[Congressional Record (Bound Edition), Volume 154 (2008), Part 10]
[Senate]
[Pages 14143-14145]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      KEY PROVISIONS OF H.R. 6331

  Mr. CASEY. Mr. President, I rise this morning, prior to our break for 
the Fourth of July holiday, to talk about Medicare and in particular 
some of the activity on the floor in the last couple of weeks, but 
especially last night.
  I wanted to highlight some of the provisions of the Medicare 
Improvements for Patients and Providers Act of 2008 because sometimes, 
when something gets voted on here, whether it is the bill or a measure 
to get us to the bill, it can go right by a lot of us and certainly can 
go right by the American people without enough focus on some of the 
provisions of the bill and some of the detail. I think it was a real 
missed opportunity, and I will talk about that in a moment, but now 
just some of the highlights.

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  First of all, with regard to physicians in America, the bill 
eliminates the pending 10-percent cut in Medicare payments to 
physicians for the remainder of 2008 and provides a 1.1-percent update 
in Medicare physician payments for 2009. It provides a 2-percent 
quality reporting bonus for doctors who report on quality measures 
through 2010 and provides financial incentives to providers to 
encourage the use of electronic prescribing technology.
  I don't think anyone in America needs to be reminded of how important 
this is, not just to make sure our Medicare system works well because 
of the positive impact this could have on doctors, but also anything we 
can do to encourage the use of information technology or other kinds of 
technology to make our system more efficient and more safe is critical. 
So that is one part of the physician section of this bill.
  For hospitals in particular and especially in my home State of 
Pennsylvania, there are so-called section 508 benefits. I will give a 
quick summary of what that means.
  This bill would extend 508 benefits to hospitals so they can continue 
to pay doctors and other providers in accordance with wages from 
surrounding areas. For northeastern Pennsylvania especially, this is a 
critical provision.
  Basically, and I am generalizing here, sometimes what happens is you 
have regions of a State that are categorized or given definitions that 
don't apply, and the reimbursement level goes down, and therefore the 
wages are impacted and they have trouble recruiting skilled personnel 
for positions in those hospitals. So we need a long-term fix for this 
situation. What this bill would do is continue to extend some help we 
have given in the past, but we do need a long-term fix, and we are 
working on that. For now, we need to provide this wage assistance to 
hospitals--and many hospitals in Pennsylvania have been hit hard by 
this--so they do not lose critical personnel to surrounding areas. It 
is a very competitive business, the business of recruiting qualified 
medical personnel.
  That is the physician section.
  The second section--and I am going to review just two or three more--
the beneficiaries. There is a lot to talk about here, but this bill 
adds a critical benefit for low-income older citizens, who are among 
the most vulnerable Medicare beneficiaries. It extends and improves 
low-income assistance programs for Medicare beneficiaries whose income 
is below $14,040. This includes the so-called Qualified Individual 
Program, which pays Part B premiums for low-income beneficiaries with 
incomes between $12,480 and $14,040. This provision is important to 
beneficiaries. The bill would increase the amount of assets low-income 
beneficiaries can have and still qualify for financial help with 
Medicare costs.
  The Presiding Officer knows from his own work in the State of Ohio 
and the people he represents that as we went through the farm bill, one 
of the points we focused on with regard to food stamps was that some 
people who get a benefit from food stamps were adversely affected 
because things such as childcare expenses--so essential for a family--
were being included as part of their assets, and it made it harder for 
them to get food stamp benefits. The same kind of principle is at stake 
here, where too often the eligibility determinations for low-income 
beneficiaries are unfair. This would improve that.
  Another area I wish to talk about are pharmacies. The bill requires 
Medicare to pay pharmacies on time--as they should anyway. Isn't that 
an interesting provision? These pharmacies have to pay out on 
prescriptions, and they need reimbursement quickly so they can stay in 
business. Many of them are the only pharmacies serving their 
communities in small towns.
  When people think of my State, they think of big cities such as 
