Floor Statements

Mr. Speaker, I rise today to oppose H.R. 4281, the ``Small Business Health Fairness Act of 2004.'' This bill would hurt small businesses and patients by increasing the costs of health insurance and the number of uninsured.

If my comments today sound familiar, it is because they are almost exactly the same arguments I made last June, when this exact same bill passed the House. It was a bad idea then, and it is an even worse idea today. During this ``Cover the Uninsured Week'' the Republicans suggest association health plans can cover millions of uninsured Americans. In reality H.R. 4281 would actually add to the nearly 44 million uninsured in this country. This warmed over re-vote is a waste of time and taxpayer resources, and has nothing to do with providing affordable healthcare options to our citizens.

According to recent studies, association health plans would actually increase costs for most small businesses and their employees. Our own Congressional Budget Office has estimated that over 80 percent of small businesses would see increased premium costs under H.R. 4281. Those small employers that currently offer traditional, state-regulated health insurance would see their premiums increase by 23 percent on average. Premiums will increase because AHPs will offer only bare-bones coverage, attracting the healthiest individuals, leaving traditional health insurance plans with the sickest and most expensive patients. This shift would penalize businesses with sicker employees, and make health insurance even more unaffordable for those who need it most.

I am glad to see my Republican friends are concerned about the 43.6 million people in this country who lack health insurance. However, AHPs are not a real solution, and will actually add 1 million people to the continuously growing number of uninsured. As traditional health insurance becomes increasingly expensive, more and more businesses would have no choice but to drop health insurance for their employees, leaving these individuals with little or no opportunity to purchase health coverage.

Not only will this bill increase the number of uninsured, it will blatantly discriminate against small businesses with sicker employees-- often those businesses with lower-income and minority workers. Because H.R. 4281 would allow AHPs to avoid state laws against cherry picking, these plans would only offer insurance to small businesses with the healthiest employees. Any premium reductions touted by the bill sponsors--at most a modest 10 percent reduction--would be a direct result of cherry-picking and reduced benefits, not greater efficiency. As healthy people move into AHP's skeletal coverage, sicker people are left without health insurance, increasing the morbidity of the uninsured population by over 12 percent.

Small businesses will not be able to provide more affordable health insurance to their employees under this bill. Although proponents claim that AHPs would give small-employers bargaining power to purchase affordable health insurance, most states already have laws in place that allow for group purchasing arrangements. This bill would harm existing State laws and usurp the traditional role of States to regulate small-employer health insurance.

This bill would also preempt key State provisions that protect millions of insured Americans. For example, many States regulate insurance premiums to prevent insurers from discriminating against the sick. But under this

bill, AHPs could offer extremely-low ``teasers'' rates, and then rapidly increase premiums if the enrollee becomes sick. Many small businesses would find these high rates unaffordable, and would be forced to drop coverage. Furthermore, nearly all States have enacted external review laws, which allow patients to have an independent doctor review a claim that has been denied by the insurer. Patients who join AFPs would lose this right.

Additionally, this legislation would be a setback to government efforts to reign in fraud and abuse. Association health plan exemptions in this bill are nearly identical to those Congress grated to multiple employer welfare arrangements (MEWAs) in the 1970s, which led to widespread fraud and abuse. These exemptions allowed MEWAs to rack up $123 million in unpaid healthcare bills, and prompted the Department of Labor to open 90 fraud and abuse investigations. Congress recognized and corrected this problem, but now my Republican colleagues are ignoring the lessons of the past and are headed right back down the same dangerous road with AHPs.

Finally, this bill would exempt AHPs from state-required benefits, which have helped to ensure that millions of Americans get access to necessary healthcare services. These benefits include mammography screenings, maternity care, well-child care, and prompt payment rules. In my State, California, employees who join AHPs could also lose access to certain emergency services, direct access to OB/GYNs, mental health parity, and other important benefits.

The Democratic substitute offered today by Representatives Andrews and Kind is a real solution for providing small-businesses access to affordable health insurance. Using the $50 billion President Bush included in his FY04 budget for the uninsured, this proposal would allow small businesses to buy-into a small employer health benefits plan (SEHBP). Republicans have been stammering for years about giving people the same insurance options as members of Congress and this substitute would do just that. The SEHBP would be substantially similar to the Federal Employers Health Benefits Plan (FEHBP) and millions of uninsured would finally have the same options we have as Members of Congress.

This association health plan bill is bad for patients, bad for small businesses, and bad for states. It is opposed by over 1,000 organizations, including the National Governors Association, local Chambers of Commerce, small business associations, physician organizations, labor unions, and healthcare coalitions. H.R. 4281 would increase premiums, increase the number of uninsured, lead to massive fraud, and remove key state patient protections. I urge my colleagues to reject this legislation.

Mr. Speaker, in honor of ``Cover the Uninsured Week,'' I am pleased today to join with my colleague Rep. Sherrod Brown and more than 80 additional cosponsors in introducing the ``Medicare Early Access Act.'' This important legislation would provide an affordable health insurance option for the fastest growing segment of the nearly 44 million uninsured Americans--those ages 55-64.

In 2002, 43.6 million Americans were uninsured. There are many approaches to how we should address this growing problem. As most of my colleagues know, I am an advocate of a universal health care system in which each and every American would have health coverage. That is the most fair, affordable, and

sustainable solution to our national health care needs.

However, that won't be accomplished overnight. In the meantime, there are steps that Congress can and should be taking to develop immediate, if smaller, steps to providing people affordable health insurance coverage options. One such step is to pass legislation that would provide certain groups of individuals the option of buying into Medicare--a program with a proven track record that works. That's exactly what the Medicare Early Access Act does for people age 55 through 64.

