[Congressional Record Volume 145, Number 138 (Wednesday, October 13, 1999)]
[House]
[Pages H9965-H9970]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       PASS THE HATE CRIMES PREVENTION ACT AS QUICKLY AS POSSIBLE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentlewoman from Michigan (Ms. Stabenow) is 
recognized for 60 minutes as the designee of the minority leader.
  Ms. STABENOW. Mr. Speaker, first, as we begin this evening, I want to 
associate myself with the comments of my colleagues this evening 
concerning Matthew Sheppard and all of those who have found themselves 
the victims of hate crimes and the great necessity to pass the Hate 
Crimes Prevention Act as quickly as possible.
  This evening I am joining with colleagues to speak out in support of 
efforts to restore Medicare cuts that have been too deep and have gone 
on too long, and we have an opportunity in this session before we leave 
to fix it, and we need to do that as quickly as possible.
  The Balanced Budget Act of 1997 included numerous cuts to Medicare 
payments, to health care providers, and the original intent was to slow 
the growth of the costs of Medicare by cutting approximately $115 
billion over 5 years. Recently the Congressional Budget Office has 
projected, however, that Medicare spending has been reduced by almost 
twice that amount. Clearly Congress went too far.
  These are not simply numbers that we are talking about. These are 
people, these are families, these are doctors and nurses trying to 
provide care,

[[Page H9966]]

home health care providers, nursing homes that are trying to provide 
care, hospitals, teaching hospitals that are trying to make ends meet 
with cuts from the Federal Government that have gone too far.
  Earlier this year 80 Members of the House joined me in sending a 
letter to the President asking him that as he put together his Medicare 
reform package that he not choose to cut Medicare further. I am very 
pleased that he heard our message and that in fact he did not choose to 
cut Medicare further but instead proposed restoring $7 billion worth of 
cuts. That is a good first step, but it is not enough for us to be able 
to truly solve the problem that faces our health care providers across 
the country.
  Many of us have cosponsored numerous bills that seek to resolve 
specific problems that have arisen with the balanced budget agreement. 
Just this year I have cosponsored 10 bills myself that cover specific 
issues ranging from hospital outpatient prospective payment systems to 
the $1,500 cap placed on therapy services. My colleagues joining me 
tonight are deeply concerned and involved in this issue.
  The sheer number of bills alone that have been introduced and 
cosponsored by people on both sides of the aisle should send a strong 
message to the leadership that we need to act now. Time is running out. 
For too many time has already run out, and shame on us if we do not act 
now.
  Just today key members of the Committee on Ways and Means and the 
Finance Committee on the Senate side have introduced marks for 
legislation to mark up future bills. I am pleased that Senator Daschle 
has introduced a comprehensive bill that addresses a number of the 
issues we will speak to this evening.
  Tonight is our opportunity to outline our priorities for what this 
legislation should address. Solving the balanced budget agreement 
concerns involves dollars, Federal dollars, but as I indicated earlier, 
we have seen more than twice the amount cut that is necessary for 
Medicare's portion of the balanced budget agreement, and we are now 
facing surpluses, we are debating surpluses over the next 10 years. For 
many of us, we have been fighting to put Social Security and Medicare 
first. We have an opportunity to do that, and an important part of 
putting Medicare first is to restore the cuts that have been made and 
provide an opportunity for people to receive the health care that they 
need and deserve.

