[Pages H6520-H6531]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT OF 2008--VETO
MESSAGE FROM THE PRESIDENT OF THE UNITED STATES (H. DOC. NO. 110-131)

The SPEAKER pro tempore laid before the House the following veto
message from the President of the United States:
To the House of Representatives:
I am returning herewith without my approval H.R. 6331, the ``Medicare
Improvements for Patients and Providers Act of 2008.'' I support the
primary objective of this legislation, to forestall reductions in
physician payments. Yet taking choices away from seniors to pay
physicians is wrong. This bill is objectionable, and I am vetoing it
because:
It would harm beneficiaries by taking private health plan options
away from them; already more than 9.6 million beneficiaries, many of
whom are considered lower-income, have chosen to join a Medicare
Advantage (MA) plan, and it is estimated that this bill would decrease
MA enrollment by about 2.3 million individuals in 2013 relative to the
program's current baseline;
It would undermine the Medicare prescription drug program, which
today is effectively providing coverage to 32 million beneficiaries
directly through competitive private plans or through Medicare-
subsidized retirement plans; and
It is fiscally irresponsible, and it would imperil the long-term
fiscal soundness of Medicare by using short-term budget gimmicks that
do not solve the problem; the result would be a steep and unrealistic
payment cut for physicians--roughly 20 percent in 2010--likely leading
to yet another expensive temporary fix; and the bill would also
perpetuate wasteful overpayments to medical equipment suppliers.
In December 2003, when I signed the Medicare Prescription Drug,
Improvement, and Modernization Act (MMA) into law, I said that ``when
seniors have the ability to make choices, health care plans within
Medicare will have to compete for their business by offering higher
quality service. For the seniors of America, more choices and more
control will mean better health care.'' this is exactly what has
happened--with drug coverage and with Medicare Advantage.
Today, as a result of the changes in the MMA, 32 million seniors and
Americans with disabilities have drug coverage through Medicare
prescription drug plans or a Medicare-subsidized retirement plan, while
some 9.6 million Medicare beneficiaries--more than 20 percent of all
beneficiaries--have chosen to join a private MA plan. To protect the
interests of these beneficiaries, I cannot accept the provisions of
this legislation that would undermine Medicare Part D, reduce payments
for MA plans, and restructure the MA program in a way that would lead
to limited beneficiary access, benefits, and choices and lower-than-
expected enrollment in Medicare Advantage.
Medicare beneficiaries need and benefit from having more options than
just the one-size-fits-all approach of traditional Medicare fee-for-
service. Medicare Advantage plan options include health maintenance
organizations, preferred provider organizations, and private fee-for-
service (PFFS) plans. Medicare Advantage plans are paid according to a
formula established by the Congress in 2003 to ensure that seniors in
all parts of the country--including rural areas--have access to private
plan options.
This bill would reduce these options for beneficiaries, particularly
those in hard-to-serve rural areas. In particular, H.R. 6331 would make
fundamental changes to the MA PFFS program. The Congressional Budget
Office has estimated that H.R. 6331 would decrease MA enrollment by
about 2.3 million individuals in 2013 relative to its current baseline,
with the largest effects resulting from these PFFS restrictions.
While the MMA increased the availability of private plan options
across the country, it is important to remember that a significant
number of beneficiaries who have chosen these options earn lower
incomes. The latest data show that 49 percent of beneficiaries enrolled
in MA plans report income of $20,000 or less. These beneficiaries have
made a decision to maximize their Medicare and supplemental benefits
through the MA program, in part because of their economic situation.
Cuts to MA plan payments required by this legislation would reduce
benefits to millions of seniors, including lower-income seniors, who
have chosen to join these plans.
The bill would constrain market forces and undermine the success that
the Medicare Prescription Drug program has achieved in providing
beneficiaries with robust, high-value coverage--including comprehensive
formularies and access to network pharmacies--at lower-than-expected
costs. In particular, the provisions that would enable the expansion of
``protected classes'' of drugs would effectively end meaningful price
negotiations between Medicare prescription drug plans and
pharmaceutical manufacturers for drugs in those classes. If, as is
likely, implementation of this provision results in an increase in the
number of protected drug classes, it will lead to increased beneficiary
premiums and copayments, higher drug prices, and lower drug rebates.
These new requirements, together with provisions that interfere with
the contractual relationships between Part D plans and pharmacies, are
expected to increase Medicare spending and have a negative impact on
the value and choices that beneficiaries have come to enjoy in the
program.
The bill includes budget gimmicks that do not solve the payment
problem for physicians, make the problem worse with an abrupt payment
cut for physicians of roughly 20 percent in 2010, and add nearly $20
billion to the Medicare Improvement Fund, which would unnecessarily
increase Medicare spending and contribute to the unsustainable growth
in Medicare.
In addition, H.R. 6331 would delay important reforms like the Durable
Medical Equipment, Prosthetics, Orthotics, and Supplies competitive
bidding program, under which lower payment

[[Page H6521]]

rates went into effect on July 1, 2008. This program will produce
significant savings for Medicare and beneficiaries by obtaining lower
prices through competitive bidding. The legislation would leave the
Federal Supplementary Medical Insurance Trust Fund vulnerable to
litigation because of the revocation of the awarded contracts. Changing
policy in mid-stream is also confusing to beneficiaries who are
receiving services from quality suppliers at lower prices. In order to
slow the growth in Medicare spending, competition within the program
should be expanded, not diminished.
For decades, we promised America's seniors we could do better, and we
finally did. We should not turn the clock back to the days when our
Medicare system offered outdated and inefficient benefits and imposed
needless costs on its beneficiaries.
Because this bill would severely damage the Medicare program by
undermining the Medicare Part D program and by reducing access,
benefits, and choices for all beneficiaries, particularly the
approximately 9.6 million beneficiaries in MA, I must veto this bill.
I urge the Congress to send me a bill that reduces the growth in
Medicare spending, increases competition and efficiency, implements
principles of value-driven health care, and appropriately offsets in
physician spending.
George W. Bush.
The White House, July 15, 2008.
The SPEAKER pro tempore. The objections of the President will be
spread at large upon the Journal, and the veto message and the bill
will be printed as a House document.
The question is, Will the House, on reconsideration, pass the bill,
the objections of the President to the contrary notwithstanding?
The gentleman from Michigan (Mr. Dingell) is recognized for 1 hour.
Mr. DINGELL. Madam Speaker, for purposes of debate only, I yield 30
minutes to my dear friend, the gentleman from Texas (Mr. Barton).
Madam Speaker, I also yield 15 minutes of my time to my dear friend,
the gentleman from New York (Mr. Rangel), and I ask unanimous consent
that he be allowed to control that time.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
Mr. DINGELL. Madam Speaker, once again, the House has before it an
irresponsible, flint-hearted veto sent by the White House, which has
participated in no way in bringing us to the point where we are today.
The legislation before us is critical to ensuring access to high-
quality physician services for Medicare beneficiaries. If we fail to
override this veto, physicians will face a 10 percent pay cut, which
will jeopardize access to care for seniors and for the disabled. If we
fail to override this veto, low-income beneficiaries will lose out on
additional protections and benefits in the traditional Medicare
programs, such as coverage for more preventive benefits.

{time} 1445

Finally, if we fail to override this veto, we will miss out on an
opportunity to begin addressing the most egregious abuses made by the
private health plans operating under Medicare. Private Fee-for-Service
(PFFS) plans, one type of Medicare Advantage plan, do not have to sign
providers to be a part of their networks. The result of this is that
beneficiaries have no idea which physicians accept payments for their
plans. And if the physician does not accept payment, the physician and
the beneficiary are left holding the bag. These plans create tremendous
uncertainty, confusion and hardships for all concerned, beneficiaries
and providers.
I urge Members to vote to override the President's veto.
Madam Speaker, I reserve the balance of my time.
Mr. BARTON of Texas. Madam Speaker, I ask unanimous consent to yield
15 minutes of the 30 minutes that I control to the ranking member of
the Ways and Means Committee, Mr. McCrery of Louisiana.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BARTON of Texas. Madam Speaker, I rise in support of the
President's veto. I know that's not a popular position to take on this
floor since only 59 Members of this body supported the President when
the vote was to pass the bill a month or so ago, but I think the
position that I take is the right position on policy.
The bill before us, if the veto is not sustained, would delay--and
I'm being charitable to use that verb--the reform of competitive
bidding for durable medical equipment. It would delay that for 18
months, which in all probability would kill a program that would save
billions and billions of dollars if implemented.
We have over 300 successful bidders for durable medical equipment
that are not now going to be able to provide that. We have a program
that, according to the Government Accountability Office, 10 percent of
all the expenditures are for fraud, and we're going to perpetuate that
program. The bill before us delays the reform of competitive bidding. I
think that's a mistake.
The bill before us does prevent a, I believe, 10 percent cut going
into effect for our physicians, and that's a good thing. I don't think
any Member of this body wants our physicians that provide services for
our Medicare and Medicaid beneficiaries to have to take a payment cut.
So that is the one socially redeeming value of this bill. But it
doesn't permanently fix the system, it simply delays the cut for
another year. And next year it will be 20 percent, I think 20.7
percent. So there is no long-term fix for that, it's another kick-the-
can-down-the-road for one more year.
There are some changes in the way pharmacies are reimbursed or are
paid for or priced for their prescription drugs, a reform called
Average Manufacturing Price, which I think is a good reform. We have
had some consultations with the pharmaceutical community and the
pharmaceutical manufacturers about how to actually calculate that
price, but that reform replaced the system that was ridden with
inequity and subject to quite a bit of gamesmanship. The bill before us
would revert, as I understand it, back to the old system, which I think
is a mistake.
So I know it's not politically popular to say we ought to stand on
principle and do the right thing, but that's the position that I'm
taking. I think that's the position the President is taking. So when
the vote comes, I would hope that people would look at the underlying
issues and vote to sustain the President's position on this, which is
the position that's the best public policy for all Americans.
I haven't talked about Medicare Advantage. My good friend from
Louisiana I think will make those points, but it's obvious that this
bill significantly impacts, in a negative way, Medicare Advantage,
which is a program that 10 million of our senior citizens have chosen
to participate in to receive their Medicare benefits.
With that, Madam Speaker, I reserve the balance of my time.
Mr. RANGEL. Madam Speaker, I ask unanimous consent that the remainder
of the time that I use be yielded to Mr. Stark, the chairman of the
Subcommittee on Health, and he would have the right to distribute it to
Members that he recognizes.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New York?
There was no objection.
Mr. RANGEL. Madam Speaker, I rise in support of the veto, of the
President demonstrating once again a reckless, mean-spirited disregard
of the health of our children, our poor folks, and now the aging. And
yet I stand on the floor proud of the fact that we're on the brink of a
new day, where people like Chairman Stark, working with Chairman
Dingell and Chairman Pallone, will be able to create a system where,
whether you're old or young or live in rural or urban areas, that
health care is going to be a priority, and we don't have to come to
this floor and fight each other as to who can be the meanest in denying
people health care.
And so I just want the people to know that this really isn't a
question of Republican and Democrats because, to some extent, we're
united in sending a message to the President: Think about what you're
doing to the American people and try to help us to move forward. I hope
I'm not violating the rules by saying that.
When Ted Kennedy got out of his sick bed and walked over to the
Senate

