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Make no mistake about it, Mr. Chairman. Top notch training programs are critical to ensure quality health care for our children. Kids with unusual and medically complex diseases depend on the sophisticated resources of our children's medical ce nters. Quality pediatric care depends on high-quality training of pediatric specialists and sub-specialists, and improvements in diagnosing and treating disease depend on sophisticated basic and clinical research carried out in our children's hospitals.
This grant program has broad bipartisan support. It is co-authored by over 190 Members, including the chairs and ranking members of the critical committees, and I urge my colleagues' support of it here today.
Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment offered by the gentlewoman from Connecticut (Mrs. JOHNSON).
Mr. Chairman, the majority had a chance to review the amendment. It would provide graduate me dical ed ucation pa yments to the children's hospitals by creating a financing system for pediatric physical training. The amendment was introduced as the Children's Hospital Education an d Research Act, H.R. 1579, with significant bipartisan support.
Mr. Chairman, few contest the historic inequity in GME funding for children's hospitals. Because Medicare is the largest single payer of GME and since freestanding children's hospitals treat few Medicare patients, as the gentlewoman from Connecticut said, their GME funding is very low. This gap in Federal support jeopardizes highly successful pediatric training programs.
Since comprehensive GME reform may take more time to develop, this amendment will provide immediate financial assistance through a capped, time-limited appropriation of $280 million in fiscal year 2000 and 285 million in fiscal year 2001. This authorization would end after 2 years or with the enactment of GME reform, whichever occurs first.
Although, Mr. Chairman, I am not going to make a motion to contest the germaneness of this amendment, I do wish to point out that the bill under consideration now which reauthorizes an agency with a primary research mission is a questionable vehicle for authorizing appropriations for funding GME and children's hospitals, and I am sure the gentlewoman understands that and would acknowledge that. Moreover, on process grounds I can make a strong argument for moving the children's GME bill through the normal committee process rather than as an amendment to H.R. 2506.
But having said this, Mr. Chairman, of course I am a cosponsor of the Johnson GME bill, and I agree with my colleague from Connecticut that this authorization of appropriations will send an important message to the relevant appropriations committees that the Congress considers support of GME for doctors training in children's hospitals as a high, high priority, and therefore, Mr. Chairman, we are prepared to accept the amendment.
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Ms. PRYCE of Ohio. Mr. Chairman, I move to strike the requisite number of words.
Mr. Chairman, I rise in strong support of the Johnson amendment, and I congratulate my friend for her work on this very and most important issue, and I appreciate the chairman's support. Very simply, this amendment makes an investment in children's health by authorizing funds for physician training. Currently the Medicare program provides the most reliable and significant support for graduate me dical ed ucation, b ut children's hospitals do not treat Medicare patients who are largely senior citizens.
Mr. Chairman, the current system leaves children's hospitals searching for compensation for the time-consuming and resource-intensive training they provide to enhance our physician work force. While children's hospitals or while children's teaching hospitals represent only 1 percent of all hospitals, they train nearly 30 percent of all pediatricians, nearly half of all pediatric specialists and a significant number of general practitioners.
Now I have spent the better part of the past year in and out of Children's Hospital in Columbus, Ohio, and I know firsthand the critical difference between medical ca re for adults and medical ca re for children and all the commensurate differences in training that go along with the treating of a sick child as opposed to a grown adult including very basically the size of medical eq uipment, the dosage of drugs, the size of prosthetics, the administration of anesthesia, the ongoing development, the physical development, of children, the communication barriers. The list goes on and on, and it is absolutely critical for the physicians who treat children to have the proper training to meet the needs and challenges that are specific to children.
It is this kind of training that our Nation's children's hospitals are uniquely qualified to provide. Our current system of financial support for medical tr aining disadvantages children's teaching hospitals, and the Johnson amendment begins to address the inequities of our graduate me dical ed ucation sy stem by authorizing a grant program to advance pediatrician training and pediatric research. It is a small price to pay to ensure that our children's hospitals can continue their mission to care for the sickest and poorest children while training the next generation of caregivers. It makes sense to add this provision to legislation that is focused on promoting public-private partnership to ensure health care quality research and patient access to care.
This interim solution to fix the inequities of our GME system has the support of 190 Members of the House and 38 Senators who have cosponsored similar legislation. I urge the rest of my colleagues to join us in support of the Johnson amendment and in recognition of the special work that children's doctors devote their lives and energies to.
Mr. LARSON. Mr. Chairman, I move to strike the requisite number of words.
Mr. Chairman, I rise today in support of the amendment offered by my esteemed colleague from Connecticut (Mrs. JOHNSON). The amendment provides funding for grants to children's hospitals to train pediatricians. This amendment incorporates the provisions of H.R. 1579, the Children's Hospitals Education an d Research Act of 1999. It was one of the first bills I cosponsored on becoming a Member of this body.
This amendment greatly affects the 59 independent children's teaching hospitals across this Nation. Although these hospitals represent less than 1 percent of all hospitals in the Nation, they train over 5 percent of all physicians, 29 percent of all pediatricians and most pediatric specialists.
