[Congressional Record Volume 147, Number 53 (Wednesday, April 25, 2001)]
[Senate]
[Pages S3923-S3927]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. GRAHAM (for himself and Mr. Nelson of Florida):
  S. 771. A bill to permanently prohibit the conduct of offshore 
drilling on the outer Continental Shelf off the State of Florida, and 
for other purposes; to the Committee on Energy and Natural Resources.
  Mr. GRAHAM. Mr. President, I rise today with my colleague, Senator 
Bill Nelson, to introduce legislation that will protect the coast of 
Florida in the future from the damages of offshore drilling.
  In past Congresses, I have introduced similar legislation that sought 
to codify the annual moratorium on leasing in the Eastern Gulf of 
Mexico and ensure that state's receive all environmental documentation 
prior to making a decision on whether to allow drilling off of their 
shores.
  Today, I am introducing legislation that takes these steps, plus 
several others. The Outer Continental Shelf Protection Act will protect 
Florida's fragile coastline from outer continental shelf leasing and 
drilling in three important ways.
  First, we transform the annual moratorium on leasing and preleasing 
activity off the coast of Florida into a permanent ban covering 
planning areas in the Eastern Gulf of Mexico, the Straits of Florida, 
and the Florida section of the South Atlantic.
  Second, the Outer Continental Shelf Protection Act corrects an 
egregious conflict in regulatory provisions where an effected state is 
required to make a consistency determination for proposed oil and gas 
production or development under the Coastal Zone Management Act prior 
to receiving the Environmental Impact Statement, EIS, for them from the 
Mineral Management Service.
  Our bill requires that the EIS is provided to affected states before 
they make a consistency determination, and it requires that every oil 
and gas development plan have an EIS completed prior to development.
  Third, our bill buys back leases in the Eastern Gulf of Mexico which 
are an immediate threat to Florida's natural heritage and economic 
engine.
  What does this bill mean for Florida? The elimination of preleasing 
activity and lease sales off the coast of Florida protects our economic 
and environmental future.
  For years, I have taken my children and grandchildren to places like 
Grayton Beach so that they can appreciate the natural treasures and 
local cultures that are part of both their own heritage and that of the 
Florida Panhandle.
  We have a solemn obligation to preserve these important aspects of 
our state's history for all of our children and grandchildren. Much of 
our identity as Floridians is tied to the thousands of miles of 
pristine coastline that surround most of our state.
  The Florida coastline will not be safe if offshore oil and gas 
resources are developed. For example, a 1997 Environmental Protection 
Agency, EPA, study indicated that even in the absence of oil leakage, a 
typical oil rig can discharge between 6,500 and 13,000 barrels of waste 
per year. The same study also warned of further harmful impact on 
marine mammal populations, fish populations, and air quality.
  In addition to leakages and waste discharges, physical disturbances 
caused by anchoring, pipeline placement, rig construction, and the 
resuspension of bottom sediments can also be destructive. Given these 
conclusions, Floridians are unwilling to risk the environmental havoc 
that oil or natural gas drilling could wreak along the sensitive 
Panhandle coastline.
  Because the natural beauty and diverse habitats of the Gulf of 
Mexico, the Florida Keys, and Florida's Atlantic Coast attract visitors 
from all over the world and support a variety of commercial activities, 
an oil or natural gas accident in these areas could have a crippling 
effect on the economy. In 1996, the cities of Panama City, Pensacola, 
and Fort Walton Beach reported $1.5 billion in sales to tourists. 
Florida's fishing industry benefits from the fact that nearly 90 
percent of reef fish caught in the Gulf of Mexico come from the West 
Florida continental shelf.
  For the last several years, I have been working with my colleagues, 
former Senator Connie Mack and now Senator Bill Nelson, Congressman Joe 
Scarborough, and others to head off the threat of oil and natural gas 
drilling. In June of 1997, we introduced legislation to cancel six 
natural gas leases seventeen miles off of the Pensacola coast and 
compensate Mobil Oil Corporation for its investment. Five days after 
the introduction of that legislation and two months before it was 
scheduled to begin exploratory drilling off Florida's Panhandle, Mobil 
ended its operation and returned its leases to the federal government.
  While that action meant that Panhandle residents faced one less 
economic and environmental catastrophe-in-the-making, it did not 
completely eliminate the threats posed by oil and natural gas drilling 
off Florida's Gulf Coast. Florida's Congressional representatives fight 
hard each year to extend the federal moratorium on new oil and natural 
gas leases in the Gulf of Mexico. But that solution is temporary.
  Today we are introducing the Outer Continental Shelf Protection Act 
to make permanent our efforts to protect Florida's coastlines. I look 
forward to working with my colleagues on the Energy and Natural 
Resources Committee to move this legislation forward and protect the 
coast of future generations of Floridians and visitors to Florida.
                                 ______
                                 
