Henry Waxman

Mr. WAXMAN

Mr. WAXMAN. Mr. Chairman, I have a chart that I want to display so that Members can see the full consequences of this tobacco issue. This chart indicates the causes of death in the United States. Deaths related to tobacco come close to 20 percent. It is higher than the combination of deaths due to illicit drugs, motor vehicle accidents, sexual behavior, guns and firearms, toxic agents, microbial agents, and alcohol; all of them combined. This is a major health problem in this country. We need to address it. The Centers for Disease Control came out with a report a couple of weeks ago. They have indicated to us that we are losing this war against smoking in America. Forty percent of white teenaged girls are smoking. Three thousand new kids are taking up smoking each day. What are we are going to do about it? What is a commonsense rational policy for this Nation to avoid the consequences of 400,000 people dying each year? How do we stop our kids from taking up smoking? Now, the Durbin amendment is not a solution. We need some commonsense solutions, but it is a reasonable step that we ought to take. I have listened to the discussions of the representatives from the tobacco growing areas. They say that we are treating their farmers like second-class citizens, we are saying that they are criminals. No one is saying that. They have a legal right to grow those crops and to sell them. But the fact of the matter is, why should taxpayers help them when we face this kind of consequence from this product? We ought to be talking about, if we really care about those farmers, how to make a transition to other crops as we, as a nation, try to discourage people from smoking. That is what we ought to be doing, and if the gentleman wanted to deal with the problem, we would try to come to terms with it. We have enormous pressures to keep the status quo. Do not touch the subsidies going to tobacco farmers. People say, ``Well, let's deal with alcohol.'' Well, let us deal with alcohol, but let us recognize the disproportionate deaths from tobacco. They say, ``Well, let's do something about kids smoking,'' but those same people that said that on the House floor object to the Food and Drug Administration promulgating regulations. They are in favor of some voluntary effort by the tobacco industry which, as an industry, has a conflict of interest. The industry does not want to discourage kids from smoking because those kids that take up smoking as 13-, 14-year-olds are their customers when they are adults. They are the ones who get hooked on nicotine. I urge that we support this amendment. It is a good first step. We ought to do it. There is no reason not to do it.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, I thank very much the managers of this bill for giving me an opportunity to speak, and I do not come here to speak on the substance of the bill, but the process. When whole idea of the Corrections Day Calendar was proposed, I raised a lot of concern about it because I thought it might be a vehicle for special interest proposals, for controversial matters cloaked, perhaps, in a cover that maybe they are not as controversial as they otherwise would be perceived to be. I thought my misgivings were misplaced when I went on the corrections day advisory committee and participated in the process where, up to now, we have presented bills that were noncontroversial, bipartisan, clear-cut corrections of Federal law. But this bill is a controversial matter. It affects the gentleman from Massachusetts, Mr. Olver's district, and he is opposed to the bill, the administration vigorously opposes it, the gentleman from California, Mr. Miller, as a ranking Democrat on the Committee on Resources, and the gentleman from Massachusetts, Mr. Studds, the ranking Democrat on the subcommittee, oppose the bill; Sierra Club and other environmental groups oppose the bill. Mr. Speaker, this is not appropriate for the Corrections Day Calendar, and I am very disappointed that this bill has been put on as a corrections day matter. When it came before the corrections day advisory committee, no Democrat was present, there was a ballot vote where the Republicans voted one way and whatever Democrats voted, voted the opposite way. The Chair of the corrections day advisory committee was advised that this was controversial and that had Democrats been at the meeting, we would have opposed this bill being placed on the Corrections Day Calendar. The fact this bill is on the calendar as a corrections matter undermines the whole idea of the validity of a Corrections Day Calendar. It discredits the work of the advisory group for the Corrections Calendar. So I wanted to speak out on this issue, opposing this proposal not only in substance, which others can speak more articulately about, but in terms of the process itself.

Mr. WAXMAN

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

Mr. WAXMAN. Mr. Speaker, I rise in support of this important legislation to increase the minimum wage. I am well aware of the likely impact of this increase on the Medicaid program, of which nursing home services are the largest part of that spending. Nursing homes employ large numbers of minimum wage workers. Since most nursing home funding is reliant on government-set payment rates, minimum wage increases will have a direct and significant impact on nursing facilities. Mr. Speaker, I am concerned there will be adequate funding to maintain the level of quality we fought so hard for. Current Medicaid law requires that rates which States pay to nursing homes be reasonable and adequate to meet their costs and to be in conformity with applicable State and Federal laws. Certainly the Fair Labor Standards Act is an applicable Federal law. I feel we should reaffirm for the record that current law requires States to adjust their nursing home reimbursement rates to take into account the increased costs that nursing homes incur in complying with the increase in the minimum wage. I would like to ask the gentleman if he agrees with this position.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, I am pleased to yield 2 minutes to the gentleman from New York [Mr. Ackerman]. (Mr. ACKERMAN asked and was given permission to revise and extend his remarks.)