As we all know, the baby-boomers are quickly approaching retirement, and health insurance is a major concern. Unfortunately, retiree health benefits have vanished or are quickly disappearing, leaving people with few or no affordable coverage options. A recent employer survey suggests that only 38 percent of large employers offer any type of retiree health benefits. Other recent research shows that 10 percent of the largest employers terminated all subsidized health benefits for future retirees in 2003.

With shrinking retiree benefits and no affordable options available in the individual market, people age 55 through 64 are often uninsured or gravely underinsured. Besides the 3.5 million uninsured between ages 55-64, another 3 million are forced to buy inadequate, overpriced coverage in the individual market. Most near elderly cannot purchase individual coverage because age rating and other underwriting techniques result in excessive premiums. Those that are even offered coverage are often required to pay astronomical deductibles and co- pays, or are severely limited by pre-existing condition exclusions.

In 1965, Medicare was specifically designed to provide coverage for those the market would not insure. Today we have the opportunity to expand on the original purpose of Medicare by providing access to people the market does not adequately cover. The Medicare Early Access Act would reduce the number of uninsured, provide better coverage for the underinsured, and improve the health status of this vulnerable population without harming Medicare or other insurance markets.

That's why the Medicare Early Access Act makes so much sense. It would allow people in this cohort to buy into Medicare and enjoy the exact same benefits available to all other Medicare beneficiaries. Premiums for these new participants would be based on actuarial calculations of the cost of providing services to the population. There would be no effect on the Medicare trust fund because premiums will cover the entire cost of services provided.

To ensure premiums are affordable, the bill provides a 75 percent advanceable, refundable tax credit. Thus, participants would pay a monthly premium equal to 25 percent of the cost of the program--an amount similar to what employed individuals pay for their health benefits.

I am pleased to report that advocacy organizations representing consumers and seniors agree with us. The Medicare Early Access Act has been endorsed by The Leadership Council of Aging Organizations (LCAO) which is a coalition of national nonprofit organizations concerned with the well-being of America's older population and committed to representing their interests in the policy-making arena. I would like to thank the 27 members of the LCAO who signed a letter in support of the Medicare Early Access Act. The full text of their letter appears at the end of my statement.

In our quest to reduce the number of uninsured Americans, the Medicare Early Access Act, is a great start. This bill would provide affordable, comprehensive coverage to the most vulnerable uninsured who have few, if any, health insurance options in the current marketplace. The system necessary to implement this bill is already in place; all we have to do is agree the uninsured deserve viable coverage options. I look forward to working with my colleagues on both sides of the aisle to enact this proposal.

The Medicare Early Access Act Bill Summary

Mr. Speaker, I rise today to pay tribute to John Jermanis, City Manager of San Leandro, California. This year, John is marking 35 years of outstanding service in municipal government.

John was born and raised in Berkeley, California. He attended Berkeley High School, received his bachelor's degree in business administration from San Francisco State University, and has done graduate studies in public administration with California State University Hayward.

He began his municipal government service in 1969 as an accountant with the city of Livermore. In 1971, John was hired by the city of San Leandro as assistant Finance Director and has been with the city for 33 years. In 1982, he became the City's Finance Director, and in 1977, he was appointed by the City Council as City Manager.

John has a proven track record with the city of San Leandro that is hard to beat. His professionalism, intellect, and commitment to the city are exemplary. He is focused on making sure San Leandro stays on sound fiscal footing and is responsive to the needs of its citizens.

His colleagues know John Jermanis as City Manager Extraordinaire. This is a fitting description of his talent and a tribute to his expertise in city management.

Mr. Speaker, I rise today to recognize the 40th Anniversary of Girls Incorporated of the Island City in Alameda, California. Girls, Inc. of the Island City held a successful 5th Annual Celebration of Excellence luncheon on May 1, 2004, in conjunction with their milestone anniversary.

Forty years ago, a group of Alameda citizens established a program for girls which was incorporated as Alameda Girl's Club, Inc. Kaye van Valkenberg, served as its first Board President (1964-1967) and together with other local civic leaders inspired what is now called Girls Inc. of the Island City. Over 300 girls currently participate in Girls Inc. of the Island City programs.

The mission of the organization is to inspire all girls to be strong, smart and bold through innovative programs, activities, and advocacy. The goal of its Activity Centers is to provide quality services to children and families, to encourage and support children's growth, and assist families to meet economic needs and family goals.

Girls Inc. of the Island City is a local member organization of the national Girls Inc. organization offering programs focused on helping girls of all races, ethnicity, economic and social backgrounds avoid violence, drug addiction, and teen pregnancy; teaching girls literacy in economics and the media; and encouraging girls to pursue careers in math, science and technology, and become community leaders.

Six program areas--careers, and life planning; health and sexuality, leadership and community action, sports and adventure; self-reliance and life skills; and culture and heritage are the foundation of Girls, Inc. of the Island City.

Girls, Inc. of Island City continues to inspire all girls to be strong, smart and bold and to have confidence and be safe in the world. I applaud its forty years of exemplary service and join the city of Alameda in appreciation for this organization's efforts to make a positive difference in the lives of girls.

Mr. Speaker, I yield myself such time as I may consume.

