[Congressional Record Volume 148, Number 112 (Monday, September 9, 2002)]
[Senate]
[Pages S8386-S8388]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. DeWINE (for himself and Mr. Durbin):
  S. 2913. A bill to amend the Employee Retirement Income Security Act 
of 1974, the Public Health Service Act, and the Internal Revenue Code 
of 1986 to provide health insurance protections for individuals who are 
living organ donors; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. DeWINE. Madam President, I rise today to raise the awareness of 
an issue that affects over 22,000 people a year, and that issue is 
organ donation. The sad fact about organ donations is this: We have the 
medical know-how to save lives, but we lack the organs. We lack organs 
because most Americans simply are unaware of the life-giving difference 
they can make by choosing to become organ donors.
  Sadly, each day the waiting list for those needing organs continues 
to grow. Today, nearly 79,000 people remain on the national transplant 
waiting list. Right now, more than 50,000 people, alone, are waiting 
for kidney transplants. That number is expected to double within the 
next decade. Additionally, between 12 and 16 people die each day just 
waiting for an available organ.
  To remedy the organ shortage, we must increase public awareness. By 
educating the public and raising awareness, more people will choose to 
become organ donors. At the very least, through these efforts, we can 
encourage more families to discuss what their wishes are and whether 
they would want to be organ donors.
  But our efforts must not stop there. We must do more than just 
implement public awareness campaigns, because the face of organ 
donation is changing. For the first time ever, the number of living 
organ donors outnumbered cadaver donors. Last year, there were 6,081 
donor cadavers while 6,485 people opted to become living donors, 
usually giving up a healthy kidney to help a family member or friend.
  Recognizing this, my colleague, Senator Durbin, and I introduce a 
bill today that would help protect living organ donors in the group 
insurance market. Our bill would ensure that those individuals who 
choose to be living organ donors are not discriminated against in the 
insurance marketplace. Our bill builds on the protections provided by 
the Health Insurance Portability and Accountability Act, so that living 
organ donors are not denied insurance nor are they applied 
discriminatory insurance premiums because of their living organ donor 
status.
  Quite simply, a brother who donates a part of his kidney to his 
sister should not be denied health insurance. But tragically, that is 
what oftentimes happens. Frequently, individuals who are living organ 
donors are denied health insurance or restricted from the insurance 
market. Instead, we should celebrate living organ donors and remove 
obstacles and barriers for the successful donation of organs. Insurance 
shouldn't undermine someone's decision to be a living organ donor.
  Some States are evaluating how living organ donors affect the market. 
States are amending their Family Medical Leave eligibility so that 
living organ donors can participate and benefit from the program. The 
Federal Government, with the Organ Donor Leave Act of 1999, offered 30 
days paid leave to Federal employees who chose to be an organ donor. 
But, paid leave and job protection doesn't mean much if people are 
denied health insurance or are required to pay higher premiums because 
they donated an organ to save another person's life.
  The impact of living organ donation is profound. A living organ donor 
not only can save the life of one patient, but can also take that 
person off the waiting list for a cadaver donation. That means the next 
person on the waiting list is ``bumped up'' a spot--giving additional 
hope to the 79,000 persons on the national transplant waiting list.
  Living organ donors give family members and friends a second chance 
at life and the opportunity to reduce the number of people on the 
waiting list to receive an organ. It is time for Congress to make a 
sensible decision in support of a person's decision to be a living 
organ donor. I encourage my colleagues to join me in co-sponsoring this 
bill.
                                 ______
                                 
      By Mr. ROCKEFELLER:
  S. 2914. A bill to amend title XVIII of the Social Security Act to 
provide for appropriate incentive payments under the medicare program 
for physicians' services furnished in underserved areas; to the 
Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, today I introduce the Medicare 
Incentive Payment Program Refinement Act of 2002. This bill makes 
needed and long-overdue changes to the Medicare Inventive Payment 
Program, an initiative conceived to address the growing primary care 
physician shortage in some of our country's most medically underserved 
communities. The number of physicians needed to care for all 
individuals, especially our aging seniors, continues to grow in remote 
rural areas and in underserved urban areas. However, rising health 
costs and the difficulties of operating a practice in underserved 
communities has exacerbated the physician shortage. Although the 
Medicare Incentive Payment Program aims to address the financial 
hurdles facing physicians in needy areas, the program has failed to 
achieve real results. This bill will make fundamental changes to 
improve the program's effectiveness.
  Rural areas, in particular, are in need of efforts to retain primary 
care physicians, since the difficulties of operating a practice often 
drive doctors to larger areas with more resources and professional 
support. According to the Federal Office of Rural Health Policy, over 
20 million Americans live in areas that have a shortage of physicians, 
and between 1975 and 1995 the smallest counties in the U.S., population 
under 2,500, experienced a drop in their physician-to-population ratio. 
More than 2,200 primary care physicians would be needed to remove all 
nonmetropolitan HPSA designations, and more than twice that number is 
needed to achieve adequate physician staffing levels nationwide.
  According to the National Rural Health Association, nonmetropolitan 
physicians treat a larger number of Medicare and Medicaid beneficiaries 
than their urban counterparts do, generating less income for physicians 
per patient. Furthermore, nonmetropolitan physicians are less likely to 
perform high cost medical services due to their limited number of 
resources. Understandably, MIPP monies can affect the quality of life 
for rural physicians and help prevent the mass migration of