      By Ms. COLLINS:
  S. 772. A bill to permit the reimbursement of the expenses incurred 
by an affected State and units of local government for security at an 
additional non-governmental property to be secured by the Secret 
Service for protection of the President for a period of not to exceed 
60 days each fiscal year; to the Committee on the Judiciary.
  Ms. COLLINS. Mr. President, today I introduce a bill to provide fair 
reimbursement to state and local law enforcement organizations for 
additional costs incurred by them in providing frequent assistance to 
the Secret Service to protect the President of the United States.
  Of course, the Secret Service has the principal responsibility for 
protecting our Presidents. Without the assistance of state and local 
law enforcement organizations, however, providing that protection would 
be more costly and more difficult, if not impossible. For the most 
part, state and local law enforcers provide this assistance with no 
need for or expectation of reimbursement from the Federal government. 
In some cases, however, reimbursement is appropriate. It is 
appropriate, for example, when state and local law enforcement 
organizations are required to incur substantial expenses on a frequent 
basis in localities that are small and thus does not have adequate 
financial bases to provide the necessary services without 
reimbursement.
  This is not a new idea. Dating back to at least the Administration of 
President Jimmy Carter, the Federal government has provided 
reimbursement to local and sometimes state organizations where sitting 
Presidents maintain a principal residence. In the early 1990s, 
reimbursement was provided for

[[Page S3924]]

services provided for then-President Bush's visits to Kennebunkport, 
Maine. Reimbursement is similarly available now to Crawford, Texas. The 
bill I am introducing will extend this authority to localities and 
states other than the place of principal residence when the sitting 
President so designates.
  I envision that it will help, for example, the Kennebunkport Police 
Department and associated law enforcement organizations in my home 
state. I expect that the allure of summer in Maine will draw President 
George W. Bush to the Bush family residence in Kennebunkport for 
several visits in the coming months. My bill will help ensure that the 
town, with a population of only 3,720, will not have to shoulder alone 
the substantial financial burden associated with these visits. In 
addition, however, I anticipate that in the future other localities 
will benefit, for this bill has been carefully drafted to provide 
reimbursement to localities and states designated by future Presidents.
  This bill will not result in an unlimited ``windfall'' to local and 
state law enforcement organizations. It requires that the organizations 
requesting reimbursement first incur the expenses and therefore will 
likely discourage excessive expenditures. It also limits the number of 
days for which reimbursements may be sought to not more than 60 days 
per fiscal year. In addition, it provides reimbursement only for 
services provided in conjunction with visits to small localities with a 
population of no more than 7,000 residences. Finally, the total amount 
of reimbursement is limited to not more than $100,000 per fiscal year.
  I encourage my colleagues to support this modest, yet important and 
equitable provision of support to local and state law enforcement 
organizations.
                                 ______
                                 
