[Congressional Record (Bound Edition), Volume 148 (2002), Part 8]
[Senate]
[Pages 10387-10391]
[From the U.S. Government Publishing Office, www.gpo.gov]




           HEALTH CARE CHALLENGES IN THE STATE OF WASHINGTON

  Mrs. MURRAY. Madam President, seniors in Washington State cannot get 
the medical care they need, and I have come to the floor today to 
explain the problem and to offer a solution that has the support of 
doctors, nurses, hospitals, and patients throughout Washington State.
  While many States are facing challenges in health care, the problems 
are especially severe in my home State, where providers are struggling 
to care for patients in a system that is falling down around them. 
There are many reasons for this crisis, but one of the most fundamental 
is the unfair way in which Medicare reimburses doctors and providers.
  Just look at what happens to the seniors I represent. They have spent 
their lives working hard, raising their families, and paying into the 
Medicare system. In fact, they have paid the same percentage of their 
income into Medicare as Americans from every State. But when they 
retire, they find that their access to health care depends upon where 
they happen to live. If they live in Washington State, they can expect 
far less access and far fewer benefits than seniors in other States. 
That is because Medicare reimbursement rates vary State by State.
  Today, those reimbursement rates don't reflect the true cost of 
providing care, and they are penalizing patients and providers 
throughout Washington.
  Madam President, in recent years, we have lost many physicians and 
clinics, especially in our rural areas. These unfair Medicare rates are 
making the problem even worse by encouraging doctors to retire early, 
to move, or to stop seeing Medicare patients altogether.
  At the same time, these rates make it even harder for us to attract 
the new doctors, nurses, and health care professionals that we need to 
fill the growing void. As a result, seniors have to spend all day long 
on the phone trying to find a doctor who will see them. More often than 
not, they are told the doctor is not accepting any new Medicare 
patients.
  Today, I want to explain the problem, show the impact it is having on 
the people of my State, and talk about a legislative proposal that 
Senator Cantwell and I have introduced to give Medicare patients the 
equity they deserve.
  For years, the health care challenges of Washington State have been 
getting worse, just like in the Presiding Officer's State. More and 
more patients don't have insurance and families don't have enough 
insurance. There is a shortage of health care professionals. That is 
causing problems, especially in our rural areas. There are many reasons 
for these difficulties, including our growing retired population, the 
rising cost of medical care and prescription drugs, as we all know, and 
paperwork and insurance.

[[Page 10388]]

