Heather Wilson

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, I rise today in support of our 44th annual Loyalty Day, which is celebrated on May 1. On this day, let us reflect with pride on our great country and remember with gratitude the contributions of the many loyal and courageous Americans; such as fire fighters, law enforcement officers, community service leaders, and military personnel who have given so much of themselves both at home and around the world to preserve our freedom. Although we don't know the exact start of Loyalty Day, it did start in the 1930s as a counteractant of the May Day Communist exhibition. The Public Law 85-529 was signed by President Eisenhower in 1958 to officially commemorate this special day. Members of the Veterans of Foreign Wars thought that these ``disruptive forces of the communism'' needed to see that the loyalty of Americans could not be uprooted so easily. They decided that they would organize parades and ceremonies, with other patriotic organizations joining in. With an extensive letter-writing campaign, and the help of the speaker's bureaus the theme of loyalty of Americans began to mold into something. Plays and tours of our national shrines aided this. The motto is to instill the ideals of our founding fathers to ``remain loyal to America''. Indeed, it is a day; meant for making all of us in America feel proud of our country. The country to which we belong. Join me and the members of The Veterans of Foreign Wars of the United States, George O. Breece Post 401 in recognition of Loyalty Day 2002.

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, I rise today to introduce legislation that will improve equity in the Medicare system and help to alleviate the growing problem of physician retention and recruitment in many areas. The current physician fee schedule for Medicare has several components, one of which is a geographic index supposedly to adjust for cost differences in different areas. While this makes sense for a physician's expenses for office rent and other costs to vary by region, the time spent evaluating and treating a patient should not depend on where a senior lives. My bill equalizes the physician work component of the Medicare physician fee schedule. The physician work component measures the physician time, skill and intensity in providing a service. Two additional components account for practice expense and malpractice expense. While practice and malpractice reimbursement should reflect differences in geographic costs, significant differences in physician fees in a national market for health care providers directly creates shortages in some communities like New Mexico, and excesses in other communities because they pay more. This bill would eliminate the impact of the adjuster on physician pay by making it equal across the country. The physician work geographic practice cost index (GPCI) for New Mexico is 0.973. Bringing New Mexico to a 1.00 geographic adjuster whether through a floor or making all physician fees equal would translate into about a $2,592,203 annual increase in Medicare payments to New Mexico physicians. More and more seniors are learning that their physician has moved to a neighboring state because salaries are dramatically higher. New Mexicans don't pay into Medicare based on where we live, and we should not be denied access to health care because of where we live. Seniors in rural areas or ``low cost areas'' have seen increasing numbers of doctors leave for higher paying areas. Keeping doctors in rural states is extremely difficult because of the pay gap driven by discriminatory Medicare reimbursement. The disparities are very large. In 2000, average Medicare payments per beneficiary in New Mexico were $3,726, while in Texas average payments were $6,539--70 percent more. I urge my colleagues, especially those in rural states to consider this bill and its intent to bring equity and access to the outdated Medicare system.

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, today I am introducing a bill to help New Mexican children and their parents access quality, affordable child care. My bill would provide federal funds to help day care centers cover the costs of getting accredited. For many children, child care centers are an introduction to the world of learning. It's critical to start a child off on the right foot. That's why I am focusing on federal child care programs for low-income families and people working their way off welfare. We need to make sure that all children in child care have access to high quality, affordable programs. This bill will make a real difference for childcare centers that rely, at least in part, on federal block grant funds. It will help day care centers provide the quality of care that children need. In New Mexico we have more than 22,000 children in federally subsidized child care programs. The Quality Child Care Act of 2002, will increase funding to help child care centers pay for the cost of accreditation. Currently, federal law requires that 4% of Child Care and Development Block Grant funding is used for child care quality programs. The bill will increase the current 4% funding requirement to 8% and would require that 4% be set-aside to help child development centers and homes pay for the costs associated with accreditation. CCDBG is a federal program administered by the Department of Health and Human Services (HHS) that provides grants to states to subsidize the child care expenses of low-income families with children under age 13, as well as for activities intended to improve the overall quality and supply of child care for families in general. Education is my personal passion. In the coming weeks I intend to introduce two more bills focused on early childhood education.

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, it rained in Washington last Wednesday. By Thursday morning the sun was burning through the mist that blanketed Arlington National Cemetery. On the north side of a ridge near a grove of evergreen trees an Air Force honor guard carried Jason Cunningham's casket to his final resting place. There were six honorary pall bearers who followed the casket up the incline to where the family and a small cluster of others waited. Those six all wore the maroon berets of the Air Force elite pararescuemen. There were dozens of PJs there, mostly from Jason's squadron in Georgia. All of them had completed their PJ training at Kirtland Air Force Base. Over the ridge to the south of where we stood two cranes lined the sky where crews work feverishly to rebuild the Pentagon. You could hear the throb for work from the site and it was comforting, somehow, to know that even as we grieve deeply for those lost we are rebuilding and going on. Jason Cunningham was a New Mexican and, by all accounts, a good man who was willing to risk his life in daring missions to rescue others. That's what PJs do. When Navy SEAL Petty Officer Neil Roberts was left behind after his helicopter was attacked in a mountain valley in Afghanistan, Jason and his team went in to try to rescue him. They got into a vicious fire fight. Jason, the Navy SEAL, and five others were killed. Eleven Americans were wounded. Even when you know a cause is just, when those who fight do so willingly, when you know it's a fight we have to win, the grief is just as deep. The rifle shots of the honor guard, the echoes of taps, the rescue choppers flying by in a last salute, the wide-eyed children of a soldier who won't be coming home, weighed heavily on everyone at Arlington on Thursday. There were thousands of New Mexicans who would have been at Arlington if they could have. I went to represent them and to let the Cunninghams know that the thoughts and prayers of thousands of New Mexicans are with them. We are sorry that Jason isn't coming home and grateful for his service and his sacrifice defending us and our way of life. Operation Anaconda has been the costliest battle so far in Afghanistan. There will be more battles in this war against terrorism. Let's keep the troops in our thoughts and prayers.

