Charlie Stenholm

Mr. STENHOLM

Mr. STENHOLM. Not until they drill.

Mr. STENHOLM. That is most certainly the fear, and it is not just a fear, it is a reality if we impose these regulations all across the United States, as someone might in a certain area in which we have a different rainfall characteristic. The annual rainfall in my district ranges from 14 inches in the west to 35 inches in the eastern part of my district, the part that adjoins the district of the gentleman from Texas (Mr. Barton). Therefore, there are different components. But the law gets interpreted and put into place and enforced in ways that assume that a drilling rig in west Texas is going to suddenly be faced with a 20-inch rain.

Mr. STENHOLM. In the case of a flood, wet dirt that goes into a home is a pollutant.

Mr. STENHOLM. Two years ago, but I take the gentleman's point. Ironically, we are facing the same question in some regions of this country where dirt is considered a pollutant, and we are attempting to regulate plows. I remember 3 years ago, I believe, in Arizona, we were attempting to regulate dust storms. That is difficult to do, the same way the gentleman is talking about regulating when is it going to rain and how much is it going to rain. From the standpoint of a normal operation in my district, again, on my own farm, the site is prepared. It would be unconscionable to require a permit, going over 6-8 months, or order to find an opportunity there based on storm water. It is done based on other conditions, and that is already current law.

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

Mr. STENHOLM. Mr. Speaker, let me say the concern I have, when the regulations are read and the experiences we have had, we have had some extremely damaging experiences with the Endangered Species Act. What the gentleman says--7-day permit, that is correct; but someone comes in and sues at the exact moment, and then we get into the litigation and all of the questions based on it.

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, I rise in strong support of the Cardoza motion to instruct Medicare conferees. The Cardoza motion instructs conferees to insist on a House-passed provision that would largely eliminate reductions in Medicaid disproportionate share hospital payments, or better known as DSH payments, currently scheduled to go into effect in fiscal year 2004 and fiscal year 2005 and provide some benefits in later years. DSH funding is our Nation's primary source of support for our safety net hospitals that serve our most vulnerable populations. Medicaid DSH is especially important now as the number of uninsured Americans continues to rise, with now over 43 million Americans without health care coverage. In our State of Texas, I say to my friend from Houston, where nearly a quarter of the population has no health insurance, hospitals and health care clinics rely heavily on the DSH payments in order to finance care for the poor and uninsured. Despite the growing demand, Texas is increasingly constrained from making DSH payments to needy hospitals. In the recent budget cycle, Texas State legislators slashed millions in funding and services throughout the Medicaid program in response to the State budget deficit. In fiscal year 2003, Texas DSH payments were reduced by $80 million due to statutory limits in Federal law. All of these cuts inevitably will fall on the shoulders of Texas' poor and uninsured, depriving them of their access to basic health care as providers like hospitals are left with no choice but to reduce services. Particularly this is a problem in rural areas. If hospitals and health care providers do not close their doors or fold under the financial pressure, they may shift the burden of caring for the poor and uninsured by charging more to the patients who can afford to pay, making health care more expensive for all Americans. The House DSH provision contained in the Cardoza motion is essential to ensuring that the most vulnerable Texans continue to receive vital health care services. The provision, section 1001 in House bill 1, would provide Texas an estimated $140 million increase in fiscal year 2004 over current law. Sufficient DSH payments are absolutely critical if hospitals and health care clinics are to continue to serve the neediest and the poorest Texans. Now is not the time to deny the poor and uninsured access to the health care they need or to shift the burden to the average American on an experimental program. I cannot say how strongly I oppose the general provisions that my friends on the other side of the aisle seem to believe that privatizing Medicare, turning Medicare over to the private industry, is going to be the best way to serve the uninsured in Texas. It will not work because it cannot possibly work when you already have a program that the administrative cost runs consistently less than 2 percent. No one has ever been able to show me in any debate, any discussion, anywhere at any time that you can do a better job with less money. I would enjoy hearing people defend this from the standpoint of something other than philosophy. But in the case tonight, we have a clear choice. This motion is clear to us, unless you believe, as some do, that privatizing is the way to go. We have already experimented with this in agriculture. We have done it now for 10 years. It has not worked and cannot work, and we continue to hear folks coming to the floor of the House talking about the need for additional Federal involvement in disaster programs covered by insurance. It does not work there. It cannot possibly work in something as important as health care. I encourage all of my colleagues to support the Cardoza motion to instruct Medicare conferees and hope the conferees are listening carefully.

