 for heart by-pass surgery. The beneficiary pays between $503 and $736, and Medicare picks up the rest. For many seniors, that's already at lot of money. Under the Kyl/Archer so called ``freedom of choice,'' a doctor can charge more than $2,747 for a by-pass, but it's the Medicare patient who picks up the full tab. Can seniors afford this? Almost 75% of Medicare beneficiaries have incomes less than $25,000, so extra bills can be a disaster. By contrast, the average MEDIAN NET income is $160,740. Today, doctors can charge $711 for prostate surgery, $903 for cataract removal, $77 for an office visit, $32 for an electrocardiogram; and $30 for a chest x-ray. All these services are covered by Medicare. Under Kyl/Archer there are no limits to what doctors can charge, and seniors will pay every penny even after paying into Medicare through their lives. ------------------------------------------------------------------------ Under Medicare If Doctor

Mr. STARK

Mr. STARK. Mr. Speaker, managed care does many things will and some things poorly. It has been my impression that its major failing lies in the area of mental health and substance abuse services--and the following report submitted to the Congressional Budget Office in October 1997 by J. Wrich & Associates, Inc. (JWA) confirms that impression. The report, which describes a pattern of lying about services, malpractice, and profiteering at the expense of some of the sickest in our society, is a call to action. As we consider managed care consumer protection and quality legislation, we need to provide special protections in the mental health and substance abuse sectors. In the coming weeks, I will be proposing legislation to address some of the issues so well-raised by the Wrich report. Portions of this report follow:

Mr. STARK

Mr. STARK. Mr. Speaker, as the nation moves increasingly toward managed care, a high priority must be to give the patient/consumer reliable, accurate information on the qualify provided by HMOs. On February 26 the chief medical officer of the Medicare agency testified that the popular HEDIS data used to measure how well HMOs are doing in a variety of areas is, in some cases, very inaccurate and misleading. I've asked the Health Care Financing Administration to give us more information on this problem and the extent of the errors. There are private groups which accredit HMOs and use HEDIS data to help measure those plans. The leader in these private groups is the National Commission on Quality Assurance. But it is all very confusing to the consumer. The following shows why. The October 13, 1997 issue of US News and World Report rated 223 HMOs using data largely from the National Commission on Quality Assurance's HEDIS system. The rating also showed whether NCQA had given full or partial accreditation to those HMOs. Using the HEDIS data on things that people care about, like immunization rates, mammography rates, etc., US News ranked plans as Above Average or Below Average--but the NCQA accreditations had relatively little to do with how plans did on the US News ratings. For example, NCQA denied accreditation to 2 plans that US News found among the best, but denied none among the plans that US News found the worst. Following is a table my staff did showing the results. What can be done to make this babble of ratings more useful to the public? How NCQA Accreditation Compares to U.S. News and World Report Rankings of HMO's -------------------------------------------------------------------------------------------------------------------------------------------------------- 1-Yr. Prov. U.S. News ranking Full Acc. Acc. Acc.\1\ Denied Review N/A \4\ P/S/E \3\ Totals -----------------------------------------------------------------------------------------------------------------\2\------------------------------------ ****............................................................ 41 15 0 2 0 6 0 64 ***............................................................. 46 30 7 1 1 5 6 96 **.............................................................. 47 30 0 1 1 16 8 103 *............................................................... 13 7 1 0 1 5 10 37 Not ranked...................................................... 14 0 0 0 1 7 5 27 Totals.................................................... 161 82 8 4 4 39 29 327 -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ Provisional accreditation; plan meets some standards; can move up if review after one year shows improvement. \2\ Initial status determiend but under review. \3\ Initial status Pending/review Scheduled/rating Expired. \4\ Accreditation information not available. Source: U.S. News and World Report, October 13, 1997. One of the most important things would be to ensure that these private accrediting and rating groups, which are paid for their services by those they rate, are true to the public interest. I have proposed legislation, H.R. 800, which would require that the boards of accrediting organizations like NCQA and JCAHO include public interest representatives and public meetings. So much money is at stake in the quality ratings of managed care plans, that I do not believe the ratings should be directed in private and by boards of directors who include representatives of the interest being evaluated.

