[Congressional Record Volume 152, Number 119 (Thursday, September 21, 2006)]
[Senate]
[Pages S9860-S9861]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      PHYSICIAN MEDICARE PAYMENTS

  Ms. STABENOW. Mr. President, I rise today to urge my colleagues to 
come together to pass an update of the physician Medicare payments and 
to stop what will be over a 5-percent cut that will take place in 
January if we do nothing.
  We need to have a sense of urgency about this issue. Eighty Senators 
on both sides of the aisle--80 out of 100--came together and signed a 
letter to our leader asking that a positive Medicare payment update for 
2007 happen before the Senate adjourns. Senator Reid spoke on the floor 
in support of that effort. I urge our Senate leader to come to the 
floor, and in the final days of the session before we break for the 
elections do what 80 people in this Senate--80 Senators out of 100--
have come together and agreed physicians must be provided, which is a 
positive Medicare payment update for 2007.
  I am deeply concerned that after the election we may or may not have 
the focus in order to be able to get that done before the end of the 
year. It is vital not just to physicians but to the people we 
represent--the seniors, people with disabilities--that we get this 
done. Eighty Senators out of 100 have sent a letter to our two Senate 
leaders and have urged that we act now. Senator Reid has indicated his 
support for doing that. We need our Senate leader to bring this to the 
floor so we can get it done.
  I joined these 80 Senators in sending that letter in July because we 
know that if we don't provide even a minimum update, we destabilize the 
Medicare system and put all patient access to health care at risk. That 
is not an understatement.
  There needs to be a tremendous sense of urgency about this issue. 
What has happened since July 17 when we sent the letter? Nothing. There 
has been no committee hearings, no markups--despite 80 Senators 
agreeing that we have a need to provide a minimum update for physician 
services. There has been no effort by the majority leader to bring this 
issue to the floor. We have had no willingness to bring up an issue 
that has incredible significance to tens of millions of Americans all 
across our country.
  I am here this morning because we have only 7 days or 8 days--
whatever the number is--left before we adjourn for the elections. We 
don't know what will be happening after that. We certainly know there 
are many critical issues left and much to be done. The appropriations 
process isn't completed. There are many items on the agenda after the 
election. It is very uncertain what will be happening. We know that 
right now we can get it done. We do know with certainty that come 
January there is going to be a 5-percent cut for physicians and fewer 
physicians being able to care for our seniors and people with 
disabilities if we do not act.
  With 80 people urging that we act, this should be a simple process. 
This should be, as they say, a no-brainer to bring this to the floor 
and simply get it done. We need to do something today. There is no 
reason not to do this today. We can get it done quickly. Eighty 
Senators wrote:

       The undersigned Members respectfully urge you to ensure 
     that these impending cuts are addressed before Congress 
     adjourns. At a minimum, we must provide physicians with a 
     positive Medicare payment update for 2007.

  So we have the critical mass necessary to get this approved. The 
change we are seeking in law directly tracks MedPAC's recommendation 
for what the physician payment update should be for 2007. So we have a 
solid policy. We have an overwhelming majority of Senators, based on 
solid policy, and we know if we don't make this change, our seniors and 
people with disabilities are going to lose access to their doctors.
  We know from a recent survey conducted by the AMA that if the 
scheduled cuts go into effect, 45 percent of doctors will decrease the 
number of Medicare patients they accept. Fifty percent of doctors will 
defer the purchase of health information technology which, I might add, 
is an area where we, under our budget jurisdictions for Medicare and 
Medicaid and other health care programs, will reap huge savings, 
hundreds of billions of dollars with health information technology. But 
you cannot tell a physician who is trying to make ends meet to be able 
to continue to serve people that, by the way, we are going to cut your 
payments coming in, but we want you to buy new hardware and software 
and train people and do all of these other things so that the Federal 
Government can save dollars. It doesn't make any sense.
  We also know that 37 percent of doctors practicing in rural 
communities--and in my great State of Michigan, we have a huge, 
beautiful rural part of our State. I grew up in one of those small 
towns, in Clare, in the northern low peninsula.
  I understand about access to physicians and access to health care. We 
know that 37 percent of doctors practicing in rural communities will be 
forced to discontinue rural outreach, and 43 percent of physicians will 
decrease the number of new TRICARE patients they serve. So we clearly 
have a need.
  Also, we know that when we cut payments, whether it is to physicians, 
hospitals, home health care agencies, or nursing homes, we do not 
really save any money. We just create more people who cannot get the 
care they need when they need it. And what happens? They walk into the 
emergency room sicker than they should be. They get the care they need. 
Our hospitals provide that care. But then they have to recoup those 
costs, so they roll those costs over to everybody with insurance. In a 
State with a huge manufacturing base, with employers that provide 
health care, this goes right on their backs. Businesses large or small 
end up seeing their health insurance rates go up. So the private sector 
ends up paying for all of these expenses, and it does not save money to 
cut physicians' payments or other Medicare or Medicaid payments, either 
one, because then the private sector has to look for ways to cut. They 
ask working people and their families to pay more for health care or 
they cut the kind of health insurance they have. What happens? More 
people walk into the emergency room. This happens every day.
  What are we waiting for? We have 7, 8 days left. We have a clear 
problem and a clear solution and a clear majority of Senators who want 
to see this fix happen.
  Over 20,000 M.D.s and D.O.s in Michigan provide more than 1.4 million 
seniors and people with disabilities in Michigan with high-quality 
medical

