[Congressional Record Volume 151, Number 106 (Friday, July 29, 2005)]
[Senate]
[Pages S9494-S9496]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. CANTWELL (for herself, Mr. Bingaman, Mr. Rockefeller, Mrs. 
        Lincoln, Mrs. Murray, and Mr. Corzine):
  S. 1574. A bill to amend title XVIII of the Social Security Act to 
provide for a minimum update for physicians' services for 2006 and 
2007; to the Committee on Finance.

[[Page S9495]]

  Ms. CANTWELL. Mr. President, I am proud to rise today with my 
colleagues Senators Bingaman, Rockefeller, Lincoln, Murray and Corzine 
to introduce the ``Affordable Access to Medicare Providers Act.''
  Securing access to affordable healthcare, especially for our Nation's 
seniors, is critical and it remains to be one of my top priorities. 
Access to healthcare is impacted by two key factors: we must have 
enough well qualified healthcare providers that are willing and able to 
accept Medicare patients, and the beneficiaries must be able to afford 
the premiums required to utilize their Medicare benefits. This bill 
addresses both of these issues--it will provide some stability in 
physician Medicare payment rates so that physicians can continue to 
offer high quality healthcare services while ensuring that the Medicare 
beneficiaries are not saddled with the cost and even higher premiums 
for physicians services.
  Medicare was written to cover the most basic health care for seniors. 
When the original bill passed in 1965, the legislation's conference 
report explicitly stated that the intent of the program is to provide 
adequate ``medical aid . . . for needy people, and should ``make the 
best of modem medicine more readily available to the aged.''
  While the Medicare Modernization Act provided some improvements such 
as: It also had some unfortunate consequences on the Medicare 
beneficiaries in Washington State. Medicare payments per beneficiary 
will be further exacerbated and continue to penalize Washington state 
for our efficient healthcare system. Fifty-seven percent of Washington 
state physicians are limiting or dropping Medicare patients from their 
practices. Washington falling to 45th in the Nation on reimbursements 
will not help the situation.
  A survey conducted by the Medicare Payment Advisory Council, MedPAC, 
found that 22 percent of patients already have some problems finding a 
primary care physician and 27 percent report delays getting an 
appointment. Physicians are the foundation of our Nation's health care 
system. Continual cuts, or even the threat of repeated cuts, put 
Medicare patient access to physicians' services at risk. They also 
threaten to destabilize the Medicare program and create a ripple effect 
across other programs. Indeed, Medicare cuts jeopardize access to 
medical care for millions of our active duty military family members 
and military retirees because their TRICARE insurance ties its payment 
rates to Medicare.
  Now we are told by the Medicare board of Trustees that if Congress 
does not act by the end of the year, the Medicare physician payment 
formula will likely produce a 4.3 percent decrease next year with 
similar reductions to follow in the years to come. The Medicare Board 
of Trustees also estimates that the cost of providing medical care will 
increase by an estimated 15 percent over the next six years, while 
current reimbursement levels are scheduled to drop by an estimated 26 
percent over the same time period.
  After adjusting for inflation, Medicare payments to physicians in 
2013 will be less than half of what they were in 1991. That declining 
reimbursement rate would likely mean a growing percentage of family 
physicians would decline to see new Medicare patients and, as a result, 
access to care would suffer.
  Washington stands to lose $39 million in 2006 and 1.9 billion from 
2006-2014 if these cuts go through. For physicians in Washington, the 
cuts over this period will average $13,000 per year for each physician 
in the State.
  The American Medical Association conducted a survey of physicians in 
February and March 2005 concerning significant Medicare pay cuts from 
2006 through 2013 (as forecast in the 2004 Medicare Trustees report). 
Results from the survey indicate that if the projected cuts in Medicare 
physician payment rates begin in 2006: more than a third of physicians 
(38 percent) plan to decrease the number of new Medicare patients they 
accept; more than half of physicians (54 percent) plan to defer the 
purchase of information technology, which is necessary to make value-
based purchasing work; a majority of physicians (53 percent) will be 
less likely to participate in a Medicare Advantage plan; about a 
quarter of physicians plan to close satellite offices (24 percent) and/
or discontinue rural outreach services (29 percent) if payments are cut 
in 2006. If the pay cuts continue through 2013, close to half of 
physicians plan to close satellite offices (42 percent) and/or 
discontinue rural outreach (44 percent); and one-third of physicians 
(34 percent) plan to discontinue nursing home visits if payments are 
cut in 2006. By the time the cuts end, half (50 percent) of physicians 
will have discontinued nursing home visits.
  Physicians can simply not absorb cuts these cuts and still deliver 
high quality care. We must ensure our doctors have the resources they 
need to ensure that our seniors have access to their physicians.
  There have been efforts made to address the physician payment issue 
however; they have not addressed the impact on Medicare beneficiaries 
and their premiums. I'm concerned some of the proposals would result in 
an additional burden being placed on the Medicare beneficiary by way of 
a $24 billion increase in part B premiums in 2006 and a $60 billion 
increase in 2007.
  This happens because by law, the monthly Part B premium is set at 25 
percent of the part B Trust Fund costs. Administrative or legal changes 
to increase physician payment rates that don't include a hold-harmless 
clause, increase Medicare part B expenditures and ultimately, the Part 
B premiums paid by beneficiaries.
  This is not a viable solution either as the beneficiaries are already 
being hit with premium increases and additional cost sharing due to 
implementation of the prescription drug benefit. For this reason, along 
with my colleagues, I have chosen to introduce legislation that 
provides the update for physician reimbursement rates but also holds 
the part B premiums harmless.
  I look forward to working my colleagues to pass this legislation to 
ensure that access to care for our seniors is preserved and enhanced.
  Mr. President, 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. 1574