                              {time}  1845

  Tonight we are going to talk about real pain that real people are 
suffering as a result of the deep cuts.
  Let me take just a moment in each of the three major areas and then 
ask my colleagues to respond as well. Let me speak to Michigan. I have 
had an opportunity to travel across Michigan speaking to hospital 
providers, nursing homes, home health care providers. Michigan 
hospitals alone are expected to bear between $2.5 and $3 billion, not 
million, billion dollars in cuts as a result of the balanced budget 
agreement. That is a 10 percent cut in their Medicare reimbursements 
since 1997.
  Now, to put that in perspective, 10 percent of the Medicare services 
to hospitals are providing in-patient care, persons staying overnight. 
We are talking about a 10 percent cut that could wipe out in-patient 
care in Michigan. Michigan is already suffering. Schoolcraft Memorial 
in Manistique, Michigan is suffering devastating losses of the VBA and 
they recently made the painful decision to close their maternity ward. 
Now, this is an area where now women are going to have to travel at 
least 50 miles, travel about an hour in order to deliver their babies. 
What if there is an emergency? What if that hour is too late?
  I have talked with hospitals in Marquette, Michigan in the upper 
peninsula; in northern Michigan, in my hometown in Sparrow Hospital and 
the Medical Regional Center and down in the metropolitan area of 
southeastern Michigan, Detroit Medical Center, Henry Ford Health 
Systems. In fact, Henry Ford Health Systems located in Detroit 
announced recently just last week, in fact, that 1,000 employees not 
directly involved in patient care will be asked to voluntarily retire 
or will be laid off. One thousand employees, and we have discussions of 
hospitals, whole hospitals closing.
  What is it that we need for our hospitals? We need to repeal the 
balanced budget agreement transfer provisions. I have cosponsored with 
colleagues H.R. 405 that would repeal the transfer provision. 
Currently, hospitals are not discharging patients to nursing homes 
because the paperwork and regulations are just too difficult. Secondly, 
we need to limit the reductions for outpatient care. This is a number 
one concern for hospitals, and I am pleased to have cosponsored H.R. 
2241 that would limit reductions to outpatient care.
  We need to limit reductions for in-patient care as well, and I am 
pleased to have cosponsored H.R. 2266 with the gentlewoman from New 
York (Mrs. Lowey) that would increase payments to hospitals for in-
patient care. We need to provide more support for our rural hospitals 
in communities like Manistique that are feeling the need to close their 
facilities for delivering babies.
  We need to increase Medicare's commitment to graduate medical 
education. Our esteemed colleague and ranking member on the Committee 
on Ways and Means, the gentleman from New York (Mr. Rangel) has 
recognized the importance of this issue and I am pleased to be 
cosponsoring legislation, H.R. 1785, that would stabilize payments to 
hospitals for the indirect costs associated with graduate medical 
education.
  In the areas of nursing homes, the major feature of the balanced 
budget agreement that has impacted skilled nursing facilities was the 
implementation of the Medicare perspective payment system for in-
patient services and the establishment of caps on therapy services. The 
impact of these provisions could range from decisions by nursing homes 
to no longer provide services that are not adequately reimbursed to 
limiting the amount of services that a patient can receive. The 
prospective payment system has dramatically changed the way skilled 
nursing facilities approach Medicare patient admissions.
  Now, skilled nursing facilities require more information prior to a 
Medicare admission because they have to assess the overall costs and 
compare that to the costs of reimbursement that they are receiving, and 
too many times this is keeping our frailest and sickest patients out of 
our nursing facilities.
  The other obstacle to care that nursing facilities are facing is the 
arbitrary cap of $1,500 for therapy services. The Balanced Budget Act 
created a $1,500 cap for physical and speech therapy together, and 
another $1,500 cap for occupational therapy. These caps are way too 
severe. They are not allowing patients to receive the services that 
they need. Once the beneficiary reaches the cap, the nursing facilities 
must seek payment from the patient or decide whether or not to continue 
care. Our nursing homes need to lift the arbitrary therapy cap, and we 
need to reduce the cuts from the prospective payment services.
  Finally, an area that has been hit extremely hard by the balanced 
budget agreement cuts, and that is the area of home health care. The 
Balanced Budget Agreement was expected to cut Medicare spending on home 
health by $16 billion, but earlier this year when CBO reestimated the 
Medicare budget baseline, that number had more than doubled. Right now, 
we are seeing Medicare payments to home health agencies reduced by over 
$48 billion. Not $16 billion, $48 billion. This is $32 billion more 
than Congress intended, and this needs to be addressed now. These 
numbers can be overwhelming when we look at what this means for 
patients.
  Mr. Speaker, 28 agencies have closed in Michigan. Twenty-eight 
agencies have closed in Michigan, and over 2,400 agencies have closed 
nationally or have stopped providing service. I remember, Mr. Speaker, 
being on the floor a year ago, a number of us, working on this issue of 
home health care, organizing a national rally to address home health 
care cuts, and at that time we said there were 1,200 agencies that had 
closed and that if nothing was done, we would see that double. We do 
not want to be right about that, but in fact, it has doubled. I do not 
want to be here a year from now saying it has doubled again and people 
have lost their services and that families have found themselves in 
horrible situations as a result