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, I thank the gentleman for yielding to me. I think it is particularly important to point out that the gentleman here is from South Carolina. A few weeks ago we had a hurricane called Isabel that was heading in on the East Coast, and the folks from South Carolina, North Carolina and Virginia began to plan for that hurricane because through modern technology, we can see it coming through, and we followed it. And there were a lot of homes that were boarded up. There were a lot of preparations made, a lot of batteries were bought and other supplies were bought preparing for what we could see coming. It is amazing to me that the majority party in this House refused to acknowledge the coming perfect storm. The perfect storm of fiscal deficit, now as far as the eye can see, of 400, $500 billion, trade deficits as far as the eye can see, $500 billion this year and growing, and these are the jobs that we are losing, the exporting of the jobs that are occurring. That is happening under current policy and then the third component of this perfect storm, the upcoming baby boom generation that will begin retiring in 2011. We know that is going to hit all 50 States. It is not going to pick out Virginia or North Carolina. It is going to hit all 50 States, and what are we doing in this body to prepare for it today? Zero. In fact, worse than nothing we are doing. We are digging the hole deeper. Fiscal deficits now do not matter anymore, and it is amazing to me, someone who has been around here and used to vote with my friends on the other side for attempting to bring fiscal responsibility to this body, we are now told deficits do not matter anymore. Oh, they are tried to be explained away as a percent of gross domestic product. The last one we come in with was $374 billion deficit last year; and folks say, hey, good news, it is less than the 450 we projected last July. And we are supposed to rejoice? The 374 happens to be the biggest deficit in this history of our country. Amazing. Another little perspective perhaps that people might begin to pay attention in this body is who I am talking to. It took this country 204 years to borrow the first $1 trillion. In the first 2\1/2\ years of this administration, we borrowed another $1 trillion. In the next year and a half, we are going to borrow another $1 trillion. I would hope with $1 trillion we could get one quarter of 7.2 percent gross domestic product increase. I would hope that because as we saw on my colleague's chart a moment ago, the math on this does not add up to being good business practices. Oh, when we start down this line, how many times have we heard somebody say, well, if only Congress would control spending. There are still a lot of folks out there, particularly on the talk radio shows, still blaming it on Democrats. Well, we have been in the minority for 8 years in this body, and let me give my colleagues the record of the last 8 years of Republicans in the Congress. Spending went up 6.5 percent per year compared to an average 1.6 percent in the previous 8 years. Now, I happen to agree that we have got to constrain spending. I have promised on this floor, and again, tonight, I will, to the best of my ability and knowledge, not vote for one penny more spending than President Bush asked us to spend, period; but let us stop blaming spending unless my colleagues are willing to control spending, and that means all spending. We cannot just pick out that which we like, because in the economy it is all spending. I happen to be personally of the opinion that it is worse policy to borrow and spend than it is to tax and spend; and I say that because when we tax and spend, the voters take it out on us; but when we borrow and spend, the voters are still in diapers, and they cannot take it out on us. Therefore, it is easy to borrow and spend to get through the next election; but then somebody's got to pay the piper, and boy, the hole we are digging is getting deeper and deeper. My friends and colleagues on both sides of the aisle and Mr. President and this administration, the perfect storm is gathering. The idea that we can borrow at the rate we are borrowing and spend at the rate we are spending and not have somebody pay the piper is redefining basic economics. The trade deficit is the second leg of that perfect storm, and the baby boomers are going to begin retiring in 2011, guaranteed. What are we doing? Tax cut a week. Tax cut a month. New economics. Dig the hole deeper. Well, I do not know whether it was Confucius or Garfield that first uttered the words, When you find yourselves in a hole, the first rule is to quit digging. The second observation I make in closing tonight, in listening to my colleagues on this side earlier tonight, 5-minute speeches talking about waste, fraud and abuse, it is on my colleagues' watch. If we are spending too much, Mr. President, veto some bills because they do not spend or they spend too much. Also, I am reminded of the words of the late Will Rogers, ``It ain't ignorance that bothers me so much. It's them knowing so much that ain't so is the problem.'' We listened to the debate tonight, we listened to some of the statements that were made earlier, and we look at charts that the gentleman from South Carolina (Mr. Spratt) is showing. These are facts. What I have just said about the deficit are facts. They are not made up. They are not made up. But what are we doing about it? Not one cotton-picking thing except digging the hole deeper, until somebody starts paying attention. I thank the gentleman tonight for attempting to cause some of us, hopefully to get 218 of us, to start paying attention again and do something about the deficit and the approaching perfect storm before it is too late. I thank the gentleman.