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, I rise today to speak in support of a world-class organization that has achieved world-class results. Founded in 1912 on the simple belief that all girls should be given the opportunity to develop physically, mentally, and spiritually, Juliette Gordon Low assembled a meeting of 18 girls in Savannah, GA. Today, the Girl Scouts of the USA has grown into an organization with membership numbering 3.8 million, far and away the largest organization for girls in the world. I would especially like to praise the Girl Scouts of Chaparral Council, the local Girl Scout troop from my home district. Chartered in 1958 and serving over 6,000 girls and 2,000 adult volunteers, the Girl Scouts of Chaparral Council have been teaching girls in my district the ideals of character, conduct, and patriotism for almost 45 years. Organizations like the Girl Scouts of Chaparral Council that make me proud to represent the citizens of the first district of New Mexico. The Girl Scouts of the USA is the world's preeminent organization dedicated solely to girls, where in a positive, nurturing environment, girls build character and skills for success in the real world. In partnership with committed adult volunteers, girls develop qualities such as strong moral values, leadership, a social conscience, and conviction about their own potential and self worth--values that will serve them well the rest of their lives. Being involved with Girl Scouts enables girls to develop self- confidence and expertise, take on responsibility, think creatively, and act with integrity. Girl Scouts learn the characteristics essential being good citizens and great leaders. The U.S. Congress chartered the Girl Scouts of the USA on March 16th, 1950, and at present, there is a ``Troop Capitol Hill'' made up entirely of Congresswomen who are honorary members. For 90 years, Girl Scouts of the USA has had a proven track record of empowering girls to become leaders, helping adults become positive role models and mentors for children, and helping to build strong communities. Girl Scouts of the USA truly is a place ``where girls grow strong!''

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, today I will introduce the Teacher Tax Credit Act of 2002 to the Congress. Over the next 10 years, America will have to recruit and train 2 million new teachers. While we do not have a teacher shortage now, we do have a maldistribution of teachers. This Tax Credit Act would provide a $2,000 nonrefundable tax credit for teachers, assistant teachers, principals and assistant principals who teach in title I eligible schools. Those are schools in our poorest neighborhoods where it is often hard to keep teachers, where the average experience level of teachers is lower than they are in other schools because it is a tougher job. So let us give teachers in our schools that need the most help a little more support from the Federal Government by saying, yes, we want to give you the resources you need to stay in that neighborhood, teach in that school and make sure that we leave no child behind.

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, I thank the gentleman from Illinois. I have revised a little bit of what I will say based on what we have just heard from the minority leader, because I think it shows a very clear contrast in what we are about in this House. He talks about honesty and keeping promises. I take those things very seriously, and I take my own integrity very seriously. There has been an historic reversal, as the minority leader says. That historic reversal is that we are in a recession and that America has been attacked, and we are at war. I believe there are two things this country must do now. We have to win the war on terrorism, and we have to create jobs. I think we are united, we are together on the first, and we are resolved we are going to win this war on terrorism, and we will spend what it takes to win it. But the worst thing we could do in a recession is to raise taxes. All of those little small businesses out there who are worrying about whether they are going to have to lay off more people because they cannot make the rent payment on their shop this month need the reassurance that we are with them, that we understand, that we are not going to raise their taxes. Most of this tax relief that is going to be phasing in is for middle- income Americans and particularly for families. We eliminate the marriage penalty and, as a result, 43 million Americans are not going to be paying more just because they are married. It is about time that we started honoring marriage in this country and stop taxing it. When the President of the United States came to New Mexico in August, he went with me to Griegos Elementary School in the north valley of Albuquerque, New Mexico, and as we were going down this little lane to get there, there was a sheet hung on a fence and in handwritten letters it said, Mr. President, thank you for my new bed. It cost $300. Maybe $1,700 in the pocket of an American family is not a whole lot in Washington terms, but it is in New Mexico terms. It is a lot for a New Mexico family. I think we should let them keep their own money and give small businesses the confidence to be able to hire workers this next year and create jobs and not abandon them in their time of need.

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, as Americans, we were all deeply moved when, during the days following September 11th our friends in Canada extended a helping hand to our shaken Nation. Our neighbors to the north deserve our thanks and praise for their enduring friendship. The world watched as trans-Atlantic flights were diverted to Canadian airports in Newfoundland and Nova Scotia. Personal accounts from constituents of mine, stranded in Canada because of the events of September 11th, show how remarkable the response was from the Canadian citizens who helped to care for stranded passengers. There were hot meals, showers, cots, blankets, and TV sets to watch the first news of what was happening back home. There were also teddy bears and ``field trips'' to local sights. It is during these troubled times that you find out who your real friends are. Thanks to the service men and women, and also to the citizens of the great Nation of Canada for their kindness. Your hospitality will not soon be forgotten. Washington, DC, February 4, 2002. Lt. Cmdr. M.A. Morris, Commanding Officer, HMCS Cabot, St. John's, Newfoundland. Dear Commander Morris: No one expected on the morning of September 11th what that day would be like. I expect that is especially true of you. Ash and Susan Collins, two constituents of mine from Placitas, New Mexico, told me of your professionalism and kindness following the diversion of so many guests to your station. I wanted to thank you for all you did for them and others in the same situation. It is in the tough times that you find out who your real friends are. Thank you and your service men and women for your hospitality and kindness. We won't soon forget it. Warm Regards, Heather Wilson, Member of Congress.

