Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, one of the issues under debate between the House and Senate in the Medicare budget reconciliation bill is the issue of whether managed care plans should have an external and on- going--outside--quality review, or whether we should just rely on them being periodically reviewed through the accrediting process. The Peer Review Organization for parts of the Delaware, Maryland, D.C., and Virginia area has written me, showing how HMO's that obtain accreditation from private accrediting agencies can, upon review and check by an external quality reviewing organization, be found to have serious problems. It is important that we have both accrediting and outside, external review. The excerpt from the letter from the Delmarva Foundation for Medical Care, Inc., speaks for itself. Second, I would like to include in the Record a memo from the National Health Law Program concerning the limits and dangers of relying on private accreditation. [From the Delmarva Foundation for Medical Care, July 11, 1997] Table 1 presents non-compliance rates from a Medical Record Review we did of five managed care organizations for FY 97. All but one is accredited by NCQA. Each of these clinical areas were reviewed against specific standards well known and accepted by the industry. For instance, for hypertension, specific processes of care were measured, such as whether the patient had a physical examination, specific laboratory tests, blood pressure monitoring, and diet/exercise education. TABLE 1--ACCREDITATION AND NON-COMPLIANCE RATE WITH CLINICAL PERFORMANCE

Mr. STARK

Mr. STARK. Mr. Speaker, today I rise to defend the rights of legal immigrants in our country. In particular, I would like to address the potential health care crisis that is threatening the well-being of our legal immigrants and our health care system. In the quest to shrink the Federal budget deficit, many government programs have been threatened. Many of my Republican colleagues would lead you to believe that eliminating funding for legal immigrant health care is a fiscally and morally responsible way of attacking the deficit. In the new welfare law, my colleagues have done just that, by leaving many health care funding decisions to state governors. As a result, health insurance programs that currently benefit legal immigrants, such as California's Medi-Cal Program, stand to lose funding when money-strapped states refuse to appropriate sufficient funds. Legal immigrant prenatal care is an example of an essential government funded health care program that stands to suffer. Cutting spending by ignoring the health care of those folks is a perverse approach to reforming our Government. While the benefits of regular prenatal care are widely known, I would like to refresh the memories of some of my colleagues. Regular prenatal care helps to prevent birth outcomes that can be both physically and financially disastrous and distressing. Reductions in infant mortality, long-term disability, and infant and maternal illnesses have been demonstrated in numerous studies documenting the importance of prenatal care. Healthier mothers and babies lead happier lives, resulting in smaller health care costs in the long run. Legal immigrants deserve the same access to these essential prenatal care services as full citizens. We owe much of our country's development and success to legal immigrants. My ancestors and most of the ancestors of my colleagues and fellow citizens entered the country as immigrants. We need to acknowledge not only the contributions of past immigrants, but of current legal immigrants. Many legal immigrants today serve in our military and are hard-working taxpayers. They deserve basic health services in return for their contribution to society. If legal immigrants are denied access to such effective prenatal care, both the government and these immigrants rely on Medi-Cal for their medical coverage, many of which receive prenatal care. If California gains more independent leverage in funding Medi-Cal, as is proposed in the welfare law, innocent mothers and babies stand to be denied preventive care. Instead, they will crowd our hospitals and emergency rooms for avoidable crisis care as well as routine matters. The costs that our state will have to absorb will well offset any savings incurred through the welfare law. This process will be repeated throughout the country, leaving millions of legal immigrants and their states, in dire financial, not to mention public health, straits. I am baffled by why my Republican colleagues would want to encourage the demise of prenatal care programs for legal immigrants just as programs such as Medi-Cal have proven to work so well. According to the California Policy Seminar, Medi-Cal expansions during the 1990's have increased the percentage of pregnant women who received adequate care once they began prenatal care from 72 percent in 1990 to 85 percent in 1995. Willfully halting the progress that has been made in prenatal care availability is irresponsible, immoral, and illogical. Instead of dismantling prenatal care programs for legal immigrants we should be focusing on improving the timeliness of care received by legal immigrant mothers. I appeal to my colleagues to consider these realities as we continue to debate budget expenditures. The attached summary of a California Policy Seminar study on prenatal care documents the need to maintain coverage for legal immigrant prenatal care services. An investment in important preventive health programs secures a healthy future for our country and the legal immigrants who will continue to be integral to our progress as a nation. [California Policy Seminar Brief Vol. 9 No. 2 June 1997] Access to Maternity Care in California (By Paula Braveman, Kristen Marchi, Susan Egerter, Michelle Pearl, Lisa Nelson, Michelle McDermid)

