[Congressional Record (Bound Edition), Volume 146 (2000), Part 18]
[Senate]
[Page 25829]
[From the U.S. Government Publishing Office, www.gpo.gov]



                     BBA CUTS TO MEDICARE PROVIDERS

  Mr. BAUCUS. Mr. President, I rise today to bring attention to the 
important issue of the Balanced Budget Act, BBA, of 1997, its revision 
in 1999, and the importance of providing further relief to the many 
patients and providers who have been negatively affected by its 
implementation.
  The BBA included a series of cuts to Medicare providers, including 
hospitals, nursing homes, and home health agencies. Though intended to 
cut about $112 billion from Medicare over the five-year period from 
1998 to 2001, recent estimates indicate that over twice that amount 
will be cut by the BBA. And although Congress restored about $16 
billion in funding to Medicare in 1999, much work remains to be done. 
Particularly in rural America, Congress should restore funding to 
Medicare programs for telehealth, hospital and home health care, among 
others.
  Nationwide, 25 percent of seniors live in rural areas. And though the 
BBA has hit all hospitals hard, rural facilities have suffered 
disproportionately from the 1997 legislation. According to a June 
report by the Medicare Payment Advisory Commission, small rural 
hospitals have significantly lower operating margins than rural 
facilities, on average 0.4 and 3.8 percent, respectively. Congress will 
do America's rural hospitals a great disservice by not enacting further 
BBA relief this year.
  With respect to telemedicine, a means of providing care for Medicare 
beneficiaries with the use of advanced telecommunications equipment, 
Congress can act this year to further the use of this important tool. 
Mr. President, in my state of Montana, where over 75 percent of seniors 
live in rural areas, there is no psychiatrist east of Billings--an area 
the size of the State of Florida. Telemedicine could work wonders 
toward providing rural beneficiaries with access to specialty care, 
including psychiatric care. Although Congress mandated telehealth 
reimbursement as part of the BBA, the scope of that reimbursement is 
very limited.
  We should also provide relief for home health care, one of the areas 
hit hardest by the BBA. Originally scheduled for a $16 billion cut, 
home health payments under Medicare were actually reduced by more than 
$68 billion, over four times the original amount intended. We need to 
preserve access to home care services by eliminating the scheduled 15 
percent additional reduction in Medicare reimbursement. We should also 
provide 10 percent bonus payments to rural home care agencies, a 
provision that was included in both the Senate Finance and House Ways 
and Means BBA relief bills this year.
  Mr. President, Congress should not let politics and partisan 
priorities to interfere with providing a basic human need to the people 
of our country. I urge my colleagues join me by acting on further BBA 
relief this year.

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