The Subcommittee on Health has jurisdiction over the $220 billion a year Medicare program.  Its main purpose is to improve the operations of this essential social program and to ensure that it is maintained for future generations.

Rep. Rangel is an 'ex officio' member and has been a leader in (1) trying to help expand benefits-especially pharmaceutical drug benefits-- for seniors and the disabled, and (2) help the nation's hospitals who do the most charity care for the low-income and uninsured-the so-called disproportionate share hospitals (DSH) and teaching hospitals.  In 1999, he was able to help obtain hundreds of millions of dollars for New York's premier hospitals so that they could continue to provide high quality care to those in need.

Because of the Ways and Means Committee's jurisdiction over taxes (and thus the ability to use tax incentives and penalties to shape policy), the Health Subcommittee and Rep. Rangel are heavily involved in the fight to expand health insurance coverage to the nation's 44 million uninsured, to improve long term care assistance, and to reduce the inequities in our nation's $1.2 trillion health care system.

Major issues before the 106^th Congress include:

• Medicare
• Medicare Pharmaceutical Drug Benefit
• Long-Term Structural Reform
• Expanded Access: Help for the Uninsured
• Patients' Bill of Rights Medicare
• Medicare Balanced Budget Refinement Act of 1999 and Remaining Issues from the Balanced Budget Act of 1997
• Medical Errors Reduction/Quality Improvement
• Medicare Bills H.R. 1103 and H.R. 1785 introduced by Congressman Rangel

MEDICARE

The Ways and Means Committee has jurisdiction over the Medicare program.  Medicare is a nationwide health insurance program for persons age 65 and over and certain disabled persons.  Medicare consists of two parts - Part A, Hospital Insurance, and Part B, Supplementary Medical Insurance.

Each year in October, all Medicare beneficiaries should receive a Medicare handbook, "Medicare and You", which describes and answers questions about Medicare.  If you have not received your copy of "Medicare and You" or if you have questions about Medicare, you may call 1-800-MEDICARE (1-800-633-4227).  In addition, consumer information about Medicare is available at the Medicare Internet site, http://www.house.gov/htbin/leave_site?ln_url=http://www.medicare.gov&ln_desc=Medicare+--+The+Official+U.S.+Government+Site+for+Medicare+Information.  More technical information about Medicare is available at the Internet site of the Health Care Financing Administration (HCFA), http://www.house.gov/htbin/leave_site?ln_url=http://www.hcfa.gov&ln_desc=HCFA+--+The+Medicare,+Medicaid,+and+State+Children's+Health+Insurance+Program+(SCHIP)+Agency.

Almost all Americans age 65 and over are automatically entitled to Medicare Part A.  Medicare Part B is voluntary.  All Americans age 65 and over are eligible to enroll in Part B by paying a monthly premium.  Disabled persons under the age of 65 who are receiving Social Security cash benefits on the basis of disability are also entitled to Medicare after a 24 month waiting period.  In addition, most persons who have end stage kidney disease are also entitled to Medicare.  In 2000, approximately 39 million persons are enrolled in Medicare.

Medicare Part A is paid for through payroll taxes of 1.45 percent from employees and 1.45 percent from employers.  Medicare Part B is paid for 75 percent from general revenues and 25 percent from monthly premiums from those who enroll in the program. In 2000, the Medicare Part B monthly premium is $45.50.

Medicare Part A covers inpatient hospital services.  Patients must pay a deductible ($776 in 2000) each time their hospital admission begins a new benefit period.  (A benefit period begins when a patient enters a hospital and ends when the patient has not been in a hospital or SNF for a period of 60 days.)  Medicare pays the remaining costs for the first 60 days of hospital care; after that, patients must pay a copayment for each additional day of care.

Medicare Part A covers up to 100 days of post hospital skilled nursing facility (SNF) services.  There is no deductible for SNF services, and patients are not required to pay a copayment for the first 20 days of SNF care.  Patients must pay a copayment ($97 per day in 2000) for days 21-100.

