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[Page: H9965] GPO's PDF---
The SPEAKER pro tempore. Under the Speaker's announced policy of January 6, 1999, the gentlewoman from Michigan (Ms. STABENOW) is recognized for 60 minutes as the designee of the minority leader.
Ms. STABENOW. Mr. Speaker, first, as we begin this evening, I want to associate myself with the comments of my colleagues this evening concerning Matthew Sheppard and all of those who have found themselves the victims of hate crimes and the great necessity to pass the Hate Crimes Prevention Act as quickly as possible.
This evening I am joining with colleagues to speak out in support of efforts to restore Medicare cuts that have been too deep and have gone on too long, and we have an opportunity in this session before we leave to fix it, and we need to do that as quickly as possible.
The Balanced Budget Act of 1997 included numerous cuts to Medicare payments, to health care providers, and the original intent was to slow the growth of the costs of Medicare by cutting approximately $115 billion over 5 years. Recently the Congressional Budget Office has projected, however, that Medicare spending has been reduced by almost twice that amount. Clearly Congress went too far.
These are not simply numbers that we are talking about. These are people, these are families, these are doctors and nurses trying to provide care,
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Earlier this year 80 Members of the House joined me in sending a letter to the President asking him that as he put together his Medicare reform package that he not choose to cut Medicare further. I am very pleased that he heard our message and that in fact he did not choose to cut Medicare further but instead proposed restoring $7 billion worth of cuts. That is a good first step, but it is not enough for us to be able to truly solve the problem that faces our health care providers across the country.
Many of us have cosponsored numerous bills that seek to resolve specific problems that have arisen with the balanced budget agreement. Just this year I have cosponsored 10 bills myself that cover specific issues ranging from hospital outpatient prospective payment systems to the $1,500 cap placed on therapy services. My colleagues joining me tonight are deeply concerned and involved in this issue.
The sheer number of bills alone that have been introduced and cosponsored by people on both sides of the aisle should send a strong message to the leadership that we need to act now. Time is running out. For too many time has already run out, and shame on us if we do not act now.
Just today key members of the Committee on Ways and Means and the Finance Committee on the Senate side have introduced marks for legislation to mark up future bills. I am pleased that Senator DASCHLE has introduced a comprehensive bill that addresses a number of the issues we will speak to this evening.
Tonight is our opportunity to outline our priorities for what this legislation should address. Solving the balanced budget agreement concerns involves dollars, Federal dollars, but as I indicated earlier, we have seen more than twice the amount cut that is necessary for Medicare's portion of the balanced budget agreement, and we are now facing surpluses, we are debating surpluses over the next 10 years. For many of us, we have been fighting to put Social Security and Medicare first. We have an opportunity to do that, and an important part of putting Medicare first is to restore the cuts that have been made and provide an opportunity for people to receive the health care that they need and deserve.
[Time: 18:45]
Tonight we are going to talk about real pain that real people are suffering as a result of the deep cuts.
Let me take just a moment in each of the three major areas and then ask my colleagues to respond as well. Let me speak to Michigan. I have had an opportunity to travel across Michigan speaking to hospital providers, nursing homes, home health care providers. Michigan hospitals alone are expected to bear between $2.5 and $3 billion, not million, billion dollars in cuts as a result of the balanced budget agreement. That is a 10 percent cut in their Medicare reimbursements since 1997.
Now, to put that in perspective, 10 percent of the Medicare services to hospitals are providing in-patient care, persons staying overnight. We are talking about a 10 percent cut that could wipe out in-patient care in Michigan. Michigan is already suffering. Schoolcraft Memorial in Manistique, Michigan is suffering devastating losses of the VBA and they recently made the painful decision to close their maternity ward. Now, this is an area where now women are going to have to travel at least 50 miles, travel about an hour in order to deliver their babies. What if there is an emergency? What if that hour is too late?
I have talked with hospitals in Marquette, Michigan in the upper peninsula; in northern Michigan, in my hometown in Sparrow Hospital and the Medical Regional Center and down in the metropolitan area of southeastern Michigan, Detroit Medical Center, Henry Ford Health Systems. In fact, Henry Ford Health Systems located in Detroit announced recently just last week, in fact, that 1,000 employees not directly involved in patient care will be asked to voluntarily retire or will be laid off. One thousand employees, and we have discussions of hospitals, whole hospitals closing.
What is it that we need for our hospitals? We need to repeal the balanced budget agreement transfer provisions. I have cosponsored with colleagues H.R. 405 that would repeal the transfer provision. Currently, hospitals are not discharging patients to nursing homes because the paperwork and regulations are just too difficult. Secondly, we need to limit the reductions for outpatient care. This is a number one concern for hospitals, and I am pleased to have cosponsored H.R. 2241 that would limit reductions to outpatient care.
We need to limit reductions for in-patient care as well, and I am pleased to have cosponsored H.R. 2266 with the gentlewoman from New York (Mrs. LOWEY) that would increase payments to hospitals for in-patient care. We need to provide more support for our rural hospitals in communities like Manistique that are feeling the need to close their facilities for delivering babies.
