THE HONORABLE PETE STARK (D., CALIF.), CHAIRMAN, COMMITTEE ON WAYS AND MEANS, U.S. HOUSE OF REPRESENTATIVES, ON HEALTH CARE REFORM: THE PRESIDENT'S HEALTH CARE REFORM PROPOSALS The Honorable Pete Stark (D., Calif.), Chairman, Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, today announced that the Subcommittee hearing on the President's health care reform proposals previously scheduled for Tuesday, February 1, 1994, at 2:30 p.m. in room 1310A Longworth House Office Building, will begin instead at 10:00 a.m. All other details for the hearing remain the same. Subcommittee press release #23, dated January 14, 1994.) (See Chairman STARK. Good morning. The Subcommittee on Health continues its hearings on health care reform, and as we have already learned, the President's plan is rather complex and deals with just about every issue in the health care arena. Because of this, it is not surprising to find that the plan has drawn mixed reactions. I hope this morning will provide an opportunity for members and organizations to comment on various aspects of the President's plan, and I would encourage comments on the various alternatives to the President's health care reform plan. Due to the number of witnesses testifying today, I intend to keep the hearing moving along in order to allow members to explore those issues about which they have particular questions and con cerns. I would like to recognize Mr. Thomas. Mr. THOMAS. Mr. Chairman, briefly, I think that complex plan of the President's was pre-State of the Union. Post-State of the Union, he mentioned one item. I assume that some of the others may be up for grabs, so I look forward to all the alternatives that are going to be offered. Thank you. Chairman STARK. We will begin with testimony from the following members of the House of Representatives. Before we go ahead, I would a apologize to my colleagues, both on the committee and those who have come to testify, and ask Mr. Thomas if he has seen Mrs. Doubtfire; and through the computer, I seem to be chairing two simultaneous meetings both in rooms starting with 1300. Mr. Cardin has agreed to Chair the meeting while I see if I can quickly change my costume and go back and forth. I will ask Mr. Ĉardin if he would take the gavel and I will try and return to hear some of the summary of the testimony. I hope you will forgive me. Mr. CARDIN [presiding]. Without objection, the entire statements of all of our witnesses today will be included in the subcommittee record, and I would ask that all witnesses please try to summarize their comments. Today we do have a rather long list of people to testify, an opportunity for the public to have input in the public hearing process; so I would ask everyone to be mindful of the time problems that we have. We are pleased to have our colleagues testify before the committee. We always welcome your views. You have been very actively involved in health care reform, and we appreciate your willingness to directly participate with the work of this committee. We will start with Hon. Rosa L. DeLauro from the State of Connecticut. STATEMENT OF HON. ROSA L. DeLAURO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CONNECTICUT Ms. DELAURO. Thank you very much. I thank the chairman in absentia, thank the Acting Chair and ranking member Mr. Thomas for the opportunity to be here this morning. I know you have worked very hard over the past several months. I appreciate arranging the schedule so I could speak this morning. I believe the President's State of the Union address crystallized the debate between those who believe we have a major health care problem and those who believe that things are just fine. The Presi dent clearly and forcefully restated the case for reform, and I firmly agree with his call for the Congress to pass meaningful health care reform legislation this year. Those who don't believe that there is a health care crisis, have not been talking to the people that I see in my district every week. I do not want to hold any more office hours in my hometown and listen to their heartbreaking stories about their need for health insurance. So this is an opportune moment. We must make sure that no American will lose his or her health care because they change jobs or get sick. We must also make sure that if you are fortunate enough to survive a serious illness that, subsequently, you cannot be denied health care coverage. I believe if we fail to address this, we will have squandered a tremendous opportunity. I believe the final product should reflect the President's health care bill's principles, including guaranteed universal health care coverage; a comprehensive benefits package that includes preventive services and addresses the special needs of women, children, the chronically ill and disabled; assuring high quality care; and reducing waste, fraud and abuse in the system to keep costs down. We have to devote the resources necessary to aggressively go after those who commit fraud in the system, which amounts to $80 billion a year. We need to build in safeguards against abuses. But in addition to these general principles, there are a few specific concerns that I want to mention this morning. A major concern that I have is that health care reform should address mental health care. It is an important and too long overlooked element of health insurance. The President's plan would improve mental health coverage, but it does not go far enough. On the other hand, his plan is better than most of the competing proposals. While I am fully aware that any expansion of covered services has budgetary implications, I also believe that we can be penny wise and pound foolish in continuing to give mental health treatment second class status. In fact, according to