      By Mr. TORRICELLI (for himself and Mr. Corzine):
  S. 773. A bill to provide for disclosure of fire safety standards and 
measures with respect to campus buildings, and for other purposes; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. TORRICELLI. Mr. President, today I rise to introduce the Campus 
Fire Safety Right-to-Know Act so that we can move forward in protecting 
our children at our colleges and universities. It is an unfortunate 
reality that it often takes great tragedies to highlight 
vulnerabilities in our laws.
  On January 19, 2000, several New Jersey families experienced an 
unimaginable tragedy. A fire in a freshman college dormitory killed 3 
students and injured 62 others. Investigations into the fire revealed 
that the dorm was not equipped with a sprinkler system, which could 
have saved lives. In addition, during that fatal evening, many students 
delayed leaving the building because they assumed it was a false alarm, 
an all too common occurrence.
  On March 19, 2000, a fire broke out at a fraternity house at a 
Pennsylvania university, killing three students. This was not the first 
fire at that fraternity house, in 1994, five students were killed in a 
fraternity house fire.
  On June 8, 2000, a student was killed in an early morning fraternity 
house fire at an Illinois University. Local authorities said the 
building was not protected with an automatic fire sprinkler system.
  And, as recently as April 1, 2001, a fire in a residence hall at a 
New Hampshire college forced 100 students out of the building and 
seriously damaged at least two apartments. This was the second fire to 
occur at a residence hall at that college within two months.
  This is a national crisis that endangers our children's lives.
  Although the average number of college residence fires dropped 10 
percent in the last decade, an average of 66 students still are injured 
in campus fires in dorms, and fraternity and sorority houses. In the 11 
deadly campus fires between 1900 and 1997, an average of two people 
died in each.
  The National Fire Protection Association reports that 72 percent of 
dorms, and fraternity and sorority houses that suffer fires are not 
equipped with life saving sprinkler systems, even though sprinklers are 
proven to cut by up to two-thirds the risks of death and property 
damage in fires.
  I have a proposal that will help make university housing safer. The 
Campus Fire Safety Right to Know Act would highlight the issue of 
campus fire safety by requiring colleges and universities to provide 
annual reports that explains fire policies, frequency of false alarms, 
and whether dorms are equipped with sprinkler systems.
  These reports would be straight-forward and based on the types of 
reporting that many campuses already do.
  Colleges and universities could use these reports to highlight their 
successes and progress with campus fire safety. They would be, in part, 
a marketing tool to attract students and families.
  The reports would also bring greater awareness about campus fire 
safety to schools that have not made progress, and encourage them to 
take action.
  And, the reports would be a resource for students and their families, 
so that they know whether their dorms are fire safe and can work with 
their schools to improve fire safety.
  My bill is supported by universities in my State, Seton Hall, Rutgers 
and Princeton, and is also endorsed by the National Fire Protection 
Association, the National Safety Council, and College Parents of 
America.
  We need to pass this measure so that we can ensure that the tragedies 
in New Jersey, Illinois, and Pennsylvania are the last of their kinds.
                                 ______
                                 
      By Mr. BAYH (for himself and Mr. Lugar):
  S. 774. A bill to designate the Federal building and United States 
courthouse located at 121 West Spring Street in New Albany, Indiana, as 
the ``Lee H. Hamilton Federal Building and United States Courthouse''; 
to the Committee on Environment and Public Works.
  Mr. BAYH. Mr. President, it is with great pride that I rise today to 
pay tribute to a good friend and a great man, former Congressman Lee 
Hamilton. I am honored to introduce legislation designating the Federal 
Building and United States Courthouse located at 121 W. Spring Street 
in New Albany, Indiana, as the ``Lee H. Hamilton Federal Building and 
U.S. Courthouse.''
  Lee Hamilton was born in Daytona Beach, FL, on April 20, 1931, and 
raised in Evansville, IN. He attended Evansville Central High school, 
where he excelled both in the classroom and on the basketball court. As 
a senior, he led his team to the final game of the Indiana state 
basketball tournament, and received the prestigious Tresler award for 
scholarship and athletics.
  After graduation, Congressman Hamilton attended Depauw University, 
and earned his bachelor's degree in 1952. He went on to study for one 
year in post-war Germany at Goethe University, before enrolling in law 
school at Indiana University, where he received his Doctor of 
Jurisprudence Degree in 1956.
  In 1964, Lee Hamilton was first elected to the U.S. House of 
Representatives, where he went on to serve with distinction for 34 
years. During his long tenure in office, he established himself as a 
leader in International Affairs, serving as the chairman of the House 
Foreign Relations committee, Intelligence Committee, and Iran-Contra 
committee. Mr. Hamilton was widely respected for his powerful intellect 
and impressive knowledge of foreign affairs, and remains unquestionably 
one of our nation's foremost experts on foreign policy.
  In addition to his record on foreign affairs, Mr. Hamilton also 
played an important role in reforming the institution of Congress 
itself. He cochaired the Joint Committee on the Organization of 
Congress where he worked to reform the institution by instituting the 
gift-ban, tightening lobbying restrictions, and applying the laws of 
the workplace to Congress.
  Even with all his success in Washington, however, Mr. Hamilton never 
forgot his Hoosier roots. He always remained down-to-earth and 
accessible to his Southern Indiana constituents. Over the years, he was 
presented with a number of opportunities to ascend to other offices, 
including the U.S. Senate, Secretary of State, and the Vice-Presidency 
of the United States. He chose instead to retain his House seat and 
fulfill his commitments to the people of Southern Indiana.
  Today, Congressman Hamilton remains active in foreign policy and 
congressional reform. He currently heads the Woodrow Wilson 
International Center for Scholars in Washington, DC, and serves as the 
director of the Center on Congress at Indiana University.

