[Congressional Record (Bound Edition), Volume 156 (2010), Part 13]
[House]
[Pages 19386-19393]
[From the U.S. Government Publishing Office, www.gpo.gov]




              MEDICARE AND MEDICAID EXTENDERS ACT OF 2010

  Mr. STARK. Mr. Speaker, I move to suspend the rules and concur in the 
Senate amendments to the bill (H.R. 4994) to amend the Internal Revenue 
Code of 1986 to reduce taxpayer burdens and enhance taxpayer 
protections, and for other purposes.
  The Clerk read the title of the bill.
  The text of the Senate amendments is as follows:

       Senate amendments:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     and Medicaid Extenders Act of 2010''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                          TITLE I--EXTENSIONS

Sec. 101. Physician payment update.
Sec. 102. Extension of MMA section 508 reclassifications.
Sec. 103. Extension of Medicare work geographic adjustment floor.
Sec. 104. Extension of exceptions process for Medicare therapy caps.
Sec. 105. Extension of payment for technical component of certain 
              physician pathology services.
Sec. 106. Extension of ambulance add-ons.
Sec. 107. Extension of physician fee schedule mental health add-on 
              payment.
Sec. 108. Extension of outpatient hold harmless provision.
Sec. 109. Extension of Medicare reasonable costs payments for certain 
              clinical diagnostic laboratory tests furnished to 
              hospital patients in certain rural areas.
Sec. 110. Extension of the qualifying individual (QI) program.
Sec. 111. Extension of Transitional Medical Assistance (TMA).
Sec. 112. Special diabetes programs.

                       TITLE II--OTHER PROVISIONS

Sec. 201. Clarification of effective date of part B special enrollment 
              period for disabled TRICARE beneficiaries.
Sec. 202. Repeal of delay of RUG-IV.
Sec. 203. Clarification for affiliated hospitals for distribution of 
              additional residency positions.
Sec. 204. Continued inclusion of orphan drugs in definition of covered 
              outpatient drugs with respect to children's hospitals 
              under the 340B drug discount program.
Sec. 205. Medicaid and CHIP technical corrections.
Sec. 206. Funding for claims reprocessing.
Sec. 207. Revision to the Medicare Improvement Fund.
Sec. 208. Limitations on aggregate amount recovered on reconciliation 
              of the health insurance tax credit and the advance of 
              that credit.
Sec. 209. Determination of budgetary effects.

                          TITLE I--EXTENSIONS

     SEC. 101. PHYSICIAN PAYMENT UPDATE.

       Section 1848(d) of the Social Security Act (42 U.S.C. 
     1395w-4(d)) is amended by adding at the end the following new 
     paragraph:
       ``(12) Update for 2011.--
       ``(A) In general.--Subject to paragraphs (7)(B), (8)(B), 
     (9)(B), (10)(B), and (11)(B), in lieu of the update to the 
     single conversion factor established in paragraph (1)(C) that 
     would otherwise apply for 2011, the update to the single 
     conversion factor shall be 0 percent.
       ``(B) No effect on computation of conversion factor for 
     2012 and subsequent years.--The conversion factor under this 
     subsection shall be computed under paragraph (1)(A) for 2012 
     and subsequent years as if subparagraph (A) had never 
     applied.''.

     SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICATIONS.

       (a) Extension.--
       (1) In general.--Section 106(a) of division B of the Tax 
     Relief and Health Care Act of 2006 (42 U.S.C. 1395 note), as 
     amended by section 117 of the Medicare, Medicaid, and SCHIP 
     Extension Act of 2007 (Public Law 110-173), section 124 of 
     the Medicare Improvements for Patients and Providers Act of 
     2008 (Public Law 110-275), and sections 3137(a) and 10317 of 
     the Patient Protection and Affordable Care Act (Public Law

[[Page 19387]]

     111-148), is amended by striking ``September 30, 2010'' and 
     inserting ``September 30, 2011''.
       (2) Special rule for fiscal year 2011.--
       (A) In general.--Subject to subparagraph (B), for purposes 
     of implementation of the amendment made by paragraph (1), 
     including (notwithstanding paragraph (3) of section 117(a) of 
     the Medicare, Medicaid, and SCHIP Extension Act of 2007 
     (Public Law 110-173), as amended by section 124(b) of the 
     Medicare Improvements for Patients and Providers Act of 2008 
     (Public Law 110-275)) for purposes of the implementation of 
     paragraph (2) of such section 117(a), during fiscal year 
     2011, the Secretary of Health and Human Services shall use 
     the hospital wage index that was promulgated by the Secretary 
     of Health and Human Services in the Federal Register on 
     August 16, 2010 (75 Fed. Reg. 50042), and any subsequent 
     corrections.
       (B) Exception.--Beginning on April 1, 2011, in determining 
     the wage index applicable to hospitals that qualify for wage 
     index reclassification, the Secretary shall include the 
     average hourly wage data of hospitals whose reclassification 
     was extended pursuant to the amendment made by paragraph (1) 
     only if including such data results in a higher applicable 
     reclassified wage index. Any revision to hospital wage 
     indexes made as a result of this subparagraph shall not be 
     effected in a budget neutral manner.
       (3) Adjustment for certain hospitals in fiscal year 2011.--
       (A) In general.--In the case of a subsection (d) hospital 
     (as defined in subsection (d)(1)(B) of section 1886 of the 
     Social Security Act (42 U.S.C. 1395ww)) with respect to 
     which--
       (i) a reclassification of its wage index for purposes of 
     such section was extended pursuant to the amendment made by 
     paragraph (1); and
       (ii) the wage index applicable for such hospital for the 
     period beginning on October 1, 2010, and ending on March 31, 
     2011, was lower than for the period beginning on April 1, 
     2011, and ending on September 30, 2011, by reason of the 
     application of paragraph (2)(B);

     the Secretary shall pay such hospital an additional payment 
     that reflects the difference between the wage index for such 
     periods.
       (B) Timeframe for payments.--The Secretary shall make 
     payments required under subparagraph (A) by not later than 
     December 31, 2011.
       (b) Conforming Amendment.--Section 117(a)(3) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173) is amended by inserting ``in fiscal years 2008 
     and 2009'' after ``For purposes of implementation of this 
     subsection''.

     SEC. 103. EXTENSION OF MEDICARE WORK GEOGRAPHIC ADJUSTMENT 
                   FLOOR.

       Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 
     1395w-4(e)(1)(E)) is amended by striking ``before January 1, 
     2011'' and inserting ``before January 1, 2012''.

     SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE 
                   THERAPY CAPS.