Mrs. WILSON of New Mexico

Mrs. WILSON of New Mexico. Mr. Speaker, I rise today to express my concern about legislation that the House passed by voice vote early this morning H.R. 2869, the ``Small Business Liability Relief and Brownfields Revitalization Act.'' Brownfields redevelopment effectively marries the principles of economic development and environmental protection by slowing the developing of open space by presenting property owners and developers with access to brownfields sites located in desirable locations, with existing infrastructure and affordable pricing. While I am a strong supporters and advocate of brownfields clean up, I am dishearten that H.R. 2869 did not go further to address the entire brownfields problem in this country. The Environmental Protection Agency (EPA) estimates that approximately one half of the 450,000 brownfields sites in this country are contaminated with some type of petroleum pollution. Unfortunately, H.R. 2869 ignored petroleum-contaminated sites by only including a liability exemption for brownfields sites contaminated with a ``hazardous substance'' as defined under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA). Petroleum contamination, which is not considered a ``hazardous substance'' under CERCLA, is regulated under the Resource Conservation and Recovery Act (RCRA). While H.R. 2869 does include federal grant money for a very specific set of petroleum contaminated sites, I fear that these grants alone will not be an incentive to spur the clean up of petroleum brownfields sites. Without a RCRA liability exemption for petroleum contaminated sites, only half of the brownfields sites in this country have the potential to be redeveloped. It is my sincere hope that H.R. 2869 only represents a beginning of our intent to address brownfields redevelopment. I hope this Congress will address liability protection for petroleum-contaminated brownfields sites next year so we can truly address the entire brownfields problem in this country. I look forward to working with the leadership and the committees to make comprehensive brownfields redevelopment a reality.

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, I regret that I missed the votes on Monday, November 13, 2000, on S. 2594 and S. 1972. I was delayed due to flight problems. Had I been present I would have voted ``yea'' on S. 2594, a bill to authorize the Secretary of the Interior to contract with the Mancos Water Conservancy District to use the Mancos Project facilities for impounding, storage, diverting, and carriage of nonproject water for the purpose of irrigation, domestic, municipal, industrial, and any other beneficial purposes. Had I been present I would have voted ``yea'' on S. 1972, a bill to direct the Secretary of Agriculture to convey to the town of Dolores, Colorado, the current site of the Joe Rowell Park.

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, on October 10, 2000, I was unavoidably delayed in traveling to Washington, DC, as a result of a mechanical problem with an airplane. As a result, I was unable to attend three votes. Had I been present, I would have voted: ``Yea'' on rollcall vote No. 519, the Pipeline Safety Improvement Act (S. 2438); ``yea'' on rollcall vote No. 520, allowing for the contribution of certain rollover distributions to accounts in the Thrift Savings Plan and to eliminate certain waiting period requirements for participating in the Thrift Savings Plan (H.R. 208); ``yea'' on rollcall vote No. 521, the Lupus Research and Care Amendments (H.R. 762).