[[Page H6522]]

floor, it wasn't a Democratic Senator speaking to a bipartisan Senate.
It was the voice of someone who has demonstrated compassion for all of
the things that all of us believe in. As a result of that, he has
brought us together. Let us stay together; and let's send a message to
the President, his days of doing us harm are very, very limited.
I yield the balance of my time to Chairman Stark.

Announcement By the Speaker Pro Tempore

The SPEAKER pro tempore. The Chair will remind Members to avoid
making improper references to the President.
Mr. McCRERY. Madam Speaker, I yield myself so much time as I may
consume.
Madam Speaker, I'm glad that you admonished Members to not improperly
invoke the President's name. I don't think Chairman Rangel really
thought through what he said there at first about the President being
mean-spirited with this veto. I disagree with the policy in this bill,
but I don't think Mr. Stark or Mr. Dingell or any of my colleagues were
mean-spirited in putting together flawed policy. And I think the more
that we recognize that we're all here, including the President, for the
same reason, and that's to make this country a better place, the
quicker we will get on to solving the bigger problems of the country on
a bipartisan basis. So I appreciate the Speaker's admonition.
As I say, I don't agree with the policy that's in the bill, but I do
commend those who worked on solving at least the immediate problem of
the pending cut to physicians. It is an intractable problem, very, very
difficult for us to deal with, both substantively and politically. So I
recognize that this was a tough process, a very difficult process to
bring legislation to the floor that at least solved the immediate
problem. But I think this bill represents missed opportunities. I think
it is premised on false choices, and surely does nothing to protect the
long-term solvency of the Medicare program, which we are going to have
to tackle eventually in the Congress.
I support reversing the physician pay cuts that are scheduled under
current law, but there is a right way to do it and a wrong way. I think
this bill represents the wrong way. According to CBO, more than 2
million seniors will lose the Medicare health plan that they have today
if this bill becomes law.
Now, as these provisions are fully implemented, I believe Members of
Congress will begin hearing from seniors around the country, angry,
confused, wanting to know why we passed a bill that has taken away
their health care plan. The last time we made changes that negatively
impacted these kinds of plans, we certainly heard from seniors in our
offices, and they were not happy.
Now, maybe if in this bill we permanently fix the problems of the
flawed Sustainable Growth Formula, then we might be willing to make
that trade to put up with a few angry seniors because we really did
something the right way, we permanently fixed the problem. But this
bill doesn't do that; it is another just-kick-the-can-down-the-road.
And, in effect, we make the problem worse because, as my colleague from
Texas said earlier, the next time Congress has to address this in just
a year from now, the physicians will be facing a 20 percent cut in
reimbursement. That's what this bill puts in place. That's what this
bill sets up the Congress for in about a year.
So I don't believe that the policy that is used in this bill to pay
for this temporary fix is the appropriate policy. And I believe seniors
will not be happy with us for having just used their health care plans
to kick this can down the road.
Now, I'm retiring, Madam Speaker, at the end of this Congress; I
won't be here next year. But I am hopeful that sooner, and not later,
Members of the House and Senate, on a bipartisan basis, will decide
that year-to-year rentals of this patch no longer make sense and roll
up their sleeves in a concerted effort to develop a long-term solution
to ensure that the Medicare program will be able to serve seniors for
generations to come. I don't hold any hope that we're going to do that
this year, but I do believe that this legislation, if there is a silver
lining, by creating this even higher cliff for physicians, will
probably get Congress closer to that bipartisan cooperation to solve
the problem.
With that, Madam Speaker, I reserve the balance of my time.

General Leave

Mr. DINGELL. Madam Speaker, I ask unanimous consent that all Members
have 5 legislative days in which to revise and extend their remarks on
the legislation before us.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
Mr. DINGELL. Madam Speaker, I yield 2 minutes to my distinguished
colleague and friend, Mr. Pallone, chairman of the Health Subcommittee
of the Commerce Committee.
Mr. PALLONE. Madam Speaker, last week, Congress sent to the President
a commonsense proposal that passed both Chambers with strong bipartisan
support. The bill that we sent to President Bush was a balanced
approach that would keep Medicare working for America's seniors,
doctors and taxpayers.
This bill makes a number of improvements to Medicare that have been
long overdue. The bill expands access to services for beneficiaries and
provides additional financial assistance for low-income seniors. This
bill also staves off the 10.6 percent cut to physicians' payments that
are being implemented right now by CMS.
What this bill does not do is make drastic cuts to Medicare
Advantage; it makes very modest and sensible reforms to the program.
Now, do I think that we should do more to reform Medicare Advantage?
The answer is yes. Because the Bush administration has created a bias
in favor of Medicare Advantage.
I would like to make reference to yesterday's New York Times
editorial called Medicare's Bias. It says, ``Many of the private plans
that participate in the huge government-sponsored health insurance
program for older Americans have become a far too costly drain on
Medicare's overstretched budget.''
``These private plans--that now cover a fifth of the total Medicare
population--receive large subsidies to deliver services that
traditional Medicare provides more cheaply and more efficiently by
paying hospitals and doctors directly. Congress was right--for reasons
of equity and of fiscal sanity--to pass a bill that would at least
begin to remove some of these subsidies.''
Madam Speaker, now is the time to vote to protect health care for the
elderly and disabled. Now is the time to vote to protect fair
reimbursements for our Nation's doctors and pharmacists. And now is the
time to vote to protect Medicare. Now is the time to vote to override
the President's misguided veto.
Mr. BARTON of Texas. Madam Speaker, I yield 1 minute to the
distinguished minority whip, Mr. Blunt of Missouri.
Mr. BLUNT. Madam Speaker, I thank the gentleman for yielding and for
his leading this debate today.
I think we all know what's going to happen today, but we don't know
what this debate is all about. The gentleman just mentioned that one
out of five people on Medicare now take advantage of Medicare
Advantage. This is not a debate about the insurance companies and the
doctors, this is a debate about competition.
Now, there is a legitimate division on the floor of this House about
whether competition and patient choice is part of the key to the future
of Medicare.

{time} 1500

I believe it is, and I think we could have taken care of the
providers in a way that didn't step in and impact competition. In my
district alone--and, in fact, in rural districts and minority
districts, that's where that one out of five Americans live. In my
district alone 28,000 people take advantage of the opportunity to be
part of Medicare Advantage. Half of them take advantage of the
opportunity to select their own doctor. That opportunity goes away if
this bill becomes law.
I intend to vote ``no'' today not because I don't respect the
providers but because I think this is a terrible way to solve this
problem that could be solved otherwise.
Mr. STARK. Madam Speaker, I yield myself 2 minutes.
I would like to concur and respond to my friend from Louisiana, we
are just

[[Page H6523]]