       Section 1833(g)(5) of the Social Security Act (42 U.S.C. 
     1395l(g)(5)) is amended by striking ``and ending on'' and all 
     that follows through ``2010'' and inserting ``and ending on 
     December 31, 2011''.

     SEC. 105. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF 
                   CERTAIN PHYSICIAN PATHOLOGY SERVICES.

       Section 542(c) of the Medicare, Medicaid, and SCHIP 
     Benefits Improvement and Protection Act of 2000 (as enacted 
     into law by section 1(a)(6) of Public Law 106-554), as 
     amended by section 732 of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w-4 
     note), section 104 of division B of the Tax Relief and Health 
     Care Act of 2006 (42 U.S.C. 1395w-4 note), section 104 of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), section 136 of the Medicare Improvements for 
     Patients and Providers Act of 2008 (Public Law 110-275), and 
     section 3104 of the Patient Protection and Affordable Care 
     Act (Public Law 111-148) is amended by striking ``and 2010'' 
     and inserting ``2010, and 2011''.

     SEC. 106. EXTENSION OF AMBULANCE ADD-ONS.

       (a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social 
     Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended--
       (1) in the matter preceding clause (i), by striking 
     ``2011'' and inserting ``2012,''; and
       (2) in each of clauses (i) and (ii), by striking ``January 
     1, 2011'' and inserting ``January 1, 2012'' each place it 
     appears.
       (b) Air Ambulance.--Section 146(b)(1) of the Medicare 
     Improvements for Patients and Providers Act of 2008 (Public 
     Law 110-275), as amended by sections 3105(b) and 10311(b) of 
     Public Law 111-148, is amended by striking ``December 31, 
     2010'' and inserting ``December 31, 2011''.
       (c) Super Rural Ambulance.--Section 1834(l)(12)(A) of the 
     Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by 
     striking ``2011'' and inserting ``2012''.

     SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MENTAL HEALTH 
                   ADD-ON PAYMENT.

       Section 138(a)(1) of the Medicare Improvements for Patients 
     and Providers Act of 2008 (Public Law 110-275), as amended by 
     section 3107 of the Patient Protection and Affordable Care 
     Act (Public Law 111-148), is amended by striking ``December 
     31, 2010'' and inserting ``December 31, 2011''.

     SEC. 108. EXTENSION OF OUTPATIENT HOLD HARMLESS PROVISION.

       Section 1833(t)(7)(D)(i) of the Social Security Act (42 
     U.S.C. 1395l(t)(7)(D)(i)), as amended by section 3121(a) of 
     the Patient Protection and Affordable Care Act (Public Law 
     111-148), is amended--
       (1) in subclause (II)--
       (A) in the first sentence, by striking ``2011''and 
     inserting ``2012''; and
       (B) in the second sentence, by striking ``or 2010'' and 
     inserting ``2010, or 2011''; and
       (2) in subclause (III), by striking ``January 1, 2011'' and 
     inserting ``January 1, 2012''.

     SEC. 109. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS FOR 
                   CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS 
                   FURNISHED TO HOSPITAL PATIENTS IN CERTAIN RURAL 
                   AREAS.

       Section 416(b) of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (42 U.S.C. 1395l-
     4), as amended by section 105 of division B of the Tax Relief 
     and Health Care Act of 2006 (42 U.S.C. 1395l note), section 
     107 of the Medicare, Medicaid, and SCHIP Extension Act of 
     2007 (42 U.S.C. 1395l note), and section 3122 of the Patient 
     Protection and Affordable Care Act (Public Law 111-148), is 
     amended by striking ``the 1-year period beginning on July 1, 
     2010'' and inserting ``the 2-year period beginning on July 1, 
     2010''.

     SEC. 110. EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) 
                   PROGRAM.

       (a) Extension.--Section 1902(a)(10)(E)(iv) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by 
     striking ``December 2010'' and inserting ``December 2011''.
       (b) Extending Total Amount Available for Allocation.--
     Section 1933(g) of such Act (42 U.S.C. 1396u-3(g)) is 
     amended--
       (1) in paragraph (2)--
       (A) by striking ``and'' at the end of subparagraph (M);
       (B) in subparagraph (N), by striking the period at the end 
     and inserting a semicolon; and
       (C) by adding at the end the following new subparagraphs:
       ``(O) for the period that begins on January 1, 2011, and 
     ends on September 30, 2011, the total allocation amount is 
     $720,000,000; and
       ``(P) for the period that begins on October 1, 2011, and 
     ends on December 31, 2011, the total allocation amount is 
     $280,000,000.''; and
       (2) in paragraph (3), in the matter preceding subparagraph 
     (A), by striking ``or (N)'' and inserting ``(N), or (P)''.

     SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA).

       Sections 1902(e)(1)(B) and 1925(f) of the Social Security 
     Act (42 U.S.C. 1396a(e)(1)(B), 1396r-6(f)) are each amended 
     by striking ``December 31, 2010'' and inserting ``December 
     31, 2011''.

     SEC. 112. SPECIAL DIABETES PROGRAMS.

       (1) Special diabetes programs for type i diabetes.--Section 
     330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 
     254c-2(b)(2)(C)) is amended by striking ``2011'' and 
     inserting ``2013''.
       (2) Special diabetes programs for indians.--Section 
     330C(c)(2)(C) of the Public Health Service Act (42 U.S.C. 
     254c-3(c)(2)(C)) is amended by striking ``2011'' and 
     inserting ``2013''.

                       TITLE II--OTHER PROVISIONS

     SEC. 201. CLARIFICATION OF EFFECTIVE DATE OF PART B SPECIAL 
                   ENROLLMENT PERIOD FOR DISABLED TRICARE 
                   BENEFICIARIES.

       Effective as if included in the enactment of Public Law 
     111-148, section 3110(a)(2) of such Act is amended to read as 
     follows:
       ``(2) Effective date.--The amendment made by paragraph (1) 
     shall apply to elections made on and after the date of the 
     enactment of this Act.''.

     SEC. 202. REPEAL OF DELAY OF RUG-IV.

       Effective as if included in the enactment of Public Law 
     111-148, section 10325 of such Act is repealed.

     SEC. 203. CLARIFICATION FOR AFFILIATED HOSPITALS FOR 
                   DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.

