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The 1997 act had an impressive number of people in the Senate and the House voting for the legislation. The United States was to produce $100 million of savings in 10 years. It is now estimated it will produce $200 million in savings. I voted for $100 million. That is what I thought the legislation would produce. Not all of that $200 million estimate occurs as a consequence of the changes in reimbursement. Some has occurred as a result of the vigorous effort by Secretary Shalala and HCFA to reduce fraud and, as a consequence, save taxpayer money. They made billing changes that produced some savings. They are doing a better job of
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There is no question there is a fraction of that excess $100 million that has come as a result of our making some changes to take more out of the providers than anyone anticipated. This legislation will put $23 billion back. I believe that is fair, reasonable, and defendable. I think it will have a tremendously positive impact on the ability of my State of Nebraska to get high-quality health care; that is what is at stake. What is at stake is not just the health of health care institutions but the health of the citizens of the country who depend upon those institutions.
I believe this piece of legislation is needed. It is needed in Nebraska and by citizens who depend upon their doctors, who depend upon their hospitals, who depend upon this thing we call the health care system in the United States of America. It is an issue of life and death for them. It is a very important issue. It is a very personal issue.
When we talk to somebody in a hospital, it is easy to acquire the right sense of urgency to overcome whatever ideological differences we might have. The people of Nebraska need this Congress to act. It is not just something that we are being asked to do; it is something that is necessary in order to improve the quality of life in our State.
I will go through some of the things this legislation does. For hospitals, the 1997 act cuts hospital payments in several ways: Lower inpatient payments; a new outpatient prospective payment system; a special payments cut for low-income patients: and cuts in graduate me dical ed ucation.
This legislation does not restore all of those cuts. It creates a 3-year transition period to protect hospitals under this new outpatient system, and there is additional protection for rural and cancer hospitals. The bill also moderates the cut in DSH and GME payments, a central concern of teaching and academic centers. And it takes action for pediatric hospitals.
I urge colleagues who have not studied this to examine the very low reimbursements for graduate me dical ed ucation fo r pediatric hospitals. There is a glaring difference and it will create tremendous problems as we try to train pediatricians--a very important profession in the health care industry.
There are a number of changes that increase the quality of care in Nebraska hospitals and increase the chances, especially in rural hospitals, that we will not see a continuation of what we had in 1998 when two rural hospitals closed. My hospital administrators tell me there may be more of the same unless we make some reasonable adjustments.
The Balanced Budget Act made some changes in skilled nursing facilities. We understand the need to balance the budget. This does not undo that. It is paid for. The Balanced Budget Act created a prospective payment system for skilled nursing facilities. This does not adequately account for the costs of very sick patients and rare high-cost services. This bill attempts to address both of these problems by increasing payments for groups of patients for whom payment is low and by paying separately for high-cost services, such as prosthetics, to ensure the nursing homes receive adequate payment.
We have heard about the impact of therapy caps. I hope in addition to putting some money back into the providers, we can take the advice of the Senator from Oklahoma and get some structural changes enacted in Medicare. One of the problems we have as a Congress trying to make changes in Medicare is we don't know the full impact of changes.
Senators BREAUX and THOMAS were proposing the creation of a new Senate-confirmed board that has authority over HCFA to make certain HCFA has the authority to offer fee-for-service plans on a competitive basis and make sure competitors have a level playing field to compete and offer their plans against the fee for service that HCFA has. I think it would be easier to solve the problem of dealing with waste, fraud, and abuse and make it more likely the consumers receive good information when they are trying to make decisions about what to buy. Consolidating Part A and Part B was also in the proposal of Senator BREAUX, and as a consequence of consolidating those two programs, it would make it much more likely when dealing with medical pr ocedures, such as therapy, that we get it right.
What we did with the Balanced Budget Act is create a 1,500-per-annual-beneficiary cap, but these are arbitrary. They don't allow any flexibility based upon the need of the patient. What we have done with the legislation is repeal the caps until 2003 and require HCFA to implement a new system for therapy payments that is budget neutral to caps. It is designed to address the needs for varying amounts of therapy based upon a patient's condition. That is the point I was trying to make earlier, why we need structural changes, as well.
There are varying needs of the patient that are extremely difficult for HCFA to address. It is a central system. They have fiscal intermediaries in the country making payments. It is still a centrally controlled system and awfully difficult to get it right in Ohio, Nebraska, and Missouri simultaneously. They have to apply a system nationwide. It is better, in my judgment, if we have a board of directors, Senate-confirmed, to manage HCFA, moving in a direction where the private sector is able to compete for HCFA's fee for service simultaneously, with HCFA offering its fee-for-service plans.
It makes changes in home health. We created under the BBA an interim payment system for home health agencies which limits payments on both a per beneficiary as well as a per visit basis. The temporary system locked in very low rates. This affects
rural areas more than urban areas. There are very low rates for areas that had traditionally low costs such as Nebraska. We have low costs.
