Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to congratulate Mr. Dick Faux who has recently been selected as the 1997 Business Person of the Year by the Milpitas Chamber of Commerce. Mr. Faux is the co-owner of the Bankers Mortgage Network of Milpitas located in California's 13th Congressional District. Dick as been a dedicated member of our community for over 29 years. He has been an active member of the Milpitas Chamber since February 1998 who can always be counted on to volunteer for such duties as the annual crab feed and serving on the golf tournament committees. He is also a well-known member of the Chamber's Ambassador Committee. Dick also served as president of the Milpitas Rotary Club for the 1996-97 year. Throughout his years as a Rotarian he has been a member of many of the Club's committees, chaired numerous projects for the Club and served in a variety of leadership roles. He has also been an active member of numerous other community organizations including the Milpitas YMCA, Women and their Children Housing [W.A.T.C.H], the American Cancer Society, the American Heart Association, Big Brothers, and the First Presbyterian Church in Milpitas. Dick Faux will be honored by his friends and colleagues at the Milpitas chambers' annual installation and awards banquet to be held on Friday, June 19, 1997. I am proud to recognize Mr. Dick Faux as the 1997 Milpitas Business Person of the Year.

Mr. STARK

Mr. STARK. Mr. Speaker, on June 18, 1997, the city of Fremont and the Mid-Peninsula Housing Coalition will celebrate the grand opening of Pickering Place, a 43 unit affordable housing development, in the city of Fremont in California's 13th Congressional District. I commend both the Mid-Peninsula Housing Coalition and the city of Fremont for coming together to complete this project. Affordable housing is an urgent need in California and the Mid- Peninsula Housing Coalition has been a leader in the development of affordable housing. They have developed over 3,300 units in the Greater Bay Area and are currently working on eight more projects. This new project, Pickering Place, will provide 43 affordable townhouse apartments for low-income families in our community. I would also like to take this opportunity to congratulate the Fremont City Council and the city of Fremont staff who worked together with the Mid-Peninsula Housing Coalition to develop the vision and the plan for Pickering Place. This development would not have been possible without the funding and support from a variety of sources in the community, including a loan from the Fremont Redevelopment Agency. Mr. Speaker, Pickering Place is an example of an extraordinary partnership. I applaud all of those who were involved in bringing this project to our community.

Mr. STARK

Mr. STARK. Mr. Speaker, in the few short months since Congress has embarked on the misguided and destructive mission of welfare reform, the dismantling of the safety net necessary for the health and well- being of our Nation's most vulnerable populations--our children and the elderly--has reaped deadly effects. The Republican wish has come true. Republicans have successfully removed the neediest Americans from the rolls--permanently. In March of this year, one man took his own life to avoid the uncertainty of the future. After receiving a letter informing him that he might be cut off of Social Security, Ignacio Munoz, a 75-year-old elderly legal immigrant, put a gun to his head and pulled the trigger. Mr. Munoz had worked in the United States for 40 years, but the Social Security Administration had payment records only for 10 years. Mr. Munoz committed suicide because of extreme fear of being cut off from his only means of support. Mr. Munoz' fear of being left out in the cold continues to grip the legal and elderly immigrant community. Still, with vehement opposition from State and local governments, advocacy groups, and poor and disabled Americans themselves, Republicans continue to turn a deaf ear while unashamedly forging ahead. As the Ways and Means Committee begins the welfare reconciliation markup, I believe it is important to heed these predictions from experts concerning the impact of welfare reform: children In California, nearly 250,000 children would be denied benefits.-- Children's Defense Fund Nationwide, nearly \1/2\ of all children with disabilities, or 140,000, will lose SSI.--Children's Defense Fund Nearly 3.3 million children would be denied welfare assistance.-- Children's Defense Fund 1.14 million children will be driven into poverty, making one child in four poor in America.--Children's Defense Fund Nearly 134,000 children in New York State would be impoverished.-- Children's Defense Fund 300,000 children will be cut from SSI.--Social Security Administration 50,000 children will lose Medicaid benefits.--Social Security Administration Over 57,000 children in Texas would be reduced to poverty.-- Children's Defense Fund Nearly 64,000 children in Michigan would be made poor.--Children's Defense Fund 1.2 million legal immigrants, including 450,000 children, would lose SSI and/or food stamps.--Children's Defense Fund 10% of all families nationwide would lose some benefits.--Children's Defense Fund For families with children, more than 20% would lose some benefits.-- Children's Defense Fund 20% of families with children would have their incomes reduced by $1,300 a year.--Children's Defense Fund legal immigrants 500,000 legal immigrants will be cut off the SSI rolls--Washington Post, May 3, 1997 Nearly 1,000,000 legal immigrants will lose food stamps.--Washington Post, May 3, 1997 400,000 elderly legal immigrants will not receive SSI.--Los Angeles Times, June 5, 1997 100,000 severely disabled legal immigrants will be cut off SSI.--New York Times, June 5, 1997 1,000,000 legal immigrants could lose food stamps nationwide.--Los Angeles Times, May 2, 1997 Four states--California, New York, Florida, and Texas, with \1/3\ of the House of Representatives and all with Republican governors--would be the hardest hit under this new law.--Newsday, April 10, 1997 Legal immigrants account for 5% of those in the U.S. who receive welfare, but will bear 44% of the cuts.--San Francisco Chronicle, February 13, 1997 Legal immigrants--including those poor legal immigrants over 75 or permanently disabled--are wholly ineligible for food stamps.--Center on Budget california 224,000 legal immigrants will be cut off in California--Rocky Mountain News, May 17, 1997 Over 3,000 elderly legal immigrants will lose welfare benefits in Sacramento County.--Sacramento Bee, May 17, 1997 41% of all legal immigrants who are scheduled to lose disability payments live in California.--Los Angeles Times, May 2, 1997 427,000 legal immigrants live in California.--Los Angeles Times, May 2, 1997 135,000 legal immigrants over 65 years old live in California.--San Francisco Chronicle, April 19, 1997 Three-fold increase in the number of new homeless.--Alameda County Health Care Services In California, hundreds of thousands coming off the welfare rolls would vie with one million already on the unemployment rolls for entry- level jobs.--San Francisco Chronicle, January 10, 1997

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to introduce the Reduction in Medicare Overpayment Costs Act of 1997, which imposes an administrative fee on providers who submit inaccurate Medicare claims. The American taxpayer spends nearly $200 billion on Medicare every year. However, billions are lost due to inaccurate claims or overpayment. This burdens the Nation with serious financial costs, threatening the quality of medical care and endangering the long-term sustainability of the Medicare Program. The Reduction in Medicare Overpayment Costs Act of 1997, which was introduced in the Senate by Senator McCain, will help eliminate overpayments by imposing an administrative fee to offset recovery costs. The purpose is to discourage doctors from submitting false or misleading claims and to prevent hospitals from excessively overestimating Medicare costs. The act promotes these purposes in three ways. First, the act imposes an up to 1 percent administrative fee if the repayment is more than 30 days late. Second, the act will impose an up to 1 percent administrative fee if the provider overestimates Medicare needs by greater than 30 percent. Third, the act requires the issuance of a report detailing which services typically result in overpayments. This act is needed to crack down on incorrect or inflated claim practices in Medicare. I urge my fellow members to vote in favor of this bill to ensure claim accuracy by Medicare providers.