       Effective as if included in the enactment of section 
     5503(a) of Public Law 111-148, section 1886(h)(8) of the 
     Social Security Act (42 U.S.C. 1395ww(h)(8)), as added by 
     such section 5503(a), is amended by adding at the end the 
     following new subparagraph:
       ``(I) Affiliation.--The provisions of this paragraph shall 
     be applied to hospitals which are members of the same 
     affiliated group (as defined by the Secretary under paragraph 
     (4)(H)(ii)) and the reference resident level for each such 
     hospital shall be the reference resident level with respect 
     to the cost reporting period that results in the smallest 
     difference between the reference resident level and the 
     otherwise applicable resident limit.''.

     SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN DEFINITION 
                   OF COVERED OUTPATIENT DRUGS WITH RESPECT TO 
                   CHILDREN'S HOSPITALS UNDER THE 340B DRUG 
                   DISCOUNT PROGRAM.

       (a) Definition of Covered Outpatient Drug.--
       (1) Amendment.--Subsection (e) of section 340B of the 
     Public Health Service Act (42 U.S.C. 256b) is amended by 
     striking ``covered entities described in subparagraph (M)'' 
     and inserting ``covered entities described in subparagraph 
     (M) (other than a children's hospital described in 
     subparagraph (M))''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect as if included in the enactment of section 
     2302 of the Health Care and Education Reconciliation Act of 
     2010 (Public Law 111-152).
       (b) Technical Amendment.--Subparagraph (B) of section 
     1927(a)(5) of the Social Security Act (42 U.S.C. 1396r-
     8(a)(5)) is amended by striking ``and a children's hospital'' 
     and all

[[Page 19388]]

     that follows through the end of the subparagraph and 
     inserting a period.

     SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS.

       (a) Repeal of Exclusion of Certain Individuals and Entities 
     From Medicaid.--Section 1902(a) of the Social Security Act 
     (42 U.S.C. 1396a(a)) is amended by striking paragraph (78).
       (b) Income Level for Certain Children Under Medicaid.--
     Section 1902(l)(2)(C) of the Social Security Act (42 U.S.C. 
     1396a(l)(2)(C)) is amended by striking ``133 percent'' and 
     inserting ``100 percent (or, beginning January 1, 2014, 133 
     percent)''.
       (c) Calculation and Publication of Payment Error Rate 
     Measurement for Certain Years.--Section 601(b) of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009 (Public Law 111-3) is amended by adding at the end the 
     following: ``The Secretary is not required under this 
     subsection to calculate or publish a national or a State-
     specific error rate for fiscal year 2009 or fiscal year 
     2010.''.
       (d) Corrections to Exceptions to Exclusion of Children of 
     Certain Employees.--Section 2110(b)(6) of the Social Security 
     Act (42 U.S.C. 1397jj(b)(6)) is amended--
       (1) in subparagraph (B)--
       (A) by striking ``per person'' in the heading; and
       (B) by striking ``each employee'' and inserting 
     ``employees''; and
       (2) in subparagraph (C), by striking ``, on a case-by-case 
     basis,''.
       (e) Electronic Health Records.--Effective as if included in 
     the enactment of section 4201(a)(2) of the American Recovery 
     and Reinvestment Act of 2009 (Public Law 111-5), section 
     1903(t) of the Social Security Act (42 U.S.C. 1396b(t)) is 
     amended--
       (1) in paragraph (3)(E), by striking ``reduced by any 
     payment that is made to such Medicaid provider from any other 
     source (other than under this subsection or by a State or 
     local government)'' and inserting ``reduced by the average 
     payment the Secretary estimates will be made to such Medicaid 
     providers (determined on a percentage or other basis for such 
     classes or types of providers as the Secretary may specify) 
     from other sources (other than under this subsection, or by 
     the Federal government or a State or local government)''; and
       (2) in paragraph (6)(B), by inserting before the period the 
     following: ``and shall be determined to have met such 
     responsibility to the extent that the payment to the Medicaid 
     provider is not in excess of 85 percent of the net average 
     allowable cost''.
       (f) Corrections of Designations.--
       (1) Section 1902 of the Social Security Act (42 U.S.C. 
     1396a) is amended--
       (A) in subsection (a)(10), in the matter following 
     subparagraph (G), by striking ``and'' before ``(XVI) the 
     medical'' and by striking ``(XVI) if'' and inserting ``(XVII) 
     if'';
       (B) in subsection (a)(23), by striking ``(ii)'' and 
     inserting ``(kk)'';
       (C) in subsection (a)(77), by striking ``(ii)'' and 
     inserting ``(kk)'';
       (D) in subsection (ii)(2), as added by section 2303(a)(2) 
     of Public Law 111-148, by striking ``(XV)'' and inserting 
     ``(XVI)''; and
       (E) by redesignating subsection (ii), as added by section 
     6401(b)(1)(B) of Public Law 111-148, as subsection (kk) and 
     transferring such subsection so as to appear after subsection 
     (jj) of that section.
       (2) Section 2107(e)(1) of the Social Security Act (42 
     U.S.C. 1397gg(e)(1)) is amended--
       (A) in subparagraph (D), as added by section 6401(c) of 
     Public Law 111-148, by striking ``(ii)'' and inserting 
     ``(kk)''; and
       (B) by redesignating the subparagraph (N) of that section 
     added by 2101(e) of Public Law 111-148 as subparagraph (O).

     SEC. 206. FUNDING FOR CLAIMS REPROCESSING.

       For purposes of carrying out the provisions of, and 
     amendments made by, this Act that relate to title XVIII of 
     the Social Security Act, and other provisions of, or relating 
     to, such title that ensure appropriate payment of claims, 
     there are appropriated to the Secretary of Health and Human 
     Services for the Centers for Medicare & Medicaid Services 
     Program Management Account, from amounts in the general fund 
     of the Treasury not otherwise appropriated, $200,000,000. 
     Amounts appropriated under the preceding sentence shall be in 
     addition to any other funds available for such purposes, 
     shall remain available until expended, and shall not be used 
     to implement changes to title XVIII of the Social Security 
     Act made by Public Laws 111-148 and 111-152.

     SEC. 207. REVISION TO THE MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1)(B) of the Social Security Act (42 U.S.C. 
     1395iii(b)(1)(B)) is amended by striking ``$550,000,000'' and 
     inserting ``$275,000,000''.

     SEC. 208. LIMITATIONS ON AGGREGATE AMOUNT RECOVERED ON 
                   RECONCILIATION OF THE HEALTH INSURANCE TAX 
                   CREDIT AND THE ADVANCE OF THAT CREDIT.