[[Page H9967]]

of trying to care for a loved one at home or, at the same time, finding 
themselves in a situation where someone needs to be placed back into 
the hospital or in a nursing home when they could, in fact, be at home 
or be with loved ones.
  We have numerous examples, and I know my colleagues will speak to 
this as well.
  What do our home health agencies need? We need to first eliminate the 
15 percent cut that is currently scheduled for next year, October 2000. 
We need to establish a payment system to cover what are called outliers 
or the costliest and most expensive patients that are difficult right 
now for home health agencies to serve as a result of the cuts. We need 
to provide overpayment relief. We need to revise the per-visit limits 
to at least 108 percent of the medium which is simply right now just 
too low to cover the sickest and the frailest patients. And, we need to 
develop an equitable perspective payment system for home health.
  We can achieve these goals. We can fix this problem. We have in front 
of us an opportunity. We are talking about budget surpluses for the 
next 10 years, not budget deficits. We have people that are not 
receiving health care in a country with the greatest health care 
systems available in the world, and yet too many are not able to 
receive them. We can fix this, and I am pleased tonight to be here with 
my colleagues that are going to share as well in their thoughts as they 
relate to how this affects their States.
  Let me first call on the gentleman from Illinois (Mr. Davis) who has 
been one of the leaders as well on this question of restoring Medicare 
cuts. I am so pleased the gentleman is here this evening.
  Mr. DAVIS of Illinois. Mr. Speaker, I thank the gentlewoman. Let me 
commend the gentlewoman for not only her leadership on this issue, but 
for the leadership that she has provided on a number of issues not only 
affecting your home State of Michigan, but actually affecting the lives 
of people all over America. I am indeed pleased and delighted to join 
with the gentlewoman tonight as we talk about this problem.
  Mr. Speaker, the Balanced Budget Act of 1997 ushered in the largest 
cuts in Medicaid spending since 1981. Cuts estimated at $17 billion 
over five years, and $61.4 billion over 10 years. These cuts amount to 
and account for more than 9 percent of the supposed savings under the 
Balanced Budget Act. Two-thirds of the cuts in Medicaid are from 
reductions or limits on disproportionate share or additional 
reimbursements to hospitals. These are payments to hospitals serving a 
disproportionate share of low-income, Medicaid and uninsured patients. 
Ten-year cuts, $40.4 billion. Twenty percent of the reductions shift 
the cost of Medicaid deductibles and coinsurance while the very poor to 
physicians and other providers of care. Most of the remainder of the 
cuts come from the repeal of the Buyer amendment, requiring minimum 
payment guarantees for hospitals, nursing homes and community health 
centers. 10 years worth of cuts, $6.9 billion.
  There were several other provisions which were particularly cruel. 
The phaseout of the health center cost reimbursement with 10-year cuts 
totaling $1.3 billion, and the counting of veterans' benefits as income 
with 10-year cuts totaling $200 million.
  Mr. Speaker, as disastrous as these cuts are, they are not the end of 
the story, or even the worst of the story. The impact of the so-called 
Balanced Budget Amendment on Medicare has been even more staggering, 
and it is not an exaggeration to state that the long-term existence of 
Medicare is not guaranteed. The byzantine logic of the Balanced Budget 
Amendment extended the life of Medicare by slowing the rate of growth 
in Medicare's payments to providers and shifting some home health 
services out of Part A. But the Balanced Budget Amendment did nothing 
to fundamentally address the problem of insuring the health of future 
generations of seniors.
  Medicare is based on the principle of spreading the risk for our 
seniors through a system of insurance funded through our tax system. 
Medicare has been one of the most successful Federal programs in our 
history. But now, Medicare faces new challenges, largely because we are 
living longer. By the year 2030, we expect that the number of 
beneficiaries will double, reaching a total of 76 million, or almost 20 
percent of our population. This has raised questions about how will we 
continue to fund the program.
  The Balanced Budget Amendment shortsightedly attempts to address the 
problem by saying that the government can no longer afford to pay for 
health care for our seniors. The implication is that our Nation can no 
longer afford health care for seniors and that they should be left to 
fend for themselves for that portion of health care no longer covered 
by Medicare.
  Most Americans, though, reject such a notion. We reject the notion 
that the wealthiest Nation in the history of the world cannot take care 
of the health of its seniors. This is an affront to those who have 
worked all of their lives. It is also not based on fiscal reality. By 
undermining the concept of a universal insurance pool for all seniors, 
these cuts actually will increase the inequities and costs in the 
system. The so-called unrestricted fee-for-service plan which removed 
the cap on what providers are allowed to charge and the Kyl amendment, 
which would allow providers to contract directly for services outside 
Medicare are direct attacks on the concept of a common insurance pool.