We need to increase Medicare's commitment to graduate medical education . Our esteemed colleague and ranking member on the Committee on Ways and Means, the gentleman from New York (Mr. RANGEL) has recognized the importance of this issue and I am pleased to be cosponsoring legislation, H.R. 1785, that would stabilize payments to hospitals for the indirect costs associated with graduate medical education .
In the areas of nursing homes, the major feature of the balanced budget agreement that has impacted skilled nursing facilities was the implementation of the Medicare perspective payment system for in-patient services and the establishment of caps on therapy services. The impact of these provisions could range from decisions by nursing homes to no longer provide services that are not adequately reimbursed to limiting the amount of services that a patient can receive. The prospective payment system has dramatically changed the way skilled nursing facilities approach Medicare patient admissions.
Now, skilled nursing facilities require more information prior to a Medicare admission because they have to assess the overall costs and compare that to the costs of reimbursement that they are receiving, and too many times this is keeping our frailest and sickest patients out of our nursing facilities.
The other obstacle to care that nursing facilities are facing is the arbitrary cap of $1,500 for therapy services. The Balanced Budget Act created a $1,500 cap for physical and speech therapy together, and another $1,500 cap for occupational therapy. These caps are way too severe. They are not allowing patients to receive the services that they need. Once the beneficiary reaches the cap, the nursing facilities must seek payment from the patient or decide whether or not to continue care. Our nursing homes need to lift the arbitrary therapy cap, and we need to reduce the cuts from the prospective payment services.
Finally, an area that has been hit extremely hard by the balanced budget agreement cuts, and that is the area of home health care. The Balanced Budget Agreement was expected to cut Medicare spending on home health by $16 billion, but earlier this year when CBO reestimated the Medicare budget baseline, that number had more than doubled. Right now, we are seeing Medicare payments to home health agencies reduced by over $48 billion. Not $16 billion, $48 billion. This is $32 billion more than Congress intended, and this needs to be addressed now. These numbers can be overwhelming when we look at what this means for patients.
Mr. Speaker, 28 agencies have closed in Michigan. Twenty-eight agencies have closed in Michigan, and over 2,400 agencies have closed nationally or have stopped providing service. I remember, Mr. Speaker, being on the floor a year ago, a number of us, working on this issue of home health care, organizing a national rally to address home health care cuts, and at that time we said there were 1,200 agencies that had closed and that if nothing was done, we would see that double. We do not want to be right about that, but in fact, it has doubled. I do not want to be here a year from now saying it has doubled again and people have lost their services and that families have found themselves in horrible situations as a result
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We have numerous examples, and I know my colleagues will speak to this as well.
What do our home health agencies need? We need to first eliminate the 15 percent cut that is currently scheduled for next year, October 2000. We need to establish a payment system to cover what are called outliers or the costliest and most expensive patients that are difficult right now for home health agencies to serve as a result of the cuts. We need to provide overpayment relief. We need to revise the per-visit limits to at least 108 percent of the medium which is simply right now just too low to cover the sickest and the frailest patients. And, we need to develop an equitable perspective payment system for home health.
We can achieve these goals. We can fix this problem. We have in front of us an opportunity. We are talking about budget surpluses for the next 10 years, not budget deficits. We have people that are not receiving health care in a country with the greatest health care systems available in the world, and yet too many are not able to receive them. We can fix this, and I am pleased tonight to be here with my colleagues that are going to share as well in their thoughts as they relate to how this affects their States.
Let me first call on the gentleman from Illinois (Mr. DAVIS) who has been one of the leaders as well on this question of restoring Medicare cuts. I am so pleased the gentleman is here this evening.
Mr. DAVIS of Illinois. Mr. Speaker, I thank the gentlewoman. Let me commend the gentlewoman for not only her leadership on this issue, but for the leadership that she has provided on a number of issues not only affecting your home State of Michigan, but actually affecting the lives of people all over America. I am indeed pleased and delighted to join with the gentlewoman tonight as we talk about this problem.
Mr. Speaker, the Balanced Budget Act of 1997 ushered in the largest cuts in Medicaid spending since 1981. Cuts estimated at $17 billion over five years, and $61.4 billion over 10 years. These cuts amount to and account for more than 9 percent of the supposed savings under the Balanced Budget Act. Two-thirds of the cuts in Medicaid are from reductions or limits on disproportionate share or additional reimbursements to hospitals. These are payments to hospitals serving a disproportionate share of low-income, Medicaid and uninsured patients. Ten-year cuts, $40.4 billion. Twenty percent of the reductions shift the cost of Medicaid deductibles and coinsurance while the very poor to physicians and other providers of care. Most of the remainder of the cuts come from the repeal of the Buyer amendment, requiring minimum payment guarantees for hospitals, nursing homes and community health centers. 10 years worth of cuts, $6.9 billion.
