[Congressional Record Volume 154, Number 122 (Thursday, July 24, 2008)]
[House]
[Pages H7122-H7132]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
RELATING TO THE HOUSE PROCEDURES CONTAINED IN SECTION 803 OF THE
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003
Mr. HASTINGS of Florida. Mr. Speaker, by direction of the Committee
on Rules, I call up House Resolution 1368 and ask for its immediate
consideration.
The Clerk read the resolution, as follows:
H. Res. 1368
Resolved, That section 803 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 shall not
apply during the remainder of the 110th Congress.
The SPEAKER pro tempore. The gentleman from Florida is recognized for
1 hour.
Mr. HASTINGS of Florida. For the purpose of debate only, I yield the
customary 30 minutes to my good friend, the ranking Republican of the
Rules Committee, Representative Dreier.
All time yielded during consideration of the rule is for debate only.
I yield myself such time as I may consume.
I also ask unanimous consent, Mr. Speaker, that all Members be given
5 legislative days within which to revise and extend their remarks on
House Resolution 1368.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
There was no objection.
Mr. HASTINGS of Florida. Mr. Speaker, as the Clerk just read, House
Resolution 1368 provides that section 803 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 shall not apply during
the remainder of the 110th Congress.
This resolution is needed today because of a procedural gimmick which
was stuck into the Republican Medicare prescription drug bill in the
dead of night shortly before the bill found its way to the floor back
in 2003. The provision was a way for Republicans to get conservatives
in their party to support an unpopular bill that may very well be the
largest campaign donor payback program in the history of this
institution. However, even this provision failed to prevent one of the
most shameful nights in the history of this institution as arms were
twisted and threats delivered into the wee hours of the morning to get
the votes needed to pass this bill.
Under current law, when the Medicare trustees project in two
consecutive trustee reports that general revenues will exceed 45
percent of Medicare spending within a 7-year window, an expedited
process is triggered to reduce the percentage. This expedited process,
however, bypasses regular order in the House, as well as the Rules
Committee. Once the percentage of Medicare funding coming from general
revenues reaches 45 percent, the President is required to send
legislation to the House and Senate that will address the matter. That
bill must then be introduced by the House majority and minority leaders
and referred to the appropriate committees.
The process by which that bill, or any bill meeting the requirements
of the trigger, moves through the committee process and is discharged
to the floor includes a privileged motion. The privileged motion
requires only one-fifth of the House, or just 87 Members, to second the
motion and force a vote on that motion that would bring the bill itself
to the floor for a vote. Under the trigger, if this small minority of
the House is successful and the motion passes the House, the bill would
come to the floor within 3 legislative days and can be debated with up
to 5 hours of general debate and 10 hours of debate on amendments.
Adding to the unprecedented nature of this provision, amendments are
given blanket waivers with the only requirement being certification by
the
[[Page H7123]]
Budget Committee that the bill will eliminate excess Medicare spending
from general revenues. Astonishingly, the trigger waives the rules of
the House and blocks Members from raising points of orders against the
bill for earmark, PAYGO, or any other violation of House rules. All
that a Member needs to do to force a vote on discharging a bill is
introduce a bill titled ``To Respond to a Medicare Funding Warning.''
As long as that bill meets the requirements of the Budget Committee,
then anyone, Democrat or Republican, may seek to disrupt the
proceedings of the House. Realize, if the House fails to pass this
resolution today, it will leave itself vulnerable to chaos and
extraordinary political gamesmanship.
We will lay the groundwork to effectively becoming the Senate,
stalled and unable to act as a victim of its own rules and procedures.
Every moment of every day here in session, under the guise of trying to
fix Medicare, a Member could move to discharge a bill which includes
provisions that have nothing to do with Medicare. The only way to avoid
this chaos and potential shutdown of the House in the 110th Congress is
for the House to pass this resolution today.
What is perhaps most troubling about this entire process, Mr.
Speaker, is that Congress fixed the revenue problem in a more
comprehensive manner last week when the House and Senate both voted to
override the President's veto on the Medicare Improvements for Patients
and Providers Act. In that bill, Democrats, in a bipartisan fashion,
removed waste, fraud and abuse in the Medicare advantage plan without
hurting seniors. Under our leadership, seniors continue to have access
to their doctors and prescription drugs without having their premiums
raised or coverage reduced.
Very occasionally, Mr. Speaker, many of us talk with different people
in our constituency. Last week I had an opportunity to talk with a
physician in this city named Stern. And Dr. Stern indicated to me that
I should, among other things, fight real hard to have people understand
how effective Medicare is and what a single payer plan could do for
this Nation. We talked considerably about this, and I'm delighted that
I had an opportunity to be edified by someone that is in this
profession.
But because of this Medicare trigger provision, a provision which was
not in the House or Senate bill and was slipped in the conference, I
will repeat, slipped in the conference during the dead of night, and I
was here, Pete Stark and David Dreier, all of us were here when this
happened, forced to deal with the legacy of, in my opinion, the
misguided former majority.
I urge my colleagues, Mr. Speaker, to do the right thing and support
this resolution.
I reserve the balance of my time.
Mr. DREIER. Mr. Speaker, I yield myself such time as I might consume.
(Mr. DREIER asked and was given permission to revise and extend his
remarks.)
Mr. DREIER. Let me begin by expressing my appreciation to my good
friend, my Rules Committee colleague from Fort Lauderdale, for yielding
me the customary 30 minutes. And I have to say that I rise in strongest
possible opposition to this rule. Only under this new majority, Mr.
Speaker, could an attempt to ensure fiscal responsibility be described
as nothing more than a procedural gimmick, and only under this new
majority, Mr. Speaker, can we once again be taking action that totally
subverts what we're all about here, and that is an open and fair
debate.
At issue today is a provision enacted by Republicans to ensure that
Medicare is administered in an effective and a responsible way. When we
created the prescription drug benefits for seniors, we included a
provision to require regular reports on how Medicare is funded. We
wanted to know, is the Medicare trust fund sufficient to cover the
costs? Or are we drawing from the general Treasury to pay for it? And
if we are, how much? If two consecutive reports indicated that over 45
percent of Medicare's costs would come from the general Treasury over
the next 7 years, Congress would have to act. We did not mandate what
steps Congress would have to take. We simply required that solutions be
examined, debated and brought to a vote, something that seems to be
anathema to this new majority.
We believed this provision was critically important because we, as
Republicans, have two very important goals for Medicare.
{time} 1715
First, it must effectively provide health care coverage for our
seniors. Second, Mr. Speaker, it must be run efficiently and
responsibly.
Today we are confronting exactly the scenario that concerned us and
led to this point. We have had two consecutive reports indicating that
Medicare will exceed the cost threshold for years to come. In
accordance with the law, the President submitted a proposal to restore
fiscal discipline while ensuring that seniors continue to receive high
quality care. Under the rules of the House, we are approaching the
deadline to consider the proposal. But this new majority leadership,
unable or unwilling to address runaway costs, simply wants to make this
attempt at good governance go away, completely vanish. The rule before
us today would quash the provision requiring us to consider a
legislative fix. It allows runaway entitlement spending to continue
unabated.
Naturally, our good friends on the other side of the aisle are going
to try to distract us from the facts today.
They are going to rail against the circumstances, as we have already
heard from my friend from Fort Lauderdale surrounding the original
prescription drug vote in an attempt to obscure the real issue. This is
a favorite trick of theirs, Mr. Speaker. The Democratic majority
leadership cannot defend their own actions, so they stir up fights
about Republicans. They can thunder away about 5-year-old fights all
they want, but it won't absolve them of the actions that they are
trying to take here today. Today they are in charge. They are
responsible for their actions as the majority. They cannot distract the
American people from the fact when they were presented with a proposal
for reforming the cost of Medicare, they decided to change the rules
and ignore the problem. That's exactly what is happening here.
Mr. Speaker, we have a legislative fix that was submitted by the
President of the United States and introduced by the majority and the
minority leaders as required by the fiscal discipline procedures put
into place by Republicans in this important bill. It recommends two
steps to rein in skyrocketing costs. One, it lowers the government
subsidy for prescription drug coverage for high-income seniors to save
$3.2 billion over 5 years. Second, it reforms the medical liability
system and puts patients before trial lawyers, saving nearly $4
billion.
Now, Mr. Speaker, I don't know that that is the panacea, but those
are a good start and those are the proposals that the majority leader
and the minority leader introduced as required under this law.
I know some people may not like those savings. Some of my friends on
the other side of the aisle are enamored with the present liability
system and believe that we need more litigation, not less. Others may
feel that everyone, regardless of income, should get the full
prescription drug subsidy.
There may be disagreement on these issues, but they are worthy of
consideration and debate, which is what this institution is all about.
Debate is exactly what was envisioned by this proposal. It provided for
at least ten separate alternatives, each debatable for up to an hour.