                              {time}  1900

  While we debate the future of Medicare, and I would note that a one-
half of 1 percent increase in the payroll tax would extend the Medicare 
program another generation to the year 2032, but we have turned away 
from real solutions and the impact of our hospitals is exploding like a 
bombshell.
  The 5-year impact of the balanced budget amendment will amount to 
$2.7 billion. Large urban hospitals will absorb more than $2 billion of 
those cuts in the State of Illinois alone.
  The State of Illinois has 20 congressional districts. Thus, each 
district accounts for 5 percent of Illinois' population. However, my 
district, the 7th District, will absorb $468 million of the Medicare 
cuts. That is 16.9 percent of all the cuts in the State. Over the next 
5 years, in my district, hospitals will absorb cuts that are equivalent 
to more than 75 percent of their 1997 base year Medicare payments, and 
tertiary teaching hospitals will absorb more than a billion dollars in 
cuts over the 5-year period.
  So, I would say to the gentlewoman from Michigan (Ms. Stabenow), this 
problem exists all over America and as we move towards finding a 
solution, the solutions that the gentlewoman has articulated, the 
legislation that she and others of us have cosponsored, provides a 
tremendous opportunity to move ahead and arrive at real solutions to 
these problems.
  So, again, I commend the gentlewoman for the leadership that she has 
shown, for bringing us here this evening to discuss this issue, and I 
trust that America will follow the lead of the gentlewoman and help us 
find solutions to this very serious problem, and I thank the 
gentlewoman.
  Ms. STABENOW. Mr. Speaker, I thank the gentleman from Illinois (Mr. 
Davis) for his comments. I know that his State of Illinois is not 
unlike Michigan and all of us across the country right now are having 
those conversations with our hospitals and our nursing homes and home 
health facilities, and most importantly with our families that are 
represented and served by those providers who want to serve them, who 
are quality facilities but are finding themselves in very difficult 
situations as a result of the Congress. We can change that. It is up to 
us and it is long overdue.
  I would like now to call on another colleague of mine from Illinois. 
Illinois is filled with wonderful leadership and I am so pleased to 
have a Member who has come to this body in her first term and has 
become an instant leader on a number of issues, the gentlewoman from 
Illinois (Ms. Schakowsky), who is here with us this evening to speak as 
well.
  Ms. SCHAKOWSKY. Mr. Speaker, I thank the gentlewoman from Michigan 
(Ms. Stabenow) for yielding me this time. I would like to thank the 
gentlewoman from Michigan for her tireless work on this important issue 
and for organizing this discussion tonight and also to associate myself 
with the comments of my colleague from Illinois.

[[Page H9968]]

  Recently, I joined him some days ago, speaking out on the need to 
restore payments for hospitals, particularly those hospitals that serve 
a disproportionate number of uninsured and poorly insured patients, and 
those that train medical professionals.
  Unless we act now, Illinois hospitals and hospitals across the 
country will have insufficient resources to provide the quality and 
timely care that our constituents deserve.
  I also wanted to say that there was a recent report by George 
Washington University researchers Barbara Smith, Kathleen Maloy and 
Daniel Hawkins which provides a clear warning signal that home health 
services are also threatened by the cuts that the balanced budget 
amendment had. Three million acutely and chronically ill senior 
citizens and Medicare beneficiaries with disabilities are depending on 
home health care services.
  Hospital stays are getting shorter. More and more Medicare patients 
are being sent home with ongoing medical needs. In many cases, home 
health services, if available and appropriate, are cost effective 
substitutes for hospital and nursing home care. Despite the 
overwhelming and growing need for quality home services, the George 
Washington University study demonstrates that the interim payment 
system required by the balanced budget amendment is having adverse 
impacts. Because of cost constraints, the majority of home health 
agencies have already changed their case mix. They are looking for 
patients with less complex and less expensive problems, and they are 
avoiding patients that have more complicated and more expensive needs. 
In other words, those people who are most in need of home health 
services are most at risk of losing them.
  The study concluded that in reaction to patient cuts, home health 
services are cutting staff but not just the administrative staff but 
specialists, such as occupational and speech therapists and, again, 
quality care is being compromised. Those payment cuts are having a 
serious effect on patients, and they are also costly. Evidence is 
mounting that without adequate home care more Medicare patients are 
being readmitted to hospitals and nursing homes, adding to health care 
costs. Clearly, we need to act now to restore home health service 
payments to adequate levels.
  Before I conclude, I want to talk a little bit about the effect of 
payment cuts on hospice care. Many of us have had the experience of 
caring for a loved one who is terminally ill. My beloved father, Irwin 
Danoff, lived with me and my husband until he died in 1997, and we were 
fortunate enough to have hospice care provided by the wonderful people 
at the Palliative Care Center of the North Shore.
  At a time of great need, hospice provided medical care and medical 
devices but so much more; the comfort, the dignity, the support and the 
respect not only for him but for our family as well. Half a million 
patients a year depend on hospice care. Since 1982, when the benefit 
was initiated, millions of patients have been able to die in dignity 
and in comfort because of hospice. Unless we act now to provide for 
payments, patients and families may be unable to get the care and 
support they need.
  The hospice rate per day is supposed to cover all the costs related 
to terminal illness, including physicians, oversight services, 
counseling, prescription drugs, home health aides. It allows hospice 
providers to provide coordinated care and keeps patients and families 
from having to deal with multiple providers, at such an extremely 
critical and emotionally draining time. I speak from experience.
  The plain facts are that the hospice daily rate has not kept pace 
with the cost of providing the hospice service. We believe that 
terminally ill patients should receive pain medication and pain 
management, which is what my father needed, to make sure that their 
final days are not days of agony. In 1982, when the hospice benefit 
began, it assumed the drug cost would account for 3 percent of the 
daily rate. In today's dollars, that equals about $2.50 a day for pain 
medication, and that is just inadequate. In fact, on average the cost 
of providing drugs to hospice patients is between $12 and $14 a day. 
Some drugs may cost $36 a dose, like Duragesic, a pain relief drug, or 
Zofran, an effective anti-nausea drug. It costs $100 a day, but if a 
person needs it, they need it.
  The resources are needed to make sure that with new technologies 
available to treat acute pain symptoms that those technologies actually 
get to those who need them. Not only does hospice make sense for 
patients, it makes sense for Medicare as a whole because it is such a 
cost effective way of providing care.

