[Congressional Record (Bound Edition), Volume 154 (2008), Part 10]
[Senate]
[Pages 14022-14024]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         MEDICARE IMPROVEMENTS

  Mr. BAUCUS. Mr. President, on Tuesday, the House passed the Medicare 
Improvements for Patients and Providers Act, and I urge the Senate to 
take up and pass this bill tonight.
  The House passed the bill with an overwhelming vote, 355 to 59. That 
is a 6-to-1 ratio. Even among Republican Members of the House, more 
than twice as many Republicans voted for the bill as against it.
  The Senate should take up and pass this Medicare bill not just 
because the House passed it with 355 votes, but, rather, because it is 
the right thing to do. The Senate should pass this Medicare bill 
because time is running out. I understand the House is going to adjourn 
today. I think they have cast their last vote. If we don't act soon, 
the law cuts payments to doctors by 10 percent on July 1. We have to 
stop that cut. That cut threatens access to care for America's seniors. 
Already, some providers are declining Medicare patients. That trend 
will accelerate--believe me, I have talked to a lot of doctors--that 
trend will accelerate if we don't act. We must pass this bill tonight. 
The Senate should pass this

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Medicare bill because it is the only way to avoid the cut. There is no 
other option. There is no alternative. There is no short-term solution. 
This is the only train in the station. This is it.
  The House-passed bill is very similar to S. 3101. That is the Baucus-
Snowe bill the Senate considered 2 weeks ago, but the House made three 
noteworthy changes to that bill.
  First, the House-passed bill includes legislation to delay the 
Competitive Acquisition Program for durable medical equipment. 
Congressmen Pete Stark and David Camp introduced legislation to do that 
in the House, and Senator Grassley and I, along with 24 other Senators, 
introduced that legislation here in the Senate.
  I support competitive bidding as a way to decrease costs, but 
Congress needs to ensure that these savings are not achieved at the 
expense of beneficiary access to the care they need in their own 
communities. We need to take a closer look at competitive bidding 
before it moves forward. The passage of this Medicare bill will allow 
that.
  The House-passed bill also does not include cuts in funding for 
oxygen supplies and equipment, and it does not include cuts in funding 
for power wheelchairs. Those who support these reforms make a good 
case, but ultimately the cuts could not be included as part of this 
must-pass legislation.
  This bill is a balanced package. It is a true compromise. It does not 
go nearly as far as many House Democrats wanted it to go, and it goes 
about as far as some of my Republican colleagues in the Senate can go.
  When the House passed its children's health bill last year, the House 
made major changes to the Medicare Advantage Program. Last year's House 
CHIP bill would have significantly restricted the program, but this 
House Medicare bill does not do that.
  This bill includes a reduction in the double payment for medical 
education costs to private plans in Medicare, and this bill would 
protect seniors from unscrupulous marketing practices by private health 
plans. That has to be corrected and it is in this bill. Both of those 
changes were also included in a bill crafted by Senate Republicans. I 
think they are wise, and they are wise to follow up with a similar vote 
later on tonight.
  This bill would do more. It would also require the so-called private 
fee-for-service plans to form provider networks. All other plans must, 
all other Medicare Advantage plans must, and so should private fee-for-
service plans. It would also make sure there are doctors behind those 
plans. It is not the case in current law, but that change is made in 
this bill. This bill does not--I must say--does not include deep cuts 
to Medicare Advantage payments. It also does not cut private fee-for-
service plan payments at all. It just has this provision which I think 
is a major reform.
  I would go further on Medicare Advantage, but I must say to my 
colleagues that this is not the time and this is not the legislation to 
do that. This is the time to avert the pending cut in payments to 
doctors. That payment cut would devastate access to care for America's 
seniors. We cannot let that happen. We cannot let those cuts go 
through, which would devastate care for America's seniors.
  So what else will this bill do? For Medicare beneficiaries, this 
Medicare bill would expand access for preventive services. We have all 
talked about that, and this bill does it. It would eliminate the 
discriminatory copayment requirements for seniors with mental 
illnesses. We have talked about that. We should not have discriminatory 
copayment requirements for seniors with mental illness. And it provides 
additional needed care for low-income seniors.
  The Medicare bill would take important steps to shore up our health 
care system in rural areas. It includes provisions from the Craig 
Thomas Rural Hospital and Provider Equity Act. We included that in this 
bill.
  The bill includes important relief for ambulance providers, community 
health centers, and primary care physicians. They need some additional 
help. Primary care doctors represent the backbone of our health care 
system. This legislation, the House-passed bill and the Senate bill, 
does make those provisions.
  This Medicare bill would make important improvements in pharmacy 
payments. It would make payments under the Part D drug benefit fairer 
and more timely, especially to those who dispense drugs to our Nation's 
senior citizens.
  This bill would save valuable Medicare dollars by providing a single 
bundled payment for all the services related to treating end-stage 
renal disease. That is a reform. And for the first time, dialysis 
facilities would receive a permanent, market-based update to their 
payments each year, something they have been asking for and deserve. 
This would make sure Medicare payments keep up with their costs.
  I wrote the legislation on which this Medicare bill was based to make 
sure the seniors in my home State of Montana and everywhere in our 
country can get quality, affordable health care. This Medicare bill 
would do right by low-income and rural seniors.
  This bill would expand emergency health care for veterans in rural 
areas. We all talk about helping our veterans who are coming home. This 
helps do that, particularly in rural areas where the networks are not 
there. It needed special attention. It is there in the urban areas on 
the margin but even less in rural areas. It would increase payments for 
doctors who work in rural areas. It would stop payment cuts to 
providers, and it would give them a decent increase in reimbursement. 
All of this would ensure that seniors will be able to keep seeing the 
doctors they need to see.
  I have worked for months to write a strong Medicare bill that could 
pass both Chambers with wide support. Tuesday's overwhelming House vote 
makes clear that this bill can be that bipartisan vehicle. In a sense, 
it is being taken up just in time, just before July 1. The House will 
not take up another vehicle. This is it. The House has gone home for 
its Fourth of July recess. There is not time left to craft a viable 
alternative. Even if there were, the House cannot pass it in time. The 
clock is ticking. This Medicare bill can be a slam dunk at the buzzer 
for 44 million American seniors who depend on Medicare. Let's do what 
is right. Let's ensure that seniors have access to doctors. Let's avert 
the impending payment cut to doctors, and let's pass this bipartisan 
Medicare bill.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mr. CORNYN. Mr. President, I have been talking to the physicians in 
my State who take Medicare patients, and frankly, this is a terrible 
way for Congress to do business. We see a 6-month patch on the 
physician reimbursement formula that will expire July 1, and 
unfortunately we are looking at what amounts to a partisan proposal 
here that we are basically being told to take or leave.
  As all of our colleagues know, the ranking member on the Finance 
Committee, Senator Grassley, got together with Senator Baucus after 
cloture was denied previously and pretty well had things worked out in 
a bipartisan way until the House passed their version, and then, of 
course, those negotiations broke down, leading us to this cloture vote 
we are going to have here in just a few minutes. But I have to say that 
in 1996 when Congress passed the Balanced Budget Act and contemplated 
these Draconian cuts in the physician reimbursement payments, Congress 
should have known and should have told the truth that it never intended 
that any of those cuts would ever take place--and for good reason they 
should never take place, because even under the current Medicare 
reimbursement rates, doctors--for example, in Travis County where 
Austin, TX, is located, only about 18 percent of the physicians in that 
county will actually take new Medicare patients because the 
reimbursement rates are already so low.
  Then we have this unbelievably bad way of doing business. I don't 
know anybody else who could get away

