Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the achievements of Ms. Ruth Jernigan. She retired on April 1, 1996, after a total of 44 years of tireless service as a community and legislative advocate. Ruth began working in 1952 at McDonnell Douglas in Long Beach, CA, where she was employed until 1978. In 1978, she began 18 years of service to the United Auto Workers [UAW] as a UAW international representative, where she has served as a coordinator for the UAW Western Region Political and Legislative Program. Her territory included part of northern California from Fresno to Oregon, the States of Oregon and Washington, and parts of northern Nevada. Her responsibilities included serving as the direct liaison between the UAW and city, county, State, and Federal elected officials and advocating for legislative issues on behalf of UAW members, their families, and the community. Throughout her long career, Ruth also served with distinction on several commissions. She was a commissioner for the Department of Water and Power in Los Angeles where her duties included planning and developing new programs for the department. She served as a commissioner on the Los Angeles County Commission for Women. In this capacity, she planned and developed programs to promote women to the highest levels of management in every department of the county of Los Angeles. She also served as a commissioner for Industrial Innovation for the State of California, an organization which provides a forum for debate and policy guidance for the Governor and the legislature on the role of technical innovation in maintaining California's leadership in the Nation's economy. Ruth was also a founding member of the 100 Black Women Organization of Los Angeles County, a member of NAACP, the Urban League, and the Black Women Forum. Mr. Speaker, I ask that you and my colleagues join me in recognizing Ruth Jernigan for all of her years of dedicated service. I wish her much happiness and success in her future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the National Association of Letter Carriers who will be holding their annual ``Food Drive'' Day this Saturday, May 11, 1996. I would especially like to recognize those letter carriers in California's 13th Congressional District who have worked so diligently over the past few years to make this food drive such a great success. The National Association of Letter Carriers' Food Drive Day began as a pilot program in just 10 cities in 1991. It has since grown into one of the largest one day food collection drives in our entire nation. Since 1993, letter carriers across the country have joined in a nationwide effort to make the second Saturday in May, ``National Letter Carriers' Food Drive'' Day. This program has been a tremendous success. The first nationwide drive, in 1993, gathered 11 million pounds of food. In 1994, 32 million pounds of food were collected and in 1995 almost 45 million pounds of food were donated by postal patrons nationwide. This Saturday, letter carriers will pick up food donations as they deliver the mail. To participate, one leaves canned or non-perishable food next to one's mail box or takes it to the nearest Post Office. All of the food items collected that day are then delivered to local food banks. Mr. Speaker, in the Bay Area, almost 300,000 people--half of them children--need emergency food. I urge you and my colleagues to join me in acknowledging the National Association of Letter Carriers for their efforts to help those who are less fortunate. I also urge anyone who can to participate in this Saturday's National Association of Letter Carriers' Food Drive.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to welcome Mayor Kensuke Fukushima and his delegation from the city of Fukaya, Japan, to the city of Fremont, CA, in California's 13th Congressional District. Mayor Fukushima and his delegation are here to help celebrate the founding of the city of Fremont, Fukaya's sister city, over 40 years ago. I would also like to commend Mayor Fukushima for his dedication to the sister- city program. The city of Fukaya and the city of Fremont have been sister cities for the past 16 years and the relationship has been a very important one. We have many successful programs with Fukaya, including the arts exchange, the symphony exchange, teacher and student exchanges, little league baseball, Boy Scouts, business exchange, family exchanges, and the city employee exchange. These exchanges have resulted in deep personal friendships and a greater understanding between our two cultures and communities. We owe much of the success of the sister-city program to Mayor Kensuke Fukushima. He has been a driving force since the very beginning. He was the contact citizen between the city of Fremont and the city of Fukaya prior to the formal sister-city relationship and continued to be active in the program as he held various positions in his city government. Mayor Fukushima has been mayor of the city of Fukaya for the past 8 years and has continued to be a strong advocate for the program throughout his term. Mr. Speaker, I ask that you and my colleagues join me in welcoming Mayor Fukushima and the Japanese delegation to the city of Fremont and in recognizing Mayor Fukushima for his extraordinary efforts in bringing our two cities and communities closer together.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the Asian-American Federation of California as they celebrate the third annual Asian- American Festival. The festival will be held this Saturday, May 11, 1996, at Kennedy Community Park in Union City, CA, in California's 13th Congressional District. The Asian-American Federation was formed out of the need for Asian- Americans to unify in order to address a common set of goals and ideals, and to educate all Americans about the diverse Asian cultures in America and their positive contributions to the American way of life and culture. The purpose of the festival is the same--to educate people about the history of Asians in the United States and the significant contributions that Asians have made to this country. The event is a day-long festival that has drawn is many as 3,000 people in the past. This year's theme is ``Unity in Diversity'' and the event will feature arts and crafts, cultural programs, and a variety of foods from different Asian cultures. Some of the cultures represented will be Filipino, Indian, Taiwanese, and Thai. Mr. Speaker, I ask that you and my colleagues join me in recognizing the Asian-American Federation for their efforts in working to foster a greater appreciation and awareness of Asian heritage. I also ask that you join me in congratulating the federation on organizing this important event to celebrate diversity, where all people are encouraged to come together to learn about and respect other cultures.

