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As the ranking Democratic Member of the Ways and Means Subcommittee on Health, Stark continued his efforts to improve Medicare and to fight attempts that would reduce the government's commitment to providing universal coverage for our nation's senior citizens and disabled population. He also worked to expand access to health insurance for the uninsured and to provide quality health care for everyone. His position on the Health Subcommittee allows him to specialize in these health issues which are of key importance to American families.

MEDICARE REFORM
Early in the 107th Congress, Stark introduced a blueprint for comprehensive, long-term Medicare reform. His proposal, if enacted, would modernize Medicare without raising premiums on seniors or forcing Medicare beneficiaries out of the traditional fee-for-service Medicare program and into HMOs. The proposal (HR 803) builds on Clinton Administration efforts to modernize Medicare. It would add a prescription drug benefit to the program as well. He introduced this bill to make clear that the Bush-preferred approach for Medicare reform called "Premium Support" is not the only viable option for Medicare reform.

• Leading the Fight for a Medicare Prescription Drug Benefit
  
  Stark re-ignited the debate on the need for a Rx benefit in Medicare by his introduction of a Medicare Prescription Drug benefit bill in the fall of 1998 (HR 4753). The bill was revised and reintroduced with Senator Kennedy as HR 1495.  This bill became the basis for the Democratic Medicare Prescription Drug bill later in the year.  It was support for this bill that forced the Republican House leaders into debating a prescription drug benefit in the full House.
  
  On July 14, 1999, Stark's amendment in Ways and Means to offer a tax credit of 50% for Medicare beneficiaries on the cost of drugs up to $2000 in 2003, rising to $5000 by 2009 was defeated on a party line vote, but helped force Republicans to begin to develop their own plan.
  
  Stark requested a GAO study (received Sept. 21, 1999) showing how extensively HMOs are reducing their optional Rx benefits for Medicare enrollees, thus making the case that an Rx benefit should be added to the core Medicare package so that all beneficiaries are covered, all the time.
  
  In order to bring Medicare prescription drug legislation to the House floor, Rep. Stark took the lead in filing a discharge petition on H.R. 1495, to 'discharge' the Ways and Means Committee from bottling the bill up, and thus allow a full vote in the House of Representatives.
  
  Rep. Stark worked with Members of Congress, senior advocacy and labor groups, the Administration and others to consider and draft Democratic alternatives for Medicare prescription drug coverage -- ultimately leading to introduction of H.R. 4770, the Medicare Guaranteed and Defined Rx Benefit and Health Provider Relief Act of 2000, with 115 cosponsors.
  
  HR 4770, endorsed by the President, the Vice President and major senior groups, provided a drug benefit in Medicare that would have offered voluntary insurance to all seniors and disabled, and provided catastrophic, out-of-pocket protection.
  
  This bill was offered by Mr. Stark as the Democratic 'motion to recommit' i.e., the substitute motion to the Republican private medigap drug plan. The bill fit in the allowed budget of $40 billion over 5 years, and $295 billion over ten years- providing twice as much relief and protection as the Republican bill. It failed by a vote of 204 to 222.While the 106th Congress adjourned without passing legislation creating a Medicare prescription drug benefit, it is sure to be a major issue in the new session of Congress.
  

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• Fighting Excessive Drug Prices
  
  Letter from the Medicare Administrator to Rep. Stark, May 31, 2000:
  
  "Thank you for the leadership role you have been taking in addressing the need to ensure that both Medicare and Medicaid pay appropriately for prescription drugs"
  
  In March, 1998, Rep. Stark and Marion Berry (D., Ark) filed a complaint with the Federal Trade Commission against Mylan Laboratories and three others, charging anti-competitive behavior that was driving up some generic drug costs by 4093 percent! On July 13, 2000, the FTC imposed a $137 million fine on Mylan. Since the Congressmen's complaint, prices of the drugs have come down. Stark believes that the FTC's settlement should be reviewed to ensure even further lowering of drug costs.
  
  Study of Rx Prices in 13th District: Rep. Stark requested and received two studies by the minority staff of the House Government Reform Committee. The first study reveals the amount seniors with no prescription drug coverage (i.e., those paying cash for prescription drugs) pay for their medications in the 13th District compared to the prices paid by large U.S. insurers. A separate Government Reform study prepared for Rep. Stark compares the prices paid by seniors with no drug coverage to what consumers pay in Canada and Mexico. On average, the studies found that 13th District seniors without drug insurance pay about twice as much. By passing Rep. Stark's Medicare prescription drug benefit, this unfair pricing system would be eliminated.
  
  Stark released a Joint Economic Committee report on Feb. 9, 2000 on Rx inflation, which is running at 15.4% annually compared to general health inflation of 5.6%.
  
  Stopping Rx Average Wholesale Price abuse: See Stark's initiatives under fighting Medicare fraud, which if enacted -- will result in billions in savings over the next few years.
  
  Pharmaceutical Advertising: Since a major source of the increase in drug costs has been the explosion in advertising expenses, Rep. Stark introduced the Fair Balance Prescription Drug Advertisement Act of 2000 (H.R. 4686) to deny tax deductions for unbalanced prescription drug advertising that places more emphasis on product benefits than risks or fails to meet FDA advertising standards. This issue is likely to receive a great deal of attention in the 107th Congress.
  