       (a) In General.--So much of section 36B(f)(2)(B) of the 
     Internal Revenue Code of 1986 as precedes clause (ii) thereof 
     is amended to read as follows:
       ``(B) Limitation on increase.--
       ``(i) In general.--In the case of a taxpayer whose 
     household income is less than 500 percent of the poverty line 
     for the size of the family involved for the taxable year, the 
     amount of the increase under subparagraph (A) shall in no 
     event exceed the applicable dollar amount determined in 
     accordance with the following table (one-half of such amount 
     in the case of a taxpayer whose tax is determined under 
     section 1(c) for the taxable year):


------------------------------------------------------------------------
 ``If the household income (expressed as a percent of    The applicable
                  poverty line) is:                    dollar amount is:
------------------------------------------------------------------------
Less than 200%.......................................               $600
At least 200% but less than 250%.....................             $1,000
At least 250% but less than 300%.....................             $1,500
At least 300% but less than 350%.....................             $2,000
At least 350% but less than 400%.....................             $2,500
At least 400% but less than 450%.....................             $3,000
At least 450% but less than 500%.....................          $3,500''.
------------------------------------------------------------------------

       (b) Conforming Amendment.--Section 36B(f)(2)(B)(ii) of such 
     Code is amended by inserting ``in the table contained'' after 
     ``each of the dollar amounts''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2013.

     SEC. 209. DETERMINATION OF BUDGETARY EFFECTS.

       (a) In General.--The budgetary effects of this Act, for the 
     purpose of complying with the Statutory Pay-As-You-Go Act of 
     2010, shall be determined by reference to the latest 
     statement titled ``Budgetary Effects of PAYGO Legislation'' 
     for this Act, submitted for printing in the Congressional 
     Record by the Chairman of the Senate Budget Committee, 
     provided that such statement has been submitted prior to the 
     vote on passage.
       (b) Emergency Designation for Congressional Enforcement.--
     In the House of Representatives, this Act, with the exception 
     of section 101, is designated as an emergency for purposes of 
     pay-as-you-go principles.
         Amend the title so as to read: ``An Act to extend certain 
     expiring provisions of the Medicare and Medicaid programs, 
     and for other purposes.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Stark) and the gentleman from California (Mr. Herger) 
each will control 20 minutes.
  The Chair recognizes the gentleman from California (Mr. Stark).
  Mr. STARK. Mr. Speaker, I rise in support of H.R. 4994, the Medicare 
and Medicaid Extenders Act, a bill that was passed by unanimous consent 
in the Senate yesterday because of the critical importance to our 
senior citizens and military families.
  The legislation does the bare minimum of what is needed to ensure 
that Medicare runs smoothly for the next year. Because the military's 
TRICARE system operates by many of Medicare's rules, it also protects 
the health care of our military families.
  Importantly, the bill prevents a nearly 25 percent pay cut to 
Medicare and TRICARE physicians that would otherwise go into effect on 
January 1, 2011. Giving physicians a year of certainty in their pay is 
important to protect Medicare beneficiaries' access to their 
physicians. The bill extends a host of other key policies to protect 
the health of seniors and people with disabilities.
  In the long run, we all know we need to do much better by Medicare 
than continued 1-year patches on the physician payment formula. The 
House passed a permanent solution in November of 2009, but the Senate 
was unable to move it. We need to work together across party lines to 
reach a permanent solution. In the meantime, H.R. 4994 is the 
appropriate short-term measure.
  I urge my colleagues to join us in protecting the Medicare 
beneficiaries by voting ``yes.''
  Mr. Speaker, I reserve the balance of my time.
  Mr. HERGER. Mr. Speaker, I yield myself such time as I may consume.
  When the Democrats passed their massive health care overhaul, they 
didn't spend one cent to resolve a longstanding problem and ensure 
seniors have continued access to their physician. As a result, for the 
fourth time since Obamacare passed, we are forced to take emergency 
action to prevent physicians from having their Medicare payments 
slashed. This time, the looming cut is 25 percent. The brinkmanship 
where this Democrat Congress has walked physicians up to the cliff, 
only to back away at the last minute, is unacceptable.
  My friends on the other side of the aisle are quick to remind us that 
they offered to address Medicare physician payments last fall. This is 
true. They put a bill on the floor which had already failed to pass the 
Senate. This bill would have expanded our already record deficit by an 
astounding $210 billion, a crippling debt load on top of the $1 
trillion health bill. Rather than responsibly manage the Medicare 
program, they chose instead to cut Medicare by one half trillion 
dollars to fund

[[Page 19389]]

their government takeover of health care.
  The good news is that today we are finally starting to address this 
problem in a bipartisan way. We're stopping these cuts not for 1 month 
or 2 months but for a full year. We're ensuring that physicians will be 
able to keep their doors open and that seniors will have continued 
access to their doctors. And we are doing this in a fiscally 
responsible manner without adding a dime to the deficit. We are doing 
it by taking aim at the irresponsible overspending that was created by 
the new health care law.
  Let it be known on this day, in the people's House, that dismantling 
of Obamacare begins. Once the House passes this bill and the President 
signs it into law, we will have landed the first blow to the Democrats' 
massive health care overhaul. Today we begin by removing $19 billion 
from their risky $1 trillion experiment; a risky experiment that CBO 
predicts will force health insurance premiums for millions of families 
to increase by $2,100 in 2016 alone; a risky experiment that the Obama 
administration predicts could force 117 million Americans out of their 
health plans; a risky experiment that Medicare officials have 
repeatedly warned could jeopardize seniors' access to care; a risky 
experiment that Medicare officials predict will force millions of 
seniors out of their current Medicare and retiree health coverage; a 
risky experiment that increases taxes by more than one-half trillion 
dollars at a time when unemployment is nearly 10 percent.

                              {time}  1020

  A risky experiment that would spend an additional $1 trillion on 
health care when every respective economist tells us in order to 
improve our country's fiscal health, we must get control of health care 
spending.
  My friends on the other side of the aisle repeatedly said a doctor's 
fix couldn't be paid for, that it shouldn't be paid for. Yet with 
bipartisan work, we have before us a fully offset bill that gives 
physicians 1 year of certainty while Congress works to reform physician 
payments in a fiscally responsible manner once and for all.
  So here we are today, Mr. Speaker, pulling at the thread that will 
begin to unravel ObamaCare. Rest assured, America, we are taking $19 
billion today, but we will continue to fight to get the rest next year.
  Mr. Speaker, I reserve the balance of my time.


