H.R. 5621 MEDICAID DISPROPORTIONATE SHARE (DSH) -- HON. BOBBY L. RUSH (Extensions of Remarks - December 05, 2000)

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HON. BOBBY L. RUSH OF ILLINOIS IN THE HOUSE OF REPRESENTATIVES Tuesday, December 5, 2000

Mr. RUSH. Mr. Speaker, on November 1, 2000 I introduced H.R. 5621, the Medicaid Disproportionate Share Hospital (DSH) Fairness Act of 2000. This legislation is identical to a bill which was introduced last month by the senior Senator from Illinois, with the full support of the Administration.

In 1997, Congress enacted the Balanced Budget Act (BBA) of 1997 (P.L. 105-33). The stated intent of the legislation was to slow the rate of growth in the Medicare program Unfortunately, the reductions enacted through the BBA went much deeper than expected. As a result, the net and cumulative effects of the Act have severely reduced Medicare reimbursements to hospitals and health service providers.

I opposed the Balanced Budget Act when it was debated by the House of Representatives in 1997. I believed that it was a bad policy then, and believe that it is a bad policy now.

The BBA reductions have been particularly severe on hospitals in Illinois. In my district, which encompasses the south and west sides of the city of Chicago, there are eleven major hospital facilities which have been devastated by BBA reductions. Multiply the losses across the state, and the impact on services is staggering. In the First Session of the current Congress, I introduced the Health Care Preservation and Accessibility Act of 1999, H.R. 3145,
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to provide relief to hospitals, community health centers, and skilled nursing facilities harmed by the excessive reductions of the Balanced Budget Act. Although my legislation was not enacted, the intent of many of its provisions were included in the Medicare Balanced Budget Refinement Act of 1999 (P.L. 106-113). That legislation helped relieve some of the financial strain placed on hospitals and health providers. However, while hospitals and health care providers still struggle under the economic pressures imposed the BBA reductions, a new series of proposed reductions threaten financial solvency.

In May of this year, the Health Care Financing Administration (HCFA) issued a notice to state Medicaid directors advising of its intent to revise the Medicaid funding formula known as Intergovernmental Transfers (IGT). This proposed rule would slash an additional $375 million a year in Medicaid funding for Illinois--a state in which the healthcare system is already devastated by the effects of the Balanced Budget Act--and further endanger critical health services for children, senior citizens and the poor.

Both the state of Illinois and Cook County have diligently and constructively used the IGT funding to enhance the health care system, especially for low-income, uninsured and under insured Chicagoans, over the last 10 years. Although under the Health Care Financing Administration's Notice of Proposed Rulemaking, the IGT program changes would be phased-in over a 5 year period, the proposed change would severely cripple the State's ability to provide needed health care services to Illinois citizens.

The legislation, which I have introduced with my colleague in the Senate, is designed to increase the Medicaid Disproportionate Share payments to all states and encourage states to use the DSH program as it was intended--to fund uncompensated health care. By increasing the Medicaid DSH payments, we are acknowledging the burden placed on hospitals that treat a large number of Medicaid and uninsured patients by the Balanced Budget Act and the proposed HCFA regulations.

Enactment of H.R. 5621 would allow Illinois, and all of the states, to continue to make inroads towards ensuring that an extensive safety net of hospitals and health care providers exist to provide care to the most vulnerable groups of society.

I urge my colleagues to join me in support H.R. 5621, and if this Congress fails to act on this legislation, I hope my colleagues will join me in making it a priority in the 107th Congress.
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