  Taxpayer-funded R&D: One way to help the public deal with the high cost of drugs is to ensure that the public's investment in drug development is returned, either in lower prices or by the public receiving a share of the profits. Eleven of the 14 drugs identified as the most medically significant over the last 25 years were developed with taxpayer dollars, yet drug companies continue to use the 'R&D argument' as their excuse to charge Americans the highest prices in the world. As a result, Rep. Stark collaborated with Rep. Capuano (D-MA) to introduce the Public Investment Recovery Act of 2000 (H.R. 4705). This bill calculates the proportion of taxpayer-financed R&D that led to the production and sale of a product and uses a portion of these profits to finance a Medicare drug benefit and support further R&D.
  
  Pharmaceutical Gifts vs. R&D: Because drug companies spend more than $11 billion per year on marketing and promoting their products directly to physicians -- i.e., an estimated total of $8,000 to $13,000 per physician -- Rep. Stark introduced the Save Money for Prescription Drug Research Act of 2000 (H.R. 4089). This bill denies tax deductions for certain gifts and benefits (other than drug samples) provided to physicians by pharmaceutical manufacturers. The intent of the bill is to either lower the cost of drugs caused by this lobbying, or to encourage the companies to spend more on R&D and less on marketing. Rep. Stark also submitted for the Congressional Record many examples of unsolicited drug company "freebies" that a Florida physician received in just one week -- freebies that graphically demonstrate how much money drug manufacturers waste in promoting products, rather than increasing R&D or lowering drug prices.
  
  Pharmaceutical Taxation and Pricing: According to a December 17, 1999, Library of Congress report requested by Stark, the U.S. drug industry reaps tax benefits that lowered their effective tax rates by nearly 40% relative to other major U.S. industries, yet U.S. drug companies charge the highest prices in the world. In response, Rep. Stark introduced the Prescription Price Equity Act (H.R. 3665) -- a bill to ensure that drug companies charging more for products in the U.S. than they charge in other industrialized nations would forfeit their eligibility for certain U.S. tax subsidies. Stark's amendment to deny tax breaks for the export of US-made drugs at lower prices to developed nations was defeated in the Ways and Means Committee on July 27, 2000. (Stark also wrote the Treasury Department on May 2, 2000 urging the Administration not include Rx export subsidies in their tax proposals.)
  

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• Improving Medicare
  
  The Medicare Regulatory and Contracting Reform Act: Stark co-authored bipartisan legislation (HR 3391) with Health Subcommittee Chairperson Nancy Johnson (R-CT) that unanimously passed the House. The legislation would simplify and reform the regulatory and contracting processes in Medicare. This legislation would reduce administrative burdens on providers and improve regulatory processes, while continuing to protect taxpayer dollars from being inappropriately spent under Medicare. In contrast, earlier versions of this legislation that were strongly supported by the American Medical Association and other provider organizations would have opened the Medicare doors to rampant waste, fraud, and abuse. Through Stark's efforts, the bill was refined to address provider concerns without allowing the abuses of the earlier proposal.
  
  Stark also included important beneficiary protections in the final legislation. It would establish a beneficiary ombudsman program for Medicare to provide a voice for beneficiaries within the Centers for Medicare and Medicaid Services (CMS), the government agency that runs Medicare, and enable the agency to better anticipate and respond to beneficiary needs.
  
  The legislation also establishes a single, national, toll-free telephone number "1-800-MEDICARE" for beneficiaries to call with their questions. The single telephone number will replace the pages of telephone numbers that beneficiaries now must sort through in the Medicare Handbook to find the correct number to call with their particular concern.
  
  The bill authorizes a new demonstration program that will place Medicare staff in Social Security field offices to answer beneficiary questions and provide assistance with Medicare issues. Since seniors are used to going to Social Security offices for help with their retirement benefits, it makes sense to provide Medicare assistance at the same place.
  
  By requiring the use of safe needle technology in public hospitals, the bill also completes Stark's efforts to assure that health care workers are protected from needlestick injuries. This provision builds on Stark's efforts, along with Rep. Phil English (R-PA) and others, which resulted in passage of legislation that protects health care workers in most settings from needlestick injuries in 2000. Unfortunately, that bill had a loophole that prohibited public hospitals from being included in the requirement to use safe needle technology. This provision corrects that loophole. This important provision in the bill will save lives.
  
  The bill also delays for one year the requirement in current law that begins in 2002 to "lock" Medicare beneficiaries into their Medicare+Choice plan (Medicare HMO) for a year. Stark doesn't believe anyone should be forced to remain in a Medicare HMO that doesn't meet their needs. Stark also introduced legislation (See HR 3267) to permanently remove any lock-in requirement. Although this bill only delays the lock-in effective date by one year, it is a good start.
  
  Finally, this bill takes long-overdue steps to fundamentally reform Medicare's contracting system. Stark has worked on this reform for years, which would allow Medicare to negotiate better contract terms, while maintaining quality services and fulfilling performance goals. This provision of the bill in particular is strongly supported by the Centers on Medicare and Medicaid Services.
  
  While this bill unanimously passed the House late in 2001, the Senate has not yet acted on similar legislation. Stark will continue to work closely with Rep. Johnson and others to see that these Medicare improvements get enacted into law in 2002.
  
  Improving Care for People with Chronic Health Conditions: Stark continued his efforts to make Medicare more responsive to beneficiaries' health needs by introducing HR 3188, the Medicare Chronic Care Improvement Act. Individuals with chronic illnesses represent the highest-cost, fastest-growing sector in health care. Approximately 80% of seniors have at least one chronic condition and two-thirds have at least two chronic conditions. The numbers are even higher among women, 90% of whom have one or more chronic illnesses. Yet, Medicare continues to focus on acute illnesses.
  