kicking the can down the road, but we have been doing that under his
party's leadership for the past 8 years or so. And the truth is that
none of us, the distinguished ranking member, the distinguished ranking
member of the Health Subcommittee, the distinguished Chair of the
Health Subcommittee, have any idea how we're going to solve this
physician reimbursement for the long run, and we don't have time. But I
think we have all agreed on a bipartisan basis that it is an issue that
we have to address as quickly as possible. So we do recognize that this
is a temporary fix, and we do recognize the serious problem of
reimbursing physicians, but I don't think there's any chance that we
could get that done in the time left to us in this session.
And some of the things that we have added, not all of the things we
have passed in the CHAMP Act, but there is mental health parity for
seniors, which means that they no longer have to pay a 50 percent co-
pay for mental health but a 20 percent co-pay, as they would for other
services. There are preventative care opportunities for Medicare
beneficiaries. There is support for low-income beneficiaries. There is
work toward resolving medical disparities, an issue which is of concern
to many people in this country. There is electronic prescribing, e-
prescribing, as it's called, which we think will be safer and more cost
effective in the distribution for pharmaceuticals.
As to the durable medical equipment bidding, I want to correct a
statement made earlier. It isn't going to cost the taxpayers anything.
The CBO has told us that the way this bill is designed, the durable
medical equipment providers will pay for this at their option to take
an across-the-board cut in their reimbursement rather than have a
bidding system which they felt was unworkable and not realistic.
The SPEAKER pro tempore. The gentleman's time has expired.
Mr. STARK. I yield myself an additional 30 seconds, Madam Speaker.
So while I think that it's not everything that we wanted and that we
voted for in this House on a somewhat less strong bipartisan basis a
year ago, we have made some bipartisan steps down the road. We got
bipartisan support in the Senate. And what I hope, recognizing that
many of us would do each of these things somewhat differently, a vast
majority of us here and in the other body have come together as I have
not seen in the past 10 or 12 years to work out a bipartisan agreement
to proceed, and I hope that is a harbinger of the future.
Madam Speaker, I reserve the balance of my time.
Mr. McCRERY. Madam Speaker, I yield 2 minutes to the distinguished
ranking member of the Health Subcommittee of the Ways and Means
Committee, the gentleman from Michigan (Mr. Camp).
Mr. CAMP of Michigan. I thank the gentleman for yielding.
Madam Speaker, this is not some huge legislative victory, as some
would suggest. Instead, it's about maintaining the status quo.
I am committed to finding a way around this unworkable physician
payment system that we have now, which rewards volume over quality.
Every 15 minutes doctors have to see somebody else. That system's just
plain wrong. But let's be honest. This bill only buys us about 18
months, and where has that gotten us before, as the gentleman points
out?
I would like to quote the distinguished chairman of the Ways and
Means Health Subcommittee, who said back in 2006: ``I am glad that this
bill includes a temporary update for physicians, giving us a little
breathing room heading into next year. But we're still going to have to
do some very heavy lifting in order to dig ourselves out of the $250
billion hole Republicans created by kicking the can down the road the
last few years. In the next Congress, I hope my colleagues on the other
side of the aisle work with me to address this problem once and for
all.''
Well, now we can add Democrats to the list of those digging the hole
and kicking the can down the road. And at what cost? CBO estimates that
up to 2 million seniors, mostly low income, will permanently,
permanently, lose their current health coverage under this bill for a
temporary 18-month increase in pay for physicians. Not addressing any
of the longstanding problems in terms of rewarding value and not
volume.
I can't in good conscience support this bill that pits seniors
against physicians. It's a lose-lose proposition and I will vote to
sustain the President's veto.
Mr. DINGELL. Madam Speaker, I yield myself 15 seconds.
My colleagues on the other side talk about Medicare Advantage.
Medicare Advantage gets somewhere between 11 and 30 percent more than
they are supposed to get and more than regular Medicare gets. That's
absolutely wrong. If we support this veto, we would continue that
outrage. This is something that needs to be corrected.
Madam Speaker, I am now happy to yield to my dear friend, the
distinguished majority leader, Mr. Hoyer, for 1 minute.
Mr. HOYER. I thank the chairman for yielding and would observe, as I
have before on this floor, that there is no Member of this House who
has been involved any more deeply, any more passionately, any more
effectively to protect, preserve, and expand the availability of health
care to the American people more than my friend John Dingell, the
chairman of the committee. I want to congratulate him. Not only has he
done that, but his father before him did that as well.
Madam Speaker, last week we watched as Senator Ted Kennedy returned
from the treatment of his brain cancer to cast his vote in favor of
this vital Medicare bill. I don't have to tell you how many of us in
both Chambers were moved to see that lifelong crusader for health care
come back to cast one more vote for America's seniors.
With that as inspiration, the Senate joined the House in voting by
overwhelming margins for legislation that would and does replace a 10.6
percent payment cut for thousands of doctors in Medicare with a 1.1
percent increase, a cut that would put at risk coverage and
availability of doctors for our seniors. The bill extends expiring
provisions and bonus payments critical to rural communities and
providers. The bill expands the preventive services that are available
to our seniors. The bill phases mental health parity into the Medicare
program. And it improves protections and assistance programs for our
low-income seniors, about whom all of us are concerned.
Three hundred and fifty-five of us in this House voted to pass this
legislation. Three hundred and fifty-five in an overwhelming bipartisan
vote which said this is good legislation, our people need it, and we're
going to pass it. Sixty-nine Members of the United States Senate stood
up and supported this piece of legislation. And I was pleased to see so
many Republicans lining up with us. This is an overwhelmingly
bipartisan bill as it was sent to the President of the United States.
Preventing these Medicare cuts isn't a Republican issue or a
Democratic issue. It's an issue of protecting and preserving the health
care that over 44 million seniors count on, depend on, and, yes,
deserve. And our message to the President was unambiguous: We will
stand with our seniors and our health care providers, our military
families and our disabled. And when it comes to protecting and
preserving the health care they depend on, we will put aside party
politics and we will stand together. Three hundred and fifty-five of
us, sixty-nine in the Senate.
Today President Bush decided that the overwhelming majority of the
Congress was wrong. He will have to explain, however, to America's
seniors why he was so willing to stand between them and their health
care.
But, thankfully, we don't have to take ``no'' for an answer.
Thankfully, the Constitution provides us with the ultimate policy-
making authority. And I expect, hope, and urge that the 355 of us that
stood for this legislation just a short time ago will do so again
today, not in opposition to the President but as a proponent of
legislation which seeks to solve a problem and to provide health care
for our seniors.
I urge my colleagues on both sides of the aisle to override this
misguided veto. And with their support, this bill for our seniors will
become law and they will be better for it.
Mr. BARTON of Texas. Madam Speaker, I want to yield 3 minutes to a
member of the Energy and Commerce Committee, the gentleman from
Michigan (Mr. Rogers).

[[Page H6524]]

Mr. ROGERS of Michigan. Madam Speaker, I rise with a little bit of
apprehension today, but this is really a horrible way to do what we're
trying to do today, and we've known that every year certainly since I
have been a Member of Congress. I think this is my eighth time trying
to fix what is really a bad system of telling doctors every year you're
going to be cut unless we do something. A horrible system. I think we
all agree we have to do something.
But something really spectacular happened today and I don't think in
a good way. For the first time since I've been in Congress, we've
decided that we're going to fix it as we have every single year since I
have been here except we are going to cut senior citizens off from
their programs in Medicare, for the first time since I have been here,
and that we're going to do that today. And I scratch my head a little
bit. We have always been able to come together in a bipartisan way and
say we can fix it for the doctors without taking it out of the seniors.
We don't have to punish the patients to help the doctors. And I know
they can get on planes and they are doing okay financially and they can
fly here and lobby us and talk to us and get in our ears, and that's
important. And you know what? They should. Because every single year we
tell them don't invest in your company because we are not going to tell
you their business, their business of providing medical services. Don't
invest in that because we're not sure if we are going to cut you 10
percent or give you 2 percent. Pretty hard to make that investment
decision to go to health information technology that we know will save
lives or add a new staff member that they know they might be not able
to pay for if we don't get our act together, which tells us why this
system is so horrible. But because we failed to act, this Congress
failed to act, I think the provision starts tomorrow with a 10 percent
cut. We said 2 million poor seniors in this country, you're going to
get a letter in the mail that says you no longer have service under
Medicare Advantage. Think about the fear and the confusion. Do we have
to do that? Is that the best that we can do here in this Chamber and
call it a bipartisan effort?
Ten million seniors depend on Medicare Advantage. They voluntarily
signed up. And after this bill, 200,000 of them that live in Michigan
will have fewer choices, reduced benefits, higher out-of-pocket costs.
Half of the Medicare Advantage enrollees have incomes below $20,000 a
year. Imagine the fear when your electric bills are going up because we
haven't done anything here in this Congress, when your gasoline prices
are over $4 and maybe your kids don't even come to see you anymore.
But, oh, by the way, we are going to give you this letter and we are
going to celebrate that in a bipartisan way we have stood up and said
the heck with you, you're going to have to deal with it on your own,
you 10 million seniors. Can't we do better? I think we can.
So when the President vetoed this, it wasn't about mean spiritedness
and taking things away and we're not going to help those seniors. It
was about please renegotiate. If for the last 7 years we could come
together and say we can help you doctors without punishing you senior
citizen patients, why can't we do that today? It's the first time that
we have had to do that since I have been in Congress. I know we can do
better. And when you're done, think of this: Fully 70 percent are
minorities making under $20,000 on Medicare Advantage.
The SPEAKER pro tempore. The gentleman's time has expired.
Mr. BARTON of Texas. Madam Speaker, I yield the gentleman an
additional 30 seconds.
Mr. ROGERS of Michigan. I thank the chairman.
Madam Speaker, 70 percent are minorities making under $20,000.
They'll get that letter in the mail. I doubt that they'll be
celebrating the warmth and the fuzzy feeling that we are all feeling
today because 355 people tried to read a bill that we only had 24 hours
to read.
Please, sustain the President's veto. It doesn't mean it's over. It
means we get to negotiate a bill that protect doctors, as they should,
allows them to make investments in the future of health information
technology and other things without facing a 20 percent cut. By the
way, if we did nothing, it would be a 15 percent cut by the end of next
year. Because of this bill, it's a 20 percent cut.
We have to do better. I will vote to sustain. I would urge you to
sustain the President's veto.