Mr. STARK

Mr. STARK. Mr. Speaker, the rush is on to push all Americans--except the wealthy who can afford medical savings accounts--into managed care and capitated plans. What is capitation? The American Medical Association recently published a booklet entitled ``Capitation: The Physicians Guide.'' It is designed to help doctors understand capitation, how to negotiate a managed care contract, and survive in this new world of managed care. It is artfully worded, but reading between the lines is pretty easy. The following are quotes from the booklet: To be successful under capitation, you also have to change the way you practice medicine. . . . When patients use fewer services than anticipated in setting the Per Member, Per Month (PMPM) payment, you get to retain unspent funds. Many capitation agreements also offer physicians the opportunity to participate in risk pools, another opportunity for financial gain. . . . thus risk pools provide physicians with an opportunity to benefit financially from reduced utilization of non-physician services. Capitation forces you to broaden your focus from considering the health care needs of the individual patient to considering the health care needs of the group. Capitation offers a strong financial incentive to provide cost-effective care to all patients. Under fee-for-service, providing more services translates into higher practice revenue and thus higher income. But under capitation, providing more services adds only to your costs. Improvements you can make in your practice style that reduce utilization and increase cost effectiveness increase your profitability. When primary care physicians accept capitation and are subject to risk pools, they have an incentive to reduce all types of utilization, including the use of specialists. . . . Generally, primary care physicians reduce referrals by about one-fourth when they are at risk for referred services. Mr. Speaker, the fee-for-service system where a doctor can make more by endlessly doing more is outdated and bankrupting us. It has to be changed. But be careful--managed care and capitation can kill you. Do you really want your doctor worrying more about his group than you, when you get sick? As a society, as a government we do not yet have good measures of how to judge quality, of how to know when someone is undertreating and underreferring patients. Managed care is happening very quickly, and we should not be further speeding up the movement into managed care until we have adequate consumer protections and quality measures in place.

Mr. STARK

Mr. STARK. Mr. Speaker, last year I introduced legislation, H.R. 1068, designed to reduce the onset of end-stage renal disease [ESRD] in millions of Americans who suffer from kidney disease. Today, I reiterate the need for this important measure that will work to keep kidney disease patients off dialysis and cause savings for the Medicare Program. With the establishment of the demonstration project that this bill proposes, patients will be accurately assessed to see what management services can prevent the progression of renal disease and delay the onset of dialysis. The ESRD Program, that is a part of the Medicare Program, currently serves about 200,000 beneficiaries at an estimated total per patient cost of $51,000 a year. The question that the 3-year demonstration program will work to answer is if the costs of applying preventive services to ESRD patients will delay the onset of complete renal failure, thus causing an increase in the quality of life of patients and a net savings to Medicare expenditures which is larger than the cost of the preventive services. One recent study has affirmatively answered this question. A recent report published in the Annals of Internal Medicine concluded that a reduction of protein in patient's diets will slow the progression of chronic kidney disease. The report cited five separate studies of nondiabetic patients who showed a 30-percent reduction in complications with the low-protein diet. A recent publication by the Iga Nephropathy Support Network reported that patients who reduced meat consumption, saved the kidneys a lot of hard work in clearing the body of the byproducts of protein metabolism. With 20 million Americans suffering from kidney and urinary tract diseases, these findings are monumental and a clear example of the need to provide funding for preventive services. A spokesperson for the National Kidney Foundation said that the recent breakthroughs in preventive care, ``* * * not only helps the individual, but in the long-term it keeps patients off dialysis * * * saving money.'' With an increasing number of patients entering the ESRD Program, this legislation is necessary for the containment of costs for treating dialysis dependent patients. Also, the high unemployment rate among patients who require dialysis to live will decrease as patients are able to stay in the workforce longer because of the careful management of their disease. With all of these suggestions about the benefits of prevention care and management, we must establish the demonstration program provided by this legislation.

