Bill Thomas

Mr. THOMAS

Mr. THOMAS. Well, if the gentlewoman will continue to yield, our commitment was to the Shays-Meehan, which had the most amendments attached to it. Obviously, once that is dispensed with, in terms of the amendments, that is the only amendment that we have under unanimous consent agreement. Our hope is that we will have reached a level of comity that we could move through the rest of those substitutes relatively quickly. But since we do not have a unanimous consent agreement on the amendments or the structure, it is extremely difficult to pin it down. But our goal is to complete it. We now have a clear assignment on Shays-Meehan, and to the degree we can meet that next week, we will have a much better understanding of what we need to do to agree to finish it. Obviously, my personal commitment is to get it done before we leave in its entirety.

Mr. THOMAS. I would tell the gentlewoman that is why we are going to take a major chunk of time on Monday and, as I stated, reserve another piece of time, so that, in fact, the leadership's commitment that the Shays-Meehan amendment be concluded prior to the House's August break, that is our goal, that is our commitment, and we will meet it.

Mr. THOMAS. As we did last Monday night, we are hopeful, under the unanimous consent agreement on Shays-Meehan, that we could go as late as possible, to cover as many amendments as possible, so that the rest of the week would have enough time to move to a conclusion. It will be a decision made by the participants. As the gentlewoman knows, they went very late last Monday. Our goal would be to go as late as we could, to cover as many of the amendments as we could, on Monday night, but it would be achieved under some mutual agreement. Obviously, if they go extremely late, Members would expect that any votes that would be ordered would be rolled.

Mr. THOMAS. Mr. Speaker, I believe if Members are not participating in the legislation, they should have a relatively high comfort level that there would be no votes on Monday prior to 7 p.m.

Mr. THOMAS. Mr. Speaker, I am pleased to announce that we have concluded legislative business for this week. The House will next meet on Monday, July 27, at 10:30 a.m. for morning hour, and at 12 noon for legislative business. We do not expect any recorded votes before 5 p.m. On Monday, July 27, we will consider a number of bills under suspension of the rules, a list of which will be distributed to Members' offices this afternoon. After suspensions, Mr. Speaker, the House will continue consideration of H.R. 2183, the Bipartisan Campaign Integrity Act of 1997. We hope to, as we did last Monday, make extensive progress on the Shays-Meehan amendment in the nature of a substitute on Monday, and we also hope to return to campaign finance again at some point during the week. On Tuesday, July 28, and the balance of the week, the House will consider the following legislation: H.R. 629, the Texas Low-Level Radioactive Waste Conference Report. We will finish H.R. 4194, the Veterans Administration, HUD and Independent Agencies Appropriations; H.R. 4276, Commerce, Justice Appropriations Act; the Transportation Appropriations Act; H.J. Res. 120, a Vietnam Trade Resolution; and House Resolution 507, a Resolution Providing Special Investigative Authority for the Committee on Education and the Workforce. Mr. Speaker, Members should be prepared to work late next week on these appropriation bills. If we can do that, we hope to conclude legislative business for the week by 2 p.m. on Friday, July 31.

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

Mr. THOMAS

Mr. THOMAS. Mr. Speaker, I thank the gentleman for yielding me time. Mr. Speaker, one of the things we have to make sure we do not do is revise history. I think it might be useful just to remember where the prudent layperson language in the Republican provision and in the Democrat provision came from. It came from the changes that were made in the Medicare program. I think when you examine the gag rule provision, it is in the Democratic bill, it is in the Republican bill, it came from the Medicare revisions. If you recall, I said, prior to the election, the Democrats were accusing the Republicans of trying to destroy Medicare. After the election we sat down and put together a prudent package to preserve and protect Medicare. We included a number of provisions that were applicable only to Medicare because it was a bill dealing with Medicare. That was in 1997. We then began in the Subcommittee on Health a series of hearings about the problems that were out in the current marketplace because of the distortion of the rapid movement to managed care. We began examining the Medicare changes to find what we could include in the package. You have heard repeatedly that somehow the Republican plan was thrown together in a couple of days. That is pre-election rhetoric. It simply is not the truth. We include significant patient protections; they include some patient protections. We include the opportunity to get health care, make it more affordable, make it more accessible. Do not believe me, believe the Congressional Budget Office. They looked at their bill. They evaluated it. They priced it out. They said if the Democrat's bill were law, premiums would cost more. Health care costs would go up. The Congressional Budget Office looked at our bill, they examined it, they priced it. The nonpartisan fiscal analyst said if the Republican bill became law, health care costs, premiums, would go down. In addition to that, a provision that they had said is a poison pill, it would kill the bill, the medical malpractice provision that is in the Republican bill, it is not in the Democratic bill, that that measure alone, reforming medical malpractice, would save, directly save the Federal Government and the Medicare and Medicaid program, $1.5 billion a year over a 10 year period; $1.5 billion. Where is that money going to come from? It is going to come from money that does not go to trial lawyers. Why do they call it a poison pill? Frankly, given the way their bill is structured, it is the trial lawyers who are going to be the main beneficiaries of those premiums going up. CBO says their plan increases premiums. CBO says our plan reduces premiums. Yes, it is important to address the changes in the health care market today about patient protections. It is also important to make sure that health care is affordable for more Americans. Our plan does it; their's does not.