Mr. STARK

Mr. STARK. Mr. Speaker, along with Mr. McDermott and Mr. Weygand, I am pleased to introduce the Medicare and Medicaid Fraud, Abuse and Waste Prevention Act of 1997, a bill that will implement the President's recent initiative to combat waste, fraud, and abuse in Medicare and Medicaid. Although I congratulate the Republicans for accepting many of the provisions within the administration's fraud bill, several provisions critical to the fight against health care fraud were not included in the budget Medicare package as proposed by Chairman Bill Thomas and should be made law. The U.S. taxpayer spends $191 billion each year to fund Medicare programs. However, $20 billion, or 10 percent, is lost to fraud. Too many health providers are putting their hands into the public trough. Too many individual physicians, nursing homes, and medical equipment dealers are overcharging the American taxpayer for alleged legitimate Medicare expenses. Health care fraud burdens the Nation with enormous financial costs, threatening the quality of health care, and endangering the long-term sustainability of the Medicare Program. Operation Restore Trust, a demonstration program of Health and Human Services, has recovered $23 for every $1 spent in their efforts to fight fraud. The program began 2 years ago in California, New York, Texas, and Florida, where large concentrations of Medicare recipients live. To date, the program has identified $188 million owed to the Federal Government and led to 74 criminal convictions. Why do we need these amendments to crack down on fraud and abuse in the Medicare system? It is to prevent scam artists from preying on vulnerable senior citizens. It is to prevent people like Dorothy and Barry Hultman of Connecticut from building a luxury, state-of-the-art home by scamming the system and overbilling Medicaid by $1.15 million for nonexistant or exaggerated costs. It is to prevent people like Vernon Will from filing for bankruptcy and discharging nearly $20 million in debts, while his nursing home closed in San Jose, CA, notifying 27 elderly residents that they had 1 day to pack up and leave. It is to prevent a nursing home from collecting $5,000 for surgical tape for a patient, who somehow used 12.5 miles of this tape over a 6- month period. It is to prevent drug traffickers identified by the FBI from targeting the health care system. Finally, it is to prevent the American taxpayer, vulnerable senior citizens, and the poor from being taken for a ride by scam artists. This bill would potentially save the American taxpayer billions of dollars. According to Secretary Shalala, the program's goals are threefold. First, the amendments make it difficult for fraudulent people to get into the system in the first place. Second, the amendments require providing Federal health care programs with Social Security numbers to track fraudulent or suspect invoices. Third, the amendments enact very strong penalties for those convicted of fraud. The first goal, making it difficult for a bad actor to enter into the system, and would permit the Secretary to refuse to accept or to terminate an agreement for Medicare if convicted of a felony. Under the second part of the bill, Medicare providers would be required to provide verified Social Security Numbers and employer identification numbers [EINs] for their practices and for any owners or managing employees. Lastly, the bill permits a court to impose very strong penalties for violations. The penalties include criminal and civil penalties and injunctions. Also, filing for bankruptcy would not discharge a debt to the United States under Medicare or Medicaid. Again, the goal is to deter those who would try to circumvent the law. By passing this bill we will accomplish three things. First, we will send a message to those who prey on the more vulnerable segments of our society. We will find them and punish them to the fullest extent of the law. Second, we will give new tools to those fighting health care fraud in helping them to ferret out corruption. Finally, we will reduce the corruption in the nearly $200 billion Medicare Program, saving money both in the short and the long run. I urge my fellow Members of Congress to join with me in passing this important piece of legislation. Together, we can combat waste, fraud, and abuse in Medicare and Medicaid. I refer my colleagues to the attached document, which provides a more detailed description of the bill. Medicare and Medicaid Fraud, Abuse, and Waste Prevention Amendment of 1997 Section-by-section Summary (Except as otherwise indicated, this bill amends provisions of the Social Security Act.)

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize Cheryl Cook-Kallio, teacher of social studies at Hopkins Junior High School in Fremont, CA. A public educator for over 17 years, Ms. Cook-Kallio has been awarded a James Madison Fellowship by the James Madison Memorial Fellowship Foundation of Washington, DC. Ms. Cook-Kallio is one of 61 recipients of this highly distinguished fellowship to support the continued study of American history and the Constitution by teachers of American history, American Government, and social studies. She will be awarded up to $24,000 to be used toward her master's degree. Next summer Ms. Cook-Kallio, along with the other fellowship recipients, will attend a 6-week course at Georgetown University to study the Constitution in the National Archives. Her lifelong dream has been to intensively study the Constitution, and through this fellowship, that dream will be recognized. Ms. Cook-Kallio is an annual visitor to Washington, as she accompanies her eighth grade American Government class on their end-of- the-year trip to our Nation's capital each year. Ms. Cook-Kallio is a graduate of Hopkins Junior High School herself, who went on to study at the University of North Carolina-Charlotte, and received her teaching certificate at San Jose State University. She began her career in education at Hopkins in 1979, where she has been teaching ever since. Competition for this fellowship is fierce, drawing applicants from all 50 States, the District of Columbia, the Commonwealth of Puerto Rico, and the Nation's islands and trust territories. Ms. Cook-Kallio deserves much praise for her accomplishment, as the award is intended to recognize the most distinguished of teachers. It is important for us to understand that learning is a lifelong process, that knowledge and exploration are the roots of creativity. We congratulate Cheryl Cook-Kallio and wish her the best of luck on furthering her education and on continuing to share her knowledge of the workings of our government with the students of Hopkins Junior High.

Mr. STARK

Mr. STARK. Mr. Speaker, together with Mr. Kildee, Mrs. Lowey, Mr. Miller of California, Mr. Frank of Massachusetts, Ms. Pelosi, Mr. Sanders, Mr. Tierney, Mr. Frost, Mr. Dellums, Ms. Christian-Green, Mr. Lewis of Georgia, Mr. DeFazio, Mr. Waxman, Mr. Rangel, Mr. Kleczka, Mr. Berman, Mr. Kennedy of Rhode Island, Ms. Rivers, Mr. McGovern, Mr. Kucinich, and Ms. Tauscher, I am proud to introduce the Managed Care Plan Accountability Act of 1997, a bill which amends ERISA to provide equality and fairness to the millions of Americans whose health benefits are regulated by the Federal Government. ERISA was enacted in 1974 to uniformly govern employee benefit plans. To this end, ERISA includes a wide-ranging preemption provision that supersedes any and all State laws insofar as they relate to an employee benefit plan, including health insurance. Under current law, ERISA managed care plans are often completely exempt from liability for any medical decision made as a result of plan policy. If a patient is injured as a direct result of a plan's cost- containment policy, for example, the patient is entitled to sue only for the value of the denied treatment. Patients in ERISA plans are not entitled to other compensation, such as lost wages or pain and suffering, as is currently available to patients in non-ERISA plans. For example, Newsweek magazine recently reported a case in which a managed care plan denied a heart attack victim's request for surgery because the only hospital qualified to perform the needed procedure was located outside of the plan's service area. By the time the patient appealed the decision and received the necessary approval, it was too late. The patient's heart was damaged beyond repair, and he died shortly thereafter while awaiting a heart transplant. In this case, the patient's health insurance was part of an employer-sponsored benefits package and therefore, regulated by ERISA. Under current law, the family was entitled only to the cost of the denied procedure. In other words, the most damaging thing that could happen to the HMO responsible for the loss of their loved one is the cost of the procedure that could have saved the person's life. While a price tag should never be put on a human life, there should be some reasonable compensation paid to patients and their families who are victims of medical malpractice. This is especially true when victims suffer life-altering, if not fatal injuries due directly to the negligence of a plan executive attempting to save money. Imagine if your child died of leukemia because your HMO would not authorize an early blood test. The twisted irony is that you could recover no more than approximately $130--the cost of the test. A child's life is surely worth more than $130. This is a travesty. This bill would create a new cause of action under ERISA which would allow consumers to seek additional damages from employer-sponsored health plans. The new cause of action would have concurrent jurisdiction, allowing the action to be brought either in Federal or State court. Additionally, this legislation would protect physicians from unfair lawsuits by making the health plan responsible for constraints they place on providers. Our legislation is fair and long overdue. Plans that actively manage the care of their enrollees must be held accountable for their decisions. Employees of ERISA-regulated health plans deserve the same rights and protections as people in non-ERISA plans.