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

Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentleman from New York [Mr. Towns], a very important member of the subcommittee who played an active role in the reauthorization of this legislation.

Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentleman from Massachusetts [Mr. Studds], who played such a very important role in the work on the Ryan White bill and our approach to the full AIDS epidemic. (Mr. STUDDS asked and was given permission to revise and extend his remarks.)

Mr. WAXMAN. Mr. Speaker, I yield myself 2 minutes for the purpose of engaging in a colloquy with the gentleman from Florida. (Mr. WAXMAN asked and was given permission to revise and extend his remarks.)

Mr. WAXMAN. Mr. Speaker, this bill provides that funds appropriated solely for the drug assistance program be allocated based on statewide case counts. I ask the gentleman from Florida; is that correct?

Mr. WAXMAN. I yield to the gentleman from Florida.

Mr. WAXMAN. The bill also specifies that 3 percent of the appropriations for each title of the Ryan White program be set aside for the special projects of national significance; that 1 percent be set aside for technical assistance; and 1 percent for the Public Health Service evaluation funds. It was my understanding that the $52 million for the drug assistance program would not be subject to these set-asides nor would this sum be included in calculating the set-aside taken from the formula grant. Was that the gentleman's understanding as well?

Mr. WAXMAN. Mr. Speaker, I thank the gentleman for entering into this colloquy so we can clarify this.

Mr. WAXMAN. Mr. Speaker, I have no further requests for time, and I yield back the balance of my time.

Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentlewoman from Connecticut [Mrs. Kennelly].

