Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, last December, I introduced H.R. 2839, a bill to require the Secretary of HHS to implement an on-line prescription drug information management program for Medicare beneficiaries. This system, known as the Medicare Medication Evaluation and Dispensing System [MMEDS], would provide the tools and information to beneficiaries and their health care providers that are needed to reduce instances of adverse drug interactions, over-medication, and other problems related to prescription drug use that harm our Nation's retirees and disabled. On June 11, 1996, the General Accounting Office issued report B- 261530 which discussed the benefits of a similar system in the Medicaid program. The report shows that the Medicaid program has been a clear success and--I would argue--supports the development of such a system for the entire Medicare elderly and disabled population. Following are portions of the GAO summary--positive findings which I hope will help us pass H.R. 2839 as a way to save money and lives: It is widely accepted in the health care community that inappropriate use of prescription drugs can cause adverse reactions that can lead to drug-induced illness, hospitalization, even death. Such inappropriate use can also be expensive for the Medicaid program. Concerned about this issue, the Congress mandated that states establish utilization review programs to review Medicaid prescriptions before drugs are dispenses (called prospective reviews) in order to prevent potential adverse medical reactions. The legislation did not require that prospective screening be automated. However, 43 States plus the District of Columbia have implemented or plan to implement automated prospective drug utilization review (PRODUR) systems. In most instances, PRODUR systems are implemented concurrently with an automated screening capability for Medicaid eligibility since both depend on automated systems that offer real-time responses to inquiries. The five States in our review have this feature. Automated prospective drug utilization review (PRODUR) systems increased patient safety and reduced Medicaid program costs in the five states whose systems we examined; all five states found the systems beneficial and worthwhile. During a 12-month period ending June 30, 1995, these five states' systems alerted pharmacists to over 6.3 million prescriptions that had the potential to cause adverse medical reactions from drug therapy problems including drug-drug interaction, overutilization, and pregnancy conflict.\2\ Over 650,000 (10 percent) of these prescriptions were canceled because of the potential serious risk to patients. According to state officials, pharmacists reviewed and eventually filled the other prescriptions on the basis of the pharmacists' professional judgment and/or consultation with the recipients or their physicians. Along with increasing patient safety, these systems also reduced program costs by over $30 million, according to state and contractor reports. Over $5 million of this total was attributable to rejecting efforts to refill prescriptions before a large portion of the earlier prescription would have been consumed, potentially causing harm to the patient; the remaining $25 million resulted from prescriptions that were denied due to patient ineligibility. While these direct benefits are significant, the major dollar savings, in all likelihood--though more difficult to document--are achieved through avoided hospitalization due to inappropriate drug therapy. On the basis of its review of studies related to drug-induced illnesses, the Food and Drug Administration (FDA) indicated that 6.4 percent of hospital admissions nationwide can be traced to inappropriate drug therapy; some studies cite even higher rates for the elderly. Accordingly, avoided hospitalization could potentially save hundreds of millions of dollars annually. Savings could also accrue because PRODUR systems can help identify potential fraud, waste, and abuse. The five states in our sample screened for different conditions and handled prescription cancellations differently. Consequently, reported numbers and types of patient safety alerts, prescription cancellations, and rates of savings varied. One state, for example, did not screen for pregnancy conflict. Three states automatically deny prescriptions with overutilization alerts, while the other two states place the responsibility with pharmacists to either deny or fill the prescriptions following such alerts. At present, states have no systematic way to share experiences and best practices. One approach toward accomplishing this would entail establishing a central clearinghouse at the state or federal level to collect and disseminate information. This would allow all states to make more informed decisions, offering citizens the best protection and states the most savings.

