[Congressional Record Volume 147, Number 148 (Wednesday, October 31, 2001)]
[Senate]
[Pages S11255-S11261]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS ACT, 2002
The ACTING PRESIDENT pro tempore. Under the previous order, the
Senate will now resume consideration of H.R. 3061, which the clerk will
report.
The assistant legislative clerk read as follows:
A bill (H.R. 3061) making appropriations for the
Departments of Labor, Health and Human Services, and
Education, and related agencies for the fiscal year ending
September 30, 2002, and for other purposes.
Pending:
Dorgan amendment No. 2024, to provide for mandatory
advanced electronic information for air cargo and passengers
entering the United States.
The ACTING PRESIDENT pro tempore. The Senator from Oregon.
Mr. WYDEN. Mr. President, first I salute Chairman Harkin and Senator
Specter for doing, in my view, a superb job with respect to this bill.
They have really set a special standard in terms of trying to work on
important issues in a bipartisan way. The chairman has left the
Chamber, but I want him to know how much I appreciate the good work he
and his staff are doing on this issue.
This morning I wish to talk about a health and a scientific issue of
extraordinary importance, and that is the vacancies that now exist at
the National Institutes of Health, the Food and Drug Administration,
and the National Cancer Institute. At a time when the public is focused
on public health because of bioterrorism, there are many reasons we
should be concerned about the work of these agencies and get these
positions filled.
I want to talk for a few moments about why I am so troubled by the
vacancies we are seeing at these agencies today. This has been, as all
of us know, a decade of remarkable scientific progress in the health
care field. It has really been something of a scientific and health
care renaissance with extraordinary amounts of information learned
about cells, about cancers, about what has come to be known as
biological detectors that are important as we deal with anthrax and
smallpox, and various other serious health concerns that Americans are
focused on today.
This scientific progress has been bipartisan. Democrats and
Republicans alike have joined to support funding for these very key
public health agencies, and we have worked together to ensure these
programs are properly funded.
I am convinced if those vacancies are not promptly filled, if we do
not soon get a head of the National Institutes of Health and the Food
and Drug Administration and the National Cancer Institute--if those
positions are not soon filled--it threatens to unravel some of the
important progress that has been made in this country over the last
decade.
Suffice it to say, if those positions are not filled, a message is
sent to the young scientists, to the young future leaders of this
country in the health care field, that the Federal Government does not
think this is particularly important. It takes years for
[[Page S11256]]
companies to get products developed and approved, and this is
especially true of the new products created by biotechnology. It is
important that we have scientific leadership throughout this process--
at the companies developing these products and at every level of these
two important agencies--NIH and the FDA. Without these scientists
throughout the process, in the companies, and at the Federal level,
biotech companies lose the incentive to invest in what might be the
next medical breakthrough.
I spoke to a group of students on a college campus just a few days
ago. A young woman came up to me and only half jokingly said: ``I am
ready to be the head of the National Institutes of Health. I have
focused on these issues. I have studied the questions for some time.
Why in the world can the Federal Government not get somebody to head
the National Institutes of Health right now?''
I have focused on health care and technology questions over the last
few years in Congress, and the business community is especially alarmed
that these vacancies are open. They want to work with leaders at the
Federal level to expedite the development of drugs, vaccines, and
therapies. One of these business leaders told me recently what concerns
him is that at a time when the public is focused on public health, on
the question of how to deal with anthrax and smallpox and bioterrorism,
there is not anybody home in the Federal Government.
I think it is extraordinarily important that the Congress work with
the President to get the officials we need sent up for review by the
key committees. The National Institutes of Health has now been without
a leader for almost two years.
The National Institutes of Health is now hemorrhaging the key people
they need to be effective advocates for the public health. Recently,
there was another vacancy at the National Institutes on Mental Health,
and there is a vacancy at the National Cancer Institute. There has been
a substantial period of time where we have not had anybody heading up
the Food and Drug Administration.
If we want to attract the stellar scientists whom I know Democrats
and Republicans both are so interested in supporting, we are not going
to be able to do it, and we are going to lose very talented people who
are in these agencies now.
We are already seeing a real brain drain in these essential agencies.
What we need to do, and the Congress is prepared to do, and what the
chairman and Senator Specter have made it very clear that they are
willing to do, is make sure these agencies are properly funded. What we
need now especially are scientifically sound programs to take on
anthrax, smallpox, and ensure we can allow our scientists to work on
what are known as biological detectors so we can move more rapidly and
readily to recognize the agents in the field. We can more precisely
describe the various strains of these bacteria and diseases. We will
have a chance to learn more about their genomic sequence and develop
creative strategies for public health that could pay very significant
benefits for this country. Certainly the potential benefits to this
country can be extraordinary.
I am very interested in working with the President on filling these
positions. Biomedicine research and science policy has long been
bipartisan. Senator Mack, for example, from Florida, did yeoman work
for years and years with Senator Specter, Senator Harkin, myself, and
others. That is the kind of progress, it seems to me, that is in danger
of being lost at this time.