My friend is absolutely right, it could take 10 hours, but God forbid
we spend 10 hours discussing an issue as important as this. We imposed
no restrictions. Any proposal for reining in costs could be considered
and debated. This is a foreign concept in the 110th Congress, but we
actually believe that open, rigorous debate is the key to finding
solutions to our most difficult challenges.
Unfortunately, the rule before us today continues a very troubling
pattern: the Democratic majority leadership would rather duck and cover
than stand and deliver on a very important issue for the American
people.
In case the American people haven't noticed, Mr. Speaker, the House
of Representatives has been locked in a legislative holding pattern. We
have at least five appropriations bills which have been ordered
reported by the Appropriations Committee. How many
[[Page H7124]]
have been considered on the floor during this very important
traditional appropriation month? Not a single one. Zero. Nada. None.
The same is true for real energy legislation. Oh, we've had fig
leaves on the floor like the one we had just a couple of hours ago. But
the majority is not interested in debate on these measures. They bring
controversial energy legislation that no one has ever seen to the
floor, and then they impose ultra-restrictive rules so that
Republicans, or Democrats, cannot offer their own ideas.
These flawed bills fail, of course, but the Democrats get to avoid a
real debate on the important issues of conservation, alternative energy
sources, and yes, new domestic supplies of oil.
This pattern continues today with this rule. Instead of having a real
debate on legislation to reform the Medicare program, we are using the
rules to completely avoid the program altogether.
The reason, Mr. Speaker, is simple. The Democratic majority
leadership is more concerned about protecting their Members from tough
votes than engaging in the honest and open debate they promised the
American people when they won the majority nearly 2 years ago. They are
more interested in maintaining their electoral fortunes than tackling
the tough business of actually governing.
Now if press reports are to be believed, the Democratic majority
plans to avoid the most basic responsibility we have as legislators:
making decisions about our spending priorities. Instead of doing the
business of passing appropriations bills and considering legislation on
key issues like how we can get gasoline prices down and how we deal
with Medicare, they are going to punt all of the tough choices until
the next administration. I am just shaking my head and asking, Mr.
Speaker, what is it that we are doing here and what is it that we are
afraid of when it comes to doing our work in this 110th Congress?
We have an opportunity right here and right now to break this
pattern. If we defeat this rule, we can have a real debate on
alternatives to reform Medicare spending. We can start the business of
governing and have a real debate on the real issue of fiscal
responsibility, which is exactly what this provision is all about.
But if we pass this rule, it is another blow to responsible
government. It is another example of how far the Democratic majority
leadership has fallen from the principles that they ran on and promised
the American people nearly 2 years ago.
Mr. Speaker, I urge my colleagues to vote ``no'' on the previous
question and vote ``no'' on this rule.
Mr. HASTINGS of Florida. Mr. Speaker, I yield myself 30 seconds.
I want to say to my friend, the ranking member, everything debated in
this House doesn't have to be a battle. Turning off this provision is
the correct thing to do, and I will tell you why.
The perceived problem with Medicare funding has already been
addressed. Let me repeat that. The perceived problem with Medicare
funding has already been addressed. The recently enacted Medicare
Improvements for Patients and Providers Act fixed the funding of
Medicare to keep it below the 45 percent trigger.
Let me refresh your memory. On July 15, the House voted to override
the President's veto of this important legislation. Every single member
of the Rules Committee, Democrat and Republican, voted to override.
Mr. Speaker, I yield 2 minutes to the distinguished gentleman from
New Jersey (Mr. Pallone), a member of the Energy and Commerce Committee
and a champion of SCHIP, which required overriding twice a veto by the
President.
Announcement By the Speaker Pro Tempore
The SPEAKER pro tempore. Members are reminded to address their
remarks to the Chair.
Mr. PALLONE. I thank my friend from Florida, and I rise in support of
this rule.
Since its inception, Democrats have been the party to keep Medicare
working for America's seniors and disabled. Contrast that with
Republicans when they were in charge. During their majority, Medicare
funding increased dramatically so they could shower their pals in the
insurance industry with higher reimbursements than regular Medicare,
all in an effort to privatize the program.
Republicans are willing to look past all of that, pat themselves on
the back and call themselves the party of fiscal responsibility because
of some arbitrary policy that they inserted into the Medicare
Modernization Act that pretends to address Medicare financing. This
provision is more about smoke and mirrors than it is about ensuring
Medicare remains intact.
Republicans say it is about cost containment; I say it is about cost
shifting. The sad truth is that the 45 percent trigger is designed to
reduce the obligation of the Federal Government to fund part of
Medicare, thereby shifting more costs to beneficiaries.
Since taking control of Congress, Democrats have set out to put
Medicare on a sustainable track. During our first year in charge, the
House passed the CHAMP Act which would have extended Medicare solvency
by 2 years by reducing wasteful overpayments to Medicare Advantage
plans. And just a couple of weeks ago, we enacted the Medicare
Improvements for Patient and Providers of 2008 against the President's
objections.
According to the CBO, under that bill the 45 percent threshold would
be first crossed in fiscal year 2014, 1 year later than under the prior
law. So I say contrary to what my friends on the other side of the
aisle are saying, the fact of the matter is that Democrats are being
fiscally responsible. Democrats are confronting Medicare's challenges,
and we don't need an arbitrary policy that is a relic of the previous
majority in order to do that.
Mr. DREIER. Mr. Speaker, I am happy to yield 1 minute to the very
distinguished gentleman from Westchester, Ohio, our distinguished
Republican leader, Mr. Boehner.
Mr. BOEHNER. I thank my colleague from California for yielding.
Mr. Speaker, just as the Democrat leadership of this Congress is
sticking its collective head in the sand when it comes to energy
legislation, it is doing the same with the entitlement crisis that we
face.
My colleagues, ignoring this crisis won't make it go away. But this
is just what the measure before us will do, allow us to ignore this big
problem for just a little while longer.
Earlier this year, the Centers for Medicare and Medicaid Services
warned that if Congress doesn't act, government health care spending
will grow to over $2 trillion by 2017. Medicare alone will account for
almost one-quarter of this total. We can't afford that, our children
can't afford that, and most certainly our grandchildren can't afford
it.
But today, the majority is saying, well, we are just going to wait
for the next generation of lawmakers to deal with this problem instead
of doing what we should do now. The majority is also saying something
else. They are saying thank you to their trial lawyer allies. This is
something that they have said quite often during the last 2 years, as
we all know. By not addressing the Medicare funding crisis in a
comprehensive way, we are dodging fundamental liability reform that the
entire health care system needs so sorely. Who gains? Trial lawyers.
Who loses? Patients, doctors and taxpayers.
The majority leader said several months ago that he believed Medicare
reform would be one of the most important issues for the next Congress
and the next administration. Well, with the bill before us, it is clear
that the majority leader meant what he said. But I think it is
regrettable. It is irresponsible, and it is unfair to our children and
theirs, not to mention the seniors who rely on this program today. They
are going to bear the consequences of our refusal to step up and do the
right thing.
I urge my colleagues to defeat this. Let's have the courage to do
what the American people sent us here to do: to solve this entitlement
crisis in a fair and bipartisan way.
Mr. HASTINGS of Florida. Mr. Speaker, before I yield to the next
speaker, I won't respond to the distinguished minority leader, but I
would like to submit the statements of the AARP and the National
Committee to Preserve Social Security and Medicare in support of this
resolution.
[[Page H7125]]
National Committee To Preserve Social Security and
Medicare,
Washington, DC, July 24, 2008.
House of Representatives,
Washington, DC.
Dear Representative: On behalf of the millions of members
and supporters of the National Committee to Preserve Social
Security and Medicare, we strongly urge you to support H.
Res. 1368 when it comes to the House Floor. H. Res. 1368
would suspend section 803 of the Medicare Modernization Act
of 2003 (known as the Medicare ``trigger'') for the remainder
of the 110th Congress.
The Medicare ``trigger'' requires the Medicare Trustees to
include a finding in their annual report whenever they
project that general revenues will make up more than 45
percent of total Medicare funding within the first seven
years of the 75 year valuation period. This finding was made
in the two most recent annual reports, thus requiring the
President to submit legislation to Congress to bring the
federal contribution to Medicare down below the 45 percent
threshold. The legislation is subject to expedited procedures
designed to hasten its consideration. H. Res. 1368 would
suspend the Medicare ``trigger'' through the remainder of the
110th Congress.
The 45 percent threshold at which the ``trigger'' is set
was a completely arbitrary limit included in the Medicare
Modernization Act. There has never been a public debate on
whether it is appropriate to establish a cap on the federal
revenue contribution to the Medicare program at any level,
nor has any policy rationale been identified for selecting 45
percent as that federal contribution limit. The fact that
more than 45 percent of Medicare financing may come from
general revenues poses no more of a problem in itself than
the fact that 100 percent of the financing for defense,
veterans' benefits, education or most other federal programs
comes from general revenues. The problem facing Medicare is
the cost of health care, not how the cost is allocated
between revenue sources.