Mr. STARK

Mr. STARK. Mr. Speaker, on December 22, 1995, I introduced a bill, H.R. 2839, entitled the Medicare Medication Evaluation and Dispensing System of 1995 [MMEDS]. The MMEDS would provide the tools and information to beneficiaries that are necessary to reduce the high instances of adverse drug interactions, overmedication, incorrect duration of drug treatment, and other problems that the elderly face with prescription drugs. The GAO report issued in July, 1995 called Prescription Drugs and the Elderly strongly supports the changes my bill proposes. Statistics show that the present system does not serve the elderly well: [A GAO analysis] showed that an estimated 17.5% of the almost 30 million senior citizens in the survey used at least one of the drugs generally identified as not suitable for elderly patients in 1992 (p. 4). Several studies have shown that adverse drug reactions greatly harm the elderly: They cause an estimated 17 percent of the hospitalizations of elderly patients, a figure 6 times greater than that of the general population, 32,000 hip fractures per year, and 16,000 car accidents per year. ``The FDA estimates that hospitalizations due to inappropriate prescription drug use cost about $20 billion annually'' (p. 5). Because these statistics of harm to senior citizens and the costs associated with it are so frighteningly high, the necessity for reform of the elderly's prescription drugs dispensing system is further justified. According to several experts interviewed [by the GAO], lowering the elderly's risk of adverse drug reactions requires that more detailed information on the impact of drug therapies on the elderly be developed and disseminated to health practitioners . . . Increased communication between and among physicians, pharmacists, and patients is vital to ensuring that this process is effective (p. 8). The MMEDS would provide an on-line, real-time prospective review of drug therapy before each prescription is filled or delivered to an individual receiving benefits under Medicare. The review by a pharmacist would include screening for potential drug therapy problems due to therapeutic duplication, drug-drug interactions, and incorrect drug dosage or duration of drug treatment. In the bill I have introduced, as part of the prospective drug use review, any participating pharmacy that dispenses a prescription drug to a Medicare beneficiary would be required to offer to discuss with each individual receiving benefits, or the caregiver of such an individual--in person, whenever practicable, or through access to a toll-free telephone service--information regarding the appropriate use of a drug, potential interactions between the drug and other drugs dispensed to the individual, and other matters established by the Secretary of DHHS. The Secretary would be given the duty to provide written, oral, or face-to-face communication to pharmacists and physicians concerning suggested changes in prescribing and dispensing practices. The report issued by the GAO discusses the need for more oversight of the distribution of prescribed medicines to our Nations' elderly. Unless something is done, the increase in the number of elderly in our society will increase the amount of drugs wrongly prescribed. By implementing the Medicare Medication Evaluation and Dispensing System Act, we could greatly improve the quality of care our Nation's elderly receive when they are prescribed medication.

Mr. STARK

Mr. STARK. Mr. Speaker, it is a joy to get a chance to speak to Sam when he has to sit and listen to us. Mr. Speaker, I have worked with Sam my entire 22 years on the Committee on Ways and Means. It is interesting. Sam opposed expanding the Committee on Ways and Means when all of us new youngsters came on the committee. They had a nice little club and they really did not want to add to it. But once the caucus worked its will and the Committee on Ways and Means learned about democracy and expanded its membership, Sam turned out to be the fairest of the titans on that committee for opening up and sharing the responsibility. Mr. Speaker, he wrote the rules for that committee which stand today I think as a mark for other committees in its fairness and its openness. And many of us who worked with Sam for so long remember that. He could oppose you and he is not shy and he is willing to speak out. And unlike some of us, he does not need to learn more diplomacy and reticence because he has Martha, and Martha has been able to keep Sam mellow and happy when he has been fighting like hell for something that he believes in. Mr. Speaker, Sam wrote the rules for the Committee on Ways and Means. He is an expert on trade. Then in the last Congress when we were attempting to pass welfare reform, Sam sat through every markup with our subcommittee, even though he was not on that committee, and when the bill came to full committee it was the expertise not only from his experience as he had been with Medicare from the time he voted for it as an original bill but from all the service on the Committee on Ways and Means he was able to help us pull together that coalition that was able to present to the American public a health care bill that was fair, did not increase the deficit, and opened up health coverage to every American. I hope, Sam that he can provide that for you in your retirement and you can come back and share with us when under the leadership that you set, and the goal you set for us with the President, we will accomplish that. God bless you, Sam. We will miss you.