  A 1995 Lewin study found, for example, that every dollar spent on 
hospice actually saves $1.52 in Medicare dollars that would otherwise 
be spent. I hope that we will act to provide adequate hospice payments. 
The first step would be to ensure that hospice providers receive their 
full Medicare update so that payments more accurately reflect actual 
costs. It is the compassionate thing to do. It is the medically 
appropriate thing to do. It is the right thing to do.
  Again, I want to thank my colleague, the gentlewoman from Michigan 
(Ms. Stabenow), for organizing this discussion.
  Ms. STABENOW. Mr. Speaker, I also thank the gentlewoman from Illinois 
(Ms. Schakowsky) for her comments. I am so pleased that she raised 
hospice. That is such an important service. In Michigan, I was pleased 
as a member of the State House of Representatives to help pass the law 
that we now have on the books in Michigan, and I know for my own family 
as well that hospice has been a very important service. When we look at 
all of these issues, it is the continuum of care we are talking about. 
Unfortunately, when we are not adequately funding one area it just 
moves over into the next. So we need to look at this comprehensively on 
behalf of families.
  It is now my pleasure to turn to the gentleman from Massachusetts 
(Mr. McGovern), who is a sponsor of H.R. 1917. The gentleman from 
Massachusetts (Mr. McGovern) and I have been working together on this 
issue it seems like for a long time, too long, and I know that he is 
deeply involved and cares passionately about this, and I want to thank 
the gentleman for his leadership. He has been there since the beginning 
when we have been trying to resolve the issues, particularly around 
home health care. I want to thank the gentleman for his leadership.
  Mr. McGOVERN. Mr. Speaker, I appreciate those comments and I too want 
to commend the gentlewoman from Michigan (Ms. Stabenow) for her 
leadership and for her commitment on health care issues. I do not know 
anybody in this Congress who has fought harder for the rights of 
patients or for quality care for all more than she has. She really has 
done a great job not only for the people of Michigan but for the people 
of this country and I am really proud to be part of this special order 
tonight with her to talk about what we need to do to correct some of 
the imbalances in the Balanced Budget Act and how we can make sure the 
people get the quality health care that they deserve in this country.
  Let me begin by saying that, in my opinion, Congress made a mistake 
back in 1997 when we passed the Balanced Budget Act. I voted against 
the Balanced Budget Act back then because I thought the cuts in 
Medicare were too deep, were too drastic, but I did not realize then 
and I do not think the most ardent supporters of the Balanced Budget 
Act realized then, that the cuts would be as deep or as drastic as they 
have turned out to be.
  As has been pointed out, CBO has analyzed that the cuts are about 
$200 billion more than anticipated. That is a lot of money, even by 
today's standards. That means that hospitals and home health care 
agencies and other health services are being cut by $200 billion more 
than Congress even anticipated those cuts to be.
  I think part of our job as legislators is to fix what is wrong. Even 
if we pass something that, with good intentions, if we look back on it 
and realize that mistakes were made we have to have the courage and we 
have to have the fortitude to fix it. I think this is one such case.
  Now, there is not a person in this House who has not met with 
hospitals in their districts, who has not met with home health care 
agencies in their district or visiting nurse associations or people who 
run hospice centers or nurses or doctors or patients who have

