[Congressional Record (Bound Edition), Volume 146 (2000), Part 16]
[Senate]
[Pages 23399-23401]
[From the U.S. Government Publishing Office, www.gpo.gov]



                         FOCUSING ON PRIORITIES

  Mr. KENNEDY. Mr. President, as we are coming into the final hours, 
the final days of the Senate session, there are still a number of 
measures which need focus and attention and priority. I welcome the 
leadership that is being provided now by the President and a number of 
our colleagues to try to make sure that before we leave town we try to 
remedy a situation that has developed since we passed the Balanced 
Budget Act in 1997. Included in that balanced budget effort were cuts 
that were directed to the health care providers. It was estimated at 
that particular time that the cuts would be about $100 billion. What we 
have found out over the last several years is that the projected cuts 
have been well over $200 billion. As a result, there have been 
unintended consequences that have developed.
  It seems only fair that when we look at the steps that were taken in 
the past that resulted, and continue to result today, in some very 
dramatic adverse impacts to a number of different providers in our 
health care industry, that we remedy that situation. It is particularly 
important to remedy their situation when we have the fortuitous 
economic situation in terms of the surplus that we are faced with.
  I doubt very much--in fact, I am quite sure--that if we had known in 
1997 the actual impact the projected cuts were going to have on health 
care providers, that those particular provisions of the Balanced Budget 
Act would have been successful. I am sure they would not have been 
successful. I certainly would not have voted for those provisions.
  But I welcome the opportunity to join with a number of our colleagues 
to try to remedy the situation. It is the responsible thing to do. It 
is absolutely necessary. It is not only affecting many of our excellent 
health care providers in our urban areas, but it also reaches out to 
many rural communities.
  We have had an excellent presentation from our friends as to what 
these cuts have meant for rural health care and rural health care 
providers. Let me mention, for a few moments, what is happening to some 
of the different health care providers now.
  We are very fortunate in Massachusetts to have some of the best 
teaching