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, the House recently passed a bill to increase the minimum wage, increase the amount Americans can save each year through an IRA, and to improve add funds to Medicare and Medicaid programs. An important part of that Medicare package improves the reimbursement rates for Medicare+Choice. This program offers more choices for seniors to decide what kind of health care plan they prefer. The Medicare+Choice managed care plans usually offer better services and benefits than traditional Medicare--most importantly--they can provide prescription drug coverage to seniors who cannot afford a Medigap policy. In my district, nearly 60 percent of seniors who earn less than $20,000 per year who chose a Medicare+Choice plan. But in my state, Medicare reimbursement for this program is half of what places in New York or Florida receive. And New Mexico's rate is too low for the plans to continue to offer the same quality service. H.R. 5543 will correct that disparity. This measure is strongly supported by New Mexicans, and I wish to bring your attention to the attached article written by Bob Bada, that clearly illustrates the current situation and need for this legislation and the need for a long term reform of Medicare. The Dual Edged Sword of Medicare Reimbursement--the Medicare Provider and Health Maintenance Organization Perspective (By Bob Badal) While the nation's booming economy and concomitant boosts in Federal tax revenues over the past six to seven years has extended the solvency of the current Medicare program to 2023, the baby-boom generation soon will begin to enter the program. Paying for the extended range of benefits for this increase in senior citizens will exact a large financial toll. In 2025, 69.3 million elderly and disabled persons are expected to be eligible for Medicare, up from 39 million today. The share of our nation's gross domestic product spent on Medicare is projected to almost double from 2.7 percent in 1998 to 5.3 percent in 2025. Congress passed the Balanced Budget Act of 1997 (``BBA'') to secure the financial stability of the Medicare program by providing an estimated $115 billion in cuts, over five years, in spending to physicians, hospitals, nursing homes, and home health agencies. In addition, the BBA sought to provide alternative network and product choice to beneficiaries via Medicare+Choice plans. Medicare patients, as intended by the BBA, would be able to elect coverage from Preferred Provider Organizations or private insurers, or they could establish a medical savings account, financed by the Health Care Finance Administration (``HCFA''), and purchase a high-deductible insurance policy. With the benefit of hindsight, it is apparent that the BBA, and subsequent amendments, have negatively affected not only the financial stability of Medicare providers, but also the level of choice for the beneficiaries it is mandated to protect. On this point, Senator Pete Domenici R-N.M., Chairman of the Senate Budget Committee stated: ``Seniors in many communities are treated like second-class seniors because their choice and access to care is practically nonexistent. We have created a system of healthcare defined by the `haves' and `have nots' ''. Medicare Reimbursement to Providers The BBA has created a surplus in funds for the Medicare Program over the past 2 years. This surplus is a pyrrhic victory, however. The BBA has reached a surplus by effectively transferring a growing share of the risk to the provider. The Medicare spending cuts called for by the BBA far exceeded the $115 billion Congressional Budget Office (CBO) estimate, and, in fact, will reach more than $212 billion over the five-year life of the BBA. The subsequent Balanced Budget Refinement Act of 1999 served only to restore a modest $15 to $18 billion in payments back to providers. Many providers have been forced into bankruptcy by these draconian cuts, while others have been forced to close their doors. Cardiac surgeons saw over a 10 percent drop in their reimbursement and anesthesiologists experienced an 8 percent decline. In heavily penetrated Medicare and Managed Care markets, such declining reimbursement can have a serious financial impact on many providers. John DuMoulin, director of managed care and In communities like Albuquerque, New Mexico, which has experienced a 15-physician-per-month exodus due, in part, to poor levels of physician-based Medicare reimbursement, access to quality healthcare is becoming a serious concern (New Mexico Hospital Association, January 2000). In addition, as reported in July, 2000, by the American Hospital Association, 10 percent of the nation's nursing homes have filed for bankruptcy protection, and 35 percent of the nation's hospitals are losing money on inpatient services (Healthcare Financial Management, July 2000). Faced with escalating costs of as much as 8-10 percent due in part, to scientific/ technological advances, higher drug costs, and increases in union labor nursing costs, hospitals are faced with a dilemma. They are scheduled to receive increases in Medicare reimbursement of 1.1 percent, less than the market-basket rate of inflation in fiscal 2001 and 2002. Public and provider confidence in HCFA's understanding of the relevancy and possible drastic consequences of their continued pressure on provider reimbursement is not high. To understand the reason why, one need only examine the misguided approach that HCFA has used to determine the initial solvency estimates of Medicare: In 1998, following the passage of the BBA, the General Accounting Officer (GAO) generated new estimates that said that Medicare could remain solvent until 2008. In April 1999, the Bipartisan Commission on the Future of Medicare entered the fray when it issued its report to the nation: Medicare would live until 2015, said the commission. Then in early 2000, the Medicare trustee issued yet another revised estimate for the solvent life of Medicare--2023. That estimate lasted only a few weeks before the trustees admitted they had made a few calculation errors. Medicare would be alive and kicking until 2025. (Healthcare Financial Management, ``Never Underguesstimate the Financial Future of Medicare,'' Jeanne Scott, June 2000). The formula used by HCFA to calculate physician payment creates extreme oscillations in the reimbursement scale. The swings are due in large part to HCFA's use of a variety of time periods--the current fiscal year, the calendar year and other time frames--to make calculations about physician payment. Part of the problem exists within the new ``sustainable growth rate system'' enacted by the BBA to help control expenditures for physician services under fee-for- service Medicare. The growth rate system calculates the updates to the Medicare fee schedule conversion factor, which is used to set standardized reimbursement for specific service categories. The problem, however, is that HCFA is using projected data on utilization patterns and associated healthcare provider costs rather than current actual data in establishing each year's sustainable growth rate. ``Deliberate use of sustainable growth rate estimates that are based on knowingly flawed projections-- even after actual data have become available--is arbitrary and capricious,'' the AMA said in a March 4 letter to Harriet S. Rabb, general counsel for Health and Human Services. (Government and Medicine, ``Data driving swings in Medicare pay,'' Susan J. Landers, AMNews staff. May 17, 1999). Health Maintenance Organizations and Medicare+Choice Reimbursement from Medicare Before the BBA was passed, Medicare beneficiaries essentially were limited to a choice between traditional Medicare coverage under Part A and Part B or HMO coverage. HCFA paid most Health Maintenance Organizations (``HMO'') under the Medicare risk-based system. Under this approach, HCFA generally paid an HMO a prospective amount equal to 95% of the average adjusted per capita cost (AAPCC) of providing traditional coverage to Medicare beneficiaries in the county in which they resided. This amount was adjusted to reflect geographic differences in utilization and practice parameters, as well as certain demographic characteristics of enrollees, such as gender, institutional status, and age. Payment to most HMOs was risk-based in that it was fixed, regardless of the total costs incurred by the HMO in furnishing care to an individual beneficiary. The Medicare payment rates to HMOs varied significantly across the country. Thus, HMOs more actively pursued Medicare enrollees in areas where HMO rates tended to be higher, typically in larger cities. Conversely, market penetration by HMOs was limited in other areas, particularly in rural areas, where Medicare payments to HMOs were lower. Since Medicare HMO plans have traditionally offered enhanced benefits--such as prescription drug coverage and routine physicals--to their enrollees, the lower availability of managed care options in rural areas meant that many rural beneficiaries did not have access to the same benefits as urban beneficiaries did. (ProPac, Medicare and the American Health Care System: Report to the Congress, June 1997; and PPRC, Medicare Managed CARE: Premiums and Benefits, April 1997). Under the BBA, Medicare+Choice plans would receive aggregate payments for the year based on their geographic location and the demographic characteristics of their enrollees. The BBA establishes that each county's payment is determined as the greater of (1) a local/national blend rate, (2) a national floor, or (3) a minimum update rate set at 2 percent above the previous year's rate. (Project HOPE Center for Health Affairs, ``Changes to Medicare risk plan payments as a result of the Balanced Budget Act of 1997; implications for budget neutrality [abstract],'' Schoenman, 1998). In addition, the BBA, through the use of a risk-adjustment payment, attempts to reflect the relative health status of managed care enrollees, with plans getting more money for their sickest beneficiaries. Because this risk adjustment model is based solely upon impatient hospital utilization gathered from Medicare risk contractors, there With the passage of the Balanced Budget Act, changes in the Medicare program requirements were designed to attract more managed care plans to the program. These changes have resulted in new plans in some areas, but the payment reforms in the BBA, coupled with new regulatory requirements, have already had the unintended effect of discouraging other health plans from participating, resulting in fewer choices for Medicare beneficiaries overall. In 1999, the number of Medicare risk plans declined in response to changes in public policy under the BBA. An estimated 450,000 seniors were affected in 1999 as 54 health plans announced their intent to reduce the size of the markets they served, and 45 did not renew their contracts with HCFA. In January of this year, another 41 Medicare+Choice plans announced their