[Congressional Record Volume 144, Number 142 (Saturday, October 10, 1998)]
[Senate]
[Pages S12276-S12277]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               NEED FOR URGENT ACTION ON HOME HEALTH CARE

  Mr. DORGAN. Mr. President, as we reach the conclusion of this 105th 
Congress, I note that there are a good many issues yet to be discussed 
and resolved. I wanted to come to the floor to talk about one issue 
that is very important, the issue of home health care. It is vitally 
important that Congress take action on this issue before adjourning.
  I am very familiar with home health care. This is not theory to me. 
It is not an issue that I just read about and only understand from 
books and manuals and rules and regulations.
  One snowing Wednesday evening in January a number of years ago, my 
mother was killed in a tragic manslaughter incident in North Dakota. 
She had gone to the hospital to visit a friend and on her drive home, 
four blocks from home, a drunk driver going 80 to 100 miles an hour and 
being chased by the police hit her and killed her instantly.
  During this same period, my father was having significant health 
problems, and as so often is the case, my mother was providing the bulk 
of his care at home in Bismarck, ND. I will perhaps never forget the 
moment of having to wake my father up and tell him that my mother had 
lost her life.
  In addition to the shock of losing our mother, my family understood 
that we were also going to have to struggle to make sure my father got 
the care he needed. In the days ahead, we began talking about what we 
could do to help my father in his fragile state of health. One of the 
things we discovered was that there is in this country a system of home 
health care. Through this system, skilled health care providers will 
come into the home on a routine basis to help to meet the health care 
needs of those who desperately need it.
  My family used the home health care system and the services of 
wonderful nurses and others who worked in home health to care for my 
father. It allowed us to keep my father out of a nursing home and in 
the home that he had lived in for so many years with my mother.
  Was that important? Yes. It was very important and made life much, 
much better for him. And it occurred because we have a home health care 
system that could provide the routine health care needed to allow my 
father to continue to live at home. My father is gone now, but I still 
remember how important that home health care was and still is to 
millions of families all across this country.
  Home health care is a wonderful Medicare benefit because it allows 
older Americans to remain at home and to be independent where they are 
most comfortable, rather than having to go into more costly hospitals 
or nursing homes.
  But at this time, we have in our country a very serious financing 
problem with home health care that is jeopardizing this Medicare 
benefit. Before we end this session of the Congress, we need to do 
something to address it. I would like to describe just for a moment 
what that problem is.
  Congress, last year, passed the Balanced Budget Act, something I 
supported. This legislation made a lot of changes to Medicare and to 
the home health care program. Some of those changes were warranted 
because the home health care program had mushroomed, and we had to 
constrain the rate of growth of home health care spending, which had 
more than tripled in the early 1990s.
  But Congress went too far and, in my judgment, made a mistake in the 
way it implemented what is called the interim payment system, which is 
now having a devastating impact on home health care agencies and 
Medicare beneficiaries. The current interim payment system penalizes 
the very home health care agencies that have operated most efficiently 
in the past, and it locks in the payment inequities that currently 
exist. The result is that 1,100 home health agencies nationwide have 
closed their doors.
  Unfortunately, the very Medicare beneficiaries who are being harmed 
the most by this interim payment system that is so unfair are those 
Americans who need home health care the most. That is because, under 
this interim payment system, more than 80 percent of home health 
agencies will be paid a capped amount called the ``per-beneficiary 
limit.''
  In my home State, the average per-beneficiary limit is $2,247, not 
nearly enough to cover the cost of care needed by the sickest and the 
most frail of Medicare beneficiaries.
  The home health care folks have a Hobson's choice. They can close 
their doors, or they can start a kind of cherry-picking with respect to 
those who need home health care service. In other words, they can 
choose to serve only the less ill or less sick Medicare beneficiaries 
whom they know will not exceed the per-beneficiary cap.
  I am told cherry-picking is not yet occurring in my home State. But I 
am afraid it is only a matter of time before home health agencies have 
no choice and begin to do that.
  I don't believe it was Congress' intention to cause efficient home 
health agencies to close or to stop caring for sicker patients, and I 
think it is imperative that this Congress solve this problem.
  In the negotiations on the budget, I hope very much that will happen. 
If we wait until next year, it is going to be too late. Hundreds of 
agencies will probably not be there and a good many of the sickest and 
the most frail health care beneficiaries who need home health care will 
not get it.
  I have cosponsored a bill introduced by Senator Collins and others, 
the Medicare Home Health Equity Act, that would make the home health 
payment system more fair to the historically efficient providers, and 
reduce the incentive for dropping sick patients.
  Let me emphasize again that the purpose is to make the home health 
care system more fair to the historically efficient home health care 
providers.
  There have been dozens of bills introduced to solve the problem, and 
to date more than two-thirds of the Senate from both political parties 
have cosponsored one or more of these bills, or have gone on record in 
support of efforts to address the problem.
  With nearly 70 Senators cosponsoring or supporting legislation of 
this type, I think we ought to, before Monday evening or whenever we 
adjourn, fix this home health care payment system.
  I know my colleagues on the Senate Finance Committee have been 
working to develop legislation that will at least deal with the most 
pressing problems in this interim payment system and to tide the home 
health agencies over until permanent changes can be implemented.
  One of the challenges they face is to do this in a fiscally 
responsible way that will not harm other areas of Medicare.
  It is also important, I think, not to be asking older Americans, 
especially those who have reached the age of declining income, to 
shoulder the cost for this change through a new copayment on home 
health services.
  I know that the Congress can meet this challenge if it decides this 
is a priority between now and perhaps Monday evening. Congress must, in 
my judgment, begin to select the right priorities.
  We seem to be at loggerheads here in negotiations between the House 
and the Senate, the Congress and the President, Democrats and 
Republicans. Between now and when we complete the final omnibus 
spending bill, we must make choices about what our priorities are, what 
is more important, and what is less important.
  I ask that we decide that dealing with the home health care payment 
system is more important. That it be one of the priorities.
  This is something we can do. It is not something that is terribly 
difficult. It is simply a choice that we will make--Democrats, 
Republicans, liberals, conservatives, all of us deciding together how 
we spend limited resources on nearly unlimited wants in this country.
  Mr. President, I know others wish to speak, and I would say to the 
majority leader that this will be an interesting couple of days. He, I 
am sure, will have a significant challenge working with all of us to 
try to figure out what the priorities will be in the closing hours of

[[Page S12277]]

this session. It is my fervent hope that one of those priorities will 
be to address the interim payment system in home health care.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The majority leader is recognized.

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