[Congressional Record Volume 149, Number 43 (Tuesday, March 18, 2003)]
[Senate]
[Pages S3900-S3901]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. Chafee (for himself, Mr. Graham of Florida, Mr. DeWine, 
        Mrs. Feinstein, Mr. Warner, Ms. Cantwell, Mrs. Clinton, Mr. 
        Smith, Mr. Rockefeller, Mr. Bunning, Mrs. Murray, Mr. Kennedy, 
        Ms. Landrieu, Mr. Kerry, and Mrs. Hutchison):
  S. 652. A bill to amend title XIX of the Social Security Act to 
extend modifications to DSH allotments provided under the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; to 
the Committee on Finance.
  Mr. CHAFEE. Mr. President, I am pleased to be joined today by 
Senators Bob Graham, DeWine, Feinstein, Warner, Cantwell, Smith, 
Clinton, Bunning, Rockefeller, Murray, Kennedy, Landrieu, Kerry, and 
Hutchison in introducing the Access to Hospitals Act of 2003. This 
legislation will freeze Medicaid Disproportionate Share Hospital, DSH, 
reductions at Fiscal Year 2002 levels, thereby eliminating the 
scheduled Fiscal Year 2003 drop-off in Federal Medicaid DSH funding. 
This bill will also provide a growth rate adjustment to help compensate 
for the increases in the cost of providing care to the most needy and 
indigent patients.
  This legislation is necessary because the Medicaid DSH provision 
included in the Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000, BIPA, expired on October 1, 2002. This 
provision provided crucial, but temporary, relief from the deep 
reductions in State Medicaid allotments that were contained in the 
Balanced Budget Act of 1997, BBA. With the BIPA provision, Congress 
recognized that the funding cuts in the BBA could severely undermine 
health care safety net services throughout our Nation. These payments 
help reimburse hospitals' costs of treating Medicaid patients, 
particularly those with complex medical needs, and make it possible for 
communities to care for those who lack

[[Page S3901]]

health coverage. At a time when our Nation's uninsured rate continues 
to climb above 40 million, it makes little sense to be reducing much 
needed Medicaid DSH payments to safety net hospitals.
  Hospitals in Rhode Island will absorb approximately $400 million in 
reductions as a result of changes made to the Medicare and Medicaid 
programs in the BBA. Nine out of fifteen hospitals in my State had 
operating loses in Fiscal Year 2002. After the BBA was enacted, it was 
predicted that cuts in Federal Medicare and Medicaid payments would 
cost hospitals in Rhode Island $220 million over five years; however, 
this estimate has proven to be about $180 million off the mark. Every 
other State is experiencing similar problems. According to the American 
Hospital Association, hospitals lost almost $10 million on Medicaid and 
uninsured patients in 2000. This translates into an estimated loss of 
more than $42 million over five years. Clearly, more needs to be done 
to keep our vulnerable safety net hospitals from continuing on this 
downward spiral.
  This legislation represents a common-sense approach that will help 
prevent the further weakening of our Nation's safety net hospitals and 
the long-term viability of our health care system.
  I urge my colleagues to join me in supporting this important 
legislation, and ask unanimous consent that the text of legislation be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 652

       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 ``Access to Hospitals Act of 
     2003''.

     SEC. 2. CONTINUATION OF MEDICAID DSH ALLOTMENT ADJUSTMENTS 
                   UNDER BIPA 2000.

       (a) In General.--Section 1923(f) of the Social Security Act 
     (42 U.S.C. 1396r-4(f))--
       (1) in paragraph (2)--
       (A) in the heading, by striking ``through 2002'' and 
     inserting ``through 2000'';
       (B) by striking ``ending with fiscal year 2002'' and 
     inserting ``ending with fiscal year 2000''; and
       (C) in the table in such paragraph, by striking the columns 
     labeled ``FY 01'' and ``FY02'';
       (2) in paragraph (3)(A), by striking ``paragraph (2)'' and 
     inserting ``paragraph (4)''; and
       (3) in paragraph (4), as added by section 701(a)(1) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (as enacted into law by section 
     1(a)(6) of Public Law 106-554)--
       (A) by striking ``for fiscal years 2001 and 2002'' in the 
     heading;
       (B) in subparagraph (A), by striking ``Notwithstanding 
     paragraph (2), the'' and inserting ``The'';
       (C) in subparagraph (C)--
       (i) by striking ``No application'' and inserting 
     ``Application''; and
       (ii) by striking ``without regard to'' and inserting 
     ``taking into account''.
       (b) Increase in Medicaid DSH Allotment for the District of 
     Columbia.--
       (1) In general.--Effective for DSH allotments beginning 
     with fiscal year 2003, the item in the table contained in 
     section 1923(f)(2) of the Social Security Act (42 U.S.C. 
     1396r-4(f)(2)) for the District of Columbia for the DSH 
     allotment for FY 00 (fiscal year 2000) is amended by striking 
     ``32'' and inserting ``49''.
       (2) Construction.--Nothing in paragraph (1) shall be 
     construed as preventing the application of section 1923(f)(4) 
     of the Social Security Act (as amended by subsection (a)) to 
     the District of Columbia for fiscal year 2003 and subsequent 
     fiscal years.
       (c) Effective Date.--The amendments made by this section 
     shall apply to DSH allotments for fiscal years beginning with 
     fiscal year 2003.
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