I stand here in just abject wonder at having 2 hours and 10 minutes to debate this bill over which there is very little controversy, a few dollars here and there; and I was going to ask the gentleman from Louisiana if he might accept a unanimous consent request that we cut the time in half, spend the first hour on this bill and spend the second hour debating whether or not Rumsfeld ordered the torture of prisoners in Iraq, and then we might have some more fun at least in the 2 hours we have got.

Does the gentleman agree?

Mr. Speaker, it is kind of sad that this bill was not worked out in committee because the differences, which I will describe shortly, are simple and there could have been a compromise, it appears to me, and certainly we have a substitute which will come up and we, I think, have to discuss both.

Let us start out by suggesting that I would like to agree with the distinguished gentleman from Louisiana that it is probably a good idea to not encourage people to spend foolishly, to buy two extra pair of eyeglasses or go out for an extra shot of Botox or something at the end of the year just to use up the money in their flexible spending account.

The problem, and where we would disagree, is that the gentleman's bill is not paid for, and this does push us further into debt; and our bill and the differences, and we have some, is paid for. If the gentleman wanted to say let us compromise right now and pay for half of it, we could get this done in 15 minutes. I am easy. But that is basically our difference. The Republican bill creates more of a deficit, and it does discourage people from spending foolishly at the end of the year and it costs, what, 8 billion bucks over 10.

Therein is the major difference. I would like to discuss one minor difference which is complex and which our substitute drops. The gentleman from Louisiana, the Republican bill, allows members of a flexible spending account to transfer money into a health savings account. The only problem with that is that, insofar as the regulations appear now, one cannot have a flexible spending account and a health savings account at the same time, so that to transfer the money from the flexible spending account into the health savings account, they have to drop their flexible spending account, and then the next year they would not have 500 bucks to transfer.

I mean, it is a way to encourage, or perhaps force, people into dropping a flexible spending account and move into a health savings account. I am not sure that was his intention, but that is the reality. And there is almost no one who would qualify to transfer money, the $500, say, from the flexible spending account into a health savings account. As a matter of fact, it is scored at 20 million bucks over 10 years; so if it is $20 at maybe 1 million people who would use it, and if our purpose is to encourage health savings accounts, I would suggest to the gentleman that that is a separate debate and perhaps not really pertinent to the question of whether we should allow people this carryover and repeal the use-it-or-lose-it provision. Had we had a chance to mark this up in committee and work it out in some detail, I think we could have worked out a system, perhaps brought two bills to the floor.

The bill, I know, and I hate to be critical, but I know it is introduced as a centerpiece of the week for the uninsured, and I am afraid that this bill does nothing for the uninsured. We cannot have a flexible spending account and not have access to insurance. So we really are not dealing with the uninsured here. People who have flexible spending accounts, as a matter of fact, probably have very generous and good health insurance coverage. So it is somewhat disingenuous, and that is the harshest thing I can think of, to suggest that this is going to have any effect or impact in Cover the Uninsured Week.

So if I could summarize just for a moment, there is a part of the bill which would help people and prevent them from frivolous spending from their flexible spending accounts. We concur in that, and our substitute includes that. Our major difference is, and we could have a vote, is it worth increasing the deficit by $8.5 billion. We have some simple ways to pay for that. For instance, not letting corporations reincorporate offshore and avoid Federal income tax on their corporate income, a theory that has some bipartisan support.

There are some egregious loopholes that were dreamed up mostly by the Enron Corporation, which we also closed. I do not think anybody would suggest that those loopholes ought to continue. So in a minimal way, we changed the Tax Code to make this, and it is a principle, we ought to pay for things that we are providing, and that is it. We would leave the health savings account portion out. We would allow people to transfer the $500 and carry it forward so they would not have a use-it- or-lose-it, and we would pay for it. Other than that I do not know what we could find to disagree about for the next 2 hours, but in my inimitable way I will be just as disagreeable as the gentleman from Louisiana would like me to be.

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

Mr. Speaker, will the gentleman yield?

Mr. Speaker, if I were to stipulate to the gentleman from Louisiana that we keep the HSA portion, would the gentleman agree to pay for it or some of it here, and we will have a compromise right now?

Mr. Speaker, I thank the gentleman.

Mr. Speaker, I am pleased to yield 6 minutes to the distinguished gentleman from California (Mr. Becerra).

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I would like to inquire of the gentleman from Louisiana, it is my understanding that you could use a flexible savings account to, for example, pay for abortion if your employer's health care plan did not provide that benefit. Is that not true?

I yield to the gentleman from Louisiana.

Mr. Speaker, reclaiming my time, there is nothing in this bill that would prohibit a woman from using the benefits of the flexible savings account for an abortion; is that correct?

Mr. Speaker, I yield 3 minutes to the gentlewoman from Texas (Ms. Jackson-Lee).

(Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

Mr. Speaker, if the gentleman will yield, I will then reserve my time and precede his closing and try and warm up the audience for what I know will be eloquent remarks.

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

Mr. Speaker, I yield 6 minutes to the gentleman from Washington (Mr. McDERMOTT), as we are blessed with his late arrival.

(Mr. McDERMOTT asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself such time as I may consume. I thank the gentleman for his comments and I would close just briefly.

I believe that the Enron employee would not have insurance. He would have some money in that health savings account, but when Enron folded up, the insurance went along with Enron. He could go into the private market and try and buy something.

I would just like to repeat, if I may, that this really does nothing to cover the uninsured. So, if this is Cover the Uninsured Week, we are burning up a couple of valuable hours that we could be discussing how to cover the uninsured with this bill.