Mr. STARK

Mr. STARK. Mr. Speaker, there was a lot of crowing at the Republican National Convention about the defeat of the effort in the 103d Congress to obtain health insurance for every American. Republicans talked a lot about letting the free market take care of the health insurance problem and how it was good that a Government solution had been rejected. Never mind the fact that the number of uninsured Americans, especially children, is rising about 1 million per year. Never mind the fact that almost all the other major industrialized nations of the world provide high quality health care to almost all their citizens yet have health inflation lower than ours. Following are the latest available figures from the Organization for Economic Cooperation and Development. The facts speak for themselves--and they should shame all of us.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to recognize the exceptional dedication of Mr. Fred Castro, a dedicated member of the Park and Recreation Commission. Fred has given over 32 years of outstanding service to the residents of California's 13th Congressional District. Fred Castro was born in Modesto and grew up in Oakland. As a young man, he joined the Navy and was stationed at Pearl Harbor when it was bombed. He served his country in the Pacific for the remainder of World War II. When he returned, he married his wife Lorraine on March 3, 1946. Fred also served during the Korean conflict, returning to the Bay Area to work in the shipyards at Mare Island, Hunters Point, and the Naval Supply Center in Oakland. Fred and Lorraine have lived in Union City since the early 1960's. In 1964, Fred was appointed to the first Parks and Recreation Commission in Union City by Mayor Will Davis. Since then, Fred Castro has tirelessly served our community for the past 32 years. The 17 parks and 2 community centers in Union City were all developed during Fred Castro's years of service to the 13th district. Fred worked to put together the bond measure in 1968 to build the Kennedy Center, and he was the chair of the dedication ceremony for the Holly Center. Throughout his career, Fred continued to promote parks and recreation through his involvement with the California Association of Parks and Recreation Commissioners and Board Members. Not only was he on the board for many years, but he was president in 1990. In addition to his continued support to our community, Fred also found time to represent commissioners and board members on the California Parks and Recreation Society, District III board. Fred Castro has been a mentor to many professionals within the parks and recreation community. The 13th district has been greatly enriched by Fred Castro's enthusiasm and dedication. Mr. Speaker, I ask you and my colleagues to join me in thanking Mr. Fred Castro for 32 years of exceptional public service.

Mr. STARK

Mr. STARK. Mr. Speaker, today I am introducing a bill which will save Medicare millions of dollars each year. This savings will not involve a decrease in coverage for Medicare beneficiaries. It simply allows us to stop paying someone else's laundry bill, and I mean that literally. Medicare was established to provide basic protection against the costs of health care while providing quality services. As organ transplants became a medical reality, Medicare became a full insurer for kidney, heart, lung, and liver transplants. Hospitals must apply for certification to perform each type of transplant and receive Medicare reimbursement. There are approximately 160 hospitals across the country which hold such contracts. We seem to be under the impression that because we have approved these facilities, all of the items in their bills to Medicare are justified. But this is not the case; hospitals add on approximately 25 percent of an imported organ's acquisition cost to cover a portion of administrative and general overhead costs, such as laundry, housekeeping services, rent, and utilities. This add-on system cost Medicare $22 million in 1995. Let me back up for a moment and put this in context. Under the diagnostic related group [DRG] system, Medicare pays hospitals a set rate for each type of injury or illness. The DRG payment covers all items and services provided by the hospital to the patient, and includes an allocation for overhead associated with each service rendered. Organ acquisition is covered separately from the DRG for organ transplants. In this case, Medicare separately reimburses transplant centers for the acquisition cost of each organ. It is this cost to which hospitals make the add-on. The problem lies particularly with cases in which the organ is imported from an organ procurement organization. Mr. Speaker, I do not mean to imply that hospitals have acted inappropriately. It is normal practice for hospitals to distribute their overhead to cost centers which are not covered by DRG's. Indirect costs are allocated across the board to all possible cost centers. However, the DRG for organ transplantation already includes an allocation for overhead. Since no medical service is associated with simply acquiring an organ from an outside agency and then billing Medicare for the organ, adding a portion of unrelated administrative and general costs is unreasonable. For example, if acquiring an organ cost a hospital $10,000, Medicare would be billed that amount plus an extra 25 percent, bringing the total to $12,500. This process bleeds the system of millions every year by charging Medicare more than its share of the overhead costs associated with transplants. The 25 percent add-on is not associated with medical services to the patient, nor administrative or general services other than billing Medicare. If we allow this practice to continue, Health and Human Services estimates suggest that this will cost Medicare as much as $35 million in 1999. The bill would amend title XVIII of the Social Security Act to provide for savings in the Medicare Program by reducing overhead payment for Medicare transplant centers. It states that hospitals may not allocate their general or administrative costs to the acquisition cost of organs imported for transplant as they determine costs to be reimbursed by Medicare. This is a bill to improve the efficiency of the Medicare Program, an objective I believe we all would like to accomplish.