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, I rise in strong support of House Resolution 300, a bill that recognizes the outstanding contributions of the faculty, staff, students, and alumni of Christian colleges and universities. America has benefited greatly from the more than 900 Christian colleges, beginning with the nation's first such college in 1636. Christian colleges add to the rich diversity of higher education, offering students and faculty a place to learn and grow in a Christ- centered atmosphere. There are four Christian universities in the 17th Congressional District of Texas: McMurry University, Abilene Christian University, Hardin-Simmins University and Howard Payne University. These Christian universities are actively rewarding scholarship and meaningful service. They help develop in their students respect and love for intellectual pursuits and faith in a loving and beneficent creator God. They graduate students with a broad and biblical worldview, an appreciation for human diversity and dedication to a life of service. I am truly honored to commend the high moral standards, Christian character and intellectual strength of the faculty, staff, students, and alumni of McMurry University, Abilene Christian University, Hardin- Simmins University and Howard Payne University. These individuals teach us how to achieve success while engaging Christian principles. I also want to acknowledge the invaluable contributions these Christian institutions bring to the Abilene and Brownwood communities. The students and staff place a high priority on community service, and these West Texas communities benefit from their dedication and servant leadership. Please join me in recognizing the unique contributions of the faculty, staff, students, and alumni of Christian colleges and universities, and other faith-based institutions, throughout this Great Nation. I am pleased to support House Resolution 300, and I urge my colleagues to lend their support.

Mr. STENHOLM

Mr. STENHOLM. Mr. Chairman, I will vote for the legislation to approve the administration's request for $87 billion in additional funding for operations in Iraq. We must provide our men and women in uniform in Iraq with the resources they need to complete their mission, as safely and securely as possible. They have performed brilliantly-- protecting civilians, maintaining order and promoting democracy while facing the threat of attacks each and every day. We are proud of them and we need to continue supporting them. I will vote to provide whatever resources our troops need to complete their mission. Unfortunately, the administration and leadership have brought this request before us under a process which forces us to approve $20 billion in spending for an ill-advised plan for Iraq reconstruction. Many of the items in the reconstruction are more appropriately the responsibility of the Iraqi provisional government or have extremely inflated costs. I commend the work of Chairman Young, Ranking Member Obey and the rest of the Appropriations Committee to scrub the administration's request and remove many questionable or low-priority items. Even with these improvements, many questions remain about how these funds will be used. Our constituents deserve to know that their tax dollars are being used in the most effective manner possible. The missteps of the past must not be compounded by wasteful spending now. The President must be willing to report to Congress--and the American people--on how the money is spent. That is what this amendment would require. A detailed accounting is needed. The American people also deserve to know what our plan is for successfully completing our mission in Iraq to improve the security and political situation and reducing our presence. While the battle to oust Saddam Hussein was well-planned and well-executed, we did not plan well for winning the peace and rebuilding the nation of Iraq. Our troops have been taking almost all the risks, and American taxpayers have been paying all the bills. Our ``go-it-alone'' strategy must end. This amendment will require the President to present a detailed plan for improving the situation in postwar Iraq and report on our progress in achieving the goals of improving the political and security conditions in Iraq. Congress and the American public need to know the impact our operations in Iraq will have on a federal budget that is nearly a half trillion dollars in deficit already. It is now abundantly clear that the costs of operations in Iraq will be much greater than was anticipated when the budget was approved just six months ago. Already, we have spent $63 billion in Iraq this year, and we are being asked to provide an additional $87 billion in this bill. That would bring the total spending on operations in Iraq to $150 billion in the year 2003--a staggering figure for one year--with more to come. There is no question that we will be in Iraq for a long time, at great expense to the American taxpayers. We have a responsibility to reevaluate our budgetary priorities to reflect that reality so that these additional expenses are not simply added to the national debt. It would be irresponsible to completely ignore those costs. We need to budget honestly for the costs of continued operations in Iraq so that Congress can consider the tradeoffs necessary to provide the needed funding without adding to the national debt. Paying for our operations in Iraq will require sacrifices. It would be extremely irresponsible for us to refuse to make any sacrifices ourselves and expect our troops to also pay the financial debts once they return home. The cause of freedom and justice is great, but it demands great commitment and sacrifice by all of us who enjoy its benefits, not simply by the men and women in uniform. Like all of my colleagues, I pray for the successful completion of our mission in Iraq and the safe return of our men and women in uniform. This amendment will help ensure that we have a plan to accomplish this goal as quickly as possible. There being no further amendments in order, pursuant to House Resolution 396, the Committee rises. Accordingly, the Committee rose; and the Speaker pro tempore (Mr. Hastings of Washington) having assumed the chair, Mr. LaTourette, Chairman of the Committee of the Whole House on the State of the Union, reported that that Committee, having had under consideration the bill (H.R. 3289) making emergency supplemental appropriations for defense and for the reconstruction of Iraq and Afghanistan for the fiscal year ending September 30, 2004, and for other purposes, pursuant to House Resolution 396, he reported the bill back to the House with sundry amendments adopted by the Committee of the Whole. Under the rule, the previous question is ordered. Is a separate vote demanded on any amendment? If not, the Chair will put them en gros. The amendments were agreed to.