Mr. STARK

Mr. STARK. Mr. Speaker, medical savings accounts are bad health policy. They are bad tax policy. The following analysis from the Center on Budget and Policy Studies explains why: Who Will Use Medical Savings Accounts and Why Will They Use Them? (By Iris J. Lav) Prior analysis of Medical Savings Account proposals has shown that MSAs would primarily benefit those at high income levels because MSAs create opportunities to accumulate tax- sheltered funs for purposes other than medical costs. Higher- income taxpayers would be most likely to take advantage of these tax shelter opportunities because the tax benefits are worth more to taxpayers in higher tax brackets and because such taxpayers can afford to pay substantial out-of-pocket medical costs if they choose to leave the tax-advantaged funds on deposit in the MSAs or if funds accumulated in the MSAs are insufficient to cover their medical bills. Recently, the Joint Committee on Taxation has released data estimating what proportion of people in each income class would make use of Medical Savings Accounts, finding that a large portion of the participants would be middle class. These data have been used to bolster claims that MSAs would benefit middle class taxpayers as well as the wealthy. But the Joint Tax data are not incompatible with the conclusion that higher-income taxpayers would be the primary beneficiaries of MSAs. As the text of the Joint Tax analysis makes clear, participation in an MSA may not be voluntary. Taxpayers who participate in MSAs because their employers offer no other option for health care coverage may not benefit from their participation and may become worse off as a result of their employers' switch from offering a conventional insurance policy or a managed care plan to a plan that offers only a high-deductible insurance plan with an MSA. joint tax highlights benefits to companies, not employees The Joint Committee notes that its estimate is based ``on the assumption that a large proportion of small- and medium- sized companies might potentially benefits from the MSA proposal and offer such plans to their employees.'' To assume that a company would benefit generally means that the company would pay less for its employees' insurance coverage. This suggests two further assumptions that likely underlie the Joint Tax analysis. Small- and medium-sized companies that do not now offer any health insurance would not begin to offer high-deductible coverage with MSAs as a result of this legislation. Such an assumption would result in increased rather than decreased costs for the companies and thus would be incompatible with the statement that the companies would benefit. The analysis must instead assume that employers currently offering conventional coverage or managed care plans would begin to offer high-deductible insurance with MSAs. Furthermore, companies would receive a cost-saving benefit from such a switch only if the total cost of the high- deductible insurance including the MSAs would be less than the cost of the insurance the company currently offers. Thus the small- and medium-sized companies that switch to high- deductible insurance with MSAs likely would not put the entire difference between the conventional insurance premium and the high-deductible insurance premium into their employees' MSAs. Companies would realize cost savings from the switch only if they choose to keep, as a profit-enhancing savings, at least a portion of the difference in premiums between the two types of plans. low- and moderate income taxpayers may participate in msas involuntarily The Joint Committee on Taxation analysis goes on to say that ``Employee wages for small- and medium-sized are weighted toward the lower- and middle-income classes. As a result, the revenue estimate assumes that taxpayers in the lower- and middle-income classes are more likely to be offered a high deductible plan coupled with an MSA as their primary health plan.'' (Emphasis added.) Although the Committee's use of the term ``primary'' is ambiguous, it suggests some further issues. Low- and middle-income employees may be reluctant voluntarily to accept high-deductible insurance with MSAs, because they usually do not have the resources to pay large out-of-pocket health care costs. An assumption that substantial numbers of such employees would participate suggests that their employers might offer only high- deductible insurance with MSAs and would no longer offer either a conventional fee-for-service policy or a managed care plan. For low- and moderate-income employees who consume significant amounts of preventive care for their young families through a health maintenance organization, for example, or have chronic health problems that require continuing care, the restriction of choice to a high- deductible plan could substantially degrade their ability to afford necessary health care services. inadequate msa deposits transfer large costs to moderate-income employees Low- and middle-income employees are likely to face high out-of-pocket costs under the high-deductible insurance plans with MSAs because the MSA contributions made by their employers are likely to fall short of the annual deductible amounts under those insurance plans. In fact, employers are unlikely to be able to afford to deposit the full deductible amount. Consider the following. A company may currently offer its employees family coverage under a conventional insurance policy and pay an annual premium of $5,200 for that coverage. If the company switches to offering a high-deductible plan with an MSA, the annual premium for the high-deductible insurance policy would be approximately $3,900. These costs assume the insurance plans are comparable except that the conventional coverage includes a $200 deductible while the high-deductible plan has a $3,000 deductible. Because the company's annual premiums savings from switching to the high-deductible insurance plan is only $1,300 per family ($5,200 minus $3,900), the company is highly unlikely to be willing to deposit $3,000--the full amount of the deductible--into the employee's MSA. In addition, employers are likely to keep some of the difference as a cost-saving benefit to the company. Thus low- and middle-income employees likely would have significantly less than half of their annual deductible amount--and most likely no more than one-third of the deductible--deposited into MSAs by their employers and thereby available to meet ongoing health care costs. Moreover, nothing in this bill requires employers to make any deposits to MSAs as a condition of offering high- deductible insurance. Once small- and medium-sized employers shift to offering only high-deductible insurance and no longer offer conventional insurance or managed care plans, they would be free to reduce or eliminate contributions to the MSAs at any time. If that occurred, the low- and moderate-income employees of those companies would be left to finance the entire deductible amounts out of their own pockets. Although the low- and moderate-income employees could make deposits on their own to an MSA, they would receive little or no tax advantage from using MSAs--because they either do not pay income taxes or pay taxes at much lower rates than the higher-income taxpayers who would be the primarily beneficiaries of this MSA legislation. In short, if low- and moderate-income taxpayers use MSAs in substantial proportions, it will likely be because they have little alternative. And the use of the MSAs with high- deductible health insurance plans is likely both to increase their risk of incurring unaffordable health care costs and reduce their ability to afford adequate levels of health care services for themselves and their families.