The President of the United States certainly has lots on his agenda
right now. All of it is extremely important as we deal with the
question of fighting terrorism. I come to the Chamber today to say it
is of extraordinary importance these positions at the National
Institutes of Health and the Food and Drug Administration move to the
top of the President's agenda, move to the top of the congressional
agenda, and we work together in a bipartisan way, as we have done on a
variety of subjects in recent weeks, to get the key officials in these
agencies in place.
To make progress in the area of biomedical research and science, we
need a public-private partnership, one where the Federal Government is
involved in ensuring our laboratories are helping address issues that
involve coming up with the basic knowledge that companies and
scientists can then take to develop the cures and therapies that will
improve the quality of life for the public.
I want to work with the President of the United States to get the
biosciences back on track. I want to make sure we don't step back from
this golden age of scientific progress, when we had an administration
committed to ensuring we moved forward with this important research,
and Congress backed it up on a bipartisan basis. The Congress has the
power to advise and consent, and it is important that the Congress and
the President work together to fill the positions at the Food and Drug
Administration, the National Institutes of Health, and the National
Cancer Institute.
We are not dealing just with bioterrorism although that is obviously
very much on our mind this morning--but the entire public health
system. We are seeing, obviously, when we open our morning newspaper,
there are gaps that we need to address. We can best address this if
officials in these key agencies are in a position to advise the
Congress.
It has been too long that we have gone without a leader at the
National Institutes of Health. It has been too long that we have gone
without a leader at the Food and Drug Administration. The Senate will
meet the President of the United States more than halfway. He can speak
for himself. He has been extraordinarily eloquent on biomedical
research over the years. Senator Kennedy, who I have discussed this
with, has made it very clear as chairman of the committee that focuses
on these issues, he is very anxious to get these officials confirmed.
I hope this message this morning, at a time when we are working on
this important bill that funds so many key health agencies, can help
spark a new effort to speed up getting these key positions filled. I,
and I believe every Member of the Senate, wants to work with the
President to get these positions filled. Even though there are so many
important issues the President has to deal with, this issue of the
vacancies at the National Institutes of Health, the Food and Drug
Administration, and the National Cancer Institute has become so
serious, it needs to be a priority matter that Congress moves quickly
to deal with. We ought to move quickly to deal with it before we
adjourn for the year.
I yield the floor.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Mr. President, we urge our colleagues to come to the
Chamber to offer amendments. There was a long list filed yesterday
where we have a unanimous consent agreement limiting amendments to
those which have been listed. Many of them are obviously placeholder
amendments. We need to move ahead with this bill. We have been on this
bill now into our second day. We have had only one amendment offered so
far. We urge our colleagues to come to the Chamber and identify what
amendments they intend to offer and to be in a position to move forward
to proceed with the disposition of this bill.
Mr. REID. Will the Senator yield?
Mr. SPECTER. I yield.
Mr. REID. We have an amendment pending, the Dorgan amendment. Has
there been a decision made whether that would be accepted or do you
want a vote on it?
It is my understanding now that staff is still working on that.
Senator Stevens wanted to alternate back and forth, and I said that
was fine, but if we could get all Democrats to offer their amendments
and all Republicans, one after the other--we are so desperate to have
amendments, we don't care where they come from.
Mr. SPECTER. If I may respond, I don't think we have a problem on
alternating. We have a problem finding amendments. If a series of
amendments from your side of the aisle come forward, we will take them;
and if a series of amendments from our side of the aisle come forward,
we will take them. If there is a complication, we will alternate. We
are now in search of amendments.
The Senator from Alabama is prepared to offer an amendment. I ask
[[Page S11257]]
unanimous consent the pending amendment be set aside so we may proceed
to the amendment of the Senator from Alabama.
The PRESIDING OFFICER. Without objection, it is so ordered.
Amendment No. 2042
Mr. SESSIONS. I thank Senator Specter for his leadership and courtesy
in allowing me to present this amendment which I believe is exceedingly
important to health care in America. It is a problem with which we
simply have to deal. It affects hospitals all over America, causing the
richer hospitals to get richer and the poorer hospitals to get poorer.
The problem is the wage index. I offer the Wage Index Fairness Act,
and I send the amendment to the desk.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:
The Senator from Alabama [Mr. Sessions] proposes an
amendment numbered 2042.
Mr. SESSIONS. Mr. President, I ask unanimous consent reading of the
amendment be dispensed.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
(Purpose: To amend title XVIII of the Social Security Act to establish
a floor on area wage adjustment factors used under the medicare
prospective payment system for inpatient and outpatient hospital
services)
On page 54, between lines 15 and 16, insert the following:
Sec. __. (a) Floor on Area Wage Adjustment Factors Used
Under Medicare PPS for Inpatient Hospital Services.--Section
1886(d)(3)(E) of the Social Security Act (42 U.S.C.