Mr. STARK

Mr. STARK. Mr. Chairman, when Congress considered NAFTA, members of this committee received the unqualified assurance form Ambassador Kantor that U.S. environmental laws and standards would not be lowered if Congress approved the agreement. Well--here we are--about to do just that as we consider the Gilcrest bill and its changes to the dolphin-safe label. A brief explanation of the fishing techniques of the Mexicans--our trading partner pushing for the change in law--might help the Members understand what is at stake here. Schools of large yellow fin tuna swim beneath schools of dolphins in the eastern tropical Pacific Ocean. The dolphin schools--often 400-500 animals--are chased at high speeds by helicopter and speed boats for periods of 30 minutes to several hours. When the dolphins become too exhausted to swim, encircling nets are dropped around the dolphins and the tuna. Many dolphins become trapped in the nets and drown. Others die from injury of extreme exhaustion. After an outcry from Americans, many of them school children, U.S. tuna companies announced in 1990 that they would not buy tuna caught while harming dolphins. The U.S. tuna fleets moved to the waters of the western Pacific nations where the tuna do not swim with the dolphins. The Dolphin Protection Consumer Information Act, 1990, codified that tuna harvested with large-scale nets is not dolphin-safe. H.R. 408 lowers our labeling standards and misleads the American people. It would allow tuna to be labeled dolphin-safe even though it was caught with encirclement techniques that we know killed and injured hundreds of thousands of dolphins before environmental laws and industry practices changed fishing techniques. H.R. 408 would allow tuna to be certified ``dolphin-safe'' merely if an observer didn't see any dolphins die. However, nothing in this bill would preclude severely injured dolphins to be dumped back into the sea to die. H.R. 408 would condone 5,000 dolphins deaths in 1997 in exchange for a promise of reduced dolphin mortality in future years. If this bill were a serious attempt to reduce dolphin mortality in tuna fishing, it would have started with current mortality levels of 2,574 in 1996. American consumers--American children--deserve a dolphin-safe label that they can take at face value--one that means what it says. We have a labeling system that consumers trust. Altering the meaning of the label is nothing short of consumer fraud. Mr. Speaker, I strongly object to our environmental laws being dictated by the Mexican fishing industry and I rise in opposition to H.R. 408.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to introduce the School-based Children's Health Insurance Act of 1997. Health insurance equals access to health care. Access to health care equals better health and a better quality of life. It is that simple, and it should be that simple for all kids. I have sponsored several bills this Congress that address the need for health insurance for uninsured children in low-income families. This bill is modeled, in part, after the nationally recognized, award winning Florida school-based Healthy Kids Program. The bill combines this effective school-based approach with a sliding scale tax credit so that all parents of children can buy affordable health insurance through their own school system. This bill provides up to a 90-percent tax credit for low-income families plus an effective distribution system for actually getting private market health insurance products to the 10 million children that are not currently covered. Each Member of Congress was elected to make laws that make sense. This bill makes sense. It realistically reaches all of the 10 million uninsured kids in America * * * quickly and efficiently. The school- based approach provides low cost but comprehensive health insurance for millions of children without new bureaucracies or hassles. Schools are the natural grouping mechanism to lower the cost of insurance for children, similar to the role large employers play in providing group coverage to their employees. It is more affordable and more portable than coverage through an employer. Are uninsured kids a problem in every community? Yes. According to the U.S. Census Bureau, fully 30 percent of all children are uninsured for at least a month during the year. In addition, 10 million kids under the age of 18--or one in seven children--are uninsured year round, without a single day's health coverage. Who are these kids that have no health insurance? Studies indicate that there are 10 million children that currently do not have health insurance for at least 1 year. That's about 14 percent of all children. One-third of these uninsured children have families below the poverty line, and another one-third have families between 100 and 200 percent of the poverty level. Almost 15 percent are from families above 300 percent of the poverty line, and most parents of uninsured children are also uninsured, 85 percent. However, 60 percent of uninsured children have at least one parent working full time. In addition, almost 50 percent of these family heads work for small firms with fewer than 25 employees. A month or a year without health insurance is long enough to suffer serious harm for a child. According to the 1987 National Medical Expenditure Survey, the most recent comprehensive national survey of health care expenditures, and use, uninsured children are almost twice as likely not to be seen for health problems that expert physicians say should ``always or virtually always come to medical attention.'' For example, according to this survey, more than half of uninsured children with asthma never saw the doctor during the year of the survey. One in three uninsured children with recurring ear infections likewise will never see the doctor. Many of these asthmatic children are hospitalized with problems that could have been prevented. Many children with untreated, recurring ear infections suffer permanent hearing loss. With the recent attack on welfare, the number of uninsured children may get disastrously worse . . . fast. Adding fuel to this fire, a recent report published by the American Hospital Association indicates that the number of individuals without health insurance will increase to nearly 46 million by the year 2002. This projected growth is attributed to a decline in the level of employer-provided health insurance. Can the school-based concept work to insure more children? Yes. This bill is modeled after the Florida Healthy Kids Corporation, a school enrollment-based insurance program that currently provides broad coverage to thousands of previously uninsured children. It was recently named a winner of the 1996 Innovations in American Government Award by both the Ford Foundation and the John F. Kennedy School of Government at Harvard University. In presenting the award, considered to be among the Nation's most prestigious public prizes, the president of the Ford Foundation, Susan V. Berresford, characterized Florida Healthy Kids as ``one example of effective government producing extraordinary results. They are helping to restore faith in government's ability to solve tough problems.'' The concept for the Florida program is simple. Most American children attend school. School systems can be used as a mechanism for creating large groups of people to cover participants the way large businesses do. Coverage is offered to families with children enrolled or residing in the school district and benefits are designed for the individual child. This is identical to employment-based insurance, except the school children become, in effect, employees qualifying themselves for coverage. A group composed of school children is large enough to provide an insurance benefit and premium package that is a good fit for families. Since premiums can still be beyond the reach of some lower income families, the coverage is subsidized on a sliding scale based on income. In Florida, the school district plays a significant and varied role that schools, nationwide, could follow. The district serves as the center of community focus, fostering relationships between the school programs, local community leaders, and area business groups. It distributes enrollment materials and verifies student eligibility, contributing significantly to administrative efficiencies. School staff, especially school nurses and teachers, help identify and put the program in touch with potential participants. Mailing labels have been provided by schools to assist with marketing efforts. Schools have also allowed the use of dial-up systems which automatically call a student's family with a prerecorded health care message. Is quality health care for children too expensive? No. When the Florida program evaluated the predicted frequency with which children utilize the offered benefits, they found that those services which typically drive up the cost of employer-based plans were not frequently used by school-age children. By including these benefits, the program has enabled families to gain a greater peace of mind with little effect on the program costs. Other state programs have attempted to control claims costs by reducing coverage for preexisting conditions, inpatient, mental health, and transplant services or by raising copayments or deductibles. The Florida program has found that these additional health benefits can be included with little impact on the premium when a thoughtful package with reasonable, affordable copayments is crafted. In fact, with 5 years of use pattern supporting data, the Florida program has been able to negotiate three premium reductions. Florida has found that children with insurance are more likely to have a health care home and therefore receive care before an illness becomes serious, reducing overall health care costs by one fourth. Preventive care is crucial to the overall well-being and development of a child. Recent studies have shown that for every $1 spent on immunizations such as measles, mumps, and rubella, $21 is saved in health care and related costs. A child's health has a direct impact on their performance in school. Children who attend school while sick are not mentally or physically prepared to meet the challenges of learning. This becomes much worse for a child who cannot afford to see a doctor and suffers through a disease until it gets better on its own, or until an illness becomes too serious for home-based treatments. This results in less productivity in the classroom and more days absent from school for the child. In fact, the average school-age child misses 4 days of school a year due to illness. And uninsured children are 25 percent more likely to miss school than those who have insurance. Independent studies of the Florida program have shown that the program is not only beneficial to the children, but to the community as well. Florida hospitals report a 30-percent drop in pediatric charity care. Emergency room visits have been shown to decline by 70 percent. Program savings like this have saved Florida $13,125,000 in health care costs in just one year. The first pilot project for Florida Healthy Kids was launched with the assistance of a demonstration grant authorized by Congress in 1989 and administered by the Health Care Financing Administration [HCFA]. This crucial experiment may never have moved from the drawing board without Federal interest and assistance. This bill would recognize the full potential that was originally hoped for by Congress for this tremendously successful program. It's just that simple. I welcome cosponsors for the bill, and comments and suggestions from the public on ways to improve the bill. The following is a summary of the bill: School-Based Children's Health Insurance Act of 1997 Summary I. School-based Health Insurance Program A qualified school-based program is operated by a local or state public school system or any public or private non profit organization operating a private school. Qualified school-based health insurance coverage is coverage that: Is offered by a qualified school-based program; is available to all children under 19 years of age; provides a comprehensive benefit package; has at least a $1,000,000 lifetime benefit; has no cost-sharing for covered preventive care; does not impose any pre-existing condition exclusions; charges premiums that are consistent with the premium section of this bill; and does not discriminate against any individual. A program will not be eligible as a qualified program if there is established a pattern of abuse or misrepresentation of this insurance Medicaid-eligible children do not qualify for this insurance since they are already covered II. Benefit Package The benefit package is comprehensive and includes well-baby and well-child care, immunizations, physicians services, laboratory tests, inpatient and outpatient hospital costs, emergency services and transportation, prescription drugs, eye exams and eyeglasses, hearing exams and hearing aids, basic dental care, physical therapy, mental health services and pre-natal care and delivery. If the parent objects to any of these services based on religious or moral conviction, they will not be provided. A religious organization operating a school-based program will not be required to provide any of these services if it is opposed by their religious beliefs. III. Tax Credit Each taxpayer who purchases a school-based health insurance policy for their dependent receives a tax credit for an amount up to 90% of the premium to buy health insurance for a qualifying dependent. The credit is available to taxpayers based on a computation of adjusted gross income plus an additional $5,000 amount for each child covered. There is a full tax credit provided at the adjusted gross income of up to $15,000 plus $5,000 per child covered by the health insurance policy. The ``$15,000'' figure represents approximately 200 percent of poverty for an individual under the age of 65. For example, a family with adjusted gross income of $25,000 and two qualifying children would receive a refundable tax credit of up to 90% of the family's cost for coverage of the two children. As a family's income rises and the need for a subsidy is less critical, the credit phases out. The credit is available only to subsidize qualified school- based coverage for children. Establishment of premiums: the program will provide a minimum contribution of 20% to the premium before a fully subsidized child's premium is calculated. The subsidy amount phases out to 10% on a sliding scale for partially subsidized children. IV. Other Provisions There is coordination with other tax provisions subsidizing health costs to disallow the credit in instances where the taxpayer also claims a medical expense for the same premium cost or claims a deduction for health insurance costs of self-employed individuals. Grants to states for school-based health insurance outreach and information programs would be established. An employer may not discriminate against employees eligible for this health insurance subsidy. The employer may not condition or vary employee benefit contributions because an employee is eligible for this program subsidy. An employer is still free to cease or reduce employer contributions for health insurance coverage as long as it applies to all its employees.