Mr. STARK

Mr. STARK. Mr. Speaker, I am introducing today legislation to make the COBRA health continuation program available to anyone between age 55 and the time they are eligible for Medicare. Restructuring, layoff, downsizing, cutback, retrenchment--these words are heard too often in the 1990's. Amid corporate struggles to maintain profitability or simply to stay afloat, something else is shrinking: the number of permanent, full-time jobs. As the level of employer-provided insurance declines and as hundreds of thousands of older workers face early retirement because of corporate downsizing, layoffs, and restructuring, the problem of health insurance for those not yet eligible for Medicare is becoming more and more serious. While corporate profits were surging to record levels in 1994, the number of job cuts approached those seen at the height of the recession, according to a May, 1995 Wall Street Journal article. Profits rose 11 percent in 1994, on top of a 13-percent increase in 1993. Corporate America cut 516,069 jobs in 1994. International Business Machines Corp. [IBM] notified 1,200 employees last fall that they would no longer have jobs. Yet IBM's fourth-quarter profits were $2.03 billion. At AT&T, 40,000 jobs were recently cut. Workers will get a lump-sum payment based on years of service, up to 1 year of paid health benefits and cash to cover tuition costs or to start a new business--but what happens to health coverage after the 1 year? In Colorado, the Adolph Coors Co. announced plans in February to lay off as many as 150 of its 230 construction workers, despite profits of $5.3 million in the fourth quarter. Safety Stores undertook one of the most brutal corporate downsizing in history as a result of its leverage buyout in the mid 1980's. Safeway dumped 55,000 employees with no medical insurance, virtually no notice, and a maximum of 8 weeks severance. A 1994 Nationwide study of 2,395 employers by A. Foster Higgins & Co., a New York based benefits consulting firm showed that among large companies--those with 500 or more employees--46 percent provide some form of coverage for early retirees, while only 39 percent provide insurance for Medicare-eligible retirees. Fewer than one in five large employers are willing to pay the entire cost of health care for their retirees, while 40 percent of the companies that do offer some form of health care coverage require the retiree to pay all of the costs. Those companies that do provide health care coverage for their retirees are increasingly requiring them to pay a share of the cost, especially for dependents. Employee Benefit Research/Institute [EBRI] tabulations of the March 1995 Current Population Survey reveal that almost 14 percent of the near elderly, consisting of persons aged 55-64, was uninsured in 1994. As the baby boom generation approaches near elderly and elderly status, the issue of health insurance coverage for this group becomes increasingly important, particularly if the proportion of individuals aged 55-64 with employment-based coverage continues to decline. Group health insurance is, of course, much less expensive than individual policy insurance, and that is why the COBRA benefit is so important and useful. The difference in cost can easily be several thousand dollars. Help with the cost of this insurance is particularly important for those in their 50's and 60's because most insurance premiums rise sharply with age. For example, in the Los Angeles market, Blue Cross of California offers a basic, barebones in-hospital $2000 deductible plan. This is a PPO plan where you are restricted to the hospitals you can use. For a couple under age 29, it costs $64 a month. For a couple between age 60 and 64, it costs $229 a month. To help ensure that the cost of COBRA continuation is not a burden to business, my bill calls for age-55+ enrollees to pay 110 percent of the group rate policy--compared to 102 percent for most current COBRA eligible individuals and 150 percent for disabled COBRA enrollees. I know that the cost of paying one's share of a group insurance policy will still be too much for many Americans and many of them will be forced into the uncertain mercies of State Medicaid policies. But for many others, this bill will provide an important bridge to age 65 when they will be eligible for Medicare. I wish we could do more--I'd like to see the gradual expansion of Medicare to all age groups, for example--but in the current climate, this bill is our best hope. Over the years, I've received many letters from around the Nation on the need for national health insurance reform. Several of these letters describe lives which would be greatly helped by the passage of this legislation, and I include them at this point in the Record. I am attaching a copy of a letter that I sent to several people earlier this year. I have to amend one inference in that letter--that I would have no health coverage after the expiration of the COBRA coverage. I would have coverage if I could afford the ridiculous $12,000 or $14,000 figures I quoted previously. Man From Illinois, Age 55+.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to recognize the students in Mr. Skip Mohatt's civics class at Amador Valley High School in Pleasanton, CA. These students recently placed first in Sacramento, CA, to win the statewide ``We the People'' civics class competition. Amador Valley High School and Mr. Mohatt have had a long history of success in this competition. This is the third year in a row that Amador Valley High Students have come in first and the fourth time in 5 years that they have won the State title. Last year, Amador Valley High School was the national champion. I want to commend Mr. Mohatt and his students for this extraordinary achievement and to wish the class luck. They are here to defend their national championship title in 2 weeks. I would like to take this opportunity to mention the students by name, In alphabetical order, the 1996 California State champions are: Evan Anderson, Jamie Bartlett, Matthew Brehm, Jarold Bunas, MacKenzie Bundgard, Erin Callahan, Michael Campbell, Ryan Darst, Leah Dellanini, Chad Duffy, Heather Erskine, Jared Fixmer, Michelle Gilbert, Kristin Johnson, Erin Kettwig, Beatrice Korbel, Jason Lew, David Loughnot, Abimbola Majekodunmi, Christina Nystrom, Tina O'Keefe, Angie Picco, Bill Reaugh, Joseph Sabbagh, Olivia San wong, Christine Splitt, Paula Tee, Randall Wat, Eric Willett, and Katrine Wilson. Mr. Speaker, I hope that you and my colleagues will join me in congratulating these students on their recent first place finish and to wish them luck in the upcoming competition.