[[Page S3925]]

  Congressman Hamilton has received numerous public service awards 
including the Paul H. Nitze Award for Distinguished Authority on 
National Security Affairs, the Edmund S. Muskie Distinguished Public 
Service Award, the Phillip C. Habib Award for Distinguished Public 
Service, the Indiana Humanities Council Lifetime Achievement Award and 
the U.S. Association of Former Members of Congress' Statesmanship 
Award. It is only fitting that we recognize Congressman Hamilton's many 
years of service to the people of Southern Indiana by naming the New 
Albany Federal Building and U.S. Courthouse in his honor.
  It is my hope that the Federal Building and U.S. Courthouse located 
at 121 W. Spring Street in New Albany will soon bear the name of my 
friend and fellow Hoosier, Congressman Lee Hamilton.
                                 ______
                                 
      By Mrs. LINCOLN (for herself and Mr. Reid):
  S. 775. A bill to amend title XVIII of the Social Security Act to 
permit expansion of medical residency training programs in geriatric 
medicine and to provide for reimbursement of care coordination and 
assessment services provided under the Medicare Program; to the 
Committee on Finance.
  Mrs. LINCOLN. Madam President, I rise today to introduce the 
Geriatric Care Act of 2001, a bill to increase the number of 
geriatricians in our country through training incentives and Medicare 
reimbursement for geriatric care.
  I am proud to be joined in this effort today by Senator Harry Reid of 
Nevada. Senator Reid has been a pioneer in seeking real commonsense 
solutions to the health care challenges facing our Nation's seniors. In 
fact, he has graciously allowed me to include in this bill components 
of a bill he introduced during the last Congress. Moreover, he has been 
an invaluable resource and ally to me as I have grappled with the 
solutions to these challenges we are seeking.
  Our country teeters on the brink of revolutionary demographic change 
as baby boomers begin to retire and Medicare begins to care for them. 
As a member of the Finance Committee and the Special Committee on 
Aging, I have a special interest in preparing health care providers and 
Medicare for the inevitable aging of America. By improving access to 
geriatric care, the Geriatric Care Act of 2001 takes an important first 
step in modernizing Medicare for the 21st century.
  The 76 million baby boomers are aging and in 30 years, 70 million 
Americans will be 65 years and older. They will soon represent one-
fifth of the U.S. population, the largest proportion of older persons 
in our Nation's history. Our Nation's health care system will face an 
unprecedented strain as our population grows older.
  Our Nation is simply ill-prepared for what lies ahead. Demand for 
quality care will increase, and we will need physicians who understand 
the complex health problems that aging inevitably brings. As seniors 
live longer, they face much greater risk of disease and disability. 
Conditions such as heart disease, cancer, stroke, diabetes, and 
Alzheimer's disease occur more frequently as people age. The complex 
problems associated with aging require a supply of physicians with 
special training in geriatrics.
  Geriatricians are physicians who are first board certified in family 
practice or internal medicine and then complete additional training in 
geriatrics. Geriatric medicine provides the most comprehensive health 
care for our most vulnerable seniors. Geriatrics promotes wellness and 
preventive care, helping to improve patients' overall quality of life 
by allowing them greater independence and preventing unnecessary and 
costly trips to the hospital or institutions.
  Geriatric physicians also have a heightened awareness of the effects 
of prescription drugs. Given our seniors' growing dependence on 
prescriptions, it is increasingly important that physicians know how, 
when, and in what dosage to prescribe medicines for seniors. 
Frequently, our older patients respond to medications in very different 
ways from younger patients. In fact, 35 percent of Americans 65 years 
and older experience adverse drug reactions each year.
  According to the National Center for Health Statistics, medication 
problems may be involved in as many as 17 percent of all 
hospitalizations of seniors each year. Care management provided by a 
geriatrician will not only provide better health care for our seniors, 
but it will also save costs to Medicare in the long term by eliminating 
the pressures on more costly medical care through hospitals and nursing 
homes. Quite clearly, geriatrics is a vital thread in the fabric of our 
health care system, especially in light of our looming demographic 
changes. Yet today there are fewer than 9,000 certified geriatricians 
in the United States. Of the approximately 98,000 medical residency and 
fellowship positions supported by Medicare in 1998, only 324 were in 
geriatric medicine and geriatric psychiatry. Only three medical schools 
in the country--the University of Arkansas for Medical Sciences in 
Little Rock being one of them--have a department of geriatrics. This is 
remarkable when we consider that of the 125 medical schools in our 
country, only 3 have areas of residency in geriatrics.

