[Congressional Record (Bound Edition), Volume 145 (1999), Part 17]
[Senate]
[Page 24639]
[From the U.S. Government Publishing Office, www.gpo.gov]



           MEDICARE BENEFICIARIES ACCESS TO CARE ACT OF 1999

  Mr. FEINGOLD. Mr. President, I rise today to express my strong 
support for S. 1678, the Medicare Beneficiaries Access to Care Act of 
1999, a bill to ensure that Medicare beneficiaries across our nation 
continue to have access to the health care services that they need. The 
package that has been introduced addresses some of the most troubling 
areas in implementation of the Balanced Budget Act of 1997, and I 
commend the Senate Democratic Leader, Senator Daschle, for the hard 
work that he and his staff put into the creation of this bill.
  I joined my Senate colleagues to vote in favor of the Balanced Budget 
Act of 1997, with the expectation that we would save $100 billion that 
would help preserve the solvency of the Medicare program. Yet the 
magnitude of cuts in BBA of 1997 have been much deeper than anyone 
intended. Present projections indicate that actual reductions have been 
in the area of $200 billion, twice as much as originally anticipated.
  The unintended consequences of the Balanced Budget Act of 1997 have 
been severe indeed. And while there is a lot of publicity about the 
impact of BBA 1997 cuts on entities like hospitals, nursing homes and 
home health agencies, the real issue here is that the cuts are 
threatening the ability of our constituents--patients who rely on these 
entities to provide care, rehabilitation, and life-saving services--to 
gain access to the care they need.
  Take for example the impact of the BBA 1997 Interim Payment System 
for home health agencies in Medicare. IPS was designed as a way to 
counteract fraud, waste and abuse within the Medicare program. 
Unfortunately, the way in which IPS was implemented created a 
counterintuitive and unfair system that penalizes low-cost areas for 
their thrift by basing reimbursement on past spending. More than 40 
home health agencies in 22 counties have closed in Wisconsin since the 
implementation of Medicare home health IPS. IPS has ratcheted Medicare 
home health payments so low that Wisconsin home health agencies are 
losing hundreds of dollars per patient per day treating Medicare 
patients. Agencies in Wisconsin are not closing just because the 
business isn't profitable, they are closing to reduce the devastating 
rate of loss.
  BBA 1997 cuts have also been devastating for our nursing homes and 
patients' ability to gain access to outpatient therapy services. 
Reimbursements to some nursing homes in Wisconsin has been so low that 
one nursing home administrator in La Crosse, Wisconsin, informed me 
that his agency, one of the few Medicare-certified ventilator-dependent 
programs in the region, was losing between $150 and $300 per patient 
per day treating patients who depend on ventilators to breathe. That 
agency had no choice but to stop new admissions of ventilator-dependent 
patients. Similarly, residents of nursing homes who require physical 
therapy, occupational therapy or speech pathology services are faced 
with an arbitrary $1500 cap on their services, an amount that is 
grossly inadequate to provide the necessary rehabilitation to patients 
recovering from a stroke, an amputation or other life-altering event. 
These arbitrary caps on the provision of rehabilitative therapy, have 
the effect--though inadvertently--of placing a cap on the extent to 
which these patients can regain their independence.
  One final area that I would like to raise is the expected impact on 
hospitals of BBA 1997 changes such as cuts to Graduate Medical 
Education payments and the impact of a Prospective Payment System on 
hospital outpatient departments. Preliminary estimates from my 
constituents at the Wisconsin Health and Hospital Association, WHA, 
indicate that Wisconsin's 28 teaching hospitals will lose almost $25 
million per year from GME cuts. In addition, WHA projects that 
Wisconsin hospitals will lose $30 million over the next three years if 
PPS is implemented--a loss of such magnitude that several rural 
hospitals in Wisconsin would likely be forced to close.
  S. 1678 speaks directly to these concerns by increasing payments to 
Medicare Dependent Hospitals and Critical Access Hospitals, of which my 
home state of Wisconsin has 44. S. 1678 also includes stop-loss 
protection to ensure that hospitals do not suffer dramatic losses under 
the Outpatient Prospective Payment System. Lastly, S. 1678 freezes 
Indirect Medical Education cuts at 6.5% over 8 years and increases the 
number of residency slots available in rural areas.
  The provisions of S. 1678 are important to ensuring continued access 
to care, and I hope my colleagues will join me in supporting this 
legislation.

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