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My colleagues yesterday discussed the urgency of this legislation again and again. I am disappointed and deeply concerned about the fact that, at least to date, there is no date yet set for consideration and markup of a bill to repair the damage done in the 1997 act. We have to address and consider and ultimately pass such a bill prior to the time we leave the Senate this year. We will do anything, and everything we know how, to ensure this becomes one of the highest legislative priorities left prior to the end of this session of Congress. It must be addressed. It must be passed. We must take this legislation up soon in order for us to accomplish what I know is a bipartisan recognition of the shortcomings and the miscalculations made in the 1997 act.

   I will say again, the fact that we have over half of our caucus already, and will probably have two-thirds of our caucus as cosponsors in the not-too-distant future, is a clear recognition of the depth of feeling our Members have on this bill and the importance we place on getting something done this year. We must do it. We will do it, and we will work with our Republican colleagues to make that happen.

   I yield the floor.

   The PRESIDING OFFICER. The Senator from West Virginia.

   Mr. ROCKEFELLER. Mr. President, I strongly agree with the words our Democratic leader has offered, and I congratulate him for mobilizing this effort, but it is a mobilization not so much of Democrats as it is of Senators in general. Hospitals and patients and skilled nursing facilities and home health agencies are not Republican or Democrat. The shortages, the closings, the health care denied is not Republican or Democrat. It has to do with the people of our States and of our country.

   This is a bipartisan matter. I know, without even having talked to but five or six of my colleagues on the other side of the aisle, when they went back to their homes during the August recess and when they have been back since, this has been the subject with which we have all been, in a sense, lobbied in the best sense; that is, lobbied by our own constituents, by our own voters, by people who are patients, by people who have had these problems.

   It is right; we should be fixing this because Congress, in 1997, when we passed the Balanced Budget Act, made changes that were larger in Medicare than any in the history of the program, and we made mistakes. This is actually one of the reasons our colleagues on the other side of the aisle often criticize congressional action because we are trying to play doctor. We often try, but we often do not do it very well. In this case, we did not. We made mistakes.

   When we make a mistake, we are causing skilled working facilities, home health agencies, and hospitals to close; we are putting in jeopardy margins of profit, which have gone into the red already, of other hospitals, particularly rural hospitals. We have to correct it.

   There is nothing more self-evident to me than the need for this Congress to take up the BBA corrections and, in fact, do them on a bipartisan basis. We do not have very much time. There

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   In my State of West Virginia, which is not large but our citizens are no less important than anybody else's, and to me they are more important, in the next 4 years our hospitals are going to face an almost $600 million cut in payment because of mistakes we made in the 1997 Budget Act. They did not make the mistakes. They have not been keeping their books incorrectly. They have not been trying to be inefficient. We made the mistakes. We made the mistakes in Congress, and it is up to us to correct them.

   Many critical public health services will be cut back. That has happened already. It will continue to happen. Home care agencies in my State expect there will be almost 5,000 less Medicare patients being admitted for their services than before.

   Eleven home health care providers in West Virginia have closed. That is not a lot, but that is a lot in West Virginia, and it is in a lot of places. We have 55 counties and 1.8 million people. Eleven home health agencies is a lot; 2,500 on a nationwide basis are closed. They are not thinking about closing but have closed because of mistakes we in Congress have made in making these enormous changes to Medicare. They have been forced to close down because the current payment system does not adequately reimburse them for what they have to do.

   CBO originally estimated home health reimbursement reductions would be $16 billion. It turned out the reduction was $47 billion. That was not the hospitals' fault; That was not the home health agencies' fault; that was our fault. We made that mistake. We have to correct that mistake.

   The $1,500 cap on therapy is having bad results on nursing home patients with Parkinson's disease, burns, and other things. We need to correct that because we made the mistakes.

   I will end by saying, I agree on teaching hospitals. We have three teaching hospitals in West Virginia. Whatever happens in general happens in a much worse way in rural States. That is by definition, that is by nature, whether it is hospitals, nursing homes, or anything else. That has always been the case.

   Rural hospitals have very little to fall back on because they do not have margins. They depend on Medicare more than those in larger and more urban States. These were unintended cuts we made, but we nevertheless made them. The mistake is ours. It is a bipartisan mistake. It came along with a very good bill, the Balanced Budget Act of 1997. Within it, there was some cancer, and the cancer was caused by us, and it is the mistakes we made which are causing havoc all over the health care world. We can change it easily and change it before we leave here, and surely we should. I yield the floor.

   Ms. MIKULSKI. Mr. President, I rise today as a cosponsor of Senator DASCHLE's bill to address the draconian cuts to Medicare under the Balanced Budget Act of 1997 (BBA). I thank Senator DASCHLE for introducing this important piece of legislation.

   I support this bill for two reasons. First, I believe the BBA went too far when it cut reimbursements to Medicare. Second, as we move towards the millennium and our senior population continues to grow, our seniors must be able to rely on a sound and secure Medicare Program. This bill will help them do just that.