Mr. STARK

Mr. STARK. Mr. Speaker, with the end of the cold war and the break-up of the Soviet Union, nuclear nonproliferation efforts continue to be a priority for United States. Many events have taken place which have strengthened nuclear nonproliferation efforts. The cornerstone of international nuclear nonproliferation, the Nuclear Nonproliferation Treaty (NPT), completed its 25-year lifespan in 1995 and was made permanent. The former Soviet states, Ukraine, Kazakhstan and Belarus have joined the NPT as non-weapons states and agreed to remove all nuclear materials from their territories. Although the international community has taken positive steps toward nonproliferation goals, new developments require scrutiny of current U.S. nonproliferation policy. Safety and security of nuclear weapons and materials in the former Soviet Union, the India-Pakistan arms race, North Korea's violations of the NPT, continuing suspicions about Iran's nuclear activities, and the availability of weapons-usable materials and technologies are leading reasons for concern. The breakup of the Soviet Union left an undetermined amount of nuclear materials scattered throughout the former Soviet territories. Large quantities of nuclear weapons, weapons materials, and technology in the former Soviet Union are all potential proliferation problems. There are terrifying reports that nuclear materials have been illegally stolen and transferred from Russia to rogue states. The sluggish economic conditions in Russia have provoked Russian nuclear and missile experts in accepting employment offers in rogue nations. And Russia isn't the only region of concern for the United States. Since the end of the cold war, North Korea has diverted plutonium to a secret bomb program, threatened to withdraw from the NPT and blocked inspections. North Korea currently has enough plutonium to build one or two bombs, but refuses to disclose the extent of its nuclear activities. Neither India nor Pakistan are a party to the Nuclear Nonproliferation Treaty--nor have they signed the Comprehensive Nuclear Test Ban Treaty. Pakistan has acknowledged the capability to build at least one nuclear reactor while some experts believe it has enough enriched uranium for 10-15 weapons. Both India and Pakistan have combat aircraft that, with modifications, would be capable of delivering nuclear weapons. The U.S. continues to suspect Iran of using its civilian nuclear program as a pretense to establish the technical basis for a nuclear weapons option. Today, I am introducing legislation that will set forth a blueprint for accomplishing critical nonproliferation objectives. The bill, the Nuclear Non-Proliferation Policy Act of 1998, establishes fourteen policy goals for the United States to pursue on nuclear arms control and nonproliferation. The arms control objectives are less important now for their own sake than for preventing nonproliferation. A comprehensive test ban, a global ban on the production of fissile material, verified dismantlement of United States and Russian nuclear weapons are measures that will help build international support for tough nonproliferation agreements, could cap the nuclear weapons programs of the threshold nuclear weapons states, and could reduce the chances of future theft or diversion of nuclear material from the former Soviet Union. Additionally, the United States must continue to support the International Atomic Energy Agency (IAEA) nonproliferation safeguards, tighten nuclear export controls in the United States and elsewhere, and increase the role of the U.N. Security council in enforcing international nonproliferation agreements. As we have recently experienced, these measures will help prevent terrorist leaders like Saddam Hussein from building a secret nuclear weapons program. Finally, the United States must make it clear that it will make no first use of nuclear weapons, that our nuclear weapons will only be used to deter nuclear attack. We should seek to have the other permanent members of the UN Security Council--who are also the other nuclear weapons states--adopt such a `no first use` policy and to pledge to assist any country which is party to the NPT and against which first-use of nuclear weapons is made. These positive and negative security assurances can help build crucial support among developing nations to sign onto the NPT. One the other hand, if the United States begins targeting third world countries with nuclear weapons, as some in the Pentagon might propose, it would give added rationale for those countries to build their own nuclear deterrents. Now, more than ever, the United States must set a firm standard in the nonproliferation arena. U.S. credibility and leadership in nonproliferation suffers when Washington subordinates nonproliferation to economic or other political considerations. None of the objectives in this bill will, on its own, stop proliferation. But by adopting a comprehensive nonproliferation policy, the United States can accomplish its overall goal of ending the further spread of nuclear weapons capability, rolling back proliferation where it has occurred, and preventing the use of nuclear weapons anywhere in the world.