Mr. STARK

Mr. STARK. Mr. Chairman, I yield myself such time as I may consume, and to congratulate the chairman and the ranking member of the Committee on the Budget for completing their work in a timely fashion and doing it with a minimum amount of rancor and a lot of hard work. They are to be congratulated for achieving balance. But I would like to suggest that balancing a budget is not an end to itself, as is being suggested by so many speakers tonight. There is too much left undone. While we can celebrate the economy, it is very difficult to celebrate when literally hundreds of millions of Americans are not going to participate. They just do not have a boat to get on as the tide rises. The key question before us tonight is, Does this budget represent our priorities? Does it contribute to raising the standard of living for American workers and their families? Does it educate our children and train them to participate in all this wondrous economic success that is planned for the years ahead? Does it maintain our technological lead over our competitors? And, most of all, who will benefit from these tax cuts? The chairman of the Committee on Ways and Means is wrong. These tax cuts go to the richest American families in our country, and he knows it, and I am sure that most of the people hearing this debate know it. That may not be bad if you are rich, but it does not do much for you if you are below $40,000 a year in income and trying to support a family. I cannot support this budget resolution because of the priorities it funds and those that it fails to fund. It calls for over $5 billion a year in manned space flight, for instance, yet it leaves 5 million children without health insurance. That is not a choice I can make. It ignores the health needs of asthmatic children who are not covered. It ignores the health needs of children with hearing loss. Those 5 million children do not get health care. And you are turning your back on them as you gaze at some missile in space which may or may not be as important to you. You have to make that decision when you vote. This budget wastes half a billion dollars a year on star wars and lets our NATO allies off the hook for true burden sharing. This money could be spent to provide day care. It could be spent to help working families in need of long-term care assistance for their seniors, in need of job training, community resources to cut crime, and it is not. It is a great budget resolution for those who favor increasing defense spending and tax cuts for the wealthy while ignoring working families and their children, while ignoring middle and low-income seniors and the less fortunate members of our society. Without the star wars spending that is in this budget, we would have the resources to fund health coverage for all our children. Is that a decision my colleagues want to make? If you want to fund star wars and cut 5 million kids out of health insurance, vote for the budget, my Republican friends. You will get your wish. Without the tax cuts, we would have the ability to extend the life of Medicare 4 or 5 years more. Do you need those tax cuts or would you like to extend Medicare for a longer time? There are a lot of things this budget does not do. We know from listening to our Republican friends that it gives huge tax cuts to the rich and somehow strangles Government services, not for the rich but for the middle- and low-income families. They are gloating over the fact that they cut the President's proposal to increase welfare benefits in half. The rich do not care about that. They got their tax cut. The people who are sleeping under bridges, let them stay there. They rejected the President's entitlement for school construction. Let the schools fall down, that with the earthquake problems put your children at risk. They do not care about the children, they care about tax cuts for the rich. They rejected the President's program for intervention in health insurance for workers. They really do not care about that. They cut food stamp spending in half again, a life support system for the low-income families on whom the Republicans have turned their back in favor of tax cuts for the very rich. They say that it makes the President face up to the realities, by cutting another $35 billion out of Medicare. Are they not proud? They cut back expansions on Medicare benefits to help those with family members with Alzheimer's. It cuts back on helping stop the outrageous overcharge on outpatient copayments by many of the greedy hospitals in this country. They are proud of it. They are bragging about it. Because they need the money to give the tax cuts to the rich. They rejected the President's program to fund Superfund to help clean up the environment. Why? Because if you are rich enough, you can clean up your own backyard and you do not have to rely on Superfund. Energy conservation, the weatherization program is gone. The rich can afford to insulate their houses. National Endowment for the Arts, National Endowment for the Humanities. I know that they can buy their box at the opera if you are a rich Republican and they rather think that somehow the arts and humanities are for left-leaning liberals. They are smart. They know how to make money. They may not be able to spell or understand art and history and they do not care if their children do, so they want to cut out the Endowment for the Arts and Humanities. WIC program for women, infants, and children. That has been denied its preservation. What do they care about helping poor women and children get decent nutrition? Student financial assistance has been denied its survival. The National Institute of Health has been denied its survival. The Center for Disease Control, substance abuse and mental health services, the administration drug treatment, all of them, denied their protection. Here is one. The Bureau of Reclamation, California Bay Delta area, where we come from, help the rich farmers in central California who farm cotton with billion-dollar subsidies for free water from the Federal Government but do not clean up the Bay Delta. Cut out OSHA. Who cares if the workers who work for the rich are protected as long as the rich get their tax cuts? The National Science Foundation, the Commission on Civil Rights, mass transit, all go by the boards under the rubric of saying, we will be a better country if the rich get a big tax cut and the poor fend for themselves as best they can and we, by the way, will have balanced the budget. They balanced it on the backs of the poor, on the backs of children who do not have health insurance. They have ignored over 40 million Americans who do not have health insurance. Not one word has come out of the Republican camp about what are we going to do to provide health insurance for 40 million Americans who do not have it? I have not heard a peep. They do not care. I suppose they do not understand that if an adult does not have health insurance, they do not get medical care. I urge my colleagues to oppose the budget unless you want to help the rich and continue to turn your back on the poor and needy in our country.

Mr. STARK. Mr. Chairman, I yield 2 minutes to the gentlewoman from New York [Mrs. Maloney].