[[Page H9969]]

not complained about these cuts in the Balanced Budget Act.
  In my State of Massachusetts hospitals will lose $1.7 billion over 5 
years. That is a pretty hefty amount of money. The bad news is that 
they have yet to face 90 percent of the cuts. The worst is yet to come.
  I have hospitals in my district, teaching hospitals and community 
hospitals, that are very good, that really I think are models of 
efficiency, that provide good quality care to the people who utilize 
them. They are getting frustrated with the remarks that come out of 
Washington that they just need to trim the fat a little bit more and 
everything will be okay. Well, to those who say that hospitals need to 
trim more fat, I would invite them to my district to tour through some 
of the hospitals that are located in my district and they will realize 
that there is no more fat to trim.
  In fact, what hospitals are cutting back on now are programs that 
benefit the elderly, that benefit children, that benefit the neediest 
people in our communities. What hospitals are doing now is they are 
cutting back on their nursing staff. I was recently visited by a CEO of 
one of my hospitals who told me he used to make it a practice over the 
years to visit the various floors in his hospitals and talk to the 
nurses and try to find out what he needed to do to make their jobs 
easier, what he needed to do to make the quality of care provided to 
patients better.

                              {time}  1915

  He says that recently because of the cutbacks when he goes by and 
tries to talk to the nurses, they do not have time to talk to them. 
They are so overwhelmed, they are so overburdened with the patients 
because they are so short staffed that they do not have the time to 
talk to him anymore.
  What is happening is that the quality of care that this hospital and 
other hospitals used to provide to patients is suffering. Nurses are 
doing a great job. They are doing an incredible job. But in too many 
hospitals, in too many health care facilities, they are being 
overworked. That is happening because of what we have done in this 
Congress, and we need to fix it. Again, it is not just teaching 
hospitals, it is community hospitals. Hospitals all across the country 
are paying a price.
  Now, we also have a problem with home health care agencies. As the 
gentlewoman from Michigan (Ms. Stabenow) pointed out, we have been 
working on this issue since 1997.
  Home health care was a wonderful phenomena. It allows families to 
stay together. If a loved one is sick, in the old days, before home 
health care, one would end up having to put that loved one into a long-
term nursing care facility, because one was just incapable of being 
able to care for that person at home.
  Home health care agencies or visiting nurse associations across the 
country have arisen, and they have allowed families to stay together. 
They have done so in a way that I think is very cost efficient.
  Now, because of the cutbacks in the balanced budget act, in 
Massachusetts, since 1997, over 20 agencies have closed. When an agency 
closes, that means that that person, who used to rely on that agency 
for home health care, has to try to find another agency to provide the 
home health care; and, oftentimes, they cannot do it.
  Oftentimes, they may be the sickest of patients, and they can have a 
difficult time trying to find another agency who will want to pick them 
up. Therefore, they are then forced to deal with the reality that they 
have to go into a long-term nursing care facility.
  To those who think we are saving money, the reality is we are not. It 
is a heck of a lot cheaper to provide somebody home health care every 
single day of the week than it is to force that person into a long-term 
nursing care facility.
  So what we are doing here in Congress really is not controlling 
health care costs. What we are doing is actually inflating health care 
cost because the cost to care for these people is going to increase, 
not decrease.
  I will say one other thing. If we do not fix this problem now, the 
governors of our States across this country are going to realize that 
Congress had just handed them a big unfunded mandate on their States, 
because when somebody goes into a long-term nursing care facility, that 
is funded mostly by Medicaid, and the States pay a large portion of 
that.
  So when the governors of this country start to realize that their 
State budgets are going to have to take more and more of their 
resources and put it into Medicaid to pay for what is happening, and 
that is people going from homes into long-term nursing care facilities, 
we are going to see the switchboard up here on the Capitol light up, 
and justifiably so.
  We should not be passing these costs on to the States. It is not 
fair. Every cost we pass on to the States means the States are going to 
have less money for education, less money for transportation, less 
money for the environment. It is simply wrong, and we need to do 
something about it.
  I have introduced a bill, as the gentlewoman from Michigan pointed 
out, H.R. 1917, the Home Health Care Access Preservation Act, that 
would deal with providing coverage for the sickest patients, the so-
called outliers, the patients that tend to be the most costly. We do 
not want those people to fall through the cracks.
  This is a modest step to try to help deal with some of the adverse 
impacts of the Balanced Budget Act with regard to home health care. I 
hope that this Congress will act on it. We have over 100 cosponsors. It 
is a bipartisan list of cosponsors. We need to do something about that, 
and we need to do something now.
  I will conclude here by simply posing a question as to whether or not 
we have the political will to fix this problem. We certainly have the 
resources. We certainly have the money. As the gentlewoman from 
Michigan pointed out, we are not dealing with deficits in 1999. We are 
dealing with surpluses.
  The question is: What are our political priorities? Do we want to 
make sure that hospitals have necessary funding? Do we want to make 
sure that home health care agencies do not close? Do we want to make 
sure that hospices are adequately funded to make sure that health care 
facilities have the funds to be able to employ enough nurses and enough 
doctors?
  If that is our priority, then we are going to act, and we are going 
to make sure that we have a budget that fixes some of the problems as a 
result of the Balanced Budget Act.
  The other question is: Will the Republican leadership of this 
Congress allow us to fix some of the mistakes that were made in the 
Balanced Budget Act? Will they allow us to bring legislation to the 
floor? Will they allow us to have input on the budget so we can 
actually fix this problem? Or is it going to be business as usual? Are 
we going to let this thing just pass and more people will suffer as a 
result of it?
  Make no mistake about it, if we do not fix this, we are going to see 
more and more hospitals close. When a hospital closes in the community, 
it is not easy for the people of that community. It is not easy just to 
go to the next hospital, because the next hospital may be several miles 
away.
  When a home health care agency closes in an area, that means that 
people are going to lose their home health care and be forced with the 
difficult question as to whether or not to have to enter long-term 
nursing care.
  When patients are denied care, when programs are closed, people 
suffer. I think that all of us in this Congress have heard loud and 
clear from our constituents all across this country about what the 
adverse impacts of this Balanced Budget Act have been. I think we have 
an obligation, we have a moral duty to fix it. We have an opportunity 
now to fix the inadequacies of the Balanced Budget Act. I hope that we 
do it.
  I will be working and fighting alongside the gentlewoman from 
Michigan (Ms. Stabenow) who I know will be out there leading the fight, 
as she always has, to make sure that people get the quality care that 
they deserve. I again just want to thank her for all the wonderful work 
that she has done. Again, I meant it when I said it in the beginning, 
that I do not know of anybody in this Congress who has fought longer 
and harder for good quality health care for people than she has. I am 
proud to be here with her today.
  Ms. STABENOW. Mr. Speaker, I thank the gentleman from Massachusetts. 
He is absolutely correct. This is a question of priorities. This is 
about