Mr. STARK

Mr. STARK. Mr. Speaker, today I am introducing the Abandoned and Derelict Vessel Removal Act of 1996. This act will provide the necessary tools to encourage the cleanup of a long-term public nuisance resulting from abandoned boats and barges found in the navigable waters of many communities in this country. This issue centers on dozens of abandoned boats and other debris which has accumulated along the Guadalupe Channel, which surrounds the community of Alviso, CA. This concern was first brought to my attention by members of the San Jose City Council, the Alviso Master Plan Task Force and, most important, members of the Alviso community. These abandoned vessels have become a public health and safety hazard to both the community as well as to those that use the adjacent public waterways. Unfortunately, Alviso is far from the only community that suffers from this problem. The Abandoned and Derelict Vessel Removal Act also make sense economically. Abandoned vessels do not just sit harmlessly by--these vessels are often used as an illegal dumping ground for hazardous materials. Cleaning up this mess is both expensive, time consuming, and places the health of the community in jeopardy. Between January 1988 and September 1991, the Federal Government spent $5.2 million to remove 282 abandoned vessels that blocked waterways. In that same time, Government spent nearly $5.7 million to clean up pollutants from just 96 abandoned vessels. This legislation would cut cleanup costs to the Government by more than 300 percent. This legislation will establish clear authority to remove vessels left unattended in a public waterway that has not been designated as a harbor or marina for more than 45 days or those left unattended in an approved harbor or marina for more than 60 days. There are approximately 17 million recreational boaters using public waterways nationwide. It is estimated that this number will increase, on average, 4 percent per year. Given this substantial increase in waterway users, regulation becomes necessary. This legislation empowers local authorities to keep public waterways clear while allowing boat or barge owners the opportunity to repair and remove vessels that are not actually abandoned. In addition, the removal of these derelict vessels will alleviate concerns regarding water quality and its impact on the public health of the local community. This legislation will promote cooperation between interested local citizens, community groups, and government agencies in their joint efforts to preserve and protect the navigable waters of the United States, and it will return the power to take action to the communities and force boat owners to take responsibility for their vessels. A community could instigate action simply by petitioning a local elected official to notify the Secretary of the Army of the problem. Proceedings to notify the boat owner, and ultimately to remove the boat, would then be taken by the Secretary. I urge my colleagues to support this legislation.

Mr. STARK

Mr. STARK. Reserving the right to object, Mr. Speaker, and I shall not object, but I would like to engage the distinguished subcommittee chair from California in a brief colloquy and ask if he would explain what this modest change in the bill does.

Mr. STARK. Further reserving the right to object, I thank the gentleman for his explanation. Further reserving the right to object, Mr. Speaker, under that reservation I would like to congratulate the distinguished gentleman from California, the subcommittee chairman of the Subcommittee on Health of the Committee on Ways and Means for his work in completing this bill. The only reason I could possibly think of to object would be so that I could then be recorded voting in favor of it, but I will not take the time of this body except to add my congratulations and to say that I am glad this was done. Mr. Speaker, I withdraw my reservation of objection.

Mr. STARK

Mr. STARK. Mr. Speaker, if the distinguished gentleman is referring to the MSA section of the bill, title III, subtitle (a), it is my understanding that Medicare beneficiaries are not permitted to open an MSA account. Is that the gentleman's intention?