The principal disagreement that we had with the bill is that it is not paid for, and we will offer, subsequently to closing this debate, a substitute where we pay for it in very patriotic and simple ways. It is not a lot of money but it is a principle that we Democrats have long adhered to, and that is, that we ought to pay for the wonderful things that are available to us in this country and not put the burden on our children and grandchildren.

So, having said that, and without fear of contradiction that I probably have more children and grandchildren than the combined audience here, I can qualify, if the Speaker will allow me,

as an expert in that area. And maybe I am a little touchy about it, but will conclude our debate on this and I appreciate the gentleman from Louisiana. Next time I hope we can resolve these differences in our committee and come to the floor, as we did in the good old days, with a unified approach to Medicare and health insurance problems.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I offer an amendment in the nature of a substitute.

I am.

Mr. Speaker, I yield myself such time as I may consume.

Our Democratic substitute addresses a real issue of concern with respect to flexible spending accounts in the use-it-or-lose-it rule.

We agree with the author of this legislation that it is unwise to create an incentive for people to spend foolishly or frivolously for a benefit that they might lose, and we have the Washington Business Group and 50 major corporate members are clear on the issue. They want the changes and they want the money carried over into FSAs. The position is shared by their employees. There is some question, and nobody really has raised it previously, as to putting this money into health savings accounts, but because that is such a minor issue it could be overlooked.

The real question here is whether we should pay for this. And it will be expensive. It is $8 billion. That is money that could be used in many programs, education programs, environmental programs, health programs, and it is a principle to which we are dedicated, and that is that we would like to expand health care in this country, but we have never offered a plan that we

will not pay for. And I find it sometimes difficult when my opponents across the aisle will not even give us a plan that costs nothing.

My Republican friends are opposed to expanding COBRA benefits. They are very expensive for people, but some 40 million people have used them since we wrote that bill on a bipartisan basis to expand COBRA benefits until a person gets another job or until they mature into Medicare. Costs zip, nothing, nada. It costs the employer nothing. Why do we object to expanding COBRA benefits? Just because it is a government plan and obviously people on the other side of the aisle do not like the government helping people unless they are very rich, of course.

So here we have just another example of not a bad piece of legislation. It could use some improvement, but it is a freebie and will predominantly benefit people in good jobs, with good health insurance and expand another tax loophole.

It is a modest one, but it is a principle. Left unchecked, we would soon have almost no tax revenue in this country at all, a position which the Club For Growth would applaud, but I am sure that those of us who are on the Federal salary or those people who are defending us now in Iraq would object to.

So I hope that we could reverse this disastrous rush to the bottom of debt and begin to be responsible in how we legislate by paying for these provisions. We will hear more later from my colleagues on the really very useful ways that it will help our economy if, in fact, we did pay for this bill under the provisions of our Democratic substitute.

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

Mr. Speaker, I yield myself such time as I may consume, before I recognize the distinguished gentleman from Massachusetts, to remind my good friend from Louisiana that the tax provisions in our substitute were recommended by the bipartisan, bicameral Joint Committee on Taxation; and these provisions have already passed on a bipartisan basis in the other body.

Mr. Speaker, I yield 4 minutes to the distinguished gentleman from Massachusetts (Mr. Neal) 2 minutes for economic logic and 2 minutes for righteous indignation, for a total of 4 minutes.

(Mr. NEAL of Massachusetts asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 5 minutes to the gentleman from Texas (Mr. Doggett).

Mr. Speaker, I yield 3 minutes to the gentleman from Michigan (Mr. Levin).

(Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I would like to suggest to the gentleman from Wisconsin (Mr. Ryan) that we do not on this side have any objection to the rollover. We think it is a good idea, and all we would suggest is that we have to pay for it. That is the only difference.

I yield to the gentleman from Wisconsin.

Actually, I am opposed to it in general, but I offer to the gentleman from Louisiana (Mr. McCrery) that we would accept that if he would pay for half of the bill. That is compromise.

It only denies the HSA, which they think is going to be a small number. There is still time to negotiate.

Mr. Speaker, I yield 4 minutes to the gentlewoman from Connecticut (Ms. DeLauro).

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I would like to close the debate on our side for our substitute. My belief is these two tax provisions, modest as they are, regardless of the underlying bill, are good tax policy and ought to be considered if for no other reason than that they correct some serious inequities in our Tax Code which have been described by previous speakers.

We are very close to a compromise with our friends on the other side of the aisle. Our substitute would eliminate the health savings account issue. But as I said, it is possible to reinstate that in conference, and if the gentleman would like to support our substitute, we could do the patriotic thing, we could provide good tax policy, we could pay for a very good idea, and we could walk out, arm in arm, saying we have helped a few people, we have paid for it, and we have brought patriotism and corporate responsibility to some of our recalcitrant corporate friends who are not doing their share.

I would urge that this substitute does no harm to the underlying philosophy of the bill of the gentleman from Louisiana (Mr. McCrery). It does add to the coffers of our Nation when it is so desperately needed. This money is contributed by those corporations whose actions are I believe indefensible, and particularly at this time of grave national emergency.

I would not want to suggest that anybody who votes against our substitute is unpatriotic, but I would suggest that it certainly is helpful for our troops and the American economy to support the Rangel substitute.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, I offer a motion to recommit.

I am, Mr. Speaker, in its present form.

Mr. Speaker, during the past several hours we have had a good debate on this bill, and I think we have agreed to some of the basic principles that the flexible savings accounts should allow a reduction of the use-it-or-lose-it rule. We had attempted to offer a compromise to get our Republican colleagues to just pay for half of the bill, which was turned down. And the bill has, indeed, many supporters.