Mr. STARK

Mr. STARK. Mr. Speaker, today I would like to join my constituents in commemorating the retirement of Officer Kenneth L. Pontious. Officer Pontious is retiring after 28 years of service to the community and citizens of Union City. During his 28 years of service, Officer Pontious has contributed to the Union City Police Department in many different capacities. He has served as a Motorcycle Patrol Officer. In addition, he has worked as a Traffic Officer and a member of the Special Enforcement Response Team. Officer Pontious has also assisted the community as a School Resource Officer giving his time directly to our young people. Finally, Officer Pontious has worked as a Field Training Officer, Rangemaster and Police Explorer Post Adviser. Therefore, Mr. Speaker, I come before you today celebrating with my constituents the career of Officer Kenneth L. Pontious. I hope you and my colleagues will also join me in congratulating him for his contribution to the community.

Mr. STARK

Mr. STARK. Mr. Speaker, last May, I introduced legislation designed to ensure that Medicare beneficiaries have access to quality care and fair treatment by their HMO's and managed care plans. Today, I reiterate the need for Medicare beneficiary protection and urge passage of the needed safeguards that H.R. 1707 provides. An important issue addressed by this measure is the serious abuse of marketing practices by HMO's. Abuses by sales agents are especially prevalent in geographic areas where people have little experience with managed care. The commission system in which many HMO agents work is an inappropriate financial incentive which leads to pressure sales to vulnerable beneficiaries. For example, when Geraldine Dallek of the Center for Health Care Rights provided testimony last year to the Senate Special Committee on Aging, she reported a story of a woman from Los Angeles who was a victim of these practices. The woman, Mrs. B, who has a fifth grade education, received an unsolicited visit from an HMO marketing agent. When Mrs. B refused to sign up for the plan, the representative persuaded her to sign an enrollment form by telling her that it would only be used to verify his visit. To remedy abusive HMO marketing practices, H.R. 1707 would prohibit door-to-door marketing and allow beneficiaries to enroll via mail. Also, it would limit the percentage of compensation received through commissions and require plans to recover commissions if the beneficiary disenrolled within 90 days. Most HMO enrollees give up their supplemental or MediGap coverage when they enroll in an HMO. Many fear that if they disenroll from an HMO, no insurance company will sell them a supplemental policy. This is a very serious issue for those who leave their HMO because they are ill and believe the HMO is not providing them adequate care. Under my bill, beneficiaries will be able to secure a supplemental plan after moving out of an HMO. H.R. 1707 requires Medicare-contracting plans and MediGap plans to participate in an open enrollment process. This provision allows for a beneficiary to enroll, disenroll, or change plans during this period without being subject to medical underwriting or preexisting exclusions. Also, the difficulty beneficiaries have making comparisons among Medicare coverage options would be dealt with by having the Secretary conduct annual open enrollment periods. During this period, Medicare beneficiaries could enroll in traditional Medicare coverage or any additional HMO-managed care options. Differences in plan benefits and costs would be presented in easy, comparative formats. A criticism of managed care plans has been the lack of readily available, understandable and comparable information of plans. This legislation works to correct this by requiring Medicare-contracting plans to provide descriptive information on plan utilization review requirements, plan standards for contracting with providers, provider credentials, and plan physician payment arrangements. This bill would standardize the basic benefit package for Medicare HMO's. Plans could not impose cost sharing other than nominal copayments for Medicare- covered services. Also, limits on additional benefits must be fully explained and enrollees given