[Congressional Record (Bound Edition), Volume 145 (1999), Part 17]
[Senate]
[Page 23973]
[From the U.S. Government Publishing Office, www.gpo.gov]



             THE MEDICARE BENEFICIARIES ACCESS TO CARE ACT

  Mr. WELLSTONE. Mr. President, I speak today in support of Senator 
Daschle's bill titled the Medicare Beneficiary Access to Care Act, S. 
1678. I am proud to cosponsor this important bill because it will 
provide relief for health care providers suffering under drastic cuts 
resulting from the Balanced Budget Act (BBA) of 1997. That legislation 
has had a very negative impact on the Medicare program and the 
financial viability of our medical establishments providing care under 
that program. The Senate Minority Leader's legislation will scale back 
some of the BBA reductions and therefore provide the necessary 
reimbursement for providers who give needed medical services to 
patients. Let me be clear, patients will be the ultimate beneficiaries 
when this bill is enacted. A basic fact is that any person seeking 
medical attention will likely visit a medical establishment currently 
being affected by BBA payment reductions. If medical facilities close 
due to BBA cuts, it will adversely impact not only Medicare 
beneficiaries, but all of the citizens in that same community who need 
access to health care.
  Back in 1997, I did not support the Balanced Budget Act. In fact, 
when this came up for consideration back then I said ``Mr. President, 
this is a huge mistake - a huge mistake.'' Realizing the vital role of 
Medicare in our country, I thought that we should be going in the 
opposite direction - providing the opportunity for all Americans to 
access decent healthcare. Although BBA passed, I did hope that it would 
not severely impact Medicare beneficiaries or the healthcare 
establishments that provide their care. Unfortunately, my worst fears 
have come true.
  I have had an almost continuous stream of people from Minnesota come 
into my office and tell me about the dramatic, draconian effects that 
BBA has had on the ability of medical establishments to provide needed 
medical services to people in my state. We have heard from large 
academic teaching hospitals, small rural clinics, home healthcare 
agencies, skilled nursing facilities, hospices and physicians. It is 
hard to think of a medical establishment that has not been impacted by 
these cuts. According to the hospitals in my state, the total impact of 
BBA cuts for Minnesota over 5 years will be $908 million. The prognosis 
is really disturbing. We hear many service providers tell us they can 
not continue their operations because of these cuts. They are going to 
close their doors and shut down. Some of these establishments are 
located in rural settings where they are the only hospital or clinic or 
nursing facility within dozens and dozens of miles. What is going to 
happen when these facilities close? The answer is that peoples' health 
will suffer and the communities will suffer economically. The 
communities will suffer because they don't have a hospital. Businesses 
will be reluctant to locate in a community that does not have access to 
healthcare.
  It doesn't have to be this way. In the United States Senate, we have 
the opportunity to fix some of the problems created by BBA. Senator 
Daschle's bill will lessen the impact of the BBA cuts on providers, 
thus benefitting patients. I think this package will make a substantial 
difference.
  This bill will help our teaching hospitals by limiting further 
decreases in the Indirect Medical Education payments. Teaching 
hospitals are important not only because they train future physicians, 
but also because they treat a large number of Medicare beneficiaries. 
For skilled nursing facilities, this bill will repeal the $1500 therapy 
caps for three years until a new system can be implemented. For Home 
Healthcare Agencies, this bill postpones the 15% cut in payments for 2 
years. For physicians, this bill would smooth out the fluctuations in 
physician payment rates. For Medicare Plus Choice, this bill provides 
enrollees with additional time to switch plans if their plan 
terminates. For clinics, this bill will create a new payment system 
that is linked to 1999 costs along with subsequent updates. For 
hospices, this bill will increase hospice payments by the full market 
basket updates.
  This bill will allow many medical facilities in my state to continue 
operating. I'm sure the same holds true for most states. We need to 
pass this bill now. Health care is too important an issue. Even though 
not everybody has access to it, we do have a great health care system 
and it needs to be preserved. The BBA was a mistake, and now is the 
time to limit some of the resulting adverse consequences. I hope that 
my colleagues will join me in support of this bill.

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