[Congressional Record Volume 153, Number 145 (Thursday, September 27, 2007)]
[Senate]
[Pages S12255-S12258]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       MAKING CONTINUING APPROPRIATIONS FOR THE FISCAL YEAR 2008

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to the consideration of H.J. Res. 52, which the clerk will 
report.
  The bill clerk read as follows:

       A joint resolution (H.J. Res. 52) making continuing 
     appropriations for the fiscal year 2008, and for other 
     purposes.

  The Senate proceeded to consider the joint resolution.


               extending the medicare section 508 program

  Mr. SPECTER. Mr. President, Senator Casey  and I, along with our 
colleagues, Senators Stabenow, Conrad, Lautenberg, Schumer and Dorgan, 
filed an amendment to H.J. Res. 52, the appropriations continuing 
resolution for fiscal year 2008, to extend the Medicare section 508 
program for 2 years. For a considerable period of time, there have been 
a number of hospitals in Pennsylvania and across the country that have 
been suffering from low Medicare wage index reimbursement, which has 
caused them great disadvantage in comparison to surrounding areas. 
Hospitals in these counties are surrounded by MSAs--metropolitan 
statistical areas--with higher Medicare reimbursements, and as a 
result, a flight of critical medical personnel occurs as hospitals are 
not able to provide employees with competitive wages.
  During the consideration of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003, I met with Finance 
Committee chairman Charles Grassley and ranking member Max Baucus about 
the bill provisions, including the need for a solution to the Medicare 
area wage index reclassification problem in Pennsylvania. Section 508 
was included in the bill, which provided $300 million per year for 3 
years to increase funding for hospitals nationally to be reclassified 
to locations with higher Medicare reimbursement rates. As part of the 
Tax Relief and Health Care Act, which was signed into law on December 
20, 2006, a 6-month extension of the section 508

[[Page S12256]]

