[Congressional Record Volume 143, Number 1 (Tuesday, January 7, 1997)]
[Extensions of Remarks]
[Page E50]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




THE MEDICAL EDUCATION TRUST FUND ACT OF 1997, THE HONORABLE KENNETH E. 
   BENTSEN, JR. OF TEXAS, BEFORE THE U.S. HOUSE OF REPRESENTATIVES, 
                        TUESDAY, JANUARY 7, 1997

                                 ______
                                 

                            HON. KEN BENTSEN

                                of texas

                    in the house of representatives

                        Tuesday, January 7, 1997

  Mr. BENTSEN. Mr. Speaker, I rise to introduce legislation, the 
Medical Education Trust Fund Act of 1997, to ensure that our nation 
continues to invest in medical research through the training of medical 
professionals in a time of declining federal expenditures and as our 
health care system makes its transition to the increased use of managed 
care.
  This legislation establishes a new Trust Fund for medical education 
that would be financed primarily by Medicare including managed care 
plans. This trust fund would provide a guaranteed source of funding for 
graduate medical education at our nation's teaching hospitals and help 
ensure that we continue to train a sufficient number of physicians and 
other health care providers particularly in the advent of managed care. 
Without such a guarantee, I am deeply concerned that the availability 
and quality of medical care in our country could be at risk.
  Teaching hospitals have a different mission and caseload than other 
medical institutions. These hospitals are teaching centers where 
reimbursements for treating patients must pay for the cost not only of 
patient care, but also for medical education including research. In the 
past, teaching hospitals were able to subsidize the cost of medical 
education through higher reimbursements from private and public health 
insurance programs. With the introduction of managed care, these 
subsidies are being reduced and eliminated.
  As the representative for the Texas Medical Center, home of two 
medical schools, Baylor College of Medicine and University of Texas 
Health Science Center at Houston, I have seen firsthand the invaluable 
role of medical education in our health care system and the stresses 
being placed on it today. Baylor College of Medicine offers medical 
training in 21 medical specialities and currently teaches 668 medical 
students, 341 graduate students, and 1325 residents. Baylor College of 
Medicine also employs 1,470 full-time faculty and 3,007 full-time 
staff. The University of Texas Medical School at Houston has 833 
medical students, 799 accredited residents and fellows, and 1,532 
faculty.
  Under current law, the Medicare program provides payments to teaching 
hospitals for medical education. These reimbursements are paid through 
the Direct Medical Education (DME) and Indirect Medical Education (IME) 
programs. DME and IME payments are based upon a formula set by 
Congress.
  Last year, the Republican budget resolution adopted by the House 
proposed cutting DME and IME payments by $8.6 billion over 7 years. I 
strongly opposed these efforts and will continue to fight any cuts of 
this magnitude to these payments. Such cuts would be detrimental enough 
in a stable health care market. But they are especially harmful given 
the impact of our changing health care market on medical education.

  As more Medicare beneficiaries enroll in managed care plans, payments 
for medical education are reduced in two ways. First, many managed care 
patients no longer seek services from teaching hospitals because their 
plans do not allow it. Second, direct DME and IME payments are cut 
because the formula for these payments is based on the number of 
traditional, fee-for-service Medicare patients served at these 
hospitals. Managed care does not pay for medical education.
  My legislation would provide new funding for graduate medical 
education by recapturing a portion of the Adjusted Average Per Capita 
Cost (AAPCC) payment given to Medicare managed care plans. The AAPCC is 
the Medicare reimbursement paid to insurance companies to provide 
health coverage for Medicare beneficiaries under a managed care model. 
These recaptured funds would be deposited into a Trust Fund. I believe 
managed care plans should contribute toward the cost of medical 
education and my legislation would ensure this. This is a matter of 
fairness. All health care consumers, including those in managed care, 
benefit from this training and should contribute equally towards this 
goal.
  These funds would be deposited into a trust fund at the U.S. 
Department of the Treasury. All funds would be eligible to earn 
interest and grow. The Secretary of Health and Human Services would be 
authorized to transfer funds from the trust fund to teaching hospitals 
throughout the nation. The formula for distribution of funds would be 
determined by a new National Advisory Council on Post-Graduate Medical 
Education that would be established by this legislation. This 
legislation would also allow Congress to supplement the Trust Fund with 
appropriated funds which the Secretary of Health and Human Services 
(HHS) would distribute. All of this funding would be in addition to the 
current federal programs of direct and indirect medical education. This 
supplemental funding is necessary to enable medical schools to maintain 
sufficient enrollment and keep tuition payments reasonable for 
students.
  My legislation would also take an additional portion of the AAPCC 
payment given to managed care plans and return it to the Secretary of 
Health and Human Services to spend on the disproportionate share 
program. Disproportionate share payments are given to those hospitals 
which serve a large number of uncompensated or charity care patients. 
Many of our nation's teaching hospitals are also disproportionate share 
hospitals. Thus, my legislation would create two new and necessary 
funding sources for teaching hospitals.
  This legislation would also create a National Advisory Council on 
Post-Graduate Medical Education. This Advisory Council would advise 
Congress and the Secretary of Health and Human Service about the future 
of post-graduate medical education. The Council would consist of a 
variety of health care professionals, including consumer health groups, 
physicians working at medical schools, and representatives from other 
advanced medical education programs. The Council would also advise 
Congress on how to allocate these new dedicated funds for medical 
education. This Council will provide Congress with needed information 
about the current state of medical education and any changes which 
should be made to improve our medical education system.
  Our nation's medical education program are the best in the world. 
Maintaining this excellence requires continued investment by the 
federal government. Our teaching hospitals need and deserve the 
resources to meet the challenge of our aging population and our 
changing health care marketplace. This legislation would ensure that 
our nation continues to have the health care professionals we need to 
provide quality health care services to them in the future.
  I urge my colleagues to support this effort to provide guaranteed 
funding for medical education.

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