[[Page S8387]]

needed health care professionals from underserved areas.
  The Medicare Incentive Payment Program, as it exists today, has not 
fulfilled its original mandate, to recruit and retain primary care 
physicians in health professional shortage areas. Passed as part of 
OBRA 87, the program pays all physicians a 10 percent bonus for each 
Medicare recipient they treat. This enhanced reimbursement is meant to 
offset the financial advantage of providing service in more populous 
areas, as well as help physicians with the costs associated with 
operating a practice in an underserved community. Most importantly, the 
program aims to increase health care access for Medicare beneficiaries 
and improve the health of communities overall.
  However, analyses from the Office of the Inspector General of HHS, 
the GAO, and independent health experts confirm that the program is 
unfocused and largely ineffective. All physicians are eligible for 
bonus payments, even when they may not be in short supply. Bonus 
payments are 10 percent, not enough to lure physicians to underserved 
areas, especially if the payment is based on a basic, primary care 
visit. Finally, many physicians do not even know this program exists, 
and those that do are often unsure whether they are delivering care in 
a HPSA and how to bill for the payment appropriately.
  To improve the program, this bill increases the bonus payment from 10 
percent to 20 percent and allows only those physicians providing 
primary care services, including family and general medicine, general 
internal medicine, pediatrics, obstetrics and gynecology, emergency 
medicine, and general surgery, to receive the incentive payment. 
Finally, my bill automates payments, so physicians no longer have to 
guess whether they are eligible for the program. These improvements 
will strengthen the original intent of the legislation, to recruit and 
retain primary care physicians in underserved areas, and strengthen the 
primary health care infrastructure of our country's most needy 
communities.
  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:
       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 ``Medicare Incentive Payment 
     Program Refinement Act of 2002''.

     SEC. 2. REVISION OF INCENTIVE PAYMENTS FOR PHYSICIANS' 
                   SERVICES FURNISHED IN UNDERSERVED AREAS.

       (a) In General.--Section 1833(m) of the Social Security Act 
     (42 U.S.C. 1395l(m)) is amended to read as follows:
       ``(m) Incentive Payments for Physicians' Services Furnished 
     in Underserved Areas.--
       ``(1) In general.--In the case of physicians' services 
     furnished by a physician with an applicable physician 
     specialty to an individual who is enrolled under this part 
     and who incurs expenses for such services in an area that is 
     designated under section 332(a)(1)(A) of the Public Health 
     Service Act as a health professional shortage area, in 
     addition to the amount otherwise paid under this part, there 
     also shall be paid to the physician (or to an employer or 
     facility in the cases described in clause (A) of section 
     1842(b)(6)) (on a quarterly basis) from the Federal 
     Supplementary Medical Insurance Trust Fund, an amount equal 
     to 20 percent of the payment amount for the service under 
     this part.
       ``(2) Applicable physician specialty defined.--In this 
     subsection, the term `applicable physician specialty' means, 
     with respect to a physician, the primary specialty of that 
     physician if the specialty is one of the following:
       ``(A) General practice.
       ``(B) Family practice.
       ``(C) Pediatric medicine.
       ``(D) General internal medicine.
       ``(E) Obstetrics and gynecology.
       ``(F) General surgery.
       ``(G) Emergency medicine.
       ``(3) Automation of incentive payments.--The Secretary 
     shall establish procedures under which the Secretary shall 
     automatically make the payments required to be made under 
     paragraph (1) to each physician who is entitled to receive 
     such a payment. Such procedures shall not require the 
     physician furnishing the service to be responsible for 
     determining when a payment is required to be made under that 
     paragraph.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to services furnished on or after 
     January 1, 2003, in an area designated under section 
     332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 
     254e(a)(1)(A)) as a health professional shortage area.
                                 ______
                                 
