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The House in Committee of the Whole House on the State of the Union had under consideration the bill (H.R. 2506) to amend title IX of the Public Health Service Act to revise and extend the Agency for Health Care Policy and Research:

• Mr. CAPUANO. Mr. Chairman, I rise in support of the Pediatric Graduate Medical Education (GME) amendment offered by Mrs. JOHNSON of Connecticut. The amendment, identical to H.R. 1579, The Children's Hospital Research and Education Act of 1999, would provide targeted Graduate Medical Education funding to our nation's freestanding children's hospitals by creating a fair and equitable financing system for pediatric physician training.

• In today's increasingly competitive health care marketplace, independent children's teaching hospitals face serious challenges in receiving adequate patient care reimbursement to cover the added costs of their GME program. Unlike other teaching hospitals, freestanding children's hospitals do not qualify for the one remaining, stable source of GME financing--Medicare--because they care for children, not the elderly. As a consequence, these hospitals receive less than 0.5% of the level of Medicare direct and indirect medical education support that all teaching hospitals receive. Boston Children's Hospital, located in my district, estimates the cost of GME to be in excess of $20 million of which only $2-3 million is reimbursed from the state's Medicaid program. This leaves $17 million in unreimbursed expenditures that the hospital is forced to absorb. This gap in federal support jeopardizes highly successful pediatric training programs and places these children's hospitals at increasing competitive risk.

• Comprehensive GME financing reform is needed by all hospitals, however, its achievement is several years away at best. This bill addresses the need for interim federal GME support for these children's teaching institutions which although accounting for less than 1% of all hospitals, train nearly 30% of all pediatricians and nearly half of all pediatric specialists. The passage of H.R. 1579 would allow for freestanding children's hospitals to receive an immediate source of financial assistance through a capped, time-limited appropriation that would provide GME payments to children's hospitals. The measure would authorize a $280 million grant in FY2000 and $285 million in FY2001. The passage of this bill would help sustain the vital role played by our Nation's freestanding children's teaching hospitals and would make payments to children's hospitals commensurate with those provided to other teaching facilities.

• Without a consistent source of financial support, children's hospitals cannot fulfill their mission--providing clinical care for the sickest and poorest children, training the next generation of care givers for children, and investing in research to improve children's health care. If we really care about our children's future, we must ensure that they have access to the best medical care in the world. With this in mind, I urge each of my colleagues to give this amendment their strongest support.

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