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the invaluable health service performed by the William S. Graham, or ``Billy,'' Foundation for Melanoma Research in Castro Valley, CA. The Billy Foundation is an incorporated, nonprofit foundation--and perhaps the only public foundation dedicated to supporting melanoma research. Established in 1996, the foundation is named in memory of Billy Graham, a 22-year-old man who succumbed to this deadly disease after a long, courageous battle. The president and founder is Billy's mother, Karen L. Graham, who, with the help of a medical advisory committee and several cancer experts, has vowed to educate the public on early detection and prevention of melanoma, the most dangerous form of skin cancer. Unfortunately, the incidence of melanoma is rising at an alarming rate. This year, nearly 40,000 people will be diagnosed. If treated in its very early stages, melanoma is a highly curable cancer. Without early detection, however, this potentially curable disease can be fatal. The Billy Foundation is spreading the word that far too many diagnoses are made in later stages--when the curability rate is only about 20 percent. To help with early identification of melanoma and pre-cancerous conditions, and inspired by this being National Melanoma Month, the Billy Foundation has begun a unique lifesaving program called the MOLE PATROL. With a recently donated van, the MOLE PATROL's staff of volunteer dermatologists provide free melanoma spot-screenings throughout bay area. The MOLE PATROL will screen in high population geographic areas including coastal areas, beach resorts, amusement parks, schools and sports events. The van will also visit schools and community organizations to disseminate educational materials and information on the disease and the foundation. Finally, the foundation's findings will be used in the national statistics calculated by the American Academy of Dermatology. With melanoma's high incidence and low cure rate, it is shocking that this deadly disease gets so little attention--and so little funding for research. We thank the Billy Foundation for alerting us to the seriousness of sun exposure and for heightening public awareness of the early stages of this potentially tragic disease.

Mr. STARK

Mr. STARK. Mr. Speaker, today I am reintroducing legislation to authorize the Environmental Protection Agency [EPA] to establish a California Urban Environmental Research and Education Center [CUEREC]. I am honored to be joined in this effort by nine California colleagues: Mr. Dellums, Mr. Matsui, Mr. George Miller, Ms. Eshoo, Mr. Torres, Mr. Brown, Mrs. Tauscher, Mr. Berman, and Mr. Filner. Legislation to authorize EPA research programs was unfortunately not acted upon in the last Congress. However, CUEREC did receive a line item in the 1995 Department of VA, HUD and independent agencies appropriations bill to cover start-up costs. This line item has allowed CUEREC to begin its first year of operation and the Center was dedicated on October 21, 1994 at a tree planting ceremony on the Cal State Hayward campus. The bill requests $4.5 million for fiscal year 1998 because CUEREC is mandated to work with all 22 California State Universities in its second year of operation and because CUEREC will need this level of support to carry out the activities set out for it in the legislation. Currently, CUEREC is in the process of linking California's major university system--the Cal State University [CSU] campuses, the University of California [UC] campuses, as well as private universities and colleges--to deal with the employment and environmental challenges of California's military base closures and defense conversion. Among other activities CUEREC will: help remove market barriers for small environmental business enterprise development; help in military base conversion and utilization focused on increasing sustainable economic development and job creation throughout California; encourage the transfer of government developed and/or sponsored environmental technology to the private sector while working closely with such laboratories as Lawrence Livermore, Sandia, and Lawrence-Berkeley; encourage the funding of viable environmental projects throughout California; assist women and minority owned small businesses in complying with local, state, and federal environmental regulations and taking advantage of opportunities in sustainable economic development; avoid duplication in environmental research and education programs by developing an on-line data base of such activities available to all California universities and colleges; help coordinate Cal State and UC environmental applied research and education programs; and advise local, state, and federal officials on the economic and environmental implications of development programs throughout California. Prior to CUEREC, no EPA sponsored research center had been established in California, Seventeen such EPA sponsored research centers have already been established in other states. CUEREC would be the first to focus on urban environmental policy, base closures, and defense conversion environmental problems. CUEREC would also be the first to include all of the universities and colleges in a single state. Both Senators were very supportive of the legislation last year. CUEREC is a unique program, providing many important benefits for California and a cost effective model university based program for the nation and I urge my California colleagues to support it.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the achievements of a remarkable group of young people from Hayward, CA, who are being honored for their participation in the California State University-- Hayward Upward Bound program. On Saturday, May 24, 1997, Cal State-Hayward will host its Seventh Awards Recognition Banquet. Seventy-one Upward Bound program participants, 19 of whom are graduating East Bay Area seniors, and their parents will be honored. In the summer of 1965, the Upward Bound program began in colleges and universities across the country, to recruit low-income students in the 8th, 9th, and 10th grades for participation in this college awareness program. The Cal State-Hayward program was later established in the fall 1990, and provides tutoring instruction, counseling, career orientation, and assistance in defining career goals, applying for college admission, and filling out financial aid applications. The type of student selected for participation in upward bound is a very special one. These low-income students, chosen for their potential and desire to achieve, have had the opportunity to experience educational development and personal growth within a college setting while still in high school. Upward bound students work tirelessly in either the academic year sessions or summer sessions which consist of tutorial sessions during the week, complimented by Saturday sessions for field trips and cultural activities. Students are referred to upward bound through school administrators, instructors, counselors, or community agencies who have recognized low- income students who would otherwise have been without the resources and guidance so necessary to the college preparation process. As a result, many of these students will be the first in their families to receive a 4-year degree. As we maintain that educating our young people is priority No. 1, I am inspired by these real-life testimonials to the obstacles students can conquer when given a boost. We congratulate them on their achievement, admire their dedication, and wish them well in any endeavor they choose. Printed below are the names of the students to be honored at this year's banquet: Ninth Grade: Diana Ascencio, Tennyson; Andrea Bozant, Mt. Eden; Gabriel Cortez, Hayward; Stephanie Jones, Hayward; Robyn Moss, Hayward; Alberto Williams, Hayward; Pablo Chavez, Dublin; Tiana Gaskins, James Logan; Marco Palomino, James Logan; Gabriela Pena, James Logan; Jason Wells, James Logan; Ruby Lopez, San Lorenzo; Bogdana Marchis, San Lorenzo; Nocmi Arrieta, Tennyson; Peng Lim, Tennyson; Gaby Bressler, Hayward; Joshua Jones, Hayward; Eujenia Garcia, Hayward; Ana Gutierrez, Hayward; Vanessa Perez, Hayward; Marion Thurmond, Hayward; Damali Burton, Castro Valley; Andrea Williams, Castro Valley. Tenth Grade: Noel Amezquita, James Logan; Emiliano Leyba, James Logan; Alisha Lovett, James Logan; Arnid Ramamoorthy, James Logan; Monifa Willis, James Logan; Steve Hayes, Hayward; Carlos Bressler, Hayward; Mario Guerrero, Hayward; Mahasin Mu'min, Hayward; Lissette Padilla, Hayward; Tanea Rhea, Hayward; Jose Herrera, Tennyson; Saila Molina, Tennyson; Michael Martin, San Lorenzo; William Watkins, San Lorenzo; Juan Flores, Arroyo; Ed Santana, Arroyo; Michael Boykin, Castro Valley; Ariana Sanchez, Richmond. Eleventh Grade: Darryl Hampton, James Logan; Feliza Montes De Oca, James Logan; Reyna Nava, James Logan; Sonia Abrego, Mt. Eden; Michael Barrett, Mt. Eden; Ricshell Bunton, Mt. Eden; Phuong Nguyen, Mt. Eden; Oliver Chang, San Lorenzo; Anthony James, San Lorenzo. Twelfh Grade: Joy Hadden, James Logan; Sylvia Mora, James Logan; Nicole Poston, James Logan; Jarrad Woods, San Lorenzo; Edward Gorton, San Lorenzo; Miguel Lopez, San Lorenzo; Raymond Chan, Tennyson; Miguel Duenas, Tennyson; Houng Huynh, Tennyson; Tim Lin, Tennyson; Carlos Martin, Tennyson; Reocel Mercado, Tennyson; Mariano Preciado, Tennyson; Yazmin Ramirez, Tennyson; Kiet Truong, Tennyson; Brant Guerrero, Hayward; Larry Leatherwood, Hayward; Rebecca Akin, Hayward; Claudia Flores, Arroyo.

