[Congressional Record (Bound Edition), Volume 147 (2001), Part 20]
[House]
[Page 27579]
[From the U.S. Government Publishing Office, www.gpo.gov]



    LEGISLATION TO BE CONSIDERED IN SECOND SESSION OF 107TH CONGRESS

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Nebraska (Mr. Bereuter) is recognized for 5 minutes.
  Mr. BEREUTER. Mr. Speaker, today I have introduced four bills for 
consideration during the next year and I want to call them at least 
briefly to the attention of the House for the Members and staff who 
will be watching or reading the Congressional Record.
  The first of them is entitled the Lewis and Clark Voyage of 
Scientific Discovery Act, and it really is a comprehensive effort to 
foster the better management of the biological and physical health of 
the Missouri River.
  The second and third bills relate to Afghanistan and Central Asian 
republics and the ability and assistance and authorization for that 
part of the world to produce food sufficient to feed themselves, at 
least on a sustainable or subsistence basis.
  The second of the bills relates to a multi-lateral approach we would 
participate through the Treasury Department with cooperation and 
assistance with the State Department. It has 15 bipartisan cosponsors 
already, and it would utilize a trust fund with the fiduciary 
responsibility placed in the World Bank.
  The third is a bilateral authorization program involving the State 
and USAID, and I will come back to those two bills briefly.
  The fourth bill is a Rural Equity Payment Index Reform Act, and I had 
a chance to briefly mention that in a 1 minute address several hours 
ago. This bill will address a significant differential and 
reimbursement levels to urban and rural health care providers. The 
formulas used by Medicare programs to reimburse health care providers 
for beneficiaries' medical care, are not accurately measuring the cost 
of the providing services and are reimbursing physicians and other 
health care providers in a manner that disadvantages rural providers 
and, therefore, rural citizens.
  Many rural communities have had great difficulty retaining physicians 
and other skilled health care professionals. Recruitment difficulties 
for primary and tertiary care remain more severe in areas with lower 
costs of living indices. It makes little sense, therefore, to pay 
physicians less in lower costs of living areas when these areas usually 
have the physician shortages.
  The Rural Equity Payment Index Reform Act will lessen the disparity 
which currently exists between urban and rural areas. Specifically, the 
legislation would guarantee that we would have a gradual phase-in of a 
floor of 1.000 for the Medicare physician work adjuster, thereby 
gradually raising all localities with a work adjuster below 1.000 to 
that level.
  Since it would be politically impossible to lower the work adjuster 
levels for health care providers in urban areas, the adjustment upward 
to the 1.000 floor would be enacted without regard to budget neutrality 
agreement in the present law, thereby requiring Congress to change law 
to authorize an increase in program expenditures.
  While Congress has attempted to correct the inequities for hospitals, 
it has not addressed parallel problems with the physician component of 
our country's rural health infrastructure.
  The Benefits Improvement and Protection Act of 2000 addressed 
inadequate payment for Medicare+Choice organizations, and took steps to 
stabilize and improve rural hospital payment. Nothing substantive in 
the legislation, however, addressed the underlying issues of inadequate 
reimbursement of the costs of providing physician services under 
Medicare Part B.
  According to the Centers for Medicare and Medicaid Services, 
``physician work'' is the amount of time, skill and intensity a 
physician puts into a patient visit. Physicians and other health care 
providers in rural areas put in as much or even more time, skill and 
intensity into a patient visit as do physicians in urban areas. Yet, 
rural physicians are paid less for their work under the Medicare 
program than those who practice in urban areas! This is not only 
unfair, but discriminatory against rural areas!
  The amount Medicare spends on its beneficiaries varies substantially 
across the country, far more than can be accounted for by differences 
in the cost of living or differences in health status. Since 
beneficiaries and others pay into the program on the basis of income 
and wages and beneficiaries pay the same premium for Part B services, 
the geographic disparity results in substantial cross-subsidies from 
people living in low payment states with conservative practice styles 
or beneficiary preferences to people living in higher payment states 
with aggressive practice styles or beneficiary preferences. Physician 
work should be valued equally, irrespective of the geographic location 
of the physician.
  The work geographic practice costs index for Nebraska is currently 
0.949. According to this Member's calculations, establishing a floor of 
1.000 would translate into a $7,562,772 annual increase in Medicare 
payments to Nebraska physicians. We have information of the current 
index levels for other states that we can make available to interested 
Members.
  Mr. Speaker, this Member urges his colleagues to support the Rural 
Equity Payment Index Reform Act.
  Mr. Speaker, with respect to the Afghanistan bills, the two that I 
have introduced, I would say it is important that Members understand 
that as Afghanistan moves towards developing a new government, it is 
important for the U.S. to provide incentives for the people of 
Afghanistan to create a new national government which will move towards 
increased stability in the region.
  I would like to thank the distinguished Members from both sides of 
the aisle who have agreed to serve as original co-sponsors of the 
measure, and, in particular, the distinguished gentlelady from North 
Carolina (Mrs. Clayton). Her commitment to assistant people in the U.S. 
and the rest of the world feed themselves through the Farmer-to-Farmer 
program and other technical education programs will truly be missed in 
this Body during the next Congress.
  Mr. Speaker a very special note of appreciation is extended to Dr. 
Fred Starr of the School for Advanced International Studies of Johns 
Hopkins University for the concepts that undergird this legislation and 
for his generous amount of time and advice to this member and my staff 
Alicia O'Donnell, as we drafted this legislation. The distinguished Dr. 
Starr first explained his views and proposal at an Aspen institute 
breakfast sponsored by the distinguished former senator from Iowa, Rich 
Clark.