1395ww(d)(3)(E)) is amended--
(1) by inserting ``(i) In general.--'' before ``The
Secretary'', and adjusting the margin two ems to the right;
(2) by striking ``The Secretary'' and inserting ``Subject
to clause (ii), the Secretary''; and
(3) by adding at the end the following new clause:
``(ii) Floor on area wage adjustment factor.--
Notwithstanding clause (i), in determining payments under
this subsection for discharges occurring on or after October
1, 2001, the Secretary shall substitute a factor of .925 for
any factor that would otherwise apply under such clause that
is less than .925. Nothing in this clause shall be construed
as authorizing--
``(I) the application of the last sentence of clause (i) to
any substitution made pursuant to this clause, or
``(II) the application of the preceding sentence of this
clause to adjustments for area wage levels made under other
payment systems established under this title (other than the
payment system under section 1833(t)) to which the factors
established under clause (i) apply.''.
(b) Floor on Area Wage Adjustment Factors Used Under
Medicare PPS for Outpatient Hospital Services.--Section
1833(t)(2) of the Social Security Act (42 U.S.C. 1395l(t)(2))
is amended by adding at the end the following: ``For purposes
of subparagraph (D) for items and services furnished on or
after October 1, 2001, if the factors established under
clause (i) of section 1886(d)(3)(E) are used to adjust for
relative differences in labor and labor-related costs under
the payment system established under this subsection, the
provisions of clause (ii) of such section (relating to a
floor on area wage adjustment factor) shall apply to such
factors, as used in this subsection, in the same manner and
to the same extent (including waiving the applicability of
the requirement for such floor to be applied in a budget
neutral manner) as they apply to factors under section
1886.''.
Mr. HARKIN. Will the Senator yield?
Mr. SESSIONS. I yield.
Mr. HARKIN. Which amendment?
Mr. SESSIONS. The Wage Fairness Index Act.
Mr. HARKIN. I thank you.
Mr. SESSIONS. I note that Iowa is also adversely impacted by this
wage index formula.
I introduced this amendment as a bill earlier this year with my
colleagues, Senator Shelby and Senator Hutchinson. We have a terrible
inequity in the system and in the index formula. This amendment will
establish a floor on the area wage index adjustment factors that are
utilized under the Medicare prospective payment system for inpatient
and outpatient hospital services. I believe this is the best way to do
that.
Several other Members have other proposals to help fix this problem.
This is a solution I believe would be most effective. Over the past
several years, I visited a number of hospitals, 15 or more, in the
State of Alabama. In every one, hospital administrators and staff have
urged me to do something about the wage index. Time after time it has
been cited to me in personal and confidential discussions, just heart
to heart, as we discussed the frustrations and problems they face in
hospitals, and in particular rural hospitals. It has been raised to me
as a No. 1 issue facing hospitals in Alabama.
The Alabama Hospital Association and its members have helped craft a
plan. They consider it an emergency problem and a priority for them.
The National Hospital Association has recognized this as a problem, and
they support reform.
A complicated and a mostly arbitrary formula, the wage index, is part
of the hospital prospective payment system which was created just in
the early 1990s, about 10 years ago. We are just now beginning to feel
how it plays out in real life. It was an effort to cut Medicare
spending. It established a base rate for Medicare reimbursement based
on two components--the labor component and the nonlabor-related costs.
That is how a hospital is paid for Medicare services they render to a
person who is not otherwise paying. This could be the elderly on
Medicare and they come in and the hospital provides services. All they
get for that service is what the Federal Government pays them under the
Medicare Act.
So everyone knows that basically hospitals are not making any money.
In fact, they lose money, often, on Medicare patients. It is the
individuals who pay their way or have insurance to pay their way who
help them be a success. The hospitals that have larger numbers of
Medicare patients who serve a poorer population are more critically
impacted by this problem. Once again, the wage index is falling
particularly hard on hospitals that serve a disproportionately high
number of Medicare patients and poor patients--Medicaid also.
It established a base rate for paying Medicare costs. They decide how
much we are going to pay for a gall bladder operation, how much we will
pay for pneumonia and other things, and that is what the hospital gets.
They factor that on labor and nonlabor costs.
Nonlabor costs--that is the material and all--are similar nationwide,
and the factors come out the same. But labor-related costs must be
adjusted to regional differences in wage costs. This adjustment is made
according to the wage index. The wage index, by the way, is a larger
component of the cost of hospital care than the other factors. It is
the biggest component. I believe about 60 percent of the reimbursed
rate is based on the wage rate.
Rural areas such as Alabama and other States have lower wage costs,
which is not a good thing. We don't like it that our nurses and support
personnel aren't paid the same wages as in other States. But it is true
we have some lower wage rates. Therefore, the Medicare reimbursement
cost for health care in Alabama and many other States and rural areas
even within larger States is much lower. Actually, Alabama has the
lowest average wage index in the country and Montgomery, AL, the
capital--a good, strong city, not some small rural town--has the lowest
wage rate in the State. In fact, the wage index for all Alabama
hospitals is between .74 and .89, well below the national average of
1.0.
In other words, where the national average is hospitals are
reimbursed at the rate of $1, they are reimbursed at the rate of maybe
78 cents in Alabama, many of them at 74 cents. Some hospitals in the
country that have somehow, some way, under this formula found their
costs higher, they get as much as $1.50. So it is twice as much, 74
cents to $1.50, on 60 percent of the formula on the payment for health
care. This is too big a gap. This is more than we ought to accept. For
person in Iowa, a person in Alabama, their health care is just as
valuable and as important as the health care of someone in New York or
California.
