[Congressional Record Volume 161, Number 101 (Tuesday, June 23, 2015)]
[Senate]
[Pages S4546-S4549]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. GRASSLEY (for himself and Mr. Gardner):
S. 1648. A bill to amend title XVIII of the Social Security Act to
create a sustainable future for rural healthcare; to the Committee on
Finance.
Mr. GRASSLEY. Mr. President, I come to the floor today to discuss a
bill I am introducing, the Rural Emergency Acute Care Hospital Act, or
REACH Act.
Since January 2010, 55 rural hospitals have closed their doors. It is
even more troubling that the pace of rural hospital closures appears to
be accelerating.
As you can see from this chart, the number of hospital closures has
increased each year over the past 5 years. These closures are creating
a health care crisis for hundreds of thousands of Americans across the
country.
The REACH Act will create a new rural hospital model under Medicare
that will enable struggling rural hospitals to keep their doors open
and maintain the most critical hospital service: emergency medicine.
When a rural hospital closes, the community loses the lifesaving
capabilities of the emergency room. According to the National
Conference of State Legislatures, 60 percent of trauma deaths in the
United States occur in rural areas. After a traumatic event, access to
an emergency room within 1
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hour can make a big difference between life and death.
Take, for example, Portia Gibbs from North Carolina. At 48, Portia
suffered a heart attack 75 miles from the nearest emergency room. She
later died while waiting for a helicopter to arrive that would have
taken her over the State line to Virginia, where the closest hospital
was located. If Portia's heart attack had occurred just 1 week earlier,
Portia would have been transported to a hospital in Belhaven, NC, just
30 miles away. Unfortunately, the facility in Belhaven had closed just
6 days before Portia's heart attack, citing insurmountable financial
struggles.
Then there is the tragic story of 18-month-old Edith Gonzalez who
choked on a grape in her hometown of Center, TX. Edith's frantic
parents rushed her to their local hospital, Shelby Regional Medical
Center, only to discover that it had closed just weeks earlier. By the
time little Edith arrived at the next closest hospital, she had passed
away.
While we can't say with certainty that both Edith and Portia would
have survived if their local hospitals had not closed, we know the
earlier people access care, the better their chances are.
The term used by emergency medical practitioners is the ``golden
hour.'' The golden hour is the hour following a traumatic event when
lifesaving intervention--like that which can be provided in an
emergency room--has the best chance of impacting survival. In other
words, the longer a patient has to wait to receive emergency medical
care, the lower their chances will be for survival.
Rural hospital closures mean patients have to travel longer distances
to access emergency medical care. Ensuring that rural communities keep
their emergency care resources could make the difference between life
and death. Rural hospital closures also extend beyond the loss of
emergency services to include economic consequences for rural
communities. Hospital closures can mean the death of a rural community.
Approximately 62 million Americans live in rural areas. Rural
communities play an integral role in the economic stability of this
country through their invaluable contributions in food production,
manufacturing, and other vital industries.
In addition to supporting the medical needs of those who participate
in rural industry, rural hospitals also serve as the single largest
employer in a rural community. The economic impacts of closing a
hospital when no other hospital is close by are devastating. If we care
about the physical and economic health of rural communities, we must
make a change that will reverse the trend of accumulating rural
hospital closures.
iVantage Analytics compiled a report for the National Rural Health
Association which identified 283 additional hospitals at risk of
closure based upon performance indicators that matched those of the 53
facilities that already closed.
Allow me to direct the Presiding Officer's attention to this map.
This map depicts the approximate locations of 53 of the 55 hospitals
that have closed in the last 5 years.
I would like to point out that between the printing of this chart and
today, two additional rural hospitals have closed. That alone is a
clear indication of the problem I am trying to convey.
Now, imagine this same map depicting five times the number of
hospital closures you see here. That is what is what will happen if we
do not act to protect America's rural hospitals. Furthermore, the loss
of those additional hospitals would not only impact local economies but
would also result in a $10.6 billion loss in GDP. It must change, not
only for the health of rural Americans but also for the health and
stability of our economy.
Payment cuts to hospitals are one contributing factor to rural
hospital closures. More significant, however, is the current Medicare
payment structure that supports rural hospitals. Today, the Medicare
payment structure for hospitals is focused on inpatient volume.
