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Mr. President, I would also like to commend the Senators who originally joined Senator DASCHLE and me in introducing this legislation. Senators WARNER and LINCOLN, who sponsored this measure in a previous Congress, have long exhibited their enthusiasm for fixing recycling rules. They are true leaders--leaders who have fostered this reasonable, workable, environmental proposal. Senator BAUCUS, the Ranking Minority Member of the Environment and Public Works Committee, has also been an avid supporter of recycling by including a version of the Superfund Recycling Equity Act in his comprehensive Superfund reform bill in the 103rd Congress. His six years of leadership in trying to fix public policy for recyclers is appreciated.
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Mr. President, this bill would not be where it is at today, on the cusp of becoming law, had it not been for the active support of the late Senator John Chafee--a dear friend to me and many of our colleagues. John Chafee was a respected leader of the Environment and Public Works Committee. His advice and counsel helped shape my bill and he was an original cosponsor. I am proud to have been associated with him on this bill and its legislative process. I consider it a tribute that this bipartisan bill, negotiated with the Administration, representatives of the national environmental community, and the recycling industry, was supported by John Chafee, a man for whom consensus was so important. I believe this is not a footnote to John Chafee's legacy; rather I believe that he made this kind of cooperation possible.
The former mayor of Warwick, Rhode Island, is now the newly appointed Senator from Rhode Island. I have already had an opportunity to hear our newest senator--Senator LINCOLN CHAFEE--tell me about what Warwick has done with regards to recycling. It is a proud record--a record that would be extended and enhanced by this bill. I find it a credit to John Chafee's legacy that his son would be working with me on this legislation. Less than a month in the Senate and already LINCOLN's voice is being heard in ways that will directly help Rhode Island.
Mr. President, I also must recognize the vision of trade associations like American Petroleum Institute and National Federation of Independent Businesses for supporting an incremental solution. It would have been easier for these groups to oppose the bill because it did not address all the fixes for which they have been advocating. However, AFI and NFIB recognized that this increment would not jeopardize their efforts; rather it exemplifies the efforts of various stakeholders to accomplish something positive for the environment albeit it incremental.
And finally, I must thank the various staff members who have diligently worked toward the passage of this legislation: Eric Washburn and Peter Hanson of Senator DASCHLE's staff, Tom Gibson and Barbara Rogers of the Environment and Public Works committee staff, Charles Barnett of Senator LINCOLN's staff, Ann Loomis of Senator WARNER's staff, and my former staffer, Kristy Simms, who set the stage for this years success.
While too often Senators have seen various interest groups tell Congress why we cannot achieve some worthy environmental goal, the history of the Superfund Recycling Equity Act is replete with evidence of people coming together to correct a problem. Everyone, including myself, realizes that comprehensive reform is necessary to fix the vast array of problems in many different sectors of the environmental community. Unfortunately, we do not live in a perfect world, so Congress must do what is achievable whenever it is possible. This is good public policy --increments will show all parties there is a bridge for bipartisan environmental fixes. Recycling is the first of many necessary fixes, and I would bet my colleagues that it will not be the last fix.
This is a great day for many environmental groups who saw a change that they supported, not be taken hostage by the debate that has for so many years paralyzed reforms to Superfund. The original
negotiation that resulted in the basis of the bill was tough and long--but it was fair. Each of the negotiating partners left items on the table that they would have wanted in an otherwise perfect world. Their collective approach was always bipartisan--they never pitted one party against another by pledging one group of interests against another. They remained loyal to their agreement for an unheard of five years--an eternity in Washington. Though this legislation was a long time in coming, I am grateful for its passage.
Mr. President, this is a great day for my good friend and fellow Mississippian, Phillip Morris. It is also a great day for the thousands of mom-and-pop recycling firms across America, like the one owned by Phillip Morris. This legislation protects the legacy of these firms which in most cases have been handed down through generations--often started by new immigrants to America nearly a hundred years ago. This ends the long Superfund nightmare that our nation's recyclers have suffered. Each time they sold their recyclable products they were, unintentionally, exposing themselves to costly Superfund liability. Removing Superfund as an impediment to recycling is a predicate to higher recycling rates throughout the nation.
The Superfund Equity Act is not about special interests getting a fix. No, this bill is about representing constituent interests throughout America and promoting the public interest. That is why Senator DASCHLE and I have 68 cosponsors--cosponsors that range completely across the liberal and conservative political spectrum, and range across all regions of America.
Mr. President, let me be clear, the Superfund Recycling Equity Act corrects a mistake nobody intended to make. When the Comprehensive Emergency Response, Compensation and Liability Act (CERCLA) was enacted in 1980, there was no suggestion that traditional recyclables--paper, plastic, glass, metal, textiles, and rubber were ever intended to be subject to Superfund liability. As a result of court interpretations, however, the sale of recyclables as manufacturing feedstock was considered to be arranging for the disposal of the material and, therefore, subject to Superfund's liability scheme. However, as we have all come to know as a matter of public policy, recycling is not disposal; it is the exact opposite of disposal.