To further exacerbate the problem, Alabama has to compete for nurses
and hospital personnel with nearby urban areas such as Atlanta. To
recruit these highly qualified health care professionals, Alabama
hospitals must compete with urban wages. This has become a bidding war
and has really impacted adversely the bottom line of hospitals in the
State. Until we fix this problem, Alabama hospitals and hospitals all
over the country will continue to lose millions of dollars each year.
Unfortunately, it is falling hardest, and the losses fall most often,
on
[[Page S11258]]
hospitals in poorer areas, the ones that are actually doing the care
and the good deed of treating people who otherwise would not have
health care. They are already forced to make the most of limited
resources and to continue to provide care for the State's uninsured.
These hospitals will face tough decisions regarding health care
services. They will continue to postpone important projects and the
purchasing of much needed equipment. The rich are getting richer and
the poor are getting poorer.
In fact, what happens is, when your wage index is low and you talk
with your nurses about what kind of raises they might expect, or how
many RNs and how many LPNs and how many less skilled personnel you have
because you are not being reimbursed at the national rate but maybe 75
percent of the national rate, you end up cutting those salaries even
more, so you have more LPNs rather than RNs, you have more support
personnel than nursing personnel to try to get by, and what happens
then? Your wage index goes down even further. They come in and say:
Look, your wage index isn't that high. You don't get reimbursed as
much. So your formula can even go down worse.
The Center for Medicare and Medicaid Services, CMS, the Medicare
Payment Advisory Commission, and the MedPAC have recognized the
problem, and they have even made recommendations to improve the wage
index.
In addition to these recommendations, several pieces of legislation
have been introduced in this Congress to address the wage index. Five
bills have been introduced so far this year to address the wage index.
Forty-five Senators from twenty-nine States have either sponsored or
cosponsored wage index legislation.
Eight members of the Senate Finance Committee, including the ranking
member, Senator Grassley, agree something must be done. Unfortunately,
although many have recognized the problem with the wage index, we have
not been able to do anything to fix it.
So I raise this issue today to call attention to what is a critical
problem in health care in America. Particularly in light of September
11, we know we are going to have to be sure we have a healthy health
care system to deal with crises with which we may be faced at any time.
If we allow an unfair reimbursement system to continue, then we will
allow our hospitals to weaken and eventually close.
This is a matter of serious import. The wage index is irrational. It
is not working correctly. It is ratcheting down wages on poorer
hospitals in rural areas. When the hospitals cut and reduce and cut and
reduce, then the next year the wage index formula people come in and
say your wages are lower, and your index drops even further, and you go
down even more.
This is something we have to confront. I will share this specific
example from my hometown of Mobile, AL. The wage index dropped from .81
to .77, whereas 50 miles away in Pensacola, FL, it is maybe .87; it is
in the high .80s in Pascagoula, MS, an hour's drive either way from the
city. That means millions of dollars of reimbursement for those people.
Montgomery, our capital, has the lowest rate in the Nation. Its
hospitals are hurting as a result.
Mr. President, this is an important issue. The time has come to
address it. Although this is a Health and Human Services bill that
deals with health care issues, I recognize that this amendment is not
appropriately favored to be offered here--although we could offer it
with a point of order. I hope we can begin to draw some attention to an
issue that is getting out of control. The gap is simply too large. We
cannot accept it. We cannot allow it to continue. We have to do
something to fix this problem.
My bill will bring everybody up to 92 percent. It would not bring
down anybody. It would at least bring those 74-cents-on-the-dollar
hospitals up to 92 cents on the dollar. They would still be well below
the national average--and well below the people who are above the
national average--but it would at least bring them out of poverty and
allow them to provide the kind of quality health care we need.
Mr. President, I appreciate the opportunity to make these remarks. I
yield the floor and suggest the absence of a quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. DAYTON. Mr. President, I ask unanimous consent the order for the
quorum call be rescinded.
The PRESIDING OFFICER (Mr. Edwards). Without objection, it is so
ordered.
Mr. DAYTON. Mr. President, I ask unanimous consent that I be
permitted to speak as in morning business for 5 minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The remarks of Mr. DAYTON pertaining to the introduction of S. 1600
are printed in today's Record under ``Statements on Introduced Bills
and Joint Resolutions.'')
Mr. DAYTON. Mr. President, I yield the floor and suggest the absence
of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. SESSIONS. Mr. President, I ask unanimous consent the order for
the quorum call be rescinded.
The PRESIDING OFFICER (Mr. BAYH). Without objection, it is so
ordered.
Mr. SESSIONS. Mr. President, I will just follow up on the remarks I
made previously concerning the wage index and share with our fellow
Members some of the information I have concerning this issue.
I have a letter from the Mobile/Baldwin County area hospitals. It was
sent to me, Senator Shelby, and Congressman Callahan. I will share some
of the things that are in it supporting the legislation I have offered.