  As if that were not alarming enough, the number of geriatricians is 
expected to decline dramatically in the next several years. In fact, 
most of these doctors will retire just as the baby boomer generation 
becomes eligible for Medicare. We must reverse this trend and provide 
incentives to increase the number of geriatricians in our country.
  Unfortunately, there are two barriers preventing physicians from 
entering geriatrics: insufficient Medicare reimbursements for the 
provisions of geriatric care, and inadequate training dollars and 
positions for geriatricians. Many practicing geriatricians find it 
increasingly difficult to focus their practice exclusively on older 
patients because of insufficient Medicare reimbursement. Unlike most 
other medical specialties, geriatricians depend most entirely on 
Medicare revenues.
  A recent MedPAC report identified low Medicare reimbursement levels 
as a major stumbling block to recruiting new geriatricians. Currently 
the reimbursement rate for geriatricians is the same as it is for 
regular physicians, but the services geriatricians provide are 
fundamentally different. Physicians who assess younger patients simply 
don't have to invest the same time that geriatricians must invest 
assessing the complex needs of elderly patients. Moreover, chronic 
illness and multiple medications make medical decisionmaking more 
complex and time consuming. Additionally, planning for health care 
needs becomes more complicated as geriatricians seek to include both 
patients and caregivers in the process.
  We must modernize the Medicare fee schedule to acknowledge the 
importance of geriatric assessment and care coordination in providing 
health care for our seniors. Geriatric practices cannot flourish and 
these trends will not improve until we adjust the system to reflect the 
realities of senior health care.
  The Geriatric Care Act I am introducing today addresses these 
shortfalls. This bill provides Medicare coverage for the twin 
foundations of geriatric practice: geriatric assessment and care 
coordination. The bill authorizes Medicare to cover these essential 
services for seniors, thereby allowing geriatricians to manage 
medications effectively, to work with other health care providers as a 
team, and to provide necessary support for caregivers.
  The Geriatric Care Act also will remove the disincentive caused by 
the graduate medical education cap established by the 1997 Balanced 
Budget Act. As a result of this cap, many hospitals have eliminated or 
reduced their geriatric training programs. The Geriatric Care Act 
corrects this problem by allowing additional geriatric training slots 
in hospitals. By allowing hospitals to exceed the cap placed on their 
training slots, this bill will help increase the number of residents in 
geriatric training programs.
  My home State of Arkansas ranks sixth in the Nation in percentage of 
population 65 and older. In a decade, we will rank third. In many ways, 
our population in Arkansas is a snapshot of what the rest of the United 
States will look like in the near future.