Emergency rooms act as a loss leader, and income is primary generated
through inpatient stays.
A RAND study published in 2013 found that the average cost of an
inpatient stay is 10 times the cost of an emergency room visit.
Researchers at the University of North Carolina found that many of the
at-risk rural hospitals around the country have an average of two or
fewer patients admitted to a hospital on any given day. These hospitals
can have up to 25 inpatient beds, and if only 2 or fewer of those beds
are filled every day, that is a utilization rate of 8 percent or less.
Instead of letting these facilities close because they do not have
the needed inpatient volume to generate enough revenue, why not let go
of the underutilized inpatient services in favor of sustaining life-
saving emergency care. That is what the REACH Act does. It provides a
voluntary pathway for rural hospitals to eliminate their underutilized
inpatient services and ensure residents have access to emergency
medical care that saves lives. A key component of the bill that allows
the rural emergency hospital model to function is the requirement for
these facilities to have protocols in place for the timely transfer of
patients who require a higher level of care or inpatient admission.
The value of the rural emergency hospitals in the case of a life-
threatening emergency will be their ability to administer lifesaving
measures in order to stabilize a patient before they are transferred to
a higher level of care.
In addition to providing lifesaving emergency care, rural emergency
hospitals will have the flexibility to provide a wide array of
outpatient services, including observation care, skilled nursing
facility care, infusion services, hemodialysis, home health, hospice,
nursing home care, population health, as well as telemedicine services.
This list is not all-inclusive but is just a sample of the outpatient
services rural emergency hospitals could provide to their communities.
The door is left open for rural emergency hospitals to design their
outpatient services to match the needs of their communities.
There are roughly 1,300 critical access hospitals in America,
including 82 in Iowa, the second most just behind Kansas. I am not
suggesting that 1,300 critical access hospitals will become rural
emergency hospitals. Some hospitals may never consider giving up their
inpatient beds, others may consider it in the future, but some critical
access hospitals need this or something like it right now.
The rural emergency hospital model, with its outpatient and emergency
care services, will be good for the health of rural communities and our
Nation because of the critical care it will provide when and where
rural Americans need it. When there is a farm accident in the afternoon
or a heart attack in the middle of the night, that emergency room can
be the difference between life and death. Medicare needs a payment
policy that recognizes that simple fact.
I look forward to continuing to work with my cosponsor Senator
Gardner, other colleagues, and stakeholders in building a sustainable
future for rural health care.
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By Mr. BROWN (for himself, Ms. Collins, Ms. Warren, Ms. Hirono,
Mr. Blumenthal, Mr. Vitter, Ms. Murkowski, Mr. Whitehouse, Mr.
Reed, Ms. Baldwin, Mr. Franken, Mr. Udall, and Mr. Heller):
S. 1651. A bill to amend title II of the Social Security Act to
repeal the Government pension offset and windfall elimination
provisions; to the Committee on Finance.
Mr. BROWN. Mr. President, I rise today to address America's
retirement savings crisis. A 2013 survey conducted by the Governors of
the Federal Reserve System found that roughly 31 percent of Americans
have no retirement savings or access to a defined-benefit pension. In
addition, 19 percent of respondents nearing retirement--those aged 55
to 64--reported having zero savings or pension to rely on in the coming
years.
In light of these figures it is more important than ever that
Congress ensure America's seniors have access to the Social Security
benefits they have earned. Yet provisions such as the Windfall
Elimination Provision, WEP, and the Government Pension Offset, GPO,
prevent millions of Americans--including teachers, firefighters, and
police officers--from receiving their full benefits. It is time
Congress repealed them.
This afternoon, I, along with Senator Collins and a number of my
Senate colleagues from both sides of the aisle,
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introduced the Social Security Fairness Act. This bipartisan bill will
repeal both the WEP and GPO provisions which Congress enacted in 1983
and 1977, respectively. In December 2014, these unfair provisions
chipped away at more than 2 million Americans' Social Security
benefits. That same month, in my State of Ohio, more than 200,000
Ohioans had their Social Security benefits reduced because of these
provisions.