They note this:
Because of the huge discrepancy in the Area Wage Index
which applies in Mobile and Baldwin Counties, Alabama as
compared to our neighboring areas of Pascagoula, Mississippi
and Pensacola, Florida, not to mention the even greater
discrepancy with other parts of the country, we are beginning
to face a critical shortage of skilled registered nurses with
which to staff our hospitals. In the last three months alone
we have lost at least 87 registered nurses from our area
labor pool to traveling nurse agencies and to facilities in
adjacent states. Collectively, we have over 200 registered
nurse vacancies in the hospitals of Mobile and Baldwin
Counties. . . .
We are literally unable to compete with the salaries that
are being offered these individuals because of the very low
(.80) Medicare Area Wage Index under which we must now labor.
Already our ability to handle the volume of patients being
seen in our emergency rooms has been hampered and the waiting
time has increased significantly. Already this summer we have
had occasions where one or more of our hospitals have had to
declare a ``Code Red'' status, meaning that they could not
accept any more patients in their facility that would require
intensive care due to a lack of staffed intensive care beds.
As a matter of fact, this weekend I was in an airport and talked to
an administrator at one of our area hospitals. He told me for the first
time in years, they cannot accept more patients. This is a great
hospital. My mother has been there a number of times; other relatives,
including my father, have been hospitalized there. I said: You mean you
don't have beds or you don't have nurses?
He said: We don't have nurses. We have the beds. We don't have
nurses.
This index situation is working in a perverse way so that when you
economize, when you reduce your cost and cut your salary and negotiate
toughly with nurses and pay them the most minimum salary you can get
away with paying them, then they come back the next year and rate your
wage costs lower. Then they want you to cut it again next year. This
thing is getting out of sync.
We have nurses in Alabama--and I have heard this all over the State
in talking to administrators--who go off for a week or two. They work
long hours at nearly twice the salaries they make in the State of
Alabama. Then they quit working at the local hospitals where they have
worked before. This is done because the majority of health care in
hospitals in most areas of the country is Medicare/Medicaid work. So if
you are not paying a living wage, if you are not paying a basic amount
for those Medicare payments--this is our elderly who are most often
hospitalized--then the net result of all that is the hospital gets
squeezed badly.
Last year, we made a good step in increasing the overall inflation
index for
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hospitals. We had reduced that substantially as part of the Balanced
Budget Act of 1997. It helped us create a surplus in this country, but
we realized that it was beginning to cut deeper and deeper and deeper
into hospitals. So this helped hospitals across the board.
I know the hospitals in more rural areas are at a double disadvantage
because 60 percent of their reimbursement cost is based on the wage
index.
Again, in Mobile, one of the larger cities in the State, a city on
the coast, Mobile's wage index is 80. They get 80 cents on the dollar.
The average in America is $1. Some hospitals in America are being
reimbursed at $1.50. So this is really a huge difference. That is
almost twice.
In Montgomery, another sizable city in the State of Alabama--Alabama
is a State of 4 million people, an almost average State in America--it
is being reimbursed at 74 cents on the dollar. That is half what you
are getting reimbursed in some other areas of this country.
It is draining our qualified nursing personnel and endangering health
care, causing the poor to be poorer and the rich, in a way, to get
richer. At least the poor will get poorer. Nobody is getting rich on
Medicare reimbursement today.
I will share one more letter from the Baptist Health Care System of
the State of Alabama. I talked with Dennis Hall a number of times. I
have visited in several of his hospitals around the State of Alabama.
He is passionately of the belief that the wage index is devastating
their health care system. He said:
The national crisis is affecting hospitals in Alabama in
dramatic ways. Most of the hospitals in Alabama, including
the very strong Baptist Health System, are losing money on
operations. We have counted on interest earnings on
reserves to offset losses. However, most institutions are
now facing losses on their reserves also.
Our total losses in operations for our year ended June 30,
2001 will be in excess of $21 million. Charity, Medicaid and
Medicare played a big role in causing these losses. We simply
cannot continue to sustain these operating losses. We
certainly cannot be adequately prepared to respond to bio-
terrorism should it strike one of our hospitals where we
serve.
Mr. President, I have also a letter from the Coffee Health Group. I
visited the Coffee Health Group. It is in Florence, AL, the Quad Cities
area. There are a number of people in this area, a series of smaller
communities in a fairly sizable metropolitan area.
This is what Carl Bailey writes me:
The wage index is a complicated issue that I truly believe
few understand. Nevertheless, you have asked us to help you
get some grasp of the problem by describing the impact of the
recruitment of a registered nurse from one of our Alabama
hospitals (``Hospital A'') to another institution (``Hospital
B'') that is already receiving higher Medicare payment due to
higher wage index.
Hospital B will pay the travel, lodging, and higher wages to recruit
the RNs. This additional cost to Hospital B actually increases the wage
index for Hospital B.
The hospital that is hiring a person at a higher wage and paying all
these costs then bills that to create a higher wage index.
This increase can only be paid from other areas because of budget
neutrality.
Get that? This increase for Hospital B that is paying a higher wage
can only be paid from taking money from the other areas because of
budget neutrality. We only have a certain pot of money.
Therefore, Hospital A must share in the cost of paying for the
increased wages of Hospital B. Since Hospital A cannot replace this RN,
Hospital A's average wage decreases due to the loss of an employee with
a higher than average hourly rate.