       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 ``Affordable Access to 
     Medicare Providers Act of 2005''.

     SEC. 2. MINIMUM UPDATE FOR PHYSICIANS' SERVICES FOR 2006 AND 
                   2007.

       (a) Minimum Update.--
       (1) In general.--Section 1848(d) of the Social Security Act 
     (42 U.S.C. 1395w-4(d)) is amended by adding at the end the 
     following new paragraphs:
       ``(6) Update for 2006.--The update to the single conversion 
     factor established in paragraph (1)(C) for 2006 shall not be 
     less than 2.7 percent.
       ``(7) Update for 2007.--
       ``(A) In general.--The update to the single conversion 
     factor established in paragraph (1)(C) for 2007 shall not be 
     less than the product of--
       ``(i) 1 plus the Secretary's estimate of the percentage 
     change in the value of the input price index (as provided 
     under subparagraph (B)(ii)) for 2007 (divided by 100); and
       ``(ii) 1 minus the Secretary's estimate of the productivity 
     adjustment factor under subparagraph (C) for 2007.
       ``(B) Input price index.--
       ``(i) Establishment.--Taking into account the mix of goods 
     and services included in computing the medicare economic 
     index (referred to in the fourth sentence of section 
     1842(b)(3)), the Secretary shall establish an index that 
     reflects the weighted-average input prices for physicians' 
     services for 2006. Such index shall only account for input 
     prices and not changes in costs that may result from other 
     factors (such as productivity).
       ``(ii) Annual estimate of change in index.--The Secretary 
     shall estimate, before the beginning of 2007, the change in 
     the value of the input price index under clause (i) from 2006 
     to 2007.
       ``(C) Productivity adjustment factor.--The Secretary shall 
     estimate, and cause to be published in the Federal Register 
     not later than November 1, 2006, a productivity adjustment 
     factor for 2007 that reflects the Secretary's estimate of 
     growth in multifactor productivity in the national economy, 
     taking into account growth in productivity attributable to 
     both labor and nonlabor factors. Such adjustment may be based 
     on a multi-year moving average of productivity (based on data 
     published by the Bureau of Labor Statistics).''.
       (2) Conforming amendment.--Section 1848(d)(4)(B) of the 
     Social Security Act (42 U.S.C. 1395w-4(d)(4)(B)) is amended, 
     in the matter preceding clause (i), by striking ``and

[[Page S9496]]

     paragraph (5)'' and inserting ``paragraphs (5), (6), and 
     (7)''.
       (b) Exclusion of Costs From Determination of Part B Monthly 
     Premium.--Section 1839(g) (42 U.S.C. 1395r(g)) is amended--
       (1) in paragraph (1), by striking ``and'' at the end;
       (2) in paragraph (2), by striking the period at the end and 
     inserting ``; and''; and
       (3) by adding at the end the following new paragraph:
       ``(3) the application of the amendments made by section 
     2(a) of the Affordable Access to Medicare Providers Act of 
     2005 (relating to a minimum update for physicians' services 
     in 2006 and 2007).''.
                                 ______