Mr. STARK

Mr. STARK. Mr. Speaker, the opponents of managed care consumer protections constantly say that the cost of the reforms will substantially drive up costs, and therefore cause employers to drop insurance coverage for their workers. Some of their cost estimates are laughable. Remember the old Western, ``Have Gun, Will Travel?'' There is a whole industry in Washington of Ph'Ds who serve the same bounty hunter role. ``Have Ph'D; Will Produce the Study Results YOU Want.'' Or as the old vaudeville joke goes, ``If the man wants a green suit, turn on the green light.'' One reason the studies are silly is that the States are already requiring, for the roughly 50% of plans that they can regulate, that managed care plans comply with the type of reforms we are proposing. Another reason is that the managed care trade association, AAHP, already requires as a condition of membership that a plan comply with many of these standards. The question arises, why should there be much extra cost if the plans are already complying with their trade association's quality standards? Using data from Blue Cross Blue Shield, my staff has compiled the following matrix of State actions. Clearly, the passage of Federal legislation will not be asking the managed care plans to deal with issues they are not already dealing with on a wide scale. State Consumer Protection Laws Attached is a preliminary summary of States' consumer protection laws. This information, taken from the Blue Cross/ Blue Shield Association's 1997 Survey of Health Plans, indicates that all but four states have enacted at least one of the managed care quality protections listed in the President's Consumer Bill of Rights. In addition: Thirty-nine (39) states have enacted laws prohibiting ``gag clauses'' in provider contracts. Twenty-nine (29) states have enacted laws allowing direct access to specialists without prior approval from the plan's primary care physician. These laws apply primarily to OB- GYN's, but a few also refer to chiropractors, dermatologists, and other specialists. Another five (5) states are expected to propose direct access to specialists in 1998. Twenty-six (26) states have enacted laws requiring payment for certain care delivered in an emergency room. Almost half (12) of these states also impose a ``prudent layperson'' standard. Another nine (9) states are expected to introduce legislation with the ``prudent layperson'' standard in 1998. Twelve (12) states have external grievance review laws that require health plans to allow enrollees to appeal coverage or claims denials to an outside medical expert of panel, if dissatisfied with the outcome of the plan's internal appeals process. Another 12 states are expected to enact mandatory external grievance review laws in 1998. Sixteen (16) states (CA, DE, FL, HI, IA, ID, IL, IN, KY, MD, ND, OK, PA, SC, TN, and WA) are expected to propose a framework of quality standards for managed care plans in 1998.

Mr. STARK

Mr. STARK. Mr. Speaker, 50 years ago, Dr. Sidney Garfield with six other physicians forged a pioneering, self-employed medical partnership to provide prepaid health care services and preventive health care services to the residents of northern California. The group ministered to its members' health care needs, both on and off the job. Since those doctors began their work, the physicians, nurses and employees affiliated with The Permanente Medical Group have improved community health by providing medial care, conducting clinical and medical research, creating and supporting community health programs, bestowing grants and donations, and providing scholarships, education and training for medical students and health professionals. I can attest personally to the group's lasting community involvement. For example, in my district, the staff of The Permanente Medical Group volunteers clinical time on Saturday mornings to remove gang-related tattoos from at risk youth who want to make positive changes in their lives. The Permanente Medical Group is now the nation's largest medical group, comprised of more than 3,700 physicians, as well as nurses, employees and other caregivers. In Northern California alone, they provide health care services to more than 2.5 million people. The men and women affiliated with the medical group have consistently demonstrated their excellence, creativity and care as they have provided quality health care to all the people of our communities. Through its 50 year affiliation with the Kaiser Permanente Medical Care Program, The Permanente Medical Group has demonstrated that affordable and high quality medical care can be provided through a relationship, both integrated and autonomous, between a non-profit health care plan and an independent, self-governing medical group. This is a model relationship in which medical decision-making and standard- setting are safeguarded and conducted by medical professionals. Mr. Speaker, I ask you to join me in celebrating the half century of remarkable care that Californians have received and wishing The Permanenete Medical Group another fifty years of excellence in the community.