      By Mr. BIDEN:
  S. 2916. A bill to put a college education within reach, and for 
other purposes; to the Committee on Finance.
  Mr. BIDEN. Mr. President, as another school year starts, many college 
students are worrying not only about their class loads and their 
coursework, but about where the money to pay for their educations will 
come from. Today, the average cost of attending a public 4-year college 
has jumped to $9,000, up 7.7 percent from last year. This represents 
the highest rate of increase since 1993. For those families that choose 
to send their children to a private institution, that number rises. Up 
4.7 percent from the year before, the average cost of a private 4-year 
institution is now close to $24,000 a year.
  What do these rising tuition costs mean? Hard working American 
families are spending a larger percentage of their incomes than ever 
before to send their children to college. To attend the University of 
Delaware, where I went to school, it costs nearly 20 percent of a 
Delaware family's average annual income to cover costs. To attend a 
private college or university, that number, in some instances can jump 
to over 40 percent of annual income.
  To help remedy this situation I come to the floor today to 
reintroduce legislation to help American families afford their 
children's tuition. This comprehensive package, ``The Tuition 
Assistance for Families Act,'' builds upon previous steps that others 
and I have taken to make it possible for more families to provide their 
children with a college education. I introduce this bill so that the 
decision to send one's child to college will not be overshadowed by the 
decision of how to pay for it.
  The ``Tuition Assistance for Families Act'' will provide middle class 
American families with a $12,000 tuition tax deduction each year. Based 
on legislation that I introduced with Senator Schumer last year, at 
$12,000 this deduction provides real, meaningful tax relief. Tax relief 
that American families have been waiting for. Tax relief that can go a 
long way in helping them afford room, board and tuition.
  The bill that I am introducing today also expands the two tuition tax 
credits enacted in 1997--the Hope Scholarship and the Lifetime Learning 
Tax Credit. Under current law, the Lifetime Learning Credit allows a 20 
percent tax credit on the first $10,000 in higher education expenses in 
year 2003. Under my bill, the Lifetime Learning Tax Credit percentage 
would jump from 20 to 25 percent and raise the amount of education 
expenses subject to the credit to $12,000. In terms of real dollars, 
this would mean that a student who files in tax year 2003 under my plan 
could get up to $3,000 back in taxes. Under current law, the maximum 
allowable credit is only $2,000. That is a $1,000 difference. $1,000 
that can go directly into a student's pocket to pay for books, a 
computer or tuition. The also raises the income limits for each credit 
to $130,000 per family, per year, so that more families are afforded 
the help that they need.
  This bill reintroduces the idea of a $1,000 merit scholarship to be 
awarded to the top 5 percent of each high school's graduating class. 
These types of scholarships not only reward student achievement, they 
help to ensure that the best and brightest students have the ability to 
go on to college--thereby increasing the pool of well-qualified 
American workers for the information technology age.
  This act also increases the maximum Pell Grant award from $4,000 to 
$4,500. During the 2001-2002 school year, the maximum Pell Grant award 
covered about 42 percent of the average tuition, room and board at a 
public 4-year university. During the 1975-76 it covered 84 percent of 
these same costs. Clearly, the purchasing power of these grants has 
dramatically declined. As such, the debt load of American families and 
American students has increased considerably over the years as students 
have looked to federal and private loans to finance their educations. A 
report released just this March by the State PIRG's Higher Education 
Project found that at the end of the 1999-2000 school year, 64 percent 
of college students graduated with student loan debt at an average of 
$16,928, nearly double the average debt load just eight years ago. 
Double the debt load in 1994.

[[Page S8388]]

  It is the dream of every American to provide for their child a better 
life than they had themselves. Helping families afford the increasing 
cost of a college education will move us closer to making that dream a 
reality. For this reason, I have spent a great deal of time in the 
Senate fighting to provide tax relief for middle class American 
families struggling with the cost of college. And while I was pleased 
when some of the ideas I advocated were adopted in the 1997 tax cut 
bill, it is clear that as tuition costs rise dramatically, working 
Americans need additional assistance. The ``Tuition Assistance for 
Families Act'' will provide extra help so that more families can afford 
to give their children a brighter and better future. Let's not allow a 
college education to become a luxury when, in the information 
technology age, it is an absolute necessity.

                          ____________________