Limiting the federal government's contribution to the
Medicare program ignores Medicare's financing structure,
which was designed to rely on general revenues to finance
about 75 percent of Part B and Part D. This structure allows
the revenue raised by income taxes to shoulder a higher
portion of the responsibility for Medicare's funding, placing
the burden on a revenue source which is relatively
progressive and taxes all income.
If general revenue contributions are limited, the burden
would shift to beneficiaries, who are typically retirees on
fixed incomes or the disabled, generally the least able to
shoulder the burden of increased costs. In fact, about 70
percent of Medicare beneficiaries have incomes under $25,000
and 85 percent have incomes under $40,000. Nearly two-thirds
of older households have incomes under $20,000, and they are
already spending 30-50 percent of their incomes on health
care.
Arbitrarily cutting Medicare without getting at the root of
the continuing upward trend of health care costs is a
strategy for failure. It has real impacts on real people--
most of whom have nowhere else to go for coverage and limited
ability to pay higher medical costs, accounting for rising
senior bankruptcies.
Measuring Medicare's financial health solely by considering
the percentage of general revenues contributed to the program
produces a meaningless number, which will nonetheless be used
as a catalyst for policy decisions that could have a
devastating effect on the health care of seniors and people
with disabilities. For example, the 45 percent limit has been
triggered, in part, because more beneficiaries are being
treated in outpatient settings than in hospitals. While this
shift may disproportionately increase costs for Medicare Part
B, which accelerates the date at which the cap will be
reached, when compared with Part A, which is not counted in
the limit, it is generally considered a positive development
in health care.
A second major reason the cap was triggered is the Part D
prescription drug program. Although Part D is providing
needed drugs to millions of seniors, the cost of these drugs
is still rising much faster than general inflation. We
believe this is the result of the lack of a traditional
Medicare drug option, which the Medicare Modernization Act
specifically prohibited. In addition, the Act provided
billions of dollars in subsidies in order to entice private
insurance and drug companies into the Medicare program. While
passage last week of H.R. 6331 helped trim some of the most
egregious overpayments, billions in subsidies continue to
flow to private companies. Both the rising cost of drugs and
the private sector subsidies provide little or no benefit to
Medicare enrollees, yet they contribute to the rise in costs
both for beneficiaries and the federal government--and
accelerated the date at which the cap was reached.
Finally, the legislation submitted by the President in
response to the ``trigger'' could have devastating
consequences to Medicare beneficiaries with little oversight
by Congress. For example, Section 101(d) of the implementing
legislation directs the Secretary of the Department of Health
and Human Services to design and implement a new performance-
based reimbursement system for all Medicare providers as well
as a new ``incentive'' program intended to drive Medicare
beneficiaries to selected providers under this new system.
With this one provision, Congress would delegate to the
Secretary unprecedented authority to change the way the
Medicare program operates through the regulatory process,
rather than reserving such important decisions for Congress
and the Committees of jurisdiction.
The President's legislation also would dramatically expand
Medicare means-testing through a provision that has been
proposed repeatedly as part of the President's budget
submission only to be rejected by Congress. Section 301 of
the President's bill would expand means-testing to include
the Part D program, a policy which many experts believe would
be extremely difficult to administer, and further would not
allow the income limits to rise to reflect inflation. Income
limits that are not indexed ultimately affect far more people
than the ``wealthy'' they are originally designed to cover--a
fact well demonstrated by the current reach of the
Alternative Minimum Tax.
Medicare faces challenges in the future, but they are not
unique to the Medicare program--they reflect the same
pressures driving health care costs for those under age 65.
Addressing these challenges will not be advanced by a
contentious debate on the share of program costs funded
through general revenues. In fact, such a debate will
distract from the true challenge of Medicare: determining how
to provide high-quality health care for an aging population
in an era of rising health care costs.
We strongly urge the House to suspend the Medicare
``trigger'' by passing H. Res. 1368 and focus instead on
making health care affordable for all Americans.
Cordially,
Barbara B. Kennelly,
President & CEO.
____
AARP: Medicare Trigger Ignores Real Problem--Skyrocketing Health Care
Costs
Washington--David Sloane, AARP's Senior Vice President for
Government Relations and Advocacy, issued the following
statement on a scheduled vote today in the House of
Representatives to consider a bill brought on by the Medicare
``trigger'':
``The Medicare trigger is an unfortunate and misguided
effort that could do more harm than good. That's why AARP
supports the legislation being considered today by the House
that would delay trigger action.
``Medicare's financial woes are symptomatic of the runaway
costs of the overall health care system. Medicare's troubles
can only be solved by systemic health care reforms.
``Arbitrary Medicare cuts will needlessly hurt millions of
Americans without addressing the core problems. If Congress
is serious about controlling spiraling health care costs, the
way to go about it is to have a thoughtful debate on the
systemic drivers of health care costs in this country, not to
take a meat axe to Medicare in the middle of the night.
Congress is gearing up for that debate next year, and we look
forward to working on serious, bipartisan efforts to reform
our health care system.''
Mr. Speaker, I yield at this time 2 minutes to the gentleman from
Arkansas (Mr. Berry), a member of the Budget Committee.
Mr. BERRY. Mr. Speaker, I thank the gentleman from Florida for
yielding.
I never rise that I don't encourage anyone that can hear me to keep
in their hearts and minds and in their prayers our men and women in
uniform and their families, and especially those on the battlefield
today.
Having said that, it is interesting to hear our colleagues on the
other side of the aisle talk about fiscal responsibility. It is
interesting to hear them suddenly have an attack of concern about our
children and grandchildren and the debt that is going to be passed on
to them which includes pretty close to $8 trillion that their party has
built up and their Presidents have built up.
It is clear and has been for many years that the Republican Party
intends to destroy Medicare any way it can. ``Let it wither on the
vine'' were the very words that they used.
The interesting thing about this is we know how to fix these things.
Health care is not so complicated we can't fix it. It is a matter of
getting the collective, bipartisan political willpower to do the right
thing.
{time} 1730
This particular problem can be fixed with a very simple thing, just
do away with the overpayment to the private health care plans, $4.6
billion we overpay the private plans. Why would we want to be so
generous to the insurance companies?
I certainly don't like the idea of my children and grandchildren
having to pay off a debt that we incurred because we overpaid the
insurance companies. What is so special, I wonder, about the insurance
companies that we can't resist to take care of them over and over
again?
I urge my colleagues to vote against this provision.
Mr. DREIER. Mr. Speaker, at this time I am happy to yield 3 minutes
to
[[Page H7126]]
the very distinguished ranking Republican on the Committee on Ways and
Means, the gentleman from Shreveport, Louisiana (Mr. McCrery).
Mr. McCRERY. Mr. Speaker, I have some prepared remarks, but I want to
address a couple of things that have been said, because I think it's
important for the House to understand.
Number one, the gentleman from Florida said that we have already
solved this problem, and he is right in one sense. There was enough of
a pay-for in the last Medicare bill that we passed, that had we couched
it properly, we could have used as a pay-for to get us within the
window required by MMA, but we didn't do that. We didn't go through the
proper procedure. So to suggest that we now can just do away with the
rule because in some other bill we created enough funding that would
have worked had we followed the proper procedure, I think, is a very
tenuous argument.
The whole purpose of the provision, and the second thing I want to
address, is this notion that this was slipped in in the dead of night,
and it was just totally a Republican effort to somehow kill Medicare. I
would say to the House that this suggestion was first made by the
National Bipartisan Commission on the Future of Medicare that was
chaired by Bill Thomas and John Breaux, a Republican and a Democrat.
So we didn't come up with this in the dead of night. It is something
that had been circulating, and I thought it was a good idea then, I
think it's a good idea now. It's regrettable that the House stands
ready today to dispose of this very worthwhile rule.
All the rule was intended to do, it wasn't intended to kill Medicare.
What it was intended to do is force us to face the problem every year,
because we all know, those of us who are familiar with the program,
familiar with the structure of the program and the financing of the
program, know that more than 45 percent of general revenues are going
to be used to pay the costs of this program very soon. Then it will be
every year, and it will grow.
In fact, if we allow this program to go on autopilot, it will grow
from about 2.7 percent of GDP this year to over 14 percent of GDP by
the end of the 75-year CBO window, over 14 percent. We only take in in
revenues, total revenues, between 18 and 19 percent of GDP. So if we
allow this program to just go like it is now without discussion or
debate or reform, we are going to have to do away with most spending
for defense, education, roads, highways, unless, of course, we have a
dramatic increase in taxes.
Mr. Speaker, I appreciate the opportunity to tell this House that the
product would be irresponsible.
Mr. Speaker, I strongly urge my colleagues to vote against this
irresponsible change in the rules of the House.
