[Congressional Record (Bound Edition), Volume 146 (2000), Part 10]
[Senate]
[Pages 14603-14604]
[From the U.S. Government Publishing Office, www.gpo.gov]



                               BBA RELIEF

  Mr. WELLSTONE. Mr. President, since its passage in 1997, the BBA has 
drastically cut Medicare payments in the areas of hospital, home health 
and skilled nursing care services, among others.
  While the reductions were originally estimated at around $100 billion 
over five years, recent figures put the actual cuts in Medicare 
payments at over $100 billion.
  These cuts have consequences. Beneficiaries with medically complex 
needs face increase difficulty in accessing skilled nursing care. 
Hospital discharge planners have greater difficulty obtaining home 
health services for Medicare beneficiaries as a result of the BBA. 
Rural Hospital margins have dropped four percentage points continuing a 
dangerous trend that threatens access to care in rural America.
  Last year, Congress acknowledged that the Medicare savings that 
resulted from the 1997 Balanced Budget Act went far beyond what we 
intended, and passed the Balanced Budget Refinement Act (BBRA) but it 
didn't go nearly far enough.
  With actual cuts in payment of $200 billion from the BBA, the BBRA 
reversed at best only 10% of these actual cuts in payment to providers 
caused by the BBA.
  My state of Minnesota has been hit very hard by the BBA cuts, and 
last year's fix hasn't stopped the pain. As I said when I voted against 
the BBA, the cuts are too harsh and they will hurt our health care 
system. Both urban safety net hospitals and rural hospitals are feeling 
the pain. They are cutting back services, they are short staffed, like 
the hospital in Aurora, MN are faced with closing if they can't find a 
way to restructure so that their reliance on Medicare is not so great.
  My colleagues should be aware that in rural Minnesota typically 70% 
of the revenue for rural hospitals is from Medicare and Medicaid. 
Hospitals are often the largest employers in these communities and new 
businesses won't locate in a community if it doesn't have a hospital. 
You can't blame them.
  In addition these hospitals are critical to the tourism industry, 
which in my state is made up largely of mom and pop resorts, 
restaurants, lodges, canoe outfitters, fishing guides, cross country 
ski lodges as well as the downhill ski areas, snow mobile trails, 
vendors who cater to hunters and fishermen and women, bicyclists who 
use our state trails, the list is a long one.
  When these folks become sick or are injured while out in the 
wilderness, on the water, on the ski hill or while hunting, they need a 
local hospital to treat their injury or illness. In our state of 
Minnesota these front line health care providers are small rural 
hospitals in communities like Cook, Grand Marais, Ely and Teo Harbors. 
We can't fly out all the people with broken bones or heart attacks 
during a blizzard, or in the fog. We need hospitals there to provide 
the care.
  Northwestern Minnesota has been hit again by flooding this year. I 
don't know how many years in a row this has happened. We need health 
care there in these communities for farm families who are struggling 
with the farm economy, the weather and a health care crisis in their 
family. The hospitals in Northwestern Minnesota are on the razors edge 
of staying open. These BBA cuts hit them hard and hurt them badly.
  Southwestern Minnesota is a part of my state that relies on the farm 
economy. When families are not making any money at farming like this 
year and last year, whether it be collapsed hog prices, milk, or grain 
prices, through no fault of their own they don't have money to buy good 
insurance, the counties' revenue from property taxes that supports the 
rural county hospitals can't keep up and if Medicare isn't there with a 
fair level of reimbursement, they face the possibility of closing as 
well.

[[Page 14604]]