Mr. STARK

Mr. STARK. Mr. Speaker, a recent investigation of New York City hospitals has uncovered startling evidence of substandard care at hospitals with high accreditation scores from Joint Commission on Accreditation of Health Care Organizations (JCAHO). In a scathing report, the Public Advocate for the City of New York presents strong evidence that hospitals circumvent JCAHO's annual announced survey visits--simply by hiring extra staff to make operations look smoother than they really are. In too many cases, the report finds that JCAHO's high test scores mask a darker reality--that some accredited hospitals may be endangering the health of patients because they don't meet basic standards of care. The New York City report demonstrates widespread quality of care problems in 15 accredited City hospitals. For example, it finds: Inadequate supervision that can mean patients are left in pain; substantial delays in treatment of emergency room patients; outdated and broken equipment; overcrowded, understaffed clinics; unsanitary conditions throughout the hospital; incomplete and poorly documented patient charts. Clearly, when such conditions are present, JCAHO should respond with sanctions, not high praise. Yet only last year, JCAHO flunked fewer than 1% of hospitals. The organization says that it fails so few because it prefers to work with hospitals to ``correct'' any violations that are detected. But if its accreditation standards are low to begin with, then can consumers and plans really rely on JCAHO reports? This is a critical question for Medicare beneficiaries, since JCAHO- accredited hospitals are ``deemed'' to have met Medicare's ``Conditions of Participation,'' a key proxy for quality of care. The weaknesses of JCAHO's current system are made plain in the New York report. Simply put, there are no surprise inspections, and little apparent follow-up of pro-forma walk-throughs. ``Simply investigative steps, such as unannounced visits, confidential employee interviews, and document audits'' could make a vast difference in what JCAHO actually found. To make matters worse, under the Joint Commission's arbitrary scoring system, hospitals with serious quality of care problems are often awarded high accreditation scores. In effect, JCAHO surveyors are encouraged to rank hospitals highly on each standard, even if the hospital is unable to meet that standard! This practice makes a mockery of the review process. In fact, almost all (98 percent) of the institutions surveyed in the New York City study received scores of 80 or better on a 100 point scale, and none had a score below 70! Mr. Speaker, I am astounded that, of the 18,000 institutions surveyed each year, none are judged to fail outright. Nearly all of them met JCAHO standards. These inflated grades are confusing and misleading. Although each facility is rated on individual standards, the highest score of 1 on a scale of 1 to 5 only indicates 91% compliance; a score of 2 indicates only 76% compliance. The results of such a skewed system are that public health authorities are left to do the hard work of sanctioning and shutting down facilities that are appalling deficiencies. In 1994, New York City's Union Hospital was reviewed by JCAHO and given a score of 92. Three years later, in March 1997, the hospital's score rose to a near-perfect 97. But later that year, the New York Department of Health concluded that hospital staff had failed to properly treat high-risk emergency room patients, including two rape survivors, and was using outdated and expired drugs. Nurses pointed to understaffing and a lack of experienced staff in the pediatric, post- partum, and maternity departments and the emergency room. By October, public health authorities moved to partially shut the hospital, which has since filed for bankruptcy. In Brooklyn, New York, Interfaith Medical Center received a JCAHO score of 89 in 1995 that was raised to 94 a year later. Strange, because a 1997 Wall Street Journal article on Interfaith painted a picture of a badly deteriorated facility, with heating and plumbing systems in bad disrepair and non-functioning elevators. Hospital staff, the story found, had to stave off invasions of rats, mice, and flies. Even the hospital's president, Corbett Price, was quoted as saying, ``This hospital is being held together by rubber bands and Band-Aids.'' JCAHO's problems are not confined to New York. In Las Vegas, poor care at Columbia/HCA's JCAHO-accredited Sunrise Hospital generated numerous newspaper articles and television pieces in October 1996, ultimately causing JCAHO to place the facility on probation a year later. Just recently, JCAHO placed Columbia's North Houston Medical Center on preliminary non-accreditation status--but only because an employee called a hotline number to report that problems had been overlooked-- including a high level of incomplete patient records. After returning to North Houston in December, JCAHO downgraded the hospital's status. In other cases, where serious problems have been brought to light by state inspection teams, JCAHO has proved reluctant to downgrade a hospital's accreditation status. Given this spotty record, I am outraged by media reports that the Joint Commission is considering softening its already loophole-ridden review process. According to a leading trade publication, Modern Healthcare, JCAHO may move to allow hospitals that self-report a ``sentinel event'' within five days of its occurrence will be put on accreditation watch. The definition of ``a sentinel event'' is one that could lead to the death or serious injury of a patient. The misguided scoring and lax oversight documented in the New York report suggests that another system of oversight is needed. I am cosponsoring two bills that would overhaul the current voluntary review process. The Accreditation Accountability Act of 1997 (H.R. 800) would require all Medicare-accrediting organizations to hold public meetings. One-third of governing board members would be members of the public. Second, the Medicare and Medicaid Provider Review Act of 1997 (H.R. 2543) would levy user fees on hospitals and other health care providers to underwrite the costs of independent federal compliance and audits. I am happy to report that President Clinton included the heart of this bill in the budget package he recently sent to Congress. For too long, we've given JCAHO and the Health care industry the benefit of the doubt. Self-policing simply isn't working. The New York City report is all the evidence we need to show that patients suffer-- sometimes fatally--from substandard care provided by JCAHO-accredited hospitals. Let's put patients' needs first, back where they belong.

