[Congressional Record (Bound Edition), Volume 154 (2008), Part 9]
[Senate]
[Pages 12097-12098]
[From the U.S. Government Publishing Office, www.gpo.gov]




          MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT

  Mr. BAUCUS. Mr. President, today I rise to urge passage of S. 3101, 
the Medicare Improvements for Patients and Providers Act.
  This is the right bill for America's seniors and the health care 
providers who treat them. It is a balanced bill, and it enjoys strong 
bipartisan support.
  It hasn't been easy to get to this point. I have engaged in earnest 
negotiations with Senator Grassley, Minority Leader McConnell, and the 
administration to reach a compromise on this bill.
  After several weeks of talks, it became clear that we would not be 
able to reach agreement on a bill that is fair to both rural and urban 
areas, and that balances the need to help America's seniors with the 
need to address the pending payment cut for Medicare providers.
  So I have worked with Democrats and willing Republicans to craft this 
legislation, the right legislation, and I urge all Senators to 
enthusiastically support it.
  There is urgency in this call for support. We must act now to block 
the cuts that Medicare's doctors will face on July 1.
  This legislation gives doctors a decent, measured increase in 
reimbursement that doesn't explode costs or excessively raise premiums.
  It includes provisions to improve the quality of care that is 
provided and, as is so urgently needed, increases access to primary 
care.
  It will also save lives and reduce costs by requiring doctors to use 
e-prescribing by 2011 whenever they give Medicare patients 
prescriptions.
  But the legislation goes further. It also takes care of America's 
seniors.
  First, it expands access to preventive services. Preventive care can 
identify health problems before they become health catastrophes.
  To help beneficiaries identify medical conditions and risk factors 
early, this bill allows new preventive services to be added to the 
program, so long as they are recommended by the U.S. Preventive 
Services Task Force and are approved through regular regulatory 
channels.
  Second, the bill finally gets rid of the discriminatory copayment 
rates for seniors with mental illnesses.
  Many older Americans experience depression and other mental health 
problems, but Medicare currently requires a much higher copayment for 
mental health services.
  That copayment is 50 percent, compared to the 20 percent required for 
physical health care services.
  This legislation lowers copayments for seniors' mental health 
services until they match other copays, making sure that seniors can 
afford the screening and treatment they need.
  The bill also expands the drug benefit's coverage to include 
benzodiazepines and barbiturates used for epilepsy and mental health 
treatment.
  Third, for low-income seniors this act expands programs that help 
with their out-of-pocket costs. Medicare pays many health costs for 
seniors, but some low-income beneficiaries need extra help to afford 
even basic care.
  And although subsidies are available through the Medicare Savings 
Programs, or MSPs, beneficiaries must prove their assets are low enough 
to qualify.
  The assets test for these programs has not been raised since 1989--
even though the cost of living, and certainly the cost of medical care, 
have increased astronomically since then.
  The bill takes an important step to improve access for these 
beneficiaries by increasing the level of savings that MSP applicants 
may have and still qualify for help.
  We also discount the value of life insurance policies and financial 
help from churches or family members from counting against a senior's 
eligibility for assistance.
  Fourth, this bill protects seniors from unscrupulous marketing 
practices by private health plans.
  Countless reports have surfaced about aggressive, fraudulent and even 
abusive sales and marketing practices used by Medicare Advantage plans, 
the private plan option in Medicare.
  This legislation builds on the CMS-proposed rule to ban abusive 
marketing of Medicare Advantage and other plans once and for all. 
Marketing abuses are extensive. This legislation stops that.
  The Medicare Improvements for Patients and Providers Act takes 
important steps to shore up our health care system in rural areas.
  It ensures that hospitals in these areas get the resources they need 
to keep their doors open, and expands access to tele-health services.
  It also includes important relief for ambulance providers and 
physicians serving rural areas.
  Pharmacy payments are another area where the legislation makes 
important improvements.
  Pharmacies are an integral part of the health care infrastructure in 
America.
  Prescription drugs play a huge role in medical treatment, and many 
people see their pharmacists more regularly than their physicians.
  Pharmacists are also vital to the ongoing success of the Part D 
prescription drug benefit.
  Changes in this bill, including fairer and more timely payments to 
those who dispense drugs to our nation's senior citizens, can make the 
benefit work better for pharmacists, and thereby for seniors.
  Furthermore, this act would save valuable Medicare dollars by 
providing one, fully bundled payment for all end-stage renal disease-
related services.
  This will improve the quality of care these vulnerable beneficiaries 
receive by balancing incentives and instituting a rigorous quality 
improvement program.
  And, for the first time, dialysis facilities will receive a 
permanent, market-based update to their payments each year, to make 
sure that Medicare payments keep up with their costs.
  One of the questions I am asked most about is how this bill would 
address Medicare Advantage payments.
  Federal spending for private Medicare Advantage, MA, benefit plans, 
including health maintenance organizations, preferred provider 
organizations, and private fee-for-service plans, has grown rapidly 
since Congress increased payments for MA in the Medicare Modernization 
Act of 2003.

[[Page 12098]]

  CBO tells us that the Federal Government will pay these private plans 
$74 billion in 2008, at a rate 13 percent higher than traditional 
Medicare fee-for-service providers receive.
  In sum, every Medicare beneficiary in the country, regardless of 
whether they are enrolled in an MA plan or remain in traditional fee 
for service, will pay $2 extra per month to subsidize these extra 
payment rates.
  Private fee-for-service plans, in particular, get a special deal that 
costs taxpayers and beneficiaries alike.
  The law doesn't require these plans to sign contracts with hospitals 
or doctors, rather, providers are ``deemed'' part of the network. And 
plans can pay these providers 100 percent of traditional fee-for-
service rates even as they receive 117 percent of that rate in 
reimbursement from Medicare.
  They are also exempt from reporting quality measures that all other 
plans must report. In other words, they have a good deal. Too good of a 
deal.
  Another, and just as obvious, example of how Medicare pays these 
plans too much is the double payment for indirect medical education, 
IME. So-called IME payments are intended to defray the higher patient 
care costs at facilities with graduate medical education programs.
  But these payments are made twice: once to the facility itself, and 
again to Medicare Advantage plans, with no requirement that plans pass 
the IME funding along to teaching hospitals.
  This bill will save taxpayers $13 billion over 5 years by requiring 
private-fee-for-service plans to form provider networks and eliminating 
the double payment for IME to MA plans.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. BAUCUS. I ask unanimous consent to speak for an additional 3 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. It will also require private fee-for-service plans to 
report on quality measures like other plans are required to do.
  Some in the Senate, and many in the Bush administration, oppose any 
reforms to private fee-for-service plans.
  They oppose protecting beneficiaries from private plans' unscrupulous 
marketing practices.
  Just as regretfully, they oppose expanding access that poor seniors 
have to assistance with their out-of-pocket costs, and to evidence-
based preventive services.
  So now we in the Congress have a choice. We can protect private 
health insurance plans. We can leave low-income beneficiaries behind.
  We can neglect our obligations to ensure that the Medicare program 
works for all seniors or we can do the right thing.
  We can pass meaningful, bipartisan Medicare legislation that, yes, 
blocks the cuts to physician payments, which is absolutely crucial, but 
which does so much more, that brings much-needed relief to rural areas, 
improves quality, and cuts costs in the appropriate places.
  That is what we ought to do. That is what America's seniors deserve.
  I urge my colleagues to support passage of this balanced legislation.
  Mr. BAUCUS. I yield back the remainder of my time.
  The PRESIDING OFFICER (Mr. Nelson of Nebraska). The Senator from 
Missouri is recognized.

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