the National Institutes of Mental Health, equitable insurance coverage for severe mental disorders. would yield $2.2 billion annually in net health care savings through decreased use of general medical services and decreased social costs. If you determine that it is not possible to provide full coverage for all mental health services right away, I would encourage your subcommittee to consider taking one small additional step beyond the President's plan by providing full coverage for neurobiological disorders in the initial benefits package. In the same manner in which they have limited coverage for all mental health problems, insurance plans have discriminated against these disorders, which include Tourette's syndrome, autism, and obsessive-compulsive disorder, because they have been classified as "mental health" disorders. However, recent advances in science document that many severe mental illnesses are actually physical illnessesneurobiological disorders-that are characterized by significant neuroanatomical and neurochemical abnormalities. Legislation that I have introduced, the Equitable Health Care for Neurobiological Disorders Act, would ensure that health insurance plans would have to provide equitable coverage for neurobiological disorders on a par with the manner in which they cover other "physical" dis eases. Another issue I am concerned about is graduate medical education. I represent a congressional district which is fortunate to have one of the finest academic health centers in the country and a first-rate health care professional community. However, I also represent an area which the Department of Health and Human Services says is a primary health care shortage area. We must make sure that whatever approach to graduate medical education we take in health care reform that we wind up with adequate numbers of primary care and specialist physicians in our underserved urban and rural areas and that everyone has proper access to them. The President's proposal calls for a dramatic increase in the number of primary care physicians we train versus specialists. While there seems to be a consensus that we need to move in that direction, there is a lot of concern about how we achieve the proper physician mix. I believe that we have to carefully consider what incentives we use to attract medical students into primary care practice, how we determine the number of specialists that we will need in the future, and how residency slots will be distributed and funded. The Federation of Pediatric Organizations, representing the community of practicing and academic pediatricians, has developed a graduate funding proposal which you may wish to consider in your subcommittee's deliberations in this matter. In short, the proposal calls for the creation of a national health care workforce commission, akin to the Base Closure Commission, that would determine the appropriate national number and allocation of residency slots. Funding, derived from all health payers, would be allocated directly to programs, regional or local consortia, or given to medical students as proposed in the Commonwealth Fund task force report on academic health centers. With your permission, I would like to submit for the record copies of this proposal and the Commonwealth Fund report. The final matter that I would like to touch on affects senior citizens in my State. It is a glitch in Medicare reimbursement for services provided on voluntary ambulances. When Connecticut seniors call for an ambulance, they often are billed hundreds of dollars for paramedic services that Medicare will not cover. Medicare will cover paramedic services when a commercial ambulance answers the call for help, but not when a volunteer ambulance takes a senior to the hospital. A community-sponsored ambulance is often qualified to provide only basic life support services because they don't have the highly trained paramedics necessary to perform advanced life support services. When necessary, community ambulances borrow paramedics from commercial ambulances and because the paramedic services are performed aboard this voluntary or basic life support ambulance, neither the volunteer ambulance services nor the paramedic can bill Medicare for reimbursement. Unless this technicality in Medicare law is changed, volunteer ambulance services may soon disappear and lives will be endangered. If communities give up their volunteer ambulances, they will be forced to rely on commercial ambulance services that often must travel longer distances to pick up patients, wasting precious minutes that can mean the difference between a senior's life and death. I have introduced legislation that would allow "intercept" paramedics providing emergency life support aboard nonprofit ambulances to apply directly for Medicare reimbursement. These “intercept," which is what they are called, paramedics would be covered at the same rate under part B of the Medicare program, as they would be when they bill for services on commercial ambulances. Intercept service will only be billable to Medicare if transportation services are provided by a town-sponsored noncommercial ambulance corps. The paramedic providing these services must meet the same qualifications Medicare currently requires for paramedics as part of full ALS services. I would submit that legislation and ask you to give serious consideration to rectifying this situation as you deliberate health care reform legislation. Thank you for providing me this opportunity to talk with you today. A tremendous task is ahead of you, and I know that there is a long witness list this morning. I look forward to talking with you further about some of these issues. Mr. CARDIN. Thank you. [The attachments to the statement follow:] |