Medicare Part A covers post hospital home health services for patients who are homebound and need skilled care.  Medicare Part A also covers hospice care for terminally ill patients who need palliative care at the end of life.

Medicare Part B covers certain preventive services, the services of doctors and other practitioners, hospital outpatient and clinic services, home health services that do not immediately follow a hospitalization, dialysis services for end stage kidney disease patients, laboratory services, home medical equipment, and certain other medical services. Patients must pay the first $100 in services (the Part B deductible).  Medicare usually pays 80 percent of Medicare's allowed charge, and patients must pay the other 20 percent.

Medicare does not cover the costs of outpatient prescription drugs (with the exception of certain outpatient cancer drugs).  In addition, Medicare does not cover long term care, experimental services, services needed while traveling in other countries, and services that are not medically necessary.

Help for certain low-income Medicare beneficiaries is available through State Medicaid programs.  Medicare beneficiaries who also qualify for Medicaid are eligible to receive all Medicare and all Medicaid benefits.  Other low-income Medicare beneficiaries may receive assistance in paying their Medicare monthly premiums and their Medicare deductibles and copayments.  All low-income Medicare beneficiaries should inquire about this assistance at their local Medicaid offices.

Medicare beneficiaries may receive their services through the original Medicare program or through a Medicare+Choice plan.  The Medicare handbook, "Medicare and You", describes and answers questions about Medicare choices available in your area.  In addition, consumer information about Medicare choices is available at the Medicare Internet site, http://www.house.gov/htbin/leave_site?ln_url=http://www.medicare.gov&ln_desc=Medicare+--+The+Official+U.S.+Government+Site+for+Medicare+Information.  If you have questions about your Medicare choices, you may call the toll-free number 1-800-MEDICARE (1-800-633-4227).

Medicare Reform is a topic of great debate in the Congress.  As the baby-boom generation reaches age 65 and becomes eligible for Medicare, the number of Medicare beneficiaries will almost double.  Financing experts project that Medicare's current financing structure - with its separate financing for Part A and Part B - will not be able to sustain the program at that time.  In addition, many believe that the current Medicare program is inadequate because it lacks coverage for prescription drugs and long term care.  In response to these concerns, the President and others have recommended significant changes to Medicare.  To help pay for the costs of Medicare, the President has proposed using a portion of the budget surplus projected over the next 15 years.  In addition, to control rising costs in Medicare, the President has proposed expanding the use of cost-containment measures such as competitive bidding.  Greatly increased anti-fraud measures have already help to reduce the growth in Medicare spending.  Medicare beneficiaries are urged to help fight fraud in Medicare by calling 1-800-MEDICARE (1-800-633-4227) when they suspect fraud.

Prescription drugs - The President has proposed expanding Medicare benefits to include coverage for outpatient prescription drugs.

Improving Preventive Benefits - The President has proposed expanding Medicare coverage for preventive benefits and eliminating deductibles and coinsurance for preventive benefits.

Medicare Buy-In for Certain People Aged 55-64.  Many people aged 55-64 have great difficulty obtaining health insurance, and the President has proposed permitting certain people aged 55-64 to purchase Medicare.  Persons aged 62-64 without employer sponsored insurance would be permitted to purchase Medicare.  In addition, persons age 55-62 who involuntarily lose their jobs and health care coverage would be permitted to purchase Medicare.  Retirees whose former employers terminate their health coverage would be permitted to pay to extend their employer's coverage until age 65.

MEDICARE OUTPATIENT PRESCRIPTION DRUG COVERAGE

Medicare beneficiaries need help meeting the cost of prescription drugs.

• The average beneficiary is spending roughly $1,000 a year on prescriptions.

• One third of Medicare beneficiaries have no coverage for prescription drugs.  Two-thirds of beneficiaries have no coverage or unreliable drug coverage.

• Medicare HMOs are retreating from drug coverage.  Premiums and copays are rising, caps of $1,000 or even $500 per year are being imposed more frequently, and more Medicare plans are eliminating entirely their optional drug benefits.