Mr. STARK

Mr. STARK. Mr. Speaker, I join today with Mr. Shaw, Mr. Ramstad, and a broad bipartisan group of cosponsors from the Ways and Means Committee in introducing legislation to make structured settlements available to men and women who have suffered severe physical injuries in the workplace. I have been a long-time supporter of structured settlements, going back to the original 1982 legislation that enacted section 130 of the Internal Revenue Code to encourage the use of structured settlements for physical injuries in tort cases. I believe that making the structured settlements available for physical injuries suffered in the workplace is fully consistent with the original rationale and policy that lead to the enactment of the Code section 130 structured settlement tax rules. People who suffer severe and permanently disabling physical injuries in the workplace have the same need as badly injured tort victims for long-term financial security to cover the expenses of ongoing medical care and daily life. I look forward to working with my colleagues on the Ways and Means Committee and in the House to pursue adoption of this legislation.

Mr. STARK

Mr. STARK. Mr. Speaker, on March 20, I introduced The Medicare Medication Evaluation and Dispensing System Act of 1997 [MMEDS]--a bill calling for implementation of a computerized information management program to review prescriptions for Medicare beneficiaries both before and after they are dispensed. A recent study appearing in the American Journal of Public Health provides another reason MMEDS should be passed this Congress. Based on their findings, the authors concluded: ``Increased involvement by pharmacists and physicians in systematic drug utilization review is warranted''. Overall, the study found inappropriate drug prescribing and utilization among the elderly living in board and care facilities. Depending on the criterion applied, between 20 percent and 25 percent of residents had at least one inappropriate prescription. Approximately a quarter of elderly residents received at least one inappropriate drug. Board and care facilities provide an alternative to nursing homes for the elderly; the homes usually do not provide nursing care, but assistance with activities of daily living--including drug management. Most board and care homes do not use pharmacists for drug-utilization review and do not computerize prescription drug data in a readily retrievable manner. Thus MMEDS is especially necessary to help bring an end to inappropriate drug prescribing for the elderly living in these facilities. I would like to insert excerpts from the March, 1997, study on Inappropriate Drug Prescriptions for Elderly Residents of Board and Care Facilities into the Congressional Record: [From the American Journal of Public Health, Mar. 1997] Inappropriate Drug Prescriptions for Elderly Residents of Board and Care Facilities (By Diana L. Spore, PhD, Vincent Mor, PhD, Paul Larrat, PhD, Catherine Hawes, PhD, and Jeffrey Hiris, MA) Introduction Board and care facilities are community-based alternatives to nursing homes, housing elders with physical limitations, cognitive impairment, mental health problems, and chronic physical health conditions. They provide protective oversight, personal care, and assistance with activities of daily living and instrumental activities of daily living in congregate settings. Most facilities do not provide nursing care, but do store drugs and provide assistance with drug-use management in many instances. Board and care homes have been criticized for a lack of medical supervision in drug administration and monitoring, nonexistent drug-management programs, and unskilled staff; however, inappropriate drug use in these settings has been largely unstudied. Use of inappropriate medications can have serious clinical consequences, ranging from adverse drug reactions that affect elders' functional independence and psychosocial well-being to an increased risk of mortality. Using the largest multistate sample of board and care homes assembled to date, we examine the prevalence and correlates of inappropriate drug prescriptions among elderly residents. Given that on the long-term care continuum, board and care is midway between living in the community without assistance and residing in nursing homes, we apply the Stuck and Beers criteria to derive estimates of rates for presumptively inappropriate drug prescriptions. results Inappropriate Drug Prescriptions According to the Stuck and modified Stuck criteria, almost 18% of residents were prescribed at least one presumptively inappropriate drug. The most frequently prescribed inappropriate drugs included propoxyphene, long-acting benzodiazepines, dipyridamole, and amitriptyline. Approximately 6.8% of elders were prescribed one or more presumptively inappropriate psychotropics. Of those elders prescribed a drug included in the modified Stuck criteria, most (82.4%) were prescribed only one of the problematic drugs; 17.6% were prescribed two or three of the medications; and 38.5% were prescribed inappropriate psychotropics. Multiple prescriptions most frequently involved combinations of propoxyphene or a long-acting benzodiazepine with one other inappropriate drug (e.g., propoxyphene with amitriptyline). According to the Beers criteria, almost 25% of residents had an inappropriate prescription. Of those with inappropriate prescriptions, 83.8% were prescribed an entirely contraindicated drug (regardless of dose); 19.3% were prescribed drugs that were problematic due to high dosages; and 40.5% were prescribed inappropriate psychotropics. discussion Using a large, multistate sample of board and care homes, this study examined the prevalence and correlates of inappropriate drug prescriptions among elderly residents. Almost one in four residents had at least one presumptively inappropriate prescription. Of those elders prescribed any drugs, 20.2% to 27.4% had inappropriate prescriptions. Rates for inappropriate drug prescriptions are high, but lower than what has been reported for nursing home residents and relatively comparable to rates among community-dwelling elders. Only a minority of elderly board and care residents were prescribed more than one inappropriate medication. However, such combinations can cause additive central nervous system effects--such as confusion, excessive drowsiness, and dry mouth--which tend to be more serious problems in the elderly. For the most part, board and care homes do not use pharmacists as consultants for drug-utilization review, do not computerize drug data in a readily retrievable manner, and do not routinely maintain comprehensive charts documenting residents' clinical or physical status. Thus, we believed that identifying general characteristics associated with inappropriate drug use might prove useful in future efforts to target residents for whom drug-utilization review may be especially warranted. Residents with a larger number of regularly scheduled prescriptions were more likely than others in the sample to receive at least one inappropriate drug. Thus, the number of prescriptions may serve as a simple indicator for targeting residents at higher risk of inappropriate drug use. Indeed, in other arenas, having five or more prescriptions has been used as one indicator of the need for the services of a consultant pharmacist. The Health Care Financing Administration recently published a final rule on regulation for drug-utilization review programs for Medicaid-covered prescription drugs. These regulations--which were not targeted specifically for residential care facilities--require that state Medicaid agencies have pharmacist counseling programs to ensure that prescriptions are medically necessary, appropriate, and unlikely to produce adverse side effects. We suggest that state board and care regulations be systematically reviewed with an eye toward incorporating and stimulating the development of pharmacy counseling and drug-utilization review programs that are specific to conditions faced in these facilities.

Mr. STARK

Mr. STARK. Mr. Speaker, today our colleagues Mr. Serrano, Mr. Dellums, Mr. Kleczka, Mr. Underwood, Mr. Frank, Ms. Christian-Green, Ms. Pelosi, Mr. Hall of Ohio, Ms. Ros-Lehtinen, Mr. Berman, Mr. Waxman, Mr. Cramer, Mr. Ehrlich, Ms. Clayton, Mr. Rangel, Mr. Gonzalez, Mr. Moakley, Mr. Frost, Mr. Ackerman, Mr. Spence, and I take great pride in reintroducing the Gift of Life Congressional Medal Act of 1997. The enactment of this legislation, which doesn't cost taxpayers a penny, will not only honor the individual organ donor and their loved ones, but will also heighten the awareness of the organ shortage, ultimately resulting in more organ donation. There is a major undersupply of available and suitable organ donors. Currently, there are 50,000 individuals waiting for an organ transplant in the United States. The number of people on the list has more than doubled since 1990 and a new name is added to the national patient waiting list approximately every 18 minutes. Despite the numerous problems that organ donation programs have faced and conquered over the years, a major problem still exists. The demand for organs will continue to grow with the improvement of medical technologies. Without expanded efforts to increase the supply of organ donation, the supply of suitable organs will continue to lag behind the need. For the many would-be organ recipients, the consequence of shortage is death. It is clear that expanded efforts are necessary in order to increase the number of organ donors. According to some researchers, it may be possible to increase by 80 percent the number of organ donations in the United States through incentive programs and public education. A congressional medal recognizing donors and their families can play a very important and effective role in our efforts to encourage such donation. Our proposed Gift of Life Medal Program will be administered by the regional organ procurement organizations [OPO's] and managed by the entity administering the Organ Procurement and Transplantation Network. Once the decision to donate an organ has been made, the donor or the family member of the donor will be asked by the regional OPO whether participation in the Gift of Life Medal Program is desired. The OPO will give each donor or family member the option of receiving a Gift of Life Medal, recognizing that some may not want to participate. If requested, a public presentation will be made to honor the donor. A presentation by a local official, community leader, or Member of Congress would be a tremendous opportunity to increase the awareness concerning the desperate need for organ donation. Every action has been taken to insure that the issuance of the Gift of Life Medals results in no net cost to the Government. In addition, I am proud to report that the legislation has the strong support of the United Network for Organ Sharing [UNOS] and the Coalition on Donation. Any one of us, or any member of our families, could need a life saving transplant tomorrow. We would then be placed on a waiting list to await our turn, or our death. So, I ask that our colleagues help bring an end to waiting lists and recognize the enormous faith and courage displayed by organ donors and their families. Please join us as cosponsors of the Gift of Life Congressional Medal Act of 1997. These donors offer others a second chance by providing the most precious gift imaginable, the gift of life.