  The Medicare Chronic Care Improvement Act would improve Medicare benefits, financing, and oversight for people with chronic conditions such as Alzheimer's disease, arthritis, depression and Parkinson's disease. Patient benefit packages would be updated to include increased access to preventive and wellness services. Medicare would compensate providers for time they spend coordinating complex patient needs and teaching patients and their family caregivers how to better manage their conditions. Medicare payment systems would also be updated to better account for the additional costs of caring for patients with chronic conditions.
  
  The Medicare Outpatient Copayment Reduction Act: For most Medicare services, beneficiaries are required to pay 20% of the allowed payment amount while Medicare pays 80%. However, due to an error in the original Medicare outpatient benefit payment formula, the beneficiaries copayment rate for outpatient services has been significantly higher, at times as high as 90%.
  
  Stark partially corrected this inequity in other legislation that was enacted, reducing the copayment rate for outpatient services to 40% by 2006.
  
  This additional Stark bill (HR 3284) would continue the reduction so that by 2010 Medicare beneficiaries would pay just 20% cost-sharing for outpatient services. It's a long overdue beneficiary improvement!
  
  Delay in Medicare Payment Updates for Outpatient Hospital Services: Because of programming problems, CMS informed Congress that it would not be able to implement the outpatient department payment rates scheduled to go into effect January 2002. CMS would have had to hold payments to hospitals and pay later, causing much disruption. Stark had joined all Chairmen and Ranking Members of the House Committees on Ways and Means, Energy and Commerce and the Senate Finance Committee to request that HHS delay the implementation of the 2002 rates. On Dec. 31, 2001, CMS published notice in the Federal Register announcing the delay.
  
  Stark joined with other Democrats in requesting that the reductions in beneficiary cost-sharing for outpatient services scheduled to go into effect on January 1, 2002, and not be delayed along with the payment updates. As a result, CMS announced that they would implement cost-sharing reductions for beneficiaries on schedule.
  
  The Medicare Mental Health Modernization Act: In April 2001, Stark and Senator Paul Wellstone (D-MN) introduced legislation (HR 1522) to expand Medicare's outpatient and inpatient mental heath benefit.
  
  The current benefit structure discriminates against people seeking treatment for mental health and substance abuse conditions. Medicare currently requires a 50% co-payment for mental health services instead of the 20% co-payment required for most other Part B medical services. Unlike all other inpatient services, there is also a 190-day lifetime cap on psychiatric hospital services. The Stark-Wellstone bill would eliminate the lifetime limit and reduce the co-pay to the 20% level enjoyed for other Part B medical services.
  
  These discriminatory practices are compounded by a mental health benefit package that is generally outdated and inadequate. Over the past decade there have been tremendous advances in mental health diagnosis and treatment. At the same time, Medicare's mental health benefit package has remained virtually unchanged since the Medicare was enacted in 1965. To reflect the improved treatment options available for mentally illness, the Medicare Mental Health Modernization Act would allow beneficiaries to access a broad range of community-based residential and outpatient services.
  
  Only 50% of seniors who need mental health services actually receive the services they need, in part because of the shortages in mental health professionals. The Medicare Mental Health Modernization Act would expand the provider base by allowing social workers, mental health counselors as well as marriage and family therapists to bill Medicare directly for mental health services.
  
  The Medicare Mental Health Modernization Act has 64 cosponsors in the House of Representatives and 8 cosponsors in the Senate.
  
  Medicare Critical Need GME Protection Act: Stark introduced HR 1928 to provide the HHS Secretary with flexibility to adjust Medicare reimbursement for graduate medical education if solid evidence is presented that a shortage, or immediately pending shortage, is apparent for a particular specialty or subspecialty. Stark supports the Medicare policy that reduces payments for specialty training, but recognizes that there are instances when the Secretary might need flexibility to address shortages of particular types of doctors. This bill provides such flexibility to the Secretary of HHS.
  
  Medicare Coverage for Adult Day Care Services: Stark joined with Rep. Jerry Kleczka (D-WI) to introduce legislation (HR 3585) that would allow Medicare home health services to be provided to eligible beneficiaries at adult day care centers. This legislation would improve quality of care for the patient and provide the ability for the primary caregiver to be out of the home while the patient was at an adult day care center.
  
  Medicare Hospital Investment Act (HR 2490): For many years, Stark successfully worked to prevent health care providers from inappropriately profiting from referrals and recommended follow-up care. This year, Stark furthered those efforts by joining with Rep. Jerry Kleczka (D-WI) to introduce legislation closing a loophole in current federal law to ensure that physicians who have ownership stakes in boutique hospitals (for example, a cardiac care hospital) do not find themselves in a conflict of interest between financial gain and patient referrals.
  
  Disabled Workers Opportunity Act: In 2001, Congress passed important legislation called the "Ticket to Work Act," which extended the length of time that a disabled Medicare beneficiary could maintain their Medicare coverage after returning to work to 8.5 years. Stark believes that we should fully support the efforts of disabled beneficiaries to return to the workforce. Therefore, he has introduced HR 481, a bill to allow disabled workers to permanently keep their Medicare coverage.
  
  Medicare Social Work Equity Act: Rep. Stark continued his efforts to fix a problem from the Balanced Budget Act of 1997 that results in decreased access to social worker services in nursing homes. He reintroduced legislation (HR 2294) to fix the law so that social workers would be directly reimbursed by Medicare for providing clinical services to Medicare beneficiaries in nursing homes - as psychologists and psychiatrists are reimbursed for such treatment.
  
