[Congressional Record Volume 146, Number 137 (Friday, October 27, 2000)]
[Senate]
[Pages S11283-S11286]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              MEDICARE BALANCED BUDGET REFINEMENT PROPOSAL

  Mr. REED. Mr. President, I want to first commend my colleague, 
friend, Senator Reid from Nevada, for not only his statement but his 
leadership in this body to try to move the process along. 
Unfortunately, we have reached an impasse.
  We have sent to the President an appropriations bill for the 
Commerce- State-Justice Departments which will be vetoed because of 
glaring deficiencies in that bill.
  We are holding in abeyance for the moment a conference report which 
not only deals with Medicare readjustments because of the Balanced 
Budget Act of 1997, but also contains provisions dealing with assisted 
suicide--a hodgepodge of issues, all of which will, once again, elicit 
a Presidential veto.
  Let me just speak for a moment about this pending bill, although in 
some respects it defies description. It is more of an accumulation of 
different ideas thrown together to get out of town. But part of it 
deals with Medicare and balanced budget refinement proposals.
  All of us in this body for the last several years have been pointing 
out some of the consequences--many of then unintended--of the Balanced 
Budget Act of 1997 with respect to Medicare reimbursement in an effort 
to make sure that our health care system continues to be vibrant and 
continues to be sustainable. And we are resolved to try to address 
these issues and in a bipartisan way.
  But we have found ourselves with a very partisan approach--an 
approach that has not included any of my Democratic colleagues on the 
Finance Committee, and has included no real participation by the 
Democrats in this body at all with respect to issues that are of 
concern to all of us which should be dealt with on a bipartisan basis.
  As a result, we are faced with legislation that comes to us which is 
terribly distorted and terribly slanted, and which will not deal with 
the real crisis we face. In fact, many health care providers, such as 
hospitals, home health care agencies, hospice agencies, nursing homes, 
and others are literally

[[Page S11284]]

being shortchanged in the process where a significant and inordinate 
amount of money is going to HMOs that operate Medicare managed care 
plans.
  These are the same HMOs that abruptly, in many cases, withdrew from 
the market because they could not make their margins--that walked out 
on seniors. And, in effect, we are rewarding them for abandoning 
seniors and walking away from them by giving them a huge amount of 
money with the presumption, of course, that this money will be passed 
on to the providers who care for our elderly and disabled. That is not 
the case at all.
  With respect to the not-for-profit HMOs, their first instincts will 
be to build up their reserves and continue to negotiate very tough 
reimbursements with hospitals and nursing homes. In some cases, they 
are the only game in town. They can go to a hospital or a nursing home 
or a home health agency, and say: These are the terms--take it or leave 
it. But their goal will not be simply passing on the generosity of the 
Federal Government to providers--the people actually giving the care. 
It will be to enhance their own financial positions by continuing to 
put aside money for the proverbial rainy day.
  When it comes to the for-profit HMOs, their incentive is not only to 
enhance their financial position because that is what enhances their 
stock price in the market, but also to provide dividends to their 
shareholders. After all, they are profit-making enterprises.