Mr. President, let me say that again--recycling is not disposal, and a law is needed to remove this confusion. Sad, but true.
Enactment of this legislation clarifies this point and corrects the misinterpretations that have cost recyclers--primarily small family-owned businesses--millions and millions of dollars for problems they did not cause. With passage of the Superfund Recycling Equity Act, the costs of cleanup at sites that utilize recyclable materials as feedstock will be borne, rightfully, by those persons who actually cause or contribute to the pollution. As a result, those facilities will be less likely to cause contamination because they will no longer have recyclers to help them pay for Superfund cleanup. That's a powerful market incentive and will cause the consuming facility to become more environmentally conscientious.
Let me be clear, this legislation will not alter the basic tenants of environmental law--polluters will still pay. This legislation does not relieve recyclers of Superfund liability where they have polluted their own facilities. It also does not protect these businesses when they have sent materials destined for disposal to landfills or other facilities where those materials contributed, in whole or in part, to the pollution of those facilities. Furthermore, the public can expect recyclers to continue to be environmentally vigilant because they must operate their businesses in an environmentally sound manner, in order to be relieved of Superfund liability.
Today is a victory for coalition building that avoids the attack strategies that are so often employed by trade associations in DC. I hope they see the wisdom in building coalitions around achievable increments. This is how Congress can move forward. This is how Congress shows that it not only hears from its constituents but it acts successfully. Hostage taking, distortion, and scorch the earth approaches are not productive legislative strategies or lobbying tactics. Trade associations need to seek achievable solutions, develop responsible legislative goals, and avoid Beltway attack politics. I am extremely pleased that Congress has been able to take this tiny but very important step forward in reforming the Superfund law. I hope this accomplishment will inspire others to work for sensible, incremental solutions that help both our environment and our nation's economy.
I am proud that today Congress leveled the playing field and created equity in the statutory treatment of recycled material and virgin materials. I am proud to have removed the disincentives to recycling without loosening any existing liability laws for polluters. I am proud to have represented the mom and pop recyclers across America. I'm especially proud of the fact that this was all done in a bipartisan manner.
Mr. MOYNIHAN. Mr. President, 2 years ago, as part of the effort to balance the Federal budget, Congress enacted the Balanced Budget Act of 1997--which we have come to know as the ``BBA.'' Among other provisions, the BBA enacted major changes in the way Medicare pays for medical services. As implementation of these changes proceeds, concerns have been raised that some of them are having unintended consequences that threaten the viability of health care providers--and consequently the overall availability of health care to our constituents.
In order to alleviate some of these unintended consequences of the BBA, the appropriations conference report before the Senate today incorporates by reference H.R. 3426, the ``Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of 1999.'' This legislation will restore some $17 billion over 10 years to hospitals, skilled nursing facilities, home health agencies, and other Medicare and Medicaid providers. The bill will also facilitate administrative actions that will provide an additional $10 billion of relief to hospital outpatient departments.
H.R. 3426 has many important provisions; here are some of the highlights:
Teaching hospitals will receive $600 million in additional Indirect Medical Education (IME) paym ents over fiscal years 2000 and 2001. They will also benefit from other provisions that add money back to hospital outpatient departments, and which scale back cuts in Medicare disproportionate share payments to hospitals serving low-income patients. I will have more to say about teaching hospitals in a moment.
Rural hospitals will be assisted by: an exemption from the new payment system for hospital outpatient departments; improvements in the Critical Access Hospital (CAH) program; a 5-year extension of the Medicare Dependent Hospital program; and an update in payments for Sole Community Hospitals (SCHs).
Skilled Nursing Facilities--usually referred to as SNFs--would receive $2.1 billion of assistance over 10 years by: increasing payments for certain medically complex patients; permitting SNFs to switch immediately to a more favorable payment system; and excluding certain high cost items from consolidated billing.
The caps on payments for rehabilitation therapy would be suspended for two years pending development of a better payment system; and hospice facilities, which are covered under Medicare part A, would receive temporary payment increases in fiscal years 2001 and 2002.
Other provisions of the bill would: stabilize the formula used to calculate payment for physician services; lift time limits for state use of a fund for delinking of welfare and Medicaid eligibility; slow the phase-down of a Medicaid cost reimbursement to community health centers and rural health clinics; and provide adjustments to the State Children's Health Insurance Program--known as CHIP--which was enacted by the BBA of 1997
GRADUATE MEDICAL ED UCATION< p> &n bsp; I would like to focus the remainder of my remarks on one particular aspect of this legislation--funding for graduate medical ed ucation. My State of New York is the home to 117 teaching hospitals--almost 10 percent of our Nation's academic medical centers. < p> The cumulative effect of several provisions in the Balanced Budget Act of 1997 has produced an unintended financial burden on teaching hospitals. First, the BBA enacted a multi-year reduction in payments for the indirect costs associated with medical education, known as IME payments. Second, many teaching hospitals serve a large share of low-income inpatients and have therefore been burdened by the BBA's cuts in disproportionate share hospital (DSH) payments. Finally, many teaching hospitals are also subject to the BBA's reductions in hospital outpatient department reimbursements.