The resolution before us today would prevent the House from having to
hold any debate about the looming financial crisis facing the Medicare
program. Apparently, the Democrats don't want to talk about reforming a
program that is slated to go bankrupt in 2019.
This rules change isn't about a specific proposal to change Medicare.
What it would do is repeal a bipartisan provision that would force
Congress to at least take note of Medicare's increasingly unsustainable
financial situation and begin to consider solutions.
But instead of having an open discussion about how to address the
out-of-control costs of this program, today's resolution allows the
Congress to bury its head in the sand and kick the can down the road,
letting a future Congress deal with this ever worsening problem. This
is irresponsible.
The facts are clear. Medicare is facing bankruptcy. The combination
of rising health care costs and an aging population have created a
financial hurricane on the not-too-distant horizon.
Last year, Medicare spending totaled about 2.7 percent of our GDP.
That figure will more than double by 2030 and hit 14.8 percent by the
end of the CBO's 75-year budget window. Since total federal revenues,
historically, have been between 18-19 percent, it is clear we cannot
let Medicare spending increase on auto-pilot unless we are willing to
substantially raise taxes or cut all other government spending.
The need for structural reform of Medicare is not just Republican
rhetoric. In recent testimony before the Ways and Means Health
Subcommittee, the non-partisan Medicare Payment Advisory Committee
(MedPAC), which was created by Congress to advise us on Medicare
payment issues, said that, ``The [Medicare] program's shaky financial
outlook is a strong impetus for change.''
Now my colleagues on the other side of the aisle will claim that this
45 percent trigger was created by Republicans as a way to privatize or
block grant the Medicare program. Let me remind them that this policy
was first suggested by a bipartisan Medicare task force that was
chaired by Democratic Senator John Breaux.
And let me also point out that there are many ways that we could
solve this problem. But ducking it is surely not on that list.
Mr. Speaker, I urge my colleagues to reject this rule change. This
problem will not go away just because we ignore it. The longer we wait
to address it, the more difficult the solution will be.
Mr. HASTINGS of Florida. Mr. Speaker, at this time I am very pleased
to yield 2 minutes to the distinguished gentleman from North Dakota, a
friend of mine and classmate, a member of the Committee on Ways and
Means, Mr. Pomeroy.
Mr. POMEROY. I thank the gentleman for yielding.
Mr. Speaker, I have a great deal of respect for the preceding
speaker, the ranking member of the Ways and Means Committee. The facts
of what he said are absolutely correct. Health care costs are out of
control. They are threatening the future of the Medicare program. They
are threatening the future of U.S. health care.
But the issue before us is a trigger which would have one of two
results, only one of two results, cut Medicare benefits or raise
Medicare premiums on our seniors. Now, if we are going to address, and
we need to address the underlying systemic problems in our health care
system, but this trigger, which would simply cut Medicare or raise
seniors' premiums, is not the way to systemically address our problems.
I believe that it's incorrect to single out Medicare for this
treatment, to single out seniors for the overall problem of broader
health reform. We need to work together on health reform. I hope the
next Congress will give us an opportunity to do that, but the months
remaining in this Congress don't.
Look, we had to override the President's veto to prevent a 10 percent
cut in physician reimbursements under Medicare, cuts that would have
threatened universal access of our seniors under Medicare. We had to
override a veto. So moving forward with a trigger mechanism that at
this hour in the administration is going to cut Medicare or raise
seniors' premiums is certainly not the way to address the broader
issues of health care costs.
I look forward, as a member of the Ways and Means Committee, to
working with my colleagues on both sides of the aisle as we address
health care costs. Let's not have this trigger.
Mr. DREIER. Mr. Speaker, I just want to say we have a wide range of
choices as to how we can cut spending.
At this time I am happy to yield 2 minutes to my very distinguished
friend, the gentleman from Springfield, our distinguished Republican
whip, Mr. Blunt.
Mr. BLUNT. I thank my good friend for yielding.
Mr. Speaker, I heard my good friend say we ought to deal with this in
the next Congress, and I wonder why, why the next Congress. Why not
this Congress? The reason we are having this critical we must vote
today, vote right now, is that we haven't taken advantage of this
opportunity to move forward on reform. The notice came up weeks ago. In
fact, the notice came up months ago, and that's when the majority could
have brought a great debate to the floor instead of the debate about
whether we should debate or not.
Over a decade ago, Congress created the National Bipartisan
Commission on the Future of Medicare. One of the recommendations of the
commission was to require a trigger so that the Medicare trustees in
Congress will have to publicly debate whenever the Medicare program is
in danger of becoming insolvent. The trigger is one of the many
recommendations of this commission, not ideas just out of thin air,
recommendations of this commission that were formally adopted as part
of the Medicare prescription drug bill in 2003.
But this Congress seems to never miss an opportunity to miss an
opportunity. I am very disappointed that the Democrat leadership has
halted consideration of key legislation designed to safeguard the
future of Medicare, reconsideration, in fact, that's required by law
unless we today vote to say we
[[Page H7127]]
are not obeying that law. If not obeying that law is the right thing to
do, I don't know what could be more important than having a discussion
on the future of Medicare, unless it would be the future of energy, and
we are not having that discussion either.
Let's debate it, let's talk about it, let's see what we can do. One
of the ideas that we have put forward that apparently is particularly
fearsome is medical liability reform. If this rule passes, we will
avoid being forced to debate and vote on lawsuit abuse and its impact
on seniors, taxpayers and doctors. Such a reform will lower health care
costs for all Americans and save Medicare $4.8 billion over the next
decade.
The SPEAKER pro tempore. The time of the gentleman from Missouri has
expired.
Mr. DREIER. I am happy to yield my friend an additional minute.
Mr. BLUNT. They don't want to debate means testing for wealthy
seniors or more competition to serve patients. We could be doing all of
those things today. We could be doing none of those things today. We
could be debating whatever the majority wants to debate.
The point is we could be having a debate about the future of
Medicare. First, we are afraid to debate energy. Now we are afraid to
debate Medicare. What are we willing to debate on the floor of this
House?
I want to have that debate. I oppose this vote to run away from those
solutions.
Mr. Speaker, I would like to submit in the Record the statement of
the Health Coalition on Liability and Access on this legislation. That
states that medical liability reforms are a central part of reducing
costs and improving access and quality in the Medicare program.
[From the Health Coalition on Liability and Access, July 24, 2008]
Statement From HCLA Chair on Medicare and Medical Liability Reform
Washington, DC.--HCLA Chair Shawn Martin issued the
following statement regarding today's Congressional vote on
Medicare:
``Today Congress will consider legislation pertaining to
the so-called ``trigger'' provision of the Medicare
Prescription Drug, Improvement and Modernization Act of 2003.
Complying with the law's requirements, the President has put
forward legislation, which includes medical liability
reforms, to address the Medicare funding issue. The Health
Coalition on Liability and Access believes that medical
liability reforms are a central part of reducing costs and
improving access and quality in the Medicare program.
``Medical lawsuit abuse drives up the cost of medicine for
everyone. In fact, it's estimated that medical liability
reform would save Medicare $4.8 billion annually, not
including savings from reductions in the practice of
defensive medicine.
``Comprehensive medical liability reforms have a proven
track record of success at the state level of reducing health
care costs and increasing patient access to quality medical
care. Controlling our nation's Medicare costs is one more
reason America needs national medical liability reform.''
Mr. HASTINGS of Florida. Mr. Speaker, I am very pleased at this time
to yield 2 minutes to the distinguished gentleman from South Carolina,
who is the chairperson of the Budget Committee, my good friend, Mr.
Spratt.
Mr. SPRATT. I thank the gentleman for yielding.
Mr. Speaker, we are here today because the Medicare Modernization Act
of 2003 includes a trigger. That trigger is exercised when general fund
revenues, as opposed to trust fund revenues, premiums and payroll
taxes, exceed 45 percent of the Medicare program.
Once the Medicare trustees determine in two back-to-back reports that
the 45 percent threshold will be crossed within 7 years, the
administration must submit legislation ``eliminating excess general
revenue Medicare funding.''
The trustees submitted their first such report last year, projecting
that general revenues would fund 45.07 percent of Medicare in 2013, the
last year of the 7-year window. This year the trustees issued a similar
warning, and the administration sent Congress a bill to keep general
revenues below 45 percent through 2013. According to CBO's analysis,
the administration's bill will hold general revenues below 45 percent
until 2014 by charging higher premiums to Medicare beneficiaries who
make above a certain income level.
Instead of enacting the administration's proposals, the House and
Senate enacted last week into law the Medicare Improvements for
Patients and Providers Act of 2008 over the President's veto. CBO
calculates that this new law will keep general revenues below the 45
percent threshold through 2014, just as the administration's bill would
have. So substantively and for all practical purposes, we have met the
trigger's financial requirements, and we have made this issue moot for
the rest of this Congress.