{time} 1515

Mr. STARK. Madam Speaker, I would like to yield 1 minute to the
distinguished gentleman from California (Mr. Becerra).
Mr. BECERRA. I thank the gentleman for yielding.
Madam Speaker, over 1 year ago, we were trying to figure out how we
would resolve this situation where seniors were on the verge of losing
access to their doctor and where doctors were fretting whether they
would be able to get enough reimbursement to be able to continue to
offer services to these seniors. And it's very difficult to come to
consensus.
We almost went over the cliff. That 10 percent cut to doctors almost
came to be. But today we have a chance after the President's veto to
make sure that doctors will get their payment, seniors will get their
services and then we can all move forward to try to deal with the major
reforms to Medicare that we must make. Three hundred fifty-five to
fifty-nine. That was the vote in the House some 3 weeks ago to pass
this legislation. Sixty-nine to thirty in the Senate.
It's not often that you get a strong vote in the House. It's not
often that you get a strong vote in the House and the Senate. This is
bipartisan. This is bicameral. It is the type of consensus we need. We
did something for our seniors who are modest income. We did something
to make sure that we have better oversight over those doctors that are
unscrupulous. And at the same time, we did this without adding a single
cent to the deficit for a Federal budget which right now is in the hock
for $400 billion. This is the right way to go. We will overturn the
President's veto on a bipartisan basis.
Mr. McCRERY. I yield 3 minutes to the gentleman from Kansas (Mr.
Moran).
Mr. MORAN of Kansas. I thank the gentleman from Louisiana.
Madam Speaker, I voted in favor of H.R. 6331 and will vote to
override the President's veto today. This is a very important piece of
legislation for those of us who care strongly about our communities and
their survival. And in rural America the delivery of health care is in
jeopardy. The pharmaceutical aspect of this bill is one that perhaps
has been understated. But those of us who care about the community
pharmacists believe that the direction that this bill provides in
requiring a timely payment through prompt payments under part D and the
elimination for 1 year of the average manufacturers' price, which will
undercut the ability of pharmacists to deliver prescription drugs under
Medicaid, and the elimination of bidding for durable medical equipment
is awfully important.
Much of the focus is upon the elimination of the 10 percent reduction
in reimbursement to our physicians for Medicare. And I want to quote
from one of my physicians back home in Kansas in a letter to me dated
July 7. ``It is with mixed emotions that I am writing to inform you of
my intent to leave my Family Medicine practice in Kansas. I have
reached the point where I am no longer willing to expose myself or my
family to the risk of having to rely upon an increasingly unreliable
(and poor) source of income; specifically Medicare. I do not have the
margin to absorb others' incompetence or our government's capricious
reimbursement. I am no longer willing to be a pawn in the ideological
chess match in Washington and therefore as of today I will no longer
accept Medicare patients.
``I am at a point in my career where I must consider my family as
well as my retirement. We once again have been threatened with an
across-the-board 10 percent cut. Congress and the Medicare system are
taking advantage of good-intentioned physicians who are more interested
in caring for patients and upholding and honoring the Hippocratic Oath
than lining their pockets. I feel a sense of guilt, as though I am
betraying my Medicare patients. I have realized, however, that it is
not I that has betrayed the elderly, rather Congress.''

[[Page H6525]]

I think it's important for us to move forward with this legislation.
It's a matter of survival for the delivery of health care to many
seniors, particularly those who come from places like I do where the
population is Medicare dependent. And I appreciate the gentleman from
Louisiana giving me the opportunity to express my position and to
indicate once again that I will override President Bush's veto.
Mr. DINGELL. Madam Speaker, at this time, I'm happy to yield to the
distinguished gentlewoman from Colorado (Ms. DeGette) 2 minutes.
Ms. DeGETTE. Madam Speaker, although these much-needed updates for
physician payments are the crux of today's bill, numerous improvements
to the Medicare program and beneficiary protections are also included.
It also provides incentives for physicians to use e-prescribing
technology, and it extends and vastly improves low-income-assistance
programs for very-low-income Medicare beneficiaries.
And it includes a 2-year reauthorization of the Special Diabetes
Programs for Type 1 diabetes and for American Indians, which has been a
priority of the Congressional Diabetes Caucus for many years. Thanks to
over a decade of investment in the Special Diabetes Programs, we can
point to tangible and significant progress, such as the creation of an
artificial pancreas, that is improving the lives of many people.
And this multiyear reauthorization was just what we needed. I want to
talk for a minute about Medicare Advantage though. Medicare Advantage
was originally conceived of as a way to save money in the Medicare
system. But the way it has evolved over the years, we now have 13
percent overpayments to the insurance companies that administer
Medicare Advantage. There is no evidence that this money goes to the
senior citizen beneficiaries. And there is further no evidence that if
we cut these overpayments that these senior citizens are going to lose
their insurance, because there is no evidence that they're getting that
13 percent overpayment.
Now I would suggest if there was a 13 percent overpayment to the
traditional Medicare program, the other side would be having a fit
because we would just be throwing money away. But, according to them,
it's all right if we throw 13 percent away and give it to private
insurance companies.
In my opinion, we need to bring our entire Medicare program into
balance no matter how it is being administered. We need to be sure that
it's ministered efficiently. And ultimately, we need to restore balance
to our entire health care system. Vote ``yes'' to override this veto
and restore the physician payments.
Mr. BARTON of Texas. Madam Speaker, could I inquire as to the time
remaining on the four sides.
The SPEAKER pro tempore. The gentleman from Texas has 7 minutes, and
the gentleman from Michigan has 8. The gentleman from Louisiana has
5\1/2\, and the gentleman from California has 9\1/2\.
Mr. BARTON of Texas. Madam Speaker, I don't have any speakers at this
time, so I will reserve the balance of my time.
Mr. STARK. Madam Speaker, I'm pleased to yield 1 minute to the
distinguished gentleman from North Dakota (Mr. Pomeroy).
Mr. POMEROY. I thank the gentleman for yielding.
This debate has a familiar feel. Once again the President has vetoed
legislation important to rural America, legislation that was supported
by a broad bipartisan consensus in this body. We saw the same thing in
the farm bill, overrode him once, overrode him twice, and we need to
override today as well. Those that argue that rural interests are best
served by standing with the President's position on this are arguing
that we ought to pay insurance companies more, cut doctors, cut
hospitals and somehow this produces a better health result. It doesn't
stand up.
This bill provides very important reimbursements, not just to
physicians, but also to struggling rural facilities representing the
infrastructure for health care in rural America. Passing this bill and
overriding the veto addresses physician payments. It addresses
critical-access hospitals. It addresses sole-community hospitals. It
addresses rural ambulance services. It addresses rural pharmacies. That
is why the Rural Health Care Association supports the bill. It is why
the Rural Health Care Coalition supports the bill. Please vote to
override.
Madam Speaker, I rise in strong support of overriding the President's
veto of H.R. 6331, the Medicare Improvements for Patients and Providers
Act, legislation that strengthens the Medicare Program and maintains
our commitment to rural America.
With an estimated 40 percent cuts in physician payment reductions
under Medicare expected by 2016, Medicare's physician payment system is
clearly broken. Because of the flawed Sustainable Growth Rate, 2008
Medicare physician payment rates are about the same as they were in
2001. This has prevented some physicians and the hospitals who employ
them from making needed investments in staff and health information
technology as well as created a great deal of uncertainty and
instability for physicians and hospitals as they run their businesses.
H.R. 6331 takes an important step forward by reversing these
previously scheduled cuts in Medicare payments over the next 18 months
while also providing a 1.1 percent update for 2009. This translates to
at least $30 million for North Dakota's doctors and hospitals over the
next year and a half, bringing relief for many of our struggling
hospital systems. I am hopeful that these 18 months will give Congress
the time it needs to make commonsense and much needed reforms to the
SGR system so that North Dakota hospitals and doctors will have the
fairness and stability in Medicare payments they deserve.
H.R. 6331 also makes a strong commitment to maintaining access to
important rural health services by investing in $3 billion in our
vulnerable rural health care delivery system. Rural America continues
to be challenged by shortages of health care providers, barriers to
health care access, and geographic isolation. In my own home State of
North Dakota, approximately 80 percent of the State is designated as a
partial or full county Health Professional Shortage Area. In order to
address these unique challenges, the Medicare Modernization Act (MMA)
enacted special payment enhancements to make sure that rural health
care facilities and providers have the resources they need to deliver
quality care in their communities.
Unfortunately, many of these important provisions have expired and
further assistance is needed to ensure that seniors living in rural
America have access to quality, affordable health care. That is why
Representative Greg Walden and I, as co-chairs of the bipartisan Rural
Health Care Coalition, introduced H.R. 2860, the Health Care Access and
Rural Equity (H-CARE) Act, legislation that addresses these and other
barriers to quality health care by recognizing the unique
characteristics of health care delivery in rural areas and assisting
rural health care providers in their efforts to continue to provide
quality care to rural Americans.
I am pleased that the Medicare Improvements for Patients and
Providers Act (MIPPA) of 2008 incorporates many important provisions
from H-CARE that will do much to protect the fragile rural health care
safety net. More specifically, MIPPA will do the following:
Ensure that rural doctors are paid the same rate for their work as
their urban counterparts by extending the 1.0 work floor on the
Medicare work geographic adjustment applied to physician payments
through 2009, bringing in $9 million to North Dakota;
Improve Medicare reimbursements for Critical Access Hospitals by
directly increasing payments for critical lab services performed
outside the hospital that will benefit North Dakota's 34 CAHs;
Boost reimbursements to sole community hospitals by updating the data
used to calculate their Medicare reimbursements;
Protect access to rural ambulance services by providing rural
ambulance providers an additional three percent of their Medicare
reimbursement in order to help cover their costs;
Require prompt payment to rural pharmacies by Medicare prescription
drug plans;
Extend a provision that allows 19 North Dakota hospital-based labs to
directly bill Medicare for pathology services;
Expand access to telehealth services by allowing hospital-based renal
dialysis facilities, skilled nursing facilities, and community mental
health centers to be reimbursed under Medicare for telehealth services;
Reauthorize and expand the FLEX Grant Program to include a new grant
program that could mean up to $1 million to Richardton, North Dakota,
as they convert from their status as a Critical Access Hospital; and
Extend Section 508 of the Medicare Modernization Act which provides
nearly $10 million a year to North Dakota hospitals to give them the
resources they need to compete in an increasingly competitive labor
market.
The Medicare Improvements for Patients and Providers Act is a good
bill that has been endorsed by the National Rural Health Association
and deserves every Member's support.