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with--other than the Congress--passing temporary patches on the 
reimbursements that are paid to physicians. They last for a year, they 
last for 6 months, such as this last one that leads us up to the edge 
of a cliff here on July 1, and then we are told by the distinguished 
chairman of the Finance Committee that we have to take it or leave it 
or the cuts will occur. Well, frankly, no one believes the cuts will 
actually occur because Congress will act.
  I suggest that rather than this terrible way of doing business that 
nobody else could ever get by with and rather than frightening the 
Medicare beneficiaries who need access to the doctors who are paid 
using this Medicare reimbursement formula, we ought to scrap the entire 
method of reimbursing doctors for Medicare and start over again, 
recognizing that we are not going to allow these Draconian cuts to 
occur, this 10-percent-plus cut that goes into effect July 1 and the 
20-percent-plus cut that will occur 18 months from now. I think we 
ought to acknowledge that we are not going to let those cuts go into 
effect and scrap the sustainable growth rate formula by which those 
Medicare reimbursements are calculated because it is just not honest. 
It is not honest. It is scaring not only the Medicare beneficiaries, it 
is impairing access to health care for those to whom we promised the 
Medicare Program would actually work.
  So I don't know what is going to happen on this vote on cloture. I 
suspect cloture may not be invoked. My hope is that there would be a 
bipartisan way to find our way forward. I believe it already exists in 
the form of a negotiation that Senator Grassley and Senator Baucus have 
undertaken here in the Senate and that we shouldn't use this kind of 
brinkmanship to scare not only the Medicare beneficiaries--the seniors 
who depend on this health care--but also the physicians who are 
reimbursed under this formula.

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