Mr. STENHOLM. Mr. Speaker, $87 billion is a lot of money to add to our already exploding debt. There is no question we will be in Iraq for a long time at great additional expense to American taxpayers. Many of us are willing to make tough choices to pay for these costs. The cost of freedom and justice is great, but it demands great commitment and sacrifice by all of us who enjoy its benefits. Since the leadership of this body will not even allow us to consider options to pay for these costs, the least we can do is require a portion of the spending on rebuilding Iraq to be repaid by those who will benefit most from that spending. Every dime we spend in Iraq will come from borrowed money added to our national debt. It is extremely irresponsible for us to expect the young men and women who are making great sacrifices in Iraq today to also bear the burden of the financial debts for rebuilding Iraq once they return home. I urge a vote for this motion to recommit.

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, I thank the gentleman from Texas for yielding me this time, and I thank him for bringing again this motion to instruct to the floor of the House. Some of our colleagues are asking why do this again. Listen carefully to the rationale and the reasons of why we are doing it again. It is critical to rural districts all over the United States. This is a matter of life and death for 27 hospitals in my district. The issue is fairness, and this is the third time that I have had to correct my friends on the other side of the aisle for the red-herring approach that they are talking about. No one is advocating a government-run program unless by that they are suggesting that they are not in favor of continuing Medicare. If they are in favor of letting Medicare go, then they are correct; but I do not think the majority of the House is talking about that. Certainty we are not. And when they talk about budget issues, make it very clear, we are proposing to live within the budgeted amount of $400 billion and not one penny more, period. But what we are saying is that when we are looking at rural hospitals in particular, there are some issues that the conferees need to listen to, and yes, one can make the argument this is procedural, and I understand that, but when that conference bill comes back on the floor and we are going to have to vote on this issue, I am asking my colleagues, for example, in Kansas 1, 37 hospitals will lose $21,682,000; Georgia 11, six hospitals, $17 million; Texas 19, 18 hospitals, $39 million; Texas 23, 11 hospitals, $11 million; Indiana 8, 13 hospitals, $28 million; North Carolina 8, 12 hospitals, $43 million; Minnesota 1, 15 hospitals, $45 million. I can go on and on on this list. This is money that would not be coming if the conferees come back and say market basket is not applicable. And one can say, yes, this is a cut from a rate of increase; but that is precisely what we are talking about in rural areas. We have been cut and cut and cut to the point we cannot take any more, and we have got to have some rationale and reasoning, some logic, now in saying to rural areas, you must be treated fairly; and that is what the best of both the House and the Senate bill does. We are arguing about a philosophical direction, and with all due respect, I do not agree with the direction that the majority wish to take the conference, and I think a majority of this body does not. I really do. That is why we will continue to come on this floor and suggest to our colleagues who continue to vote against this motion to instruct, take a good look, listen to their hospitals back home, listen to what is being proposed and see how they will vote when that conference committee completes its work and brings it back to the floor of the House. And everyone now I hope understands that the conference is in trouble because we have some irreconcilable forces. It is kind of like the Texas redistricting plan. We have got some folks not willing to give. And when we have that, then we run the risk of doing nothing, and no one wants to come out of this Congress by doing nothing. We have a tremendous need of dealing with the cost of medicine, and there are ways that we can do some great things to reducing the amount of cost of health care to our senior citizens and to others, middle-income America. But pay particular attention, and this is done for the benefit of our colleagues, the conferees having to recognize that we have got to come to an agreement with the Senate or otherwise nothing will happen. Again, I repeat, this is not a budget issue. We are just saying we have a recommendation to the conferees of how they spend the money. We are not talking about spending any more. And if you believe your hospitals can do with less, continue to vote as you have been voting. Do not instruct the conferees. But you had better start talking to them because if the conferees insist on doing it the way they insist on doing it, we risk the whole bill; and nobody wants to see that done.