  All of us today could share stories about the challenges faced by our 
parents, our grandparents, our families, our friends, our loved ones as 
they contend with the passing years. These are

[[Page S3926]]

the people who have raised us, who have loved us, who have worked for 
us, and who have fought for us. Now it is our turn to work for them, to 
fight for them, and this is where we must start.
  I ask my colleagues to join me in support of this legislation to 
modernize Medicare, to support crucial geriatric services for our 
Nation's growing population of seniors. I also urge my colleagues to 
recognize that this is only the beginning of what I hope will be a 
grand overhaul of the way we think about and deliver care to our 
Nation's elderly. There are many more things to discuss and to 
address--adult daycare, long-term care insurance, just to name a few. 
But it is essential that we begin soon, that we begin now in preparing 
those individuals we will need 10 years from now in order to be able to 
care for our aging population in this Nation.
  Madam President, I also want to submit three letters of support for 
this bill, along with a list of organizations that support this 
important legislation, and encourage all of my colleagues to recognize 
the unbelievable responsibility we have today to prepare for the 
seniors of tomorrow. I ask unanimous consent that the items I mentioned 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                              The National Council


                                                 on the Aging,

                                   Washington, DC, April 24, 2001.
     Hon. Blanche L. Lincoln,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Lincoln: On behalf of the National Council on 
     the Aging (NCOA)--the nation's first organization formed to 
     represent America's seniors and those who care for them--I 
     write to express our organization's support for the Geriatric 
     Care Act of 2001.
       A major shortcoming of the Medicare program is the grossly 
     inadequate, fragmented manner in which chronic care needs are 
     addressed. Some of the major problems include: specific 
     geriatric and chronic care needs are not clearly identified; 
     services are poorly coordinated, if at all; medications are 
     not managed properly, resulting in avoidable adverse 
     reactions; family caregivers are excluded from the care 
     planning process; transitions across settings are disjointed; 
     and follow-up care and access to consultation to promote 
     continuity are often unavailable. All of these serious 
     problems cry out for Medicare coverage of care coordination. 
     NCOA strongly supports your efforts to address these critical 
     shortcomings in the Medicare program.
       NCOA also supports efforts to increase the number of health 
     care providers who have geriatric training. Given the aging 
     of our population and the coming retirement of the baby 
     boomers, it is important to have physicians trained to care 
     for older patients who may be frail and suffer from multiple, 
     chronic conditions. We applaud your efforts to meet this 
     challenge by introducing legislation to allow for growth in 
     geriatric residency programs above the hospital-specific cap 
     established by the Balanced Budget Act of 1997.
       We applaud your leadership on behalf of our nation's most 
     frail, vulnerable citizens and stand ready to assist you in 
     working to enact the Geriatric Care Act of 2001 into law this 
     year.
           Sincerely,
                                                    Howard Bedlin,
     Vice President, Public Policy and Advocacy.
                                  ____

                                     American Association of Homes


                                   and Services for the Aging,

                                   Washington, DC, April 18, 2001.
     Hon. Blanche L. Lincoln,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Lincoln: I understand that you are introducing 
     legislation to provide incentives for the training of 
     geriatricians and to require Medicare reimbursement for 
     geriatric assessments and care management for beneficiaries 
     with complex care needs. The American Association of Homes 
     and Services for the Aging (AAHSA) strongly supports your 
     proposal, which would help to alleviate the serious shortage 
     of physicians trained to meet the special needs of older 
     people.
       AAHSA is a national non-profit organization representing 
     more than 5,600 not-for-profit nursing homes, continuing care 
     retirement communities, assisted living and senior housing 
     facilities, and community service organizations. More than 
     half of AAHSA's members are religiously sponsored and all 
     have a mission to provide quality care to those in need. 
     Every day AAHSA members serve over one million older persons 
     across the country.
       Residents of long-term care facilities rely on physician 
     services more than the general population does. The severity 
     of older people's medical conditions compounded by multiple 
     co-morbidities demand more time per visit than younger or 
     healthier people need. Many of these seniors would benefit 
     from the services of a geriatrician, who is trained in the 
     special medical needs of older people. Unfortunately, few 
     physicians elect to specialize in this field. In addition, 
     the Medicare Part B fee schedule does not recognize the 
     specialty services of geriatricians and the time and effort 
     they spend providing medical care of this older, more 
     vulnerable population. Nursing facilities have a difficult 
     time finding physicians, let alone geriatric specialists, to 
     serve residents. Geriatric clinic practices find it difficult 
     to provide the level of service this population requires and 
     deserves for the payment that they receive through the 
     Medicare fee schedule.
       Your legislation would do much to address these issues, and 
     AAHSA is anxious to work with you toward its passage. Please 
     feel free to contact Will Bruno, our Director of 
     Congressional Affairs.
           Sincerely,
                                   William L. Minnix, Jr., D. Min.
     President and CEO.
                                  ____