intentions to leave the Medicare market, with 58 additional plans announcing a reduction in their service area. In addition, many HMOs that remain have raised premiums or cut benefits to beneficiaries, including prescription benefits. Consequences When Providers and Medicare+Choice plans pull out of markets on such a grand scale, the implications for seniors are tremendous. Access to care, continuity of care, cost of healthcare services, and provider/Medicare HMO (both inpatient and outpatient) ``flight'' are the paramount concerns of most Medicare beneficiaries (Modern Healthcare, ``The exodus escalates, Medicare+Choice market pullouts to nearly double in 2001,'' Benko, July 3, 2000). As Medicare reimbursement to providers continues to fall far short of rates obtainable from private payers, providers will increasingly refuse to serve Medicare patients and/or will reduce the quality of services rendered to them. (Economic Commentary, ``Medicare: Usual and Customary Remedies Will No Longer Work,'' April, 1997). For some providers, this decrease in reimbursement may prove to be too costly, forcing them out of business all together. Declining Medicare reimbursement to HMOs has had a similar effect, and has proven to be even more costly to Medicare beneficiaries than Medicare cuts in provider reimbursement. A study by the Barents Group, Westat, and the Henry J. Kaiser Family Foundation, performed in 1998, providing data on 2,163 Medicare beneficiaries who were involuntarily disenrolled from their Medicare risk HMO, confirms the implications of Medicare's declining HMO reimbursement methodologies, and subsequent decreases in Medicare contracted HMOs. The study identified seven areas of concern: Benefit Reductions: Eighty-four percent of beneficiaries reported prescription drug coverage in their former HMO, but only 70% reported coverage after their plan withdrew. Beneficiaries most likely to have lost one or more benefits also were those most likely to have health problems and least able to pay for those benefits. The disabled under age sixty- five, those age eighty-five and older, and the poor and near poor were more likely to have moved to traditional Medicare with no supplemental coverage and were most likely to report losing benefits after the transition. Increased Out-of-Pocket Costs: Four of every ten beneficiaries reported paying higher monthly premiums after their Medicare HMO left the market, with the share of beneficiaries paying no premiums for supplemental benefits declining from 67 percent to 53 percent and the share of beneficiaries reporting premiums of $75 or more a month rising from 3 percent to 21 percent. Joining another Medicare HMO, however, does not appear to protect beneficiaries against premium increases or cost concerns. One quarter of those who joined another HMO reported paying higher premiums after switching HMOs and said they expect to have higher doctor and hospital expenses. Continuity of Care: Most beneficiaries (91 percent reported having one person they think of as their personal doctor or nurse. However, 22 percent of beneficiaries said that they had to find a new personal doctor after their plan withdrew, and 17 percent had to find a new specialist. Beneficiaries in traditional Medicare with no supplemental coverage were much less likely than others were to report having a personal doctor after their plan pulled out and more likely to report having to change specialists. For markets where provider financial viability is already threatened by high percentages of uncompensated care and dwindling commercial insurance payers, continuity of care is further diminished. Impact on Patient Interactions: Time spent with Medicare patients on each visit is being reduced, and multiple visits for multiple problems are being required. Some physicians selectively refer the more difficult, costly cases to other physicians. Videos are being substituted for face-to-face patient counseling and education. Cutting Amenities: Services for the convenience of patients are being dropped, such as arranging for community services, in-office phlebotomy and x-ray services, and incidentals such as post-procedure care kits. Screening and counseling are being curtailed. Satellite offices are being closed. Telephone consultations are being reduced, with office staff returning more telephone calls from patients. Impact on Access: Medicare patient loads are being reduced, limited or eliminated. Some physicians accept Medicare patients only by referral. Money-losing services, especially surgical procedures, are not being offered to Medicare patients. Simple procedures formerly performed in the office are done in outpatient facilities. In addition, access to specialists is decreasing. Specialists refer patients back to primary care physicians as soon as possible, and are less willing to become primary physicians for their chronically ill patients. ``Reimbursement generosity from private insurance relative to that from Medicare negatively affects physicians' assignment rates, implying that the elderly's access to health care and/or the financial burden is likely to be jeopardized by further reductions in Medicare Technology lags: Many providers are not renewing or updating equipment used in their office, but shifting to hospitals to perform Medicare procedures. Purchases of equipment for promising new procedures and techniques are being postponed or canceled. Solution How should we design Medicare if we had it to do over again? To restore the viability of the program's promise to future generations, and to prevent the drop in access of quality, cost effective healthcare for beneficiaries, the American Medical Association's approach makes sense. Medicare funding, states the AMA, must be shifted from the pay-as-you- go system to one in which beneficiaries have a larger responsibility to provide health insurance for their own retirement health care during their working years. Shifting out of a tax-based, pay-as-you-go system to a system of private savings can assure that all working Americans have access to health care in retirement. This does not means, however, that government would not have a major role to play. The government would continue to make a substantial contribution toward the purchase of insurance for the elderly and it would enforce requirements for individual saving. From a financial standpoint, greater individual funding of retirement health care has at least five advantages over a government-based system: A private system would allow individuals to freely choose the types of health care plans that meet their particular needs. Individual funding would remove federal budgetary considerations and the accompanying extraneous budgetary issues from government policy toward the system. Much of the funding of a private system would be invested in economic activity in the private sector, rather than in unfunded federal debt that must be repaid by subsequent tax revenue. A higher rate of return is possible with investment of funds in private sector economic activity than in government debt instruments. And, above all else, provider as well as Medicare+Choice HMO reimbursement would be appropriately set at free market competitive levels, as established by the consumer. (Rethinking Medicare: A Proposal from the American Medical Association--``Solutions for Medicare's Short-term and Long- term Problems'', February, 1998). Conclusion It is somewhat paradoxical to think that providers of healthcare and their long-time adversary, the HMO (or in this case, the Medicare+Choice HMO), actually may have something in common. Providers of healthcare and managed care organizations agree that the Health Care Financing Administration, and its reimbursement methodologies, have eliminated some of the incentive for providing quality, cost effective access to care for beneficiaries. Nevertheless, because there is only a finite amount of dollars that HCFA can provide to the delivery of healthcare for beneficiaries, any short-lived alliance between providers and HMOs breaks down. Both parties will continue to fight over available healthcare dollars. Worse yet, as the population ages and the number of Medicare beneficiaries grows--leading to a subsequent decline in Medicare tax revenues per beneficiary-- the battle for government healthcare funding will increase. Most health care groups and analysts believe Congress will allocate some additional money to Medicare fixes this year. The large budget surpluses, the greater-than-expected savings from 1997 Medicare cuts, and the data supporting providers' and managed cares' claims of financial pain make it difficult for lawmakers to ignore the problems. ``I think the surplus makes it easier to make corrections and to make a larger amount of corrections,'' said Rick Pollack, executive vice president for the American Hospital Association. Bob Blendon, a health policy and political analysis professor at Harvard University, however, states that members of Congress ``. . . may be concerned about paying for tax cuts and a Medicare prescription drug benefit, as well as ensuring that Medicare cuts won't have to be reinstated if the surplus disappears.'' Despite the cautious optimism among providers, in a highly charged political environment like a presidential election year, the issue remains undecided and unresolved, and the deterioration in service continues apace. Aetna U.S. Healthcare: 23 counties in 14 states, 355,000 lives. Humana: 45 counties in 6 states, 84,000 lives. Foundation Health Systems: 18 markets in 6 states, 19,000. Oxford Health Plan: 6 Louisiana parishes, 5,900. Gulf South Health Plans: 5 Louisiana parishes, 4,000. United Healthcare: Bristol County, R.I., 1,700. Additional Pullouts pending: Cigna Corporation, Philadelphia Pennsylvania, announced last month that it is leaving 13 of its 15 Medicare HMO markets, affecting about 104,000 members, effective January 1, 2001. Cigna cites Medicare payment reductions mandated by the BBA have made it difficult for MCOs generally to offer benefits cost effectively. (Healthcare Financial Management, July 2000, ``Cigna Drops Most Medicare HMOs''). Carefirst Blue Cross and Blue Shield reports its intent to close Maryland's largest Medicare HMO by year-end, displacing 32,000 members. Carefirst blames the government's skimpy reimbursement rates, which it says aren't keeping pace with medical cost increases. Pacificare's Secure Horizon plan will uproot 20,300 lives when it exits 15 markets in Arizona, Colorado, Texas and Washington. The company has been changing its benefit offerings and boosting members' premiums and copayments in an effort to offset reduced government payments. ``For us to remain viable in the long term, congressional action is needed. We've been urging Congress for over two years to increase funding for the Medicare+Choice program,'' says Robert O'Leary, CEO Pacificare. (Modern Healthcare, July 10, 2000, ``More Plans dropping Medicare HMOs'').