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, I rise in strong support of the Kind motion to instruct. It was amazing listening to my colleague from Colorado, because his statement has no relationship whatsoever to this motion to instruct. The Kind motion will include a fallback provision to ensure that seniors have prescription drug coverage where private plans choose not to participate. It has nothing to do with increasing the size of any program. It just says if the program that is in the House bill does not work, there is a fallback. Congress has a responsibility to guarantee this very important component of health care for all seniors, not just those who happen to live in an area where a private drug plan is offered. Contrary to what you may have heard, and we just heard it a moment ago, this motion will not require a government prescription drug plan or bust the budget. The Medicare fallback would only apply if the private sector fails to provide prescription drug plans in rural areas. The Kind motion to instruct also includes important improvements to rural health care providers. Because of the very high proportion of elderly in rural areas, Medicare is a very large and critical source of payment for rural health care providers. Inadequate Medicare payments to rural hospitals and other rural health care providers over the last several years have only deepened the challenges to quality health care. The Kind motion to instruct would take the best provisions. It was amazing listening to all of this stuff that is going to happen in this bill. We are saying take the best provisions in the House bill and the best provisions that have passed the Senate and make sure that those get in the final bill, because rural America can stand no less. The Kind motion to instruct also rejects the House provisions that would cut hospital inflation increases. Hospitals cannot rebound from a $12 billion payment cut from rate of increase. I want to be sure everybody understands rate of increase. But that is not the problem. The problem is rural areas have not kept up over the last 10 years, and, therefore, unless we have the market basket as designed, rural hospitals are going to find themselves in an even deeper hole. Hospitals are already operating on a thin profit margin. They are hurting. One out of three hospitals in America is operating in the red. More than 57 percent of all hospitals lose money under the Medicare program. A reduction in the market basket would wreak havoc on our Nation's hospitals, particularly the more vulnerable rural hospitals. That is why we come again to the floor again tonight saying, please take a look. And to those on the other side of the aisle who did not vote yesterday on it, take another look. Look at your district. Listen to your hospitals, listen to your constituents, and see if they do not agree. Again, let me repeat, the myth that this is a budget-busting motion, it is not. We agree with the $400 billion, period. I do not want to hear any more of this ``budget-busting.'' That is right out of the playbook that has got us into $560 billion deficits today. We agree. We are just saying take the $400 billion, reprioritize, and make certain that rural hospitals get a fair shake. That is all that we are saying. Even with stronger rural provisions, a Medicare fallback and no reduction in the hospital market basket update, the bill passed by the other body stays within the $400 billion. They do it; we can do it. We just disagree with some of the priorities of some of the folks on the other side of the aisle, and we believe that most Members of rural areas, most Members who have rural hospitals, agree with this basic presumption that we ought to have an instruction. Hospitals are important. The crisis has, of our rural hospitals, we have closed 470 in the past 25 years. I have several in my district hanging by a thread. If you succeed in doing what you are arguing for, they will bust that thread. Please support the Kind motion to instruct. It is good for 9 million rural Medicare beneficiaries and will put us on a path toward economic stability.