There were several other provisions which were particularly cruel. The phaseout of the health center cost reimbursement with 10-year cuts totaling $1.3 billion, and the counting of veterans' benefits as income with 10-year cuts totaling $200 million.
Mr. Speaker, as disastrous as these cuts are, they are not the end of the story, or even the worst of the story. The impact of the so-called Balanced Budget Amendment on Medicare has been even more staggering, and it is not an exaggeration to state that the long-term existence of Medicare is not guaranteed. The byzantine logic of the Balanced Budget Amendment extended the life of Medicare by slowing the rate of growth in Medicare's payments to providers and shifting some home health services out of Part A. But the Balanced Budget Amendment did nothing to fundamentally address the problem of insuring the health of future generations of seniors.
Medicare is based on the principle of spreading the risk for our seniors through a system of insurance funded through our tax system. Medicare has been one of the most successful Federal programs in our history. But now, Medicare faces new challenges, largely because we are living longer. By the year 2030, we expect that the number of beneficiaries will double, reaching a total of 76 million, or almost 20 percent of our population. This has raised questions about how will we continue to fund the program.
The Balanced Budget Amendment shortsightedly attempts to address the problem by saying that the government can no longer afford to pay for health care for our seniors. The implication is that our Nation can no longer afford health care for seniors and that they should be left to fend for themselves for that portion of health care no longer covered by Medicare.
Most Americans, though, reject such a notion. We reject the notion that the wealthiest Nation in the history of the world cannot take care of the health of its seniors. This is an affront to those who have worked all of their lives. It is also not based on fiscal reality. By undermining the concept of a universal insurance pool for all seniors, these cuts actually will increase the inequities and costs in the system. The so-called unrestricted fee-for-service plan which removed the cap on what providers are allowed to charge and the Kyl amendment, which would allow providers to contract directly for services outside Medicare are direct attacks on the concept of a common insurance pool.
[Time: 19:00]
While we debate the future of Medicare, and I would note that a one-half of 1 percent increase in the payroll tax would extend the Medicare program another generation to the year 2032, but we have turned away from real solutions and the impact of our hospitals is exploding like a bombshell.
The 5-year impact of the balanced budget amendment will amount to $2.7 billion. Large urban hospitals will absorb more than $2 billion of those cuts in the State of Illinois alone.
The State of Illinois has 20 congressional districts. Thus, each district accounts for 5 percent of Illinois' population. However, my district, the 7th District, will absorb $468 million of the Medicare cuts. That is 16.9 percent of all the cuts in the State. Over the next 5 years, in my district, hospitals will absorb cuts that are equivalent to more than 75 percent of their 1997 base year Medicare payments, and tertiary teaching hospitals will absorb more than a billion dollars in cuts over the 5-year period.
So, I would say to the gentlewoman from Michigan (Ms. STABENOW), this problem exists all over America and as we move towards finding a solution, the solutions that the gentlewoman has articulated, the legislation that she and others of us have cosponsored, provides a tremendous opportunity to move ahead and arrive at real solutions to these problems.
So, again, I commend the gentlewoman for the leadership that she has shown, for bringing us here this evening to discuss this issue, and I trust that America will follow the lead of the gentlewoman and help us find solutions to this very serious problem, and I thank the gentlewoman.
Ms. STABENOW. Mr. Speaker, I thank the gentleman from Illinois (Mr. DAVIS) for his comments. I know that his State of Illinois is not unlike Michigan and all of us across the country right now are having those conversations with our hospitals and our nursing homes and home health facilities, and most importantly with our families that are represented and served by those providers who want to serve them, who are quality facilities but are finding themselves in very difficult situations as a result of the Congress. We can change that. It is up to us and it is long overdue.
I would like now to call on another colleague of mine from Illinois. Illinois is filled with wonderful leadership and I am so pleased to have a Member who has come to this body in her first term and has become an instant leader on a number of issues, the gentlewoman from Illinois (Ms. SCHAKOWSKY), who is here with us this evening to speak as well.
Ms. SCHAKOWSKY. Mr. Speaker, I thank the gentlewoman from Michigan (Ms. STABENOW) for yielding me this time. I would like to thank the gentlewoman from Michigan for her tireless work on this important issue and for organizing this discussion tonight and also to associate myself with the comments of my colleague from Illinois.
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Recently, I joined him some days ago, speaking out on the need to restore payments for hospitals, particularly those hospitals that serve a disproportionate number of uninsured and poorly insured patients, and those that train medical professionals.
Unless we act now, Illinois hospitals and hospitals across the country will have insufficient resources to provide the quality and timely care that our constituents deserve.
I also wanted to say that there was a recent report by George Washington University researchers Barbara Smith, Kathleen Maloy and Daniel Hawkins which provides a clear warning signal that home health services are also threatened by the cuts that the balanced budget amendment had. Three million acutely and chronically ill senior citizens and Medicare beneficiaries with disabilities are depending on home health care services.
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