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, the gentleman from Michigan (Mr. Dingell) who just spoke talked how he would write this bill if he had the opportunity to, but the underlying bill went through the Committee on Commerce, and he voted for it. The reason he voted for it is it is a bipartisan bill, and it is a good piece of legislation. I want to talk about the Medicare+Choice provisions because I was the author with the gentleman from Minnesota (Mr. Luther), a Democrat, of the underlying bill. Senator Wyden and Senator Domenici were the authors in the Senate. The biggest threat to eliminating the discrimination against States like New Mexico is not a motion to instruct. It is that the President of the United States has said he intends to veto this bill which will save health care coverage for a million Americans, 15,000 of whom live in New Mexico. And do my colleagues know who runs the HMOs in New Mexico? The Catholic church, the Presbyterian church, both of them running nonprofit corporations and Loveless hospital that has been serving our community for almost 60 years. Mr. Speaker, I encourage the President of the United States to sign this bill and restore health care for America's seniors.

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, House Resolution 605 expresses the sense of the House of Representatives that communities should implement the Amber Plan to expedite the recovery of abducted children. Mr. Speaker, when a child is abducted, the family's anguish and fear is beyond measure. The Amber Plan was created to quickly enlist the public as partners with law enforcement and the news media to intervene before an abduction ends in serious injury or death for an innocent child. The plan was created in 1996 in memory of 9-year-old Amber Hagerman who was kidnapped and murdered in Arlington, Texas. To date, the plan is credited with saving the lives of at least 9 children nationwide. This is how the plan works: When a child is reported abducted, law enforcement notifies local television and radio stations. Both TV and radio announcements are broadcast describing the child and other details. The public is given phone number to call if they see the child. House Resolution 605 calls upon communities across the U.S. to implement their own Amber Alert programs to assist locally in the recovery of abducted children. House Resolution 605 has been endorsed by the National center for Missing and Exploited Children. They are working to bring this program to cities and towns nationwide and I commended them for their efforts. Mr. Speaker, I would also like to thank my colleague Mr. Lampson from Texas for his assistance with this resolution and commend him as the Chairman of the Missing and Exploited Children's Caucus.