But what we have seen during the course of this current administration is indirectly a complete raid on the Social Security and Medicare Trust

Funds. Basically, the Republicans have spent all of the surplus in Social Security and Medicare, and that, in my opinion, is indefensible. Whether we agree about flexible savings accounts or medical savings accounts is not the issue. This bill directly, specifically, transfers out of the trust funds $3.4 billion. The Republicans are raiding the Social Security and Medicare Trust Funds.

Now, that may not sound like a lot to my colleagues across the aisle, but to the people who depend on Social Security and Medicare, the idea that they are stealing money out of the Medicare and Social Security Trust Funds blatantly, I think they will find offensive.

This reduction in receipts should not be permitted to occur. It will not harm this bill. The bill will go forward exactly as the distinguished gentleman from Louisiana has outlined it and has prevailed. The only difference is our motion to recommit asks us all to stand up and take the pledge to protect Social Security and Medicare and its trust funds for all of those who depend on their benefits in this country.

This bill takes care of well-employed, well-insured individuals. This does not help any uninsured people at all. It gives an additional benefit to people with first-class medical insurance. Why then should we spoil an otherwise decent bill by taking the first step to destroy Medicare and Social Security for people who are unable to get health insurance? That is wrong.

We have all committed to protect Social Security and Medicare. You cannot oppose this motion to recommit and say you are protecting it. You are stealing almost $3.5 billion over the next 10 years out of these trust funds.

To support our motion to recommit would merely say find it someplace else; take it out of general revenues, take it out of trade, take it out of anything, but do not take it out of the hard-earned benefits that our senior citizens are entitled to. This could be the first step toward destroying the financial viability of Medicare and Social Security.

If you vote for our motion to recommit, you are standing up and suggesting that you will protect the trust funds that underlie Social Security and Medicare. If you vote against it, you are saying, ``We don't care. Take the seniors' money. What the heck. We can spend it. We have spent everybody else's money. We have spent our grandkids' money.''

I ask you, out of compassion, those of us who are seniors might not be able to get a job anyplace else if I am not reelected. My Social Security, please do not steal it. Do not make my little children go out and get an extra paper route to take care of me in my dotage. We need this. Our parents need it. We must protect our children.

So, to repeat, the bill will go through exactly as the Republicans have crafted it; but if you vote for our motion to recommit, you get the added benefit of saying to every senior in your district, I stood up and protected your Social Security and Medicare benefits by protecting the trust funds to which this money would go.

Mr. Speaker, I urge support for the motion to recommit.

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, I rise in strong opposition to H.R. 4280, legislation that would undermine the right of patients and their families to seek appropriate compensation and penalties when they, or a loved one, are harmed or even killed by an incompetent health care provider.

At best, this bill is a wrong-headed approach to the problem of rising malpractice health insurance costs. At worst, it is designed to protect bad doctors, HMOs, and other health care providers from being held accountable for their actions. Either way, this bill is harmful to consumers and should be defeated.

The most ludicrous aspect of this debate today is the fact that it is completely unnecessary. The House already passed this exact same legislation last March and there is no need for us to be here debating it again.

The only reason that Republicans are bringing up this bill today is that it is ``Cover the Uninsured Week'' and they have no real proposals to help cover the uninsured. So, they are trotting out medical malpractice reform so they can have another vote that doctors appreciate and they can again blame the Senate for not taking action on the legislation. It is political showmanship pure and simple--it has no other meaning.

This bill is identical to H.R. 5 which was passed last year, so if my comments look familiar, it is because I am raising the exact same points in opposition.

The Republican Leadership has once again brought forth a bill that favors their special interests at the expense of patients and quality health care. Doctors, hospitals, HMOs, health insurance companies, nursing homes, and other health care providers would all love to see their liability risk reduced. Unfortunately, this bill attempts to achieve that goal solely on the backs of America's patients. I said, ``attempts to achieve that goal'' intentionally.

Despite the rhetoric from the other side, there is absolutely nothing in H.R. 4280 that guarantees a reduction in medical malpractice premiums. There is not one line to require that

the medical malpractice insurance industry--in exchange for capping their liability--return those savings to doctors and other providers they insure through lower malpractice premiums. To quote one of many economists on this matter, Frank A. Sloan, an economics professor from Duke, recently said, ``If anyone thinks caps on pain and suffering are going to work miracles overnight, they're wrong.'' In fact, the outcome of this bill could have zero impact on lowering malpractice premiums and instead go into the pocketbooks of the for-profit medical malpractice industry. Of course, the bill's proponents avoid mentioning that very real possibility.

Proponents of this bill also like to say that they are taking California's successful medical malpractice laws and putting them into effect for the Nation. This is also hyperbole. California did not simply institute a $250,000 cap on medical malpractice awards. The much more important thing California did was to institute unprecedented regulation of the medical malpractice insurance industry. This regulation limits annual increases in premiums and provides the Insurance Commissioner with the power and the tools to disapprove increases proposed by the insurance industry. It is this insurance regulation that has maintained lower medical malpractice premiums. Yet, the bill before us does absolutely nothing to regulate the insurance industry at all.

Supporters of this bill would have you believe that medical malpractice lawsuits are driving health care costs through the roof. In fact, for every $100 spent on medical care in 2000, only 56 cents can be attributed to medical malpractice costs--that's one half of one percent. In addition, a recent report by the Congressional Budget Office highlights the same fact. Specifically the report states, ``Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 top 0.5 percent, and the likely effect on health insurance premiums would be comparably small.'' So, supporters are spreading false hope that capping medical malpractice awards will reduce the costs of health care in our country by any measurable amount. It won't.