reasonable notice that benefits are expiring. Managed care is a system that provides financial incentives to provide less care. A 1989 GAO report concluded that this system that puts providers at financial risk for expensive medical treatment inherently contains incentives to deny or delay needed care. The problem of inconsistent and delayed utilization review practices of managed care plans would be remedied in several ways by H.R. 1707. First, financial compensation could not be given to individuals performing the UR based upon the number of denials. Second, negative determinations about medical necessity or appropriateness will be required to be made by clinically qualified personnel. Also, final determination of coverage must be made within 24 hours. The amendments would also update HMO plans in the area of access to emergency medical services. Specifically, plans could not require preauthorization for true emergency medical care and could not deny a claim for a beneficiary who uses the ``911'' system to access services. Also, plans must define ``emergency medical care'' in terms easily understood by the average person. An example of why this is needed is given by the Center for Health Care Rights which reports a case of a San Diego woman who went to her HMO's urgent care center for treatment of an injury. She was told that the center had many people waiting and only one doctor on duty. The beneficiary was instructed to go to the nearest emergency room. The HMO later denied her claim because the emergency room treatment was not authorized. These requirements will also benefit physicians by mandating reimbursement by the plan to those physicians who provide emergency services in nonplan hospitals in order to fulfill the Federal antidumping law. An important protection standard in this legislation would benefit those who seek out-of-plan treatment: Providers plans would be prohibited from charging more than Medicare would have paid under fee- for-service rules. Also, plans would be required to make arrangements for beneficiaries to have occasional dialysis service outside the plans area. Recognizing the special needs of individuals with disabilities and chronic-illness, the amendments guarantee enrollees access to designated centers of excellence. The standard for the designation of a center of excellence will be established by the Secretary. Factors that would be included in the Secretary's designation would include specialized education and training, participation in peer- reviewed research, and treatment of patients from outside the facility's geographic area. To improve due process for providers in networks, public notices would be required as to when applications by participating providers are to be accepted. Notification of a decision to terminate or not renew a contract would be required not later than 45 days before it is to take effect. In order to ensure access to enrollees throughout a plan's service area, the Secretary may require plans to contract with certain clinics and other essential community providers in the service area. In general, the service area of a Medicare-contracting plan would be an entire metropolitan statistical area. To comply with this plan, Federal regulators would be given authority to impose intermediate sanctions. Currently, the Secretary has the authority to bar participation in Medicare. Under this plan, the Secretary could prohibit plans from enrolling beneficiaries until it meets all Federal requirements. A new review process would allow HMO's to submit a corrective action plan for violations. A civil money penalty up to $25,000 for each violation that adversely affects an individual enrolled in the plan would be authorized. The Medicare beneficiary protection amendments are a powerful step toward safeguarding the health of Medicare beneficiaries. Last year, an inspector general's survey found that 16 percent of enrollees planned to leave their HMO, but felt they could not. Even worse, 66 percent of disabled/ERSD enrollees wanted to leave their HMO's. These statistics and others indicate that HMO's are often failing to properly serve many Medicare beneficiaries. The remedies I propose will move us toward better quality and a fairer managed care system.