Mr. WAXMAN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am extremely pleased we have completed our work on the House-Senate conference and we have reached an agreement to allow us to reauthorize the Ryan White Act. This is an important program in dealing with the AIDS epidemic throughout this country. I think from the very beginning of this reauthorization everyone wanted to continue the program, but we had some issues that we had to resolve. One issue that took some discussion was the question of how to direct our attention to deal with trying to prevent the transmission of AIDS to newborns. Appropriately, the conference said that we should put an emphasis on encouraging pregnant women to be tested so that if they were HIV positive and undertook therapy, they could in fact stop the transmission of HIV to the newborn. But in the case where there has not been a test with the mother, we wanted to establish a procedure for having newborns tested. I think we came up with a good compromise position that will move things in the right direction and deal constructively with this problem. The second area that we had to resolve were the funding formulas for distribution of money under this act to cities and to States under title I and title II. It makes sense to continue the two separate authorizations for these two titles. Second, we agreed in changes in the formulas which were designed in light of new information and the changing nature of the AIDS epidemic. We did not want to allow large shifts in funding that cities and States severely affected by the epidemic would face, so we did have tight limits on any losses from these areas. In addition, we tailored the funding formulas appropriately to take into account the continuing enormous need for funding in States and cities like my own State of California and Los Angeles district, as well as the State and city of New York, States of Florida and Texas, and others where the AIDS epidemic began and where it will always remain a significant problem. On a personal note, I am pleased that the formulas we adopted do result in significant increases of funds for Los Angeles and for the State of California, where the need for services for people with HIV and AIDS and for access to drug therapies for the very large number of affected people remains to severe problem. Mr. Speaker, in conclusion, and I am going to make a further statement for the Record to reflect the views that I have on this legislation, let me say I am extremely proud to have been the original author of the Ryan White CARE Act and to have been a part of its reauthorization. This is a law that has worked, and it will continue to be an integral and essential part of this country's response to the AIDS epidemic. I want to express my appreciation to the chairman of the Committee on Commerce, Mr. Bliley, and the chairman of the Subcommittee on Health and the Environment, Mr. Bilirakis, for the cooperative and truly bipartisan way in which this legislation has proceeded. I want to acknowledge the hard work of the GAO staff who helped us with title I and II formula calculations, and I want to thank the committee staff, Melody Harned of the majority and Kay Holcombe of the minority, for their significant contributions to this process. Mr. Speaker, I am extremely pleased that we have completed our work in the House-Senate conference and have reached agreement about the reauthorization of the Ryan White CARE Act. Programs under this Act provide health care services for people with HIV disease and AIDS throughout this country, through public health departments in cities and states; through community-based organizations; and through a variety of primary care providers and social service organizations dedicated to helping patients and families affected by this devastating disease. One very important Ryan White program focuses on the need for more research on AIDS and HIV disease in woman and children. Another focuses on programs directed toward prevention of HIV infection and AIDS. In total, this legislation represents a successful and very important comprehensive approach to HIV and AIDS, and its reauthorization is surely among the most significant legislative accomplishments of this Congress. I think from the very beginning of this reauthorization, Members on both sides of the aisle and on both sides of the Capitol have completely agreed on one point: that we should reauthorize these important programs. We did, however, have several areas of difference which needed to be resolved and have been resolved in the conference. One of these related to the matter of HIV testing of women and newborns. This is a difficult and contentious issue, and I am extremely pleased that we were able to reach agreement. Under this agreement, we have broadened the grant program included in the House bill so that grants can be used to assist States to implement the CDC guidelines relating to counseling and voluntary HIV testing of pregnant women, as well as to determine the HIV status of newborns. I am especially pleased with this change because I think it places emphasis where we can do the most good--preventing the perinatal transmission of HIV infection. The legislation then asks the Secretary to make a determination, in consultation with appropriate medical organizations, about whether it is the standard of practice in medicine to test newborns for HIV. If the Secretary makes this determination, then, in order to continue to receive Title II funding under Ryan White, States would need to meet one of two performance standards. The State could demonstrate that, through voluntary counseling and testing programs, it is determining the HIV status of 95 percent of women who are in prenatal care. Alternatively, the State can demonstrate that it has reduced pediatric AIDS, contracted through perinatal transmission, by 50 percent, compared to the 1993 level. This date is important in that it reflects the time at which we learned that treatment of HIV- positive pregnant women with AT can prevent perinatal transmission. Only if States cannot demonstrate the achievement of one of these specified goals would they be required to put in place either legislative or regulatory requirements relating to the mandatory HIV testing of newborns, as a condition of their continuing to receive title II funding under the Ryan White Act. Further, any State that did choose this route would be required to have in place important protections such as requirements that health insurance could not be denied or canceled, based on the fact that an individual has been tested or is HIV-positive. These provisions are over and above the protections already provided in the Americans with Disabilities Act and under applicable State law. The ADA requires that all persons with disabilities--including those with HIV or AIDS--be protected from arbitrary insurance discrimination. In other words, under the ADA, an employer or insurance company cannot treat people with HIV or AIDS differently from people with other serious conditions that pose equal financial risk. That is clear. Many State laws also provide a State remedy already for such discrimination. That is also clear. The Coburn-Waxman amendment as included in this bill would go further and provide protection to people who have simply undergone testing for HIV, whether or not they are perceived by the insurance company as having HIV. The goal of this amendment is clear. We are all trying to reduce any disincentives for anyone to be tested. The Coburn/Waxman amendment also provides a different enforcement device to assure that such discrimination is prohibited, that is, that States could lose their Ryan White money. With all three of these protections in place--ADA, State law, and Ryan White, the conferees feel that we will make significant public health strides in getting people who may be afraid of being tested less afraid. I am pleased with this result, because I think we have placed the emphasis where it should be--not on testing as an end in itself, but on reducing the number of babies born with HIV. Reaching pregnant women, and educating them about the importance, both to them and to their babies, of knowing their HIV status at a time when it will do the most good and actually prevent perinatal HIV transmission, is what we should be doing. After all, our goal here is to stop the transmission of HIV to babies. I think this compromise emphasizes and also helps us achieve that goal. A second issue that has proven difficult to resolve is how funding under this act is distributed to cities and States. The conference report deals with these issues in three ways. First, the conferees agreed that, particularly in light of the increases in funding for both titles I and II under the fiscal year 1996 appropriations bill, it made sense to continue authorizing two separate appropriations for these two titles. Second, we agreed that although changes in the formulas were designed were needed, in light of new information and the changing nature of the AIDS epidemic, we did not want to allow such large shifts in funding that cities and States severely affected by the epidemic could not absorb them. Thus, while we have agreed to make significant changes in the way funds are allocated to cities and States, we have placed tight limits on losses. In addition, we have tailored the funding formulas appropriately to take account of the continuing enormous need for funding in States and cities, like my home State of California, and my Los Angeles district, as well as the State and city of New York, and the States of Florida and Texas, and others where the AIDS epidemic began and where it always will remain a significant problem. On a personal note, I am pleased that the formulas we adopted do result in significant increases of funds for Los Angeles, and for the State of California, where the need for services for people with HIV and AIDS and for access to drug therapies for the very large number of affected people remains a severe problem. Mr. Speaker, in conclusion let me say that I am extremely proud to have been an original author of the Ryan White CARE Act and to have been a part of its reauthorization. This is a law that has worked and will continue to be an integral and essential part of this country's response to the AIDS epidemic. And finally, I want to express my appreciation to the chairman of the Commerce Committee, Mr. Bliley, and the chairman of the Health Subcommittee, Mr. Bilirakis, for the cooperative and truly bipartisan way in which this legislation has proceeded. I want to acknowledge the hard work of the GAO staff, who helped us with the title I and II formula calculations. I particularly want to thank the committee staff--Melody Harned of the majority and Kay Holcombe of the minority-- for their significant contributions to the process. Mr. Speaker, I reserve the balance of my time.