  In January, Medicare payments to doctors were slashed by 5.4 percent 
nationwide. Because many private insurers base their rates on Medicare 
payments, providers cannot shift the costs as they could in the past. 
In addition, Washington State is facing a budget shortfall and that has 
affected funding for Medicaid.
  As we in Washington State try to address those national challenges, 
we are starting out several steps behind. That is because Washington 
State receives far below the national average in Medicare payments per 
patient. As this chart behind me shows, Medicare rates vary by State. 
Shown here are the average Medicare payments per beneficiary. These 
figures come from the Federal agency that manages the program--the 
Centers for Medicare and Medicaid Services, known as CMS. These figures 
are for fiscal year 2000. I would love to show more recent numbers, but 
I understand CMS has decided they are no longer going to calculate or 
distribute these figures.
  Looking at this chart, you can see that these figures vary 
dramatically between States. At the top is Louisiana. They get, on 
average, $7,336 per Medicare patient. At the bottom is Iowa, which 
receives less than half that, just $3,053. When you include the 
District of Columbia, Washington State, my State, ranks 42nd in the 
Nation in Medicare reimbursement beneficiary. The Presiding Officer's 
State of Arkansas ranks right here at about 28th in the Nation. It is 
well below the average of what most States get. The national average is 
$5,490. Washington State, my State, receives $3,921 per patient.
  In fact, in New York, a doctor can be reimbursed at twice the rate as 
Washington State for some procedures. That affects the stability of our 
doctors, hospitals, clinics, and home health care providers. Over the 
lifetime of a Medicare beneficiary, it can mean thousands of dollars 
less spent on their care in Washington.
  These regional inequities have resulted in vastly different levels of 
care and access to care. For example, in Florida, up here at the top of 
the chart, a lot of Medicare beneficiaries have access to prescription 
drugs and prescription eyeglasses in their Medicare Plus Choice 
program.
  In Washington State, while there may be some willing providers, there 
are no open plans available that offer prescription drug coverage, much 
less eyeglasses, because of our low reimbursements.
  Overall, this is about fairness and access to health care. So I want 
to point out four reasons this morning why this system is unfair to 
patients in my State and the other States that rank at the bottom in 
reimbursements.
  First, Washington State seniors pay the same rate into Medicare as 
everyone else. During their working years, every American pays the same 
percent of their income into the Medicare system, no matter where they 
live.
  During retirement, every American pays the exact same dollar amount 
in part B premiums, no matter which State they live in. Washington 
seniors pay the same, but they do not get the same access to care, and 
that is not fair.
  Second, the reimbursement rates do not reflect the true costs of 
providing care. The cost of treating a patient does not magically drop 
when you cross the border into my home State of Washington. The health 
care pressures we are facing do not stop at the State line, but 
payments do, and that is forcing doctors to choose between helping 
patients and staying in business. That is not fair.
  Third, health care today is affected by national trends that require 
more equal reimbursement rates throughout the country. Two of those 
trends are the shrinking pool of available doctors and the growing need 
for expensive medical equipment.
  There are a limited number of medical professionals, and every State 
is now competing to attract them. Because Medicare rates are so much 
lower in my State, we cannot offer the same salaries or the same 
recruitment incentives.
  Hospitals face this challenge when it comes to medical technology. 
Today, health care relies increasingly on sophisticated expensive 
technology. An MRI machine costs the same amount for a hospital in 
Florida as a hospital in Washington State, but the only difference is 
the hospital in Washington State receives far less money from Medicare 
to pay for it. Overall, that means our State cannot attract the 
providers or buy the equipment that other States can, and that is not 
fair.
  I recently heard from doctors with Olympia Radiation Oncology in 
Olympia, WA, and they said:

       While the cost of state-of-the-art equipment and personnel 
     remains the same from state to state, the reimbursement is 
     allowing appropriately reimbursed states to maintain a higher 
     quality of care, while Washington State is struggling to 
     deliver basic care. . . . If this problem is not addressed in 
     a timely manner, we will continue to have a migration of 
     young people and businesses out of our state, and we will be 
     left with an aging population with suboptimal care.

  My State is being penalized for doing the right things in health 
care, and that is not fair. Washington State has a long tradition of 
providing high-quality, low-cost health care, but today that innovative 
tradition is being used against us by the Medicare system. Other States 
spend more than twice what we spend and end up with less healthy 
outcomes while we are being punished for providing excellent care at 
low costs, and that is not fair.
  This is an issue of fairness. Our seniors pay the same into the 
system and pay the same Part B premiums, but we do not get the same 
access or benefits. Our doctors have to choose between staying in 
business or accepting Medicare patients because Medicare payments do 
not reflect the true costs.
  Our State is competing with every other State to attract doctors and 
to buy medical equipment, but we do not have the same resources as 
Medicare provides to other States.
  Finally, our State is being penalized for providing highly efficient, 
high-quality health care at low costs. Any way we look at it, the 
system is not fair to the people I represent.
  This difference in reimbursement rates would not be a big deal if it 
were just a bureaucratic formula on a piece of paper, but we are 
talking about whether or not people can see a doctor, and I can tell 
you, unfair Medicare rates are hurting patients in Washington State in 
several ways. Many doctors are leaving our State, retiring early, or 
even refusing to accept Medicare patients. Nationwide a study by the 
American Academy of Family Physicians found that 17 percent of family 
doctors are not accepting new Medicare patients. The problem is even 
more severe in my State. The Washington State Medical Association 
conducted a survey last November and found that 57 percent of 
physicians who responded said they are either limiting their Medicare 
patients or dropping all Medicare patients from their practice.
  Many experts believe that study does not even show the full extent of 
the problem. Other doctors are just leaving our State altogether. Since 
1998, the number of Washington State Medical Association members 
leaving our State has increased by 31 percent.
  To illustrate this problem, the Washington State Medical Association 
took out print advertisements in Washington State newspapers. And they 
say: Eastern Washington, my State, has a thriving medical community. 
You will find them in places like Boise, ID and Eugene, OR.