Mr. STARK

Mr. STARK. That is the only effective way to measure it?

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

Mr. STARK. Mr. Speaker, the gentleman just stated some interesting statistics of 17 percent and 18 percent tax rates. I suspect the gentleman was referring to the percentage of gross domestic product.

Mr. STARK. Mr. Speaker, I thank the distinguished gentleman for yielding me this time. Mr. Speaker, this amendment proposal is really nothing more than political sham, phony or not, and we all know it. These proceedings, which will amount to 5 or 6 hours, are a pathetic political circumstance, staged by the radical Republican leadership of the House, to hopefully be broadcast at prime time on today's tax day. At this moment in our history, a brief moment, the House happens to be under the control of a misguided vanguard who are ideologically opposed to any tax increases whatsoever. That does not mean we should pervert our Constitution, which has served us so well and supports the longest lasting system of democratic government in modern history. That is right. This is just another cheap publicity stunt. Remember the Contract With America? That bunch of stupid ideas that sounded so good? Now the Republicans are using that constitutional amendment as a prop and a shallow scheme to convince the public that new majority is working in the best interests of average Americans. The same radical zealots who said they would save Medicare when they actually wanted to destroy it and handed out tax breaks to the rich are trying to trick us again. Just as Americans file their tax forms, we have the promise of a constitutional amendment to require a two-thirds vote. But the absurdity of this proposal goes much deeper. Any major government initiative requires funding. Think of it, if this law had been in effect, you would not now have Social Security or you would not now have Medicare. And somebody earlier mentioned family values. Well, that would be fine, except there would be no highway system for the families to go anywhere and you would not be able to vaccinate your children, because we pay for those childhood vaccines with a tax. All of that would not be here today if this amendment were to pass, and that is not how it is supposed to be done. Amending the Constitution is a serious matter, and this resolution has been rushed through without any discussion or deliberation at the committee level, without any public debate, simply so it could be here tonight on tax day. This is no way to run a country, and my colleagues on the other side of the aisle who support this proposal should be ashamed.

Mr. STARK. I thank the gentleman for clarifying that.

Mr. STARK

Mr. STARK. Mr. Speaker, I yield 4 minutes to the gentleman from Washington [Mr. McDermott]. (Mr. McDERMOTT asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield myself the balance of my time. I would just suggest that the Republicans would like to spend almost $4 billion on long-term care insurance at the same time they cut $90 billion out of Medicaid, which pays for long-term care for the poorest. It is true that we had a bill that would have provided health insurance to all Americans, and there are 40 million Americans out there uninsured who obviously the Republicans do not give a hoot about. All they care about are the rich, who can enjoy the medical savings accounts. So if you do not have insurance and your children do not have insurance, the Republicans are doing nothing. If you are very rich or you know some rich people, they get helped by this bill. The Dingell-Spratt-Bentsen amendment would be the bill to support, which would get us the Roukema-Kennedy-Kassebaum bill, which does all the good things on a bipartisan basis that we need to do and does away with the claptrap that has been added on to this bill with the awful intention of killing it, which to me is cynical, and it is cynical because it is going to hurt the poor and the elderly while it helps the rich, like Ross Perot and the friends of the Republicans. And that is not what this country needs. We have 40 million people who do not, whose COBRA benefits could protect them; 3\1/2\ million who will expire. The Republicans voted against extending it. Support the Dingell-Spratt-Bentsen amendment.

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

Mr. STARK. Mr. Speaker, I reserve the balance of my time.

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. It is interesting that the previous speaker spoke about parasites I think here to enlighten us about parasites. is the gentleman from Virginia [Mr. Moran], who will tell us about the Golden Rule Insurance Company, which gave Mr. Gingrich's political operations over $1.5 million, which is why we are discussing these MSA's. Mr. Speaker, I yield 3 minutes to the gentleman from Virginia [Mr. Moran].

Mr. STARK. Mr. Speaker, I yield 4 minutes to the gentleman from Michigan [Mr. Levin]. (Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 3 minutes to the gentleman from Maryland [Mr. Cardin].