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MEDICARE PRESCRIPTION DRUG COVERAGE
Congressman Stark had hoped that a Medicare prescription drug benefit could be enacted in 2001. While the Democrats and Republicans were far apart about how such a benefit should be structured, both sides agreed that a benefit was needed. President Bush had also campaigned for president on a pledge to create a Medicare drug benefit.

Unfortunately, Congress declared President Bush's first proposal, called "Immediate Helping Hand," a non-starter. This plan, outside the Medicare system, would have provided block grants to the states to expand state low-income drug assistance programs for seniors.

Stark opposed the effort to create a drug benefit apart from Medicare since seniors need comprehensive health coverage within the Medicare system. Nor were states eager for these block grants that would have shifted the obligation to fund and administer a drug benefit from the federal government to the states. Stark argued that current state drug programs cover only the low-income seniors but all seniors could use help with the high cost of drugs. Stark also pointed out that other state efforts to provide health coverage for children had not been successful. Six years after the enactment of Children's Health Insurance Program, a program the states actually wanted to administer, almost 10 million children are still without health insurance.

In July 2001, the Bush Administration announced a new Medicare initiative that would provide a Medicare-approved prescription drug discount card to seniors. Under this plan, Medicare would give certain drug discount cards a Medicare seal of approval. Medicare would then market these cards to beneficiaries for a $25 a year fee. Seniors would only be allowed to own one of these new Medicare-approved cards. And, the Bush Administration claimed that the cards would provide savings to seniors of "10-25%" off retail prices they were paying today.

Stark raised immediate concerns with this proposal. First, Stark stated that the Administration had no legal authority from Congress to create such a program nor had the Administration followed appropriate administrative procedures in developing this initiative. More importantly, the plan was so loosely structured that there were no guarantee that seniors would see any real savings with these cards. Stark raised serious concerns that seniors might pay for these cards and get no savings for this expenditure.

Stark reached out to state regulators who have begun to regulate similar discount cards because of concerns that the cards advertised far greater savings than they actually provided. In a letter, Kansas Insurance Commissioner Kathleen Sebilius told Stark, "the most common complaint is that while the literature touts discounts upwardly of 40-60 percent, the discount is considerably less, often less than 10 percent." And she closes her letter with the adage that "what sounds too good to be true, remains too good to be true."

All of these concerns led Stark to join a lawsuit filed by the National Association of Chain Drug Stores and the Community Pharmacists that would enjoin the Bush Administration from moving forward with this drug discount card proposal. Stark filed an amicus brief in the case on August 7, 2001. In his statement announcing the filing of the brief, Stark said:"President Bush's program is designed to benefit the private industry, not those people entitled to benefits under Medicare and for whom Medicare was created. The program has been thrust on an unsuspecting public without Congressional action and merely serves to delay a meaningful and substantial prescription drug program for our senior citizens. That is why I so vehemently oppose the way this program was developed and why I am joining in this legal effort to block its implementation."In September 2001, the federal court agreed with the case brought forth by the drug stores and Stark and halted implementation of the Bush drug discount card program. Later in the year, the judge concluded that the Administration could move forward with a new prescription drug discount card proposal, but he required that they follow the appropriate Administrative Procedures Act requirements when announcing the new proposal. In addition, he made clear that plaintiffs in this case may return to court if they believe the Administration still has not met legal standards for developing the proposal. The administration is expected to come forth with yet another plan early in 2002.

In an effort to gather more information about the effectiveness of existing drug discount card programs, Rep. Stark along with other health care leaders in Congress asked the General Accounting Office to study of the existing programs and determine whether they provide a meaningful discount to participants. That full study is due in 2002, but a preliminary analysis of discount card programs in four different metropolitan areas found that their discounts were often less than 10% and that similar prices could often be obtained through on-line pharmacies or through retail drug stores in the community.

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OTHER PRESCRIPTION DRUG INITIATIVES

Stark continued to pursue additional prescription drug initiatives to reduce the prices of prescription drugs for seniors.

Fair Drug Prices for Seniors: Stark cosponsored legislation (HR 1400) introduced by Rep. Allen (D-ME) and cosponsored by 120 colleagues that would require that prescription drug companies sell drugs to Medicare beneficiaries at a price equivalent to their average foreign sales price. This bill would end the ability of the pharmaceutical industry to reap excessive profit from American seniors for drugs while charging lower prices overseas. While this bill is not a substitute for a Medicare prescription drug benefit, it would immediately provide seniors lower prices for their medications.

Direct To Consumer Advertising: Direct to consumer advertising of prescription drugs is skyrocketing. In fact, drug companies' advertising budgets doubled between 1998 and 2000. This increase in advertising correlates with the increased prices of prescription drugs. In addition, doctors report that patients are difficult to dissuade when they have heard the glowing promise of a new drug advertised.

Stark introduced the Fair Balance Prescription Drug Advertising Act (HR 2352) that would deny tax deductions for drug advertisements that the Food and Drug Administration (FDA) found were unbalanced. More specifically, the legislation would require that such advertisements provide equal time for a radio or TV ad, or equivalent typeface in a print ad, for the pros and cons of the particular drug. If enacted, this bill would prohibit these companies from lauding the benefits of their drugs and then burying the often very serious side-effects in such tiny print that it is impossible for most people to read.