Mr. STARK

Mr. STARK. Mr. Speaker, for offices receiving mail on the Kyl-Archer bill to let any doctor at any time bill any Medicare patients as much as the doctor wants, the following article from the February, 1998 AARP Bulletin will provide a useful insert-answer. The AARP article shows that a number of groups have been trying to scare seniors into contributing to a phony cause. [From the AARP Bulletin, Feb. 1998] AARP Answers `Scare Campaign' on Medicare Private Contracting (By Elliot Carlson and Don McLeod) Medicare beneficiaries are being flooded with misinformation about their right to enter into private contracts with their doctors. As examples, observers cite reports in some newspapers and magazines stating that, because of the 1997 Balanced Budget Act (BBA), doctors will be barred from treating older patients on a private basis. ``What we have here,'' says AARP legislative director John Rother, `is a concerted scare campaign aimed at misleading Medicare beneficiaries into believing that they have lost the freedom to choose their own doctors and seek the care they need.'' That's false, Rother says. Rather than weakening an enrollee's right to contract privately with doctors, he adds, the recently enacted BBA actually expands that right. Prior to passage of that law last fall, Medicare beneficiaries and doctors were not permitted to contract privately for services Medicare covered, such as office visits. Any doctor treating a Medicare patient had to file a claim with Medicare and was limited in how much he or she could charge a beneficiary. The BBA liberalizes these provisions. For the first time, effective Jan. 1, 1998, the law allows doctors to contract privately with Medicare enrollees for services that are already covered by Medicare. But no sooner was the BBA enacted, Rother points out, than some groups started misinterpreting it--telling people incorrectly that the new law, rather than expanding enrollee rights, had taken them away. One group, he notes, has been writing beneficiaries, quite erroneously, that if they pay a doctor out of their own pocket for a treatment not covered by Medicare, then their doctor will be barred from treating Medicare patients for two years. Not so. Patients always could--and still can--privately buy services not covered by Medicare, such as prescription drugs, eyeglasses and hearing aids. ``Beneficiaries have always been able to pay out of their own pocket for services not covered by Medicare without penalty to themselves or their physicians,'' says Nancy-Ann DeParle, administrator of the Health Care Financing Administration, which runs Medicare. ``The new Balanced Budget Act doesn't change that.'' And you always could--and still can--pay for extra medical tests you want without you or your doctor being penalized, even if your doctor disagrees about the need. A case in point is mammograms. Under the law Medicare pays for one mammogram per year. If you have a history of breast cancer in your family and your doctor deems it advisable, Medicare will pay for a second test. Even if you aren't a high-risk case for breast cancer but you simply want a second test, you can go ahead and pay for it on your own without penalty to you or your doctor. But the 1997 BBA does change some things. As noted above, it allows doctors for the first time to contract privately with Medicare enrollees for services that are already covered by Medicare. This change stems from a bill advanced last June by Sen. Jon Kyl, R-Ariz., who said the change was needed to allow ``those 9 percent of the physicians who do not treat Medicare patients to continue to treat their patients [after patients turn 65] as they always have.'' In the waning hours of the debate on this proposal, House-Senate conferees modified the Kyl provision and incorporated a number of enrollee protections. A key protection requires doctors to disclose contract terms. Thus, the doctor and Medicare patient must both sign a contract in which the patient agrees not to file a claim with Medicare. The patient also agrees to pay 100 percent of whatever amount the doctor charges. The contract must disclose that Medicare will pay no portion of the cost of the service. Nor will the enrollee's medigap policy. Also, the new provision is limited to doctors who agree, in an affidavit, to forgo all payment from Medicare for two years--a clause that has turned out to be controversial. Critics argue that the ``two-year ban'' makes it very hard for doctors to take advantage of the Kyl provision. And, they add, it could discourage doctors from taking new Medicare patients. Such concerns don't stand up to close examination, says Tricia Smith, coordinator of AARP's legislative health team. ``There is good reason for the two-year exclusion.'' For starters, ``the provision is a real protection for Medicare patients,'' she says. ``It's intended to prevent doctors from picking and choosing patients based on income and severity of illness. ``Also,'' Smith adds, ``it seeks to protect Medicare against fraud.'' In the wake of the controversy over private contracting, Senator Kyl is advocating a new bill that would go well beyond the intent of his original proposal. Not only is he seeking to eliminate the two-year ban, but he also wants to allow doctors to contract privately with low-income patients and those in managed care. And he wants to let doctors pick and choose what services they will contract for. The legislation is supported by the American Medical Association (AMA), which has opposed Medicare's limits on balance billing--the extra amount doctors can charge beneficiaries over and above Medicare's payment. But AARP, along with the New York-based Medicare Rights Center and some other consumer groups, strongly opposes the Kyl legislation. The American College of Physicians has raised serious questions about it. ``These proposed changes could open up Medicare to even more fraud and abuse than we see now,'' says AARP's Smith. ``Medicare would have a very hard time identifying which services were paid for privately. Thus, doctors could double- bill and collect from both beneficiaries and Medicare.'' Critics, AARP among them, also worry about the danger that private contracting could create a ``two-tiered system''--one for better-off enrollees who could afford high-priced doctors and another for all other enrollees. Finally, AARP and other critics worry about the ability of doctors to charge any price for services rendered and the Medicare enrollee being held responsible to pay 100 percent of the bill. ``When a beneficiary agrees to a private contract, he or she is liable for 100 percent of what the doctor chooses to charge for the service,'' Smith observes. ``When beneficiaries discover that and recognize that their medigap policy won't cover the costs, they may find that the out-of- pocket costs will be unmanageable.''