       It's getting to the point where Washington doctors can't 
     afford to stay in Washington. Administrative costs are out of 
     control, reimbursement rates don't cover services, medical 
     practices are shutting down. The fact is Medicaid and 
     Medicare are grossly underfunded and private payers are 
     setting their rates according to public programs. Now what 
     does this mean to the patient? It means that even if you have 
     great health insurance, the underfunding of public programs 
     puts your personal physician's practice in jeopardy. So in 
     other words, all the insurance in the world isn't going to 
     help when your family doctor packs up and leaves the State.

  This is a pretty good description of what is happening in my State. 
When doctors leave our State or retire early, their patients have to 
look for a new doctor who will accept Medicare, and according to my 
State's medical association, each time one physician leaves

[[Page 10389]]

the Medicare Program, 2,000 patients have to find a new caregiver.
  Across Washington State, seniors are experiencing the frustration of 
spending all day on the phone and still not being able to find a doctor 
who will accept them just because they are on Medicare.
  Many articles have been published in my State detailing the trouble 
our seniors are having finding a doctor, and I have included many of 
these articles on my Web site. But I want to share one example with my 
colleagues.
  A few months ago in Sequim, WA, a small, rural community, an older 
woman came up to me in a parking lot with a cast on her arm. She told 
me when she broke her arm, she went to the doctor. He put her cast on 
and told her to come back in 4 weeks. In the interim, her doctor 
determined he could no longer take Medicare patients. So when she went 
back 4 weeks later, she found out her doctor would not see her because 
he was not accepting Medicare patients.
  There she was in this parking lot, standing there asking me how she 
was supposed to get her cast off. That is how bad it has gotten.
  These terrible examples are becoming more common every day in my 
State because unfair Medicare rates are encouraging doctors to leave my 
State or close their practices to Medicare patients. But it is not just 
a problem for people on Medicare. It ends up having an impact on 
everyone.
  When a patient cannot find a doctor, a patient ends up in the 
emergency room. The ER is really the only place where a patient cannot 
be turned away. Unfortunately, by the time they make it to the ER, 
their symptoms, which could have been addressed easily, have now 
developed into more serious medical problems.
  James Newman is an emergency room doctor in Kennewick, WA. He is the 
chairman of education for the Benton-Franklin County Medical Society. 
Dr. Newman has seen patients go into cardiac arrest in the emergency 
room because they did not get care early enough. Often those patients 
had symptoms for weeks, but they could not find a primary care doctor, 
so they end up going into cardiac arrest in the emergency room, and 
that is outrageous.
  Dr. Newman says that once a patient is ready to leave the ER, he 
cannot find a doctor who will continue to care for them. So Dr. Newman, 
who is board certified in emergency medicine and has been practicing 
for 10 years, spends much of his time trying to find doctors for his 
patients, sometimes begging and borrowing favors just to get his 
patients the care they need, and he ends up having to practice beyond 
the normal scope of his job.
  For example, he might give a patient an 8-month prescription for 
hypertension medicine because he knows that patient will not be able to 
find a primary care doctor to refill a shorter prescription. Even 
worse, Dr. Newman ends up seeing the same patients again and again in 
his emergency room because they cannot find a doctor to care for them. 
That is how bad things have gotten in my State.
  Remember, the cost of providing care in emergency rooms is much 
higher than preventing those problems in the first place. This problem 
impacts everyone who needs emergency care. Our emergency rooms are 
overcrowded. According to a recent study by the Washington chapter of 
the American College of Emergency Room Physicians, 91 percent of small 
hospitals and 100 percent of large hospitals reported overcrowding.
  In addition, 76 percent of large hospitals reported overcrowding 2 to 
3 times a week or more often.
  In addition to problems in the emergency room, these unfair rates 
also make it hard for us to recruit the new physicians we need to 
replace those who are moving and retiring early.
  I want to share with the Senate what Mike Glenn, the CEO of Olympic 
Medical Center in Port Angles, WA had to say on recruitment.
  As he tries to attract doctors, he is finding that hospitals in other 
States are offering twice the salaries he can offer.
  He says:

