[Congressional Record Volume 149, Number 11 (Wednesday, January 22, 2003)]
[Senate]
[Pages S1370-S1371]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Enzi, Mrs. Lincoln, Mr. Baucus, 
        Mr. Smith, Mr. Harkin, Mr. Domenici, Mr. Johnson, Mr. Nelson of 
        Nebraska, and Mr. Dayton):
  S. 204. A bill to amend title XIX of the Social Security Act to 
increase the floor for treatment as an extremely low DSH State to 3 
percent in fiscal year 2003; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce legislation 
with Senators Enzi, Lincoln, Baucus, Smith, Harkin, Domenici, Johnson, 
Nelson of Nebraska, and Dayton entitled the ``Medicaid Safety Net 
Improvement Act of 2003.'' This legislation is important to the 
continued survival of many of our Nation's safety

[[Page S1371]]

net hospitals that provide critical health care access to our Nation's 
41.2 million uninsured citizens, including 373,000 in New Mexico, 
through the Medicaid disproportionate share hospital, or DSH, program.
  In recognition of the burden certain hospitals bear in providing a 
large share of health services to the low-income patients, including 
Medicaid and the uninsured, the Congress established the Medicaid DSH 
program in the mid-1980's 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: Infact But Endangered,'' the National 
Association of Public Hospitals entitled ``The Dependence of Safety Net 
Hospitals'' and the Commonwealth Fund entitled ``A Shared 
Responsibility: Academic 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.
  Unfortunately, as the Commonwealth Fund report notes, ``. . . there 
are large inequities in how these funds are distributed among states.'' 
In fact, for a number of 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, Lea Regional Hospital, Plains 
Regional Medical Center, Memorial Medical Center, 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 ``extremely low-DSH states'' from 
1 percent to 3 percent of Medicaid program costs, which remains far 
less, or just about one-third, of the national average. The 18 States 
that would benefit from this legislation include: Alaska, Arkansas, 
Delaware, Idaho, Iowa, Kansas, Maryland, Minnesota, Montana, Nebraska, 
New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, 
Wisconsin, and Wyoming. 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 would like to thank Senators Baucus and Grassley, the leaders of 
the Senate Finance Committee, for their recognition of this problem and 
inclusion of this language in several bills they introduced in the last 
Congress, S. 3018, ``Beneficiary Access to Care and Medicare Equity Act 
of 2002'' and S. 2873, ``Improving Our Well-Being Act of 2002.''
  Our Nation's governors remain very concerned as well. In a letter 
written to Senators Baucus and Grassley on October 23, 2002, the 
governors of the States of Arkansas, Idaho, Iowa, Nebraska, New Mexico, 
Utah, Wisconsin, and Minnesota wrote, ``Our 15, which is now 18, States 
are in distress and cannot wait another year for some measure of 
relief. We strongly urge you to use any vehicle available to include 
the low-DSH issue. The States are seeking to raise the cap implemented 
two years ago from 1 percent to 3 percent to provide them some 
flexibility in addressing the increasing strain facing our safety net 
hospitals.''
  The governors add, ``The survival of many community hospitals, the 
lifeline for many rural community's health care and economy in our 
States, are being threatened. Current disparities in DSH funding 
severely harm our States' most vulnerable safety net hospitals.''
  At a time of growing numbers of uninsured and increased financial 
strain on our Nation's safety net, we need to increase the ability of 
``extremely low-DSH States'' to address the problems facing their 
safety net and to reduce the current inequity in funding among the 
States.
  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. 204

       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 2003''.

     SEC. 2. INCREASE IN FLOOR FOR TREATMENT AS AN EXTREMELY LOW 
                   DSH STATE TO 3 PERCENT IN FISCAL YEAR 2003.

       (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 2001'';
       (2) by striking ``August 31, 2000'' and inserting ``August 
     31, 2002'';
       (3) by striking ``1 percent'' each place it appears and 
     inserting ``3 percent''; and
       (4) by striking ``fiscal year 2001'' and inserting ``fiscal 
     year 2003''.
       (b) Effective Date.--The amendments made by subsection (a) 
     take effect as if enacted on October 1, 2002, and apply to 
     DSH allotments under title XIX of the Social Security Act for 
     fiscal year 2003 and each fiscal year thereafter.

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