[[Page H6526]]

We should quickly override this veto so that our health care providers
can get back to their business of caring for our seniors without the
uncertainty that has been hanging over their heads for the last 2
weeks.
Mr. McCRERY. Madam Speaker, I reserve the balance of my time.
Mr. DINGELL. Madam Speaker, at this time I yield to the distinguished
gentlewoman from California (Ms. Solis) 2 minutes.
Ms. SOLIS. Madam Speaker, today I rise with my colleagues to support
the overriding of the President's veto on this legislation that will
protect our seniors. Did you know that over 44 million vulnerable
Medicare patients are depending on us to pass this bill? By vetoing the
legislation, President Bush is ignoring the needs of our seniors, the
disabled individuals and our doctors.
Less than a month ago, Congress passed the bill by a margin of 355-
59. I voted for the bill so I could help ensure that 70,000 Medicare
beneficiaries, patients in my district, would be able to receive their
continued health care. The bill includes programs that help low-income
Medicare patients, including low-income Latinos. Although Latinos make
up only 6 percent of the overall Medicare beneficiaries, more than 14
percent are considered low-income seniors. Allowing a 10 percent cut
would be devastating to patient providers practicing in communities
like mine in East Los Angeles.
I have heard from many of my constituents that some California
physicians, even in my own district, are considering not taking any
more Medicare patients because of the inadequate reimbursement rate.
Even less access would be imposed upon a community that is already
faced with health care disparities and being able to access health
care. Organizations across the country understand the importance of
this piece of legislation including AARP and the American Medical
Association.
I encourage all of my colleagues, Members of Congress, to help us
override the President's misguided veto and to stand first and foremost
for our seniors and those disabled Americans that are counting on our
work here in the Congress.
Mr. STARK. Madam Speaker, I am delighted to recognize the gentlelady
from Ohio (Mrs. Jones) for 1 minute.
Mrs. JONES of Ohio. I thank the gentleman for yielding.
I know sometimes we stand on this floor and we talk about health care
for seniors in isolation. I stand here among my colleagues with many
like me who have lost both of their parents. And but for Medicare and
the services they received, their last health care probably would not
have been as good or as great. We can stand here and talk about, well,
the President didn't want to hurt anybody by overriding the veto. And
we can stand here and talk about long-term policy down the line. But
what we can't talk about is the health disparities that exist in our
country and the study that was recently released that talked about
minorities have more amputations than any other group of folks in
America. And it doesn't talk about the issue of diabetes that overrides
the minority communities across this country. Come on, y'all, let's get
a life. Let's wake up, and let's help these seniors by overriding this
veto.
And if we want to talk about better health care, better policy down
the line, then let's do it. But let's not do it on the backs of the
seniors who have worked all of their lives in order for us to be here
to even be in Congress. Thank God I had a mom and a dad.
Mr. DINGELL. Madam Speaker, at this time, I yield to the
distinguished gentlewoman from California, the vice chairman of the
Subcommittee on Health, Mrs. Capps, 2 minutes.
Mrs. CAPPS. Madam Speaker, I rise in strong support of this veto
override. It is apparent that President Bush has chosen to ignore the
will of the American people and an overwhelming bipartisan majority in
the House and the Senate. He would rather cozy up to his friends in the
insurance industry than improve access to health care for our seniors,
our frail seniors, and those with disabilities.
I am proud to support H.R. 6331, our seniors and our health care
professionals who need this legislation. Yes, this is an 11th-hour fix,
so it is not the best way to do business here. It allows me to express
a strong word of appreciation for our Chairman Dingell and chairman of
the subcommittee, Mr. Pallone, for their leadership in bringing to the
floor and supporting a long-term solution which we passed in this House
last year, known as the CHAMP Act, a comprehensive way to deal with
challenges for our seniors on Medicare.
It is a solution that will bring us to where we should be in the
long-term for reimbursing our physicians and those who provide
services. So until we have a new administration in the White House, we
have to do what we can to protect physicians and to protect their
patients. H.R. 6331 does the right thing by preventing a 10 percent cut
in reimbursements. And we all know the stories of our senior citizens
who fear the loss of their provider, particularly in hard-to-serve
areas like rural America.
I urge my colleagues to do the right thing, to vote to override the
President's veto.

{time} 1530

Mr. STARK. Madam Speaker, I am pleased to yield 1\1/2\ minutes to the
gentleman from Illinois (Mr. Emanuel).
Mr. EMANUEL. Madam Speaker, this isn't the cure-all for everything,
but it is a step in the right direction, and we should take note.
It cracks down on fraud in Medicare which is one of the ways we make
payments to doctors and seniors. It ensures that we don't overpay
health insurance companies for the care you get for less money. It
begins us on a process to make sure that we have an e-prescribe system.
And most importantly, what this does is preserve the doctor and senior
patient relationship. This is the right step to do.
Not only are we taking this step in helping Medicare and preserving
the relationship between doctors and patients, it builds on the
progress we have made by restoring $14 billion to veterans' health
care.
Also, just the other day we reversed six of the President's rules and
regulations as it relates to Medicaid. Unfortunately, we haven't taken
that step as it relates to 10 million children and their health care
program.
But this Congress, from Medicare to Medicaid to our veterans, has
begun to take the steps that are necessary, that are important to
health care reform, to ensure that people have access to the doctors
that they need and the system that we have that once again preserves
the relationship between doctors and patients.
So on a host of fronts, whether you want to crack down on fraud,
whether we want to make sure that we are not overpaying insurance
companies, whether we want to make sure we are preserving the
relationship between doctors and their patients, this is the right step
in the right direction, and I am proud that it is done in a bipartisan
fashion, once again putting the American people first.
Mr. DINGELL. Madam Speaker, I yield at this time to the distinguished
gentleman from Pennsylvania (Mr. Altmire) 1 minute.
Mr. ALTMIRE. Madam Speaker, today's vote will be a significant
victory for seniors, their doctors, and home medical suppliers. I am
especially pleased that two important Medicare provisions that I
spearheaded are included in this bill, and after this override will be
enacted into law.
This bill delays for 18 months the ill-conceived Medicare durable
equipment competitive bidding proposal that, if implemented, will do
serious harm to small medical equipment suppliers in western
Pennsylvania and around the country.
This bill also incorporates my legislation to provide prescription
drug coverage to millions of low-income seniors by permanently
eliminating the late enrollment penalty under Medicare part D.
Through his veto, President Bush demonstrates that he does not share
our values on these important issues. But this bill is good for western
Pennsylvania and good for the Nation, and I ask my colleagues to join
me in overriding this veto today.
Mr. STARK. Madam Speaker, I am pleased to yield 1\1/2\ minutes to the
distinguished gentleman from Texas (Mr. Doggett).
Mr. DOGGETT. I thank the gentleman for his leadership.
``Pay more, get less,'' that's the Bush Medicare plan. The
President's veto

[[Page H6527]]

means that taxpayers get an opportunity to pay more unnecessarily to
subsidize private insurers, while seniors and the disabled get less.
Each person in privatized Medicare costs American taxpayers $1,000
more each year than the cost for one relying on the traditional, more
efficient Medicare system. Without change, $150 billion will be wasted
on unnecessary subsidies to highly profitable private insurers. Even
Medicare's only actuary reports absolutely zero quantifiable savings
have occurred through private Medicare, and that savings will never
occur through private Medicare as currently set up, a waste of $150
billion bestowed on the insurers. That's the waste that President Bush
is so intent on protecting through his veto. We take some of that
unnecessary waste and we use it to pay physicians who are working hard
and ought not to have a cut in their reimbursement rates, and more
importantly, for the many people around this country who rely on those
physicians to care for them.
The Administration has refused time and again to offer us any
legislative fix on this waste in the so-called Medicare Advantage plan,
which is nothing but a disadvantage to American taxpayers and Medicare
recipients.
Today, we must overcome this continued obstructionism of the
Administration and its allies here in the Congress. We should reject
wasteful corporate welfare, protect our physicians, and override this
veto.
Mr. DINGELL. Madam Speaker, I yield at this time 2 minutes to the
distinguished gentlewoman from California (Ms. Eshoo).
Ms. ESHOO. Madam Speaker, I thank the chairman of our committee, Mr.
Dingell, for his leadership on this issue and so many others.
There are two things that relate to health care that absolutely
mystify me. The first is that any President, this President, would
oppose insuring children in the United States of America. Fought that,
fought that, fought that, would not expand and add 10 million children
to the health care rolls in our country. I don't understand any
President of the United States doing that.
And today, we are here to override his veto. Imagine, vetoing a bill
that allows seniors to have doctors take care of them. It's one heck of
a way to gut Medicare. There isn't any Medicare unless there are
doctors to treat the patients. In this case, it is the seniors of our
country.
I am proud that Republicans and Democrats are coming together to
provide the vote to override that bad, bad idea. And it serves the
country well because when we invest in our people, whether they are
children or seniors, we strengthen our Nation.
I thank God for Edward Kennedy and showing his tenacity to get up out
of his sick bed to cast that vote which then injected some iron in the
spine of Members of Congress. So I join with my colleagues gladly and
proudly today to override the President's veto in order to sustain
Medicare, to save money, but more importantly than anything else, to
invest in their precious lives and to celebrate that generation that
all of us hail that made America so strong and so good. Thank you,
Congress, for providing the votes to do so.
Mr. STARK. Madam Speaker, I am pleased to yield 1 minute to the
distinguished gentleman from New Jersey (Mr. Pascrell).
Mr. PASCRELL. We must overturn the President's veto, Madam Speaker.
This time the President has gone too far. He is jeopardizing the health
of over 44 million seniors.
This legislation is in the best interest of Medicare patients,
physicians, pharmacies, and other care providers. Rolling back this
administration's efforts to privatize Medicare is a critical first step
in extending the program's long-term solvency.
In overturning the President's veto of this legislation, Congress has
the unique opportunity to upend the years of this administration's
destructive attempts to privatize Medicare. And if we don't, the risk
of not implementing these modest but necessary Medicare changes is
incalculable.
Low-income families stand to become further removed from basic
medical care, services and drugs. Physicians stand to be forced out of
practice. Pharmacies, overburdened by financial stress, will have to
consider closing their doors or laying off workers, actions that will
only further depress regional economic activity.
As the number of uninsured Americans climbs to new record highs and
the economy continues to struggle, this is called for. We must come
together, both sides of the aisle, and veto what the President has
done.
Mr. STARK. Madam Speaker, I am pleased to recognize the distinguished
gentleman from Wisconsin (Mr. Kagen) for 1 minute.
Mr. KAGEN. Madam Speaker, I rise in support of overriding a veto that
is misguided. And I have the honor of speaking here today for the
nearly 90,000 people in northeast Wisconsin who are covered by
Medicare, people who would otherwise have to pay more money out of
their pocket to the insurance company rather than to where it really
belongs, for their health care.
This is an opportunity to join together as Democrats and Republicans
and do the right thing. Let's override this meaningless veto. Let's
allow our President to do the right thing. President Bush needs our
help; let's help him by overriding this veto.
Mr. STARK. May I inquire, Madam Speaker, are we prepared to close?
Mr. BARTON of Texas. Madam Speaker, the Energy and Commerce
Republicans are prepared to close.
Mr. DINGELL. Madam Speaker, I have one speaker remaining who will
close for us.
Mr. BARTON of Texas. Madam Speaker, I yield myself the balance of my
time to close, and I believe I have 7 minutes, although I don't believe
I will take 7 minutes.
Madam Speaker, I want to try to at least let the American people know
what is going on here this afternoon.
I think everybody on both sides of the aisle are for our health care
providers. We want our doctors to be fairly reimbursed. We want our
hospitals to be fairly reimbursed. We want our pharmacists to be fairly
reimbursed. We want our durable medical equipment suppliers to be
fairly reimbursed. We want our Medicare and Medicaid beneficiaries and
recipients to get quality health care and have the minimum copayments
and out-of-pocket expenses necessary for those services. So we have 435
votes for good health care policy in America.
The bill before us is not a good government bill. It is an
accountability avoidance bill, in my opinion. It is hard to read
exactly what CBO scores this bill, but on subtitle D, provisions
relating to part C, section 161, it says, phaseout of indirect medical
education, that scores over 5 years a saving of $12.5 billion and over
10 years, $47.5 billion. That's a cut.
Now I am told, I can't prove it, but I am told that $20 billion to
$25 billion of that is coming directly out of Medicare Advantage. Those
are reimbursement cuts to the 10 million seniors who have chosen
Medicare Advantage.
Now the statement has been made on the floor that we are overpaying
Medicare Advantage. What happens when there is an overpayment is that
75 percent of that overpayment goes back into the benefit pool for the
Medicare beneficiaries that choose that option, and 25 percent goes to
the U.S. Treasury. It doesn't go to the insurance companies.