                             General Leave

  Mr. STARK. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks on 
this matter.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. STARK. I would like to remind my distinguished friend that health 
reform was 100 percent paid for, and the party that wants to spend $700 
billion on the richest Americans for their tax cuts certainly shouldn't 
lecture anyone on the deficit.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from New Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, first of all let me say, as I did the other 
day, as you know, about a week ago we passed an extension to eliminate 
the cut in the SGR, the doctor's fix, until the end of this month. This 
bill before us today would take this for another year, until the end of 
December of 2011.
  And at the time, the gentleman from California (Mr. Herger) also got 
on the floor and made statements which I think totally do not represent 
what we were doing. First of all, I would say with regard to the 
doctor's fix, nobody wants a 25 percent cut in doctor's reimbursement 
rate, and that is why we were here last week for the extension to 
eliminate that cut until the end of this year, and that is why we are 
today, to eliminate that cut until the end of 2011.
  But the fact of the matter is it is the Republican Party and it is 
the party of the gentleman from California (Mr. Herger) in the House 
that refused to vote for a permanent fix when we passed it in the 
Democratic majority over a year ago. As I said that day, only one 
person, Dr. Burgess who is a physician on our committee, voted with the 
Democrats for the permanent fix. It is as a result of the inability and 
the unwillingness of the Republicans to do anything about this doctor's 
cut or reimbursement cut that we had to pass, I guess, five different 
short-term fixes.
  Now granted today we are going to have a year extension, and I am 
certainly happy that the Republicans have agreed to a year extension, 
but they still have not come along to a permanent fix and they have not 
helped us in our efforts to achieve a permanent fix. So for the 
gentleman to suggest that somehow the Republicans have been helpful and 
they wanted to deal with this problem is, in my opinion, simply not 
accurate.
  Now, let me dispel another thing. There is nothing in this bill that 
would in any way disrupt or repeal the health care reform, the landmark 
legislation that the Democrats passed again this year without any 
support from the other side of the aisle. If there was any remote 
suggestion that we were repealing or this was the beginning of the 
repeal, as the gentleman suggested, of the health care reform, not one 
Democrat would support that; and I certainly would not.
  The fact of the matter is that the health care reform was fully paid 
for. And the fact of the matter is that it did not in any way affect 
Medicare beneficiaries. We actually improved benefits for Medicare 
beneficiaries in the health care reform. We basically filled up and 
eliminated the doughnut hole. We also provided more money for copays so 
seniors who are poor or lower income would not have to do copays for 
preventative care. And the list of additional benefits for Medicare 
beneficiaries under the larger health care reform goes on and on. I 
could list more.
  So the suggestion that we somehow were cutting Medicare benefits is 
simply not true. The fact of the matter is that benefits were 
increased; the bill was paid for; and this bill today in no way takes 
away from that larger health care reform.
  Now we have paid for the health care reform. We have paid for the 
doctor's fix for an additional year in this legislation by making sure 
that people who were going to get a subsidy and who didn't qualify 
would have to pay it back. That is the only change. That is the way it 
is paid for here today.
  I just want to say, Mr. Speaker, this is a very important bill. It is 
a vital piece of legislation for America's seniors, persons with 
disabilities, and military families. Without this legislation, 
physician fees in Medicare and TRICARE would be reduced by 25 percent 
on January 1, just 3 weeks from now, and that kind of cut would 
threaten the ability of enrollees in Medicare and TRICARE to see their 
doctors. We can't allow that to happen.
  As I mentioned before, we have passed some short-term fixes. This is 
another short-term fix. But, thankfully, it is at least for another 
year until we can work out a permanent solution. The Democrats already 
passed that permanent solution without Republican help; but, 
unfortunately, therefore, it did not become law and we will have to 
address it again.
  The bill also provides help in 2011 to low-income Medicare 
beneficiaries in paying their part B premiums which are nearly $100 per 
month for many people. The legislation extends several important 
Medicare policies, including an exceptions process for therapy caps 
that allows Medicare beneficiaries to access medically needed therapy 
treatment. And it extends an important program that helps Medicaid 
beneficiaries work more hours without losing their Medicaid benefits.
  It is completely paid for over 10 years. It moved through the Senate 
by unanimous consent. It is really not controversial at all, and so I 
urge Members of the House to vote ``yes'' on this bill that provides 
stability to the Medicare program.
  Mr. HERGER. Mr. Speaker, I yield the balance of my time to the 
ranking member of the Energy and Commerce Committee, the gentleman from 
Texas (Mr. Barton).

[[Page 19390]]

  The SPEAKER pro tempore. Without objection, the gentleman from Texas 
will control the time.
  There was no objection.
  Mr. BARTON of Texas. I thank the gentleman from California for his 
courtesy.
  I would ask the Chair how much time I have remaining.
  The SPEAKER pro tempore. The gentleman has 15 minutes remaining.
  Mr. BARTON of Texas. May I ask the Chair how much time my friends on 
the majority have remaining?
  The SPEAKER pro tempore. The gentleman from California (Mr. Stark) 
has 13 minutes remaining.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  The Republicans do rise in support of this 1-year fix for the 
reimbursement rate for physicians. Having said that, I think I was able 
to listen to some of what my distinguished subcommittee chairman of the 
Energy and Commerce Committee, Mr. Pallone, was saying as I was waiting 
for the tram to come over here. It is time, Mr. Speaker, for Members on 
both sides of the aisle to put aside partisan politics and in the 
upcoming year or years, if it takes more than 1 year, sit down and 
let's really come up with a new formula to fix permanently how we pay 
our physicians.
  The current formula is based on an index that is based on inflation; 
and under the score keeping, any year in which medical expenses go up 
more rapidly than the general inflation rate, I am simplifying the 
index but this is the basic part of it, you have to find savings in 
that particular year or there is a negative balance created in the 
physician reimbursement fund. The current system is not sustainable. It 
doesn't work. It doesn't reflect the practice of medicine. But because 
of our score keeping, we keep getting further and further behind and so 
each year the 1-year cut gets bigger and bigger. This year it would be 
25 percent.
  Now obviously when most of our physician community claims, and I 
think with justification, that they are not being adequately reimbursed 
for treating Medicare patients, you have the situation as you have in 
my district, and I am sure each of us can say in our own districts, in 
their districts, physicians are not taking Medicare patients. In my 
home county of Ellis County, the county seat is a community of about 
30,000, Waxahachie, Texas. The mayor of Waxahachie is a personal friend 
of mine, and I have known him for over 20 years.