• Employer-sponsored retiree health coverage is plummeting, dropping by 25 percent from 1994-1998 alone.

• The three Medigap policies that include drugs are a bad deal for beneficiaries.  Many seniors enrolled in a Medigap policy with drug coverage are paying a premium that costs more than the value of the prescription drug benefit alone.

• Ensuring that seniors can pay to fill their prescriptions would free up resources to improve the quality of care, cut other health care costs, and - through the bill-paying mechanism - use computers to guard against medical errors related to wrongful prescribing and to reduce expensive adverse drug reactions.

Stark-Dingell-Waxman-Kennedy (H.R. 1495):  Universal Medicare drug benefit with a $200 deductible and 20 percent coinsurance for seniors up to $1,700 per year.  Seniors with very high drug expenses get 100 percent of their drug costs paid by Medicare (i.e., stop-loss) after $3,000 in annual out-of-pocket spending.  The premiums are 25 percent of program cost.

President Clinton's Proposal:  Universal Medicare drug benefit worth $1000 of insurance rising to $2500 by 2009 and with proposed stop-loss coverage of $35 billion over ten years.  There is no deductible.  The copay is 50 percent, and the premiums are 50 percent of program cost.

Allen-Turner-Waxman (H.R. 664):  Drug manufacturers that engage in business with the federal government would be required to make their products available to participating pharmacies at the best price available to the Federal Government or any large insurer.

Breaux-Frist (S. 1895):   Beneficiaries could buy a "high option" plan that would pay for $800 worth of drugs, and 25 percent of the cost of this program would be subsidized.  But to buy it, beneficiaries also would be required to buy a catastrophic policy that - after a $2000 deductible - would cover all non-Rx Medicare costs (copays and deductibles).  Seniors would be forbidden from buying Medigap policies to fill that $2000 cap.  The independent office of the Chief Actuary of Medicare has just written that, assuming no adverse risk selection (and there would be), the premium for this high option plan would be $1240 a year.  So a senior with a $1000 prescription drug costs would pay $1440 a year for $800 worth of drugs [($1000-$800) + $1240].  Note also that the Chief Actuary has estimated that basic Medicare premiums - now $45.50/month - also would go up about 47 percent under premium support.) 

Bilirakis (H.R. 2925):  If a state chooses to participate, it must cover low-income seniors up to 120 percent of poverty, with the option of extending that to 200 percent of poverty.  States get to decide the income threshold, and they can establish asset or resource tests as well.  This bill also has a federal stop-loss program that picks up after $1,500 in expenses.  But to get it you have to have prior "qualified" coverage from an HMO or a group health plan or a Medicare+Choice plan, and there's no special help for the low-income.

Snowe-Wyden (H.R. 2782):  Includes a voluntary drug benefit that subsidizes costs for beneficiaries enrolled in supplemental drug policies created by the SPICE board, Medicare+Choice plans, and group health plans.  The subsidy varies by income and increases at lower income levels.  However, there is no guarantee that the funds will be available to offer the full premium assistance described in the bill, since the premium subsidies are contingent on revenues in the SPICE trust fund, which are derived from tobacco tax increases and the on-budget surplus.

PUBLIC SUPPORT FOR A MEDICARE DRUG BENEFIT

The public overwhelmingly recognizes the need to provide seniors with access to affordable drugs.  According to a Harris poll, 90 percent of Democrats, 87 percent of liberals, and 80 percent of Republicans and conservatives support a Medicare drug benefit.  In addition, 70 percent of those participating in a recent Discovery/Newseek poll ranked the high cost of prescription drugs as "the most important problem with the health-care system."

REPUBLICAN RELUCTANCE

Despite the public's priorities, has there been a real reluctance for Republicans to move forward on the issue of Medicare prescription drug coverage this Congress.