Physician Gifts vs. Research and Development: Pharmaceutical companies spend more than $11 billion a year on marketing and promoting their products to physicians. They take physicians on trips, feed them fine meals, provide them tickets to sporting events, and do almost whatever they can think of to encourage them to prescribe their drug over those of their competitors.

Stark introduced the Save Money for Prescription Drug Research Act (HR 2641), in order to limit these expenditures and encourage the channeling of those dollars into medical research. The bill denies tax deductions to the drug companies for certain gifts and benefits (other than drug samples) provided to physicians by pharmaceutical manufacturers.

Medicare Payment for Covered Prescription Drugs: Medicare does cover a limited number of prescription drugs through the Part B benefit. These are drugs that are provided by a physician usually in their office and are most often drugs related to cancer treatment and chemotherapy. Stark has worked for years to refine the way Medicare pays for these drugs because the current payment methodology, called average wholesale price (AWP), results in drastic overpayment by Medicare for these medications. In addition to his concern that Medicare is overspending, there is evidence that indicates that doctors may make prescribing decisions based on their profit margins on the drugs rather than on what drug may be best suited for the patient.

This year, the GAO released a new report proving that the AWP system has resulted in vast overpayments. The report found that AWP is 13% to 23% greater, on average, than the actual costs charged to physicians. In some cases, the spread between AWP and actual costs is as much as 86%. And, according to the Inspector General, the AWP abuses cost Medicare some $1.9 billion annually.

This year the Justice Department also began to move forward with prosecuting drug companies for abuses of the AWP system. One such case resulted in a settlement with TAP Pharmaceuticals of $875 million in fines - the largest criminal fine ever in health care fraud prosecution.

Stark has introduced legislation to halt this AWP abuse in past Congresses and, based on the findings of this new GAO analysis, he is developing additional legislation to introduce early in 2002.

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THE MEDICARE+CHOICE PROGRAM

The Medicare+Choice (M+C) program was created as part of the Balanced Budget Act of 1997. Since its enactment, Stark has supported numerous consumer protection provisions to the Medicare+Choice program.

These plans are required to cover all of Medicare's benefits and have traditionally offered extra benefits to beneficiaries to entice them to join their plan. The most important of these extra benefits is a prescription drug benefit, but they have also offered benefits such as: reduced cost sharing, eyeglass coverage, hearing aides, and physical exams to name a few. They are able to offer these extra benefits because Medicare has historically overpaid these plans for the beneficiaries that they cover. Beneficiaries who join these Medicare + Choice plans give up their ability to go to the provider of their choice and are limited to the network of providers in that plan and the procedures that plan requires for their use.

The M+C program created a new payment methodology for Medicare HMOs and other private plans that chose to participate in Medicare. But each year since its enactment, there has been an exodus of plans from the program causing instability and confusion for seniors who had been in those plans. In both 1999 and 2000, Congress increased payments to M+C plans in order to try to stem their exodus from the program. Plans continue to argue that their payments must be increased yet again if they are to remain in Medicare.

In 2001, Stark commissioned a GAO study which found that while M+C payments increased by more than $1 billion in 2001, few plans increased benefits, entered or re-entered areas, or expanded into additional service areas. In fact, 83% of plans didn't use the new money on benefits at all, instead using it to "stabilize networks," which translates into paying more to providers.

This year, while many M+C plans left the program, we began to see a new phenomenon. Plans remaining in the program are adjusting their benefits and cost-sharing structures in ways clearly designed to encourage people with certain conditions to leave their plan and to shift more costs to patients in general.

In Stark's Alameda County, CA district, plans are charging new hospital deductibles of up to $400, new cost-sharing of $25 or more for dialysis treatment. (Plans previously charged nothing for this treatment which patients must have three times per week.) One plan reduced their drug benefit from $1600 to $1000 a year. Another plan changed their drug benefit so that it only covers generic medications.

In the Milwaukee, WI district of Jerry Kleczka (D-SI), one plan instituted a new $295 copayment for each day of hospitalization!

The Medicare+Choice program was designed for beneficiaries to get additional benefits in exchange for a limited choice of providers. The benefit packages described above show that in some instances a Medicare beneficiary can now be worse off in a M+C plan than in traditional Medicare - even without a Medigap policy.

In response to these drastic changes in benefits and cost-sharing, Stark introduced the Medicare+Choice Consumer Protection Act (HR 3267). This bill would protect beneficiaries in M+C plans in the following three ways:

• Eliminating the so-called "lock-in" that begins in 2002 that will prohibit a Medicare beneficiary from leaving an M+C plan at any time of their choosing.
• Providing guaranteed issue Medigap protections to beneficiaries whose M+C plans reduce benefits, increase cost-sharing, or eliminate the patient's doctor or hospital from the plan. Such guaranteed issue protections exist for beneficiaries if their plans pull out of Medicare. But, if they change enough that they no longer meet the patient's needs, that patient must be protected to return to Medicare and purchase a protected Medigap policy as well.
• Prohibiting M+C plans from charging higher cost-sharing for a particular service than Medicare FFS charges for the same item. This would end the ability of M+C plans to use cost-sharing as a way to push sicker and costlier patients out of their plans.
  
  While not solving solve all the Medicare+Choice problems, the bill would protect beneficiaries from many abuses occurring today. It is endorsed by numerous consumer advocacy organizations.
  