                                              American Association


                                     for Geriatric Psychiatry,

                                     Bethesda, MD, April 24, 2001.
     Hon. Blanche L. Lincoln,
     U.S. Senate,
     Washington, DC.
       Dear Senator Lincoln: On behalf of the American Association 
     for Geriatric Psychiatry (AAGP), I would like to take this 
     opportunity to thank you for your introduction of the 
     ``Geriatric Care Act of 2001.''
       Although geriatric psychiatry is a relatively small medical 
     specialty, it is one for which demand is growing rapidly as 
     the population ages and the ``baby boom'' generation nears 
     retirement. Arbitrary, budget-driven limits on Medicare 
     payment for graduate medical education, such as caps on the 
     aggregate number of residents and interns at a teaching 
     hospital, could discourage the expansion of training programs 
     in geriatric psychiatry and other fields that are extremely 
     relevant to the Medicare population. Your bill would help to 
     increase the number of physicians with the specialized 
     geriatric training that is needed to serve the growing number 
     of elderly persons in this country.
       In addition, we support the provision of your bill, which 
     would provide Medicare reimbursement for assessment and care 
     coordination. This will help to provide those Medicare 
     beneficiaries with severe physical and mental disorders with 
     the access to the appropriate and coordinated care that they 
     deserve.
       AAGP commends you for your commitment to ensuring that 
     America's senior citizens have adequate access to effective 
     health care, and we look forward to working with you on the 
     ``Geriatric Care Act of 2001.''
           Sincerely,
                                              Stephen Bartels, MD,
     President.
                                  ____


              Supporters of the Geriatric Care Act of 2001

       American Association for Geriatric Psychiatrists.
       Alzheimer's Association.
       Alliance for Aging Research.
       American Geriatrics Society.
       National Chronic Care Consortium.
       National Council on Aging.
       National Committee to Preserve Social Security and 
     Medicare.
       American Association for Homes and Services for the Aging.
       International Longevity Center.
                                 ______
                                 
      By Mr. BINGAMAN (for himself Mr. Enzi, Mr. Baucus, and Mr. 
        Wellstone):
  S. 776, A bill to amend title XIX of the Social Security Act to 
increase the floor treatment as an extremely low DSH State to 3 percent 
in fiscal year 2002; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce legislation 
with Senators Enzi, Baucus, and Wellstone, entitled the ``Medicaid 
Safety Net Hospital Improvement Act of 2001.'' This legislation is 
absolutely critical to the survival of many of our nation's safety net 
hospitals. It would provide additional funding to address their growing 
burden of providing uncompensated care to many of our nation's 42.6 
million uninsured residents, including 463,000 in New Mexico, through 
the Medicaid disproportionate share hospital, or DSH, program.
  In recognition of the burden bourne by hospitals that provide a large 
share of care to low-income patients, including Medicaid and the 
uninsured, the Congress established the Medicaid DSH program to give 
additional funding to support such ``disproportionate share'' 
hospitals. By providing financial relief to these hospitals, the 
Medicaid DSH program maintains hospital access for the poor. As the 
National Governors' Association has said, ``Medicaid DSH's funds are an 
important part of statewide systems of health care access for the 
uninsured.''
  Recent reports by the Institute of Medicine entitled ``America's 
Health Care Safety Net: Intact But Endangered,'' the National 
Association of Public Hospitals entitled ``The Dependence of Safety Net 
Hospitals'' and the Commonwealth Fund entitled ``A Shared 
Responsibility: Academic

[[Page S3927]]