You get that? Hospital A's, the losing hospital's wage index goes
down because their wage rate goes down because they lost one of their
higher paid people and one of their better people.
This lowers the wage index for Hospital A and because of budget
neutrality further increases the wage index gain for Hospital B. To
respond to the shortage of staff, Hospital A then hires two or three
nursing assistants to share the workload, reducing the number of
nurses. This creates an even lower wage index for Hospital A which
decreases the wage index even more. It also decreases the quality of
care in Hospital A. Again, because of budget neutrality, the decrease
in reimbursement to Hospital A is passed on as a higher wage index to
Hospital B. Hospital B is now in a better financial position to hire
additional employees from Hospital A than they were before, and the
cycle continues.
Although this scenario takes three years to play out, the
mechanics are very real. We in Alabama have been living with
similar recruitment strategies and subsequent negative
reimbursement impact that has occurred in the past. Our loss
in the past cannot be recruited, but we must stop the flow of
Medicare funds from the ``have-nots'' to the ``haves.''
Mr. President, those are the points we are making. This affects
hospitals all over America, States such as New York. Both Senators from
New York support wage index reform because their State has large
numbers of hospitals that are being adversely affected. It is not just
what State or what area of the State you are from; the gap has grown
too great, and the gap is widening and accelerating. It is not good for
quality of health care in America. We have to do something about it.
Perhaps this is not the best bill to fix it, but I hope we can bring
some increased attention to it. I look forward to working on it.
I yield the floor.
The PRESIDING OFFICER. The Senator from Iowa is recognized.
Mr. HARKIN. Mr. President, I thank the Senator from Alabama for
raising this very important issue. It is also an important issue to our
providers in my State also, I might add. According to the Iowa Hospital
Association, providers in Iowa would get about an additional $25
million a year under this amendment. To put it simply, we are being
discriminated against in our State and in a lot of rural areas, as I am
sure Alabama is.
This critical issue is at the center of States' like Iowa that are
trying in vain to recruit and retain an adequate number of providers in
rural areas. This is something of which I am very supportive. This is a
point in time where I wish I were chair of the Finance Committee and we
had a finance bill on the floor and we could take care of it right now.
The Senator raised this issue in good faith. He is right on the mark.
We have to change this wage index floor. We have to raise that floor.
Also, I say to my friend from Alabama, since we are now talking about
this issue, I ask him to look at another piece of legislation that I
and others have introduced called the FAIR Act. The difference in
States between Medicare reimbursement for Medicare patients on a per
patient basis vary widely. Some States are as low as about $3,000 per
beneficiary per year; some States are as high as $7,000 per beneficiary
per year. In other words, if you are on Medicare in one State, the
reimbursement rate for your State might be as high as $7,000; in
another State, it may be less than half that amount. In Iowa, we are
No. 50 out of the 50 States. I think Alabama is down pretty low with
us. We need to close that gap. My bill would do just that as well as
address the wage index floor problem this amendment seeks to address.
My bill would take the national average and you say that no State can
go over 105 percent and no State can go under 95 percent. You would
leave some leeway for different problems, but no State could go over
105 percent and no State could go below 95 percent of the average. I
ask the Senator to take a look at that because that is something that
would even out some of the problems we have in Medicare reimbursements.
But the bottom line is simple. Any Medicare reform bill, whether it is
attached to an appropriations bill or goes on its own, has to include a
provision to level the playing field and fix a system that is currently
unfair and inequitable. Again, I would like like to accept the
Senator's amendment and include it in this bill, but the Chair and
Ranking Member of the Senate Finance Committee have made it clear that
they will oppose any attempt to attach amendments that fall under the
jurisdiction of the Finance Committee--including this amendment--to
this appropriations bill.
I wanted to mention that, and I thank the Senator for raising this
issue. Count me on board to work with him to see what we can do.
Mr. SESSIONS. I think it would take a point of order to do this. I
wanted to
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raise this issue, and maybe others would like to speak on it. I would
like to go on to another issue. I have had my say at this point.
Perhaps a vote would not be necessary on this amendment or on a point
of order. It is a health care bill.
It is time to talk about one of the biggest problems we have in
health care, which I believe is the wage index. I have been to
hospitals and talked to administrators and CFOs, the people writing the
checks, and the heads of nursing, and they see people leave, driving up
the wage index at another hospital and reducing theirs even further. We
have to fix this.
Mr. HARKIN. The Senator is right on target on this issue.
Mr. SESSIONS. I thank the Senator for his interest and leadership.
I yield the floor.
Mr. SPECTER. Mr. President, I commend my distinguished colleague from
Alabama for raising this important issue. I believe it has national
implications. There is certainly a problem in my state of Pennsylvania.
For those who are watching on C-SPAN II and don't understand the
procedures, it might be worth a word or two of explanation. This is a
matter for the Finance Committee, and they have the jurisdiction over
this matter and have lodged an objection to having it taken up on this
bill.
So what we have to do is look for an opportunity to raise it in a
context where there is a Finance Committee bill on the floor. At that
time, I think the Senator from Alabama will have a lot of support. I
thank him for raising the issue at this time.