  I think it is entirely fallacious to believe that by simply giving 
money to HMOs for seniors, with no accountability and no requirements, 
they will in return provide coverage. Simply giving them the money is 
the wrong way to ensure that our seniors and disabled receive adequate 
health care.
  That is precisely the path that has been chosen in this partisan 
Republican legislation that we will see in the days ahead.
  We would like to see Medicare managed care plans succeed. We would 
like to see that happen. But we can't simply wish by giving them money 
that they will change the practices they have pursued over the last 
several years.
  When they looked at the situation, when they thought they were not 
getting the kind of return and the kind of profits they should in these 
programs, they simply walked away.
  Yet we are not requiring them even with this great infusion of money 
to commit to stay the course for our seniors. It is the wrong approach.
  The right approach--the approach that was advocated very forcefully 
by my colleagues on the Finance Committee on the Democratic side--is to 
provide additional reimbursements and additional support for the actual 
providers--the hospitals, the hospice agencies, and home health 
agencies--all of the agencies that are struggling just to stay afloat 
and to stay viable.
  In particular, we have seen over the course of the last several years 
with respect to home health agencies that many have gone out of 
business because of severe cuts in the reimbursements. We originally 
estimated that $16.1 billion would be saved over five years. It turns 
out that we have already saved $19. 7 billion in just two years and are 
on track to save four times what we originally projected. It is about 
time to put the money back in to these important activities.
  Yet, that is not what this bill would do. As I mentioned before, this 
conference report contains several last minute additions coming from 
the outfield, including the misnamed Pain Relief Promotion Act, which 
is an attempt to undercut the legislation and the will of the people of 
Oregon with respect to the very sensitive issue of assisted suicide.
  I strongly disapprove of assisted suicide. I am pleased that my State 
of Rhode Island has, in fact, adopted legislation that outlaws this 
practice but still makes the prescription of drugs by physicians for 
the purposes of alleviating pain a medical matter and not a law 
enforcement matter.
  The fallacy of the approach embodied in the Pain Relief Promotion Act 
is to take the Drug Enforcement Agency and make it the arbiter of good 
medical practice. I can't think of a more inappropriate combination of 
institutions and functions than that. But that has been thrown into the 
mix in this conference report.
  We have been endeavoring over many months to come up with bipartisan 
solutions to these issues of Medicare reimbursement and of the 
restoration of funds that were cut in 1997 under the Balanced Budget 
Act. But it has come to naught so far.
  I hope that in the next few days in anticipation of a Presidential 
veto there will be a second or third or fourth look at these issues and 
we can try to deal with them in a thoughtful and constructive way.
  One particular issue is the fact that we face a further 15-percent 
reduction in home health care reimbursement rates, which is currently 
scheduled to take effect in October of 2001.
  We already know that these agencies cannot sustain such a further 
reduction. But the only thing that this bill does is temporarily delay 
it for another year.
  I have joined with many of my colleagues, including Senator Collins 
of Maine, to suggest the elimination of this 15-percent cut because 
agencies have to know not only that they have a 1-year reprieve, but 
they can plan with some confidence for the years ahead, and that they 
won't face such a further draconian cut in their reimbursement.
  It is the only way they can attract the kind of financial lending 
support they need to cover expenses. It is the businesslike thing to 
do.
  That is another irony. For a party that styles themselves as 
conscious of the business community and knowledgeable of the ways of 
business, the massive distribution of funds to HMOs defy the logic of 
both the not-for-profit and for-profit HMO because they will not pass 
them on. They will either disgorge them to their shareholders as 
profits or they will put them aside so that their ratings and their 
financing will be that much more secure when they are raided by outside 
groups.
  So this legislation is not only unhelpful for the people who need the 
help, the providers and ultimately the seniors, but it is, I think, 
contradictory to the obvious business practices that will be undertaken 
by the HMOs and others who receive these great funds.
  I suggest, again, we go back to the table, that we look hard at all 
these proposed solutions to the problems engendered by the 1997 
Balanced Budget Act in regard to Medicare, and that we strive for a 
bipartisan approach that will get the money to the providers who give 
the care to the seniors. If we do that, we are going to make great 
progress. If we don't do that, we will be back here again next week 
dealing with another proposal after a Presidential veto.
  Now that is just one aspect of what has been transpiring in this 
body, one aspect of the impasse we face.
  Today we sent to the President legislation providing appropriations 
for Commerce, Justice, and State Departments. What we did not send 
forth was legislation that would include the Latino Fairness Act, that 
would include, also, fairness for other groups.
  One group in particular of which I have been very supportive is the 
Liberian community in the United States. I have heard my colleagues on 
the other side say the reason we are not doing this is because we will 
not engage in country-specific relief in our immigration laws. That is 
nonsense. We have had country-specific relief. We have had it 
throughout the history of this country. One just has to look at the 
Cuban community in this country to see very specific and very helpful 
country-specific relief in terms of the rules of immigration, rules of 
establishing permanent residence.
  Also, people suggested we don't want to legitimize people who come 
here illegally and stay here illegally without the color of law. In the 
case of the Liberian community, these individuals have been recognized 
and allowed to stay here under temporary protective status issued first 
by President Bush and continued subsequently. Now, however, they face 
deportation because their TPS status has lapsed. They are now under a 
status called deferred enforced departure--still legal status, allowing 
them not only to stay here but also to work. So this is a group of 
people who are legally recognized to be here, and they have the same 
rights, I believe, or should have the same rights, as everyone else.