Health Centers and the Provision of Care to the Poor and Uninsured'' 
have all highlighted the importance of the Medicaid DSH program to our 
health care safety net.
  As the Commonwealth Fund report, which was released just this last 
week, notes: ``The Medicaid DSH program has had a beneficial effect on 
patient access. The average payment rate for Medicaid inpatient 
services has increased dramatically. Medicaid payments for hospital 
services were only 76 percent of the cost of providing this care in 
1989. By 1994, Medicaid payments had increased to 94 percent of 
costs.''
  Unfortunately, as the Commonwealth Fund report adds, ``. . . there 
are large inequities in how these funds are distributed among states.'' 
In fact, for 15 states, including New Mexico, our federal DSH 
allotments are not allowed to exceed 1 percent of our state's Medicaid 
program costs. In comparison, the average state spends around 9 percent 
of its Medicaid funding on DSH. This disparity and lack of Medicaid DSH 
in ``extremely low-DSH states'' threatens the viability of our safety 
net providers. In New Mexico, these funds are critical but inadequate 
to hospitals all across our state, including University Hospital, 
Eastern New Mexico Regional Hospital, St. Vincent's Hospital, Espanola 
Hospital, and others.
  In an analysis of the Medicaid DSH program by the Urban Institute, 
the total amount of federal Medicaid DSH payments in six states was 
less than $1 per Medicaid and uninsured individual compared to five 
states than had DSH spending in excess of $500 per Medicaid and 
uninsured individual. That figure was just $14.91 per Medicaid and 
uninsured person in New Mexico. Compared to the average expenditure of 
$218.96 across the country, such disparities cannot be sustained.
  As a result, this bipartisan legislation increases the allowed 
federal Medicaid DSH allotment in the 15 ``extremely low-DSH states'' 
from 1 percent to 3 percent of Medicaid program costs, which remains 
far less, or just one-third, of the national average. I would add that 
the legislation does not impact the federal DSH allotments in other 
states but only seeks greater equity by raising the share of federal 
funds to ``extremely low-DSH states.''
  Once again, the Commonwealth Fund recommends such action. As the 
report finds, ``States with small DSH programs are not permitted to 
increase the relative size of their DSH programs .  .  . [C]urrent 
policy simply rewards the programs that acted quickly and more 
aggressively, without regard to a state's real need of such funds.'' 
Therefore, the report concludes, ``.  .  . greater equity in the use of 
federal funds should be established among states.''
  Again, this is achieved in our legislation by raising the limits for 
``extremely low-DSH states'' from 1 percent to 3 percent and not by 
redistributing or taking money away from other states.
  Failure to support these critical hospitals could have a devastating 
impact not only on the low-income and vulnerable populations who depend 
on them for care but also on other providers throughout the communities 
that rely on the safety net to care for patients whom they are unable 
or unwilling to serve.
  As the Institute of Medicine's report entitled ``America's Health 
Care Safety Net: Intact But Endangered'' states, ``Until the nation 
addresses the underlying problems that make the health care safety net 
system necessary, it is essential that national, state, and local 
policy makers protect and perhaps enhance the ability of these 
institutions and providers to carry out their missions.''
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 776

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicaid Safety Net 
     Improvement Act of 2001''.

     SEC. 2. INCREASE IN FLOOR FOR TREATMENT AS AN EXTREMELY LOW 
                   DSH STATE TO 3 PERCENT IN FISCAL YEAR 2002.

       (a) Increase in DSH Floor.--Section 1923(f)(5) of the 
     Social Security Act (42 U.S.C. 1396r-4(f)(5)) is amended--
       (1) by striking ``fiscal year 1999'' and inserting ``fiscal 
     year 2000'';
       (2) by striking ``August 31, 2000'' and inserting ``August 
     31, 2001'';
       (3) by striking ``1 percent'' each place it appears and 
     inserting ``3 percent''; and
       (4) by striking ``fiscal year 2001'' and inserting ``fiscal 
     year 2002''.
       (b) Effective Date.--The amendments made by subsection (a) 
     take effect on October 1, 2001, and apply to DSH allotments 
     under title XIX of the Social Security Act for fiscal year 
     2002 and each fiscal year thereafter.

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