Over the past 35 years, fewer and fewer workers have been given
access to defined-benefit plans, and, today, only about half of the
total U.S. workforce is covered by an employer-sponsored retirement
plan. That is why Social Security is critical for so many. Congress
should make sure that every American has access to all the Social
Security benefits he or she has earned. Repealing these provisions is
an important step in that direction.
I ask my colleagues to join me in repealing the WEP and GPO by
cosponsoring this legislation.
Ms. COLLINS. Mr. President, I rise to speak about the Social Security
Fairness Act of 2015, which I am joining my colleague from Ohio in
introducing today. This bill would repeal both the windfall elimination
provision, WEP, and the government pension offset, GPO. We believe that
these two provisions in the Social Security Act unfairly penalize
certain individuals for holding jobs in public service when the time
comes for them to retire.
The WEP affects individuals who have worked in both the private
sector and in public sector jobs for which Social Security taxes were
not withheld. For such individuals, the WEP applies a special formula
to calculate benefits, reducing them compared to what would otherwise
be paid.
The GPO affects retired public employees whose spouses are entitled
to Social Security benefits. When these individuals apply for Social
Security spousal or survivor benefits, the GPO applies an offset,
reducing the Social Security benefit based on the amount of that
individual's public pension. In some cases, the spouse will not be
entitled to any spousal or survivor benefit because of the GPO.
The WEP and the GPO have enormous financial implications for many of
our teachers, police officers, firefighters, postal workers and other
public employees. Given their important responsibilities, it is simply
unfair to penalize them when it comes to their Social Security
benefits. These public servants--or their spouses--have all paid taxes
into the Social Security system. So have their employers. They have
worked long enough to earn their Social Security benefits. Yet, because
of the GPO and WEP, they are unable to receive all of the Social
Security benefits to which they otherwise would be entitled.
The impact of these two provisions is most acute in 15 States,
including Maine, which have state retirement plans that lack a Social
Security component. However, it is important to point out that the GPO
and WEP affect public employees and retirees in every state, including
our emergency responders, other Federal employees, and postal workers.
Nationwide, more than \1/3\ of teachers and educating employees, and
more than \1/5\ of other public employees, are affected by the GPO and/
or the WEP.
As of 2013, one and a half million people were affected by the WEP
and 615,000 people had their benefits reduced by the GPO. Many more
public employees across the country stand to be harmed in the future.
Moreover, at a time when we should be doing all that we can to attract
qualified people to public service, this reduction in retirement
benefits makes it even more difficult for our federal, state and local
governments to recruit and retain the public servants who are so
critical to the safety and well-being of our families.
What is most troubling is that this offset is most harsh for those
who can least afford the loss: lower-income women. In fact, of those
affected by the GPO, more than 80 percent are women. According to the
Congressional Budget Office, the GPO reduces benefits for more than
200,000 individuals by more than $3,600 a year--an amount that can make
the difference between a comfortable retirement and poverty.
Many Maine teachers, in particular, have talked with me about the
impact of these provisions on their retirement security. They love
their jobs and the children they teach, but they worry about the future
and about their financial security.
Roxie Brechlin of Bar Harbor, Maine, is one of many examples of the
effect that the GPO and the WEP have on our teachers when they retire.
Mrs. Brechlin first began paying into Social Security when she took her
first summer job at age 16. After graduation, she continued to pay into
Social Security for 18 more years before getting her first teaching
job. Mrs. Brechlin worked as a teacher for 23 years, and for 14 of
those years she worked full-time at another job during the summer,
paying more and more into Social Security each year.
Mr. Brechlin recently contacted my office to explain the effect that
the WEP and GPO will have on his wife. Mrs. Brechlin recently retired.
When she applied for Social Security benefits, the WEP applied, and her
benefit was reduced by two thirds. Mr. Brechlin is more concerned about
what would happen to his wife if he were to predecease her. Normally, a
widow would be eligible to continue to collect 100 percent of her
husband's benefit. Mrs. Brechlin, however, would not be able to collect
any survivor benefit, due to the application of the GPO. Not only does
this fact worry Mr. Brechlin, he also sees it as unfair.
