[Congressional Record Volume 145, Number 125 (Thursday, September 23, 1999)]
[Senate]
[Pages S11366-S11367]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

                             By Mr. CONRAD:

  S. 1631. A bill to provide for the payment of the graduate medical 
education of certain interns and residents under title XVIII of the 
Social Security Act; to the Committee on Finance.


    graduate medical education fair technical amendment act of 1999

 Mr. CONRAD. Mr. President, today I am pleased to introduce the 
Graduate Medical Education Fair Technical Amendment Act of 1999. This 
legislation will take important steps to sustain and improve the 
availability of medical professionals in communities in my State.
  Mr. President, as you know, the Balanced Budget Act of 1997 (BBA) 
included many measures to control rising health care spending, 
including provisions that reduced the level of resources for graduate 
medical education. In particular, the BBA set a limit on the amount of 
medical residents for which teaching hospitals can receive 
reimbursement. This cap was set according to the number of medical

[[Page S11367]]

residents on staff as of December 31, 1996. While this reimbursement 
limit has helped to contribute to the overall savings generated by the 
BBA, I am concerned that it has unfairly limited the ability of certain 
programs to adequately train future health care providers.
  Over the last few years, we have heard much discussion about the 
issue of physician oversupply. As you may know, various experts suggest 
that the true problem regarding physician supply is an unequal 
distribution of physicians across the country. In my State of North 
Dakota, for example, more than 85 percent of the counties are in health 
professional shortage areas. There certainly isn't a physician 
oversupply in my state--we are grateful for the health care providers 
serving our communities and we are grateful to have facilities with the 
capability to train medical residents.
  Recently, it came to my attention that one of the teaching hospitals 
in my State had committed to training an increased level of medical 
residents. This situation arose because another facility in my State 
was no longer able to offer these residents an adequate training 
experience. The facility's decision to take on the new residents was 
important--while we cannot guarantee that physicians trained in my 
State will pursue permanent practice in the State, we know that 
providers are more likely to serve where they are trained. And it is 
important to note that the University of North Dakota produces a higher 
percentage of graduates who practice in rural settings than any medical 
school in the Nation.
  The facility took on these residents assuming that they would receive 
adequate Medicare graduate medical education reimbursement to train 
these individuals. Unfortunately, retroactively set BBA limits capped 
the allowable reimbursement level just prior to the time the residents 
in question came on board. Thus, the facility was already committed to 
training these residents but the funds they depended on to do so were 
no longer available. The result of this situation is that the entire 
graduate medical residency program is suffering and I am concerned tat 
this could result in reduced services for beneficiaries.
  The legislation I introduce today will correct the unintended 
consequence of the BBA by allowing a technical adjustment to medical 
resident caps in certain situations. I am confident this legislation 
will help ensure we have adequate resources to meet our health care 
needs well into the future. I urge my colleagues to support this 
important effort.
                                 ______