During consideration of the BBA Refinement legislation, the Ways and Means Subcommittee on Health Republicans ALL voted against an amendment offered by Rep. Karen Thurman to include a drug discounting provision based on Rep. Allen's drug discount proposal.  This legislation would have given seniors a price discount on their prescription drugs and permitted beneficiaries finally to purchase medicines at a fair price - bringing an end to the drug companies' price discrimination.

Additionally, at the close of the last session, Republicans decided to bring the BBA Refinement Act to the House floor under the suspensions calendar so that amendments - such as a drug discounting provision - could not be introduced.

DISCHARGE PETITION PROCESS

On February 16, 2000, Reps. Stark and Shows filed two discharge petitions on H.R. 1495, the "Access to Prescription Medications in Medicare Act" and H.R. 664, "The Prescription Drug Fairness for Seniors Act."  These discharge petitions are being pursued for the same reason Democrats had to force Republicans to act on campaign finance reform and the Patients' Bill of Rights.

Even though the Republicans now have started holding hearings and have formed a Republican task force to address Medicare prescription drug coverage, Democrats do not believe they really want to go forward with meaningful prescription drug legislation this year.  The Shows and Stark discharge petitions could be the only means of forcing the full House to address the crucial issue of affordable access to prescription drugs for our Nation's seniors and disabled.

These two discharge petitions go hand-in-hand to demonstrate that Democrats stand for a universal drug benefit and for ending drug company price discrimination against seniors.  Both discharge petitions call for an open rule to bring each of these bills to the House floor for consideration.  Signing these petitions simply puts Members on record as wanting the House of Representatives to debate on the floor the issues of prescription drug pricing and a Medicare prescription drug benefit.

MEDICARE REFORM: LONG-TERM RESTRUCTURING AND PREPARING FOR THE BABY-BOOM GENERATION RETIREMENT

In March, 1999, the BBA-created Bipartisan Commission on the Future of Medicare (known as the Breaux-Thomas Commission) failed to report a proposal to save and improve Medicare for the pending retirement of the Baby Boom generation.  Eleven votes were needed to report a proposal.  A Premium Support proposal did get the support of ten members and has been the subject of numerous hearings, reports, and studies.  In the fall of 1999, Senators Breaux and Frist introduced S. 1895, incorporating many, but by no means all, of the Commission's 10-vote proposal.  No legislation has been introduced yet on the House side, although Chairman Thomas has said that the House will consider 'reform' legislation in 2000.  Many have tied consideration of Medicare reform/restructuring to the consideration of any Medicare pharmaceutical benefit expansion.

In response to the Premium Support idea, the President on June 30, 2000, issued his own plan.  While most of the legislative language has been developed, it had not been introduced when this document was prepared in March 2000.  Attached is a summary of the major differences between Breaux-Thomas of March 1999, Breaux-Frist S. 1895, and the President's plan.

Basically, the President achieves Trust Fund solvency to 2025 by dedicating 15 percent of the budget surplus to Medicare, starts a modest drug benefit for all beneficiaries, and keeps Medicare fee-for-service system available for seniors without large increases in premiums.  Medicare fee-for-service is modernized substantially by converting into a better, PPO (preferred provider organization)-type purchaser.  These PPO-type changes, however, will be resisted by many providers who fear being left out of the PPO.

Under the President's proposal, managed care plans would obtain more savings for Medicare by competing on the basis of price for a set package of benefits.

Breaux-Thomas achieves only one or two years solvency, helps only those under 135 percent of poverty with pharmaceuticals, and most importantly, uses higher premiums to push most seniors into private, bare-bones HMOs.  It also would subject Medicare to annual budget votes if general revenue spending exceeds 40 percent of total program spending (which it is expected to do by 2008).  Many Democrats point to this change as endangering the concept of Medicare as an entitlement, free of the yearly budget fights.