Mr. STARK

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

Mr. STARK. Mr. Speaker, I thank the gentleman for yielding. Picking up on the questioning of the gentleman from Washington, it would be my understanding that we were unable to find the funds to, say, give a working-class family any relief in either bill because if you get $1 million in capital gain, it is my understanding you would save $80,000. That is 80,000 bucks to somebody who is making $1 million in capital gain. The person who is working as a teamster or a carpenter and, say, has no children is getting nothing, zip. That $80,000 as that capital, if you postpone selling that and the stock went up and up and up, that $80,000 would increase over time, and 5 and 10 years from now, the person working at $45,000 has still got nothing out of this bill.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the distinguished chairman for yielding, and I want to agree with him, particularly as to the Medicare part. We are supporting the House position, and we have, and it has been a bipartisan exercise and has not been demagogued. I will talk more about it later. And I agree that the long range program is what has not been addressed by either side, to our shame. We are getting to that. But for now, we have the high ground in the House and I am happy it hear that he is going to, because basically all we are asking is that we stick to the House position.

Mr. STARK. Mr. Speaker, I yield myself the balance of my time.

Mr. STARK. Mr. Speaker, I close by suggesting that I am pleased that my colleagues will be supporting this motion to instruct on a bipartisan basis. Send a strong message to the Senate about our feelings. But I want to warn my colleagues about the future. Any attempt to make Medicare a two-income-level plan, indeed to make it a welfare plan, could put the seniors in the same fate as second class Americans that we will be debating in the next 10 or 20 minutes, because once we allow any Medicare beneficiaries to become in any way suggested that they are welfare beneficiaries, we will see by the attitude that this House directs toward them what could be the sad fate of seniors. So think about it. We must keep Medicare as a broad program in which all seniors participate, and as we change it, and we must do that, we must make sure that it does not become a two-class program, because Members will see the dangers in the future debate on this issue. Mr. Speaker, I thank the distinguished chair of the Committee on the Budget and the ranking member and the chairman of the subcommittee for their courtesy.

Mr. STARK. If the gentleman would continue to yield, I think it was 25 short. But other than that, I am aware of it.

Mr. STARK. Mr. Speaker, I thank the distinguished ranking member for yielding me this time, and I yield myself 2\1/2\ minutes. Mr. Speaker, insofar as the Medicare provisions in this bill are concerned, it is a matter of record that we have had strong bipartisan cooperation and agreement in the House. My remarks today are designed to amplify the problems in the Senate bill and for whatever other effect we may have is to give us a stronger hand in dealing with the Senate in conference, which indeed has been a tradition of motions to instruct for many years. A vote by this House representing the strong feelings that we have in support of our bill is an aid in negotiating and to show that we have the support of the American people. The Senate has basically taken a silk purse and turned it into a sow's ear. We find this morning a poll of the Washington Post that says 64 percent of the people oppose extending the wait for Medicare to age 67. The AARP bulletin, which I now get, Mr. Speaker, says that the Medicare measure takes the wrong turn. That is in relationship to the Senate bill. The Senate also allows doctors to bill patients more, or extra. It allows doctors to force patients to give up Medicare if they want certain specialty care from these doctors. It cuts payments to the Nation's safety net hospitals by 20 percent. It increases home health care cost in the Nation's frailest and sickest by $760 a year. I hope that the conference committee will stand firm and fix these provisions, and I pledge to work with the gentleman from California [Mr. Thomas] and the gentleman from Ohio [Mr. Kasich] to see that we do prevail over the Senate, for these provisions will do harm to the Medicare system. There are ways in which we can change Medicare and make it more solvent. I would like to work with them. I believe that raising the age limit without a plan to protect the people from 65 to 67 is the wrong way to go, and I think we can work to fix that in the years ahead.

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

Mr. STARK. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from California [Mr. Waxman].

Mr. STARK. Mr. Speaker, would the gentleman yield?

Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Ohio [Mr. Strickland].

Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished gentleman from Maryland [Mr. Cardin].

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from Connecticut [Mrs. Kennelly].

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Ohio [Mr. Kucinich].

