Bill Thomas

Mr. THOMAS

Mr. THOMAS. Reclaiming my time, I thank the gentleman for the clarification. I still have difficulty with the language, because the word between physician and health care professional is not ``and,'' it is ``or.'' So that it could be the physician or the health care professional, and the health care professional, depending on the way we define it, could be the candy striper in the hospital, and the candy striper in the hospital is the health care professional, and they make decisions regarding medical care and treatment. Does Congress want to go on record that it is the sense of Congress that the orderly, that the cook, that the person who is doing menial tasks but is classified as the health care professional is going to make decisions regarding medical care and treatment. Is that what we are doing it?

Mr. THOMAS. Reclaiming my time, Mr. Chairman, that means that somebody who is trained in giving someone a bath, because they are incapable of doing that is one of the activities of daily living that would be classified as the health care professional and, therefore, Congress believes that they should make medical care and treatment decisions; that is what the sense of Congress says. I think it is fairly early in the morning, and we are getting a little carried away in terms of what we want to do. If we want to say as a Congress, people who give people baths ought to be able to make medical decisions about their care and treatment, vote yes on this sense of Congress.

Mr. THOMAS. I yield to the gentleman from Iowa.

Mr. THOMAS. Reclaiming my time, Mr. Chairman, I think the gentleman from Iowa (Mr. Ganske) will find that is about the all-inclusive description of health care professionals I have heard, including people who give people baths.

Mr. THOMAS. I understand that, but this says the sense of Congress is that decisions regarding medical care and treatment, it does not say how we take a bath.

Mr. THOMAS

Mr. THOMAS. Mr. Speaker, parliamentary inquiry.

Mr. THOMAS. Mr. Speaker, parliamentary inquiry.

Mr. THOMAS. Mr. Speaker, I ask unanimous consent that during consideration of H.R. 4680, all Members be permitted to use exhibits in debate.

Mr. THOMAS. Mr. Speaker, my answer to the Gentlelady from New Jersey is that this bill guarantees that at least two plans will be available in each area. In fact, the Medicare Benefits Administrator would administer the program in a manner such that all eligible individuals would be assured of the availability of at least two qualifying plan options in their area of residence, at least one of which is a drug plan. If necessary to ensure such access, the Administrator would be authorized to provide financial incentives, including the partial underwriting of risk, for a PDP sponsor to expand its service area under an existing prescription drug plan to adjoining or additional areas, or to establish such a plan (including offering such plan on a regional or nationwide basis). It would be written in the statute that all participating seniors will be guaranteed at least two plans from which to choose. I thank the Gentlelady for seeking this important clarification.

Mr. THOMAS. Yes, I can describe them. First, we federalize the dual eligibles. We give the governors more than $22.8 billion in additional funds to spend in their States. Second, the bill allows maximum flexibility to take current State programs and so-called wraparound or integrate them with the Federal program. But most importantly the legislation creates a commission which is charged with developing a program to address these transitional issues. And it says in the legislation that the proposal must protect current program participants and the financial interests of the States involved. Those States, who on their own offer seniors Medicare prescription drugs should have a special handling to handle the transition with the Federal and the State program.

Mr. THOMAS. Mr. Speaker, am I permitted under the rules, under parliamentary inquiry, to inform all members of the majority party that the leadership urges a no vote?

Mr. THOMAS. Mr. Speaker, I yield myself the balance of the time. Mr. Speaker, this really is an opportunity for the House of Representatives to address a problem that, frankly, needed to be addressed for some time. The two plans have a lot in common, but I do think people need to understand that the Democrats' plan does not afford seniors choice. The bipartisan plan, not only affords them choice, but requires at least two options in every area of the country. The way in which we have structured our plan, the Congressional Budget Office says we save seniors twice as much as the Democrats' plan out-of-pocket. We provide pocketbook protection now. It is not true of the Democrats' plan because they wrote a plan to fit a budget window. Not until 2006 does their catastrophic or out-of-pocket protection plan really begin. AARP, the American Association of Retired Persons, has said the bipartisan plan is in Medicare, notwithstanding whatever may be said on the floor today. The American Association of Retired Persons has said this is an entitlement regardless of whatever may be said on the floor today. Most importantly, it provides seniors comfort and assurance that the bipartisan plan is a prescription drug benefit in statute. No amount of an attempt to confuse seniors should alter that position. This is in Medicare. It is an entitlement, and the benefit is in statute. Do not take my word for it. Take the word of the American Association of Retired Persons. Vote yes on H.R. 4680.

Mr. THOMAS. I would respond that, yes, the issues have been resolved.

Mr. THOMAS. Mr. Speaker, it is my pleasure to yield 1 minute to the gentleman from Georgia (Mr. Collins), a member of the Committee on Ways and Means. (Mr. COLLINS asked and was given permission to revise and extend his remarks.)

Mr. THOMAS. Mr. Speaker, it is my pleasure to yield 1 minute to the gentleman from Iowa (Mr. Nussle), someone who has been extremely important in helping us shape the rural assistant portions of this particular legislation.