Mr. THOMAS. Mr. Speaker, contained among the numerous provisions in the motion to recommit is striking the medical savings accounts. Notwithstanding the gentleman's representation that this will save billions of dollars a year, the Congressional Budget Office says that simply is not so. In fact, it will save less than $1 billion a year. That is the point on which the point of order turns, because the gentleman's addition of the acceleration of the self-employed deduction in fact scores more than $1 billion and therefore is subject to a 303 Congressional Budget Act point of order. It in fact increases the budget before the final budget is adopted in a given fiscal year. It applies clearly in this particular instance. A point of order, therefore, lies against the gentleman and I would urge the Chair to sustain the 303(a) Congressional Budget Act point of order.

Mr. THOMAS. Mr. Speaker, on the point just registered, this is the House and not the Senate. The Senate just read 10-year numbers, the House operates on 5-year numbers, and the point of order still stands.

Mr. THOMAS. Mr. Speaker, I would tell the gentleman that I have no interest in playing on the margin; I want to go to the heart of the problem and change it.

Mr. THOMAS. Mr. Speaker, if the gentleman will continue to yield, I could not agree with the gentleman more. The current system is fatally flawed. What we are doing is simply working on the edges. The only way to fundamentally deal with the problems in our health insurance area is to empower consumers, empower them with the wherewithal to purchase the insurance, and just as importantly, empower them with the knowledge to make choices. They have neither of those in today's current system. It needs fundamental reform beginning with the Tax Code, and with the collection of data, to make those changes possible.

Mr. THOMAS. Mr. Speaker, I would inform the gentleman that the Subcommittee on Health is a subcommittee of the Committee on Ways and Means. In looking at the Tax Code, we are very concerned about what has happened. Clearly, there are some advantages to managed care and HMOs in dealing with treating the patient, but I think it is fairly obvious that most employers turned to a controlled cost structure, as well. The employed had no ability to control the rising costs, 18\1/2\ percent a year in 1988. What they did was determine, I will take a health care that gives me a fixed dollar amount per employee.

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

Mr. THOMAS. I tell the gentleman the numbers I just read come from a Joint Tax Committee publication July 24, 1998. But the gentleman is not bad being only one day behind.

Mr. THOMAS. Mr. Speaker, the gentleman is reading from a document that I do not believe is current. Would he cite the number and the date?

Mr. THOMAS

Mr. THOMAS. Mr. Speaker, some of this debate has literally taken my breath away. If anyone listening to this debate wonders how in the world Republicans could get away with treating Americans the way we do, listening to the Democrats, I ask them to just look at the calendar. This is the pre-election warm-up. Remember Medicare? Pre-election, Republicans were going to destroy Medicare. Well, the American people did not listen to them. We were returned as the majority. And as chairman of the Subcommittee on Health, we prepared a Medicare reform package that was passed in my subcommittee 11-0, no Democrats dissenting. Prior to the election, it would destroy Medicare. After the election, post-politics, everything is okay. Today we are debating patient protections. Here we go again. It is pre-election time. Have things changed out there in America? Of course they have. In 1988, health care inflation was 18\1/2\ percent. Today it is less than 5 percent. Why? To a very good extent, just 5 years ago, in 1993, about a majority of Americans, about half, got their health care from managed care. Today, if they get it from their employer, it is about 85 percent. So health care markets have changed. Have there been distortions? Yes, there have been distortions. Do there need to be corrections? Of course there need to be corrections. But when we unite egos and politics, we get some pretty ugly offspring. There have been Members who have taken the well and virtually every word they spoke about the Republican plan is absolutely, totally false. This headline that says ``the bill would allow sale of patient data'' in today's Washington Post is totally, absolutely false. If my colleagues will turn to the bill, on page 260, the language is clear. If we read on, it says, ``Limitation on Sale or Barter. Notwithstanding subsection (c) which is a limit which guarantees that State law is not overridden,'' it says, ``no health care provider or health plan may as part of conducting health care operations sell or barter protected health information,'' period. What was said to be contained in the Republican bill is absolutely, totally false. What we heard from my colleagues was that they want ``medical necessity'' defined in law. Who defines ``medical necessity'' in law? Bureaucrats, Health Care Financing Administration. We get specific items, medical necessity. That is cookbook medicine. Who do we have define ``medical necessity,'' for example, in an emergency room? Quote, page 144: ``A prudent emergency medical professional.'' It is the medical professional there looking at the patient and their problem that determines what needs to be done, not some book drawn up by bureaucrats that lists what is and what is not medically necessary. It has been said that it does not say ``pain.'' What this bill says is that ``a prudent lay person who possesses an average knowledge of health and medicine would determine such examinations to be necessary.'' Not itemized; across the board. I heard my colleague the gentlewoman from North Carolina (Mrs. Clayton) say she cannot find the gag rule. I will tell her page 141, section 2706, says, ``patient access to unrestricted medical advice.'' So please understand, it is a pre-election season. But let me tell my colleagues something else. The Congressional Budget Office has laid out the numbers on the plan. Their plan increases premiums. Our plan reduces premiums. Under the Republican plan, CBO, ``lower medical malpractice costs would reduce Federal direct spending for Medicare and Medicaid by $1.5 billion over 10 years.'' We have heard them say ours is a sham and it drives prices up. It is simply not true. CBO says their plan will drive premiums up. CBO says our plan will drop premiums. Correct the marketplace and Federal costs. Vote ``yes'' on 4250.