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EXPANDING COVERAGE FOR THE UNINSURED

Stark continued his efforts to expand health insurance to the more than 39 million people who lack coverage in our country. The economic recession that began in March 2001 along with the terrorist attacks of September 11 led to increases in the number of people who lost their health insurance due to job loss. Particular Congressional attention was focussed on these people and that will continue to prove true in 2002.

MediKids: On May 3, Stark introduced the MediKids Health Insurance Act of 2001 (HR 1733). Sen. Rockefeller introduced a companion bill in the Senate. The bill would ensure that every child born in our country would be enrolled in a Medicare-type program, called MediKids, unless they had coverage elsewhere. The benefits would be tailored to meet the needs of children and would include prescription drugs. The bill is endorsed by organizations advocating protections for children, including The American Academy of Pediatrics and the Children's Defense Fund.

Upon introduction of the bill, Marion Wright Edelman of the Children's Defense Fund said, "Your legislation reminds Congress, the Bush Administration, and the nation of the importance of insuring every uninsured child. Rhetoric about how we value children will ring hollow until we back it up with substance. Your legislation is the kind of substance essential to making our pledges to children ring true."

Stark believes that covering all children through MediKids can serve as a building block toward universal coverage for everyone in our country.

COBRA Coverage Extension and Affordability Act: On May 24, Stark joined with Rep. Moakley (D-MA) to introduce a bill (HR 2005) that would extend COBRA health insurance continuation coverage from its general limit of 18 months under current law to five years. Recognizing that older workers who leave the workforce often face impossible obstacles to getting affordable coverage in the individual marketplace, the bill would also allow people age 55 and over to maintain their COBRA coverage until they become eligible for Medicare. Finally, the bill would provide for a 50% refundable tax credit toward the cost of COBRA coverage to help offset the high cost for enrollees who must pay 102% of the premium. (COBRA costs average $588 a month for a family coverage.)

The ability of a worker to remain in their previous employers' plan was especially important to Rep. Moakley who knew the value of continuity of care because he was suffering from cancer. Mr. Moakley died shortly after this legislation was introduced, but Stark continues to advocate the COBRA extension.

Medicare Early Access and Tax Credit Act: Stark was the original proponent of letting uninsured older adults "buy into" Medicare in a revenue neutral way. Former President Clinton adopted this proposal and urged Congress to enact it during his presidency. Stark introduced the latest version of this legislation (HR 1255) on March 27, 2001. The bill provides new insurance options for certain people age 55 through 64 or through a special COBRA continuation program for workers age 55 through 64 whose employers renege on their promise to provide retiree health coverage. This version also provides a 50% tax credit to help people with the expense of buying-in.

Health Coverage for Displaced Workers: The terrorist attacks of September 11 and the recognition that our country was in a recession led to a debate over how best to address the health care needs of displaced workers and their families.

Stark, along with other Democrats, advocated a 75% COBRA subsidy for displaced workers and block grants to the states to provide temporary Medicaid assistance to those who had lost their jobs and health insurance, but were ineligible for COBRA. The proposal also provided a temporary increase in the Medicaid matching rate to the states in order to help offset the states' growing budgetary concerns due to the economic downturn.

The Republicans floated a proposal that would provide a 60% refundable tax credit for people who had lost their jobs due to the economic downturn. Their tax credit could be used to buy COBRA continuation coverage or could be used to purchase insurance in the individual marketplace. Their proposal also included two block grant programs to the states to further expand coverage.

Stark argued that the 60% subsidy was not enough to make coverage affordable, given that the standard family policy today costs $588 a month and a typical unemployment paycheck is only $900 a month. Furthermore, the individual market is so unfair that anyone with preexisting conditions would be priced right out of it even with the subsidies. Stark pointed out that the Republican block grant proposals didn't have enough money in them and didn't even require that those funds be used to expand health coverage.

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PATIENTS' BILL OF RIGHTS

Stark continued to work for the enactment of a national Patients' Bill of Rights. He may have been the first member of Congress to introduce a package of managed care protections for consumers in the 104th Congress. In the 106th Congress, the House passed a strong Patients' Bill of Rights while the Senate passed a far weaker version. Stark served on the conference committee to iron out the differences between those two bills, but the conference committee failed to complete action before the Congress adjourned.

The situation changed in the 107th Congress when the Senate returned to Democratic control. Stark again cosponsored the Patients' Bill of Rights and the Senate actually passed a strong Patients' Bill of Rights in July 2001. The House then followed by passing a very weak version of the legislation in August.

The major remaining battle in the Patients' Bill of Rights is the issue of liability. Will health plans be held liable for the harm they cause. The House-passed bill had severe restrictions on that liability which Stark fears will make the law meaningless if enacted.

Though 2001 ended without resolution of these differences, Stark will push for enactment of a strong Patients' Bill of Rights in 2002.

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ADDITIONAL HEALTH INITIATIVES

Quality of Care for People in Assisted Living Facilities: Stark reintroduced his resolution (HJ Res 13) calling for a White House Conference to study quality of care in assisted living facilities and to make recommendations on this issue. Stark wants to ensure that seniors are safe and secure in whatever long-term care home they choose. Under current law, there is no uniform regulation of assisted living facilities, leading to severe concerns about quality of care for residents. Stark was alerted to this problem by a constituent whose mother died in one of these facilities due to lack of proper care.

Stark provided written testimony to the Senate Aging Committee at a hearing to investigate problems with quality of care in assisted living facilities. He also wrote to President Bush urging him to convene a special White House Conference to provide national focus on this important issue.