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, all of us in this body have an enormous responsibility to the American people as we put together a bill that will shape the lives of 40 million current Medicare recipients and the millions more that will be retiring in the near future. This bill will make changes that will have profound effects on all Medicare beneficiaries and particularly on the one in four who live in rural America. Rural beneficiaries have different health care needs and delivery systems than those living in urban areas and Congress has a responsibility to pass a Medicare prescription drug reform bill that is responsive to their needs. The motion to instruct conferees that I am offering today will put the House on record in support of a conference report that addresses the unique challenges facing seniors and health care providers in rural areas as much as possible. The motion would instruct conferees to agree to the following: Guaranteed prescription drug coverage through a Medicare fallback option in areas where private drug plans are not available. The best provisions improving Medicare payments to health care providers in rural areas that were included in the Senate bill or the House bill. Reject the cut in payments to hospitals in the House bill which will adversely affect hospitals in rural areas and undercut the benefits of the rural health care improvements. Rural beneficiaries have consistently had less access to Medicare managed care plans. Since 2000, rural beneficiaries have been four times more likely than urban beneficiaries to lack a private plan option. This problem of low market penetration in rural areas by private insurance plans may be even more pronounced for a drug-only insurance plan. This motion would address this problem by calling on the conferees to accept a guaranteed fallback plan be offered through traditional Medicare that would be offered in areas where fewer than two private plans have entered to ensure that all seniors have access to this benefit. The House bill does not include a fallback provision to ensure that seniors have prescription drug coverage in areas where private plans choose to not participate. Instead, the House bill allows the Secretary to pay the drug-only plans whatever it takes to entice them to offer plans. Because premiums for prescription drug coverage are based on what the plans are paid, plans that take the bribe to participate may have significantly higher premiums than those operating in more competitive areas. With one in four seniors residing in rural areas, it is extremely important that we not exclude rural seniors from having a prescription drug benefit, which is a very real risk if we do not provide a guaranteed fallback plan for seniors in areas where private plans are not available. To deny seniors in rural America the prescription drug benefit option is to deny them access to quality health care. The motion also calls on conferees to provide the strongest package possible for rural health care by taking the best of the House and Senate bills. Because of the very high proportion of elderly in rural areas, Medicare is a very large and critical source of payment for rural health care providers. Both the House and Senate bills would provide many important improvements in payments to rural health care providers. Unfortunately, there have been reports that assistance to rural health care providers is being held hostage in conference negotiations for leverage on other issues. This motion will send a clear message that the health care needs of rural America should not be used as leverage to advance an agenda on Medicare. The House bill offers assistance to health care providers in rural areas with one hand but takes away that assistance with the other hand through a reduction in payments to hospitals, which will be particularly harmful to rural hospitals. I am sure that all of us in this body who have talked to our local hospitals as I have done have heard about the challenges that our hospitals face, higher medical malpractice premiums, an increase in the uninsured population, and uncompensated care and cutbacks at the State and local levels. Reducing payments to hospitals could jeopardize the financial life of rural providers and undercut the benefits of the rural health care improvements in the bill. The benefits of improving payments to rural health care providers and increasing access to health care in rural areas will be negated if the hospital in a rural community is forced to close its doors. We must provide equal access to care for all Medicare beneficiaries, regardless of where they live. A vote for this motion is a vote to make sure that seniors and health care providers in rural America are treated fairly by the current Medicare system and the new prescription drug benefit. Mr. Speaker, I reserve the balance of my time.

Mr. STENHOLM. Mr. Speaker, I yield such time as he may consume to the gentleman from Texas (Mr. Sandlin).

Mr. STENHOLM. Mr. Speaker, I offer a motion to instruct.

Mr. STENHOLM. Mr. Speaker, I yield myself 1 minute. To respond to my friend from Texas, this is not a budget-busting amendment. We fully expect the conferees to live within the $400 billion. We have a different idea of the prioritization than what the majority party has, and we are just expressing that today. And also, when the House has a chance to vote, Members on both sides can see whether or not the priorities we believe are the most important should be considered by the conferees. And also with the emphasis on government-run, let me remind my friend from Texas that it is only if the private system fails in rural America, will we have a return to a Medicare plan. Only if it fails. We worry because of the past history of private plans in rural America. We worry that they may not work, and we think it would be irresponsible for us not to provide a fallback. That is our opinion. It is not government- mandated, and these little speech lines that keep flowing out, this is a different idea, a different opinion, and we just expressed it today. Mr. Speaker, I yield 4 minutes to the gentleman from Ohio (Mr. Brown).

Mr. STENHOLM. Mr. Speaker, I yield 3\1/2\ minutes to the gentleman from Iowa (Mr. Boswell). (Mr. BOSWELL asked and was given permission to revise and extend his remarks.)

Mr. STENHOLM. Mr. Speaker, I yield 2 minutes to the gentleman from New Jersey (Mr. Pallone).

Mr. STENHOLM. Mr. Speaker, I yield 3 minutes to the gentleman from Tennessee (Mr. Tanner). (Mr. TANNER asked and was given permission to revise and extend his remarks.)

Mr. STENHOLM. Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Rodriguez).