What supporters of this bill really do not want you to understand is how bad this bill would be for consumers. The provisions of this bill would prohibit juries and courts from providing awards they believe reasonably compensate victims for the harm that has been done to them.

H.R. 4280 caps non-economic damages. By setting an arbitrary $250,000 cap on this portion of an award, the table is tilted against seniors, women, children, and people with disabilities. Medical malpractice awards break down into several categories. Economic damages are awarded based on how one's future income is impacted by the harm caused by medical malpractice. There are no caps on this part of the award. But, by capping non-economic damages, this bill would artificially and arbitrarily lower awards for those without tremendous earning potential. This means that a housewife or a senior would get less than a young, successful businessman for identical injuries. Is that fair? I don't think so.

The limits on punitive damages are severe. Punitive damages are seldom awarded in malpractice cases, but their threat is an important deterrent. And, in cases of reckless conduct that cause severe harm, it is irresponsible to forbid such awards.

The issue of rising malpractice insurance costs is a real concern. I support efforts by Congress to address that problem. That is why I would have voted for the Democratic alternative legislation that Reps. Conyers and Dingell brought to the Rules Committee last night. Unlike H.R. 4280, the Dingell/Conyers alternative would not benefit the malpractice insurance industry at the expense of America's patients. Instead, it addresses the need for medical malpractice insurance reform--learning from the experience of California--to rein in increasing medical malpractice premiums. Rather than enforcing an arbitrary $250,000 cap, the bill makes reasonable tort reforms that address the problems in the malpractice arena--penalties for frivolous lawsuits and enacting mandatory mediation to attempt to resolve cases before they go to court. It also requires the insurance industry to project the savings from these reforms and to dedicate these savings to reduced medical malpractice premiums for providers. The Dingell/Conyers bill (H.R. 1219) is a real medical malpractice reform bill that works for doctors and patients alike.

The Democratic alternative bill is such a good bill that the Republican leadership refused to let it be considered on the House floor today. They were afraid that if Members were given a choice between these two bills, they would have voted for the Democratic bill. Once again the House Republican leadership has used their power to control the rules to stymie democratic debate.

Medical malpractice costs are an easy target. My Republican colleagues like to simplify it as a fight between America's doctors and our Nation's trial lawyers. That is a false portrayal. Our medical malpractice system provides vital patient protection.

The bill before us drastically weakens the effectiveness of our Nation's medical malpractice laws. I urge my colleagues to join me in voting against this wrong-headed and harmful approach to reducing the cost of malpractice premiums. It is the wrong solution for America's patients and their families.

Mr. Speaker, Iran's deceptions about its nuclear weapons program are rightly condemned. The United States ought to use the tools at our disposal--both political and economic--to demand an end to their egregious policies.

However, this resolution calls for the U.S. to use ``all appropriate means to deter, dissuade, and prevent Iran from acquiring nuclear weapons.'' As long as President Bush is in office, I can no longer trust that our foreign policy will be carried out using ``appropriate means.'' This President is no longer deserving of our trust.

That's why I am forced to vote present on this resolution. I simply don't trust that President Bush won't misinterpret Congressional intent and attempt to use this resolution in ways Congress never intended.

The pre-emptive quagmire in Iraq in which we now find ourselves was started under the pretense of deterring and preventing weapons of mass destruction. In fact, President Bush used past declarations of Congress meant merely to reprimand Iraq to justify full-blown war against that regime.

Mr. Speaker, the Bush foreign policy of pre-emptive war, threats, and isolation has made the world a far more dangerous place. I want no part of this neoconservative agenda.

Mr. Speaker, I rise to vote no on this resolution. It is right to condemn the brutal and abhorrent abuse of Iraqi prisoners. But, this resolution is not strong enough. Without language authorizing a full-fledged Congressional investigation into this matter, we are failing our responsibility.

Republicans refused to allow any language to be added to this resolution providing for an investigation into these crimes. They have limited our ability to bring those responsible to account for their actions. This is wrong, especially when our ideals have been undermined and our leadership again tarnished throughout the world.

These acts of humiliation, torture and even murder are outrageous. They are a shameful affront to the Iraqi people and those throughout the Arab and Muslim World. As a Nation, we owe the victims of these acts and the Iraqi people a full apology and investigation into how these abhorrent abuses were allowed to occur.

The torture and abuse of prisoners at Abu Ghraib prison are part of a larger systemic pattern of abuse with which this administration has been complicit. We know--as the Washington Post reported in December, 2002--that prisoners captured in Afghanistan by the U.S. were transferred to other nations to be tortured for information. We already are well acquainted with the mistreatment of prisoners at Guantanamo Bay. This latest expose of torture and abuse at the Iraqi prison is just one more example of heinous treatment at the hands of our Government.

We trust in the honorable service of our troops. This does not reflect on the Americans bravely serving in Iraq. But, responsibility does lie with those at the very top of leadership and at the feet of this President.

It is time Congress launch an investigation to end these patterns of abuse. If Congress does not act to right this wrong, I do not trust this administration will. We must condemn these acts of torture and abuse. Given that this resolution completely fails to provide Congress with the tools to initiate such investigations, I am forced to vote no.

Mr. Speaker, I rise today to pay tribute to the grand opening of the new Tiburcio Vasquez Health Center, TVHC, Hayward Clinic. TVHC has been providing health care services to Hayward, California, residents since 1990. With a patient volume of more than 14,000 encounters annually, TVHC outgrew its previous clinic. To meet the growing demand for its community based health care services, TVHC embarked on a Hayward Clinic Relocation and Expansion Project, culminating in the grand opening of its new and expanded Hayward Clinic.