The Connecticut Children's Medical Ce nter is located in the center of my district and is one of these hospitals that desperately needs this graduate me dical fu nding for their education pr ograms. I have heard from many of my constituents and work closely with the staff at the medical ce nter, its president, Larry Gold, and Eva Bunnell who is a tireless advocate on behalf of the children of our great State of Connecticut.
As a parent of three children, I understand the importance and necessity of this funding. This amendment would authorize annual funding for 2 years and provide a more equitable, competitive playing field for independent children's teaching hospitals.
I wear this pin today, which is the Connecticut Children's Medical Ce nter's logo. It represents an open-armed child made of colorful blocks. A 8-year-old from the hospital said the logo looks like a kid ready to give a hug.
We cannot turn our backs on the Nation's children and the care they deserve, and aside from the hugs they richly deserve, they need funding. Without this funding, these independent hospitals, which care solely for children, will find it hard to operate to the best of their ability.
I commend the gentlewoman from Connecticut (Mrs. JOHNSON) for her tireless work on behalf of children in the State of Connecticut and across this Nation. She has done so since she was a member of the Connecticut State Senate. I rise in support of this amendment today and urge our colleagues to join us.
Mrs. JOHNSON of Connecticut. Mr. Chairman, will the gentleman yield?
Mr. LARSON. I yield to the gentlewoman from Connecticut.
Mrs. JOHNSON of Connecticut. Mr. Chairman, it really is a pleasure to have the gentleman from Connecticut here and in support of the remarkable Children's Hospital in Hartford, Connecticut, but I think it gives us a good example of why this is so urgent and why my colleague, the gentleman from Florida (Mr. BILIRAKIS) has been so generous as to let us bring this on this bill.
[Time: 17:00]
Truly, in the environment in which our hospitals are operating, our remarkable little Children's Hospital is a good example of the terrible circumstances these children's centers face. They serve mostly children. Medicaid reimburses much worse than Medicare reimburses, to begin with, and then they are right in the middle of Hartford so they have many, many uninsured children, many very poor children, who need a lot of special care, and yet they get not one cent or hardly a cent of reimbursement for their teaching and research initiatives. We just cannot let this happen.
In the interim, we need this money to help them survive this period of extraordinary change in reimbursements. I just appreciate the gentleman's long working relationship with them, the help he has been on this bill.
I would also like to just take a moment to thank the ranking member, the gentleman from Ohio (Mr. BROWN), who has been a long solid advocate of children's hospitals and worked hard on this amendment for the year and a half or 2 years we have been working on it.
Mr. LARSON. Mr. Chairman, reclaiming my time, I can add no more to the gentlewoman's eloquence.
Mr. WAXMAN. Mr. Chairman, I move to strike the requisite number of words.
Mr. Chairman, I rise in support of this amendment offered by our colleague, the gentlewoman from Connecticut (Mrs. JOHNSON). By providing adequate Graduate Me dical Ed ucation fu nding to children's hospitals, this amendment will ensure that our Nation's premier pediatric health care institutions are capable of pursuing their research, training, and primary-care missions on a firm financial footing.
For too long Congress has failed to remedy a clear inequity in the funding of Graduate Me dical Ed ucation at children's hospitals. Because GME funding is contingent upon an institution's Medicare census, children's hospitals have not received adequate funding for the direct and indirect expenses of operating essential pediatric residency programs.
This amendment has strong bipartisan support in both the House and the Senate. I urge my colleagues to cast a vote in favor of strengthening our children's health care by supporting this amendment.
Let me conclude by saying how pleased I am that the House has reauthorized AHCPR, soon to be called the Agency for Health Research and Quality. I am proud to have been the one to have introduced this legislation creating the agency in 1989 with Senator KENNEDY. Just three years ago, AHCPR underwent a near-death experience arising from partisan politics, so I am
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Ms. McCARTHY of Missouri. Mr. Chairman, I move to strike the requisite number of words.
Mr. Chairman, I want to thank the chairman of the subcommittee, the gentleman from Florida (Mr. BILIRAKIS) for accepting this amendment, to thank the gentlewoman from Connecticut (Mrs. JOHNSON) for her tireless efforts in championing it, and to thank my ranking member, the gentleman from Ohio (Mr. BROWN), for his tireless work as well in support of our children.
I am a cosponsor of similar legislation, and I am very pleased we are moving forward now on this key issue, which will authorize $565 million in appropriations for children's hospitals to maintain their graduate re sidency training programs.
This is critical to the health of our children. Children's hospitals are responsible for the pediatric training of almost one-third of the Nation's pediatricians. A lack of Federal support jeopardizes all education an d training programs in children's hospitals, thereby threatening not only the pediatric workforce, but future health-care research and our children's health. It would be penny-wise and pound-foolish to continue down this path.
In my district alone, this temporary funding will help train 70 doctors at Children's Mercy Hospital, a freestanding regional facility in Kansas City. The Johnson amendment supports the 59 children's teaching hospitals all across our country. I commend the sponsor and chairman and ranking member.
Mr. BACHUS. Mr. Chairman, I move to strike the requisite number of words.