[[Page H9970]]

our deciding what the priorities for the country are.
  I remember a few months ago when colleagues in this House and Senate 
in the majority felt that the priority was a tax cut, a tax cut that 
was geared to the top 1 percent wealthiest individuals in the country, 
and they were able to pass a tax cut that took basically all of the on-
budget surplus, almost $800 billion, much more than we are talking 
about here.
  We are talking about less than a tenth of that, few percentage points 
of that to help with Medicare so that people have health care that they 
need when they need it. So the priority was to do that. The President 
said no. He vetoed that.
  We now have an opportunity to come back and do what I know the 
gentleman from Massachusetts (Mr. McGovern) and I have been saying all 
along, which is put Social Security and Medicare first. The first step 
with Medicare is to restore the cuts. We have to do that so that we can 
then go on to strengthen it.
  I often think about the fact that, in my mind, Social Security and 
Medicare are great American success stories. Prior to Social Security, 
half of the American seniors were in poverty. Today, it is less than 11 
percent. Prior to Medicare being enacted in 1965, half the seniors 
could not purchase insurance, could not get health insurance.
  Today one of the great things about our country is that, if one is 65 
years of age, one knows, or if one is disabled, one knows that one is 
able to have basic health care provided to one in this country. This is 
something we should be proud of. I do not understand why it is now, 
when we are faced with the opportunity to decide what our American 
priorities are for the next 10 years, why we are fighting with the 
majority to restore what everyone agrees were cuts that went too far.
  Mr. McGOVERN. Mr. Speaker, I just want to echo what the gentlewoman 
from Michigan has just said. When I go around to my district, what 
people are talking about is, not tax cuts for the wealthy, but they are 
talking about good quality health care for all. They are talking about 
expanding Medicare, which I have yet to find anybody who thinks that 
Medicare is a bad idea. Everybody in my district thinks it is a great 
idea. It is one of the most successful social programs in the history 
of this country. They want to expand Medicare to provide a prescription 
drug benefit. They would rather have a prescription drug benefit than 
see Donald Trump get a tax cut.
  Those are the choices we are faced with right now. We have a surplus, 
as the gentlewoman pointed out. The resources are there. Are we going 
to take that surplus, invest it in Social Security, invest it in 
Medicare, make sure that hospitals have the funding that they need, 
make sure that we have enough nurses and doctors, make sure that our 
home health care agencies can stay strong, make sure that there is a 
prescription drug benefit for all Medicare eligible senior citizens? 
Are we going to do that, or are we going to blow this opportunity?