The IPS locked in those very low costs in October 2000, and the IPS is scheduled to be replaced by a new PPS system for home health services. Those payments will be reduced in an arbitrary fashion by 15 percent. We make three changes in the legislation that are vital: First, we postpone this 15-percent cut for 2 years; second, we assist low-cost agencies that have been disadvantaged under the IPS by increasing the per visit limit; finally, the bill reduce administrative burdens placed upon the providers by eliminating interest on overpayments, eliminating a 15-minute reporting requirement, and eliminating a requirement for home health agencies to do the billing for durable medical eq uipment.
We make changes for physicians. The BBA created a new system for physician payments based on a target rate of growth. The system includes bonus payments and reductions intended to create incentives to meet the target rate of growth. However, what we have done will cause payments to fluctuate widely, creating tremendous uncertainty in the physician communities and causing physicians who are out there trying to manage a clinic or their business to say: We can't depend upon HCFA. We can't depend upon a revenue stream. There is too much uncertainty in the system. We may opt out as a consequence.
They are facing a very big challenge in dealing with HCFA's representation that there may be fraud when, in fact, all that has occurred is there are a number of additional changes that will be very constructive for physicians, for Medicare+Choice, for rural health clinics, federally qualified health centers, and for hospice care where we have not had any rebasing of payments since 1982. It is a $1 billion--an extremely important program.
Unfortunately, we do not pay a lot of attention to the problem we are facing when individuals know for certain they are dying. Hospice addresses that. This is an important change, in my view, and I urge colleagues on both sides of the aisle to say, whether it is with the Daschle bill, which I support, or a bill that comes out of the Finance Committee, which I am apt to support as well: This is one of the things we need to do. We need to get this done.
I hope we can at least get some minimal changes in Medicare as well, but we need to address this.
Mr. BINGAMAN. Mr. President, I rise today to join my colleagues in introducing the ``Medicare Beneficiary Access to Care Act of 1999.'' I want to commend the leadership in the development of this legislation and hope
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The bill is designed to modify some of the many, unforseen consequences of the Balanced Budget Act of 1997. Daily I receive letters and calls citing the negative impact of the Balanced Budget Act on access to patient care and to the delivery of quality care in an ongoing and coordinated fashion. In my State of New Mexico, the health care delivery system has been particularly hard hit. Essentially, the system for delivery of health care that we have worked so hard to attain is being eroded and must be bolstered before patients face a crisis.
I represent a state where 21 out of 33 counties are designated as health professional shortage areas. I represent a state that has seen an exodus of physician specialists and rural doctors this past year. Over the last year, New Mexico had 70 home care agencies close despite yeoman's efforts to keep these agencies open and serving our citizens. This represents closure of over 40 percent of our home health care agencies. We currently have one county, Catron, that has no home care entity available for serving patients. Failure to deal with the additional 15-percent cut that is slated to go into effect in October of 2000 would be the end of numerous other home health agencies throughout my state. It would be inexcusable not to address this issue this session.
Additionally, the system is further under stress in the nursing home arena. We have seen one nationally based entity declare bankruptcy and face the demise of others. Long term care facilities must be reimbursed at a level that reflects the acuity of the residents for whom they care. Long term care is key not only for the residents but for their families near and far.
Mr. President, several of my colleagues have addressed the issue of GME and the plight of our teaching hospitals. Hospitals have a multitude of services that they provide and which we should bolster. I must note, for example, that in New Mexico, declining Medicare reimbursement is forcing the only acute care hospital in Dona Anna County to close a 15 bed skilled nursing unit because of mounting financial losses. Realities such as this must make us mindful of the far reaching and adverse effects the BBA of 1997 is now having on communities and their residents. We want to ensure that no other facilities face closure.
Finally, I must add that rural and frontier clinics are critical components to care for seniors and others in the community with limited resources and serve to allow for timely, geographic access where there otherwise would be no health care available. I am pleased that some redress of their needs is provided in this legislation.
Others have outlined the components of this legislation and I will not repeat the specifics. It is sufficient to say, that these changes are needed to avert a crisis in the health care delivery system of this country, to maintain access to quality care for our seniors and to rectify problems for the system that were created inadvertently. We must act now to provide for easy access to quality, continued health care for our citizens.
I look forward to working with all of my colleagues here in the Senate to see that this legislation is passed prior to adjournment.
Mr. MURRAY. Mr. President, I am pleased to join with my Democratic colleagues in introducing this important legislation. In the Balanced Budget Act of 1997, we reformed the Medicare program to extend its solvency. In the past year, we have seen the dramatic and negative impact of those reforms on patients and health care providers. The bill we are introducing today will fix those unintended consequences and will ensure that millions of seniors have access to high quality health care. I urge the Republican leadership to act on it before we adjourn for the year.