Mr. STENHOLM. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, this motion to instruct conferees is not a budget buster. It is a red herring to suggest that we are going to bust the budget at $400 million. I support that, and those of us who support this resolution support that. It is a red herring. One of the things my friend from Texas does not seem to want to acknowledge is that there are many hospitals, as the gentleman from Iowa (Mr. Boswell) pointed out, there are many hospitals that have not enjoyed the increases that hospitals in the bigger towns have enjoyed over the last 20 years. And when you have not gotten the increases that some have gotten and you have gotten a lesser amount of reimbursement, you are hurting. That is why we believe the Senate provisions are fairer to those hospitals. The gentleman is totally correct when he says they get less of an increase, no one is getting cut; but when you have a baseline that is too low, it is important that you get a chance to compete on a level playing field with those hospitals who enjoy a little better situation. We have argued for that for years, but unsuccessfully. Now we notice that there is bipartisan support for acknowledging that rural hospitals and many inner city hospitals have the same problem and that we should, in fact, recognize and begin to correct that disparity. Regarding the pharmaceutical benefits and the going back to a government program, only if it fails will we go back to a Medicare government program. But some of us, myself included, are very skeptical that private businesses are going to be as interested in rural areas with less people as they are in urban areas; and, therefore, a fall- back is critical to us. But it does not do what the gentleman said it did. It is only if it fails; only if it fails will we have a fall-back. Now, in conclusion, it is difficult for me, and I will not miss the opportunity to say that to be lectured by my friend from Texas on fiscal responsibility, I say to the gentleman, that is a joke. For the gentleman to have supported and continue to support the economic game plan of his side of the aisle that has given us the largest deficits in the history of our country, $689 billion and going up, and I know this because my friend from Texas voted for the last bill that increased the deficit another $12 billion. I did not, and I will get criticized. But I think it is time for us to be fiscally responsible, but I find that it is only when it is convenient. If it is a tax cut, it is great. But if it is being fair to rural hospitals, that is a no-no. As to the child tax credit, the debate that went on before this, let me point out that every single dime of tax dollars that have been collected on the Social Security system are being spent for current operating expenses. Really, we are borrowing, in addition to that, $560 billion. Differentiating between Social Security taxes and income taxes is a joke, a joke. Just because it was done for 40 years is no longer reason for us to continue to do it. But do not lecture me on fiscal responsibility. Do not let staff feed the little notes in saying here is what it does and here is what it does not, because this motion does not bust the $400 million budget. We live within it. We only ask the conferees to make the changes. Yes, it will be difficult. Yes, you cannot do what you want to do. You cannot do the things that you want to do in total, but it is a reasonable compromise; and that is what conferences between the House and the Senate are all about. It is taking the differences and working them out in a very, very good and concise way. But do not lecture us on budget. Go somewhere else. Argue the philosophical. That is a fair shot. The gentleman and I philosophically disagree apparently on the direction that this ought to be. That is a fair shot, and we will argue that. But this amendment does not bust the budget. It offers some, we hope, constructive suggestions; and I hope that the House will in an overwhelming vote say to the conferees, we believe this has merit, take a look at it, and let us pass it. Mr. Speaker, this amendment is not what is important. It is what comes back, because that is what is, in fact, going to be affecting lives. And in rural areas, this is a critical difference from a hospital's standpoint. If we cannot do what this amendment does, we are going to continue to have real problems in rural areas, and anybody that represents a rural area needs to take a good hard look and hopefully join in support of this amendment. Mr. Speaker, I yield back the balance of my time.

Mr. STENHOLM. Mr. Speaker, on that I demand the yeas and nays.

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, subject to rule XXII, clause 7(c), I hereby announce my intention to offer a motion to instruct on H.R. 1, the Medicare Prescription Drug and Modernization Act of 2003. The form of the motion is as follows: Mr. Stenholm of Texas moves that the managers on the part of the House at the conference on the disagreeing votes of the two Houses on the Senate amendment to the bill H.R. 1 be instructed as follows: (1) The House recede to the Senate on the provisions to guarantee access to prescription drug coverage under section 1860D-13(e) of the Social Security Act, as added by section 101(a) of the Senate amendment. (2) To reject the provisions of section 501 of the House bill. (3) The House recede to the Senate on the following provisions of the Senate amendment to improve rural health care: (A) Section 403 (relating to inpatient hospital adjustment for low volume hospitals). (B) Section 404 (relating to medicare disproportionate share adjustment for rural areas), but with the effective date applicable under section 401(b) of the House bill. (C) Section 404A (relating to MedPAC report on medicare disproportionate share hospital adjustment payments). (D) The following provisions of section 405 (relating to critical access hospital improvements): (i) Subsection (a), but with the effective date applicable under section 405(f)(4) of the House bill. (ii) Subsection (b), but with the effective date applicable under section 405(c)(2) of the House bill. (iii) Subsections (e), (f), and (g). (E) Section 414 (relating to rural community hospital demonstration program). (F) Section 415 (relating to critical access hospital improvement demonstration program). (G) Section 417 (relating to treatment of certain entities for purposes of payment under the medicare program). (H) Section 420 (relating to conforming changes relating to Federally qualified health centers). (I) Section 420A (relating to increase for hospitals with disproportionate indigent care revenues). (J) Section 421 (relating to establishment of floor on geographic adjustments of payments for physicians' services). (K) Section 425 (relating to temporary increase for ground ambulance services), but with the effective date applicable under the amendment made by section 410(2) of the House bill. (L) Section 426 (relating to appropriate coverage of air ambulance services under ambulance fee schedule). (M) Section 427 (relating to treatment of certain clinical diagnostic laboratory tests furnished by a sole community hospital). (N) Section 428 (relating to improvement in rural health clinic reimbursement). (O) Section 444 (relating to GAO study of geographic differences in payments for physicians' services). (P) Section 450C (relating to authorization of reimbursement for all medicare part B services furnished by Indian hospitals and clinics). (Q) Section 452 (relating to limitation on reduction in area wage adjustment factors under the prospective payment system for home health services). (R) Section 455 (relating to MedPAC study on medicare payments and efficiencies in the health care system). (S) Section 459 (relating to increase in medicare payment for certain home health services). (T) Section 601 (Increase in medicaid DSH allotments for fiscal years 2004 and 2005). (4) The House insist upon the following provisions of the House bill: (A) Section 402 (relating to immediate establishment of uniform standardized amount in rural and small urban areas). (B) Section 403 (relating to establishment of essential rural hospital classification). (C) Subsections (a), (b), (d), and (e) of section 405 (relating to improvements to critical access hospital program). (D) Section 416 (relating to revision of labor-related share of hospital inpatient pps wage index). (E) Section 417 (relating to medicare incentive payment program improvements). (F) Section 504 (relating to wage index classification reform). (G) Section 601 (relating to revision of updates for physician services). (H) Section 1001 (relating to medicaid disproportionate share hospital (DSH) payments).

