[Congressional Record (Bound Edition), Volume 145 (1999), Part 20]
[Senate]
[Page 28712]
[From the U.S. Government Publishing Office, www.gpo.gov]



                          BALANCED BUDGET ACT

  Mr. DOMENICI. Mr. President, I came down to make a few remarks about 
a bill that is in conference, a subject matter we have been talking 
about for some time, and that is the Balanced Budget Act and what kind 
of impact it had on skilled nursing homes, on rural hospitals, and 
other parts of the entire health delivery network in the United States. 
While I won't take very long today, I do come because I think it is 
very urgent to the conferees on what we have been calling a ``Medicare 
replenishment'' bill--a bill that goes back and says let's make a few 
adjustments to the Balanced Budget Act as that Budget Act sought to 
restrain the cost of health care in three, four, or five areas.
  Particularly, I want to talk about the House and Senate and the 
ultimate compromise on the legislation to increase payments for the 
nursing home patients and proprietors and owners of skilled nursing 
homes and that industry. In fact, the problems in the nursing home 
industry are as severe, if not more severe, than in any other part of 
the health care system in the United States. To talk about hospitals as 
if they are more important than skilled nursing homes, and that we 
should worry more about hospitals and less about skilled nursing homes, 
is not to address the issue properly, for there are literally hundreds 
of thousands of Americans, men and women, predominantly women, in the 
skilled nursing homes across this land. Some are Ma and Pa owners of 
one or two units; some are corporately owned, where hundreds of these 
particular skilled nursing home facilities are owned by a company.
  A couple of weeks ago, a very large nursing home company with 
headquarters in my home State filed for chapter 11 bankruptcy 
protection. That was a second nursing home chain to file for bankruptcy 
protection in the last 2 months. These two nursing home chains own 
hundreds of facilities all over the country. So every Senator should be 
concerned about what is happening to this industry and to these 
facilities and their ability to care for our senior citizens.
  The Senate Finance Committee, which got input from many Senators and 
many parts of America's health delivery system, reported out a very 
good bill in the area of skilled nursing homes and, likewise, in the 
other delivery components of American health care. In it, there are two 
provisions which are particularly important. First, it provides, over 
the next 3 years, for $1.4 billion in higher payment rates for skilled 
nursing facilities. These increases are targeted at what everyone 
agrees is the problem--that current rates do not cover the high costs 
of medically complex cases. In other words, skilled nursing homes and 
the population of these homes have changed rather dramatically in the 
last 15 years, and there are more and more very sick people in the 
skilled nursing home facilities, and we call these medically complex 
cases. The reimbursements we are now giving skilled nursing homes do 
not cover the care for the medically complex cases. Secondly, it put a 
moratorium--that is, the Senate bill--on the $1,500 therapy caps that 
have been so disruptive to care to many seniors.
  Quite frankly, one of the messages I would like the Senate to hear 
today is that the House bill is completely inadequate in this area. In 
fact, the House bill puts only $100 million--one-tenth of $1 billion--
directly into the payment rates to correct the problem of high cost 
cases. That is $1.3 billion less than the Senate bill. Obviously, there 
is a problem, or there isn't a problem. If there is no problem, then 
the House is right. Fund it with $100 million, which is almost nothing. 
But if there is a problem, obviously $100 million over 3 years will not 
solve that problem. The Senate is more apt to be right at $1.3 billion 
for skilled nursing homes.
  The House bill tries to salvage the concept of putting caps on 
therapy services, which is the wrong way to be approaching and 
controlling the costs in this area.
  The Medicare relief package reported by our Finance Committee--I give 
the Finance Committee great credit and Chairman Bill Roth extraordinary 
credit--includes other provisions: $1.8 billion for teaching hospitals, 
all hospitals $2.5 billion more than today's plans, and for home 
health, $1.3 billion to delay a 15-percent cut.
  Many of us have looked at all of these and think they are needed and 
should be supported. But certainly to go to conference and tragically 
leave out of the package anything significant for skilled nursing 
homes, I tell you that we will rue the day. It will not be 6 months to 
a year when there will be closings across this land, and we will have 
sick senior citizens unattended in nursing home after nursing home 
across this country.
  Even if the other provisions survive the conference and the nursing 
provisions do not, let me repeat that I think we will have failed the 
No. 1 problem in the delivery system right now, especially for those 
who can do nothing for themselves. They are the very sick seniors in 
nursing homes.
  I don't know any other way than to say that the Senate voted 
overwhelmingly for these provisions. I hope that means they will carry 
this message into this conference and will insist that the House 
concede when it comes to skilled nursing home parts of this bill and 
put substantially more into reimbursing provisions; that is, the two 
that I have mentioned here today.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative assistant proceeded to call the roll.
  Mr. DOMENICI. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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