Mr. STARK

Mr. STARK. Mr. Chairman, February 4, the House wasted an afternoon debating a totally meaningless ``sense of the Congress'' that the taxpayer ``should'' not have to pay about $300,000 in lawyers' fees for a group which had sued the White House over the make-up and secrecy of the long-defunct Health Care Task Force. It was pure partisan bashing of the Clinton's health reform efforts. I repeatedly offered a unanimous consent amendment (the parliamentary rules of germaneness prevented a regular amendment) to make the Resolution real: to save the taxpayers from paying this fine. Repeatedly the Republicans rejected the offer to do what they claimed their Resolution was ``trying'' to do. All in all, their position on this Resolution was the most transparent political nonsense that the Congress has seen in years. The following memo from the American Law Division of the Library of Congress makes the silliness of their Resolution clear: Library of Congress, Congressional Research Service, Washington, DC, February 4, 1998. To: House Committee on the Judiciary. From: American Law Division. Subject: Draft Joint Resolution Expressing the Sense of Congress that the Award of Attorneys' Fees in the Magaziner Case Not be Paid With Taxpayer Funds. This memorandum is furnished in response to your request for an analysis of the above draft joint resolution, which was prompted by a recent federal district court decision. In Association of American Physicians and Surgeons, Inc. v. Clinton, 1997 U.S. Dist. LEXIS 20604 (D.D.C. Dec. 18, 1997), the plaintiffs sued for an injunction declaring that the President's Task Force on National Health Care Reform did ``not qualify for an exemption from the Federal Advisory Committee Act [FACA, 5 U.S.C. App. 2 Sec. Sec. 1-15] as an advisory group composed solely of `full-time officers or employees' of the government.'' During the litigation, Ira C. Magaziner, Senior Advisor to President Clinton, submitted a sworn declaration that all working group members were federal employees. The court found that this declaration was false, and that ``the most outrageous conduct by the government in this case is what happened when it never corrected or up- dated the Magaziner declaration.'' Eventually, however, the government took action that amounted to what the court called a ``total capitulation.'' The plaintiff then filed an application with the court for an award of attorneys' fees; i.e., it asked the court to order the government to pay its attorneys' fees. A federal court may not order the United States to pay the attorneys' fees of another party, unless a statute authorizes it to do so. FACA contains no such authorization. However, the Equal Access to Justice Act (EAJA) authorizes awards of attorneys fees against the United States in two instances. First, under 28 U.S.C. Sec. 2412(b), it authorizes federal courts to order the United States, when it acts in bad faith, to pay the attorneys' fees of the prevailing party. Second, under 28 U.S.C. Sec. 2412(d), it provides that, in any civil action (other than tort cases) brought by or against the United States, ``a court shall award to a prevailing party other than the United States fees and other expenses . . . unless the court finds that the position of the United States was substantially justified or that special circumstances make an award unjust.'' Under Sec. 2412(d), but not under Sec. 2412(b), fees are capped at $125 per hour, and only individuals whose net worth did not exceed $2 million at the time the civil action was filed, and organizations whose net worth did not exceed $7 million and that had not more than 500 employees, may recover fees. In response to the plaintiff's motion for an award of attorneys' fees, the court found that, prior to August 1994, the United States had acted in bad faith, and therefore was liable for the plaintiff's attorney's fees for that period without regard to the $125 per hour cap. As to the subsequent period, the court found that the plaintiff had prevailed, that it was an organization with a new worth below $7 million and fewer than 500 employees, and that the position of the United States, though taken in good faith, was not substantially justified. It therefore awarded fees for the subsequent period, subject to the cap. The total award, for both periods, came to $285,864.78. The draft joint resolution expresses ``the sense of the Congress that the award of $285,864.78 in attorneys' fees, costs, and sanctions that Judge Royce C. Lamberth ordered the defendants to pay in Association of American Physicians and Surgeons, Inc., et al. versus Hillary Rodham Clinton, et al., should not be paid with taxpayer funds.'' As a sense of Congress expressed in a joint resolution, this proposal will have no legal effect if it is enacted. If its language were introduced as a bill and enacted as a public law, then its effect, provided it were upheld as constitutional, would be to preclude the United States from complying with the district court's order to pay the plaintiff its attorney's fees. This hypothetical statute, by itself, would not require anyone to pay the attorney's fees, because, as EAJA permits fee awards only against the United States, there would be no legal basis to assess the fees against anyone else. An argument might be made, however, that this hypothetical statute would violate the Takings Clause of the Fifth Amendment, which provides: ``nor shall private property be taken for public use, without just compensation.'' The hypothetical statute arguably would deprive the plaintiff of its private property, in the form of a fee award that a court had ordered paid to it. However, Association of American Physicians and Surgeons, Inc. v. Clinton remains subject to appeal, and, if it were reversed on appeal, the plaintiff would lose its entitlement to a fee award. See, Poelker v. Doe, 432 U.S. 519, 521 n.2 (1977). Consequently this property may not be ``vested,'' and, if the hypothetical statute were to take effect prior to its vesting, then, arguably, no unconstitutional taking would occur. In Hammon v. United States, 786 F.2d 8, 12 (1st Cir. 1986), the court of appeals wrote: ``No person has a vested interest in any rule of law entitling him to insist that it remain unchanged for his benefit.'' [Citations omitted]. This is true after suit has been filed and continues to be true until a final, unreviewable judgment is obtained. Chief Justice Marshall first announced that principle in The Schooner Peggy, 5 U.S. (1 Cranch) 103, 110, 2 L. Ed. 49 (1801). The Supreme Court held in that case that a court must apply the law in force at the time of its decision, even if it is hearing the case on appeal from a judgment entered pursuant to prior law. A caveat, however: the preceding quotation states only the majority view as to when ``property'' status attaches to a cause of action. There is also case law supporting the ``contention that one has a vested property right in a cause of action once it has somehow accrued. [Citations omitted] Those cases are conceptually difficult to reconcile with cases that hold that a plaintiff does not have a vested property right in a claim unless there is a final nonreviewable judgment.'' Jefferson Disposal Co. v. Parish of Jefferson, LA, 603 F. Supp. 1125, 1137 n.31 (E.D. La. 1985). A cause of action accrues once the injury that gives rise to the cause of action has occurred. Therefore, those cases that find accrual sufficient for vesting would ipso facto find a final lower court judgment sufficient for vesting. Other cases do not make clear whether final judgments trigger property status only once they are no longer reviewable. For example, in O'Brien v. J.I. Kislak Mortgage Corp., 934 F. Supp. 1348, 1362 (S.D. Fla. 1996), the district court wrote: ``Reviewing the relevant Eleventh Circuit case law, it appears clear that a mere legal claim affords no enforceable property right until a final judgment has been obtained.'' One might argue that, even if mere accrual is not sufficient to trigger property status, and a final judgment is necessary, a nonreviewable judgment may not be necessary. Again, however, the majority view appears to be that a nonreviewable judgment is necessary. Consequently, it appears that the stronger argument would be that a statute that overturned the award of attorneys' fees in Association of American Physicians and Surgeons, Inc. v. Clinton, before a final appeal had been decided or the time in which to appeal had run, would be constitutional. The draft joint resolution, we reiterate, does not purport to overturn the award of attorneys' fees; it would merely express the sense of Congress that the government not pay the fee award, and does not express the sense of Congress that anyone else pay it.