Mr. STARK

Mr. STARK. Mr. Speaker, the President's budget proposes to reform a major defect in Medicare--the ability of hospital outpatient departments [HOPDs] to overcharge beneficiaries. Due to the way the law is worded, patients today pay--on average--about 45 percent of the allowable cost of a hospital outpatient procedure. They should be paying 20 percent. Unless fixed, the problem will just get worse and worse, with seniors and the disabled paying more and more. Simply put, the problem arises because Medicare pays the hospital on the basis of reasonable cost, while the beneficiary is stuck with 20 percent of charges--and charges can be anything the hospital wants to say they are. On February 4, Representative Coyne and myself introduced a bill, H.R. 582, to provide for an immediate correction of this serious Medicare beneficiary problem. I urge the Budget Committee, as it considers the size of the Medicare budget cuts, to make an allowance for the fixing of this problems. In the meantime, the public should be advised to shop around for a better price than the HOPDs offer. Of the roughly 7,000 procedures that are done in HOPDs, 2,700 are also done safely and competently in ambulatory surgical centers [ASCs], where the price is usually much lower--and where the beneficiaries copay is limited to 20 percent. Following are some examples of the difference to a patient in using an ASC instead of an HOPD. Newspapers, the electronic media, and consumer groups could do a great service to the Nation's seniors and disabled by checking on these prices in their local market and advertising the difference to seniors. Caveat emptor--big time. Comparison of Hospital and ASC Fees illustrative example No. 1 Description: Procedure: Inguinal Hernia Repair. Location: Milwaukee, Wisconsin. CPT Code: 49505. Date: June 18, 1996. ------------------------------------------------------------------------ Comparative payments--

Mr. STARK

Mr. STARK. Mr. Speaker, today our colleagues Mr. Serrano, Mr. Dellums, Mr. Kleczka, Mr. Underwood, Mr. Frank, Ms. Christian-Green, Ms. Pelosi, Mr. Hall (OH), Ms. Ros-Lehtinen, Mr. Berman Mr. Waxman, Mr. Cramer, Mr. Ehrlich, Ms. Clayton, Mr. Rangel, Mr. Gonzalez, Mr. Moakley, Mr. Frost, Mr. Ackerman, Mr. Spence, and I take great pride in reintroducing The Gift of Life Congressional Medal Act of 1997. The enactment of this legislation, which doesn't cost taxpayers a penny, will not only honor the individual organ donor and their loved ones, but will also heighten the awareness of the organ shortage--ultimately resulting in more organ donation. There is a major undersupply of available and suitable organ donors. Currently, there are 50,000 individuals waiting for an organ transplant in the United States. The number of people on the list has more than doubled since 1990 and a new name is added to the national patient waiting list approximately every 18 minutes. Despite the numerous problems that organ donation programs have faced and conquered over the years, a major problem still exists. The demand for organs will continue to grow with the improvement of medical technologies. Without expanded efforts to increase the supply of organ donation, the supply of suitable organs will continue to lag behind the need. For the many would-be organ recipients, the consequence of shortage is death. It is clear that expanded efforts are necessary in order to increase the number of organ donors. According to some researchers, it may be possible to increase by 80 percent the number of organ donations in the United States through incentive programs and public education. A congressional medal recognizing donors and their families can play a very important and effective role in our efforts to encourage such donation. Our proposed Gift of Life Medal Program will be administered by the regional organ procurement organizations [OPO's] and managed by the entity administering the organ procurement and transplantation network. Once the decision to donate an organ has been made, the donor or the family member of the donor will be asked by the regional OPO whether participation in the Gift of Life Medal Program is desired. The OPO will give each donor or family member the option of receiving a gift of life medal, recognizing that some may not want to participate. If requested, a public presentation will be made to honor the donor. A presentation by a local official, community leader or Member of Congress would be a tremendous opportunity to increase the awareness concerning the desperate need for organ donation. Every action has been taken to ensure that the issuance of the gift of life medals results in no net cost to the Government. In addition, I am proud to report that the legislation has the strong support of the United Network for Organ Sharing [UNOS] and the Coalition on Donation. Any one of us, or any member of our families, could need a life saving transplant tomorrow. We would then be placed on a waiting list to await our turn--or our death. So, I ask that our colleagues help bring an end to waiting lists and recognize the enormous faith and courage displayed by organ donors and their families. Please join us as cosponsors of The Gift of Life Congressional Medal Act of 1997. These donors offer others a second chance by providing the most precious gift imaginable--the gift of life. The bill is as follows:

Mr. STARK

Mr. STARK. Mr. Speaker, I rise in support of H.R. 1226, the Taxpayer Browsing Protection Act. This bill bolsters the administration's position of zero tolerance for unauthorized browsing of taxpayer information. Current law focuses more on unauthorized disclosure of taxpayer information. This bill addresses--and makes a crime--IRS employees looking at a taxpayers records when they have no justifiable reason to do so, even if no disclosure of the information to others takes place. Taxpayers are entitled to privacy of their records and we must assure that the information they provide the IRS will be protected. Protection of privacy rights of taxpayers is critical for a voluntary tax system. IRS employees also deserve to have their ranks purged of those whose unlawful acts bring shame on Federal workers. As a cosponsor of H.R. 1226, I am pleased to see that the House is responding to the administration's request for action on this legislation.

Mr. STARK

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, the gentleman from California has described the bill well and accurately. There is no controversy, or, that I know of, any opposition to it. It is supported on our side. I urge its adoption. Mr. Speaker, I yield back the balance of my time. General Leave

Mr. STARK

Mr. STARK. Mr. Speaker, I thank my distinguished colleague for yielding me the time. Mr. Speaker, I could not begin to match the eloquence of the previous speakers on this side who would suggest to the American public that they are at grave risk of having their Constitution damaged by a capricious majority who would today--in kind of a television stunt that is hardly worthy of a second rate talk show host--try and convince the American people that they are doing something to save them money or to save the Government. It is again a sham. There is much that we could be doing in this body that is important, and obviously we are not. But it is important to note what might have happened had this kind of a silly constitutional amendment been agreed upon earlier. Social Security would now be bankrupt. It would not have been saved in the 1984 legislation which did not receive a two-thirds vote. As the Republicans have repeatedly tried to raise the taxes on the senior citizens for Medicare in their own rule which required two-thirds last year, they had to waive the rule to increase the premiums on Medicare beneficiaries. That was a Republican move. The health coverage availability and affordability bill would have imposed additional taxes on withdrawals from medical savings accounts, an equally silly idea, but again the Republicans had to waive their own rule. The Republicans could not operate, they do not know how to operate the House with a two-thirds rule they have in here now. If they had to read the Constitution without moving their lips, I suspect they would be in real trouble. The House waived or ignored the two-thirds rule each time it would have applied. This resolution is far more restrictive and it is a bad idea through and through. It is a gimmick. It is showboating. It denigrates the Constitution. We were all sent here to make tough choices, some unpopular. Occasionally it is necessary to raise revenues in this country. We would no longer have airport traffic control. Our Nation's transportation infrastructure would disappear. The Medicare Social Security Program would no longer be able to be kept viable. All of these would be the outgrowth of this cockamamie idea that has come up and would be much better if we would just pledge allegiance a few more times today in honor of those good citizens who do pay their taxes, which happens to be mostly the lower middle income folks, I might add, and not the rich folks who can take advantage of the many loopholes that we have built into the system. I urge my colleagues to ignore this, to vote no, to pretend that it did not happen, to go back home and say that there are important things that this Congress could do but they are not being presented to us by the Republican majority.