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, I want to thank the chairman and the ranking member for their work on this bill. I am the junior member of the Permanent Select Committee on Intelligence, and I have found it to be a pleasure to work there because of the workmanlike and bipartisan and professional approach to oversight in the intelligence community. We have a wonderful staff and a focus on what this country needs in a quiet way. Intelligence is the eyes and ears of our national security. Events like those we have seen today bring that home more closely than we usually see in the day-to-day events of intelligence. It is an important part of keeping our Nation strong and free. And it is more and more difficult because of the diversity of threats that we face as a Nation. We have more data from which to derive information and that creates a tremendous challenge for our intelligence agencies. I wanted to particularly thank the chairman and the ranking member for what this bill does for counterintelligence. It strengthens counterintelligence in a number of ways, particularly giving more tools to the agencies that need them in order to counter threats from other intelligence agencies. I also want to commend them on their oversight of our counterintelligence program in this country. The committee played a quiet role in the creation of the NNSA which John Gordon is now the capable head of. And this committee, I think, brought some common sense and some balance to what we needed to do to protect our Nation's secrets while not damaging that which we were trying to protect. I appreciate the committee's point of view, its common sense approach, its balance and its competence in this area.

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, today I would like to share with you the story of Mr. Armand Audini better known as ``Dini'' to his co-workers. Mr. Audini has worked at the New Mexico VA Medical Center in Albuquerque New Mexico for 30 years now. Because of his dedication and loyalty, Green Thumb Inc. presented this octogenarian with the most Outstanding Older Worker award. Mr. Audini is truly a shining example of America's mature worker who is changing the stereotypes about aging and he serves as a positive role model for our younger generation. Mr. Audini has seen his work process enter the world of ``high tech'' and he has met the challenge of a computerized environment admirably. Mr. Speaker, please join me in honoring Mr. Audini's enthusiasm and commitment to today's work force. He truly exemplifies that Ability is Ageless.

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, the following graduating high school students from the First Congressional District of New Mexico have been awarded the Congressional Certificate of Merit. These students have excelled during their academic careers and proven themselves to be exceptional students and leaders with their scholastic achievements, community service, and participation in school and civic activities. It is my pleasure to be able to recognize these outstanding students for their accomplishments. Their parents, their teachers, their classmates, the people of New Mexico and I are proud of them. Certificate of Merit Award winners 2000 Albuquerque High School, Calesia Cole; Bernalillo High School, Sobeida M. Quintana; Del Norte High School, Adam Bill; Eldorado High School, Katrina Petney; Estancia High School, Lorenzo Maes; Evangel Christian Academy, Joy Henderson; Evening High School, Hope Castillo; Freedom High School, Crystal Torres; Hope Christian School, Nicholas Targhetta; La Cueva High School, Danielle Jung; Los Lunas High School, Kristian Shaffer; Menaul High School, Daniel Chapman; Moriarty High School, Stephen Joosten; Mountainair High School, Anna Luna; New Futures High School, Yadira Escalante; Rio Grande High School, Rebecca Pauline Baca; School on Wheels, Ralph J. Alires; Sandia High School, Bonnie Saul; Sandia High School, Francheska Bardacke; Sandia Preparatory School, Michelle Lee Milne; Sierra Alternative High School, Geoff Joslin; St. Pius X High School, Antonio Sandoval; Valley High School, Brenda Bustillos; West Mesa High School, Julia Hartmann; and West Mesa High School, Que Huong Dong.

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, I yield 3 minutes to the gentleman from Louisiana (Mr. Tauzin), chairman of the Subcommittee on Telecommunications, Trade and Consumer Protection.