       Doctors in nearly every field are either fleeing our state 
     to earn higher salaries, or staying but with growing levels 
     of dissatisfaction and resentment.
       Physician headhunter firms have targeted our state as 
     fertile ground to find doctors willing to pack up and leave 
     for positions in states benefitting from more Medicare 
     dollars.
       If this situation is not quickly remedied, many Washington 
     communities will face critical shortages of physicians.
       Imagine a trip to a hospital Emergency Room without 
     qualified ER doctors to provide life saving treatment, or 
     without anesthesiologists to staff the Operating Room.
       This is not a doomsday scenario, but a logical consequence 
     of the current Medicare reimbursement system.

  There is no denying that unfair Medicare rates are hurting patients 
and providers in Washington State.
  Doctors are leaving our State or refusing to see new Medicare 
patients.
  As a result, seniors cannot find doctors who will accept them.
  Too often, those seniors end up in the emergency room in much worse 
condition.
  We cannot even dig ourselves out of this hole because the low 
reimbursement rates make it hard for us to recruit new doctors to 
Washington State
  It is going to get worse.
  As I mentioned earlier, in January, Medicare payments to doctors were 
cut by more than 5 percent.
  They are expected to continue to decline in the next 3 years for a 
total decrease of 17 percent by 2005.
  That is untenable. We need to do something about it.
  Unfortunately, the Bush Administration does not acknowledge the 
severity of the problem.
  In April, Tom Scully, the administrator of CMS, told Washington 
seniors that ``access was not yet a serious problem.''
  On Wednesday, I asked him about it at a hearing, and he said 
basically the same thing: That it will be a problem, but it is not a 
serious problem today.
  They do not get it.
  CMS is not going to fix this.
  The White House is not going to fix this.
  The Office of Management and Budget is not going to fix this.
  If we are going to fix this problem, we are going to have to do it 
right in the Senate.
  That is why Senator Cantwell and I have introduced S. 2568, the 
MediFair Act.
  The MediFair Act is designed to restore access and fairness to 
Medicare, and--in the process--help seniors, the disabled and all of 
our citizens.
  This proposal is based on what I have heard from doctors, nurses, 
hospitals and patients over the past year.
  Our bill has been endorsed by the Washington State Medical 
Association, the Washington State Hospital Association, and the 
Washington Nurses Association.
  On the House side, companion legislation has been introduced.
  It has the support of lead sponsor Adam Smith along with 
Representatives Dicks, McDermott, Baird, Inslee, and Larsen.
  The MediFair Act is a starting point for eliminating the regional 
inequities in Medicare.
  The bill will make the system more fair.
  It will ensure that seniors are not penalized when they choose to 
retire in the State of Washington.
  It will encourage more doctors to accept Medicare patients.
  It will make it easier for us to recruit new doctors to our State.
  And it will help our hospitals and home health agencies get the 
resources they need to care for our patients.
  Let me explain my bill. The MediFair Act works to bring States up 
from the bottom of the reimbursement list.
  The legislation would ensure that every State receives at least the 
national average of per-patient spending.
  The bill does not affect States that currently receive the national 
average or just above the national average.
  Further, our bill promotes efficient health care and healthy 
outcomes.
  This is an area where we really need to correct the incentives.
  Here is how Mike Glenn of the Olympic Medical Center put it:

       The concern is not over 42 states receiving better Medicare 
     reimbursement than Washington, but over what is rewarded and 
     what is not.