Mr. STARK

Mr. STARK. Mr. Chairman, I rise in support of the Conyers amendment to H.R. 1775, the Intelligence Authorization Act of 1997. There is no reason for the intelligence budget to be classified information. How can we justify a multibillion--or is it more--blank check every year without adequate oversight and minimum public discussion? If this Congress is serious about balancing the budget, we should not throw money into an unaccountable hole. Since almost all of the intelligence spending is hidden within the defense budget, we are misled about the real amount of intelligence spending through false line items in the defense budget. We must have budget integrity. The intelligence budget is routinely reported by the media without compromising national security. When the Government keeps this open secret clandestinely hidden, the American public grows increasingly cynical about their Government. I believe that our intelligence community could better justify the funding they receive from Congress with a disclosed budget. In the same vein, the intelligence community could help to balance the budget by submitting their funding to the same scrutiny faced by domestic priorities. This amendment is about accountability and the public's right to know. There is no reason to keep this information from a full and open debate. I urge my colleagues to support the Conyers amendment.

Mr. STARK. Mr. Chairman, I rise in support of the Sanders amendment to H.R. 1775, the Intelligence Authorization Act of 1997. The cold war is over. The specter of communism no longer lurks on the horizon. While we face new challenges in this new age, the need for clandestine activity has been severely lessened. I support the Sanders amendment to reduce the intelligence authorization by 10 percent. While the exact level of appropriations is confidential, the New York Times reports that over $30 billion is spent to support the intelligence community. A 10-percent cut would place $3 billion back into deficit spending, or provide funds for many other more necessary activities. Thirty billion dollars is more than twice the combined intelligence budgets of our supposed hostile nations--North Korea, Iraq, Iran, Syria, Libya, and Cuba. It is also more than the intelligence budgets of the United Kingdom, Australia, Germany, and Canada combined. Within so many other pressing domestic priorities, can the taxpayers of this country afford $30 billion, or more for intelligence activity? I urge my colleagues to join me in supporting the Sanders amendment to H.R. 1775.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise in support of the amendment to H.R. 858 offered by Representative Miller which would ensure the environmental integrity of an otherwise bad bill. Based on its own merit, H.R. 858 is a bill that would have serious environmental and fiscal impacts. Proponents of H.R. 858 have sold the bill as a consensus between environmentalists and the timber industry. In reality, no such consensus exists. Environmental organizations from the affected forests oppose this bill. To date, not a single environmental organization has endorsed the bill. Further, when the Clinton administration hosted meetings between the Quincy Library Group and environmental organizations, the Quincy Library Group ended those negotiations. So much for collaboration. There are a number of serious concerns with the legislation. If enacted, this bill would double the amount of logging that is currently being practiced on the Lassen and Plumas National Forests and the Sierraville Ranger District of the Tahoe National Forest. Further, there are no assurances that the logging will not violate environmental law. The massive experiment consisting of up to 350,000 acres of logging over a 5-year period, would be done prior to environmental review. This is fundamentally contrary to the provisions of the National Environmental Policy Act and National Forest Management Act. The experiment could cause tremendous harm on the ground. Finally, the bill is bad for the taxpayers. The Congressional Budget Office has stated that the implementation of the increased logging levels that would be allowed by H.R. 858 would cost taxpayers $83 million over the next 5 years. This money will come from other programs on the Lassen and Plumas National Forests. It is fiscally irresponsible to continue to spend taxpayer dollars to subsidize an increased logging program that already costs taxpayers millions of dollars each year. Representative Miller allows the pilot project to go forward, but simply makes sure that no environmental laws are waived or superseded. What could possibly be wrong with that? Let's do the right thing for the environment. The environmental analysis should determine the levels of logging, not a handful of local residents who would ask the rest of the taxpayers to pay the $83 million price tag for a project that makes an end run around our country's environmental laws. I urge my colleagues to support the Miller amendment, and if accepted, to support H.R. 858.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to submit for the ='04'>Record recent testimony I presented to President Clinton's Advisory Commission on Consumer Protections and Quality in the Health Care Industry. The need for consumer protections in managed care is great--I urge my colleagues to pass legislation to protect the millions of patients in managed care plans: Testimony of Congressman Pete Stark Before the Advisory Commission on Consumer Protection and Quality in the Health Care Industry Secretary Shalala, Secretary Herman, and Members of the Commission: Thank you for this opportunity to present testimony concerning critically needed consumer protections for the millions of Americans in managed care plans. Background Health care consumers who entrust their lives to managed care plans have consistently found that many plans are more interested in profits than in providing appropriate care. In the process of containing costs patients are often harmed. My constituent mail has been full of horror stories explaining the abuses that occur at the hands of HMOs and other forms of managed care. For example, David Ching of Fremont, California had a positive experience in a Kaiser Permanente plan and then joined an employer sponsored HMO expecting similar service. He soon learned that some plans would rather let patients die than authorize appropriate treatment. His wife developed colon cancer, but went undiagnosed for 3 months after the first symptoms. Her physician refused to make the appropriate specialist referral because of financial incentives and could not discuss proper treatment because of the health plan's policy. Mrs. Ching is now dead. This tragedy and others like it might have been avoided if the patient had known about the financial incentives not to treat, or if the physicians had not been gagged from discussing treatment options, or if there had been legislation forcing health plans to provide timely grievance procedures and timely access to care. It is too late for some victims, but it is not too late to provide these protections for the millions of people in managed care today. A few years ago, Congress recognized a crisis in the health care industry. Expenditures were soaring and overutilization was the rule. At that