I support the rule before us which would turn off the Medicare
trigger for the remainder of this Congress. I find, as the chairman of
the Budget Committee, the legislation we have just enacted ``eliminates
excess general revenue Medicare spending'' and complies with the
Medicare law's financial test. Consequently, there is no need or reason
to exercise the trigger.
The SPEAKER pro tempore (Mr. Cuellar). The time of the gentleman has
expired.
Mr. HASTINGS of Florida. I yield the gentleman an additional 30
seconds.
Mr. SPRATT. I thank the gentleman.
I would add that the Children's Health and Medicare Protection Act
would have accomplished and satisfied the law's requirement, also, if
for technical reasons it had been entitled ``a bill to respond to
Medicare funding warning.''
I support this resolution and urge its adoption.
Mr. DREIER. Mr. Speaker, may I inquire of the Chair how much time is
remaining on each side.
The SPEAKER pro tempore. The gentleman from California has 14
minutes. The gentleman from Florida has 15.
Mr. DREIER. Mr. Speaker, obviously, through this extraordinary
process, there is such a demand for time. We have so many committees of
jurisdiction. It is a real challenge. We have only 14 minutes
remaining; is that it?
The SPEAKER pro tempore. That is correct.
Mr. DREIER. At this time I am happy to yield 3 minutes to the
distinguished ranking member of the Committee on Budget, the gentleman
from Janesville, Wisconsin (Mr. Ryan).
Mr. RYAN of Wisconsin. I thank the gentleman.
Mr. Speaker, my chairman of the Budget Committee just spoke, and,
yes, he did read that the CBO said that the bill that passed on the doc
fix, according to the CBO, does satisfy the trigger.
So if you are satisfying the trigger, then why are you turning it
off? If you are actually accomplishing the objective set out with this
law, then why are you getting rid of this trigger? Why do we have this
trigger?
We have this trigger. It's a funding warning because Medicare is
going bankrupt. Medicare is a $36 trillion unfunded liability. You know
what it's going to be next year by this time? It's going to be $38.4
trillion. Do you know what will happen in 5 years if we do nothing to
save Medicare as the Democratic budget proposes to do? $48 trillion
unfunded liability.
The preceding paragraph in this CBO report goes on to specify that
the judgment, the referee of the trigger, are the trustees. So why
don't we take this bill off the floor, have the trustees verify what
CBO says that maybe, in fact, this bill that you just passed, that we
all passed, does satisfy the trigger, and don't turn off this funding
warning. Turning off this funding warning is basically saying, ignore
the fact that Medicare is going bankrupt. Make sure that Congress does
nothing to fix this problem.
I might add that this CBO estimate relies on the fact that next year
we are going to cut doctors by 21 percent in Medicare. The only reason
this estimate holds up is if we guarantee a 21 percent payment cut to
all doctors servicing Medicare. That's why we are in conformity with
this trigger as CBO says.
CBO is not the referee of this. The trustees are, the trustees of
Medicare.
Turning off this trigger is basically saying that we have no fiscal
discipline, we have no intention of saving Medicare from bankruptcy, we
have no intention of being good stewards of the taxpayer dollars, we
have no intention of controlling spending.
{time} 1745
We have every intention of making matters worse, not only by doing
nothing, but adding more spending. That is reckless. That is fiscal
abandonment.
[[Page H7128]]
The trigger was a bipartisan idea. A Democrat in the Senate and a
Republican in the House came up with this idea to make sure that
Congress saw fair warning and actually addressed these issues before it
got out of control.
And so, instead of addressing these warnings, instead of bringing
Medicare toward solvency, instead of making sure we can guarantee this
program for seniors in the next generation, what are we doing in this
Congress? We are sticking our heads in the sand. That is wrong. This
shouldn't pass. You know better.
More to the point, if you think you are satisfying it, then why are
you turning it off? That makes no sense.
The only opportunity, the only explanation is you don't want to have
this tool of fiscal discipline. You don't want the American people
knowing that you are actually contributing to the insolvency of
Medicare, that you are actually making matters worse. That is wrong,
and I urge defeat of this.
Announcement By the Speaker Pro Tempore
The SPEAKER pro tempore. Members are reminded to address their
remarks to the Chair.
Mr. HASTINGS of Florida. Mr. Speaker, at this time I am very pleased
to yield 2 minutes to the distinguished gentleman from California, who
is the chairman of the Health Subcommittee, Mr. Stark.
(Mr. STARK asked and was given permission to revise and extend his
remarks.)
Mr. STARK. I can only say that I have never heard people who have
just won whine so loudly about the fact that they won. They didn't do
it when they won the baseball game. I guess if I had a trophy for them,
they might be happier.
But you are right. My friend, Mr. McCrery, and my friend, Mr. Ryan,
are both right. We did solve, in 6331, all of the Rules Committee
Democrats, the Republicans voted for it. The majority of the Ways and
Means Republicans voted for it. The majority of the Energy and Commerce
Republicans voted for it. We solved it.
They may be unhappy with the fact that we solved it because most
Republicans would like to see Medicare privatized, and this was a plan
that did not get enough votes out of the commission to be recommended.
A couple of wild hares on the commission suggested it, but they
couldn't get enough votes to make it a recommendation. So it has never
been.
If you wanted to have a trigger for the Defense Department, and you
wouldn't, I might support it. But you don't.
This is just, the trigger was just a method to try and privatize
Medicare and let it wither on the vine. So you won. We have met the
requirements in terms of the funds saved in 6331, the Republican
speakers have attested to that.
So I would say, let's go home. We do have problems in Medicare. We
are vastly overpaying Medicare Advantage and getting nothing for it. We
are vastly overpaying for the drug benefit because the Republicans
wouldn't allow the Secretary to bargain for better prices. The
Republicans have frustrated every attempt to save money in Medicare and
make it a more efficient system. So I am willing to have that debate
any time. And I think we will have to come back and do it.
But for now we have satisfied the requirements of the trigger. We
were unable to get it done in a timely fashion.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. HASTINGS of Florida. I yield the gentleman an additional 30
seconds.
Mr. STARK. I urge the adoption of this rule, which will save us the
problem of seeing beneficiaries pay more in taxes, which I don't think
the Republicans want to do. And I think that it is time that we
recognize that we, by a vast bipartisan majority, solved the issue,
temporarily though it may be, and we will have to revisit it next year
to make Medicare a more effective system.
Mr. DREIER. I yield myself 10 seconds, Mr. Speaker, to say to my very
good friend that if, in fact, he is willing to have a debate any time
on this issue, what he needs to do is vote ``no'' on this rule so that
we can proceed with that debate.
At this time I am happy to yield 3 minutes to the very distinguished
chairman of the Republican Study Committee, my friend from Dallas, Mr.
Hensarling.
Mr. HENSARLING. Mr. Speaker, before the Democrats became the majority
party in this institution, they waxed eloquent about fiscal
responsibility. The now-Speaker, Nancy Pelosi of California, the
gentlelady said, ``It is just absolutely immoral, immoral for us to
heap those deficits on our children. No new deficit spending.''
And before he became the majority leader, the distinguished gentleman
from Maryland said, ``There is no more single burden of responsibility
more crucial to bear than tackling the deficit honestly and head on.''
Mr. Speaker, that is what they said before they became the majority
party. We have discovered, Mr. Speaker, their words were cheap. Their
deeds are very expensive.
Since becoming the majority party 18 months ago, we have seen, under
their watch, the Federal deficit double.
Mr. Speaker, under the Democrats' watch we have seen the single
largest 1-year increase in the Federal debt.
Mr. Speaker, under the Democrats' watch we have seen the Federal
Government's unfunded obligations go to the largest number ever, $57.3
trillion.
Mr. Speaker, under the Democrats' watch we have seen the largest
Federal budget ever.
Mr. Speaker, under the Democrats' watch, just yesterday, just
yesterday a blank check was given to Fannie Mae and Freddie Mac that
ultimately could cost the taxpayer $5 trillion.
And not to be outdone, Mr. Speaker, today the Democrat majority turn
off, turn off the Medicare trigger designed to save the program for the
next generation. Again, Mr. Speaker, the Democrats' words were cheap.
Their deeds are very, very expensive.
The trigger means that we begin the reform process in Medicare, and
it also means that we will spend $178 billion, almost a 7 percent
increase, over the next 5 years. And how do we reform it?
Mr. Speaker, we ask that this body put patients and doctors before
personal injury trial attorneys. That is what we do. And we ask that
maybe the upper income of our Nation be able to pay a little bit more
for their prescription drugs.
Now, what happens, Mr. Speaker, when the Democrats do nothing?
Well, according to the General Accountability Office, ``The rising
cost of government entitlements are a fiscal cancer that threatens
catastrophic consequences for our country and could bankrupt America.''
Mr. Speaker, I ask my colleagues on the other side of the aisle, join
with us, put the next generation above the next election. Work with us
to ensure that we can get better healthcare at a more reasonable cost.