As one of the leaders in delivering multicultural and linguistically appropriate health care services in southern Alameda County, Tiburcio Vasquez Health Center, Inc., is part of a centralized, effective system of licensed medical providers, community health education, social work and nutrition services. TVHC has been providing comprehensive primary care and supportive services to the medically indigent, low-income, primarily Latino population in southern Alameda County since 1971.

TVHC has repeatedly been recognized for its achievements in outreach and education that incorporates members of the clinic and surrounding community to govern, direct and participate in all aspects of the clinic operation to insure the quality and success of its service delivery and myriad of programs. They include a nationally recognized Women, Infants and Children, WIC, program out of three sites serving over 5,000 southern Alameda County clients and a comprehensive Family Support Service program through partnerships with the Every Child County/First Five Commission, the California Maternal and Child Health Branch Adolescent Family Life Program and the Alameda County Cal-Learn Program.

TVHC clinic sites are certified California Comprehensive Perinatal Services Program Providers. Comprehensive sick and well child-care, adolescent care, adult care, and care of chronic and acute illness associated with aging are also provided as well as HIV/AIDS education and prevention and case management services.

TVHC's award-winning community health programs, include the Nuestro Salud Nuestro Futuro chronic disease education program and Vide con Esperanza, a breast cancer support group for Spanish speaking Latinas and their families.

A comprehensive staff of over 135 health professionals is expert at providing culturally competent services to people of all ages, races, lifestyles and backgrounds. As a federally qualified health center, TVHC, Inc., as the parent nonprofit corporate entity, operates three primary medical clinic sites, Tiburcio Vasquez Health Center in Union City, the Miranda Health Center in Hayward, and the Logan Health Center, located at the James Logan High School in Union City.

The new Hayward Clinic will have a capacity to provide health care services for 28,000 patient encounters and will attract 3,000 new primary care users. Tiburcio Vasquez Health Center is a model for community-based health care. Its mission reflects its commitment: Tiburcio Vasquez Health Center is dedicated to promoting the health and well being of its community by providing accessible, high quality care. Our organizational and individual commitment is to ensure this human right through quality service, advocacy and community empowerment.

I applaud Tiburcio Vasquez Health Center, Inc.'s commitment to excellence. I offer my heartfelt congratulations on the opening of its newest clinic in Hayward, California to be dedicated on May 20, 2004.

Mr. Speaker, I rise today to oppose the fiscally irresponsible and inadequate H.R. 4181, ``Make Permanent Marriage Penalty Relief,'' and in support of the Democratic Substitute that helps more families and is fiscally responsible.

The Republicans have brought a bill to the floor that is not paid for. In fact, their plan would add $105 billion over the next 10 years to the federal budget deficit.

In contrast, the Democratic substitute provides marriage penalty tax relief to more Americans than the Republicans bill, but pays for it in a fair manner by limiting tax cuts for the wealthiest Americans.

The Democratic substitute provides more marriage penalty relief to 13 million families than the GOP bill by ensuring that tax relief from the marriage penalty is not taken away or reduced by the alternative minimum tax. The Republican bill denies full marriage penalty tax relief to 13 million families next year, including more than 25 percent of the middle-class families making $75,000 to $100,000, by failing to fix the inequities caused by the current alternative minimum tax system.

The Democratic substitute also provides immediate marriage tax penalty relief to more Americans by increasing the value of the Earned Income Tax Credit for more lower-income working couples. The Republicans fail to give these families immediate relief in their bill.

Again, the Republican bill demonstrates the misguided priorities of the Republican Party. Rather than ensuring that all hard working families get marriage tax penalty relief, the Republicans have decided to bankrupt this country to ensure that their fat cat rich elite donors continue to get away with paying absurdly low taxes. The ultimate losers are our children who will be left to pay the bill for the large budget deficits that President Bush and our Republican colleagues in Congress are planning to leave them.

I urge my colleagues to support the Democratic substitute bill and vote against the insufficient and unaffordable Republican proposal.

Mr. Speaker, I rise today because, once again, the drug industry has lied to the American people in another desperate attempt to justify their outrageously high profits. While this fact should shock no one--indeed, it has become routine--we must not let their ridiculous propaganda go unchallenged.

On Wednesday, April 7, speaking on C-SPAN's Washington Journal, Pfizer CEO Hank McKinnell told listeners that Pfizer spends only two percent of its revenue on advertising for prescription drugs. Even under the most optimistic projections, that's just fuzzy math.

In 2003, total advertising expenses for Pfizer were a whopping $2.962 billion. That's 6.55 percent of the company's revenue, over three times the amount cited by Mr. McKinnell. Moreover, a report from Families USA, Profiting from Pain: Where Prescription Drug Dollars Go, which was based on a review of industry annual financial reports submitted to the SEC, found that Pfizer spent 35 percent of its revenue on marketing and promotion, and only 15 percent on research development (and 24 percent on profit). That same study found that Pfizer spent 8 percent more of its revenue on marketing than the average of all companies reviewed.