Mr. STARK

Mr. STARK. Mr. Speaker, enclosed is a copy of a letter I've received from a Midwestern doctor. Dear Representative Stark: I am not from your district or even from California but I know your interest in problems with the pharmaceutical industry so I wanted to share this outrage I just found out to my dismay. I called the Darby Drug Company to order a thousand tablets of the generic for Lomotil and found that what had been $27.95 in 1997 is now $325.00--honestly--more than a 10% increase. I could not believe it but was told it is true. They don't have the 1998 catalogue yet but they say that is the new price. Help! I have seen increases in the prices of drugs that seemed too high, but this is absurd. How can they get away with it? Certainly the cost of making it did not go up more than 10 times in less than a year. The reason given me was that now there is only one company making it--a lame excuse for taking such advantage of patients in need. Thanks for your efforts to protect the poor consumer.

Mr. STARK

Mr. STARK. Mr. Speaker, all across the United States, Blue Cross and Blue Shield health insurance plans are changing their stripes through mergers, conversions, other changes in corporate status, or buy-outs. As many of my colleagues know, these changes have triggered debate in many states over the fate of charitable assets of these plans. As one observer put it, ``The Blues see green. Consumers see red.'' In California, for example, two new foundations have over $3 billion for health care, courtesy of the Blue Cross conversion. In New Jersey, an appeals court ruled last year that the Blues there are, in fact, ``charitable and benevolent.'' In Texas, the attorney general is in court to block the merger between the Texas and Illinois Blues. In North Carolina, the state legislature set up a study commission to examine the fate of the Blues plan there. In Kansas, the attorney general has filed a claim against the officers and directors of the Blues for breach of their fiduciary duty in connection with their campaign to deny the charitable status of the assets. Each of these cases demonstrates that the tug-of-war over charitable assets is a state matter. Rarely, if ever, does Congress become involved, though perhaps the time is drawing near for a national examination of these trends. Right in our own backyard here in the nation's capital, the Washington Blue Cross plan recently merged with the Maryland plan headquartered in Baltimore. This followed passage of HR 3025 at the end of the last session of Congress, facilitating the merger by amending the Federal charter of the DC Blues, which is the only Blue Cross plan nationwide to have been chartered by Congress rather than by a state. The merger is being challenged in two court actions brought by the Blue Cross policyholders and by a national patient advocacy foundation, who claim that the merger involves an illegal shift in control of charitable assets away from the intended beneficiaries. Lawyers for Blue Cross are citing congressional action on HR 3025 as a defense in the lawsuits. While HR 3025 modified the DC Blues' charter to change its provisions for membership, the legislation was silent on all issues involving the plan's charitable and benevolent status and the charitable nature of assets. A review of the last minute consideration of this legislation in November 1997 that Congress took no action to diminish the charitable status of the Blues plan, nor did Congress contemplate the effect of HR 3025 on the DC Blues' obligations arising from its charitable status.