Do not get rid of this Medicare trigger that so many of us worked so
hard to place in this valuable program.
Mr. HASTINGS of Florida. Mr. Speaker, at this time I would yield to
my good friend, the distinguished gentleman from California (Mr.
Thompson), who is a member of the Ways and Means Committee, 2 minutes.
Mr. THOMPSON of California. Mr. Speaker, I rise in support of this
rule. The trigger is an arbitrary way to try and reform Medicare.
Moreover, no hearings were ever held to determine whether the trigger
was set at the right level of general revenues. The trigger was
literally added in the back room during conference on the Medicare
Modernization Act. It wasn't in the House bill. It wasn't in the Senate
bill.
The chief actuary from the nonpartisan Centers for Medicare and
Medicaid Services testified before our committee that the trigger is
judgmental, not scientific. He said there is no analytical
rationalization for setting the trigger level funding at 45 percent.
This trigger is politically, not policy, based.
We need to focus on system-wide issues to address costs in both
private insurance and Medicare. The trigger is no substitute for real
reform. We have taken important steps in this Congress to assure
Medicare solvency. The CHAMP Act, which was passed last year by the
House, included significant Medicare cost savings and extended the
solvency of the hospital trust fund.
The bipartisan Medicare bill, the bill that became law after we
overrode the President's veto, extended that solvency of Medicare and
pushed back the date the trigger is pulled, while providing $18 billion
in beneficiary improvements for seniors.
[[Page H7129]]
I urge everyone to support this rule change so we can continue to
work towards real reform in the next Congress.
Mr. DREIER. Mr. Speaker, at this time I am happy to yield 1\1/2\
minutes to my very good friend from Midland, Michigan, a hardworking
member of the Ways and Means Committee, Mr. Camp.
Mr. CAMP of Michigan. Mr. Speaker, I come from a large family. My
wife and I have three children of our own, so I have seen little kids
stick their fingers in their ears and shout ``I can't hear you.''
I never thought I would see the Congress do it, but that is exactly
what the Democrats are asking us to do today, stick our fingers in our
ears and shout at the Medicare trustees that we can't hear their
warning. We couldn't hear it the first time they said it. We couldn't
hear it the second time they said it, and we certainly don't hear it
the third time they have said it.
The Democrats' response to the looming Medicare crisis is as childish
as it is irresponsible. By repealing the Medicare warning, as this rule
change would have us do, it is akin to be warned you are out of money
and still going out for an expensive dinner and leaving the bill for
the next group to sit down.
You know who gets stuck with the tab in this scenario? The American
taxpayer, and it is a $1.5 billion tab in the first year alone. But
that is just the tip of the iceberg. Every year we fail to address
entitlement reform, future generations are saddled with an additional
$2 trillion worth of debt.
With the Medicare Hospital Trust Fund set to go bankrupt in a decade,
I, for one, cannot ignore, and I urge my colleagues not to ignore these
Medicare warnings. We should reject this resolution, and we should
begin to transform Medicare so it can continue to benefit future
seniors.
Mr. HASTINGS of Florida. Mr. Speaker, at this time I am very pleased
and privileged to yield 2 minutes to the gentleman from New York, who I
feel knows as much or more about this issue than anyone, the chairman
of the Committee on Ways and Means, Mr. Rangel.
(Mr. RANGEL asked and was given permission to revise and extend his
remarks.)
Mr. RANGEL. My colleagues, as we move toward the end of this
legislative session, I would hope, at some point, that the minority
just not be guided by blind ideology and to see whether we can prepare
ourselves to work together in the future. In all of the years that we
have had this administration, they have talked about the unfairness of
taxes, and yet they have not seen their way clear even to suggest what
we should do about it.
I know they are busy starting wars in various places, but it would
seem as though the executive could take a deep breath.
They talk about entitlements, how we have to get rid of them, that it
is causing us to go into bankruptcy. And unless I missed something
during my brief illnesses, they have never suggested what you do with
Social Security; not a note, not anything private, not a call from
Paulson saying, can we talk?
And now we talk about----
Mr. DREIER. Mr. Speaker, would the gentleman yield? I would be happy
to yield additional time if my friend would yield to me.
Mr. RANGEL. Well, why don't you give me the additional time and----
Mr. DREIER. You yield to me, and then I would be happy to yield
additional time.
Mr. RANGEL. How much time are you ready to negotiate here? We can
work out something.
Mr. DREIER. That is exactly what my friend is arguing, and I am here
and willing to do just that, on this issue and every single other
issue.
Mr. RANGEL. Why would you wait until the last day? You know, you guys
have been in office all this time, and now you want to talk. This is
absolutely ridiculous. And we should resolve the problem by having a
trigger, and cut across the board. Just have a trigger? Is that the way
you think we are going to have a system?
How much time do you yield to me, my dear friend from California?
Mr. DREIER. I am happy to yield to my friend 30 seconds.
Mr. RANGEL. Thirty seconds? That is no time.
Mr. DREIER. I took 2 seconds and I'm yielding him 30. That's a pretty
fair deal.
Mr. RANGEL. Well, all I am saying is that you are not setting a tone
that we can work next year in an administration that totally are not
blinded, whether you call it entitlements. We are talking about
providing services for the 40 million people who really don't have it.
So let's stop talking about what the heck you intend to accomplish in 2
weeks. It's over. Get over it. Forget about it. Do what you have to do
politically, see what you can salvage, and let's come back next year
and get the job done.
{time} 1800
Mr. DREIER. May I inquire of the Chair how much time we have
remaining on each side.
The SPEAKER pro tempore. The gentleman from Florida has 9 minutes.
The gentleman from California has 6 minutes and 20 seconds.
Mr. DREIER. At this time I am happy to yield 1\1/2\ minutes to my
very good friend who is a former member of the Rules Committee, Mr.
Gingrey.
Mr. GINGREY. Mr. Speaker, I thank the gentleman for yielding, and I
won't take all of my time.
I just want to say that I am tremendously opposed to this resolution.
When we passed Medicare Modernization and the Prescription Drug Act
back in November of 2003, I was a freshman Member of the House, a
physician Member of the House, and I felt very strongly that we needed
to give our seniors a prescription drug benefit. They had been asking
for it for years. The Democrats were in the majority most of those
years. And yet in 2003, most of my colleagues on the other side of the
aisle voted ``no.'' I think it was their feeling, most of them, that
the prescription drug benefit didn't go far enough.
On our side of the aisle, though, Mr. Speaker, there was great
concern of cost, and I truly believe that the prescription drug part D
and Medicare modernization would not have passed this body had not
section 803 been in there, that trigger to say when we have spent so
much, the President would have to come back and offer a solution to try
to control the cost and no better way than the medical liability reform
to cut down on all of the defensive medicine that doctors practice.
It's not the premiums that they pay for malpractice, it is the
defensive medicine. All of these tests that are unnecessary.
And then, of course, to means-test part D, just as it would have
mean-tested part B for these so many years, if we were not means-
testing part B, the monthly premium would still be $15 a month instead
of $96.
Defeat this resolution. Bring fiscal responsibility to this body.
Mr. HASTINGS of Florida. Mr. Speaker, I am very pleased to yield 1
minute to the very distinguished gentleman from Texas, a member of my
class and a member of the Committee on Ways and Means, Mr. Doggett.
Mr. DOGGETT. The President offers a very simple Medicare fix: Seniors
pay more. Taking a bigger cut from our seniors and our disabled
individuals for their drug benefit premiums is hardly a true fix.
You know, down in Texas, Mr. Speaker, we have steers that have been
cut. They've been fixed. They've been fixed for all time, and that's
the kind of fix that I think these Republicans have in mind for
Medicare.
Contrast the President's fix on Medicare this week with the
President's veto on Medicare last week. These Republicans are so eager
to privatize Medicare, they're willing to spend $1,000 of taxpayers'
money every year for every person that they can get to leave
traditional Medicare. By our overriding the President's veto, we saved
billions of dollars in unnecessary waste. But there are tens of
billions of dollars of additional waste right there in the system. And
you know what? They deserve a Texas-type fix. They need to be fixed and
removed.
The SPEAKER pro tempore. The gentleman's time has expired.
Mr. HASTINGS of Florida. I yield the gentleman an additional 1
minute.
Mr. DOGGETT. The Medicare actuary's own reports show that that this
$1,000 waste per person per year that the Republicans insist on, that
kind of waste, tens of billions of dollars of waste, does not produce
any quantifiable benefit, any quantifiable saving
[[Page H7130]]
through this failed Republican experiment in privatizing Medicare.
Improving Medicare's finances requires more than a trigger like the
President talks about to extend it for a year. We need a willingness to
pull the trigger on Medicare waste that these Republicans have plugged
in with these unnecessary subsidies that cost more and deliver less.
I say it has something to do with the energy bill, and they're right.
These seniors have been drilled by the Republicans for the last 7\1/2\
years. Drill here, drill now. These seniors get drilled when they go to
the gas station. They get drilled when they go to the grocery store.