Mr. Chairman, first of all, I would like to commend the gentlewoman from Connecticut (Mrs. JOHNSON), the chairman of the subcommittee, the gentleman from Florida (Mr. BILIRAKIS), and the gentleman from Ohio (Mr. BROWN) for offering this amendment.
Let me tell you what it means to one hospital of the 59. Children's Hospital of Alabama is the only freestanding pediatric hospital in the State of Alabama. It not only receives patients from Alabama, it receives patients from Mississippi and from as far away as Chattanooga, Tennessee.
Children's Hospital presently spends $4 million to $6 million annually for Graduate Me dical Ed ucation. U nlike hospitals which treat Medicare patients, Children's Hospital receives no Medicare funds, and, therefore, no Medicare graduate me dical ex pense reimbursement.
As the gentlewoman from Connecticut has said, Medicaid reimbursements are less, commercial insurers are not offering reimbursement for these expenses, and, with the recent changes in Medicaid and Medicare, all our hospitals are operating under cost controls, but our children's hospitals are operating on the severest of restraints.
Children's hospitals, we have heard various figures on how many of the pediatricians these hospitals train. Children's hospitals train 75 percent of the pediatricians in Alabama; and, nationwide, although children's hospitals train 25 percent or one-fourth of pediatricians, they train almost all pediatric sub-specialists. These are the people that treat our little boys and girls with cancer, with epileptic seizures, those children who are injured in accidents. Our sickest children come to our children's hospitals. They need the best of care, and they need medical do ctors who are trained and trained well.
It is for this reason that I support enthusiastically the amendment of the gentlewoman from Connecticut (Mrs. JOHNSON), for, as we are fond of saying in this body, our children deserve the best, and that includes the best health care, and that includes the best trained health care pediatricians. This amendment will assure that.
To the gentlewoman from Connecticut (Mrs. JOHNSON), I thank you for your hard work; and I commend the body for its consideration of this measure.
Mr. BENTSEN. Mr. Chairman, I move to strike the requisite number of words.
(Mr. BENTSEN asked and was given permission to revise and extend his remarks.)
Mr. BENTSEN. Mr. Chairman, I rise in support of the amendment offered by the gentlewoman from Connecticut (Ms. JOHNSON) and commend her for offering this amendment. I also want to commend the ranking member, the gentleman from Ohio (Mr. BROWN). Both the gentlewoman from Connecticut (Mrs. JOHNSON) and the gentleman from Ohio (Mr. BROWN) have been the original sponsors, of which I am an original cosponsor, of the bill, H.R. 1579, the Children's Hospital Education Re search Act, and I commend them for having the foresight to introduce this legislation.
The JOHNSON amendment would provide critically important Federal funding for our Nation's 59 independent children's hospitals, including six such hospitals in Texas. I have the honor and distinction to represent two children's hospitals, Texas Children's Hospital, which is a qualified independent children's hospital, as well as Memorial Hermann Children's Hospital, which is part of a larger hospital system. In addition to that, I have the Shriner's Orthopedic Hospital in my district in the Texas Medical Ce nter complex, which is in the 25th District. All of these are teaching hospitals aligned with the Baylor College of Medicine and the University of Texas.
As has been pointed out by many Members today, there is a great disparity in the level of Federal funding for teaching hospitals for pediatrics versus other types of teaching hospitals. That is due in large part because of how we have structured our medical ed ucation pr ogram around the Medicare system.
As the gentlewoman knows from the Committee on Ways and Means, this is a broader issue that we need to address. Some of us, the gentleman from Maryland (Mr. CARDIN) and myself, have some ideas. Others have their ideas. The chairman of the Committee on Ways and Means, my next-door neighbor in Houston, has his ideas. But, nonetheless, we should not wait until we come to a conclusion on that. We ought to act as the chairman of the subcommittee said. This is the right thing to do right now.
As has been pointed out, these hospitals, while only being a small percentage, train a very large percentage of the pediatricians. As the gentlewoman from Connecticut (Mrs. JOHNSON) pointed out, these hospitals are under tremendous financial pressure. They are under financial pressure from the private sector in managed-care health plans. They are under pressure in the Medicaid program.
In fact, back in 1997, as part of the Balanced Budget Act, we made pretty dramatic reductions in the disproportionate share program. Fortunately, we were able to ease those a little bit as it affected States like mine in Texas, Connecticut, and others. Those reductions were made, nonetheless. We know that the Nation's children's hospitals do carry a disproportionate share of both indigent and Medicaid patients, which just adds to the fiscal burden that they have to address.
This bill would provide in a 2-year capped program some additional funding to address this situation. But, more importantly, in the long term it would underscore the Federal commitment to ensuring that we continue to have the world's best pediatric care and that we continue to have the world's best medical ed ucation pr ogram.
I hope by passage of this amendment, and hopefully passage of this bill and funding of this bill, that we can go a step further, and when we look at the overall Graduate Me dical Ed ucation pr ogram or the medical ed ucation pr ogram, we will look beyond just Medicare and understand that training doctors and training the other allied health positions is not just something that is benefited by the Medicare beneficiaries; but all of us, including our children, benefit from this; and, thus, we should take that into account in structuring the program.
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