Breaux-Frist probably does even less for solvency, because it drops many of the difficult changes (such as increasing the age of Medicare eligibility, cutting payments to providers in out-years, etc.) and adds an expensive new catastrophic benefit for low income seniors.  As the attached letter from the independent Office of the Chief Actuary of Medicare makes clear, the Breaux-Frist plan would result in a major (47 percent) increase in premiums for seniors.  The $800 drug benefit will cost seniors at least $1240.  (That includes a catastrophic benefit after $2000 of expenses, but prohibits seniors from buying medigap insurance to help with the $2000.)  The Committee on Ways and Means also has received two reports from the Congressional Research Service calling into severe question the feasibility of the seven person Medicare Board which would seek to administer (outside the civil service) Medicare's $300-billion-plus program.  These reports are available upon request.

Outlook:  Chairman Thomas continues to say that the House will debate and vote on some or all of these restructuring ideas, especially as part of a prescription drug benefit.  Senate Finance is holding five hearings on the proposal, and some predict that they will propose, at a minimum, some type of Medicare Board to 'reform' HCFA's governance structure.

EXPANDED ACCESS: HELP FOR THE UNINSURED AND LONG-TERM CARE

When the House and Senate passed the Patients' Bill of Rights legislation, they coupled it with tax changes designed to increase access to health insurance for the uninsured, speed up 100-percent deductibility for health insurance costs of the self-employed, encourage the purchase of long-term care insurance, expand Medical Savings Accounts, and make other health-related tax changes.  The House also included legislation designed to help small business owners purchase insurance through Association Health Plans and HealthMarts - quasi-insurance purchasing groups which do not need to comply with various State laws and mandates.

The House-passed provisions were estimated to cost about $69 billion over ten years; the Senate provisions cost about $39 billion.  These issues may be resolved in the pending Conference Committee.

Unfortunately, tax deductions do almost nothing to help the uninsured.  About 43 percent of the uninsured pay no Federal income taxes, and about another 45 percent who are in the 15-percent Federal income tax bracket, are helped little by a tax deduction.  Many Democrats are urging that, instead of tax deductions which almost entirely help those who already have insurance, Congress consider either refundable tax credits or the President's proposals to spend more on the Children's Health Insurance Program (CHIP) and Medicaid.

The Congressional Budget Office has estimated that the AHP and HealthMart provisions in the Republican access title also help very little.  CBO estimates that a little over 300,000 previously uninsured might become insured through small businesses which would be able to buy insurance at lower rates under the AHP and HealthMart proposals.  Unfortunately, for 20 million other workers in the majority of small businesses, insurance rates would be likely to go up.

The AHP/HealthMart proposal would insure fewer previously uninsured individuals than would the President's proposal to help people age 55 and over who have no insurance buy into Medicare.  The President has proposed to assist with the early Medicare buy-in through a 25-percent tax credit or through the assisted purchase of COBRA health continuation benefits.

Outside the Patients' Bill of Rights Conference, there is increasing discussion of the use of refundable tax credits to help the uninsured buy policies.  Representatives Armey, Stark, Rogan, and McDermott have introduced bills. Subcommittee on Health Chairman Thomas also has suggested he may introduce a major bill in this area.

All these proposals cost $20 to $50 billion a year.  Because most individual health insurance in America is sold at retail, is medically-underwritten, and increases in cost as one ages, tax credits without fundamental insurance reform will do little for those who most need insurance.  (For data supporting this statement, see the Congressional Record of March 8, 2000, pages E247-E248.)  Rep. Stark's bill does allow individuals who benefit from the credit to select group-rate-priced insurance similar to that available to Federal workers.

There are other ways to expand coverage.  For example, Rep. Stark and Senator Rockefeller hope to introduce a bill that would enroll every child born after January 1, 2002, automatically in a Medicare-type program (MediKids).  Under their legislation, if a family has comparable private insurance, the family can opt out.  After 18 years, every child in America would be insured, regardless of family job status, etc.  By phasing in the benefit year-by-year, the costs of the program initially would be very low, but would, over time, cover the expense of ensuring that every child in America is insured.