Medicare wage index program until September 30, 2007, was included.
  Mr. CASEY. I thank my colleague, Senator Specter, for his important 
work over the years on this issue, and I greatly appreciate our 
collaboration since I have taken office to find both an immediate and a 
long-term solution to the wage index problem. This issue is critical to 
ensuring that health care is available to Pennsylvanians and all 
Americans in areas that are being underfunded by the Medicare wage 
index reimbursement system. Further complicating this issue are the 
exceptions to the Medicare wage index regulations. Since 1987, 
exceptions have been created to the wage index program for rural 
facilities, new facilities and others. In fact, in 1999, Congress 
passed legislative reclassifications for specific hospitals to allow 
selected facilities to move to a new MSA and receive greater Medicare 
reimbursement. While these reclassifications have improved funding for 
those hospitals, hospitals that did not receive improved funding are 
being further disadvantaged.
  Mr. CONRAD. I, too, want to lend my support for a 2-year extension of 
the Medicare section 508 hospital program. As the chairman and ranking 
member well know, I worked within the Finance Committee during the 
Medicare Modernization Act to create this vital program. For too long, 
Medicare has shortchanged Rural States, like North Dakota, in the wage 
index formula by not accurately reflecting real wages. Furthermore, the 
reclassification system has been biased towards urban areas and has 
failed to take into account the rural health care system experience 
where service areas overlap and facilities routinely compete across 
several hundreds of miles for professional staff. The section 508 
program has helped to somewhat level the playing field for these 
hospitals--allowing them to improve their wages and make other 
significant investments--but its continuation is critical to ensuring 
the financial viability of many hospitals in North Dakota. The Congress 
must pass Medicare legislation this fall that includes a 2-year 
extension of the section 508 program.
  Mr. BAUCUS. I appreciate the leadership my colleagues have shown on 
this important issue. Extending the section 508 program is a priority 
of the Finance Committee. Unfortunately, an agreement could not be 
reached to include this provision in this bill.
  Mr. GRASSLEY. I thank my colleagues for introducing this amendment. 
This program provides vital funding for many hospitals including those 
in Iowa, and I was very disappointed that the House blocked our attempt 
to extend this program. It is unfortunate. Extending this program, 
however, does not address fundamental problems related to the wage 
index system. As mandated under the Tax Relief and Health Care Act of 
2006, the Medicare Payment Advisory Commission, MedPAC, released their 
report examining an alternative Medicare wage index methodology. The 
legislation also requires the Secretary of Health and Human Services to 
propose revisions to the wage index in the fiscal year 2009 Medicare 
hospital inpatient prospective payment system proposed rule. I look 
forward to considering this proposal as we continue our work to make 
Medicare hospital payments more equitable.
  Ms. STABENOW. I also wish to thank Senators Specter and Casey for 
raising this issue. We have worked together to ensure the continuation 
of 508 while we work to ensure that Medicare reimbursement more 
adequately reflects our hospitals' true costs. Section 508 funding has 
provided crucial assistance to a number of hospitals in my State, 
although I note that there are still inequities in the reimbursement 
system that must be corrected.
  Mr. SCHUMER. Mr. President, I am, like my colleagues, strongly in 
favor of extending the section 508 program. This is a critical program 
for some New York hospitals, and I appreciate the chairman's commitment 
to include the extension in future Medicare legislation.
  Mr. LAUTENBERG. I would also like to thank the chairman and ranking 
member for their leadership on this issue and Senators Specter and 
Casey for their continued support. Without an extension of the section 
508 program, hospitals in New Jersey stand to lose over $22 million. 
These hospitals cannot afford to sustain this loss and still provide 
the care needed to New Jersey residents. I look forward to working with 
my Senate colleagues to provide an extension of this important program.
  Mr. DORGAN. I thank Senators Specter and Casey for raising this 
issue. Extending the section 508 program is critical for many North 
Dakota hospitals and is an important step to address the long-standing 
inequities in Medicare payment between urban and rural providers. I 
appreciate the commitment of the chairman and ranking member of the 
Finance Committee and look forward to working with them to see that 
this extension is enacted.
  Mr. CASEY. I thank the chairman and ranking member of the Finance 
Committee for their support on this issue. The House of Representatives 
has already moved forward to pass legislation that would extend this 
program. This program is scheduled to expire on September 30, 2007, and 
action to extend the program for 2 years must be taken. Mr. Chairman, I 
appreciate our conversations about this issue in which you expressed 
your commitment to working to pass an extension to the section 508 
Medicare wage index program this fall that will also make hospitals 
whole to the date of expiration.
  Mr. SPECTER. I understand that the Senate is likely to take up 
legislation which will include a number of Medicare provisions during 
this session of Congress. I would appreciate the assurance of the 
chairman and ranking member of the Finance Committee that any Medicare 
related legislation that is considered by the Senate this session 
include a 2-year extension of the section 508 program that is 
retroactive to October 1, 2007.
  Mr. BAUCUS. I assure my colleagues that I am committed to working to 
address concerns about this issue as part of any Medicare related 
legislation that may come before the Senate.
  Mr. GRASSLEY. I look forward to working with Chairman Baucus and 
other Finance Committee members to address this issue.
  Mr. SPECTER. I thank my colleagues and look forward to working with 
them on this issue.
  Mr. CASEY. I thank my colleagues as well and look forward to 
resolving this issue.


                                  eas

  Mr. CARDIN. Mr. President, with regard to the fiscal year 2008 
continuing resolution that the Senate is taking up today, I would like 
to pose a question to the Senators from West Virginia and Washington. 
It is my understanding that the Commerce Committee has drafted a bill 
to reauthorize the Federal Aviation Administration, FAA, and that bill, 
S. 1300, should reach the Senate floor this session. That bill includes 
language with regard to Essential Air Service, EAS, to extend the 
state-determined mileage waiver. I thank the Committee for its work on 
that provision as it affects an airport in my State, as well as 
airports in South Dakota and Pennsylvania. In the interim, I would like 
to clarify that it is the intention of the Appropriations and Commerce 
Committees that EAS support continue for the airports in Hagerstown, 
MD; Brookings, SD; and Lancaster, PA along with the other airports 
nationwide that will continue to receive EAS funding through the 
Continuing Resolution today. I would direct this question to the 
chairman of the Commerce Subcommittee on Aviation Operations, Safety & 
Security if it his intent to continue EAS support for airports in 
Hagerstown, MD; Brookings, SD; and Lancaster, PA?
  Mr. ROCKEFELLER. Yes. We do hope to pass the full FAA authorization 
this session, and it contains the EAS mileage waiver. In the interim, 
it is the intent of the Committee that EAS funding should continue to 
these airports.
  Mr. CARDIN. I would further like to get the views of the chairman of 
the Appropriations Subcommittee on Transportation, Housing and Urban 
Development, and Related Agencies on this matter.
  Mrs. MURRAY. This continuing resolution provides funding for the 
Essential Air Service program at the current rate with the expectation 
that the program shall continue to function as it is functioning now. 
We expect the Department of Transportation to avoid any major policy 
decisions that can impact