Mr. WAXMAN. I withdraw my reservation of objection, Mr. Speaker.

Mr. WAXMAN. Reserving the right to object, Mr. Speaker, I want to clarify that this will allow us to move forward on the House floor to consider the Ryan White reauthorization bill, allowing discussion of that legislation and a vote.

Mr. WAXMAN. Mr. Speaker, I yield 1 minute to the gentleman from New Jersey [Mr. Payne].

Mr. WAXMAN

Mr. WAXMAN. They are not being rewarded for their good deeds, Mr. Speaker, they are being rewarded for their bad deeds, by the power of those in their delegation that have been able to exact this special pork barrel treatment for the State of Louisiana.

Mr. WAXMAN. Mr. Speaker, I want the record to be very clear about the Louisiana situation. They did take Federal dollars on the claim that this was supposed to go to hospitals that served a disproportionate share of low-income patients. They put up some phony State dollars which were in fact Federal dollars, leveraged the Federal dollars to match it, and then used the additional Federal dollars for their own budget balancing, paying for roads and prisons. Second, Mr. Speaker, I want the record to be clear that the State of Louisiana has not underspent because they were more efficient and gave better care than other States in the rest of the Nation.

Mr. WAXMAN. Mr. Speaker, I thank the gentleman for yielding time to me. Mr. Speaker, I listened to the statements from the gentleman from Louisiana [Mr. Livingston], the chairman of the Committee on Appropriations, about the plight of the State of Louisiana. Louisiana is trying to handle its own State budget, but so is every other State in this country. What Louisiana is getting is a very sweet deal. It is a special treatment. It is pork barrel money. They are getting Federal dollars without doing what they are required under Federal law to put up for their own citizens who receive Medicaid benefits. The reason they are in this fix has nothing to do with the Federal Government. It has to do with the abuse by the State of Louisiana in the 1980's when they leveraged Federal dollars into the Medicaid Program and then did not even use it for health care. They used it for roads and they used it for prisons. They used it to balance their budget and they became addicted to that money. Now, because they have one of their own in a very powerful position, they are being singled out; they and New Hampshire, to get Federal dollars to help them meet their fiscal requirements. The State of California has a problem. Every State has a problem to make their budgets match income and outgo. Medicaid is a big cost. But the Federal Government should not be standing in the place of those State governments to take on their responsibilities. Put this in the context of what Republicans wanted earlier this year. What they wanted was a block grant with cuts in Federal and State dollars under the Medicaid Program, and the public that is to be served by those programs be damned. They could go without care under the provisions of what is substituted for the existing Medicaid Program under the Republican proposal. This is an outrage. It is unfair. It should not have happened.