Mr. STARK. Mr. Speaker, I yield myself the balance of my time. Under the rules, my motion to recommit is not debatable. I would urge that my colleagues on both sides of the aisle support the motion to recommit the Kennedy-Kassebaum agreement to conference, a conference which has never existed, and to work out an acceptable mental health amendment along the lines of the Domenici-Wellstone mental health parity compromise. The gentleman from Texas is right. We asked them not to load up the original Kennedy-Kassebaum bill with Christmas tree giveaways to the drug companies, giveaways to Golden Rule Life, all of whom are big contributors to the Republican Party. But as long as that has been done and Members on this side are going to vote for the bill, I pose the question on the motion to recommit as to why the Republicans would deny mental health benefits at no cost. You have to explain that to every family who has a mental health illness in the family. For relatively no or little cost at all, you are denying mental health coverage to millions of Americans. I do not know why you do that. There is no good reason. There is no good reason at all except if you are trying to bail out the insurance companies because most of your staff used to be lobbyists for them. But what I am suggesting to you is that for less than 16 cents a thousand dollars of premium you can add mental health benefits to every employee in this country. Why you would deny that escapes me. Why you would not take away the fear that somebody with a mental health illness would get the same treatment that somebody with a physical illness is, to me, obscene just to deny that for whatever reason. There has been no good reason offered to deny these benefits. Private insurance premiums would rise less than sixteen one-hundredths of a percent; $5 a year in deductibility. Yes, you will have different opinions from the health insurance industry for whom your staff have been captives, but the truth is that if you were willing to provide fair coverage and willing to go against the interests of the big contributors to your campaigns, you would do the right thing for the American people. You will have to face every mental health group in this country, who will say it is the Republicans who have denied mental health coverage to millions of American workers for the sake of big campaign contributions. That, to me, is an obscenity that I would not want to face in the political arena. The small businesses that you have helped have been limited. The bailing out of one drug company, which is also in the motion to recommit, is another example of payoffs from big drug companies. Is there no humanity? Your health bill was yesterday, when you denied access to any help to a million children. That was your health reform. Now you are going to deny mental health coverage to the Americans who need it. All I can say is it is a shame, it is a travesty. Yes, people will vote for the limited expansions you give to less than 400,000 people a year, but no, why would you deny mental health coverage to these people? Vote for the motion to recommit. You can do the right thing back in conference quickly and then your bill might have some credibility.

Mr. STARK. Mr. Speaker, I yield myself 4 minutes. Mr. Speaker, the bill that passed the Senate unanimously was a great bill. The conference product that we discuss today is an okay bill. The House Republicans have turned the Senate silk purse into a sow's ear, and there are many reasons for disappointment. For example, why, my Republican friends, is there no mental health parity amendment? We should have done it. It was part of the bill passed by the Senate. It does not cost much. Sixteen cents per thousand is all it costs. We could raise the deductibility $5 for every policy and pay for it. So I would say to the gentleman from Texas, Bill Archer, if his grandson had been born with mental illness, he could not have afforded to be treated because this bill would deny him that coverage. We did not have a real conference where we could have worked this out. We could have phased in the cost of eliminating these caps, but the Republicans would refuse to meet on this issue. The bill's antifraud provisions are bad. The advisory opinions on intent-based fraud cases are unprecedented, and the Justice Department- HHS's Inspector General strongly oppose them. It will cost Medicare $388 million in foregone revenues over 6 years. Advisory opinion fees are not dedicated to the inspector general, and it devastates the agency's ability to fight fraud that they talk about. The MSA's are bad. The earlier version could cost $1 billion over 5 years. Who knows what this modest plan will do? But it is a payoff to J. Patrick Rooney and the Golden Rule Insurance Co., who have given the Republicans over $1.2 million, that we can determine. The conference agreement tries to limit the harm by limiting MSA's, but we doubt if it will. Last night someone inserted a 2-year monopoly patent extension for the American Home Products Co., which has really nothing to do with this bill. There is a guaranteed issue only to small groups. The Senate bill guaranteed that any group, any company, could buy any group health plan sold in a State. The House Republicans limited the guaranteed issue to small businesses of 50, so a firm of 51 people does not have guaranteed access while a firm of 50 does. It makes no sense at all. It is silly. It discriminates against mid-size companies in dangerous lines of work: logging companies, for example. The MediGap duplication. This allows the sale of unnecessary and duplicative health insurance policies, a special interest gift to American Family Life Insurance Co. The consumer groups are outraged. This will let unscrupulous salesmen once again sell policies which seldom or never pay out any benefits. As for phasing in the deduction for self-insured, the Senate did a far better job. The GOP bill goes to 80 percent by 2006. The House Democrats would have had 80 percent by 2002. It is backloaded. They could and should have used the MSA money to increase the deduction for all self-employed. Mr. Speaker, this bill channels people into a limited number of plans and could drive up rates. There is a proposal for cross-subsidization, but there is no guarantee. The Senate bill had an easy and obvious solution: Every individual plan offered by an insurer had to be available to an eligible individual. We do not need this complicated proposal. We should have kept it simple. What the bill does not do is the price of policies are unaffected. They could remain too high. This is only going to help 400,000 people, the CBO tells us. The number of uninsured is rising at 1 million a year. Medicaid cuts passed yesterday will hurt millions of people. We took one step forward with this bill, and yesterday we took 10 steps backward, so I hope that this bill could be expanded and returned to conference to do the job and the proper job that was done by the Senate under the leadership of Senator Kennedy. Mr. Speaker, I reserve the balance of my time.