  We have a moment in our history where, because of a good economy, we 
have this surplus. If we cannot fix these problems now, if we cannot 
extend some of these benefits now, then when will we be able to do it?
  Ms. STABENOW. Mr. Speaker, I totally agree. I would much rather be 
here, as I know the gentleman from Massachusetts would, talking about 
how we modernize Medicare with the prescription drug coverage than to 
say that we are here having to talk about restoration of cuts or 
hospitals closing, literally closing.
  I do not think there is yet a total understanding of the depth of the 
cuts and the suffering and the struggle that is going on today; whole 
hospitals closing or maternity wards closing or home health agencies.
  A wonderful agency that I have worked with in Brighton, Michigan, the 
first time I visited there, it was two floors with nurses, home health 
providers on two floors that were serving people in Livingston County. 
I went back after the BBA was enacted. It is now one floor. The other 
floor is totally empty.
  What does that mean? That means those home health nurses, those 
individuals that were providing care to people in their homes are no 
longer available there to do that. It also means job loss. We are 
talking about supporting small business.
  When a hospital closes, when Henry Ford Health Systems has to lay off 
or early retire 1,000 people, those people are caring for their 
families. We are not just talking about the care, we are talking about 
jobs, incomes, the ability of people to care for their own families. So 
this is serious.
  My concern is that we have a very short window of opportunity now to 
fix this, 3 weeks, 4 weeks possibly, certainly just a matter of weeks. 
We know there are bills that have been introduced. There are people 
that are talking about the issue. We need to get beyond the talk. The 
gentleman from Massachusetts and I have been talking about this for a 
long time. It is now time to do something about it.
  Mr. McGOVERN. Absolutely. Mr. Speaker, one thing I hope that we do in 
this Congress is, not simply pass sense of Congress resolutions to say 
that we feel your pain, I hope we pass legislation that has some teeth 
in it, that actually puts some of the money back into hospitals and 
health care in this country.
  People are suffering all over this country because of these cuts. And 
we have an obligation in this Congress to fix the problem and to take 
some of these resources that have been generated by a strong economy, 
that have produced this surplus, and put it back into health care to 
make sure that people have the very best health care in the world.
  I mean, this is the United States. We have the finest health care 
technology, the best doctors, the best nurses, the best facilities in 
the world. The problem is that a lot of people cannot take advantage of 
them because they do not have the resources or the money to do so.
  The gentlewoman from Michigan has heard from her constituents. I have 
heard from my constituents. People come into my office because their 
loved one has just lost their home health care or because their HMO 
will not reimburse a particular service that they had done because they 
are being told because Medicare reimbursements or because of caps on 
therapy, because of programs that hospitals have that are being cut 
off.
  I mean, it is painful to watch as people come into our office and 
tell us these sad stories. But what is more frustrating than listening 
to these stories is the fact of knowing that we have the ability to fix 
this, and so far we have not done it.
  I think we just need to keep the pressure on, and I hope that the 
people who are watching will keep the pressure on, because we have an 
opportunity to, right now. This budget deal should not go through 
unless there are some real fixes in there for hospitals. We are going 
to do a weekend here to fight the good fight.
  I again thank the gentlewoman for this special order and for all of 
her great efforts.
  Ms. STABENOW. Mr. Speaker, let me just say in conclusion as well, I 
again thank the gentleman from Massachusetts (Mr. McGovern). I thank my 
other colleagues. To those that are having the opportunity to listen 
this evening, I would hope that they would pick up the phone and call 
their Representative, call their Senator, be involved, e-mail, 
mailings, whatever means they have of communicating. Now is the time to 
do that.

                              {time}  1930

  We do have the best health care system in the world. But right now we 
are in a situation where we are jeopardizing people's health, people's 
quality of life, and in many cases, unfortunately, their lives. And it 
is not necessary. This is fixable. We can do something about it. 
Medicare works. It is a great American success story. We need to make 
sure we keep it that way.

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