It is time for us to take action, and I urge all of my colleagues to
join us in cosponsoring the Social Security Fairness Act to eliminate
these two unfair provisions.
______
By Mr. REED (for himself, Mr. Durbin, Mr. Markey, Mr. Whitehouse,
and Mr. Leahy):
S. 1654. A bill to prevent deaths occurring from drug overdoses; to
the Committee on Health, Education, Labor, and Pensions.
Mr. REED. Mr. President, today, in an effort to decrease the rate of
drug overdose deaths, I am pleased to be joined by Senators Durbin,
Whitehouse, Markey, and Leahy in introducing the Overdose Prevention
Act. Representative Donna Edwards is introducing this bill in the other
body.
Throughout the country, the death rate from drug overdoses has been
rapidly climbing. According to the Centers for Disease Control and
Prevention, CDC, drug overdose death rates have more than tripled since
1990, and more than 110 Americans died each day from drug overdoses in
2011. More than half of these deaths are attributable to opioids, like
prescription pain relievers or heroin. Indeed, this tragic epidemic has
hit particularly hard in my home state of Rhode Island, where in 2014,
239 individuals died from drug overdoses.
Americans aged 25 to 64 are now more likely to die as a result of
drug overdose than from injuries sustained in motor vehicle traffic
crashes. While overdoses from illegal drugs persist as a major public
health problem, fatal overdoses from prescribed opioid pain medications
such as oxycodone account for more than 40 percent of all overdose
deaths.
It is clear that we must do more to stop these often preventable
deaths. Fortunately, the drug naloxone, which has no side effects and
no potential for abuse, is widely recognized as an important tool to
help prevent drug overdose deaths. Naloxone can rapidly reverse an
overdose from heroin and opioid medications if provided in a timely
manner. Overdose prevention programs, including those that utilize
naloxone, have been credited with saving more than 26,000 lives since
1996, according to the CDC.
Opioid abuse and overdose is not an abstract threat found in far-off
corners. It is a national public health crisis and it's taking place
right here at home in our communities and our neighborhoods.
Rhode Island is taking steps to combat this scourge and is leading
the way in adopting innovative solutions. Through a ``collaborative
practice agreement,'' some Rhode Island pharmacies are dispensing
naloxone, along with training about its proper use, to anyone who walks
in and requests the treatment, no prescription necessary. In addition,
the Rhode Island State Police carry naloxone in every cruiser.
The Overdose Prevention Act, which we are introducing today, would
complement these efforts and take important steps towards addressing
this
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issue nationally and increasing access to naloxone in our communities.
The legislation aims to establish a comprehensive response to this
epidemic that emphasizes collaboration between state and federal
officials and employs best practices from the medical community, as
well as programs and treatments that have been proven effective to
combat this startling national trend. This is an emergency and it
requires a coordinated and comprehensive response.
Specifically, the bill would authorize the U.S. Department of Health
and Human Services, HHS, to award funding through cooperative
agreements to eligible entities--like public health agencies or
community-based organizations with expertise in preventing overdose
deaths. As a condition of participation, an entity would use the grant
to purchase and distribute naloxone, and carry out overdose prevention
activities, such as educating and training prescribers, pharmacists,
and first responders on how to recognize the signs of an overdose, seek
emergency medical help, and administer naloxone and other first aid.
As rates of overdose deaths continue to spike, public health
agencies, law enforcement, and others are struggling to keep up without
clear and timely information about the epidemic. Therefore, the
Overdose Prevention Act would also require HHS to take steps to improve
surveillance and research of drug overdose deaths, so that public
health agencies, law enforcement, and community organizations have an
accurate picture of the problem.
It would also establish a coordinated federal plan of action to
address this epidemic. The Overdose Prevention Act seeks to bring
together first responders, medical personnel, addiction treatment
specialists, social service providers, and families to help save lives
and get at the root of this problem.
I am pleased that the Overdose Prevention Act has the support of the
American Association of Poison Control Centers, the Drug Policy
Alliance, the Harm Reduction Coalition, and the Trust for America's
Health. I look forward to working with these and other stakeholders, as
well as our cosponsors to urge the rest of our colleagues to join us in
supporting this crucial legislation.
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