{time} 1545

Seventy-five percent of an overpayment is reinvested in benefits for
Medicare Advantage beneficiaries, and 25 percent goes as a savings to
the taxpayers who are providing the funds. That sounds to me like a
pretty good deal.
Now let's talk about the physicians. One of the few good things in
the bill is that we are going to delay the physician reimbursement cut
of 10 percent that was effective this year. It would have been
effective July 1, I believe. That's a good thing.
But is there a reform in this package that sets a different formula
for next year and the next year and the next year? No. Were there
discussions on a bipartisan basis about that? No. Has any effort that I
am aware of really been made to fix that program, to fix that fee
schedule? No.
So what happens on the floor next year? We have a 20 percent cut that
will go into effect if we don't do something between now and July of
next year. That's not good government.

[[Page H6528]]

That's, as I said, accountability avoidance.
Let's talk about the pharmaceutical system. There is a good thing in
this bill, I have to be honest about that. The prompt pay is a good
thing. I support that. But the delay of the average manufacturing price
reform is a bad thing. Is a bad thing.
Now I admit there are some problems with average manufacturing price,
about definitions of what's included in the cost and what kinds of
costs are included, but that's a technical detail that could be worked
out. But to delay a true reform that tries to reimburse pharmacists for
the true cost of the drugs, to me, is another avoidance in
accountability.
Then let's talk about durable medical equipment. GAO says that 10
percent of everything that we pay for durable medical equipment through
Medicare is fraud. What we do is delay for 18 months the competitive
bidding system that we have been working on for over 10 years. Now it
should tell us something that the industry apparently signed off on an
across-the-board cut of about 10 percent in order to avoid competitive
bidding.
That would tell me that we are overpaying right now for durable
medical equipment and oxygen supplies, at least that much, if they are
willing to accept an across-the-board cut instead of competitive
bidding. The 300 suppliers that won the competitive bidding contracts,
they are just out on a limb now. They probably have lawsuit remedies
that will cost the taxpayer billions and billions of dollars more. So
all we are doing is delaying the reforms that we have worked so hard in
the past to implement for 1 year. For 1 year.
Now I understand the politics of that. Any time you tell a
constituency, we're going to give you more money this year, that's
probably a good thing politically. As I said at the start, I'm friends
with the physicians in my district, I'm friends with the pharmacists in
my district, I'm friends with the durable medical suppliers in my
district, and they're good people. They're trying to provide good
services.
But to simply delay some of these reforms for 1 year or 18 months at
the costs that are going to be incurred, as I said at the start of my
closing remarks, that's not good government, that's accountability
avoidance.
I am very happy to support the President's veto. If by some stroke of
good public policy we did sustain the veto, we would be happy to work
with my friends on both sides of the aisle and in the other body to
come up with some true reform, some true changes in public policy that
were permanent and would fix this problem, because, mark my words, if
we don't sustain the veto, we will be back here next year, and we will
probably be doing the same thing that we are doing today.
That's not good government. I hope we will vote to sustain the
President's veto.
Madam Speaker, I yield back the balance of my time.
Mr. STARK. Madam Speaker, I yield myself the balance of my time and
urge a vote to override the veto.
It isn't everything that everybody wants, but it protects 40 million
seniors from losing their access to primary care physicians, and it
gives us time to deal with the reforms that are necessary in an orderly
way.
We should put an end to the overpayment to Medicare Advantage, to
stop giving them a blank check to provide services, which, in many
cases, are second rate. Good managed care plans that are not for profit
and come under the Medicare Advantage plan can exist at 98 percent of
payment. There is no reason to overpay the charlatans who provide
second-rate service and overbill the taxpayers by anywhere from 13 to
40 percent.
We have made some advantages and some benefits come together on a
bipartisan basis to give us time to do the work that we should to make
our Medicare system sustainable, expand its benefits, save money for
the taxpayers and provide the kind of quality medical care to which our
seniors are entitled. I urge a ``yes'' vote to override the veto.
Madam Speaker, I yield back the balance of my time.
Mr. McCRERY. Madam Speaker, I yield myself the balance of my time.
I want to talk about two things quickly in closing. There has not
been much said during this debate about part of the President's veto
message that I think is important. So I am going to read that section
from the veto message. It concerns the prescription drug program. The
President says, ``The bill would constrain market forces and undermine
the success that the Medicare Prescription Drug Program has achieved in
providing beneficiaries with robust, high-value coverage--including
comprehensive formularies and access to network pharmacies--at lower-
than-expected costs. In particular, the provisions that would enable
the expansion of ``protected classes'' of drugs would effectively end
meaningful price negotiations between Medicare prescription drug plans
and pharmaceutical manufacturers for drugs in those classes. If, as is
likely, implementation of this provision results in an increase in a
number of protected drug classes, it will lead to increased beneficiary
premiums and copayments, higher drug prices, and lower drug rebates.
These new requirements, together with provisions that interfere with
the contractual relationships between part D plans and pharmacies, are
expected to increase Medicare spending and have a negative impact on
the value and choice that beneficiaries have come to enjoy in the
program.''
I think that is an important consideration as we decide whether to
sustain or override the President's veto.
Just one other item, and that's this question of paying the insurance
companies more than the regular Medicare reimbursement. That has been
often stated but still is not the case. By law, the margin over the
regular Medicare payments have to go in these plans to beneficiary
services or reduction of premiums or go back to the trust fund. That
extra margin does not go to the insurance companies.
In fact, GAO did a study of the margins of profit of these insurance
plans and Medicare Advantage and found that the average margin of
profit was 5 percent, a margin that is considerably lower, I might add,
than some other sectors of Medicare services. I just wanted to clear
that up and urge all of my colleagues to consider this vote very
carefully and urge them to sustain the President's veto.
Madam Speaker, I yield back the balance of my time.
Mr. DINGELL. Madam Speaker, at this time I yield to the distinguished
Speaker of the House, Ms. Pelosi, the remainder of my time.
Ms. PELOSI. I thank the gentleman for yielding, I commend him for his
extraordinary leadership on this subject.
Madam Speaker, I have not been able to watch the entire debate,
because I was involved in meetings, but I hope it was made known to all
who are following this debate how historic this is that we have Mr.
Dingell as part of the management of this bill and bringing this bill
to the floor. He comes from a strong tradition of access to affordable,
reliable health care for all Americans.
His father had it as his life's work in the Congress. Mr. Dingell was
a young Congressman at the time he sat and presided. He sat in the
chair and presided and gaveled the passage of the Medicare bill. I
don't know if that has been discussed here today, but I want to be sure
that all who follow the record of Congress know of the long history,
the family tradition and the tremendous leadership that Mr. Dingell has
provided in this regard.
I also want to commend Mr. Pallone from the Energy and Commerce
Committee for his work in this important legislation; Mr. Stark, the
Chair of the committee of jurisdiction in the Ways and Means Committee.
Thank you, Mr. Stark, for your leadership. I also commend Mr. Rangel
for the important work that he did to make this vote possible today.
People across America saw us pass this bill before the Fourth of July
break, and it was celebrated by seniors who were concerned, and with
people with disabilities, who were concerned about the impact of this
however modest reform of Medicare. After the break, the Senate took up
the bill once again. They failed with 59 votes the first time. You need
60 in the Senate, as you know.
The whole country was jubilant and applauded when Senator Kennedy
came to the floor, a fighter for America's seniors, a fighter for
people with disabilities, a fighter for our children,