[[Page 10390]]

       Washington hospitals and physicians are proud of our record 
     of pioneering high quality, cost effective medicine. And we 
     do so by focusing on treatments that can help, while avoiding 
     overuse of treatments that cannot.
       This style of medicine yields equal if not better patient 
     outcomes. Our reward for this is to be paid a fraction of our 
     actual costs.
       To make matters worse, states who do not embrace our style 
     of cost effective care continue to demand and receive twice 
     as much funding from Medicare for no discernable difference 
     in patient outcomes.
       The gap between the ``haves'' and the ``have-not States'' 
     is growing.
       If Medicare does not change this--through action like the 
     MediFair bill--Washington hospitals in Medicare dependent 
     areas will enter into a death spiral until they are forced to 
     close their doors.

  So our bill promotes the right things: efficient healthcare and 
healthy outcomes. It will force States that receive inordinately high 
payments to improve the quality of their healthcare.
  Payments would be reduced to those States, which do not realize 
healthy outcomes--such as extending life expectancy or reducing rates 
of diabetes or heart disease.
  Simply put, our bill finally holds states accountable for the health 
care they provide with Medicare dollars.
  Before I close, I want to answer just a few questions about my bill.
  Some are concerned about the possible cost of fixing the inequities 
in Medicare.
  I am, too.
  But I also know that there is a high cost to doing nothing as seniors 
lose their doctors and their access to healthcare.
  There is a cost to the community when seniors end up in-and-out of 
the emergency room on a regular basis.
  And of course, there is a human cost to the patients and their 
families.
  Another question I have heard is:
  How will this bill attract support from Senators from high 
reimbursement states?
  First, States that are using Medicare dollars efficiently and 
effectively don't need to be concerned.
  Either way, I recognize that not everyone will embrace this specific 
legislative proposal.
  I want to find a solution that will help seniors get the care they 
need, and I recognize that there may be different ways to approach the 
problem.
  This MediFair bill is a starting point. It's a way to draw attention 
to the problem and get folks to look at various solutions.
  What matters is fixing the problem, so I welcome ideas and 
suggestions from anyone who wants to help us solve this problem.
  Finally, some of my colleagues may wonder how this bill fits into our 
efforts to provide a Medicare prescription drug benefit, which is 
something I have worked to pass for several years.
  We have introduced the ``Medicare Outpatient Prescription Drug Act of 
2002,'' of which I am a cosponsor.
  Our work on prescription drugs should not keep us from fixing this 
fundamental problem.
  After all, a prescription drug benefit isn't worth anything if there 
aren't any doctors to write out a prescription. So both issues are 
critical, and we need to move forward on both of them.
  We need to fix these problems now--before another senior in my State 
loses her doctor--before another patient goes into cardiac arrest in 
the emergency room because he could not find a doctor when his symptoms 
first appeared.
  The system is unfair, and as Dr. Sam Cullison said, ``Sadly, it is 
the Medicare patients themselves who are paying the price for this 
inequity.''
  We can restore fairness to Medicare.
  We can help patients get the medical access they need, and the 
MediFair Act is part of that process.
  I invite my colleagues to talk with Senator Cantwell and me about how 
we can move this or any other proposal forward.
  I conclude by saying that this is a matter of critical national 
attention, and I am going to work every single day to educate our 
fellow Senators, who are also impacted. We have to do something about 
this.
  I ask unanimous consent that several articles be printed in the 
Record.
  There being no objection, the articles were ordered to be printed in 
the Record, as follows:

                [From the Everett Herald, June 4, 2002]