Not only does Pfizer and the drug industry lie about the amount of money they spend on ads, but the ads also mislead consumers about the advertised drugs themselves. According to one advertising executive with significant experience with DTC ads, the purpose of advertising is not to educate consumer, but rather ``to identify the emotions we can tap into to get that customer to take the desired course of action.'' Moreover, in a survey of 1,872 people who viewed drug advertisements, 70 percent said they had learned little or nothing more about the conditions the drug is supposed to treat, and over half said they learned little or nothing more about the drug being advertised. Very few ads informed viewers of how successful the treatment is, what alternative treatments are available, how long a patient needs to take the drug, or attempts to correct common misconceptions about the disease the drug treats. Predictably, a strong majority of doctors--75 percent--said that the ads caused patients to think that advertised drugs work better than they do.

These ads have contributed to the skyrocketing cost of prescription drugs. In fact, a 2000 study showed that nearly half of the increased spending on pharmaceuticals was attributable to the fifty most advertised prescription drugs.

Americans have been clamoring for lower prescription drug prices, yet all the drug companies have offered them is a string of excuses, empty promises, and outright lies. Mr. Speaker, Americans deserve better.

Mr. Speaker, I rise today to pay tribute to the 25th Anniversary of the League of Women Voters of Alameda, California. The League of Women Voters of Alameda became a fully approved Local League in September 1978. The founders of the League established the organization based on their belief that our Nation's democracy depends on an informed and participative citizenry.

The Alameda League has made significant contributions to the City of Alameda, as well

as Alameda County, the State of California, and the Nation by supporting sound government initiatives, providing voter education on ballot measures, conducting candidate's forums, and registering voters.

The Alameda League continues to be an active participant in local and regional civic committees and has taken action in addressing city, state and national issues through careful study. The League reviews issues and takes positions that enhance the quality of the city of Alameda such as clean air and water, education, libraries, civic safety preparation, housing planning and development, and open space. Additionally, the Alameda League provides neutral observers to monitor the activities of the city council, school board and other boards and commissions within the City of Alameda.

I congratulate the Alameda League of Women Voters for their commitment to public service. The organization, over the last 25 years, has provided valuable contributions to Alameda, California. I applaud their dedication to making sure their local, State, and Federal government is close to the public's pulse as they continue to reach out to the citizenry through education and civic participation.

Madam Speaker, I am in support of the Guardsman and Reservists Financial Relief Act.

The courageous Americans serving in harms way should not be forced to suffer for their services through unnecessary financial hardship. This legislation would allow members of the National Guard and Reserves deployed in extended duty in Iraq and elsewhere the opportunity to borrow against their 301(k) plans and retirement savings to make ends meet.

This bill may give reservists more flexibility to meet financial pressures. But President Bush and Republicans in Congress can--and must--do more for our troops who are making sacrifices on our behalf. They deserve better pay and better health care and benefits for their families.

Several thousands reservists who were on the verge of coming home from Iraq recently had their stay extended. By next month, the Pentagon expects reservists to make up 40 percent of the total force employed there. In fact, more than 325,000 Guardsmen and reservists have been activated since September 11, many taking a pay cut when called to active duty.

With the bill before us today, reservists aren't getting additional pay to help support themselves and their families. They're just being allowed to borrow against their retirement without a penalty--as if having to pay back their lost retirement savings later because of lost wages isn't penalty enough.

It is important to remember that most people who've joined the Guard and the Reserves never signed up expecting to be deployed on extended tours of duty. Yet, they have accepted that responsibility and served courageously in Iraq. But, let us not forget our reservists are still bearing the consequences.

Many families of Guard and Reserve troops have had to cope with lost income since their civilian salaries are suspended while they are on active duty. The military pay for most reservists is often far lower than their civilian job forcing many families to work overtime, use their savings or even go on welfare.

Rather than putting it on reservists to make up for this lost pay, Congress ought to pass the Equity for Reservists Pay Act, legislation I support to require federal agencies to pay employees the difference between their civilian and military wages while they are on active duty. Congress ought also extend military pay raises. We ought to extend the child tax credit to low-income families of those serving in Iraq or Afghanistan.

Although I support this legislation, Republicans have sadly missed the mark today. This just doesn't repay our troops for their service. But, I'm not surprised considering that President Bush wants to cut imminent danger pay and separation allowances, putting our troops further in the hole.

I urge my colleagues to pass this legislation today. But this should not be the last step this Congress takes to help those brave Americans who continue to sacrifice for our nation.

Mr. Speaker, I rise today to honor the memory of Lance Cpl. Travis J. Layfield. Travis, a 19-year-old resident of Fremont, California, served his country with honor in the United States Marines. Sadly, he was killed during a firefight in the Anbar Province of Western Iraq on Tuesday, April 6, 2004.

The 2003 graduate of Washington High School has become a hero to all of us for his service with the 2nd Battalion, 4th Marines, 1st Marine Division, 1st Marine Expeditionary Force out of Camp Pendleton in southern California.

Travis entered ROTC while in junior high school and was totally focused on a career in the Marine Corps. Last year he completed 12 weeks of basic training at the Marine Corps recruit depot in San Diego. He left for the Middle East in February 2003, first heading to Kuwait and later Iraq.

There has been a tremendous outpouring of love and respect for Travis from his classmates and friends at his high school alma mater, Washington High School, as well as the entire community of Fremont, California, who are mourning the loss of this proud young marine.

We shall long remember Lance Cpl. Travis J. Layfield. He gave his life for peace and democracy and died, as a noble marine, serving our country. Our prayers and thoughts are with his family.

Mr. Speaker, earlier today during the vote on final passage of H.R. 3550, I was called off the floor to receive a phone call from my office. In my distraction, I thought I had voted in favor of H.R. 3550 when in actual fact I had not cast my vote. Had I not been distracted, I would have voted `Aye' on final passage of H.R. 3550.