[Congressional Record Volume 154, Number 107 (Thursday, June 26, 2008)]
[Senate]
[Pages S6222-S6223]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         MEDICARE IMPROVEMENTS

  Mr. HATCH. I wish to say a few words about why I oppose the cloture 
motion on the motion to proceed on H.R. 6331, the Medicare Improvements 
for Patients and Providers Act. As I said last week when we were 
considering the cloture motion on the Baucus Medicare bill, my goal is 
to have bipartisan legislation signed into law by the President on July 
1. Let me be clear, I wish to continue to work with my colleagues on 
the other side of the aisle in order to get this done. We were so close 
to an agreement in the Senate earlier in the week, but after the House 
voted on Tuesday, those discussions basically stopped, although we can 
put this together in 10 minutes if we work in a bipartisan way.
  To be honest, the House Medicare bill, H.R. 6331, contains many 
provisions that both sides strongly support. These provisions include 
restoring Medicare reimbursement rates for physicians so their Medicare 
payments are not reduced by 10.6 percent on July 1.
  Let me be clear, no one wants to cut Medicare reimbursements for 
doctors. We want Medicare beneficiaries to continue to have access to 
high-quality health care and the ability to see their own doctors.
  There is not just one Medicare bill. The Baucus Medicare bill; the 
Grassley Medicare bill, which I cosponsored; and H.R. 6331 all include 
provisions to restore physician payments. All three bills include 
provisions on e-prescribing. Mandatory e-prescribing will significantly 
reduce medical errors, thus protecting beneficiaries.
  Another issue that has overwhelming support is the delay of the 
competitive bidding program. I was a member of the House-Senate 
conference committee on the Medicare Modernization Act of 2003. Even 
back then, Senator Grassley and I expressed grave concerns about the 
inclusion of the Medicare competitive bidding program. I worried about 
the impact it would have on small durable medical equipment companies, 
particularly those in rural areas. I am still concerned because there 
are many unanswered questions about the bidding process and how the 
winning bids were selected. If we do not come to an agreement by July 
1, this program will go into effect.
  A related issue that is included in all three Medicare bills is the 
elimination of the clinical lab competitive bidding program. There was 
broad support to repeal the clinical lab competitive bidding program as 
well.
  There are rural provisions included in all three bills that are very 
important to my home State of Utah, which has many rural areas.
  These provisions improve payments for sole community hospitals, 
critical access hospitals, and increase ambulance reimbursement rates 
in both rural and urban areas.
  All three bills include a policy to create a bundle payment system 
for end-stage renal disease, or ESRD, services

[[Page S6223]]

provided to kidney dialysis patients. They also provide positive 
composite rate updates for 2 years until the bundled payment system is 
created.
  All three bills include Medicare reimbursement for six kidney disease 
education sessions.
  All versions of the Medicare legislation also include an expansion of 
telehealth services to skilled nursing facilities, hospital-based renal 
dialysis, and mental health centers.
  So as one can see, we agree on most all the issues. Unfortunately, 
there is one issue where we do not agree, and it is standing in the way 
of getting this legislation signed into law.
  H.R. 6331, the House Medicare bill, and the Baucus Medicare bill, 
include provisions that would reform the Medicare Advantage Program in 
a way that is unacceptable to both the White House and many of us who 
support the Medicare Advantage Program and I believe 90 percent of the 
people who do support that program.
  In 2003, I sat through hours of negotiations with administration 
officials, House Members, and Senate colleagues for days, weeks, and 
months, including Finance Committee Chairman Baucus, to create the 
Medicare Advantage Program to the Medicare Modernization Act of 2003. 
Let me remind my colleagues, before 2003, the Medicare Advantage 
Program, then known as Medicare+Choice, was not working very well, 
especially in rural parts of our country because the Medicare payments 
were too low. The Medicare+Choice plans serving Utah simply left 
because they were in the red. They were not making money and, as a 
result, Utah Medicare beneficiaries could only be covered by 
traditional Medicare.
  Through the MMA, we finally figured out how to provide choice to 
Medicare beneficiaries in both rural and urban areas. Medicare 
beneficiaries in Utah now have a choice in Medicare coverage they did 
not have before the MMA was implemented.
  The biggest difference between the bill before us today and the 
Grassley Medicare bill is the House Medicare bill, if signed into law, 
will no longer allow private fee-for-service plans to deem. You are 
probably asking: What on Earth is deeming? It is quite simple.
  Deeming allows beneficiaries who have opted for private fee-for-
service plans the ability to see any Medicare provider because these 
plans do not have to establish networks.
  Private fee-for-service plans have provide coverage options to 
Medicare beneficiaries living in rural areas who previously did not 
have choice. In other words, the ability to deem has been especially 
important in rural areas, where it is difficult for network-based plans 
to persuade providers to contract with them and for employer groups 
that provide coverage for retirees living in areas across the country.
  The elimination of deeming could be the elimination of health care 
coverage choices for beneficiaries living in rural areas.
  It could also cause certain retirees to lose their health care 
coverage because employer health plans that provide coverage in all 50 
States will cease to exist because they cannot establish networks.
  My friends who support this bill will argue they are not cutting the 
Medicare Advantage Program by eliminating deeming. They also will try 
to say that the elimination of deeming will not have an impact on 
health care choices offered to beneficiaries living in rural areas.
  I have already been told by one employer in Utah that this provision 
will force them to stop offering health care coverage to almost 12,000 
retirees--12,000 retirees. I am worried it could hurt coverage for 
beneficiaries in rural areas as well. Quite honestly, we do not know 
the full impact of this specific policy.
  Therefore, I simply cannot support a provision that eliminates 
deeming for private fee-for-service plans, and that is one of the 
reasons I am going to vote against cloture.
  We must vote against cloture in order to ensure we can begin work on 
a bipartisan bill that will be signed by the President. We do not need 
to be wasting our time going back and forth on bills that do not have a 
chance of becoming law.
  Trust me, this bill will not be signed into law because, while the 
take-it-or-leave-it attitude may work over in the House, it does not 
work in the Senate.
  I urge my colleagues to vote against cloture so we may begin work on 
a bipartisan bill that will continue to protect choice of coverage for 
all beneficiaries--and I think that work would take all of 10 minutes--
including those living in urban and rural areas and those who are 
covered through an employer retirement plan.

  This motion must be defeated so we can prove to Medicare 
beneficiaries, Medicare providers, and our House colleagues that 
bipartisanship is alive and well in the Senate and that we are willing 
to keep working on this bill until we get it right.
  The PRESIDING OFFICER (Mr. Sanders). The majority leader.

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