Mr. President, in the absence of any Senator seeking recognition to
introduce an amendment, I ask our colleagues to come forward. We have
29 amendments on the list on one side and 32 on the other, for a total
of 61. We need to proceed to conclude this bill. The conference is
going to be very lengthy. If we are to have the appropriations for the
National Institutes of Health, and the education bill, and the other
matters, we are going to have to move ahead and not have this folded
into a continuing resolution. I urge colleagues to come forward.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. DASCHLE. Mr. President, I ask unanimous consent the order for the
quorum call be dispensed with.
The PRESIDING OFFICER (Mr. Carper). Without objection, it is so
ordered.
Amendment No. 2044
Mr. DASCHLE. Mr. President, I ask unanimous consent the pending
amendments be set aside and that an amendment I have just sent to the
desk be considered.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will report.
The legislative clerk read as follows:
The Senator from South Dakota [Mr. Daschle] proposes an
amendment numbered 2044.
Mr. DASCHLE. I ask unanimous consent the reading of the amendment be
dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')
Mr. DASCHLE. Mr. President, I rarely come to the floor to offer
amendments on appropriations because, I have to say, especially in this
case, the chair and ranking member have done a phenomenal job under
very difficult circumstances to get us to this point. I admire their
work and their leadership and appreciate very much their extraordinary
efforts as we have attempted to accelerate consideration of the
appropriations bills.
I come to the floor to offer this amendment in part because I believe
this provides perhaps the only vehicle we will have to consider
legislation that I believe ought to have the opportunity to be
considered before the end of this year. I offer the amendment on this
bill in part because of the importance I think this legislation holds,
not only for firefighters but for the country as a whole.
When the planes crashed into the World Trade Center on September 11,
the shift had just changed at fire houses all across the country. In
New York, firefighters who had just worked through the night could have
gone home, but they didn't. Without a moment's hesitation, they rushed
to what we now call Ground Zero to try to save lives.
They climbed on the first pumper or ladder truck they saw. One group
of firefighters even commandeered a city bus to get to the World Trade
Center as quickly as they could. Retired firefighters who heard what
had happened rushed from their homes. Within hours, we now know, 343
New York City firefighters had lost their lives in the greatest
terrorist attack in our Nation's history.
More than 7 weeks later, other firefighters, police, and rescue
workers continue to comb through the still smoldering pile at Ground
Zero, still risking their lives.
We have heard many words of praise for these heroes, and for their
extraordinary efforts and for their first responders who risked their
lives at the Pentagon, and in western Pennsylvania. They deserve every
word of that praise, and far more.
As we honor them, it is important to remember that they are not
alone.
Every day, in every State in America, firefighters, police officers
and other emergency workers risk their lives to protect our safety. But
in 18 States, they don't have the legal right to sit down with their
employers and talk about their own health and safety.
That is wrong, and I believe the time has come for those
circumstances to change.
That is why Senators Dodd and Gregg, and I are offering this
bipartisan amendment today: the Public Safety Employer-Employee
Cooperation amendment.
Our amendment extends the basic right of collective bargaining to
firefighters, police officers, paramedics, and emergency medical
technicians.
It guarantees public safety officers the right to form and join a
union, and the right to bargain collectively over hours, wages, and
conditions of employment.
That is it.
There are things this amendment does not do, and I want to clarify
and emphasize that.
It expressly forbids strikes or ``lockouts'' by public safety
workers. It exempts all States with State bargaining laws for public
safety workers that are equal to or greater than this proposal. And it
preserves all management rights.
We know the essential role firefighters, police and other first
responders played on September 11.
We know the role Capitol Police played on October 15. When a member
of my staff opened a letter containing anthrax, Capitol police officers
were immediately notified and were there immediately as well. They
risked their lives to protect us. As a result, six law enforcement
officers were exposed to the deadly bacteria. Today, every one of them
is on the job.
Capitol Police are all working 12-hour, 14-hour days, 6 days a week,
to protect us all; and they are all union members.
People who say that protecting public safety workers' basic rights
will somehow jeopardize the public safety simply do not understand the
dedication of the men and women who take these jobs.
We owe them our thanks. We owe them the basic right to collective
bargaining. We owe them this opportunity to look out for themselves in
the best way they know how, in their health, in their work, and in
their lives.
So, Mr. President, I hope that our colleagues will look favorably on
this amendment. I commend the extra effort made by Senators Kennedy and
Dodd in particular, and Senator Gregg, who has been an outspoken
advocate and proponent of this legislation. I am grateful to them. I am
especially grateful for the opportunity this afternoon to offer this
amendment with their support.
Mr. KENNEDY. Mr. President, I thank our leader, Senator Daschle, for
the introduction of amendment No. 2044 to this Health and Human
Services appropriations. I welcome the opportunity to cosponsor this
with him.
So much of the Labor, HHR appropriations bill addresses the well
being of our Nation's workers. We must meet the needs of all our
workers, including our public safety workers, who do so much for us.
The firefighters tell us that this amendment is their highest
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priority. This amendment is the least we can do for them, in light of
the sacrifices they have made for our country.