   When I travel throughout the State of Maryland, the issue my constituents want to talk about most is cuts in services for the elderly. I have worked long and hard to find solutions to these cuts. That is why I cosponsored an amendment to the recent tax bill which placed a priority on fixing Medicare before providing for a tax cut. That is why I am working on a new and improved Older Americans Act, and that is why I am cosponsoring Senator DASCHLE's legislation, which helps providers who are struggling under BBA cuts to Medicare.

   The BBA is one of the reasons why we have a projected budget surplus. It put us on the right track of fiscal prudence, but it went too far in the case of Medicare by imposing deep cuts on providers: It cut reimbursements to home health agencies; it cut reimbursements to nursing homes; it cut reimbursements to Medicare HMOs. Our seniors and our providers are now feeling the effects of these cuts.

   What exactly do these cuts mean? In my State of Maryland, this means that 34 Home Health Agencies have closed their doors and only two public Home Health Agencies remain. This is a particular problem in rural counties in Maryland. Agencies in these areas are committed to providing health care to those who cannot travel to hospitals or doctors offices. In fact, they are so committed to providing home-bound patients with care, I know some health care providers who have traveled to homes by a snowmobile in winter months just to get to a patient. But because of substantial cuts in reimbursements under BBA, these agencies are left with no choice but to close their doors; families lose these services, employees lose their jobs, and nobody wins.

   Our Skilled Nursing Facilities (SNFs) also need the relief provided by this legislation. The BBA changed the way that payments are calculated so that facilities do not get paid more money when they provide expensive services such as chemotherapy or prosthetics. In some cases, the reimbursement is so low, that facilities cannot afford to take the patients who need a high level of care. I hear stories about patients who need chemotherapy treatment but cannot find a facility to provide it. Why? The answer is because Medicare doesn't pay enough to cover the cost of the chemotherapy treatment. Where does this patient go? They could go to a hospital, but frequently this is more expensive, or might not specialize in these services. Patients and their families do not want to hear complex stories about payment methodologies, or resource utilization groups. What these families want to hear is that their loved ones can get the care that they need.

   My State of Maryland has also had a devastating problem with Medicare HMOs. Because of payment changes, reimbursements to many HMOs were cut. What are the effects of these cuts? One HMO in my state is projecting losses of over $5 million this year in the rural counties of Maryland alone. This HMO can no longer afford to cover Medicare patients so it is closing up shop. 14,000 senior citizens in Maryland will lose their Medicare HMO. Where do these seniors go? In the rural counties of Maryland, these seniors do not have any other Medicare HMO to choose. They all left--not because they weren't making a profit--these HMOs couldn't even break even. Rural counties throughout Maryland and the nation will have seniors with little or no access to the extra benefits many HMOs provide, including prescription drug coverage and preventive benefits such as dental, vision and hearing screenings.

   Imagine if your 85-year-old grandmother, living on a fixed income, got a letter in the mail that says in 4 months she will no longer have a Medicare HMO. She might not understand what it means. Is she losing her health care coverage altogether? Is she losing her doctor? Is she losing her medicine coverage? In many cases, my constituents aren't wondering where they should go for a mammogram or prostate screening, but if they can even go at all because their HMO is leaving town.

   Some will say these cuts aren't so bad--why can't you just buy a Medigap policy? For around $150 a month you could get some of the supplemental benefits that HMOs provide. But many of these senior citizens only have $11,000 or $12,000 a year in retirement income and many times their income is much less. These seniors cannot afford $150 a month for a Medigap policy, so many of them will be forced to make difficult choices between food, rent, health care and prescription medications. This legislation provides needed relief so that our seniors would not have to make these terrible decisions.

   I also know that our non-profit health facilities are having a particularly rough time. These are providers such as Hebrew Home in Rockville, Maryland, or Mercy Hospital in Baltimore, who are struggling to provide care under current reimbursements. It is especially difficult for these providers because the care they provide is

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   One of my priorities as a United States Senator has always been to honor your mother and father. It is a good commandment and good public policy--in the federal law books and checkbooks. We must address these cuts in Medicare because our safety net for seniors is badly frayed, and senior citizens are being left stranded because many health care providers have no choice but to close their doors.

   In 1965 when Medicare was created, the Federal Government promised that Americans who work hard all of their lives can count on Medicare when they retire. I believe that promises made should be promises kept. Senator DASCHLE's bill will help us keep the promise we have made to the Nation's senior citizens.

   Mr. JOHNSON. Mr. President, I am pleased to cosponsor the Medicare Beneficiary Access to Quality Health Care Act introduced today that works to correct the inequities of Medicare reforms included in the Balanced Budget Act of 1997.