time, I chose to address this problem with laws that prohibited physicians from making unnecessary referrals to health organizations or services that they owned. Others responded by pushing Americans into new managed care plans that switched the financial incentives from a system that overserves to a system that underserves. They got what they asked for. The current system rewards the most irresponsible plans with huge profits, outrageous executive salaries, and a license to escape accountability. Unfortunately, patients are dying unnecessarily in the wake of this health care delivery revolution. It must stop. Several states have already addressed the managed care crisis. In 1996, more than 1,000 pieces of managed care legislation flooded state legislatures. As a result, HMO regulations were passed in 33 states addressing issues like coverage of emergency services, utilization review, post- delivery care and information disclosure. Unfortunately, many states did not pass these needed safeguards resulting in a piecemeal web of protections that lacks continuity. The states have spoken; now it is time for federal legislation to finish the job and provide consumer protections to all Americans in managed care. H.R. 337--The Managed Care Consumer Protection Act of 1997 I have introduced a bill--H.R. 337--The Managed Care Consumer Protection Act of 1997 which includes a comprehensive set of protections that will force managed care plans to be accountable to all of their patients and to provide the standard of care they deserve. This legislation includes measures to protect patients from the abuses of managed care on several fronts. One particular provision in the bill would require the managed care plan to at least see the patient and perform some form of preventive health screening before the Federal government pays the monthly capitated dollar amount. We should not continue to pay plans a monthly fee when many times, the plan has never seen the beneficiary face-to-face. If one of the goals of managed care is to focus on preventive care, the patient must--at the very least--first be seen by the managed care plan. I am pleased that many of the provisions in my bill were included in the recent Medicare proposals in both the Ways and Means and the Commerce Committees. I have attached a summary of the bill for your review. Many Members testifying today have introduced legislation with similar provisions. In that light, I will focus on only a few issues. A Plea to Revisit the Physician Financial Incentive Issue I am the author of the law limiting physician financial incentives to withhold care. I am very disappointed in the regulation implementing this law. The regulation allows a plan to place a doctor 25 percent at risk. How many of you flew here on an airline that gave 25 percent bonuses to its airplane mechanics NOT to spend too much time checking the plane's safety? Good luck going home. What is particularly disappointing about the 25 percent figure is that there is some data that the industry average is closer to 19 percent. The 25 percent figure should be lowered. I urge you to recommend that it be phased down over a period of years to a level where the average patient would not be offended or suspicious. If you think the 25 percent figure is okay and won't change behavior in strange ways, I refer you to a Wall Street Journal article of two weeks ago, which talked about doctors selling Amway products to their patients to make extra money on the side. The doctor featured in the article had seen his income from $400,000 a year to $300,000, so he was selling soap to everyone in sight. Think about it. Need to Reform Government Oversight Structure HCFA has an impossible task: to promote managed care and at the same time to try to regulate it on behalf of consumers. The two missions are inconsistent: you can't do both well. Note the current controversy over the Grijalva case, where HCFA has come down on the side of the HMO companies, much to the anger of every consumer group in the nation. We need a new structure of governance as managed care grows. I urge the Commission to recommend a restructuring of government to address this problem. Let HCFA be the promoter and payer of managed care plans. That is certainly their bureaucratic culture and history. For the public and the consumer, we need a new, independent consumer commission that will make coverage, consumer appeals and grievance, and quality measurement decisions. I recommend to you the SEC-type model suggested in several books and articles by Professor Marc Rodwin of Indiana University. This Commission should be composed of consumers and must be structured so it is never captured by the industry. We need an independent consumer commission now. We will need it more each passing day. I do not believe that HCFA has yet made Medicare coverage decisions on the basis of cost to the program. But as the Baby Boom generation retires and the financial pressures on the program become more intense, will people be able to trust their government to make medically honest coverage decisions? Will HCFA become a rationing system that controls costs but may not be good for our health? Various right-to-life groups are already questioning the program. An independent consumer commission that would address coverage issues would prevent this government rationing issue from becoming a future divisive issue in our aging society. A wise industry would support such a Commission: it is their only hope to show the public that there is an independent, honest ombudsmen whom families can turn to in matters of life and death concerning health care. The managed care industry is facing a weekly drumbeat of ridicule in the one place that truly has the pulse of the American public-- the nation's comic strips and political cartoons. The last page of my testimony attaches two cartoons from just the Washington Post of the last week. What would it be worth to the HMO industry for these cartoons to go away? They will go away when the public no longer things they are funny and when they no longer resonate. An independent, pro-consumer Commission is the single best answer to ending the ridicule and bad press. The impending crisis in rural managed care I urge the Commission to take a special look at what I believe is an impending crisis in rural health care. In the Medicare Reconciliation bill, Congress is preparing to place a very high floor on payments to managed care plans in rural counties--a floor far above their cost of serving the beneficiaries who live in those communities. At the same time, we are making it easy for local doctors and hospitals to form Provider Sponsored Organizations or ``baby HMOs'' that serve as few as 500 enrollees. PSOs in rural America, where there is already a shortage of providers, will certainly look like monopolies. The combination of the high managed care payments and the new PSOs will work to force most rural Americans into brand new HMO-type organizations. The good news is that the payment floors will be so high that (if the ACRs are calculated honestly) rural Americans will be offered a wide range of extra benefits. The bad news is that it may be hard for rural Americans to get referrals to urban or out-of-area providers who can provide better quality care than their local rural