[[Page S11285]]

  This whole issue with respect to Liberians, with respect to Latinos--
really, hundreds of thousands who have come here; many have been here 
for decades or more--who are part of our economy, just as all of those 
high-tech workers whom we labored so diligently to accommodate under 
the H-1B visa program. In fact, in places such as Nevada, the home of 
my colleague, Senator Reid, the business communities are asking us to 
pass the Latino fairness bill because it is their workers who are 
affected by not being recognized or allowed to establish permanent 
residence.
  I think we can do much more and should do much more. This discussion 
leads invariably to a litany of lost opportunities and partisan action 
which undercuts the very brave language of Governor Bush who talks 
about bipartisanship. Certainly we haven't seen any bipartisanship 
here. We haven't seen a great deal of leadership here on issues that 
are important to all of us and are particularly important to the 
American people.
  If we finish next week simply by adopting the remaining 
appropriations bills, we will have neglected to deal with the real 
issues that the American people have demanded of us for months and 
months and months. There will be no prescription drug benefit for 
seniors. Yet I hazard a guess that each and every one of us has gone 
back to our States and talked with fervor and passion about how 
critical it is these seniors have access to a Medicare prescription 
drug benefit. Yet that is not likely to happen. Another lost 
opportunity, another missed chance at the issue, another disappointment 
to the legitimate hopes of the American people that we would work 
together and accomplish something for them.
  We have not enacted a meaningful Patients' Bill of Rights. Yet for 
months and months and months we have been talking about it. We have 
seen our colleagues in the other body pass a bipartisan Patients' Bill 
of Rights. Yet in this body it has languished, and its days are now 
numbered. So we will not have, for the American people, something they 
want: Simply to be able to get from their managed care organization the 
benefits they thought they were entitled to and that their employer 
typically thought he or she had paid for. But we are not doing that 
because in this body we didn't pass a real Patients' Bill of Rights. We 
passed a sham. My collages hoped that sham would be enough of a 
diversion so the American people will forget what we failed to 
accomplish.
  Education reform. Governor Bush is talking about education and 
touting his record of education. The Rand study has showed some 
evidence that is not really a record of success but it is a record of 
less than success. We haven't even gotten around to doing the routine 
business of the Congress. This is the first time in decades we have 
failed to pass the Elementary and Secondary Education Reauthorization 
Act. It is the first time we didn't do it in a bipartisan way, 
listening to the voices of all of our colleagues, trying to accommodate 
them, all to try to come up with a product that would represent further 
progress in reforming education.
  Reforming education or providing incentives for States to do the bulk 
of that work because that is their responsibility more than ours--we 
haven't done that. As a result, we haven't made progress on improving 
teacher training, we haven't made progress for modernizing libraries, 
we haven't made progress with parental involvement, we haven't reduced 
class size or repaired crumbling schools or done all we can to keep our 
schools safe from violence.
  Frankly, one of the reasons we did not have the will to bring this 
legislation to the floor was a paranoia on the side of the Republicans 
that we would actually vote on sensible gun controls that would help 
improve the safety not only of our schools but of our streets and our 
communities all across this country. And as a result, we sacrificed on 
the altar of fidelity to the NRA a chance to pass elementary and 
secondary education legislation in this Congress.
  We haven't passed a hate crimes bill that would say stoutly, 
vigorously and courageously that we just don't talk about tolerance in 
the United States, we actually have laws to require the same.
  We would actually have a Federal statute that would assist 
communities when they find themselves convulsed by the kind of vicious 
hate crimes that we saw in Wyoming with Matthew Shepard, that we saw in 
Texas with Mr. Byrd, so that there would be a Federal response, not 
