[Congressional Record Volume 146, Number 148 (Tuesday, December 5, 2000)]
[Extensions of Remarks]
[Pages E2123-E2124]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            H.R. 5621 MEDICAID DISPROPORTIONATE SHARE (DSH)

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                           HON. BOBBY L. RUSH

                              of illinois

                    in the house of representatives

                       Tuesday, December 5, 2000

  Mr. RUSH. Mr. Speaker, on November 1, 2000 I introduced H.R. 5621, 
the Medicaid Disproportionate Share Hospital (DSH) Fairness Act of 
2000. This legislation is identical to a bill which was introduced last 
month by the senior Senator from Illinois, with the full support of the 
Administration.
  In 1997, Congress enacted the Balanced Budget Act (BBA) of 1997 (P.L. 
105-33). The stated intent of the legislation was to slow the rate of 
growth in the Medicare program Unfortunately, the reductions enacted 
through the BBA went much deeper than expected. As a result, the net 
and cumulative effects of the Act have severely reduced Medicare 
reimbursements to hospitals and health service providers.
  I opposed the Balanced Budget Act when it was debated by the House of 
Representatives in 1997. I believed that it was a bad policy then, and 
believe that it is a bad policy now.
  The BBA reductions have been particularly severe on hospitals in 
Illinois. In my district, which encompasses the south and west sides of 
the city of Chicago, there are eleven major hospital facilities which 
have been devastated by BBA reductions. Multiply the losses across the 
state, and the impact on services is staggering. In the First Session 
of the current Congress, I introduced the Health Care Preservation and 
Accessibility Act of 1999, H.R. 3145,

[[Page E2124]]

to provide relief to hospitals, community health centers, and skilled 
nursing facilities harmed by the excessive reductions of the Balanced 
Budget Act. Although my legislation was not enacted, the intent of many 
of its provisions were included in the Medicare Balanced Budget 
Refinement Act of 1999 (P.L. 106-113). That legislation helped relieve 
some of the financial strain placed on hospitals and health providers. 
However, while hospitals and health care providers still struggle under 
the economic pressures imposed the BBA reductions, a new series of 
proposed reductions threaten financial solvency.
  In May of this year, the Health Care Financing Administration (HCFA) 
issued a notice to state Medicaid directors advising of its intent to 
revise the Medicaid funding formula known as Intergovernmental 
Transfers (IGT). This proposed rule would slash an additional $375 
million a year in Medicaid funding for Illinois--a state in which the 
healthcare system is already devastated by the effects of the Balanced 
Budget Act--and further endanger critical health services for children, 
senior citizens and the poor.
  Both the state of Illinois and Cook County have diligently and 
constructively used the IGT funding to enhance the health care system, 
especially for low-income, uninsured and under insured Chicagoans, over 
the last 10 years. Although under the Health Care Financing 
Administration's Notice of Proposed Rulemaking, the IGT program changes 
would be phased-in over a 5 year period, the proposed change would 
severely cripple the State's ability to provide needed health care 
services to Illinois citizens.
  The legislation, which I have introduced with my colleague in the 
Senate, is designed to increase the Medicaid Disproportionate Share 
payments to all states and encourage states to use the DSH program as 
it was intended--to fund uncompensated health care. By increasing the 
Medicaid DSH payments, we are acknowledging the burden placed on 
hospitals that treat a large number of Medicaid and uninsured patients 
by the Balanced Budget Act and the proposed HCFA regulations.
  Enactment of H.R. 5621 would allow Illinois, and all of the states, 
to continue to make inroads towards ensuring that an extensive safety 
net of hospitals and health care providers exist to provide care to the 
most vulnerable groups of society.
  I urge my colleagues to join me in support H.R. 5621, and if this 
Congress fails to act on this legislation, I hope my colleagues will 
join me in making it a priority in the 107th Congress.

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