[[Page S9861]]

services under the Medicare Program. Our Michigan families get 
wonderful care from wonderful doctors. Our American families receive 
wonderful care from wonderful doctors. But the question is, Will they 
be able to continue to receive those services? I would argue, not 
unless we do something now about the payment system used to reimburse 
physicians for Medicare services.
  Beginning January 1, 2007, the Medicare sustainable growth rate 
formula will cut payments to physicians and health care professionals 
by 5.1 percent. What does that mean in real dollars? In Michigan alone, 
it is $137 million in cuts to Medicare. The average cut for a physician 
in Michigan will be $34,000. As medical costs go up--as we see the cost 
of sustaining an office and other costs and medicine going up, 
everything is going up--we are cutting back on the physicians' 
reimbursements. These cuts will be particularly devastating for primary 
care doctors, the very doctors, according to the Medicare Payment 
Advisory Commission, MedPAC, many Medicare beneficiaries rely on for 
important health care management.
  Again, we are scheduled to adjourn in 7 days. It is time to resolve 
this issue so that our physicians know they are going to be able to 
continue to care for Medicare patients come January.
  This is not a new issue. MedPAC considers the Medicare SGR formula a 
flawed, inequitable mechanism for controlling the volume of services 
and first recommended repeal of the Medicare SGR formula in 2001. Since 
then, they have consistently recommended repealing the formula. I have, 
in fact, put forward a bill that would do that and set up a physicians 
commission to recommend what should be done. We don't have time for 
that between now and the end of the year, but we do have time to do 
what needs to be done in the next 7 days, which is to stop the cut that 
is scheduled to take effect in January. We need to stop that, and 
instead of a freeze that was given last year, we need to give a modest 
update for our physicians so they will know that we understand how 
important their services are to seniors and people with disabilities.
  In conclusion, I wish to share a couple of letters I have received. I 
have received so many letters from physicians around Michigan 
expressing grave concern. These are people who care very much about the 
people they serve. They are trying to keep it together so they can 
continue to serve people, whether it is in Detroit, Lancing, or Grand 
Rapids, up north, in the upper peninsula.
  I received a letter from a physician in Cheboygan, MI, which is a 
small town on the lower tip of the northern peninsula. Timothy M. 
Burandt, D.O. in surgery, wrote me a letter that says:

       In 1982, I graduated from medical school and took an oath 
     to care for all patients in need. As a general surgeon 
     practicing in rural northern Michigan, I am committed to 
     caring for all of my neighbors, not just those with 
     insurance.
       My expenses keep going up as I also have a responsibility 
     to my staff to support them with fair wages and benefits.
       Without adequate reimbursement, I cannot continue to offer 
     my services to everyone who walks through my door. There 
     simply aren't enough resources. Please don't force me to 
     choose which patients I should care for. I would rather 
     retire early and close the practice.

  I don't want Dr. Burandt to have to close his practice in Cheboygan, 
MI. The families in Cheboygan, MI, cannot afford for him to close his 
practice, and there is no excuse for us not to act so he doesn't have 
to.
  Also, Tara Eding, a doctor of internal medicine in Hamilton, MI, 
writes:

       It will be very difficult to remain in practice as 
     internist. The majority of my practice (including 3 other 
     partners) is made up of Medicare patients. It is already 
     difficult to maintain a primary care practice in this field. 
     We have recently had to ``trim'' overhead by cutting staff, 
     restricting our services, etc. and I only see things getting 
     worse. If these cuts are made it will drive us out of 
     practice.
       I have already stopped accepting new Medicare patients and 
     if these cuts go through I will not have a choice. I will be 
     forced to stop participating in one way or another. We would 
     not be able to keep our practice open as it exists today.

  There is a sense of urgency in these letters. There is a sense of 
urgency that we need to feel on the floor of the Senate. We have 80 
people in this body on both sides of the aisle who have called on our 
leaders to act. We have a sound policy, we have a sense of urgency, and 
we have time to get this done in the next few days.


                   Unanimous Consent Request--S. 1547

  Mr. President, I ask unanimous consent that the Finance Committee be 
discharged from further consideration of S. 1574, a bill to provide for 
a minimum update for physician services under Medicare, and that the 
Senate proceed to its immediate consideration; that the amendment at 
the desk to strike the language pertaining to an update for 2006 be 
considered and agreed to; that the bill, as amended, be read three 
times, passed, and the motion to reconsider be laid upon the table, 
without intervening action or debate.
  The ACTING PRESIDENT pro tempore. Is there objection? The Senator 
from Idaho.
  Mr. CRAIG. It is necessary that we object. The Senator from Michigan 
makes a tremendously valuable point. I hope the Senate does the right 
thing after we come back from the recess for the elections in November 
to deal with this critical issue which deals with our doctors and 
Medicare, but at this moment in time, I have to object to proceeding.
  The ACTING PRESIDENT pro tempore. Objection is heard.
  The minority time for morning business has expired.
  The ACTING PRESIDENT pro tempore. The Senator from Colorado.

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