[[Page H6529]]

a fighter for working families in America. He left his own physical
challenge behind to come to the floor of the Senate all the way from
Massachusetts to be the 60th vote.
It was such an historic moment, and nine Republican Senators changed
their votes on the strength of Senator Kennedy's vote. It was 59 until
he voted, and then he made the 60th, and then it became 69, and it was
pretty exciting. People cheered, and everyone was tear filled and happy
that this happened, affordable, reliable, health care for America's
seniors and those with disabilities passed.
Then the President said that he would veto the bill. It was such a
downer.
Here we are again today to come back to have an overwhelming
bipartisan support in the Congress of the United States, in the House
of Representatives, to say to the American people we understand the
challenges they face. All of the seniors organizations and disabilities
groups, of course, support this legislation, but just about every
health-care providing group in our country supports this legislation as
well, except one, and that is some in the health insurance industry. I
guess the President is voting with them and not with America's seniors
and those with disabilities when he vetoes the bill.
I am very proud of the work of, again, Mr. Rangel, Mr. Dingell, Mr.
Pallone, Mr. Stark. I thank them for their leadership. You have given
us an opportunity to vote for the American people, not only as their
representatives, but on their behalf, and we are all grateful to you
for that. I urge a vote to override the veto.
Mr. MICA. Madam Speaker, I plan to vote to sustain the President's
veto on H.R. 6331.
I wanted to clarify my action to sustain the President's veto on H.R.
6331, the Medicare Improvements for Patients and Providers Act of 2008.
First let me say that I in no way support a 10.6 percent reduction in
payment to our physicians that participate in Medicare, nor do I
support the meager .5 percent increase to physicians in this
legislation. Both the proposed cuts and the increase are an insult to
one of our Nation's most honorable and vital professions.
I did not support this measure when it came before the House of
Representatives because of the aforementioned reasons, and furthermore
I think it is degrading to the medical profession to force physicians
and medical professionals to come before Congress time and time again
since 2002 and most recently in December of last year to plead with
Congress not to cut their Medicare reimbursements for services
rendered.
The override of this Presidential veto is not a victory for the
medical profession, the American Medical Association or the hard
working dedicated physicians that I represent. In fact passage of this
measure over the President's veto only exacerbates the situation and in
18 months physicians will face the prospect of a 20 percent cut in
their payment. Furthermore this bill takes an estimated $48 billion
from the Medicare Advantage Program--a program designed to provide our
seniors with choices.
It is imperative that Congress address the deteriorating condition of
the Medicare program and enacts corrective measures that will keep this
reoccurring nightmare cast upon our medical professionals from
happening again in the future. What is even worse, the bill has
proposed budget gimmicks that will contribute to further unnecessary
increases in Medicare spending and aid in the further financial
destruction of the Medicare program.
Congress must get serious and address the deficiencies in our
Medicare system especially as we face an onslaught of baby boomers soon
to be eligible for the program.
Mr. BACA. Madam Speaker, today, we find ourselves fighting for H.R.
6331, the Medicare Improvements for Patients and Providers Act of 2008.
It is with great pleasure that I stand here today in support of this
necessary veto override measure, fighting and doing my part to protect
our seniors, the disabled and the American people.
For months now, I have been actively listening to leaders in my
district in San Bernardino, California, about the necessary need to
pass H.R. 6331.
Congress has made it clear over the last weeks that we are standing
our ground on behalf of the American family.
Unfortunately, President Bush is playing politics on the backs of our
seniors and today vetoed H.R. 6331. This is unacceptable. Congress will
not stand by and watch our seniors on Medicare get turned away next
time they go see their doctor.
This is not about politics; it's about our struggling American
families that are constantly choosing between putting food on the table
and paying for medicines.
Today, I proudly will vote to override the President's veto and put
America's seniors and their families first.
I urge my colleagues to vote for this veto override and remember that
we are here to represent the families in our district that so
desperately need help.
Mr. ETHERIDGE. Madam Speaker, I rise to express my support for this
vote to override the President's veto of H.R. 6331, the ``Medicare
Improvements for Patients and Providers Act of 2008.'' We cannot
abandon Medicare's promise to America's seniors and disabled citizens
that they would have access to high quality health care in their time
of need.
As of July 1, physicians face a 10.6 percent cut in their payments
from Medicare. As of July 1, patients undergoing a variety of medical
treatments, from radiology to oxygen treatments, face a cutoff in
services. As of July 1, the relationship between medical suppliers and
the beneficiaries they serve is at risk.
Madam Speaker, this bill fixes all of these threats to Medicare and
improves access in many other ways. Instead of a cut, it provides a
slight increase in payment for physicians, ensuring doctors can
continue providing Medicare services. Instead of cutting beneficiaries
off from their medical services, it allows exceptions to current caps
on medical therapy. It also ensures access to community pharmacies, by
providing for fair and prompt payment for prescriptions.
Additionally, H.R. 6331 improves access to health services for all
Medicare beneficiaries. It extends grants that rural health care
providers can use to improve the quality of care facilities provide and
to strengthen health care networks. It supports telehealth services in
rural communities, improves access to ambulance services for small
hospitals, and increases Medicare payments for community health
centers.
By overriding the President's veto, Congress is standing with seniors
and their ability to continue to see the doctors they know and trust.
By overriding the veto, we are standing for better health care for all
Medicare beneficiaries. I urge my colleagues to join me in continued
support of this bill.
Mrs. CHRISTENSEN. Madam Speaker, today I rise in strong support of
H.R. 6331--The Medicare Improvements for Patients and Providers Act. I
also rise to urge all of my colleagues--on both sides of the aisle--to
do what this President won't: to protect the millions of seniors and
people with disabilities who rely on Medicare to preserve their health
and well-being.
As a physician and as the Chair of the CBC Health Braintrust, I find
it more than unfortunate that this President would veto a piece of
sound health legislation that would help our Nation's most vulnerable,
and that would prevent the catastrophic payment cuts to physicians.
With this override, we will ensure that seniors and active-duty
military personnel and retirees have access to doctors who they not
only know, but who they trust.
Additionally, I feel strongly--as do more than 150 national
organizations--that H.R. 6331 is a bill that needs to be enacted
because it will reduce many of the health inequities that
disproportionately and detrimentally affect millions of racial and
ethnic minorities, as well as rural Medicare beneficiaries, by:
strengthening the collection of data to better assess and identify
solutions to health disparities; enhancing the scope of preventive and
mental health benefits; bolstering low-income assistance programs for
Medicare beneficiaries; improving access to quality health care for the
millions of rural Americans--a disproportionate number of whom are
racial and ethnic minorities--who currently experience insurmountable
barriers to care; strengthening and reforming the Medicare Advantage
plans without reducing access to the services needed by the tens of
thousands of seniors who rely on them to stay healthy; and protecting
access to pharmacies so that our seniors have consistent and reliable
access to their medications and so that our pharmacies--particularly
those in low-income communities--are reimbursed promptly and adequately
by Part D programs.
Madam Speaker, this bill passed in the Senate 1 month after it passed
in the House, and did so with a veto-proof margin.
We--as a Congress--have not had many successes with introducing and
passing smart and sound health policies that are as socially and
medically appropriate as they are fiscally responsible. This bill could
be one such success and I therefore urge my colleagues to vote ``yes''
on this important bill.
Mr. CONYERS. Madam Speaker, I rise to voice my strong support for
overriding the President's veto of H.R. 6331, the Medicare Improvements
for Patients and Providers Act of 2008. This important legislation
amends titles XVIII and XIX of the Social Security Act to extend, for
18 months, expiring provisions under the Medicare program. This bill
prevents the implementation of a scheduled 10.6 percent cut in Medicare
reimbursements for physicians and other health care professionals,

[[Page H6530]]