Mr. STARK

Mr. STARK. Mr. Speaker, it would be difficult today to suggest that American families in general do not deserve tax relief, and those who pay taxes, mostly the middle and lower income working people, certainly feel that it is a burden and they are going to feel it as they run around trying to find the money today to pay their taxes. It is a fact that our taxes are lower, our Federal income tax, than any other developed nation in the world. It is also a fact that it is probably more unfairly distributed, with the very wealthy in this country paying nowhere near their fair share of the burden of supporting this country, which goes, interestingly enough, disproportionately to benefit the rich, who pay the least. Now, if in fact there is some relief, perhaps what it ought to be is relief from the unfair structure which has allowed corporations to escape paying much, if any, tax, which has allowed the very rich in this country to escape from paying much, if any, tax, and the taxes go into a system which now leaves us with 10 million uninsured children, 43 million uninsured Americans without health care insurance. We are the only developed nation in the world that treats our people in the health care system so poorly. Yet we have a low tax system, and it is disproportionately the low-income people who are uninsured and whose children are uninsured. So relief is in the eye of the beholder. While I think we will all be voting ``yes'' to provide tax relief to the Americans, I think the Americans watching our actions will have different reactions. Those who do not pay any tax and are very rich would like relief from the fear that we might make them do the right thing. Those who are very poor and do not have health insurance for their children or do not have a decent place to live or do not have the prospect of being able to send their children to college might hope that we will do the right thing and let the tax code be a vehicle for sharing some of the largesse in this Nation. So as we think about tax day, I hope we will think about the fairness of the code, how it could strengthen our country by allowing everyone in this country to share in its munificence and indeed support tax relief, but define it a bit more broadly and define it so that every American can participate and enjoy the bounties of this country.

Mr. STARK

Mr. STARK. Mr. Speaker, the bill before us states that assisted suicide, euthanasia, and mercy killing have been criminal offenses throughout the United States and under current law would be unlawful, and this, in other words, makes this bill totally unnecessary. Mr. Speaker, Medicare does only cover medically necessary services. It does not pay for suicide. No one can bill for suicide. No matter what some State may decide to do about suicide, Medicare would not pay for it. It is not now covered and it will not be. This bill is a facade for a Congress that is doing nothing. There are a lot of reasons people in our society are driven to suicide. This bill does not deal with those. This bill does nothing to provide mental health counseling. This bill does not require that insurers offer mental health services that could prevent suicide. It does not provide for health insurance for children to ease the fears and frustrations of parents. It does not stop managed care companies and for-profit HMO's from denying health care that can lead to death and disability. It does not stop the gag rules that cause managed care doctors to mistreat patients. The Consortium for Citizens with Disability says prohibiting people from using Federal funds to end their lives is not worth much. Why do we not provide public and private assistance so they can live their lives? If we want to help, why do we not ensure that Americans, regardless of income, have access to quality care; have home health care so they can live in their communities rather than in institutions; ensure that untreated depression is no longer mistaken as a desire to die. We can enhance the quality of life, Mr. Speaker. Any public policy in the area of physician-assisted suicide should include a proposal to fund mental health services and anti-pain services necessary for decent basic living. Mr. Speaker, this bill does nothing. It just addresses a problem that does not exist. It eases some pseudo-religious wackos. It does nothing to address the real problems in our society that cause people to seek suicide or assisted death. It is a sham. It is a shame. We are a sad, sad Congress if we pass this bill.

Mr. STARK

Mr. STARK. Mr. Speaker, on February 4, Representative Coyne and myself introduced a bill to provide for an immediate correction of a serious Medicare beneficiary problem: the overcharging of seniors and the disabled by hospital outpatient departments [HOPD]. The President's budget also calls for a correction of this problem, but phases in the correction over a 10-year period. In Medicare, the program generally pays 80 percent of part B bills and the patient pays 20 percent. But because of the way the HOPD benefit was drafted, currently beneficiaries are paying about 45 percent and Medicare 55 percent. Simply put, the problem arises because Medicare pays the hospital on the basis of reasonable cost, while the beneficiary is stuck with 20 percent of charges--and charges can be anything the hospital wants to say they are. Recently, the American Association of Retired Persons asked its members for examples of problems they had had with HOPD billings. They received an overwhelming response, and over the coming weeks, I would like to enter some of these letters in the Record. These examples are the proof of why we need to fix this problem ASAP. The first is from Mrs. Patterson of Chico, CA, who was in the hospital 5 hours, and Medicare paid the full bill--less than 20 percent--of over $4,000, including $900 of pharmacy. Curious to me on the hospital bill is the box at bottom right, showing expected payment of Medicare $327.52, estimated amount not paid by Medicare $3016.18. In questioning the hospital bookkeeping office, I was told that Medicare actually pays only the small amount and the hospital absorbs the rest. Mrs. Patterson, or her medigap policy if she had one, paid $818.80 on total charges of $4094--20 percent of charges. Medicare then determined that the fair cost of the procedure was $1146.32, but since Mrs. Patterson had already paid $818.80, Medicare only paid the rest of the fair cost--or $327.52. What the bookkeeper didn't tell Mrs. Patterson was that what the hospital ``absorbed'' was an outrageous and unjustified charge that no one should have paid--sort of like the sticker price on an auto at a used car dealership. Yet in this case, the beneficiary paid 71.5 percent of the fair cost and Medicare 28.5 percent--a far cry from Medicare's ``promise'' of a 20-80 percent split. The second letter printed below is from the Robertson family of Alhambra, CA, for cataract surgery. In this case, the total Medicare allowed cost of the procedure was $2114.80, but Medicare didn't pay 80 percent--it only paid 47 percent and the patient paid 53 percent. The last letter is also printed below, from a man in north central California. It reflects the absolute nonsense hospitals are telling patients when they question these bills. When you examine the bills-- not reprinted below--it is clear that on a bill showing charges of $2522.50, the patient paid 20 percent of the charges or $504.50. Medicare determined that the cost of the procedure was worth $933.33, but since the beneficiary had already paid $504.50, Medicare only owed another $428.83. In this case, the beneficiary paid 54 percent of the fair cost, while Medicare escaped with only paying 46 percent. These letters are a testament to the need to pass H.R. 582. Robertson, Alhambra, CA, September 17, 1996. AARP, Outpatient Stories, Dept. 601 E St. NW, Washington, DC. The enclosed Medicare EOMB copy is for cataract surgery services, surgeons fee not included. Medicare paid the hospital $988.45. This payment is not disclosed on the EOMB. As shown on the EOMB, the patient is responsible for $1,126.35. Gentlemen: I am glad to see that you are concerned about the Medicare outpatient matter. At the time of my cataract surgery (see dates) I could not get anybody interested. As you say in your article and also in the latest Medicare Handbook (Page 15 under heading ``What You Pay'') the patient pays 20% of the charges not of the amount that Medicare approves of, as is usually the case with part B of Medicare. It does not say that Medicare is responsible for 80% of the charges and indeed, in my case it only paid 17% of the charges (see copy of the bill) although I paid my 20%. As you can see, the remaining 63% was written off and no one paid it. At the time, I called the hospital on the phone and the representative said that the hospital has a special contract with Medicare allowing them to pay the tiny fraction of the charges (17%). She claimed that the $1,589.17 write-off was a ``loss'' to the hospital. As I said in the beginning, I am glad that someone with clout is interested in this unfairness.