What this resolution is about is preventing the President from drilling
them on their Medicare also.
Let's approve this resolution.
Mr. DREIER. Mr. Speaker, may I just inquire of my friend how many
speakers he has on his side.
I have got to say that before I do, Mr. Speaker, we have the
Committee on the Budget, Ways and Means, Energy and Commerce, the Rules
Committee, all of which have jurisdiction on this. We've been limited
to 30 minutes of debate on this side, and I just wondered if he might
be interested in propounding a unanimous consent request that we extend
the debate by maybe 5 minutes on each side.
Mr. HASTINGS of Florida. I do not yield for that purpose.
Mr. DREIER. The gentleman is going to have to object. I was asking
unanimous consent if we might.
Mr. HASTINGS of Florida. I object.
Mr. DREIER. Mr. Speaker, so may I inquire again as to how much time
is remaining on each side, Mr. Speaker.
The SPEAKER pro tempore. The gentleman from California has 4 minutes
and 50 seconds. The gentleman from Florida has 7 minutes.
Mr. DREIER. May I just inquire how many speakers are on the other
side.
Mr. HASTINGS of Florida. I am going to be the last speaker.
Mr. DREIER. At this time, Mr. Speaker, I am happy to yield 2 minutes
to my very good friend from Georgia (Mr. Price).
(Mr. PRICE of Georgia asked and was given permission to revise and
extend his remarks.)
Mr. PRICE of Georgia. I thank my friend and leader from California
for yielding.
This do nothing, no energy Congress has perfected changing the rules
to suit themselves. But this may take first prize.
Virtually all of us talk about the need for entitlement reform.
Entitlement, that's those programs that comprise about 55 percent of
the budget. I call it a ``yes'' moment at home. It's when the crowds
say, Yes, yes, please. Some reform is needed. And the rules currently
in place would allow for some real reform, especially in the area of
lawsuit abuse reform, not cuts in Medicare. Not an increase in
premiums.
As a physician for nearly 30 years, I understand clearly the need for
liability reform, and it's imperative not just to decrease malpractice
costs but to end the practice of defensive medicine estimated to be
greater than $300 billion annually. That's $300 billion of savings
without any Medicare cut, without any increase in premiums.
Mr. Speaker, make no mistake, this vote today is about fiscal
responsibility and ending frivolous lawsuit abuse. Let's work together.
Americans want action on this issue, and they want it now. This
proposed rules change means no reform.
Mr. HASTINGS of Florida. Mr. Speaker, at this time I did have an
additional speaker, and I would ask to yield 1 minute to the
distinguished gentleman from California (Mr. Stark).
Mr. STARK. I thank my friend from Florida for yielding, and I just
wanted to make a point. It's been suggested several times by my friends
across the aisle that over 75 years, the unfunded cost of Medicare, as
they calculate it, is $36 trillion. You know what? They're right.
But what they don't tell you is by the same calculation, the unfunded
cost of the McCain-Bush tax cuts is more than $100 trillion. So if you
weren't giving away all of this money to the rich people and all of the
Republicans who inherited money from their parents and never had a real
job in their lives, maybe we could solve it. It would just take a third
of the Bush-McCain tax cuts to solve the unfunded liability for the
next 75 years for Medicare.
So when you talk about these things, folks, let's include all the
other goodies that you're giving away.
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore. Members are reminded to make their remarks
to the Chair.
Mr. DREIER. Mr. Speaker, I yield myself 20 seconds to say to my
friend that we have been constantly arguing that we're willing to sit
down and talk about this and debate these issues at any time. And we're
willing, and the two top dogs on the Ways and Means Committee have both
said they're willing to do that; and we've been willing all along. And
that's exactly what this provision is all about.
The fact of the matter is the tax cuts that have been put into place
dramatically surge the flow of revenues to the Federal Treasury. We all
know that. And we have a responsibility to look at anything we possibly
can to bring about a fiscally responsible Medicare program and we're
going to do that.
With that, Mr. Speaker, I would like to yield 1 minute to my very
good friend from Tennessee (Mrs. Blackburn).
Mrs. BLACKBURN. Mr. Speaker, you know, it is so interesting serving
on the Health Subcommittee at Energy and Commerce, and one of the
things that we look at and are very concerned about, 11 years from now
the Medicare trust fund could go bankrupt. That's what we hear from the
trustees. Health care spending is going to be 20 percent of the GDP as
we go through the next 10 years.
And here we had a trigger, something that is a nugget of good
government that is put into an entitlement bill. And look at what is
happening? This is what you're wanting to take away. It is put there to
look at the long-term solvency of this problem. And that is one of the
things that we hear from our constituents every day. They have their
money that they have earned, that they are putting in every month so
that Medicare will be there for them when they retire.
And what do they get from you all? You're not wanting to come in and
address this issue. You want to pull the trigger back.
I think it is irresponsible. I do think it is an abdication of our
responsibility, and I would encourage those here to oppose that
resolution.
Mr. HASTINGS of Florida. Mr. Speaker, I would inquire of my friend
from California if he has any remaining speakers. I am the last speaker
for our side, and I'm going to reserve my time until you have closed
for your side.
Mr. DREIER. Let me say, Mr. Speaker, that we very clearly have an
opportunity before us. We have an opportunity to defeat this rule so
that we can do what it is that we came here to do. We have had a wide
range of recommendations that have come here from the Medicare
commission. And we have a proposal that is before us submitted by the
majority leader and the minority leader as required under this law. It
made two very important recommendations dealing with liability reform
in ways which we could bring about fiscal responsibility of Medicare.
That's what our charge is. That is what our job is as Members of the
United States Congress.
The action that we are about to take in this House is to simply sweep
it under the rug and pass off to the future what we were sent here to
do right now. We're rapidly approaching the date by which time we need
to begin taking action. That is July 30. And our colleagues,
unfortunately, have chosen to turn their back on those who want to
bring about a fiscally responsible solution to a challenge that we all
know is looming.
Mr. Speaker, I urge my colleagues to defeat this rule so that we can
move ahead and do the right thing for our seniors and for future
generations.
With that, I yield back the balance of my time.
Mr. HASTINGS of Florida. Mr. Speaker, I yield myself the balance of
the time.
Mr. Speaker, I have sat and stood here with great amusement as my
colleagues on the other side of the aisle have come to the floor to
oppose this resolution. After all, if it were not for their actions,
this resolution wouldn't even be necessary.
The ``45 percent Medicare trigger'' was nothing more than a gimmick
designed to gain the votes of conservative
[[Page H7131]]
Republicans for their Medicare prescription drug bill. It was drafted
behind closed doors. I was here, Mr. Speaker. Mr. Rangel tried to get
into their conference. They locked the doors without any consultation
with Mr. Rangel of the Ways and Means Committee, members that were in
the minority without any involvement or notification to the minority.
It was then slipped into the conference at the last minute and had not
passed the House or the Senate.
It's amazing, Mr. Speaker. My friends on the other side agreed to
this trigger and preach fiscal responsibility and are now supporting a
process which could force the House to allow legislation to the floor
in clear violation of its PAYGO and earmark rules.
I was really amused that the distinguished gentleman that is head of
the Republican Study Committee came in here as much as he talks about
earmarks and is going to come here and talk about fiscal
responsibility.
I was also amused that the last lady speaker who took it upon herself
to talk about this measure but forgot, I guess, that she voted to
override the President's veto last week.
But now they come to the floor to complain because their Members
bought a pig in a poke. Give me a break.
{time} 1815
The last time I checked, they were the dealer with all the cards in
2003.
Mr. Speaker, next Wednesday, Medicare will turn 43 years old. Since
its founding, the program has provided health care to hundreds of
millions of seniors, including my momma and my grandpapa.
Almost 35 percent of the people living in my district are senior
citizens, and the overwhelming majority of them depend on Medicare.
Members have a choice today between reviving the Republican legacy of
political and procedural gimmickry or standing up for seniors and sound
public policy.
While Republicans choose to play games and engage in political
hyperbole, my Democratic colleagues and I have chosen America's
seniors.
I urge my colleagues to support this resolution.
Mr. HERGER. Mr. Speaker, I rise today in the strongest opposition to
this dangerously irresponsible resolution.
For over 40 years, millions of seniors across America have enjoyed
longer and healthier lives as a result of the health care provided
through the Medicare program. Yet as a result of demographic changes
and rising health care costs, Medicare is now in dire financial
straits. The numbers are absolutely staggering. According to the most
recent report by Medicare's Board of Trustees, Medicare's unfunded
obligations have surpassed $85 trillion. That's more than six times the
annual output of our entire economy, and more than fifteen times the
current federal debt held by the public.
