[Congressional Record Volume 147, Number 81 (Tuesday, June 12, 2001)]
[Senate]
[Pages S6137-S6138]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN (for himself, Mr. Craig, Mr. Bingaman, Mrs.

[[Page S6138]]

        Murray, Mr. Feingold, Mr. Kohl, and Mr. Leahy):
  S. 1020. A bill to amend title XVIII of the Social Security Act to 
improve the provision of items and services provided to Medicare 
beneficiaries residing in rural areas; to the Committee on Finance.
  Mr. HARKIN. Mr. President, I am pleased to be joined today by my 
colleagues, Senator Craig, Senator Bingaman, Senator Murray, Senator 
Feingold, and Senator Kohl to introduce the Medicare Fairness in 
Reimbursement Act of 2001. This legislation addresses the terrible 
unfairness that exists today in Medicare payment policy.
  According to the latest Medicare figures, Medicare payments per 
beneficiary by State of residence ranged from slightly less than $3,000 
to well in excess of $7,000. For example, in Iowa, the average Medicare 
payment was $2,985, nearly 45 percent less than the national average of 
$5,364. In Idaho, the average payment is $3,592, only 66 percent of the 
national average.
  This payment inequity is unfair to seniors in Iowa and Idaho, and it 
is unfair to rural beneficiaries everywhere. The citizens of my home 
State pay the same Medicare payroll taxes required of every American 
taxpayer. Yet they get dramatically less in return.
  Ironically, rural citizens are not penalized by the Medicare program 
because they practice inefficient, high cost medicine. The opposite is 
true. The low payment rates received in rural areas are in large part a 
result of their historic conservative practice of health care. In the 
early 1980's rural States' lower-than-average cost were used to justify 
lower payment rate, and Medicare's payment policies since that time 
have only widened the gap between low- and high-cost States.
  Two years ago I wrote to the Health Care Financing Administration 
(HCFA) and I asked them a simple question. I asked their actuaries to 
estimate for me the impact on Medicare's Trust Funds, which at that 
time were scheduled to go bankrupt in 2015, if average Medicare 
payments to all states were the same as Iowa's.
  I've always thought Iowa's reimbursement level was low. But HCFA's 
answer surprised even me. The actuaries found that if all States were 
reimbursed at the same rate as Iowa, Medicare would be solvent for at 
least 75 years, 60 years beyond their projections.
  I'm not suggesting that all States should be brought down to Iowa's 
level. But there is no question that the long-term solvency of the 
Medicare program is of serious national concern. And as Congress 
considers ways to strengthen and modernize the Medicare program, the 
issue of unfair payment rates needs to be on the table.
  The bill we are introducing today, the Medicare Fairness in 
Reimbursement Act of 2001 sends a clear signal. These historic wrongs 
must be righted. Before any Medicare reform bill passes Congress, I 
intend to make sure that rural beneficiaries are guaranteed access to 
the same quality health care services of their urban counterparts.
  Our legislation does the following: requires HCFA to improve the 
fairness of payments under the original Medicare fee-for-services 
system by adjusting payments for items and services so that no State is 
greater than 105 percent above the national average, and no State is 
below 95 percent of the national average. An estimated 31 States would 
benefit under these adjustments, based on the Health Care Financing 
Administration's projections of the 1999 payment data.

  Requires HCFA to improve the fairness of payments to rural 
practitioners who bill under Medicare Part B by narrowing the range of 
the Geographic Payment Classification Indices, GPCIs. Currently, there 
are dramatic geographic differences in payments for physician services 
with little scientific data to support the disparity. Providers in 
rural areas are under-compensated. This act would restrict the range 
for each GPCI so that no GPCI is greater than 1.05 or less than .95 of 
the standard index of 1.00. Practitioners who work in rural areas will 
benefit from this change in geographic adjusters.
  It ensures that beneficiaries are held harmless in both payments and 
services, ensures budget neutrality, and automatically results in 
adjustment of Medicare managed care payments to reflect increased 
equity between rural and urban areas.
  This legislation simply ensures basic fairness in our Medicare 
payment policy. I urge my Senate colleagues, no matter what State 
you're from, to consider our bill and join us in supporting this 
commonsense Medicare reform.
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