[Congressional Record Volume 154, Number 108 (Friday, June 27, 2008)]
[Senate]
[Pages S6310-S6311]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
KEY PROVISIONS OF H.R. 6331
Mr. CASEY. Mr. President, I rise this morning, prior to our break for
the Fourth of July holiday, to talk about Medicare and in particular
some of the activity on the floor in the last couple of weeks, but
especially last night.
I wanted to highlight some of the provisions of the Medicare
Improvements for Patients and Providers Act of 2008 because sometimes,
when something gets voted on here, whether it is the bill or a measure
to get us to the bill, it can go right by a lot of us and certainly can
go right by the American people without enough focus on some of the
provisions of the bill and some of the detail. I think it was a real
missed opportunity, and I will talk about that in a moment, but now
just some of the highlights.
First of all, with regard to physicians in America, the bill
eliminates the pending 10-percent cut in Medicare payments to
physicians for the remainder of 2008 and provides a 1.1-percent update
in Medicare physician payments for 2009. It provides a 2-percent
quality reporting bonus for doctors who report on quality measures
through 2010 and provides financial incentives to providers to
encourage the use of electronic prescribing technology.
I don't think anyone in America needs to be reminded of how important
this is, not just to make sure our Medicare system works well because
of the positive impact this could have on doctors, but also anything we
can do to encourage the use of information technology or other kinds of
technology to make our system more efficient and more safe is critical.
So that is one part of the physician section of this bill.
For hospitals in particular and especially in my home State of
Pennsylvania, there are so-called section 508 benefits. I will give a
quick summary of what that means.
This bill would extend 508 benefits to hospitals so they can continue
to pay doctors and other providers in accordance with wages from
surrounding areas. For northeastern Pennsylvania especially, this is a
critical provision.
Basically, and I am generalizing here, sometimes what happens is you
have regions of a State that are categorized or given definitions that
don't apply, and the reimbursement level goes down, and therefore the
wages are impacted and they have trouble recruiting skilled personnel
for positions in those hospitals. So we need a long-term fix for this
situation. What this bill would do is continue to extend some help we
have given in the past, but we do need a long-term fix, and we are
working on that. For now, we need to provide this wage assistance to
hospitals--and many hospitals in Pennsylvania have been hit hard by
this--so they do not lose critical personnel to surrounding areas. It
is a very competitive business, the business of recruiting qualified
medical personnel.
That is the physician section.
The second section--and I am going to review just two or three more--
the beneficiaries. There is a lot to talk about here, but this bill
adds a critical benefit for low-income older citizens, who are among
the most vulnerable Medicare beneficiaries. It extends and improves
low-income assistance programs for Medicare beneficiaries whose income
is below $14,040. This includes the so-called Qualified Individual
Program, which pays Part B premiums for low-income beneficiaries with
incomes between $12,480 and $14,040. This provision is important to
beneficiaries. The bill would increase the amount of assets low-income
beneficiaries can have and still qualify for financial help with
Medicare costs.
The Presiding Officer knows from his own work in the State of Ohio
and the people he represents that as we went through the farm bill, one
of the points we focused on with regard to food stamps was that some
people who get a benefit from food stamps were adversely affected
because things such as childcare expenses--so essential for a family--
were being included as part of their assets, and it made it harder for
them to get food stamp benefits. The same kind of principle is at stake
here, where too often the eligibility determinations for low-income
beneficiaries are unfair. This would improve that.
Another area I wish to talk about are pharmacies. The bill requires
Medicare to pay pharmacies on time--as they should anyway. Isn't that
an interesting provision? These pharmacies have to pay out on
prescriptions, and they need reimbursement quickly so they can stay in
business. Many of them are the only pharmacies serving their
communities in small towns.
When people think of my State, they think of big cities such as
Philadelphia or Pittsburgh or Erie or Scranton or Harrisburg or
Allentown. But in between, we probably have more small towns than most
States in the country. In those smaller communities, that pharmacy is
sometimes the only option for many families--and not just rural
families but many families who just live in small towns. It is
certainly reasonable to expect these pharmacies to be reimbursed within
14 days, and that is what this bill does. It forces the Federal
Government to do what it should do, which is to pay pharmacies on time.
Medicare Advantage. That is something we are going to be talking more
about, but that is a subject of significant debate in the country. This
bill deals with that issue directly. It also deals with rural providers
and other beneficiaries.
The bill protects access to care in rural America by extending and
building upon expiring provisions, including improving payments for
sole community hospitals, critical access hospitals, and ambulances. It
extends expiring provisions that preserve payment equity for rural
physicians and rural hospitals that run clinical laboratories.
I could go on from there, but I won't. This isn't just about some
Medicare concerns we have in our cities, this is about rural America
and access to care in rural America. And Pennsylvania has as much of a
rural population as virtually any State in the country. We are at least
in the top five, at last count.
So all of this is a way to summarize the bill and not do justice
necessarily to the detail of the bill. This was a bill that was worked
on here, worked on in the Finance Committee for many weeks, and worked
on in the House in consultation with the Senate. The chairman of the
Finance Committee, Max Baucus, and his team and people
[[Page S6311]]
on that committee worked very hard, and I will tell you, to have it
stopped, as so many things have been blocked around here--when I look
at the total votes, Democrats did their job. We voted, every one of us,
in unison to get this legislation moving forward. Yet, if you look at
the total, on this vote last night there were eight Republicans who
voted to move the bill forward.
When you consider what is at stake--I mean, we listened to the
arguments from the other side, but when you talk about making sure
physicians are treated fairly so they can treat older citizens in
Pennsylvania, Ohio, and across the country; when you talk about
reimbursement in the case of hospitals in northeastern Pennsylvania,
where they are competing for skilled personnel, yet we are not going to
move something forward that can help them on their wages so they can
have the best possible care for older citizens--in my home area of
northeastern Pennsylvania, we have the highest percentage of people
over 65 of anyplace in the country. We need help with this wage index
problem to recruit the best personnel.
When you talk about beneficiaries, these are very vulnerable low-
income beneficiaries, some of whom do not just have to worry about
their Medicare benefits, but they are standing in lines to get food
from food pantries. The Presiding Officer has talked about this a lot
over the last year. The price of everything in their lives has gone
up--gasoline and food, they are worried about Medicare, they are
worried about their children and their grandchildren. And we can't vote
to move something forward? It is outrageous that we have this split
where you get all these Democrats voting for it and only eight
Republicans.
Finally, when it comes to pharmacies and rural providers, my
goodness, if we can't move legislation forward to make sure the Federal
Government pays pharmacies within 14 days, what are we doing? We can't
get the votes to move forward.
People across America and families on Medicare are worried. They are
worried about Medicare and how it is going to impact their lives. I
want them to be aware of what happened here. Democrats voted in unison
to move this forward, to make these changes to the Medicare Program.
The other side did not. It is a very simple equation. I know we will
vote on this again, and I hope our colleagues on the other side, when
they consider what is at stake for rural America--for small towns
across the country and for very vulnerable people--I hope they would
take that into consideration and vote the right way for older citizens
and for those families.
I yield the floor. I suggest the absence of a quorum.
The ACTING PRESIDENT pro tempore. Will the Senator withhold his
request?
Mr. CASEY. I will withhold.
Mr. SESSIONS. Mr. President, may I be recognized?
The ACTING PRESIDENT pro tempore. The Senator from Alabama is
recognized.
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