Protecting Quality of Care for Nursing: Stark introduced bipartisan legislation (HR 3238) with Rep. Steven LaTourette (R-OH) to protect quality patient care and stem the growing shortage of nurses in our country. The legislation would strictly limit the use of mandatory overtime for nurses and is endorsed by every major organization representing nurses.

Upon introduction of the bill, Mary Foley, President of the American Nurses Association said, "ANA believes that your initiative to ban the use of mandatory overtime through Medicare provider agreements in appropriate because the abusive use of overtime contributes to poor patient care and therefore is a matter of public health safety."

Contact Lens Prescription Release Act: If you get an eyeglass prescription from an opthomologist or optometrist, you can take that prescription and get your eyeglasses from the provider of your choice. The FTC required such practice in the 1970s as it became apparent that eye doctors were profiting over charging high prices for eyeglasses that they prescribed for their patients.

Today, consumers face the same problem with contact lenses. The FTC has taken no action to require that contact lens prescriptions be made available to patients so that they can purchase from the provider of their choice. Stark has introduced a bill (HR 2663) that would require the release of these prescriptions. Purchase of lenses would require a valid prescription less than two years old to prevent concerns about quality of care.

Gift of Life Medal of Honor: Because of the shortage of available organs in this country, Stark introduced the Gift of Life Medal of Honor (HR 708) to provide a Congressional medal of honor for organ donors and their families. This legislation would honor the individual organ donors and their loved ones, and heighten awareness of the current organ shortage so that organ donations might increase.

Mental Health Parity: Stark worked closely with Senate colleagues and proponents in the House to advance mental health parity for everyone with private health insurance. The Senate included a strong mental health parity provision in their version of the Labor HHS Appropriations bill in 2001. Their provision required private health insurance to cover mental health services in the same manner they cover physical health care. The proposal did not apply to small companies. Employers were not required to cover any mental health coverage, but if mental health benefits were covered at all, they had to be covered equally.

Stark helped unite 224 members of the House in signing a letter to the Labor, HHS appropriators supporting inclusion of the Senate provision in the final bill. However, the Republican leadership in the House vehemently opposed the provision and it did not make it into the final bill. The opposition to this bill reveals the underlying prejudice toward the millions of individuals who suffer the painful consequences of mental illness.

Stark's fight for mental health parity will continue in 2002.

Bringing Health Care into the Information Age: In 1996, Congress passed legislation to enable health plans and health care providers to exchange information electronically. The Health Insurance Portability and Accountability Act (HIPAA) established a common electronic language for health care administrative functions such as submission of claims and enrollment in a health plan. These electronic standards are scheduled to go into effect October 2002. HHS estimates these administrative efficiencies will save nearly $30 billion over ten years - savings that can be redirected toward improving health care quality and access to services.

Many health plans and providers, however, said they could not be ready by the October 2002 deadline. They argued that they needed more time to ensure a smooth transition to the new electronic environment. Other members of the health care system, hospitals in particular, said that they will be ready in time and are eager to reap the return on investments they have made in new technology and revised processes.

Stark was instrumental in crafting a meaningful compromise to address these concerns, the Administrative Simplification Compliance Act (HR 3323). This bill gives health plans and health care providers an extra year to implement the HIPAA electronic standards, provided they can outline how they will achieve compliance within that timeframe. They must describe their budget and work plans and they must allow at least six months for testing the new standards. These requirements will help assure that the plans and providers can not come back next year and argue for another delay because they are still not ready.

Congress overwhelmingly passed this legislation and it was signed into law.

Social Security (top)

Women's Issues (top)

Stark consistently voted to preserve a women’s right to choose and to support overseas family planning programs.

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FEHBP Contraceptive Coverage

President Bush’s FY02 budget request recommended elimination of FEHBP contraceptive coverage. Although Congressman Stark wrote to Chairman Istook urging him to retain contraceptive coverage for federal employees in the Treasury-Postal appropriations bill, the original House bill did not continue FEHB contraceptive coverage. Rep. Lowey then offered an amendment to continue FEHBP coverage, which passed, paving the way for the final bill to continue FEHBP contraceptive coverage in 2002.

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Unborn Victims Of Violence Act (UVVA)

Stark opposed this bill (HR 503) that would create new federal crimes for bodily injury or death of an “unborn child” in utero. UVVA is a deceptive attempt to erode Roe vs. Wade by legislatively defining when life begins. In April 2001, the House passed the bill by 252-172. The Senate has not taken up this bill. As an alternative, Congressman Stark supported Rep. Lofgren’s Substitute, which strengthens punishments for crimes against pregnant women without weakening a woman’s right to choose. The Lofgren Substitute failed to pass the House.

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The Global Gag Rule

Stark supported efforts by Reps. Lowey and Lee, and Senator Boxer to overturn the Global Gag Rule reimposed by President Bush but their efforts were unsuccessful in the FY ‘02 Foreign Operations conference agreement. The Global Gag Rule prohibits the US Agency for International Development from granting family-planning funds to any foreign non-governmental organization unless it agrees not to use its own private, non-US funds for abortion services, advocacy, counseling or referrals to a legal abortion provider.

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United States Agency for International Development (USAID) and United Nations Population Fund (UNFPA)

Stark wrote to President Bush urging him to continue the commitment to USAID and UNFPA in FY ‘02 by funding USAID family planning programs and the US contribution to UNFPA at levels of $524 million and $35 million respectively. Unfortunately, the Conference report for FY ‘02 Foreign Operations appropriations included $446.5 million in funding for USAID population assistance program, no more than the amount requested in the President’s budget. And although the conference report funded UNFPA at $34 million, President Bush froze all UNFPA money.