and extends the 0.5 percent payment update for 2008 and provides a 1.1
percent payment increase for physicians in 2009.
In addition to delaying reimbursement cuts, H.R. 6331 speeds up
reimbursements for Medicare Part D claims and delays cuts to Medicaid
generic prescription drug reimbursement. The bill also includes a delay
in the flawed Medicare DMEPOS (durable medical equipment, prosthetics
and supplies) competitive bidding program. H.R. 6331 also improves
beneficiary access to preventive and mental health services by
eliminating discriminatory co-payment rates for Medicare outpatient
psychiatric services.
The reimbursement cuts that went into effect on July 1 have shaken
the Medicare system to its very core. It boggles the mind to think
that, with an aging population and a worsening physician shortage, this
administration and congressional Republicans have turned their backs on
hard-working physicians who care for millions of Medicare patients
across the country.
I want to reassure Michigan's Medicare doctors that I will never turn
my back on those who care for our parents and grandparents. I am proud
that, with this vote, the Democratic majority is standing up for
Michigan's Medicare doctors--a group of physicians who regularly make
financial sacrifices when they accept Medicare patients. Our support
stands in sharp contrast to the administration's position. Instead of
encouraging our best and brightest doctors to participate in the
Medicare program, the administration would encourage doctors to turn
needy seniors away from their waiting rooms.
Similarly, I will never play politics with health security of those
in our society who survived the Great Depression and won two world
wars.
Madam Speaker, at this time the passage of H.R. 6331 is a simple
necessity. We must protect our seniors and Medicare doctors while we
work to achieve a comprehensive solution to our Medicare problems. I
encourage my colleagues to support this veto override effort.
Mr. MARKEY. Madam Speaker, I rise today to urge a ``yes'' vote on
overriding President Bush's veto of the urgently needed Medicare
Improvements for Patients and Providers Act of 2008. Over the last
several months, President Bush has had an opportunity to work with a
bipartisan majority of Congress to enhance access to care for our
Nation's seniors, disabled, and military families by preventing cuts in
reimbursement to physicians.
The President had an opportunity to invest in our country's health by
ensuring that seniors would continue to have access to physicians in
the Medicare program. But instead, he opted to throw patients and
physicians under the proverbial bus, all for the sake of padding the
pockets of the Medicare Advantage program.
A veto of the President's override would not only improve seniors'
access to health care, it would also increase investment in preventive
health care, expand programs in rural communities, and guarantee mental
health benefits. For our active-duty military personnel and military
retirees, a veto override will ensure they have access to doctors they
know and trust in the military health care program, Tricare.
This bill is supported by over 150 large organizations, and most
importantly, by a vast majority of our Nation's seniors, disabled,
military families, and physicians. We need to build on the success of
this program and override this ill-timed and unconscionable veto.
At a time when the population of seniors seeking Medicare services
continues to grow, what does the President do? He vetoes a bill written
to prevent cuts to Medicare physicians, and in doing so, threatens
seniors' access to Medicare providers. This is absolutely unacceptable.
To my Republican colleagues, who are considering how to vote on this
bill today--given the overwhelming support for this bill from the
patient and provider community, I urge you to reject the President's
stand against patients and physicians in favor of the insurance
industry and join the overwhelming majority of the American public who
support this legislation.
It has been said that ``Health is the first wealth.'' Well, what does
it say about our country when seniors, military families, and
physicians are pushed aside for the interests of the insurance
industry? Let's not put increased wealth for the insurance companies
above the health of our seniors. We must give seniors the access to the
health care that they need and deserve, and that is what today's veto
override vote will accomplish.
I urge an ``aye'' vote to override this veto.
Mr. LEVIN. Madam Speaker, I urge the House to join me in voting to
override the President's veto of the ``Medicare Improvement for
Patients and Providers Act of 2008.''
A vote to override the President's veto of this bill is a vote in
support of our seniors and their doctors. It is a vote in support of
people who have worked hard, who have contributed, who have earned the
best health care available to them at this stage of their lives. It is
a vote that sends a clear message that politics should not get in the
way of their access to the care they deserve.
H.R. 6331 prevents a pending 10 percent reduction in the payments
physicians receive for treating Medicare patients. The bill also allows
for the expansion of preventive care services under Medicare, reforms
the pharmacy payment process for the benefit of our small community
pharmacies, and delays and repairs a flawed competitive bidding process
for durable medical equipment.
We must continue a vigorous effort to ensure that Medicare remains
strong for all of the Nation's citizens. This bill honors that
commitment without delaying difficult decisions about Medicare's
funding future; it is fully paid for.
I encourage all of my colleagues to vote in favor of the veto
override.
Ms. JACKSON-LEE of Texas. Madam Speaker, I rise today in strong
support of overriding President Bush's veto of H.R. 6331, the
``Protecting the Medicaid Safety Net Act of 2008.'' I would like to
thank my colleague from New York, Chairman Charles Rangel and
Congressman Dingell for their leadership in this important issue.
This legislation could not come at a more crucial time. Americans are
in need of support. Rising gas prices, food costs at an all time high,
and a rocky housing market has pushed this great Nation toward an
economic downturn. Families are clinging to basic necessities and
quality healthcare is own of those essential needs.
I am pleased to see that there is no language that inhibits physician
ownership of general acute care hospitals. I have worked tirelessly
with members of leadership and with the Texas delegation to support
general acute-care hospitals and their future development. Physicians
who have decided to build in areas where often no other hospital will--
should not be penalized for their commitment to work on the clinical
and business side of health care.
General acute-care hospitals still need to be able to:
Maintain a minimum number of physicians available at all times to
provide service;
Provide a significant amount of charity care;
Treat at least one-sixth of its outpatient visits for emergency
medical conditions on an urgent basis without requiring a previously
scheduled appointment;
Maintain at least 10 full-time interns or residents-in-training in a
teaching program;
Advertise or present themselves to the public as a place which
provides emergency care;
Serve as a disproportionate share provider, serving a low-income
community with a disproportionate share of low-income patients; and
Have at least 90 hospital beds available to patients.
This issue is of the utmost importance to me because I, like others
in the Democratic Caucus, have hospitals and hospital systems such as
University Hospital Systems of Houston in my district that would have
been greatly affected by this provision.
For example, 2 years ago St. Joseph Medical Center, downtown
Houston's first and only teaching hospital, was on the verge of closing
its doors. However, a hospital corporation in partnership with
physicians purchased it, and as a result of proper and responsible
management, has made it the premier hospital in the region, with a
qualified emergency room responsive to a heavily populated downtown
Houston. St. Joseph Medical Center is also in the process of reopening
Houston Heights Hospital, the fourth oldest acute care hospital in
Houston. This hospital will be serving a large Medicare/Medicaid
population.

I am committed to this issue and to the issue of health care for all
Americans. Provisions that could end the expansion of truly
compassionate hospital care in places like Texas, Maryland, New York,
and California have no place in health care legislation.
What I do support is legislation that seeks to aid our elderly, our
disabled, our veterans, our children and our indigent populations. I
stand here today to show my support not only for the physicians and
medical care providers of Houston, Texas, but for all of our health
care providers across this country. We need them to continue to be able
to care for our underserved and elderly--this bill allows them to do
just that.
This bill provides a delay of 18 months for the competitive bidding
program for durable medical equipment (DMEPOS). It also prevents the
10.6 percent pay cut to physicians that is scheduled to take place on
July 1, and provides a 1.1 percent update starting January 1, 2009.
This bill also includes important beneficiary improvements such as
Medicare mental health parity, improved preventive coverage, and
enhanced assistance for low-income beneficiaries.
It contains provisions that will protect the fragile rural health
care safety net. In my home state of Texas, we have not only great
urban areas such as Houston, Dallas and

[[Page H6531]]

Austin, we have over 300 rural areas in Texas with cities such as
Rollingwood and Hamilton.
Our rural health care providers are scheduled to receive steep cuts
in Medicare reimbursement rates on July 1 unless we take action now.
Such cuts are catastrophic in rural America, where a disproportionate
number of elderly Americans live. These seniors are, per capita, older,
poorer and sicker (with greater chronic illnesses) than their urban
counterparts. Additionally, recruitment and retention of providers to
much of rural America is often daunting. Provider shortages are rampant
throughout many rural and most frontier regions.
Additionally, H.R. 6331 also includes several other critical
provisions for rural providers which, cumulatively, create a rural
package that will help protect both the rural health safety net and the
health of tens of millions of seniors who call rural America home.
H.R. 6331 focuses on strengthening primary care and takes significant
strides in protecting rural seniors' access to care by correcting
certain long-standing inequities between rural and urban providers.
Thank you both for your continued concern for the health of rural
Americans. So many enduring inequities in health care must be faced by
rural patients and providers daily. H.R. 6331 offers critical
assistance and will go far to improving the health of millions of rural
Medicare beneficiaries.
Quality measures must continue to be adequately funded in order to
promote quality, cost-effective health care for consumers and
employers. The uncertainty of Medicare payments makes it increasingly
difficult for surgeons and their practices to plan for the expenses
that they will incur as they serve their patients.
The provisions included in H.R. 6331 would enable surgeons and
surgical practices to plan for the rising costs that they will continue
to face over the next year and a half.
By addressing payment levels through 2009, Chairman Rangel has given
us more time to study the payment issues surrounding Medicare and allow
us to look at the systemic reforms needed to preserve access to quality
surgical care and other physician services.
As a longtime advocate for universal health care, I believe we must
continue to support our essential medical providers so that they can
focus on patient care. We need more physicians as we seek to expand
health care for all Americans. Yet, how can we expect to grow that
workforce when we continue to cut their reimbursement levels? We must
support our physicians so that they may support and care for their
patients. We have to continue to look at how we can save Medicare and
expand it to care for those who need it most. Finally, with the recent
passing of Dr. Michael E. Debakey, I hope his life and legacy will
inspire the Congress to continue to build up the system of the health
in America for all Americans.
I urge my colleagues to join me in overriding the President's veto of
this very important legislation.
Mr. FARR. Madam Speaker, I rise today in support of overriding the
President's veto of this Medicare bill. I may not sit on the Ways and
Means Committee but I have followed the progress of this bill minute-
by-minute, it seems. The seniors in my community need this bill. The
doctors in my community need this bill. If this country wants to assure
affordable health care for its elderly, this country needs this bill.
The President's veto of this bill was a poorly cloaked nod to the
insurance industry. While the rest of us are trying to find a way to
reform the Medicare system, the White House is trying to find a way to
privatize it. Whereas government has the charge of making sure the
program delivers health care efficiently, private insurance has the
charge of making sure the program brings a profit to shareholders.
Taxpayer dollars should not be making insurance companies rich.
I urge all my colleagues to vote to override.
Mr. VAN HOLLEN. Madam Speaker, I rise in strong support of overriding
the President's veto of the Medicare Improvements for Patients and
Providers Act of 2008.
It is very unfortunate that the President has sided with the
interests of certain big insurance companies against the health care
needs of seniors. There are a number of important provisions in this
legislation that will benefit more than forty-four million Medicare
beneficiaries by preserving patient access to physicians, enhancing
preventive and mental health benefits in the Medicare program,
extending expiring provisions for rural and other providers, and
improving assistance for low-income seniors. Unlike the President,
Congress has put aside party politics and is protecting and preserving
the health care that seniors depend on.
Madam Speaker, this is an issue that affects all Americans. I
strongly urge my House colleagues to override the President's veto on
this bipartisan legislation.
The SPEAKER pro tempore. Without objection, the previous question is
ordered.
There was no objection.
The SPEAKER pro tempore. The question is, Will the House, on
reconsideration, pass the bill, the objections of the President to the
contrary notwithstanding?
Under the Constitution, the vote must be by the yeas and nays.
Pursuant to clause 8 of rule XX, further proceedings on this question
will be postponed.

____________________