  There has been a tremendous number of closings in home health care in 
Minnesota. The cuts we made were extreme. People who could be taken 
care of at home are now kept longer in the more costly hospital setting 
simply because there is no one to provide the home care.
  But let me focus on the White Community Hospital in Aurora, 
Minnesota. This is a hospital that serves an iron ore mining community 
in Northeast Minnesota. The miners in this community and others in 
communities across Minnesota's iron range mined the ore that was turned 
into steel and built our cites in the twentieth century, made the cars, 
and the rails. They are the hear and soul of America. They or their 
parents came to this country, fleeing oppression in many European 
countries, they have a strong patriotism, a powerful work ethic and a 
community second to none in the United States. When I visited them last 
week to hear about the struggle they are engaged in to keep their 
hospital open I didn't over promise, but I did promise I would do 
everything I could to help them in their fight. And I will. The BBA is 
hurting them. It is an anchor around the neck of their hospital. They 
are fighting for their hospital and we can't turn our back on them.
  I have co-sponsored numerous pieces of legislation to restore 
additional funds to Medicare providers, but what we need is 
comprehensive BBA relief and our constituents, our hospitals, our 
nursing homes, and our home health agencies cannot wait.
  When Medicare fails to pay its share, it threatens health care for 
all patients. Reduced Medicare payments are contributing to decisions 
by many providers and insurers that threaten Medicare beneficiaries' 
access to care, including staff layoffs, reductions in services, or 
even outright facility closures or decisions to withdraw from the 
Medicare program. As we all know, entire communities suffer when such 
actions take place.
  We need comprehensive and substantial relief for community hospitals, 
teaching hospitals, rural hospitals, home health agencies, and skilled 
nursing facilities, among others--and we need it now, before Congress 
adjourns before the August recess.
  This amendment simply sates that it is the sense of the Senate that 
by the end of the 106th Congress, Congress shall revisit and restore a 
substantial portion of the reductions in Medicare payments to providers 
caused by enactment of the BBA of 1997.
  I wish to let colleagues know that I am going to call for a vote on 
an amendment Monday evening that deals with the drastic reduction of 
Medicare payments in the areas of hospital and home health care, and 
also skilled nursing care.
  In 1997, we passed the balanced budget amendment, and the reductions 
in Medicare over a 5-year period were estimated to be around $100 
billion. The recent figure is going to be about $200 billion.
  Last year, we tried to do a ``fix,'' and we passed what was called 
the Balanced Budget Refinement Act. But basically what it did was 
restore about 10 percent of the actual cuts that we have made. I could 
say this in a more complete way, but what I want to do right now is 
just say to colleagues that my amendment is going to deal with these 
cuts. Either it is going to be a sense of the Senate that says by the 
end of the session, we have to restore some of this assistance, some of 
this money to our providers and to our patients and to the consumers, 
and/or I could have another amendment that says if we do not do that, 
there needs to be a freeze in the cuts.
  I am sure the Presiding Officer has heard of this in Alabama. I think 
you hear it in Nevada. I hear it in Minnesota. You hear it all across 
the country. In Minnesota, especially in our rural communities, whether 
it is White Hospital in the Iron Range in the White Lakes, whether it 
is southwest Minnesota, whether it is west central Minnesota, 
especially in our rural communities--we are going to lose these 
hospitals. They lost anywhere from 50 to 70 percent of their payment on 
Medicaid and Medicare.
  Colleagues, in 1997, I don't know what we were thinking when we voted 
for this. I think it was a big mistake. I did not vote for it. Others 
voted for it in good faith. Right now, what we are hearing is that 
these hospitals are not going to be able to provide the care. They are 
going to go under. These nursing homes are not going to be able to make 
it. We have seen severe cuts and cutbacks of services in home health 
care.
  The point is this: Yes, it is true the hospitals and nursing homes 
are important employers in these communities, so there are jobs. Yes, 
it is true the same thing could be said for home health care. But the 
worst part of it is we are talking about a dramatic decline in the 
quality of care for people. In a lot of communities, especially in 
rural America, this is the death knell for our communities. It is hard 
enough for people to struggle to earn a decent living, but people can't 
stay in the communities if there is not good health care and if there 
is not good education available. Right now, we do not have that, if 
these hospitals shut down.
  This amendment is an amendment that speaks to these cuts. It will be 
an amendment based upon many meetings I have had with community people 
all across Minnesota. I think it is an amendment that all my 
colleagues, hopefully, will support because when Medicare does not pay 
its share, it is a threat to the health care for patients and it also 
has a dramatic negative effect on our communities as well.
  I want to bring this to the attention of colleagues. I hope there 
will be a strong vote for this amendment. There is some discussion we 
are not going to do anything about this. But we never should have voted 
for cuts that are this severe. This has had just the harshest 
consequences. It was a mistake and we have to restore this funding.

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