Long-term care: The President's budget proposes a $3,000 tax credit for caregivers of dependent children and adults (up from a $1,000 proposal in last year's budget).  Republicans have proposed an additional personal exemption for dependent care.  The exemption is in the Conference on the Patients' Bill of Rights.

In the summer of 1999, Reps. Stark and Markey introduced H.R. 2691, a long-term care bill, to try to highlight this growing area of need.  The bill would establish a much wider range of Medicare home health, adult day care, hospice, and other health-related services.  No action is scheduled on this proposal.

PATIENTS' BILL OF RIGHTS/MANAGED CARE REFORM

Last October, the House passed H.R. 2723, a strong, bipartisan managed care reform bill known as Norwood/Dingell or the Bipartisan Consensus Managed Care Improvement Act.

That bill passed by the stunning bipartisan margin of 275-151 - with 68 Republicans joining with Democrats to ensure its passage.

The Senate also passed a bill on managed care reform, but it is a very different piece of legislation and falls far short of the House-passed legislation.

The conference committee had its first official meeting on March 3, 2000.  It was a ceremonial meeting in which Senator Nickles was elected chairman.

Senator Nickles stated that his goal was to have the staff proceed forward in negotiations to try to work out differences between the two bills on the common patient protection provisions (access to emergency, access to ob/gyns, etc.) and that, after we had worked through those issues, we would go onto some of the more complex issues such as external appeals, liability, and scope.

He also stated that he would like to conclude the conference by the end of March.

As this notebook is being prepared in mid-March, not much progress has been made at the staff level in reaching agreement on these "common" provisions, but the meetings are going forward.

HOUSE/SENATE DIFFERENCES:

The Senate's Republican managed care reform bill has two major weaknesses:  scope and liability.

SCOPE:  The Senate-passed bill applies mainly to the 48 million self-insured Americans and leaves more than 100 million other people in managed care under the control of the states.

LIABILITY:  The Senate-passed bill includes no changes to ERISA to give patients the right to sue their health plans for damages.  Under the Senate language, people's legal rights would be limited to collecting for the service that was denied them and, possibly, legal costs - nothing else.  Thus, aside from some civil monetary penalties that health plans could build into the cost of doing business, there is no real enforcement if the plans violate provisions of the law.

EXTERNAL APPEALS/MEDICAL NECESSITY:  The Senate-passed bill requires the external appeal entity to use the definition of medical necessity used by the plan in determining whether an appeal should be granted.  That means the plan makes all the rules, and the external appeal is not truly an independent medical decision.

CONFERENCE ISSUES

It appears that the major issue in conference will be liability (though scope will also be a major issue with Senate Republicans).  The debate has moved in the House's direction.  It no longer appears to be a debate over whether there will be liability but, instead, a debate over how that liability will be structured.  Even Senator Lott has been quoted at a recent Chamber of Commerce speech as saying, "certainly, under egregious cases, you will have the right to sue."

There is some GOP discussion of eliminating access to class action lawsuits altogether.  Obviously, low-income people sometimes only have access to the courts through such class actions.  Banning class actions would create real inequities.

The access provisions, as described below, also will be major conference issue, since all of the Republicans have voted for these same tax cuts numerous times.

BALANCED BUDGET REFINEMENT ACT OF 1999

MEDICARE PROVISIONS

The Balanced Budget Act of 1997 (P.L. 105-33) included a number of Medicare provisions.  At the time of enactment, the Congressional Budget Office (CBO) estimated that Medicare spending would be reduced by $116.4 billion over 5 years (FY 1998-2002) and $393.8 billion over 10 years (FY 1998-2007).  The BBA was intended to slow the rate of growth in Medicare spending both by slowing the rate of growth in payments to hospitals, physicians, and other providers and by establishing new prospective payment systems and other new payment methodologies.  The BBA also established the Medicare+Choice program, which was intended to expand private plan options available to Medicare beneficiaries.