Philadelphia or Pittsburgh or Erie or Scranton or Harrisburg or 
Allentown. But in between, we probably have more small towns than most 
States in the country. In those smaller communities, that pharmacy is 
sometimes the only option for many families--and not just rural 
families but many families who just live in small towns. It is 
certainly reasonable to expect these pharmacies to be reimbursed within 
14 days, and that is what this bill does. It forces the Federal 
Government to do what it should do, which is to pay pharmacies on time.
  Medicare Advantage. That is something we are going to be talking more 
about, but that is a subject of significant debate in the country. This 
bill deals with that issue directly. It also deals with rural providers 
and other beneficiaries.
  The bill protects access to care in rural America by extending and 
building upon expiring provisions, including improving payments for 
sole community hospitals, critical access hospitals, and ambulances. It 
extends expiring provisions that preserve payment equity for rural 
physicians and rural hospitals that run clinical laboratories.
  I could go on from there, but I won't. This isn't just about some 
Medicare concerns we have in our cities, this is about rural America 
and access to care in rural America. And Pennsylvania has as much of a 
rural population as virtually any State in the country. We are at least 
in the top five, at last count.
  So all of this is a way to summarize the bill and not do justice 
necessarily to the detail of the bill. This was a bill that was worked 
on here, worked on in the Finance Committee for many weeks, and worked 
on in the House in consultation with the Senate. The chairman of the 
Finance Committee, Max Baucus, and his team and people on that 
committee worked very hard, and I will tell you, to have it stopped, as 
so many things have been blocked around here--when I look at the total 
votes, Democrats did their job. We voted, every one of us, in unison to 
get this legislation moving forward. Yet, if you look at the total, on 
this vote last night there were eight Republicans who voted to move the 
bill forward.
  When you consider what is at stake--I mean, we listened to the 
arguments from the other side, but when you talk about making sure 
physicians are treated fairly so they can treat older citizens in 
Pennsylvania, Ohio, and across the country; when you talk about 
reimbursement in the case of hospitals in northeastern Pennsylvania, 
where they are competing for skilled personnel, yet we are not going to 
move something forward that can help them on their wages so they can 
have the best possible care for older citizens--in my home area of 
northeastern Pennsylvania, we have the highest percentage of people 
over 65 of anyplace in the country. We need help with this wage index 
problem to recruit the best personnel.
  When you talk about beneficiaries, these are very vulnerable low-
income beneficiaries, some of whom do not just have to worry about 
their Medicare benefits, but they are standing in lines to get food 
from food pantries. The Presiding Officer has talked about this a lot 
over the last year. The price of everything in their lives has gone 
up--gasoline and food, they are worried about Medicare, they are 
worried about their children and their grandchildren. And we can't vote 
to move something forward? It is outrageous that we have this split 
where you get all these Democrats voting for it and only eight 
Republicans.
  Finally, when it comes to pharmacies and rural providers, my 
goodness, if we can't move legislation forward to make sure the Federal 
Government pays pharmacies within 14 days, what are we doing? We can't 
get the votes to move forward.
  People across America and families on Medicare are worried. They are 
worried about Medicare and how it is going to impact their lives. I 
want them to be aware of what happened here. Democrats voted in unison 
to move this forward, to make these changes to the Medicare Program. 
The other side did not. It is a very simple equation. I know we will 
vote on this again, and I hope our colleagues on the other side, when 
they consider what is at stake for rural America--for small towns 
across the country and for very vulnerable people--I hope they would 
take that into consideration and vote the right

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way for older citizens and for those families.
  I yield the floor. I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. Will the Senator withhold his 
request?
  Mr. CASEY. I will withhold.
  Mr. SESSIONS. Mr. President, may I be recognized?
  The ACTING PRESIDENT pro tempore. The Senator from Alabama is 
recognized.

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