Mr. STARK. Mr. Speaker, I yield 5 minutes to the gentleman from Michigan [Mr. Dingell]. (Mr. DINGELL asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, may I inquire as to the time remaining on both sides?

Mr. STARK. Mr. Speaker, I offer a motion to recommit.

Mr. STARK. In its present form, yes.

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

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from New Mexico [Mr. Richardson]. (Mr. RICHARDSON asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield such time as he may consume to the gentleman from Oregon [Mr. DeFazio]. (Mr. DeFAZIO asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 3 minutes to the gentleman from Washington [Mr. McDermott].

Mr. STARK. Mr. Speaker, I yield 4 minutes to the gentleman from Michigan [Mr. Bonior], the minority whip.

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

Mr. STARK. Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentlewoman from Texas [Ms. Jackson-Lee]. (Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

Mr. STARK. Mr. Speaker, I yield such time as he may consume to the gentleman from Illinois [Mr. Yates]. (Mr. YATES asked and was given permission to revise and extend his remarks.)

Mr. STARK

Mr. STARK. Mr. Chairman, When Congress considered NAFTA, this Congress received the unqualified assurance from 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 Gilchrest bill and its changes to the ``Dolphin Safe'' label. 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. 2823 lowers our labeling standards and misleads the American consumers. 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. 2823 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. American children deserve ``dolphin safe'' labels that they can take at face value--one that means what it says. We have a labeling system that consumers requested and have come to rely on. Altering the meaning of the label is nothing short of fraud perpetrated on America's kids! I urge you to support the Studds amendment which would protect the ``dolphin safe'' label.

Mr. STARK

Mr. STARK. Mr. Speaker, the Kennedy-Kassebaum bill is a modest improvement. The elephants mated and begat a mouse. It could have been a great bill, but, in effect, it snatched mediocrity from the jaws of greatness. It would have been a much greater bill if it had avoided MSA's, if it had guaranteed group health insurance policies to firms of all sizes, not just to those with under 50 employees. It could have been a great bill if it had truly addressed medical privacy issues. There are some real dangers in the privacy being opened up by a national data computer system. And it holds terrible dangers for privacies of our citizens and their medical records being available to insurance companies across the country. It would have been a great bill if it had not been loaded up with secret last-minute multimillion-dollar breaks for one particular pharmaceutical company. And indeed it would have been a memorial bill if it had provided some modest health insurance protections which would cost relatively nothing. Senators Domenici and Wellstone were willing to offer a most inexpensive proposal to limit caps on mental health services to the same kind of caps that may exist on physical health. It is really a slap in the face to those families who must suffer mental health and pay for it out of their own pocket. For these reasons, I am inclined to support a motion to recommit the bill with instructions to get rid of that drug company welfare loophole--we have not really ended all welfare as we know it, there is still welfare for big contributors to the Republican Party--and a return to work with the Senate to develop a reasonable mental health benefit with modest if no cost to employers or employees. There is no rush, by the way. None of this goes into effect until the middle of 1997 for anybody. So anybody who thinks they are going to quit their job now cannot possibly think about it until next spring. Another week, another day might produce decent legislation without a risk to our privacy, without an affront to the ethic of the House and the Senate, and, by including mental health, a serious disability for many Americans, in this bill. I would hope that we could have followed a process. None of the Democrats in the House signed this conference report. None of the Democrats in the House met in any conference. This was a closed-door, late at night secret session between Republicans with Republicans, and the effort, as a result, is mediocre. I think we could have improved it had we been allowed to participate.