I am pleased that the legislation we are voting on today, mitigates the fiscal pressures on teaching hospitals by adding back Indirect Medical Education (IME) fund s in fiscal years 2000 and 2001. Teaching hospitals in New York will receive more than $150 million in additional IME payments over these 2 fiscal years.
In addition, the bill's relief to disproportionate share hospitals--those serving low-income patients--will assist the many teaching hospitals serving those populations. Finally, teaching hospitals across the Nation will benefit from the nearly $10 billion over 10 years in additional payments to hospital outpatient departments.
I am concerned, however, about a change made in this bill to Direct Graduate Medical Ed ucation (DGME) pay ments. Medicare DGME payments compensate teaching hospitals for the costs directly related to the graduate training o f physicians. Such DGME costs include residents' salaries and fringe benefits, the salaries and benefits of the faculty who supervise the residents, as well as other direct and overhead costs.
The current payment methodology for DGME was developed in the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Under COBRA, a hospital-specific per-resident amount was determined based on each individual hospital's 1984 Medicare allowable costs. This per-resident amount took into account the extent to which teaching hospitals already had alternative sponsorship--such as from a university, medical school, or faculty practice plan--and locked payments at that level, so as not to replace outside funding sources. In determining current DGME payments, 1984 costs are updated for inflation and subjected to a formula based on each hospital's number of current residents (which is capped under BBA), and each hospital's proportion of inpatient Medicare beds.
Consequently, there is wide variation in DGME payments from hospital to hospital. On average, New York has a higher average per-resident amount ($85,000/per resident) than the rest of the country ($67,000/per resident). However, DGME payments are hospital specific, not region specific; even within New York great variation exists. In New York DGME payments range from $156,000 per-resident to $38,000 per-resident. There are a number of factors which account for the variation in the hospital specific payments: the level of outside support from non-hospital sources; the relationship to the medical school; an d state or local government appropriations. In addition, residents' salaries, which are determined by geographic cost of living factors, further explains the variation.
The version of this legislation that passed the House of Representatives included DGME language that would change the hospital specific per-resident formula to a payment based on a wage-adjusted national average. I am pleased to say that during negotiations on these provisions, I and the distinguished ranking Democrat on the Ways & Means Committee, Representative Rangel, with Chairman Roth's support were able to significantly narrow the scope of the House provision, thereby protecting many teaching hospitals in New York and elsewhere from abrupt changes in DGME payments. The scaling back of the House provision will provide time to address the complicated DGME system in a comprehensive and fair manner.
The negotiations necessary to reach agreement on both the IME and DGME adjustments in this legislation clearly demonstrate the need for fundamental change in the way that medical education is finance d in this country. What is needed is not year-to-year adjustments in Medicare funding but an explicit and dedicated source of funding for these institutions--a Medical Education Trust Fund as I have proposed this year and in the past.
The legislation that I introduced would require that the public sector, through the Medicare and Medicaid programs, and the private sector, through an assessment on health insurance premiums, contribute broad-based and fair financial support. Changing the funding source for graduate medical ed ucation from prima rily Medicare funds to multiple payers would protect graduate medical ed ucation for the lo ng term. Teaching hospitals are national treasures; they are the very best in the world. Yet today they find themselves in a precarious financial situation as market forces reshape the health care delivery system in the United States. The all-payer trust fund I have proposed would ensure that America continues to lead the world in the quality of its health care system.
Mr. THURMOND. Mr. President, I rise in support of the Conference Report to H.R..1554, the Satellite Home Viewer Improvement Act. This is pro-consumer legislation which will promote much needed competition among television providers.
This legislation allows satellite carriers to carry local television stations for the first time. Consumers now will have a choice between cable companies and satellite companies that offer similar programming. This competition should help lower costs and increase quality service for all consumers.
In addition, this legislation contains many other pro-consumer provisions. For example, it protects consumers who are about to lose their distant signals and establishes a new consumer-friendly process to determine distant signal eligibility.
This legislation also protects local broadcasters who provide a valuable service to our communities. Most importantly, local broadcasters should benefit from the legislation's must carry requirements. The members of the conference also agreed on a provision which would encourage satellite carriers and other entities to provide local into local network service in small and rural markets. However, this provision was taken out at the last minute. I strongly support fiscally sound ways of encouraging satellite carriers and other entities to provide local network television in small and rural markets.
This legislation is a good step in promoting competition among satellite and cable providers. I urge support of this legislation, and I look forward to working early next year with other Senators regarding local into local network service for small and rural markets.
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