   I commend Senator DASCHLE for his tremendous efforts on this issue and for his leadership with the introduction of this bill. As well, I congratulate a number of my other colleagues who have contributed immensely to the crafting of this critical piece of legislation, including Senators MOYNIHAN, KENNEDY, ROCKEFELLER, BAUCUS, CONRAD, and others.

   As part of the effort to balance the Federal budget, the Balanced Budget Act of 1997 (BBA) provided for major reforms in the way Medicare pays for medical se rvices. The Balanced Budget Act of 1997 (BBA) included numerous cuts in Medicare payments to health care providers. These changes were originally expected to cut Medicare spending by about $115 over five years, but recent CBO projections show spending falling nearly twice that much. In the face of these deep cuts, health care providers are struggling, and beneficiary access to care is threatened. The Medicare Beneficiary Access to Care Act is a targeted solution to certain specific problems that the Balanced Budget Act has created.

   As implementation of these reforms proceeds, health care providers and patient advocacy groups have asserted that some of the reforms are having--or are likely to have--undesirable or unintended consequences. Areas in patient care such as rehabilitative therapy, skilled nursing facilities, home health services, and hospital outpatient services have already begun to feel the effects of the reforms set forth in 1997.

   Not surprising, I have heard from many safety net providers in South Dakota about the devastating effects such reductions in reimbursements are having throughout the health care industry. Consumers are also feeling the pain, as many individuals are being turned away from hospitals and nursing homes who cannot afford to accept new patients because of the lower reimbursement rates included in the Balanced Budget Act. These cuts are devastating and feared to have severe implications on the quality and access of health care throughout our nation, including South Dakota, unless Congress acts immediately to correct these problems. In South Dakota, and other rural parts of the country, hospitals and other health care providers have an extremely high percentage of Medicare beneficiaries making these cuts in reimbursement even more devastating. If Congress does not act in a timely fashion many of these providers may be forced to close their doors.

   I look forward to continue working with my colleagues on passage of the Medicare Beneficiary Access to Quality Health Care Act which develops creative, cost-effective approaches to address the unintended, long-term consequences of the BBA. The proposed budget surplus provides Congress the unique opportunity to address many of the deficiencies in our nation's health care system. We need to address the valid concerns of teaching hospitals, skilled nursing facilities, home health providers, rural and community hospitals, and other health care providers who require relief from the consequences of the BBA.

   Mr. CLELAND. Mr. President, we are all hearing from our constituents about the hardships they have encountered from the unintended consequences of the Balanced Budget Act (BBA) of 1997. From rural hospitals to home health care agencies, cuts in Medicare reimbursement have forced these health care providers to absorb tremendous debt and have threatened patients' access to care. Senator DASCHLE has proposed over 30 items that will provide immediate relief across the health care continuum. Among these provisions, the bill would redirect BBA surplus monies to provide a cap on hospital outpatient Prospective Payment System (PPS) loss, a delay on the proposed 15 percent cut to home health care reimbursement, a fix for the graduate me dical ed ucation re sident cap and the indigent care problem, the repeal of nursing home therapy caps, a technical correction to limit oscillations to Medicare physician reimbursement, a delay of risk adjustment for frail elderly/Evercare. Senator DASCHLE is to be commended for developing this comprehensive BBA relief bill in an incredibly short period of time. My colleague has more than met the challenge of this urgent health care dilemma. I am proud to be an original cosponsor of this critical remedial legislation for a BBA fix. I will support Senator DASCHLE with all my resources to pass a BBA fix this session.

   Mr. KERREY. Mr. President, I support the legislation offered earlier by the Senator from South Dakota, the Medicare Beneficiary Access to Care Act of 1999.

   I supported strongly the balanced budget amendment of 1997, the deficit reduction acts of 1993 and 1990, and am proud of the supporting role I played over the last 7 or 8 years in taking the United States of America to the point where the Federal Government was borrowing hundreds of billions of dollars--$300 billion when I came in 1989--to a point where we now have a surplus. It is quite an exciting change in the dynamics of this country.

   This morning's New York Times had a story by Louis Uchitelle about 1.1 million Americans having been lifted off the rolls of poverty as a consequence of demands of wages that occur because interest rates are low, corporate profits are good, and the American economy is as strong as it has been in my lifetime. It is quite impressive what a strong economy will do with low interest rates and what increased rates in productivity will do. The report also pointed out the significant problems we still have with income growth, especially with African Americans.

   But I am proud of the role I played in eliminating the deficit and creating a surplus that has contributed enormously to the growth of the U.S. economy. Certainly lots of action in the private sector contributed to it, but Congress and those who were here--Republicans and Democrats--over the last 7 or 8 years who voted for these three pieces of legislation can take some pride in taking the United States not just into recovery economically, but I remember how frustrating the deficit was--politically frustrating--that caused Americans to lose confidence that Congress could get anything done. It seemed a relatively small ``bone'' in a great nation and I am glad we finally coughed it up. I don't want to backtrack on that.

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