just an alternative way to prosecute, but resources to prosecute, with 
help and assistance. By doing this, we would send a very strong signal 
that this is not an issue of East or West or North or South, but this 
is at the core of our American values. This is a country that was built 
on the idea that men and women from very different backgrounds, very 
different cultures, very different traditions, could come together and 
form a perfect union. We have failed in that.
  We could go on, too, talking about some of the commonsense gun safety 
and juvenile justice legislation that has languished and will shortly 
expire. We have not closed the gun show loophole. That was the loophole 
that was used by the killers at Columbine High School to obtain some of 
the weapons they used on that attack. How soon we have forgotten.
  We have not passed legislation to require child safety locks on 
weapons. Yet we know that could save the lives of some children, and 
even one child's life saved because he or she would not get access to a 
firearm in the home is something for which we would be very proud. We 
have not done it, despite Senator Lautenberg's great efforts and the 
efforts of many of my colleagues.
  Although we have engaged in debates about policy, we are looking 
ahead at the consequences of this election where several things will be 
extraordinarily important--obviously. First, this election will help 
cast the composition of our Supreme Court. That is not just a 
jurisprudential matter, that is not just something that should be of 
interest to law review editors and students at law schools. It will 
shape whether or not this Federal Government can still play a vital, 
active role in the lives of its citizens, because the trend of the 
Court, the trend of the Republican appointees of the Court, has been to 
circumscribe, dramatically, the power of the Federal Government to act 
in lieu of the States.
  When people talk about the Federal role in education, that role might 
diminish dramatically, regardless of what we do in this body, if we 
have Justices who believe there is no real congressional/Federal role 
in education. That is a part of the consequences of this election.
  Governor Bush has proposed a tax policy that is hard to understand, 
except for the fact that it seems to leave very little for the other 
issues with which we must deal: making sure we transform our Armed 
Forces, making sure we can protect the solvency of the Social Security 
trust fund, making sure we can keep our Medicare obligations to 
seniors, making sure we can continue to invest in this country, in its 
infrastructure--both its physical infrastructure and its human and 
social infrastructure--through education and training.
  We are at a point now where, at the end of this Congress, we are 
facing the turn point, the turning back from the kind of fiscal 
discipline that has produced the record prosperity over the last 
several years, to a situation where we fall back again into deficits, 
into the high interest rates, into the economic stagnation of the late 
1980s and early 1990s. We could miss this opportunity to invest in our 
people, to strengthen our country, its physical strength and its 
economic vitality and its military prowess, and also its spirit as a 
nation of neighbors helping others to make their lives better and to 
make their communities better.
  We have reached this impasse. I hope we can break through this 
impasse. I hope we can, through deliberations over the next few days, 
reach a Medicare refinement proposal that will truly help providers and 
not just HMOs. I hope we can see a Commerce-State-Justice bill that 
will come back with Latino fairness legislation, that will recognize 
that these are good people, struggling to be Americans through work and 
family and all of the attributes that we see as part of America--not a 
legal status but a condition of the heart and a habit of the heart.

  I hope we can do that. But that will take bipartisan effort. It will 
take all

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our efforts. I hope over the next several days we do something we have 
not done over the last many months--work together for the benefit of 
the American people.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. L. Chafee). The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. GRAHAM. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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