            Murray's Medicare Plan a Step in Right Direction

       Sen. Patty Murray has the right intention. She wants to 
     make Medicare work better for patients and health care 
     providers alike in this state.
       Murray and the rest of the state's congressional Democrats 
     have united around a plan that would raise Medicare 
     reimbursements to health care providers in states where 
     payments are below the national average. Washington is among 
     the 10 lowest states in reimbursement rates, which actually 
     punish areas with relatively efficient health care systems.
       Murray's Medi-Fair Act would remedy the inequity by raising 
     all payment rates to at least the national average and over 
     time, forcing improvements elsewhere. It's a good plan, but 
     one that is more likely to raise much-needed discussions 
     rather than solve the problem immediately.
       The short-term political reality is that the potential 
     solutions run into a double-whammy. On one side, the Bush 
     administration appears determined to avoid domestic spending 
     increases--unless there is a high enough political gain, such 
     as with the farm bill. On the other side, major states--
     including California, New York and Florida--aren't about to 
     help others address the equity issue unless their higher 
     Medicare reimbursements can be protected.
       The best hope is that Murray and potential allies in both 
     parties, including Republican Sen. Charles Grassley of Iowa 
     (where reimbursement rates are the lowest of all), can raise 
     the level of discussion to the point that a solution becomes 
     politically necessary.
       Certainly, for Medicare patients and aging baby-boomers who 
     will soon use the system, the need for action is becoming 
     increasingly serious. The inequities have been around for 
     years, but their effects have become more severe. In this 
     state, many doctors are now refusing to take new Medicare 
     patients because the reimbursements don't cover physicians' 
     costs. The problems extend beyond doctors, though, to other 
     providers.
       For the entire health care system, the paper work 
     accompanying Medicare is also a serious issue. It aggravates 
     the low reimbursements here by running up the expenses in 
     medical offices. There is a need for a system that simplifies 
     administration, just as there is a need for a health care 
     system that provides broader access for all people, 
     regardless of age and income.
       Action on reforming Medicare's inequities should not be 
     made to wait for such larger solutions. Medicare is America's 
     most significant achievement in assuring health care access. 
     Its erosion cannot be tolerated. Whatever the politics 
     obstacles to immediate action, the Murray initiative helps 
     bring forward the issue of massive inequities in 
     reimbursements. That's a step in the right direction.
                                  ____


              [From the Bellingham Herald, June 12, 2002]

                    ``Medifair'' Is Workable Answer

       Our nation's Medicare system is so fraught with problems 
     that there is no single cure for what ails it. Recovery will 
     require multiple remedies over time. Still, U.S. Sen. Patty 
     Murray, D-Wash., took a healthy step toward a solution in 
     announcing her ``Medifair'' legislation last month.
       Much lip service has been paid to addressing Medicare 
     issues, but Murray's bill, still in draft form, advances the 
     fight.
       It's no secret that Washington state is at the low end of 
     the scale for reimbursements. That's more than evident in 
     Whatcom County, where the Family Care Network and Madrona 
     Medical groups have had to stop taking new Medicare patients 
     because they can't afford to treat them.
       Despite the fact that everyone pays into the system at 
     equal rates, the doctors who treat them are not reimbursed at 
     the same rates. States like California and Florida receive 
     far higher payments than Washington, which is being penalized 
     for trying to contain medical costs. The current formula is 
     unfair to both the patients who pay into it and to the 
     health-care providers who treat them.
       Murray's bill would require that every state receive at 
     least the national average for per-patient spending, which 
     was $5,490 in 2000. Washington received about $3,900 per 
     beneficiary in 2000, making it 42nd among the states in per 
     capita spending.
       Under Murray's proposal, states that receive 105 percent of 
     the average could see cuts.
       In reality, the bill will face very strong opposition and 
     will be difficult to pass. Big states will fight hard not to 
     have their reimbursements cut, and the formula could require 
     new revenue that won't be readily available.
       The important thing is that Murray is getting the system on 
     the table for examination.
       While Washington ranks near the bottom in reimbursements, 
     it ranks closer to the top in numbers of Medicare clients. 
     The federal plan covers about 750,000 seniors and disabled 
     people in this state, making it 18th in the nation in client 
     base, according to 1999 figures.
       U.S. Rep. Rick Larsen, D-Arlington, has already announced 
     he's behind Murray's idea.