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Protection for Domestic Violence

Stark was an original cosponsor of the Domestic Violence Victim Protection Act (HR 3595), which seeks to reduce violence in domestic relations. The House has failed to act on this and all other domestic violence bills listed below.
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Legal Assistance for Victims of Dating Violence
Stark also cosponsored legislation (HR 3193) that would expand the Violence Against Women Act of 2000 (VAWA) to include legal assistance for victims of dating violence.

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Women Immigrants’ Safe Harbor Act (WISH)

Stark cosponsored the WISH Act (HR2258), which would provide a safe harbor for legal immigrants, and their children who are victims of domestic violence. If enacted, this bill would allow immigrant women and their children to get health insurance, food, and other assistance until they are out of harm’s way.

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Condemning Acts of Domestic Violence Committed Against Women’s Health Care Providers

Stark cosponsored a concurrent resolution (H Con Res 285) condemning the 500 anthrax threats sent to reproductive health centers since October 14, 2001. The resolution also urges the Bush Administration, local law enforcement, and other government related agencies to make their best efforts to bring all those who commit acts of domestic terrorism to justice.

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Violence Against Women Office

Stark wrote to Attorney General Ashcroft urging him to appoint a director to the Violence Against Women Office (VAWO) within the Department of Justice, also bringing his attention to the Violence Against Women Office Act, which would make the VAWO office permanent at DOJ.

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National Domestic Violence Hotline

Stark wrote to Chairman Regula and Ranking Member Obey of the House Committee on Appropriations asking them to support additional funding of $652,500 for the National Domestic Violence Hotline. Created under the Violence Against Women Act of 1994, the Hotline provides callers nationwide with crisis intervention.

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Family Planning in Medicaid

Stark wrote to Health and Human Services Secretary Thompson encouraging him to reconsider his decision to deny requests by states to expand family planning services in the Medicaid program.
Stark cosponsored the Family Planning State Empowerment Act of 2001 (HR 2777), which would allow states to extend family planning services through Medicaid without applying for a federal waiver. California would lose over $100 million annually in federal matching funds if the waiver were not extended in 2004.

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United Nations Convention on the Elimination of All Forms of Discrimination Against Women

Stark cosponsored a resolution (H Res 18) urging the Senate to ratify the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW).
Stark also wrote to Secretary Powell urging him to recognize the broad support CEDAW has across the United States when advising President Bush policy as it applies to the treaty.

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Support for Afghan Women’s Rights and their Efforts to Rebuild Afghanistan

Stark wrote to President Bush urging him to make every effort to include the women of Afghanistan in the processes of reconstruction and redevelopment efforts in their country.
Stark cosponsored the Access for Afghan Women Act, which encourages the United States Department of State and the United States Agency for International Development (USAID) to ensure that Afghan women’s political, economic and social rights are recognized when the US gives aid to Afghanistan.

Stark cosponsored a resolution that calls on the Bush Administration to ensure that the post-Taliban government will protect the human and civil rights of Afghan women and to provide that women are included in any Afghan government. The resolution also commends the work of organizations led by Afghan women who continue to provide education, health and relief services during the crisis.

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Sheltering Women from Gender-Related Violence and Persecution

Stark cosponsored legislation (HR 544) that would require the Attorney General to promulgate regulations relating to gender-related persecution, including female genital mutilation, for use in determining an alien’s eligibility to receive asylum or withholding of deportation.

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Fairness for Women in the Workplace

Stark wrote to Secretary Chao opposing the Department of Labor’s plan to eliminate funding for regional Women’s offices. The Administration reversed its decision and is keeping regional offices open as a result of protests from women’s organizations and Members of the Congress.

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Capitol Art Exhibits Display American Women’s Contributions

Stark cosponsored a resolution ( H Res 106) that expresses the sense of the House of Representatives that the artwork in the Capitol, the Capitol Visitors Center, and the House office buildings should represent the contributions of women to American society.
 
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California Energy Crisis

Terascale Computing

Stark wrote to the National Science Foundation in support of the Distributed Terascale Facilities Program. This program would create a computer across several cities capable of performing TeraFLOP operations with the first computer of its size in the world. As an illustration, if a computer this size had existed five years ago, it could have mapped the human genome code in half the time it took existing computers to complete this task.

LIHEAP Funding

Stark cosponsored a resolution (H Res 300) expressing the sense of the House of Representatives that President Bush should release emergency funding under the Low-Income Home Energy Assistance Program (LIHEAP) due to the recession and the spike in unemployment. The resolution language was included in the Fiscal Year ‘02 Labor, Health and Human Services Appropriations conference report and enacted into law. (See also ENERGY.)

Protecting Injured Victims from Unethical Business Practices

Stark co-authored legislation to impose a tax penalty on unscrupulous purchasers of structured settlements payments. This bill was prompted by the practices of companies who prey on injured victims and pressure them to sell (at a deep discount) their future damage payments, which they have received as a result of a tort claim. Doing so often leaves the injured party without sufficient means to pay their medical costs. The bill created an economic disincentive for these types of companies to buy settlement payments, but allows legitimate companies to continue doing business. The bill had bipartisan support and the support of advocates for the disabled; its provisions were rolled into HR2884, the Victims of Terrorism Relief Act of 2001 and enacted into law in 2002. (See also TAX.)