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hospitals in the world. These teaching hospitals are the backbone of 
our quality health care system in America and the world.
  We are facing many challenges in our health care system. The most 
obvious one today is a Medicare prescription drug benefit. That is the 
challenge that comes first to the minds of people when we talk about 
health care needs and needed changes in our Medicare system. That is a 
very legitimate challenge. We think of our Patients' Bill of Rights. 
Many of us deplore the fact that we have not addressed these issues in 
the Senate.
  It is irresponsible that we have not taken action on a Patients' Bill 
of Rights. Although we have a majority of the Members of the House and 
a majority of the Members of the Senate in favor of a strong Patients' 
Bill of Rights, still we are denied the opportunity of addressing the 
issue. We know that every day we fail to do so, there are tens of 
thousands of Americans who are suffering as a result.
  We are unable to free ourselves from the power of the HMO industry to 
successfully pass legislation that would allow doctors to make health 
care decisions, unfettered by the decisions of bean counters from the 
HMOs who are more interested in profits than in the health of 
individuals. That is certainly one very important issue. I think we 
fail in this Congress by the fact that we have not addressed it.
  I am constantly amazed as I travel around my State, and the States of 
Pennsylvania and New York and a few other places where there are 
candidates running for Congress. One of the first pieces of legislation 
they say they support is a Patients' Bill of Rights, which obviously 
has nothing to do with the strong Patients' Bill of Rights that has 
been supported by more than 300 health providers representing women and 
children and the disabled, cancer research groups, the doctors, the 
nurses, the medical professionals. That is one issue. The second, as I 
mentioned, is a prescription drug benefit.
  We also are now focusing on teaching hospitals. These are the 
hospitals that provide the training and teaching for our future medical 
professionals including doctors, some of the applied health 
professionals, and advanced practice nurses. We have the best teaching 
hospitals in the world. We ought to keep them healthy, not endanger 
them. By not providing a healthy and robust provision in legislation in 
these final 2 days, we risk endangering our teaching hospitals.
  What do these teaching hospitals do? No. 1, they provide the best 
teaching. Secondly, they provide about 30 percent of the indigent care 
in our country, primarily--obviously--in the communities in which they 
serve. They play a very important role in providing health care to 
those who have no health insurance. Third, they are also the places 
that are developing the new technologies and techniques used in 
treating some of the most complicated cases. From there the research 
disseminates; other hospitals and other health care delivery centers 
benefit from the research done at teaching hospitals.
  These teaching hospitals are really the jewels of our health care 
system, and we cannot put them at risk. And they are at risk. The 
proposal that is being advanced by the Republicans is basically a nice 
blank check to the HMOs, the industry that is leading the fight against 
the Patients' Bill of Rights. Yet there is no guarantee that they will 
continue to provide health care to people in our society or to Medicare 
recipients. More than 900,000 Medicare recipients will be dropped from 
HMOs next year. Yet we find the Republicans shoveling billions of 
dollars into HMO coffers without any assurance that they will use those 
resources to look after the elderly. The Republicans are shoveling the 
funds into HMOs rather than investing in a prescription drug program 
for our seniors.
  We know we have the teaching hospitals on the one hand. Next we have 
the community hospitals. The community hospitals are the backbone of 
health care delivery in our communities. They are the primary health 
delivery provider in communities all across this country. They have an 
irreplaceable position. They are exceedingly hard pressed and stressed 
in being able to perform this function. They need some relief. Any 
legislation ought to have provisions in it to help provide needed 
assistance to community hospitals.
  Then there is the home health care system--the visiting nurses, home 
health care agencies. We have seen a significant decline in home health 
care agencies and home health care services generally. At a time when 
our senior population is going to double over the next 20-25 years, we 
are seeing a significant decline in home health care services, which 
makes absolutely no sense. We end up finding out that if patients 
aren't going to be able to receive home health care services, they will 
have to go into the more costly hospitals and nursing homes. It makes 
no sense from a health standpoint, and it certainly makes no sense from 
a humane standpoint.
  Our nursing homes are facing bankruptcy in increasing numbers. We 
have seen scores of bankruptcies of nursing homes in my own State of 
Massachusetts. The number of nursing homes going bankrupt is increasing 
every single day. They are in desperate straits. Not only are they in 
desperate straits, but other health care providers, such as the hospice 
program that provides such important help and assistance to those who 
have terminal illnesses, are in desperate straits as well.
  It isn't just those of us who have these facilities in our States. We 
have heard eloquent statements from those who come from rural areas. We 
want to work with them as well. We are not trying to rob Peter to pay 
Paul. We ought to have something that is going to address the needs of 
rural areas, and we welcome the opportunity to work with our 
colleagues.
  Under the leadership of Senator Daschle and Senator Reid, Senator 
Moynihan on the Finance Committee, Senator Baucus, and others, an 
excellent program has been developed from our side. We want to try to 
make sure that that is going to be considered. We don't want to be shut 
out of the process, as we are shut out of a lot of issues here.
  We have heard a good deal of debate about desiring bipartisanship. 
Well, for a good part of the time I have been in the Senate, when we 
had these kinds of matters that needed to be discussed or debated, we 
had Republican and Democratic leaders working these matters out with 
the Administration. But we are finding out that this apparently is a 
solo flight by our Republican friends, to the great disadvantage of our 
health care system. That makes no sense.
  The President has indicated he would veto this early proposal that 
has been put forward by the Republicans as a nonstarter. I certainly 
would defend that position and welcome the opportunity to discuss it or 
debate it, whatever will be necessary, because their proposal just does 
not do the job. It is one of the key remaining issues we have as we 
come to the end of this session.
  Finally, I do hope we will be able to have included in the final 
wrap-up in our balanced budget refinement the Grassley-Kennedy bill 
that helps parents of children who have disabilities. Last year, in a 
bipartisan effort, we developed legislation that permitted those 
individuals who were disabled to go into the labor market and not lose 
their health insurance. We had a good debate on it. We passed it. Now 
we find people saying, Why did it take you so long? What is happening 
is these individuals are moving towards greater independence and self-
reliance. They are becoming taxpayers and paying into the public system 
rather than just drawing from it. It has taken a good deal of time to 
achieve, but it has been enormously important.
  What we are saying now, Senator Grassley and I--and I pay tribute to 
Senator Grassley for the hard work he has done on this in the Finance 
Committee--is help parents who have children with severe disabilities. 
So many parents have children who have severe disabilities. The parents 
are unable to take any increase or any enhancement of their own pay 
because if they do, they will no longer qualify for Medicaid. And if 
they no longer qualify for

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Medicaid, they lose the health care they get for their children under 
Medicaid, and they can't afford the health care bills. These parents 
have to refuse pay increases and advancement to remain below the income 
levels for Medicaid coverage. Of course, this not only does an enormous 
disservice to that individual but also to the other members of the 
family.
  Many of these children with severe disabilities have brothers and 
sisters, yet the parent still has to work at a wage below the Medicaid 
level in order to qualify for health coverage of their children. It 
makes no sense. It is wrong. We have legislation that will address it, 
and we hope that will be considered.
  We say once again that the proposal our Republican friends are 
putting forth is a nonstarter, because we know what they are trying to 
do; that is, to give a great bundle of cash--so to speak a blank 
check--to the HMOs that have been resisting our ability to take actions 
to protect American patients. It makes no sense. It is unfair, and it 
is fundamentally wrong.
  We are going to do everything we can to try to fashion a proposal 
that is balanced, fair, and that really meets the health care needs of 
our people.

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