We have a choice to make: Are we going to take action now to save
Medicare for the future? Or are we going to ignore the problem and hope
that it just goes away? I understand that many members might prefer not
to deal with this issue in an election year. But the Medicare funding
warning trigger was designed precisely to force Congress to confront an
issue that many would rather ignore. And that's what the American
people sent us here to do: confront the tough challenges facing our
country's future. Even when that means taking some political risks.
The President has proposed some fairly modest reforms to begin
shoring up Medicare's future. I personally thought his suggestions made
sense. But under the trigger rules, the Majority was entirely free to
reject the President's ideas and develop their own proposal for reining
in the growth of Medicare. Instead, the Majority has chosen to take the
easy way out and do nothing. Today, we are sending a message to the
American people that this Congress is simply not up to the task of
solving our nation's problems.
The truth is, Mr. Speaker, we are gambling with our future. I believe
we have an obligation to do our best to leave America better off for
the generations that will follow us. I urge every member of Congress
who feels the same way to join me in voting ``no'' on this resolution.
Ms. JACKSON LEE of Texas. Mr. Speaker, I want to first take a minute
to thank my colleague Congressman Alcee Hastings from Florida for
working with leadership to this important legislation to the floor.
background on the legislation
In 2003, The Medicare Prescription Drug, Improvement and
Modernization Act, MMA, was signed into law having a significant impact
on Medicare beneficiaries and State Medicaid programs through changes
affecting those dually eligible for both Medicare and Medicaid. The
purpose of the section was to:
1. Provide a concise summary of the key provisions affecting those
dually eligible and the States, and
2. Provide details of the demographic and Medicaid expenditure
characteristics of the dually eligible, using data from ten States.
The MMA used to require that States take a practical new look at
their programs in order to better prescription drug spending. Beginning
in 2006, States will no longer provide and manage drug coverage for
patients that currently represent, on average, about 50 percent of the
State's Medicaid spending for drugs. This significant shift would have
required that States reassess available resources and the most cost-
efficient ways for employing those resources.
A determination of excess general funding, as required by Sec. 801 of
P.L. 108-173. the MMA, is issued if general revenue Medicare funding is
expected to exceed 45 percent of Medicare outlays for the current
fiscal year or any of the next six fiscal years. If the determination
is issued for two consecutive years, a warning is issued requiring
certain presidential and congressional action (Sec. 802-Sec. 804 of
MMA).
The warning alerts policy makers of one measure of the financial
health of Medicare. It attempts to focus on the impact of Medicare
revenues and outlays on the federal budget, by looking at Medicare's
burden on the Treasury. However, such a determination was issued in
both the 2006 and 2007 Medicare Trustee's reports and the
Administration was required to submit a legislative proposal to this
body to lower the ratio to the 45 percent level.
Section 803 of the MMA is also known as the Medicare Trigger because
it expedites the process for considering legislation to cut Medicare
provider payments or increase payroll taxes or beneficiary costs.
What we must ask ourselves is why some of our colleagues can vote
against the MMA trigger while we struggle to provide coverage to the
over 47 million uninsured and over 50 million underinsured in this
country .
The ``45 percent trigger'' is a completely subjective measure.
Medicare program was designed to be substantially financed by general
revenues rather than payroll taxes. The fact that a sizable portion of
Medicare's financing comes from general revenues is no more problematic
than the fact that 100 percent of the defense budget comes from general
revenues. Moreover, the reforms in Medicare included in the Medicare
Improvements for Patients and Providers Act, MIPPA, which Democrats
just enacted over the President's veto satisfy the 45 percent trigger
test earlier this year, only fails to comply with certain technical
requirements of the trigger provision (such as the name of the
statute). Therefore, this is just another reason why it makes sense to
suspend the Medicare trigger for the remainder of this Congress.
Overview of how the 45 percent trigger works
The 45 percent trigger was slipped into the GOP-drafted Medicare
Modernization Act (MMA) at the last minute in 2003.
The MMA defined what the 45 percent trigger was and, when it was
triggered, required ``Medicare Funding Warnings'' and presidential
legislation.
The 45 percent trigger is completely arbitrary and is not a sound
measure of Medicare's fiscal health.
The 45 percent trigger was triggered by two consecutive Trustees
Reports in 2007.
The President's proposed bill hits beneficiaries, rather than scaling
back the overpayments to private Medicare Advantage plans.
Unlike the President's flawed bill, the Democratic-led Congress has
just enacted a law that satisfies the 45 percent trigger, while
protecting beneficiaries.
Furthermore, the Democratic-led Congress is committed to keeping
Medicare strong and solvent well into the future.
Healthcare Crisis
The American health care crisis affects more than the Medicare
recipients and indigent persons. It affects the millions of families
who must decide between food, housing, and health coverage. Healthcare
costs in the United States are increasing about 7 percent a year, twice
the rate of inflation.
In Texas alone it has been estimated that we waste $98 billion on
administrative health costs. Administrative costs constitute 31 percent
of health care expenditures. The deteriorating U.S. health care system
is not only harming patients, but also businesses, and the economy with
healthcare costs consuming over 15 percent of GDP. It affects thousands
of small businesses who have to close their doors due to the
overwhelming cost of not only providing health coverage to their
employees, but to securing their own health insurance.
Across this great nation the health disparities between minority and
majority populations are staggering. Most major diseases: diabetes,
heart disease, prostate cancer, HIV/AIDS, low-birth weight babies--all
hit the minority communities harder. Minorities consistently have
[[Page H7132]]
decreased access to care, and receive lower quality care, when they do
have access. As the economy continues to falter and as the unemployment
rate spikes, millions of Americans are losing their health insurance.
That state of affairs will only make the health disparities worse.
Since I took office over a decade ago, I have worked to secure and
support legislation to address the healthcare crisis particularly those
facing our struggling Medicare and Medicaid recipients.
I have worked tirelessly to expand health coverage, improve the
diversity of our health workforce, improve data collection on health
disparities and then help reduce those disparities by promoting
accountability and strengthening the institutions that serve minority
communities. We must close the gap in our minority, immigrant, and
rural communities by addressing the disparities that currently exist.
Health Legislation Sponsored/Cosponsored
As a Member of the H.R. 676 Universal Healthcare Caucus lead by
Congressman Conyers, the Women's Caucus, and the Children's Caucus, I
have continued to carry the flag of Universal Health Care by
introducing or supporting legislation that will help lay the groundwork
towards universal access and quality healthcare.
In June, I introduced a health care reform bill that addressed some
of the issues that continue to plague our health care system. The
MEDICS Act is a House companion bill to Senator Baucus's Medicare
legislation that sought to unite Congress on a push for crucial
Medicare reform.
I am happy to announce that this legislation puts our health care
system on the correct path of providing proper medical assistance for
our Nation's low income, minority and rural populations. It also works
toward resolving the primary care physician shortages as well as the
racial and ethnic health disparities.
I have also supported national healthcare legislation such as H.R.
3014 and H.R. 676 which support the elimination of healthcare
disparities and universal healthcare based on a single-payer model.
As Americans, we have a strong history, through science and
innovation, of detecting, conquering and defeating many illnesses.
Quality measures must continue to be adequately funded in order to
promote quality, cost-effective health care for consumers and
employers.
The Medicare/Medicaid system as well as the private insurance system
is still not adequately addressing the cost, population growth, and
patient population complexity of Americans. That is why we must look
towards another solution.
I urge my colleagues to support our Medicare and Medicaid dependents
and vote in support of H. Res. 1368.
Mr. DINGELL. Mr. Speaker, today we protect Medicare's future. The
rule addresses a provision that was slipped into the Republican
Medicare Modernization Act, MMA, in the dark of night. It was not in
the version of the bill that was passed by the House or by the Senate.
It is yet another example of Republican efforts to choke off Medicare--
an automatic ``trigger'' that requires cuts to the program if general
revenues contribute more than 45 percent of Medicare's revenues.
My colleagues on the other side of the aisle have long tried to end
Medicare, and failing that, to let it wither slowly on the vine. Newt
Gingrich said as much in the 1990s, when he was Speaker of the House.
As required by the MMA provision, the President sent a bill to
Congress in February with his proposal to meet the trigger
requirements. His bill simply shifted costs to patients, and made no
improvements to Medicare; a good example of why this ``trigger''
doesn't work.
Democrats know how to manage Medicare--my father wrote the original
bill creating it, and we have been fighting to preserve, improve, and
protect the program for nearly 50 years. We do not need gimmicks like
an arbitrary ``trigger'' to do so.
Medicare has protected seniors, improved their health, and helped
lift people out of poverty. We must ensure that Medicare beneficiaries
continue to have access to their doctor of choice, high-quality
hospital care, and prescription drug services.
I support this rule; and I urge my colleagues to eliminate the
``trigger'' requirements for the remainder of the year.
Mr. HASTINGS of Florida. Mr. Speaker, I yield back the balance of my
time, and I move the previous question on the resolution.
The previous question was ordered.
The SPEAKER pro tempore. The question is on the resolution.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. DREIER. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
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