Mr. THOMAS. Mr. Speaker, I yield myself 30 seconds. Mr. Speaker, I submit for the Record a letter from the National Alliance for the Mentally Ill. I initially said they supported H.R. 4680, which had been contradicted by the other side. And I believe the Record should show that the letter from the National Alliance for the Mentally Ill shows support for H.R. 4680. No number of denials will change the fact that they are in support. Mr. Speaker, the letter reads as follows: National Alliance for the Mentally Ill, Arlington, VA, June 27, 2000. Hon. J. Dennis Hastert, Speaker, House of Representatives, Washington, DC. Dear Mr. Speaker: On behalf of the 210,000 members and 1,200 affiliates of the National Alliance for the Mentally Ill (NAMI), I am writing to thank you for bringing forward the Medicare Rx 2000 Act (HR 4680). This legislation offers tremendous potential for assisting Medicare beneficiaries with severe mental illnesses who do not currently have access to outpatient prescription coverage. As the nation's largest organization representing people with severe mental illnesses and their families, NAMI has long argued for the need to modernize the Medicare program and include coverage for outpatient prescription drugs. The past decade has seen tremendous advances in treatment for severe mental illnesses such as schizophrenia, bipolar disorder and major depression. This is especially the case with respect to new medications such as atypical anti- psychotic drugs for schizophrenia and selective serotonin reuptake inhibitors (SSRIs) for bipolar disorder and major depression. Unfortunately, the lack of outpatient prescription coverage within the Medicare program has left beneficiaries without access to the coverage for the treatment they need. NAMI is pleased that both Congress and the President have made legislation extending an outpatient drug benefit to Medicare a top priority in 2000. As part of NAMI's advocacy on this critically important issue, we have set forward a set of key objectives that we believe must be a part of any legislation Congress acts on this year. NAMI was pleased to offer these policy objectives in testimony to the Ways and Means Committee earlier this year. On each of these criteria, HR 4680 appears to meet the pressing needs of Medicare beneficiaries living with severe mental illnesses. Eligibility for non-elderly disabled beneficiaries on the same terms and conditions as senior citizens--NAMI is pleased that HR 4680 does not restrict coverage to elderly Medicare beneficiaries and requires plans offering prescription coverage to do so on a non-discriminatory basis during specified open enrollment periods, Affordable premiums, deductibles and cost sharing requirements--NAMI is pleased that HR 4680 specifies uniform, community-rated premiums for all beneficiaries and allows those below 135% of poverty to participate at no cost (with subsidized premiums for those between 135% and 150% of poverty), 135% and 150% of poverty), Adequate coverage for catastrophic drug expenses--NAMI is extremely pleased that HR 4680 includes a ``stop loss'' provision that will protect beneficiaries whose out of pocket cost exceed $6,000 per year, Bar on the use of overly restrictive formularies--NAMI is strongly supportive of provisions in HR 4680 designed to prevent use of overly restrictive formularies that limit access to the newest and most effective psychiatric medications. NAMI is also pleased that HR 4680 requires a process for beneficiaries to access coverage for medically necessary non-formulary medications in cases where a physician determines that a formulary medication is not as effective. Mr. Speaker, as you know, 5 million Medicare beneficiaries are people with disabilities under age 65 (13% of the 39 million Americans on Medicare). It is important to note that 30% of these 5 million Medicare beneficiaries are non-elderly people with disabilities have incomes below 100% of the federal poverty level and that 63% are below 200% of poverty. Further, it is estimated that a quarter of these non-elderly disabled Medicare beneficiaries have a severe mental illness. NAMI feels strongly that this legislation is critically important to their ability to access adequate coverage for their treatment needs. While no single Medicare prescription drug proposal meets the unique needs of each and every beneficiary with a severe mental illness, it is clear that HR 4680 addresses many of the key concerns that NAMI believes must be a part of any legislation Congress acts on this year. On behalf of NAMI's consumer and family membership, we would like to thank you for moving this legislation forward. NAMI looks forward to working with all House members--on both sides of the aisle--and the Clinton Administration to ensure that Medicare prescription drug legislation is enacted in 2000. Sincerely, Laurie M. Flynn, Executive Director.

Mr. THOMAS. Mr. Speaker, it is now my pleasure to yield 1 minute to the gentleman from Florida (Mr. Shaw), who has more than 2.7 million Medicare beneficiaries in his State.

Mr. THOMAS. Mr. Speaker, will the gentlewoman yield?

Mr. THOMAS. Mr. Speaker, it is my pleasure to yield 1 minute to the gentlewoman from Connecticut (Mrs. Johnson), and I hope this is not disruptive of the debate, who wishes to talk about something that is actually in the bipartisan plan.

Mr. THOMAS. Mr. Speaker, it is now my pleasure to yield 1 minute to the gentleman from Florida (Mr. Foley), a member of the Committee on Ways and Means.

Mr. THOMAS. Mr. Speaker, I continue to reserve the balance of my time.

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

Mr. THOMAS. Mr. Speaker, it is my pleasure to yield 1 minute to the gentleman from Minnesota (Mr. Ramstad), a member of the Subcommittee on Health of the Committee on Ways and Means.

Mr. THOMAS. Mr. Speaker, parliamentary inquiry.

Mr. THOMAS. Mr. Speaker, it is my pleasure to yield 1 minute to the gentleman from Arizona (Mr. Hayworth), a member of the committee who has more than three-quarters of a million Medicare beneficiaries in the State of Arizona.