Mr. STARK

Mr. STARK. Mr. Speaker, we are here to celebrate the career of a champion of Democratic principles in the House of Representatives. I am honored to have served with my friend, Ron Dellums. For over a quarter of a century, I have had the distinct privilege of joining Ron in the good fight. He vehemently opposed our government's involvement in Vietnam. He asked the tough questions and pursued the truth in the crime of Watergate. He demanded quality for women and minorities and defended civil rights. He did not waver in the charge to stop the testing of nuclear weapons. He fought for the poor, the disabled, and the disadvantaged, in the hope that all Americans could partake in our country's bounty. His focus, above all, was to promote peace. His work on the National Security Committee earned him the respect of all his colleagues for his grasp of issues, his focus and his powerful oratory skills. He worked for decades to expose unnecessary military spending and cut defense spending. He came here to make things better for all Americans and he succeeded. Mr. Speaker, I stood with Ron Dellums for close to three decades; I am saddened to see him go but I know he will make a difference for the better wherever he goes.

Mr. STARK

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

Mr. STARK. But has the Committee on Appropriations ever appropriated any money? There is a case where the Committee on Appropriations appropriated $430,000 to pay for the White House travel office. How does that differ in a sense technically from the money the gentleman is talking about spending?

Mr. STARK. Mr. Speaker, what about the two Secret Service agents? There were two Secret Service agents who were investigated for the accuracy of their testimony over White House FBI files. They were not victimized, I do not think. And the Committee on Appropriations voted to pay their legal defense fees. How does that differ?

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

Mr. STARK. Mr. Speaker, one of the people who was sued was investigated by the U.S. Attorney and had to spend some money to defend himself against the U.S. Attorney's investigation, and the U.S. Attorney subsequently decided that the case was not prosecutable or was not worth prosecuting. This was Mr. Magaziner. So the U.S. Attorney investigated him and said they were not going to prosecute him. Would that not be the same? As the gentleman well knows, Mr. Magaziner and I have had vast differences over the years, and I would hate to have this turned around that I am here defending him, but I wonder if perhaps there is someone that feels more strongly about Mr. Magaziner than they might have about Mr. Dale of the travel office and whether we are kind of picking and choosing. That is my concern.

Mr. STARK. Mr. Speaker, I thank the gentleman.

Mr. STARK. Yes, Mr. Chairman, of course. The amendment is germane. It draws on the language of paragraph 2 in section I and extends the very purpose of the resolution to similar actions by Members of Congress. I believe that the Parliamentarian will find that Speaker Muhlenberg, during the Whiskey Rebellion of 1793, had a precedent, saying, ``Sauce for the goose is sauce for the gander.'' And I think Speaker Clay, in dealing with the war in 1812, said, ``Take no prisoners and lie about it.'' So that, I believe, this is indeed germane. I hope that the Chairman will find it so.

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

Mr. STARK. Mr. Chairman, I yield myself the balance of my time. I am troubled, as Members may have realized, and we are doing this just to recap, I least of all would have any brief for Mr. Magaziner and whatever attempts he may have made at public service. I have no brief for people lying, whether it is Republican Presidents or Democratic Presidents or Secretary Schlesinger, Secretary Kissinger, I do not care, Ollie North. People should not lie. It does happen. In this case, the administration apologized and recognized the error of its ways and it has been assessed legal fees to a bunch of right wing wacko doctors down south. And so if they want their $280,000, then let these Neanderthals collect it. And we can do that by, in fact, accepting my unanimous consent request to make this resolution binding. I do not think my colleagues want to touch it. I think the Republicans are afraid that what they have done is so silly that it would cause more harm than good. We have offered to give it to them. We are offering it again. They can have it. They can win. Make it a law. Stop the taxpayers from having to pay the money. But they do not dare. They do not dare. They are backing away. They are cowards. Come on. Here we are, we are willing to prevent it in a law, and they will not do it. I think the American people, Mr. Chairman, have to recognize that the Republicans brought up this issue, they marched up the Hill and, when faced with no opposition, they raised the white flag of surrender and ran away from saving the very day that they tried to win. I say I think that defines the difference between the Republicans and the Democrats. Mr. Chairman, I yield back the balance of my time.