Mr. WAXMAN. I yield to the gentleman from Michigan.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, I want to express my appreciation to Mr. Pallone and Mr. Porter for holding this special order today to commemorate the Armenian genocide. Approximately 6 million people of Armenian descent live in the United States. The elderly among them still have memories of the systematic persecution of Armenians during the years of the Ottoman Empire, and the accounts of this terrible crime against humanity have been passed down through the generations. It is impossible to comprehend all of the genocidal horrors that were perpetrated against the Armenians during this dark time. In a few short years, approximately 1\1/2\ million ethnic Armenians were killed. Another one-half million were driven from their homes, robbed of their property, and saw every sign and symbol of their religion and culture obliterated and replaced with Turkish nationalist symbols. Journalist Marjorie Hagopian reported that when the Nazis contemplated the destruction of the Jewish people, one of the leaders asked whether or not there would be world repercussions for the planned atrocities. Hitler is said to have responded, ``Who cared about the Armenians?'' Would that the moral outrage of past atrocities against Armenians, Jews, Romany--gypsies, gays, labor leaders, intellectuals, and clergy prevent any such occurrence again. Sadly, even today we see in the former Yugoslavia gross violations of human rights, ``ethnic cleansing,'' massive forced relocation of populations, and other horrors for which the Armenian genocide was a horrible precedent. April 24 has been set aside to remind us of George Santayana's prophetic warning that those who forget history are doomed to repeat it. Today we honor the memory of the victims of the Armenian genocide and reaffirm our unwavering commitment to fight all crimes against humanity.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, on February 16, 1996, the State of California lost Edmund G. (Pat) Brown, one of its most beloved statesmen. All Californians have mourned the passing of this great leader, who was unmatched in his political skill, courageous leadership, and benevolence. He used his talents to make government an instrument of public good and his accomplishments as California's Governor from 1958 to 1966 are legendary. Pat Brown embodied all of the qualities the American people yearn for in their elected officials. Columnist David Broder captured him in a way we can all appreciate in a column he wrote shortly after Pat died. April 21, 1996, would have been Pat's 91st birthday. In memory of his long and rich life, I invite you to take a moment to read David Broder's words, which are reprinted below. California Is His Monument (By David Broder) If California were a nation, and not just a nation-state, the visage of Edmund G. (Pat) Brown Sr. would be carved into the Sierra equivalent of Mount Rushmore. Brown, who died last week at 90, shaped his megastate as surely as the greatest of the presidents have shaped this country. Reporters who covered him during his eight years as governor, from 1958 through 1966, and visited with him over the last 30 years mourn him as one of the true blithe spirits of 20th century politics. He was the most amiable of companions, a grand storyteller who liked nothing better than to tell or hear jokes at his own expense. For years after it happened, you could get ``the Guv'' laughing so hard that his eyes teared by describing to him the spectacle he made when he missed John Kennedy's campaign train during a whistle-stop tour of California's Central Valley in September 1960. Brown had introduced the candidate from the back platform in one of the Valley towns, then climbed down and began schmoozing with people in the crowd. Engrossed in conversation, Brown missed Kennedy's cue lines for departure--a quotation from ``Colonel Davenport'' that staff members and reporters took as a signal to jump back aboard--and made an unsuccessful lunge for the back platform. As Kennedy joined the others laughing, the portly governor jogged down the track, puffing heavily until the train was halted so he could reboard. But there was nothing comical about what Brown accomplished in Sacramento. Elected at a time of burgeoning population and economic growth, Brown put in place the three ingredients vital for sustaining his state's progress: improved transportation, education and water systems. His administration built 1,000 miles of freeways to keep the state from traffic gridlock. He opened almost a dozen new campuses of the University of California and the state colleges, giving California--for a time--the most accessible and inexpensive higher education system in the world. The Berkeley campus was one of the crown jewels of research and graduate education. Perhaps his greatest achievement was the legislation creating the California water system. A native of San Francisco, Brown recognized that water was the issue that could deepen the long-simmering division between his own northern California, eager to protect its rich water resources, and the fast-growing but arid south. At that time, before the Supreme Court's one-man-one-vote edict, small rural counties dominated the state Senate, where Los Angeles' millions of people had only one vote. It fell to Brown to cajole and pressure the Senate to authorize a 444- mile aqueduct that brought almost 2 billion gallons of water a day to the south, and later to obtain approval of the project in a closely fought referendum. It was a battle that only a visionary would have waged, but Brown was a man who believed--in a way few politicians do now--that government has enormous capacity to improve life for people. He also had an enormous capacity to enjoy people, whatever their politics. He started life as a Republican and once gained both Democratic and Republican nominations for attorney general under California's now-defunct cross-filing system. Martin Smith, the retired political columnist of the Sacramento Bee, recalled Brown saying of Ronald Reagan, who thwarted his bid for a third term in 1966, ``What an extraordinary human being. . . . Of course, I disagree with him 90 percent of the time.'' Lyn Nofziger, Reagan's former press secretary, who was here helping Sen. Bob Dole, told me that just a few years ago, when he was crossing a street in Washington, ``a big car rolled up, and Pat Brown rolled down the window, and asked, `How the hell are you, Lyn?' He tied up traffic for 10 minutes just wanting to talk.'' Jack Burby, who handled the press for Brown, recalled a different kind of encounter in 1963, a year after Brown beat Nixon to win his second term. The governor and Burby and their wives were having dinner at a restaurant in Paris. ``The Nixons and a small entourage walked in. Pat, being Pat, wanted to jump up and lick his face. I suggested that he send him a note and invite him to join us for coffee and dessert. The waiter took the note over--and a few minutes later, the Nixon party walked past us without a word, and left the restaurant.'' ``It used to drive me crazy,'' Burby said, ``that Pat had no mean streak. I would tell him, `Even FDR got even.' but he wasn't interested in that.'' The things he was interested in gave California its future. The whole state is his monument.