Mr. STARK

Mr. STARK. Mr. Chairman, I cannot support H.R. 2014, a bill to provide $85 billion in tax cuts because I believe the provisions of this bill are unfair and unwise. Our country would be far better off to delay tax cuts for a few years until we have a balanced budget. After almost two decades of trying to recover from the Reagan cuts of 1981, we should have learned that large tax cuts given when a budget is not yet balanced can create havoc for decades. We have not learned our lesson; this majority persists in pushing tax cuts with abandon. If we had the surplus, I would prefer to invest $85 billion to preserve the Medicare system--$85 billion would guarantee solvency past the year 2020, providing assurance of health security for millions of seniors. The majority party rejects that option. If the Nation had a balanced budget, I could support tax cuts but they would have to benefit all workers, not just the upper brackets. I could support education benefits, if they went to all young people, not just those whose parents have $10,000 a year to stuff in an education fund. If the Nation had a balanced budget, I could support a child credit to help the hard working families with the costs of raising children. I could never support the illusion of a family credit which is held out to all families but, in reality, available only to more affluent families. If the Nation had a balanced budget, I could support rate reduction for all taxpayers not just those who make their money from Wall Street investments. We don't have a balanced budget today. Until this bill got the House floor, the Nation was on the path to a balanced budget but we are not quite there. Perversely, in a bill designed to balance the budget, we are today considering measures which will have devastating budget results that go well into the next century. We owe it to our constituents, our children and ourselves to vote ``no'' on this bill.