                              {time}  1330

  One important incentive which the U.S. can extend is assistance to 
address one of its most immediate needs, the need to rebuild 
Afghanistan's capability to feed itself.
  Indeed, nearly all of the indigenous tools for food production and 
rural development in the Afghanistan area have been destroyed. The 
people of Afghanistan, necessarily, have eaten their seed stocks and 
most have slaughtered all of their breeding livestock to meet their 
immediate food requirements. Additionally, over 20 years of civil war 
and political unrest in Afghanistan have resulted in the destruction of 
the country's limited basic irrigation systems.
  Unfortunately, the food production capabilities in the mountainous 
regions of Turkmenistan, Uzbekistan, Tajikistan, Kyrgyzstan, and 
Pakistan have reached abject levels, too, thus results in a regional 
crisis.
  Mr. Speaker, the Afghanistan and Central Asia Republics Sustainable 
Food Production Trust Fund Act that I have introduced directs the 
Secretary of the Treasury to enter into negotiations for the creation 
of a multilateral global trust fund to address the food production 
crisis in Afghanistan and the surrounding Central Asian Republics. 
Through the trust fund, nongovernmental organizations, working in 
conjunction with local and regional entities, would receive grants to 
conduct food production in rural development projects, including 
microenterprise loan programs, in Afghanistan and in the impoverished 
mountainous regions of the countries I previously mentioned.
  Upon the creation of the trust fund, the NGOs would be immediately 
eligible to receive grants to execute projects in the countries of the 
Central Asian Republics. This is a model laid out for us by Dr. Fred 
Starr, a very distinguished member of SAIS at Johns Hopkins University, 
in a breakfast for the Aspen Institute held in this Capitol building 
several months ago.
  In order to provide the important incentive during critical stages of 
state-building, Afghanistan would not be eligible for programming until 
the Secretary of State certifies that the people of Afghanistan have 
made substantial progress towards creating a national government which 
meets four criteria: one, has diverse ethnic and religious 
representation; two, does not sponsor terrorism or harbor terrorists; 
three, demonstrates a strong commitment to eliminating poppy production 
use for opium production; and, four, meets internationally recognized 
human rights standards.
  Mr. Speaker, helping the people in the region feed themselves is not 
only benefits which we are creating for them, it is important to us and 
to other countries. It would provide an opportunity to build good will 
in a region which has been neglected by U.S. policymakers and U.S. 
assistance programs. We cannot leave a vacuum there like the one that 
was left behind after the Soviets were expelled from Afghanistan.
  U.S. leadership, in creating a long-term trust fund, can be a 
critical step towards rebuilding confidence in the USA. When funds from 
public and private sources are gathered and distributed through a 
multilateral mechanism, it becomes much more difficult for governments 
in the region to dismiss the projects as ephemeral U.S. foreign policy 
initiatives. Additionally, providing programming funds for the Central 
Asian Republics and not solely to Afghanistan, which will certainly 
become the recipient of massive bilateral and multilateral human 
assistance programs, will further demonstrate the U.S. commitment to 
the entire region.
  Mr. Speaker, I hope my colleagues will look at this legislation. I 
think it begins the process of seeking a long-term solution to the 
region's dire food production challenges; and, furthermore, it is a 
real incentive for them to move the kind of government which will bring 
peace and stability to the region.
  Mr. Speaker, this Member would note that the Afghanistan and Central 
Asian Republics Sustainable Food Production Trust Fund is not intended 
to replace similar bilateral projects which USAID has begun to conduct 
in the region. Furthermore, the trust fund is not intended to supplant 
the very necessary emergency food assistance programs in Afghanistan 
and the surrounding Central Asian Republics.
  Mr. Speaker, it is critical that the U.S. and the rest of the global 
community begin to seek long-term solutions to the region's dire food 
production challenges. Through the creation of the Afghanistan and 
Central Asian Republics Sustainable Food Production Trust Fund, the 
U.S. can take an important step toward that end.

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