Mr. THOMAS

Mr. THOMAS. Mr. Speaker, I ask unanimous consent that the business in order under the Calendar Wednesday rule be dispensed with on Wednesday next.

Mr. THOMAS

Mr. THOMAS. Mr. Speaker, I ask unanimous consent that when the House adjourns today, it adjourn to meet at 10:30 a.m. on Monday next for morning hour debates.

Mr. THOMAS

Mr. THOMAS. Mr. Speaker, I ask unanimous consent to correct an amendment that was included in the unanimous consent for the campaign reform procedure on the Shays-Meehan bill. That request is that Amendment No. 2 by the gentleman from Michigan (Mr. Smith) was duplicated and repeated as Amendment No. 34, when, in fact, the content of Amendment No. 34 is different than was accepted in the unanimous consent, and I would like to correct it with the amendment which is, in fact, the substance of Amendment No. 34.

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

Mr. THOMAS. Mr. Speaker, I am sorry to say that from an administrative point of view we are double-checking another amendment and there may be a need to offer another unanimous consent. This particular amendment is in the first batch. We hope that we will have an accurate list, and everyone will be informed, if, in fact, it is not accurate, and we will supply the correct text. Since all of them believe they were included, it was simply an administrative error in the compilation of the list, and I thank the gentleman for yielding.

Mr. THOMAS

Mr. THOMAS. Mr. Speaker, if the gentleman will continue to yield, just to say that, frankly, given the pivotal role of this particular amendment, whether it passes or fails will dictate clearly what is done with the rest of the campaign reform rule package in terms of the other amendments. So regardless of whether it passes or fails, getting to the vote will be a significant assistance in allowing us to examine how we might be able to package the rest of the time in a meaningful way. Just let me, in responding to the gentleman, add that, from this side of the aisle, I do think this is a good-faith effort in terms of trying to create a reasonable time frame. It would be extremely disappointing if from our side of the aisle, for example, on Monday, where we have devoted a significant time for campaign reform, that it would be consumed in part by procedural motions of limiting debate and that sort. If the gentleman examines the list, which I know he has, there are a significant number of amendments that have only been given 10 minutes time. That is far less than is ordinarily given for the number of amendments. What we have tried to do is limit the time. No amendment has an hour. The greatest amount of time is 40 minutes. And if there were procedural motions, that would be extremely disappointing and make the ability to create an orderly process for the entire package extremely difficult. I thank the gentleman for yielding to me.

Mr. THOMAS. Mr. Speaker, I ask unanimous consent that during further consideration of H.R. 2183, pursuant to H. Res. 442 and H. Res. 458, no other amendment to the amendment in the nature of a substitute by the gentleman from Connecticut (Mr. Shays) and the gentleman from Massachusetts (Mr. Meehan) shall be in order, except the amendments that have been placed at the desk. Each amendment may be considered only in the order listed, may be offered only by the Member designated or his designee, shall be considered as read, shall be debatable for the time specified, equally divided and controlled by the proponent and opponent, and shall not be subject to a demand for a division of the question in the House or in the Committee of the Whole. The amendments that have been placed at the desk are in a particular order and consist of 55 amendments with times ranging from 40 minutes to 10 minutes.

Mr. THOMAS. Mr. Speaker, that is correct, on the current calendar. I would tell the gentleman, though, that as usual, Mondays are not a heavily scheduled day, and it is entirely possible that we could begin the campaign reform debate once again at approximately 5 o'clock, and we could then continue into the evening as long as Members are willing. I would not at this time say that we would then continue into the morning, depending upon whether the Members are willing, but my guess is that we could put together continuously, which I think is the best use of time in the debate, for perhaps 4 or 5, maybe even 6 hours, and that would constitute a full one-third of what we have available to us under this unanimous consent request.

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