In March 1999 and in July 1999, CBO lowered its Medicare spending estimates.  Many health care provider groups stated that actual payment reductions resulting from the BBA 97 were larger than intended when the BBA was enacted.  However, the reduced estimates reflected a number of factors in addition to BBA changes, including an improved economic forecast, heightened anti-fraud and abuse initiatives, a slowdown in payments to providers, and lower enrollment in the Medicare+Choice program.  The Medicare Payment Advisory Commission (MedPAC) and the GAO found that the BBA provisions did not impede beneficiary access to care.

Both the House and Senate considered bills to mitigate the impact of the BBA provisions on Medicare providers, and on November 18, 1999, the Congress passed the conference report on H.R. 3194, the District of Columbia appropriations bill, which incorporated the agreement reached by House and Senate negotiators on the Medicare provisions.

The CBO estimated that the provisions in this bill will increase Medicare spending by $16 billion over five years (FY 2000-2004) and by $27 billion over ten years (FY 2000-1009).

• The bill increases Medicare payments to hospitals by $3.4 billion over 5 years, including $1 billion for rural hospitals.

• In addition, payments for hospital outpatient services are increased by $4.5 billion over 5 years, including an administrative change that increases payments by $3.9 billion.

• The bill increases payments for skilled nursing facilities by $2.1 billion over 5 years, including increases for services for medically complex patients.

• The bill increases payments for home health and hospice services by $1.3 billion over 5 years.

• The bill increases payments to Medicare+Choice plans by $1.9 billion over 5 years.

• In addition, the bill increases Medicare payments for various other services, such as dialysis, durable medical equipment, pap smears, and immunosuppressive drugs.

In November, 1999, the Institute of Medicine (IOM) issued a report, "To Err is Human: Building a Safer Health System".  (See http://www.house.gov/htbin/leave_site?ln_url=http://www.iom.edu&ln_desc=Institute+of+Medicine) The IOM reported that preventable adverse medical events (medical errors) are responsible for 44,000-98,000 deaths each year at a cost of $17-$29 billion.  Using the conservative figure, medical errors rank as the eighth leading cause of death in the U.S.  The Food and Drug Administration estimates that 10 percent of all hospital admissions are related to adverse drug events, and 7,000 people die each year from medication errors.  The Centers for Disease Control (CDC) has reported that hospital-acquired infections affect approximately 2 million persons annually.

The IOM found that most medical errors are caused by faulty health care systems, rather than poor performance by individual providers, and that errors can be prevented by redesigning health care systems to make it harder to make errors.  The IOM found that health care has lagged "a decade or more behind other high-risk industries in its attention to ensuring basic safety."

The IOM recommended:

• Strengthening of standards and expectations for patient safety, including greater Federal funding for research to develop performance standards and dissemination of "best practices" throughout the health care system. 

• Creating safety systems inside health care organizations, such as hospitals, nursing homes, and outpatient facilities.

• Mandatory reporting of serious adverse events - those that result in death or permanent injury, and voluntary reporting of "near misses."  Reporting should be confidential, blame-free, and non-punitive.

• Investigation of causes of errors and feedback to health care facilities.

On February 10, 2000, the Ways and Means Health Subcommittee held a hearing on the IOM report, and the Minority is working with the Majority to develop legislation to address the issues raised in the report.

INFORMATION ON MEDICARE BILLS INTRODUCED BY CONGRESSMAN RANGEL

NEWS RELEASE:  RANGEL INTRODUCES BIPARTISAN BILL TO HELP NATION'S "SAFETY-NET" HOSPITALS (March 11, 1999)

EXTENSION OF REMARKS:  INTRODUCTION OF LEGISLATION TO HELP THE NATION'S SAFETY NET HOSPITALS: CARVE?OUT OF DISPROPORTIONATE SHARE HOSPITAL PAYMENTS -- HON. CHARLES B. RANGEL (March 11, 1999)

EXTENSION OF REMARKS:  RANGEL INTRODUCES LEGISLATION (H.R. 1875) TO STOP FINANCIAL HEMORRHAGE OF NATION'S PREMIER TEACHING HOSPITALS (MAY 12, 1999)