                              {time}  1030

  His existing doctor retired. He is on Medicare. He is over 65. He 
went to find a new doctor who would treat him, and he couldn't find a 
doctor. Here is the mayor of Waxahachie, Texas, who at least 
temporarily cannot find a Medicare doctor who will accept him as a 
patient. That doesn't make sense. You can have the best health care 
system in the world, and if you don't have the doctors to implement it, 
you don't have a health care system.
  So it is my strong recommendation that Republicans--the current 
minority, soon to be majority--vote for this 1-year fix, knowing that 
it is really not a fix, that it is another kick-the-can, kick-the-
problem down the road. But in this case, at least it is for a year.
  In the upcoming Congress and when the majorities switch, I am going 
to be a member of the committee of primary jurisdiction, the Energy and 
Commerce Committee. It will be my strong recommendation to our new 
chairman, Fred Upton of Michigan; to our new Speaker, Mr. Boehner of 
Ohio; and to our new majority leader, Mr. Cantor of Virginia, that we 
sit down with our stakeholders and with our friends on the soon-to-be 
minority side of the aisle to come up with a system that adequately 
reflects the will of both parties, that also gets buy-in from the 
stakeholders and reflects the cost of practicing medicine as it is 
today.
  I know it is going to be expensive. I know it is going to be 
difficult, but it will be possible, and I hope that we can do that. I 
would ask for a ``yes'' vote when it comes time to vote for this under 
the suspension calendar.
  I reserve the balance of my time.
  The SPEAKER pro tempore. Without objection, the gentleman from New 
Jersey will control the time.
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Farr).
  Mr. FARR. Thank you very much for yielding.
  Mr. Speaker, I rise in support of this bill but with real dismay.
  First, it is ludicrous that Congress continues to pass the SGR 
instead of to fix it once and for all. This bill, though necessary, 
doesn't fix what is broken, and we will just find ourselves back here 
again next year, trying to find a way forward. It is time to ``repeal 
and replace'' the doctor payment formula and to come up with something 
new.
  Second, this bill contains special ``pork'' favors for certain 
Midwest Senators which will pay their doctors more than the doctors in 
other parts of the country--in particular, my State of California.
  Section 103 of this bill provides an arbitrary ``floor'' for certain 
doctors' payments in Iowa and in other Midwest States that will boost 
their Medicare reimbursements, but this provision does not extend to 
all doctors in the United States. Iowa will get an additional $17 
million in FY 2011, on top of regular Medicare reimbursements, which 
other States will not get. Over the 2-year cycle of FY 2010-2011, Iowa 
doctors will be reimbursed over $34 million because of this special 
``floor'' in payments inserted by Senator Grassley and by others in 
that body.
  In a bill that is supposed to be ``clean'' and that is supposed to 
simply advance a moratorium on reductions in the sustained growth rate, 
section 103 is an abomination. It is plain unfair to doctors in other 
States.
  My doctors in California and especially in my district have suffered 
for more than a decade under a misaligned doctor payment formula due to 
outdated geographic locality designations. Despite numerous government 
reports by the GAO and CMS and despite numerous times that the House 
has passed legislation to fix this problem, the Senate has refused to 
accept the fix in favor of tipping the scales in order to satisfy 
Senator Grassley's whims.
  If Congress really wants to do right by doctors, it needs to do right 
by all doctors. This bill does not do that.
  Mr. BARTON of Texas. Mr. Speaker, I yield 3 minutes to a 
distinguished member of the Energy and Commerce Committee and of the 
Health Subcommittee, the current ranking member of the Oversight and 
Investigations Subcommittee, Dr. Michael Burgess of Lewisville, Texas.
  Mr. BURGESS. I thank the gentleman, my ranking member, for yielding.
  Mr. Speaker, this is an important bill that is going to be before us 
today. Ordinarily, I would not support something this large being done 
on a suspension calendar, but this truly is an emergency for our 
Nation's patients and for our Nation's physicians.
  I support the passage of this bill. It does also give us some time in 
this body and in the other body to work on a permanent solution. There 
is plenty of blame to go around on both sides of the aisle and in both 
Houses of this Capitol as to why we are in this fix.
  The fact is that it began back in 1998 with the Omnibus Budget 
Reconciliation Act. It was extended under the Republican watch for 12 
years. Now we have had 4 years under the Democrats, and it has not been 
fixed. In fact, most of the doctors you talk to have just come through 
the worst year ever in trying to manage their practices.
  Stop and think about it for a minute.
  You've got a small medical practice of two, three, four, five 
doctors. They don't do all Medicare work--maybe it's only 5 or 10 
percent of their actual book of business. But in April and in June, we 
asked the administrator of the Centers for Medicare and Medicaid 
Services to hold the checks for a few weeks until Congress could get 
back from a recess and take up yet another fix for this problem.
  The practical effect of doing this was that we cut 10, 15 percent off 
of the operating budget for every small practice that did Medicare, 
that saw our Medicare patients in this country that we

[[Page 19391]]