Mrs. WILSON. Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 3113) to protect individuals, families, and Internet service providers from unsolicited and unwanted electronic mail, as amended.

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

Mr. WILSON

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

Mrs. WILSON

Mrs. WILSON. Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Gary Miller), who was not only a leader in pulling this legislation together here in the House but also in California before he was elected, and I would also like to personally thank him for his assistance.

Mrs. WILSON. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks on H.R. 3113, and to insert extraneous material in the Record.

Mrs. WILSON. Mr. Speaker, I yield myself 5 minutes. Mr. Speaker, the bill that we have before us incorporates the text of H.R. 3113, which is sponsored by myself and the gentleman from Texas (Mr. Green) and which passed the Committee on Commerce. It also incorporates language from H.R. 1686, the bill of the gentleman from Virginia (Mr. Goodlatte), which creates misdemeanor criminal penalties for fraudulent e-mail schemes. It also makes some technical and conforming changes to the committee bill. There are a lot of thanks that are due for this bill. I would like to thank the gentleman from Virginia (Chairman Bliley) from the Committee on Commerce and the gentleman from Illinois (Chairman Hyde) from the Committee on the Judiciary; the gentleman from Michigan (Mr. Dingell), ranking member from Committee on Commerce; the gentleman from Florida (Chairman McCollum) from the Subcommittee on Crime; as well as the gentleman from Louisiana (Chairman Tauzin) from the Subcommittee on Telecommunications, Trade and Consumer Protection; and, of course, the gentleman from Texas (Mr. Green); and the gentleman from California (Mr. Gary Miller) who have worked very hard on this bill. There are a number of staff members who also have worked hard, and they often do not get much credit around here, so I would like to thank them: Justin Lilley from the office of the gentleman from Virginia (Chairman Bliley); Andy Levin from the office of Mr. Dingell; Teddy Jones with the gentleman from Louisiana (Mr. Tauzin); John Dudas with the gentleman from Illinois (Mr. Hyde); Patrick Woehrle, who works with the gentleman from Texas (Mr. Green); Ben Cline from the office of the gentleman from Virginia (Mr. Goodlatte); Steve Cope, the Legislative Counsel; Paul Callen, the Legislative Counsel; Cliff Riccio; and, of course, my staff member, Luke Rose. The Internet community in New Mexico also deserves a lot of thanks in teaching me about this problem. But I want to talk a little bit about the problem. The most annoying thing about the Internet is junk e-mail. But it goes beyond just annoying. It also causes tremendous cost to Internet service providers. Steven Fox is a CEO of a little company in Albuquerque called Associated Information Services. He has 2,000 clients. This is a mom- and-pop Internet service provider. They get about 4,000 e-mails a day generally. But he has been fighting to keep his servers from crashing because they were under a spam attack, getting 400,000 to 2 million e- mails a day, clogging up their computers. The estimates are that junk e-mail costs the Internet service provider companies $1 billion a year and a whole lot of hassle. But it goes beyond just the hassle and the cost. Three out of every 10 junk e- mails is pornographic. I first became aware of this problem shortly after I was elected when I started getting junk e-mail. The first one had a subject line that said ``What your Federal Government does not want you to know.'' Thinking that this is from one of my constituents who is telling me about yet another failure of the Federal Government, I opened it and found myself in an X-rated e-mail Web site. Well, I guess maybe my Federal Government does not want me to know what naked women look like. That is what I concluded from that. But I also concluded that that is something that I did not want my children to see if they got an e-mail that said ``new toys on the market''. That is the problem. As I found out, as a consumer, one has no right to say do not send me any more of this. It is very likely that the return e-mail address is not accurate anyway; and that, as soon as one replies to it, it validates one's e-mail address, and they sell it to somebody else. This bill requires a valid return address on unsolicited commercial e-mail. It allows Internet service providers to set and enforce policies including having spam-free Internet service providers. It requires that unsolicited commercial e-mail be labeled, and it requires that people who send unsolicited commercial e-mail respect a consumer's request to be taken off the list. There is a right of free speech in this country, including commercial free speech on the Internet, but there is no right to force us to listen or to force us to pay the cost of junk e-mail. That is what this bill will take care of. Mr. Speaker, I reserve the balance of my time.

Mrs. WILSON. Mr. Speaker, I yield myself such time as I may consume. The creation and the growth of the Internet has been one of the most important developments of the second half of the 20th century. It started out as an academic research tool in the 1960s, then moved to the defense world. The Internet today has become the global communications, information, entertainment and commercial medium. All of us want to see electronic commerce flourish, and the Committee on Commerce particularly is focused on making sure that interstate and international commerce remains as free and as open as possible. In 1996, consumers spent just $2.6 billion in on-line transactions compared to more than $50 billion in 1999. That explosive growth will continue. But there are some things about the new medium which create problems for consumers: when someone tries to commit fraud over the Internet; when someone tries to shift costs from the person making and selling a product to those who are carrying the e-mail; and, of course, the right of consumers to say there are some things that I just do not want to have in my in-box. The reality is, with regular mail, we have rights under Federal law to say I do not want any more of that sent to my mailbox at the end of my road. But we do not have that right with Internet communications and with e-mail. This bill will give us that right, as consumers and as parents, to say there are some things I do not want to see in my in- box. I am very pleased that we were able to accomplish it. I thank the gentleman from Texas for his cooperation and his help, and the gentleman from California, as well as all of the members of the subcommittee and of the Committee on the Judiciary.