[Congressional Record (Bound Edition), Volume 149 (2003), Part 15]
[SENA]
[Pages 21365-21366]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        PROTECT HOME HEALTH CARE

  Mr. BOND. Mr. President, home health care is an important part of 
Medicare in which seniors and the disabled can get basic nursing and 
therapy care in their home. I rise today to urge the Senate Medicare 
conferees to stand firm against provisions in the House passed 
prescription drug and Medicare reform bill, H.R. 1, that would make 
further cuts in the Medicare home health benefit by reducing the home 
health inflation update and imposing a new copayment on home health 
beneficiaries.
  Home health care is convenient, but much more importantly, patients 
love it. I have seen this first hand as I have had the privilege of 
visiting with many of my constituents who rely on this benefit. They 
love home health care because it is the key to fulfilling what is 
virtually a universal desire among seniors and those with 
disabilities--to remain independent and within the comfort of their own 
homes despite their health problems.
  Since the passage of the Balanced Budget Act of 1997, BBA, no other 
group of Medicare patients and providers have endured as many 
difficulties. This is a big claim, given the many horror stories we've 
heard about the Balanced Budget Act. But absolutely nobody has suffered 
like home health patients and home health agencies. True reform means 
more than just ratcheting down payments to providers and services to 
patients.
  Since 1997 Medicare home health spending has been reduced by over 40 
percent and the number of beneficiaries by 1.3 million, or about a 
third. Forty percent of the agencies in my State have closed down or 
quit serving Medicare patients.
  In a move to modernize the Medicare program, Congress eliminated the 
home health copay in 1972 to encourage the provision of health care in 
the home rather than in more costly institutions. With all the cuts in 
home health care that have occurred since 1997--including the loss of 
venipunc- 
ture, blood drawing, as a qualifying service, the imposition of per 
beneficiary limits under the interim payment system, cuts in the market 
basket inflation update, a ``15 percent'' cut in October of last year, 
and the loss of the 10 percent rural add on in April of this year--
MedPAC has recently confirmed an alarming trend toward greater use of 
nursing home care. The reimposition of a home health copayment now 
would be a step backward that would exacerbate this recent trend.
  Home health beneficiaries already must pay the Part B deductible and 
a 20 percent copay for preparation of a home health plan of care and 
ongoing home health care oversight by a physician. Over half of home 
health patients come directly from the hospital and must pay the Part A 
deductible of over

[[Page 21366]]

$800 in order to receive the home health benefit. Often they and their 
families must pay out of pocket for personal care services to assist 
with activities of daily living.
  Our Nation's dedicated home health providers--and you know they are 
dedicated if they have stuck with it through the difficulties of the 
last few years--deserve to be left alone and given a rest. They, and 
the patients they serve, deserve to be left alone to recover from the 
post-BBA chaos. They deserve to be left alone in order to adjust to a 
new home health payment system.
  In passing the Senate prescription drug and Medicare reform 
legislation, S. 1, the Senate wisely chose to forgo further cuts in the 
home health benefit. I urge my colleagues on the Medicare conference 
committee to oppose the provisions in H.R. 1 that would further cut and 
destabilize the home health benefit.

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