This amendment is an important bipartisan effort to help protect our
Nation's public safety officers on the job. I have been pleased to work
with my Republican cosponsors, Senator Gregg, Senator DeWine, and
Senator Snowe. This amendment will measurably add to the caliber of our
defense against threats to the security of our communities. It will
also further this country's historic commitment to collective
bargaining. I can point out to the Senate the substance of this
amendment, in legislation, passed overwhelmingly from our Senate Labor
and Human Resource Committee.
I know that no one in this room needs to be reminded of the heroic
efforts made by the country's public safety officers in the last 10
days. The pictures of tired, dust covered firefighters confronting
unimaginable horror are permanently emblazoned in our minds.
The courage and dedication of those who died--including Peter Ganci,
the chief of the New York Fire Department; William Feehan, the first
deputy commissioner; and Mychal Judge, the chaplain of the Department--
set a shining example for all of us. There were 344 firefighters and
paramedics who died in the World Trade Center rescue effort. They were
members of locals 94 and 854 of the International Association of
Firefighters. And, just miles from the Capitol, hundreds of
firefighters risked their lives in the rescue efforts at the Pentagon.
America needs these men and women, now more than ever, and it is no
exaggeration to say that we owe our lives to them.
This amendment will ensure that firefighters, police officers,
correctional officers, and emergency medical personnel will be afforded
the fundamental right to bargain collectively with their employers. The
amendment guarantees the basic rights that are necessary to meet that
goal--to form and join a union; to bargain over hours, wages, and
working conditions; to sign legally enforceable contracts; and to deal
with an impasse in negotiations.
This proposal follows in the honorable traditions of our country's
labor laws, by recognizing the importance of collective bargaining to
improve job conditions, increasing worker safety, and improving
productivity. Most importantly, this amendment will lead to safer
working conditions for public safety officers and to enhanced safety
for the public that they serve.
As we now know all too well, firefighters, police officers, and
emergency medical personnel serve in some of the country's most
dangerous, strenuous, and stressful jobs. They are frequently asked to
risk--and sometimes give--their lives to protect the safety of others.
We have a moral obligation to do whatever we can to increase the safety
of these critical jobs--and thereby to add to the Nation's defense
against threats to the public's health and safety.
It is clear that this amendment will help us to meet these goals. The
men and women who serve on the front lines in providing firefighting
services, law enforcement services, and emergency medical services know
what it takes to create safer working conditions. Ensuring that these
professionals have a right to collective bargaining will give them a
voice in decisions that can literally make a life-or-death difference
on the job. Making such a difference for our country's public safety
officers will, by definition, improve our collective safety.
Available data prove that collective bargaining enhances safety.
These data show that States that lack collective bargaining laws have
death rates for firefighters that are nearly double that of States in
which bargaining takes place.
In States with collective bargaining, there were 1.5 firefighters
killed in the line of duty for every 10 thousand firefighters. In
States without collective bargaining, 2.5 out of every 10 thousand
firefighters were killed on the job. Similarly, in 1993, firefighters
in 9 of the 10 States with the highest firefighters death rate lacked
collective bargaining protection.
This amendment will also save money for States and local communities.
A study by the International Association of Fire Fighters shows that
States and municipalities that give firefighters the right to discuss
workplace issues have lower fire department budgets than States without
such laws.
When workers who actually do the job are able to provide advice on
their work conditions, there are fewer injuries, better morale, better
information on new technologies, and more efficient ways to provide the
services.
The amendment also accomplishes its goals in a reasonable and
moderate way. The amendment requires that public safety officers be
given the opportunity to bargain collectively; it does not require that
employers adopt agreements.
Nor does it regulate the content of any agreements that are reached.
Where States have collective bargaining laws that substantially provide
for the modest minimum standards set forth in the bill--as a majority
of States already do--moreover, those States will be unaffected by the
legislation.
Where States do not have such laws, they may choose to enact them or
to allow the Federal Labor Relations Authority to establish procedures
for bargaining between public safety officers and their employers. This
approach respects existing State law and gives each State the authority
to choose the way in which it will comply with the requirements set by
this amendment. States will have full discretion to make decisions
regarding their implementation and enforcement of the basic rights set
forth in this proposal.
This approach respects existing State law and gives each State the
authority to choose the way in which it will comply with the
requirements of this proposal. States will have full discretion to make
decisions regarding the implementation and enforcement of the basic
rights in this amendment.
This amendment will not supersede State laws which already adequately
provide for the exercise of--or are more protective of--collective
bargaining rights by public safety officers. This amendment is intended
to ensure that public safety officers have a role in addressing their
wages, hours, and terms and conditions of employment; and to improve
the safety and welfare of public safety officers and the communities
they serve.
It is a matter of basic fairness to give these courageous men and
women the same rights that have long been enjoyed by other workers.
They put their lives on the line to protect us every day. They deserve
to have an effective voice on the job, and improvements in their work
conditions will benefit their entire community.
I commend my cosponsors for their leadership on this important
proposal, and I urge the Senate to approve it.
I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. HOLLINGS. Mr. President, I ask unanimous consent the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The remarks of Mr. Hollings are printed in Today's record under
``Morning Business.'')
Mr. HOLLINGS. I yield the floor.
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