[[Page 10391]]

       It's time for Washington's other members of Congress, on 
     both sides of the aisle, to join this fight and help 
     Washington be a leader in Medicare reform.
                                  ____


               [From the Spokesman-Review, June 5, 2002]

                 Murray's Bill Rights Medicare Inequity

                           (By John Webster)

       Unveiling a Medicare-enhancement bill the other day, U.S. 
     Sen. Patty Murray told an unsettling story: An elderly 
     constituent wearing a cast on her arm came up to Murray and 
     said that when the time came to get her cast removed, her 
     physician refused to see her because he recently had stopped 
     accepting Medicare patients.
       Why would any member of the healing profession want to shun 
     Medicare, a major source of patients? Because, in Washington 
     state, Medicare's reimbursement rates are lousy and getting 
     worse.
       That's why Murray introduced S. 2568, the MediFair Act of 
     2002. The bill would compel Medicare officials to correct a 
     reimbursement inequity.
       The state medical association says this inequity has 
     created such financial difficulty that a growing number of 
     older physicians are throwing in the towel and retiring; 
     young physicians are moving to states other than Washington; 
     and, some Washington state physicians are deciding to stop 
     taking Medicare patients.
       These are alarming trends for the residents of our state. 
     The problem is particularly troubling for Spokane. Here, 
     there is a sizable population of low-income and elderly 
     people who depend on Medicare. In addition, Spokane is a 
     regional center for advanced medical services--one of the 
     strongest sectors in our economy. Medicare is a leading 
     source of the health care industry's income; if it fails to 
     cover costs, that's a serious problem.
       The reimbursement inequity has existed for years, but it is 
     getting progressively worse. When Medicare set its 
     reimbursement rates years ago, it built them on the status 
     quo, state by state. Medical care was more cost-efficient 
     here than in some states, so reimbursement rates here were 
     set at a lower level.
       But as years went by, physicians have faced a accelerating 
     need to invest in high-tech equipment, which costs the same 
     everywhere. Medicare's rates left Washington's clinics with 
     less money to buy that technology, than doctors had in other 
     states.
       On top of that, in 1997 Congress approved a series of cuts 
     in Medicare, to balance the federal budget. Ever since, 
     Medicare has been cutting physicians' reimbursement rates. 
     Doctors in less-efficient states with higher reimbursement 
     rates had leeway to adopt efficiencies and adjust. Not so, in 
     Washington, where rates are lower. By 2005, that 1997 budget 
     deal is scheduled to have cut reimbursement rates by 17 
     percent.
       As of 2000, Sen. Murray says, Medicare spent an average of 
     $3,921 on each Medicare beneficiary in Washington state. In 
     New York it spent $6,924. The national average was $5,490. 
     Washington's rate ranked 42nd in the nation.
       This makes it tough for Washington to keep or recruit 
     physicians.
       According to a survey by the Washington State Medical 
     Association, 57 percent of physicians are limiting or 
     dropping Medicare patients from their practice.
       Murray's bill would require Social Security to correct the 
     inequity; in states such as Washington, Medicare would have 
     to raise reimbursement rates to the national average.
       The proposal has the support of associations representing 
     the state's doctors, hospitals and nurses. Good for Sen. 
     Murray, for seeking a solution. The elderly depend on 
     Medicare, and they are counting on Congress to fix Medicare's 
     many ailments--including this one, which threatens the 
     stability of medical clinics as well as access to the 
     physicians that elderly people need.
  Mrs. MURRAY. I yield the floor.
  The ACTING PRESIDENT pro tempore. Under the previous order, the 
remaining time shall be under the control of the Republican leader or 
his designee. The Senator from Virginia.

                          ____________________