Mr. STENHOLM

Mr. STENHOLM. Mr. Speaker, I rise tonight in honor and remembrance of Robert Lloyd Kelley, who tragically passed away on March 15, 2003, at the age of 57. Robert Kelley, known as Bobby, was not only an outstanding father and beloved husband, he was also a great community leader and mentor who gave freely of his time and energy. Those who knew Bobby knew that he loved life, especially his family, his church, the Texas Aggies, his job, and his community. He was devoted to his aging parents and took care of their physical and emotional needs. Bobby was kind and generous to many in the community, but his rewards are now being reaped in the splendor of heaven. Bobby was born on February 4, 1946, in San Antonio, Texas, to Dr. E. Lloyd Kelley and the late Mary Yvonne McGarry Kelley. He is preceded in death by his mother as well as his son, Timothy Lloyd Kelley. Bobby played an active role in his community of Hondo, Texas, serving both on the board of directors and as president of the Hondo Area Chamber of Commerce, as well as president of the Hondo Owl Band Booster Club. During his life, he received numerous service awards and recognitions, including Volunteer of the Year for the Hondo Volunteer Fire Department, 1986; Community EMS Service Award, 1986 to 1990; Medina County Peace Officers Association Citizen of the Year; Hondo Area Chamber of Commerce Citizen of the Year; Outstanding Band Booster Service Award; and special recognition from the San Antonio Area Chapter of the Red Cross, as well as the Boy Scouts. He was an active member of the Hondo Church of Christ. He was the chief of the Medina County Juvenile Probation Department where he worked with the troubled youth of the area, a job which he found most rewarding, and through his department he helped a faith-based program called Angels Crossing. Bobby was always willing to volunteer and work on any project that was ``for the kids.'' He always said, ``If you can't do something for kids, what's the point? Kids are our future.'' He also served as a Texas Department of Criminal Justice religious volunteer for approximately 8 years. He loved to sing and served as a song leader at church services held at the Joe Ney Unit in Medina County. Through his work at the Joe Ney Unit he was able to secure funds to have a chapel built, and now with his passing, a formal request has been made that the chapel to be constructed as the unit be named the R.L. Kelley Chapel. It will be dedicated to helping men find God and change their life just as he dedicated his life to helping people. I extend my deepest condolences to Bobby's wife of 35 years, Jill, who is a seventh grade Texas history teacher at McDowell Middle School in Hondo, and his daughter, Lisa, who works for me on the House Agriculture Committee. Although he will be deeply missed, Bobby's spirit will live on in the hearts and memories of everyone he loved and inspired, especially his family and closest friends, today and for generations to come. Mr. Speaker, please join me in honor and remembrance of Robert L. Kelley. Medina County, Texas, was indeed fortunate to have such a dynamic and dedicated community leader who willingly and unselfishly gave his time and talents to make his community a better place in which to live, to work, to call home and to raise a family.