Mr. STARK

Mr. STARK. Mr. Speaker, I am voting against the spending provisions of the budget resolution today for several reasons. The Ways and Means Committee approved the Medicare title of the budget bill in a bipartisan manner. We were given a number--$115 billion--by the Budget Committee. $115 billion is a higher number than I would have liked, but it was what we were given. We've successfully made all the groups and lobbyists in town equally unhappy--a sure sign that we've done something right. But there are still many unacceptable provisions in the Medicare title. Medical savings accounts have no place in the Medicare Program. They are a terrible scam to rip off Medicare for the sake of insurance companies and healthy, wealthy beneficiaries. Every legitimate health care policy expert has concluded that MSA's would create extra costs, resulting in a weakened trust fund. The Congressional Budget Office estimates that the extra cost to Medicare for each person who signs up for an MSA will be $1,000 in 1999, rising to an extra $1,650 by 2007. These costs are far too great to bear when we are trying to cut Medicare spending in order to preserve the program for future generations. We could have--and should have--done more to fight fraud and abuse in the Medicare Program. The administration proposed at least a half billion dollars worth of antifraud changes which the committee did not accept. The press reports that the Medicare Office of Inspector General will soon release an audit of Medicare that shows a fraud, waste and abuse rate of 14 percent. That means about $23 billion in Medicare payments should not be made each year. Over 5 years, that equals $115 billion--the same amount we are cutting in this bill. We will never stop every last dollar of fraud and error, but we should certainly be doing better. To leave any antifraud proposals on the table when so much is being lost is not fair to the taxpayer or to the beneficiary. Tomorrow's tax bill is a great wasted opportunity for the Medicare Program. Consider this: If we did not pass a tax cut bill tomorrow, but kept the amount of money that is going to be given away--largely to the rich--in savings bonds for Medicare, we could extend the life of the Medicare trust fund past 2021. The public should ask politicians who talk about the need to restructure Medicare and cut back its benefits, why they voted for a tax break for the rich, instead of saving that money for Medicare. As we move to conference on the Medicare provisions, I challenge my colleagues to fully consider the devastating effects of Medicare structural changes proposed by the Senate. We must defeat the Senate's idea of raising the age of Medicare eligibility from 65 to 67. This proposal is certain to increase the number of uninsured when early retirees and those retiring at age 65 are unable to afford private insurance policies to bridge the gap until Medicare eligibility. We should be expanding health insurance coverage in America--not shrinking it. The Senate has proposed increasing the part B premiums and even the deductible on the basis of one's income. Others are talking about forcing seniors into managed care plans, and turning the program into a defined contribution plan that will not keep pace with inflation. The Republican spending bill is flawed in other areas as well. The Republican health proposal for children's health falls far short of providing health insurance for 5 million children as called for under the balanced budget agreement. Instead, the Congressional Budget Office estimates it will cover only half a million children. The bill proposes an unaccountable block grant which would allow States to: supplant rather than supplement, existing health funds for children; provide health care providers with additional funding even if they don't add new services for children; and use funds in a manner that would catalyze State fiscal gamesmanship. There is no requirement that a single child receive health insurance coverage under the proposal. In terms of welfare, the Republican bill makes a group of Americans, who must rely on welfare to support their children, second-class citizens. These citizens, who must work off their benefits, will have no clear protections from sexual harassment or employment discrimination, and will be deprived of other crucial worker protections. There is no requirement that workfare workers get the same benefits and working conditions as others working a similar length of time and doing the same type of work. This is simply not fair. Additionally, the Republican bill restores SSI and Medicaid to 125,000 fewer legal immigrants than the bipartisan budget agreement by the year 2007. The budget proposal would allow States to cut benefits to elderly, blind, and disabled Americans. I did not support the welfare reform bill that passed last Congress because it needlessly and cruelly throws over 1 million children into poverty, and I do not support the Republican proposals today. The Republican attempts to reform welfare will end in destitution and misery for many innocent children. For these reasons, I urge my colleagues to vote against the spending portions of the Budget Reconciliation Act and to carefully scrutinize the Senate restructuring proposals as we move toward conference.

Mr. STARK. Mr. Speaker, I want to say on behalf of myself and many of the committee's Democrats that we would like to commend the gentleman from California [Mr. Thomas], the full committee, and the Subcommittee on Health's staff director Chip Kahn for an open and consultative and bipartisan approach to the Medicare legislation. It is really a model, I suspect, of how the legislation should be written. I am not sure I can quite make myself say that it is a model of legislation, but it was done in a tradition of past Medicare bills. It extends the life of the Medicare trust fund to 2007, it makes reforms in the way we pay providers, and it indeed adds some beneficiary improvements. I do not intend to vote for the budget bill, but it is not because of the Medicare portion. If anybody was thinking of that, I would dissuade them otherwise. There are some things we should strongly oppose and do differently. We should oppose the Senate's provision to raise the age to 67, which causes more problems I think than it solves. I think we should oppose the Senate's copay provisions because we already charge Tiger Woods on $10 million, $300,000 a year for the same premium that somebody at $10,000 a year would pay $300 for and get the same benefit. Why punish Tiger Woods twice? The managed care provisions need consumer protections on emergency appeals, and there are some antifraud provisions that we should add. We are going to see a report in the next few weeks that we are spending $20 billion, I think, on fraud. That needs to be improved. We can do that. Mr. Speaker, I would urge my colleagues to applaud the work that was done. I would not have picked $115 billion as a cut, but that was the number given to our subcommittee and, considering that, they did a fair job of spreading those cuts to do the least amount of harm. Nobody liked it. If anybody had been smiling in the room, we probably would have had the wrong bill. But it was a good job, and I commend the chairman of the subcommittee for his work.

Mr. STARK

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

Mr. STARK

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Maryland [Mr. Wynn].