asked them to see. Most physician offices run very close to the margin 
every month. The consequence of this was that they had to go out and 
borrow the money to meet cash flow in April and in June. I dare say 
most of those practices have not yet fully recovered from that insult 
to the cash flow that occurred.
  So it is extremely important for us to pass a 1-year extension that 
gives them the stability to be able to plan, that gives patients the 
ability to be able to find doctors under the Medicare system and that 
gives physician offices the ability to plan for the future.
  Now, during this year that comes up, we are obligated--both sides of 
the aisle and both Houses in this Capitol--to fix this problem. Shame 
on us if it continues after this fix has expired. There is the 
political will to do it. We have heard it this morning from both sides. 
I will commit myself to working with, yes, my side, with the other side 
of the aisle and with the other House in this Capitol to work on a 
permanent solution to this. It is out there. It depends on how we want 
it to look. It depends on where we are going to get the pay-fors.
  One of the most egregious things in this health care bill that the 
President signed last March was, even though you took $500 billion out 
of the Medicare system, you used that to fund a new entitlement for the 
middle class in subsidies in the exchange. Not one dime--not one dime--
was sequestered to pay down the problem that we have with the 
sustainable growth rate formula.
  Here is the real bad news.
  The Independent Payment Advisory Board is coming up in 2015, also 
part of the health care bill that was signed into law last March. 
Doctors now, perhaps, face double jeopardy from cuts in the sustainable 
growth rate formula and from cuts within the Independent Payment 
Advisory Board.
  The time to fix it is now. It stretches out ahead of us for 12 
months. We've got time to do it. Let's dedicate ourselves to getting 
this done for our Nation's seniors.
  Mr. PALLONE. I reserve the balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I think all that needs to be said 
has been said; so let me simply say that this is a problem that needs 
to be dealt with.
  I compliment those who negotiated the 1-year fix. Hopefully, in the 
next Congress, we will work together--and I mean that seriously--in a 
bipartisan fashion to replace the existing formula with one that 
doesn't have to be updated and fixed in every session of Congress. Yet, 
for today, I would urge all of those in the current minority to vote 
for the bill under suspension.
  I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, let me associate myself completely with the 
remarks that the gentleman from Texas just made.
  I do think that it is significant that we are able to negotiate on a 
bipartisan basis a 1-year extension to avoid these cuts to the doctors, 
and I do believe we need to work together on a bipartisan basis to 
achieve a permanent fix in the next Congress.
  Ms. JACKSON LEE of Texas. Mr. Speaker, today I rise in support of the 
Senate amendment to H.R. 4994, the ``Medicare and Medicaid Extenders 
Act,'' which makes certain that our seniors and military families are 
able to continue seeing their doctors.
  Scheduled for January 1 and through 2011, this bipartisan legislation 
stops the 25 percent cut in Medicare payments to doctors. This very 
important legislation protects and supports our doctors who are serving 
Medicare recipients and active duty military, their families, the 
Reserve members and military retirees whose access to healthcare is 
tied to Medicare through the TRICARE system. If we fail to pass this 
legislation we are doing an extreme injustice to numerous Americans who 
depend on these doctors and this Congress for their healthcare.
  In my Congressional District, Riverside General Hospital (RGH), a 
member of the TRICARE network can ensure military families will be able 
to continue to see their doctors. Riverside General Hospital, formerly 
The Houston Negro Hospital was erected in 1926 in memory of Lieutenant 
John Halm Cullinan, 344th FA., 90th Div. AEP.
  St. Joseph Medical Center, in Houston, Texas, in my district, the 
only hospital in the inner city of Houston, can now continue to provide 
access to Medicare beneficiaries to Houston's most needy patient 
population as a result of this legislation in its current form. 
Currently, St. Joseph's provides $14 million in uninsured care in the 
Houston Market.
  St. Joseph Medical Center provides a full range of comprehensive 
medical and surgical services, such as, cardiology, cancer care, 
behavioral health, intensive care/critical care, emergency care, 
neurosurgery, orthopedics and pediatrics. St. Joseph Women's Medical 
Center, Houston's only full service women's hospital attached to a 
general acute care hospital, provides women's medical and surgical 
services, a family birthing center for moms and newborns, labor/
delivery/recovery suites and a neonatal intensive care unit for 
premature or seriously ill newborns. The Level III Neonatal Intensive 
Care Unit is staffed by the Small Wonders Team of specially trained 
doctors, nurses and staff who provide the smallest patients with the 
best chance at life. Specialty services provided by St. Joseph include 
an advanced wound care center, behavioral medicine, blood conservation 
and management services, occupational medicine, sports medicine and 
rehabilitation, inpatient and outpatient diagnostic imaging, and 
Corporate Healthcare Connection, a partnership with Houston's corporate 
businesses that provides expedited care to their employees. A Houston 
institution for 120 years, St. Joseph Medical Center is also a major 
provider of psychiatric beds as it currently operates 102 of the 800 
licensed beds in Houston.
  For an entire year, this legislation provides thousands with a 
practical, invaluable, and stable solution for deserving patients and 
doctors. These doctors deserve payment for the aid they render and we 
would be doing an intensely unjust service to them by not ensuring 
their repayment. Furthermore, we would be building a shaky platform for 
our constituents by not ensuring healthcare and medicine to the 
elderly, unfortunate, or those who so altruistically serve or served 
our country.
  Moreover, the bill is fully paid for according to the Congressional 
Budget Office. Furthermore, the CBO reports that it would serve to 
reduce the deficit by $2.8 billion over the next 10 years if the bill 
is passed. This is made possible by modifying the Affordable Care Act 
in the area of overpayments of tax credits to help individuals afford 
insurance. It is important to note that this bill's provision will in 
fact protect income based tax credits. Specifically, this provision 
would change the way individuals pay back overpayments when they 
receive a larger tax credit than they were eligible for based on their 
actual income for the year. Also, this legislation is highly supported 
by AARP and the American Medical Association.
  Other extensions include:
  The Transitional Medical Assistance (TMA), which allows low-income 
families to keep their Medicaid coverage as they move into employment 
and their income increases. Which is extremely important for those who 
are struggling to get on the their feet and make a way for themselves 
and their families. If we take away their assistance just as they are 
beginning to earn more money then we force those individuals to 
struggle to pay for more costly healthcare they cannot afford 
subsequently reducing their total income.
  Extension of the Qualifying Individual (Q1) Program which allows 
Medicaid to pay the Medicare premiums for those with incomes 120-135 
percent below the poverty line who are Medicare recipients.
  Mr. Speaker, I urge my colleagues to support the passage of H.R. 
4994, which greatly assists our countrymen and helps those who are 
elderly, poverty stricken, and those brave individuals who serve and 
served in our armed forces and their family members.
  Further, however the major component to keeping our health care 
system working is to not reduce doctors' payments from medicare by 25% 
as of January 1, 2011. This bill will fix that inequity and extend 
current medicare payments to doctors. Until December, 2012.
  This is good advice. I urge a ``yea'' vote.
  Ms. SCHAKOWSKY. Mr. Speaker, I rise today in support of the Senate 
amendments to H.R. 4994.
  I continue to believe that we need to make permanent reforms to 
Medicare's physician payment rules. Senior citizens and persons with 
disabilities need to know that they will be able to get high quality 
and timely care and that their doctors will be paid fairly and in a 
timely fashion. There is never really any question that Congress will 
act to prevent double-digit cuts in Medicare and TRICARE physician 
payments, but we should not have to debate these issues on a monthly 
basis.
  The bill before us today does not provide a permanent solution as I 
would like, but it does provide a one-year fix, eliminating the 
confusion and concern that is created by very short-term measures to 
prevent cuts. I am pleased