[[Page S12257]]

this program during the period of the continuing resolution--especially 
given the fact that there is already legislation reported out of 
committee and awaiting Senate action that addresses the continuation of 
air service to these communities.
  Ms. MIKULSKI. I commend my colleague from Maryland for addressing 
this issue. I am a member of the Appropriations Committee and I, too, 
understand that the Committee intends to continue EAS funding under the 
continuing resolution to airports in Maryland, South Dakota, and 
Pennsylvania that currently receive it.
  Mr. SPECTER. This issue also affects an airport in my home State, in 
Lancaster, PA. Based on the provisions in the full FAA authorization, I 
agree that it is the intent of the committee that EAS funding should be 
extended to the airports currently affected by the EAS state-
determination mileage waiver.
  Mr. JOHNSON. An airport in Bookings, SD, is also affected by the 
state-determination mileage waiver. So I am pleased to hear from all of 
my fellow appropriators that EAS funding should continue uninterrupted 
to the affected airports.
  Mr. CARDIN. I thank all of my colleagues--both those responsible for 
the FAA reauthorization and those responsible for appropriating the 
funding for EAS--for making it clear that they expect the airports in 
Hagerstown, Lancaster, and Bookings to receive EAS funding under the 
continuing resolution.
  Mr. FEINGOLD. Mr. President, I am disappointed that we are about to 
begin the 2008 fiscal year without having enacted any of the 
appropriations bills for that year. I am even more disappointed that we 
are about to vote on a continuing resolution that provides tens of 
billions of dollars to continue the misguided war in Iraq but does not 
include any language to bring that war to a close. We need to keep the 
Federal Government operating and make sure our brave troops get all the 
equipment and supplies they need, but we should not be giving the 
President a blank check to continue a war that is hurting our national 
security. For that reason, I will be voting against this resolution.
  Mr. COCHRAN. Mr. President, I would like to take a moment to speak 
about the continuing resolution on which the Senate will soon vote. The 
resolution itself is a reasonable product that is largely the result of 
bicameral, bipartisan discussions. The resolution will allow the day-
to-day functions of our Government to continue and will provide at 
least some of the additional funding that is necessary for our troops 
in Iraq and Afghanistan to execute the mission with which they have 
been tasked. It is also worth noting that the resolution does not 
attempt to use its inherent leverage to force any significant or 
controversial policy changes. I urge my colleagues to support passage 
of the resolution.
  But as we come to the end of the fiscal year, I must express my deep 
concern about the lack of progress toward enacting the appropriations 
bills. This lack of progress is not the fault of the Appropriations 
Committee. Under Chairman Byrd's leadership, the committee reported all 
twelve bills in ample time to be considered by the full Senate over the 
course of the summer. But for whatever reason, to date the Senate has 
passed only four of the twelve regular appropriations bills, and 
prospects for consideration of the remaining bills appear uncertain at 
best.
  Last year, under Republican leadership, the Senate failed to send all 
but two of the appropriations bills to the President. We were roundly 
criticized for this, and rightly so. As a result we left Federal 
agencies to limp along on a continuing resolution for 5 months, and 
were then presented with a full-year, formula-driven joint funding 
resolution to which no Senator had an opportunity to offer amendments. 
That is a process that I hope will not be repeated. No Senator should 
want that.
  We simply need to buckle down and do our work. It is true that the 
President has said he will veto many of the appropriations bills based 
on his concerns about spending levels. It seems that there are people 
on both sides of the aisle and both ends of Pennsylvania Avenue who 
feel strongly about that question, and who are quite anxious to have 
that debate. But we can't have the debate if we don't call up the 
bills. The President can't veto what we haven't presented to him, and 
Congress can't vote to uphold or override a veto that never gets 
executed.
  I understand that completing action on the remaining bills seems like 
a daunting task. But I know of no better way to complete such a task 
than to roll up our sleeves and get to work. I am pleased to hear the 
majority leader suggest that next week we will consider the Defense and 
the Commerce-Justice-Science appropriations bills. This is good news. I 
urge my colleagues to offer their amendments promptly when these bills 
are called up and to recognize that the opportunity to offer amendments 
to the subsequent bills is dependent on completing action on the 
pending bills.
  It is particularly critical that we complete action on the Defense 
appropriations bill and the supplemental appropriations necessary to 
support the men and women in our Armed Forces and our diplomatic corps. 
While I am encouraged that we may consider the regular Defense 
appropriations bill next week, I am seriously concerned about reports 
that Congress may not consider a supplemental appropriations bill for 
the global war on terror until next year. While the continuing 
resolution we will pass tonight contains some ``bridge'' funding to 
support the troops through November 16, is an inadequate amount for the 
longer term.
  As directed by Congress, the President submitted an FY 2008 war 
supplemental request in February. We expect to receive an amendment to 
that request any day. The Appropriations Committee held a hearing on 
these requests on Wednesday, and should be prepared in short order to 
act on legislation to fund our troops in the field. Delaying 
consideration of such legislation until next year is simply 
unacceptable. We have spent the last 2 weeks, and much of this 
Congress, in earnest and often useful debate on Iraq war policy. 
Amendments have been offered and votes have been taken. Deeply felt 
disagreements remain.
  But the fact is that we have tens of thousands of American men and 
women in Iraq and Afghanistan performing the mission that their 
Government has assigned to them. The new fiscal year is upon us, and it 
is time for us to get on with the business of providing our men and 
women in uniform the resources they need to perform that mission 
successfully. To try to change American policy in Iraq by slowly 
starving our troops of those resources is unfair, and it is dangerous 
to American interests.
  I urge the Senate to both forge ahead to complete action on the 
regular appropriations bills and to act promptly to provide our troops 
with the supplemental funds that they need.
  Mr. COBURN. Mr. President, I ask for the yeas and nays.
  Mr. SANDERS. Is there a sufficient second? There appears to be a 
sufficient second.
  The question is on the third reading of the joint resolution.
  The PRESIDING OFFICER. The joint resolution having been read the 
third time, the question is on passage of the joint resolution.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Delaware (Mr. Biden), 
the Senator from New York (Mrs. Clinton), and the Senator from Illinois 
(Mr. Obama) are necessarily absent.
  Mr. LOTT. The following Senators are necessarily absent: the Senator 
from Kansas (Mr. Brownback) and the Senator from Arizona (Mr. McCain).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 94, nays 1, as follows:

                      [Rollcall Vote No. 355 Leg.]

                                YEAS--94

     Akaka
     Alexander
     Allard
     Barrasso
     Baucus
     Bayh
     Bennett
     Bingaman
     Bond
     Boxer
     Brown
     Bunning
     Burr
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Coburn
     Cochran
     Coleman
     Collins
     Conrad
     Corker
     Cornyn
     Craig
     Crapo
     DeMint
     Dodd
     Dole
     Domenici
     Dorgan
     Durbin
     Ensign
     Enzi
     Feinstein
     Graham
     Grassley
     Gregg
     Hagel
     Harkin
     Hatch
     Hutchison
     Inhofe
     Inouye
     Isakson
     Johnson
     Kennedy
     Kerry
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     Levin

[[Page S12258]]


     Lieberman
     Lincoln
     Lott
     Lugar
     Martinez
     McCaskill
     McConnell
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Roberts
     Rockefeller
     Salazar
     Sanders
     Schumer
     Sessions
     Shelby
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Sununu
     Tester
     Thune
     Vitter
     Voinovich
     Warner
     Webb
     Whitehouse
     Wyden

                                NAYS--1

       
     Feingold
       

                             NOT VOTING--5

     Biden
     Brownback
     Clinton
     McCain
     Obama
  The joint resolution (H.J. Res. 52) was passed.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Mr. President, I move to reconsider the vote and I move to 
lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. REID. I ask unanimous consent to withdraw the order that relates 
to Senator Menendez on this matter.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. I also ask unanimous consent that the next votes be 10-
minute votes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________