[Congressional Record (Bound Edition), Volume 145 (1999), Part 20]
[Extensions of Remarks]
[Page 29068]
[From the U.S. Government Publishing Office, www.gpo.gov]



  MEDICARE, MEDICAID, AND SCHIP BALANCED BUDGET REFINEMENT ACT OF 1999

                                 ______
                                 

                               speech of

                           HON. BOBBY L. RUSH

                              of illinois

                    in the house of representatives

                        Friday, November 5, 1999

  Mr. RUSH. Mr. Speaker, I rise to express my opposition to the process 
by which we are considering some of the most important legislation that 
this House will debate during this session of Congress--the Medicare, 
Medicaid and Schip Balanced Budget Refinement Act of 1999. As a member 
of the Commerce Committee, I would have liked to have had the 
opportunity to fully debate the Medicare, Medicaid and SCHIP changes 
that this legislation makes. Particularly, in light of the impact the 
Balanced Budget Act has had on Illinois hospitals.
  Illinois hospitals are experiencing severe financial hardship as a 
result of the Balanced Budget Act of 1977 (P.L. 105-33). The cuts 
mandated by the BBA were supposed to simply slow the growth in the 
Medicare program. However, the Act ``overcorrected'' the growth in 
Medicare spending and severely reduced Medicare reimbursements to 
hospitals and health service providers for five years beginning in 
1997. In Illinois alone, it is estimated that hospitals will lose $2.8 
billion in Medicare payments over a five year period. The financial 
burden of the BBA cuts is particularly acute for the teaching hospitals 
in my state. Because Illinois ranks fifth in the nation in the number 
of teaching hospitals, and these facilities are expected to lose more 
than $1.6 billion over the five-year period, of the BBA's life. These 
cuts have a devastating effect on the communities that they serve.
  I opposed the Balanced Budget Act when it was debated by the House of 
Representatives in 1997. I believed that it was bad policy then, and 
believe that it is bad policy now.
  In order to provide relief for the teaching hospitals and other 
health service providers that were so adversely impacted by the BBA, I 
introduced legislation, Health Care Preservation and Accessibility Act 
of 1999, H.R. 3145, to restore some of the Medicare reimbursements that 
the BBA reduced. The legislation was intended to accomplish this in a 
number of ways:
  (1) H.R. 3415 would freeze the cuts in indirect medical payments 
(IME) to teaching hospitals at 1999 levels. It also freezes cuts in the 
disproportionate share payments (DSH payments) at 2% and provides 
payments directly to those serving a large share of low-income 
patients;
  (2) directs the Secretary of Health and Human Services to make 
payments for Graduate Medical Education (GME) to children's hospitals 
for the Medicare FY 2000 and 2001 cost reporting periods for the direct 
and indirect expenses associated with operating approved medical 
residency training programs;
  (3) sets a floor on outpatient hospital payments so that rural 
hospitals do not fall below 1999 levels and establishes a new payment 
system for rural health centers;
  (4) revises the payment system for community health centers so that 
it more adequately reimburses for the costs of care and allows safety 
net providers that provide health coverage to low-income Americans to 
be directly compensated for their services;
  (5) eliminates the $1,500 per beneficiary cap imposed by the BBA and 
replaces it with a payment system that is based on the severity of 
illness;
  (6) revises the BBA's new prospective payment system for skilled 
nursing facilities by increasing reimbursements for patients needing a 
high level of services to more accurately reflect the cost of their 
care;
  (7) delays a scheduled 15% reduction in the home health interim 
payment system if the Secretary of Health and Human Services misses the 
deadline for instituting the new prospective system. H.R. 3415 also 
allows for interest free recoupment of overpayments due to HCFA's 
underestimation of the interim payment rates for certain agencies. 
Finally, H.R. 3415 provides additional protections for seniors citizens 
and persons with disabilities and strengthens protections and sanctions 
for Medicare fraud and abuse.
  Mr. Speaker, I introduced the Health Care Preservation and 
Accessibility Act of 1999 when it looked as if we could not reach 
agreement on even the minimal BBA relief that the legislation before us 
provides to Illinois hospitals, and hospitals across the nation. I am 
reluctantly supporting the legislation before us today, because it is 
the only option that has been presented to us. But it is my hope that 
we will have the courage to revisit this issue in the next session, and 
complete the job that we have only begun with H.R. 3075.

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