Two years ago, the Medicare Program was in serious trouble--facing bankruptcy within 5 years. We had to make substantial changes to the program to extend its solvency. It was a painful and difficult process, but we made changes intended to slow the growth of Medicare expenditures.
And overall, it worked. Medicare is still functioning and is on a more sound financial footing.
But the revisions we implemented went too far. Let me give you an example. Based on the estimates we had at the time, our changes were supposed to reduce the overall growth in Medicare expenditures by $100 billion over 10 years. In reality, the changes we enacted will result in more than $200 billion in lost Medicare revenue for health care providers over the same period. This was not the order of change I supported.
And today we see that those revisions are hurting our health care providers and making it more difficult for them to give patients the high quality care they need.
When I meet with health care providers in my state, this is their top concern. Each day we delay making these corrections, we make it harder for them to ensure that quality health care is available to millions of seniors.
I have heard from hundreds of hospital administrators, home health care workers, doctors, rehabilitation therapists, teaching hospitals, skilled nursing facilities, and hospice providers. For example, I've received letters from Providence General Medical Ce nter in Everett, Washington, from hospital caregivers at Prosser Memorial Hospital, from the University of Washington's School of Medicine and from hundreds of others. They have shared with me the impact of the 1997 changes and what it means for patient care. I believe the situation is critical.
If we fail to correct this, we will see hospitals closing. We will see home health agencies turning away patients. We will see skilled nursing facilities unable to take complex patients. We will see a devastated rural health system. Our health care system is in jeopardy.
The bill we are introducing today will go a long way toward correcting some of the
unintended consequences of the Balanced Budget Act of 1997. I worked with my Democratic colleagues in drafting what I believe is a reasonable bill that provides immediate relief to hospitals, home health care agencies, skilled nursing facilities and hospice care to ensure that seniors in this country have access to quality, affordable health care services. The bill we have put forth is modest. It is not a cure-all, but it addresses the most pressing challenges. This is not about repealing the fiscal discipline imposed in BBA97. This is about adjusting the changes we made to reflect the current estimates. Our bill fixes the problems and provides legislative remedies. It does not jeopardize the solvency of Medicare. We can and should make changes to improve access and ensure access without jeopardizing solvency.
There is still much we have to address from quality care to affordable health insurance to prescription drugs. However, if the hospitals close or seniors are denied quality care, the ability to pay is not an issue. The very foundation of our health care system is at stake. This legislation is long overdue. We need to pass it and make the Medicare Program function better today.
Mr President, at the same time, we cannot forget that the entire Medicare Program will run out of money in 2015. So, I want to remind my colleagues there is still much work to be done to ensure Medicare remains a stable program that our children will be able to count on for their health care.
Mr. President, from my point of view, this Congress has failed on too many vital issues this year. This Congress failed to pass a real Patients' Bill of Rights--that would put patients and doctors, not insurance companies, in charge of their medical de cisions. Earlier this week, this Senate failed our children, by cutting our commitment to putting 100,000 teachers in the classroom to reduce the size of our overcrowded classrooms. This Congress failed to help our farmers, and all those facing too many challenges in rural America. Let me just say, that I am not giving up or letting up on any of those fights--because they are too important. And let's not forget that this Congress even failed to do one of its most basic work--passing our appropriations bill on time, with real numbers--not gimmicks.
Mr. President, it is high time we bring some good news back to our constituents. I want my hospitals and health care providers, as well as the senior citizens in Washington State, to know I have heard their concerns and I recognize the dangerous implications of BBA97 on health care. It is high time
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Mrs. LINCOLN. Mr. President, today I rise to voice my support for a bill which addresses the unintended consequences of the Balanced Budget Act of 1997. I am pleased to join my Democratic colleagues as an original cosponsor of the Medicare Beneficiaries Access to Care Act.
Since I've been in the Senate, one of the greatest concerns of Arkansans is the lowered Medicare reimbursement rate for a variety of services that resulted from the Balanced Budget Act. Yes, we must continue to rid our Medicare system of waste, fraud and abuse. That is a high priority for our government and it should remain so. However, when Medicare changes were made as part of the Balanced Budget Act of 1997, Members of Congress did not intend to wreak havoc on the health care industry.
Enough time has elapsed to know the unintended consequences of the Balanced Budget Act. Hospitals have lost tremendous amounts of money due to changes in the outpatient prospective payment system. Many hospitals in my state are on the brink of closing due to the tremendous financial losses they have suffered. Nursing homes have not been reimbursed by Medicare at rates that cover the cost of patients with acute care needs. Payments for physical and rehabilitation therapy have been arbitrarily capped. Teaching hospitals have lost funding to support their training programs. Home health agencies have been forced to absorb huge losses and limit services to the elderly. Rural health clinics have been forced to cope with even more losses and operate on a shoestring budget.
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