[[Page 19392]]

that it also includes an extension of the Medicare physician payment 
add-on for mental health, since we know that access to mental health 
services continues to be a problem in our communities.
  While much of the focus has been on the physician payment issue, 
there are other provisions in the Medicare and Medicaid Extenders Act 
that will improve access to care through December 31, 2011. Those 
include an extension of the exceptions process for Medicare therapy 
caps so that individuals who need additional services will not be 
forced to go without. It extends the Special Diabetes Programs, which 
are so important in dealing with the impacts of this terrible disease. 
The bill clarifies that orphan drugs are included in the 340B drug 
discount program for children's hospitals. It continues Medicare's 
Quality Individual program to help pay for Medicare Part B premiums for 
low-income seniors and people with disabilities and it extends 
Transitional Medical Assistance so low-income families don't lose 
critical Medicaid coverage as they move into employment.
  Passage of the Medicare and Medicaid Extenders Act will make sure 
that the end of this year won't bring with it cutbacks in access to 
health care for millions of Americans. It gives us all of 2011 to make 
these year-long extensions permanent, and I will work hard to make sure 
that we use next year to do so.
  Mr. WAXMAN. Mr. Speaker, I speak today in support of H.R. 4994, the 
``Medicare and Medicaid Extenders Act of 2010.''
  This legislation blocks a 25 percent fee cut that is scheduled for 
Medicare physician payments on January 1, 2011. A cut of that magnitude 
would jeopardize the access of seniors and people with disabilities to 
their doctors.
  Likewise, military families who rely on TRICARE need this 
legislation, because TRICARE uses Medicare rates and would also face a 
huge fee cut on January 1.
  The recent practice of Congress to legislate on physician payments 
several times per year needs to stop. Upon enactment, this will make 
the fifth SGR bill Congress has passed in 13 months.
  I am pleased that this legislation, unlike other recent SGR bills, 
would address the problem for an entire year.
  However, a 1-year solution is far less than the Medicare program 
ultimately needs. Congress must eventually confront the SGR 
permanently. The House has previously passed a permanent solution to 
the SGR problem. I hope that the next Congress is able to follow up on 
that work and fix this problem once and for all.
  This bill also ensures the continued ability of Medicare 
beneficiaries to access therapy benefits to help them recover from 
illness. And it contains other important technical changes to maintain 
the smooth functioning of the Medicare and Medicaid programs.
  Other provisions of this bill help low income Medicare and Medicaid 
beneficiaries. One provision helps low-income Medicare beneficiaries 
cover the cost of their Medicare Part B premiums. Another extends the 
transitional medical assistance program to help Medicaid beneficiaries 
as they work more hours and increase their earnings.
  This legislation is completely paid for, and it is necessary. It 
passed the Senate by unanimous consent, and I hope that all Members of 
the House will support it as well.
  One further note for purposes of interpretation. Section 204 of this 
bill contains a technical amendment to Section 340B of the Public 
Health Services Act. This language corrects an error in P.L. 111-152, 
the Health Care and Education Reconciliation Act of 2010, that 
inadvertently caused children's hospitals to lose access to orphan 
drugs at 340B prices. The language in Section 204 restores full access 
to orphan drugs at 340B prices for these hospitals. This amendment is 
retroactive as if included in P.L. 111-152. The intent of this 
retroactivity is to clarify congressional intent that there be no 
discontinuity in access to orphan drugs at 340B prices for childrens' 
hospitals. To the extent that drug manufacturers have not provided 
these discounts at any point between the enactment of P.L. 111-152 and 
the enactment of this legislation, they should do so retroactively, 
subject to HRSA or any other compliance and enforcement authority.
  Mr. CONYERS. Mr. Speaker, I rise today in support of Senate 
amendments to H.R. 4994, the Medicare and Medicaid Extenders Act.
  One of the most important priorities of Congress, regardless of our 
current economic downturn, is the financial well-being of our nation's 
hospitals, and the ability of patients to have access to medically 
necessary care when they need it.
  Passage of the Senate amendments to H.R. 4994 accomplishes both goals 
by blocking a scheduled 25 percent cut in Medicare payments to doctors 
and extending current Medicare payment rates through December 31, 2011. 
Passage of the bill today by the House will send this legislation to 
the President's desk for his signature.
  In order to have world class hospitals in the United States, we must 
have the needed funding to ensure that our nation's hospitals can 
provide the highest quality care possible. Passage of the Senate 
amendments to H.R. 4994 will help strengthen our hospitals, especially 
those located in our inner cities and rural areas. These hospitals are 
experiencing serious funding shortages, and are at risk of losing much 
needed doctors and medical staff.
  This bill is fully paid for, and according to CBO, the bill would 
reduce the deficit by $2.8 billion over the next 10 years. This 
legislation also helps to protect access to doctors for Medicare 
beneficiaries and military families, given that payment rates for 
doctors in TRICARE, the health care program for active-duty 
servicemembers, National Guard and Reserve members, military retirees, 
and their families are tied to Medicare rates. Passage of the Senate 
amendments to H.R. 4994 is a good example of how Members of Congress 
working together in a spirit of bipartisan unity can improve the health 
and well being of all Americans.
  I do want to raise some concerns with the way this bill is going to 
be paid for, which is to decrease the affordability credits for 
Americans that are needed to defray the costs of purchasing private 
insurance under the soon to be established health exchanges in 2014. I 
believe that this is tantamount ``to robbing Peter to pay Paul.'' This 
Congress should not get into the habit of viewing future benefits for 
low-income Americans as a source of funding for today's legislative 
initiatives. There are other more fair minded and progressive offsets 
which could have been utilized for this payment fix--such as taxing 
Wall Street or our nation's billionaires.
  If we are going to make sure that Medicare doctors and hospitals are 
reimbursed at an appropriate rate over the next several years, we are 
going to have to be more serious and pragmatic about how to implement 
efficiencies in the Medicare program.
  Medicare is a highly successful and efficient program, but it can't 
keep feeding the ``corporate medical monster'' forever. The time has 
come for the Federal Government to rein in the costs of for-profit 
hospital care by taking a more serious look at how we can reduce the 
costs of prescription drugs and medical technology--two of the most 
costly expenditures for hospitals and doctors.
  Furthermore, we must pass H.R. 676, ``The U.S. National Health Care 
Act,'' so that all Americans can enjoy the benefits of a universal 
single payer system, which has successfully worked in every major 
industrialized country to contain the rising costs of health care and 
provide quality health care for all. If we created this system, then we 
would be able to pay our nation's physicians at optimal levels and 
provide America's hospitals and clinics with a more financially stable, 
predictable, and efficient health care payment system for years to 
come.
  In the meantime, today's physician payment bill will allow today's 
Medicare beneficiaries to enjoy the care they have earned. I urge my 
colleagues to support the bill.
  Mr. VAN HOLLEN. Mr. Speaker, I rise in support of the Medicare and 
Medicaid Extenders Act of 2010. This legislation would reverse a 
scheduled reduction of 25 percent in Medicare physician payments and 
extend current Medicare payment rates through December 31, 2011.
  Though we are providing a year-long reprieve on the Medicare 
physician reimbursement problem, my strong preference is for this to be 
fixed on a permanent, long-term basis. Unfortunately, the Senate 
blocked legislation that was passed in the House that would have done 
exactly that.
  This legislation is needed so that Medicare beneficiaries are able to 
continue to have access to the care they need and to see their doctor 
of choice. It will also provide some stability for physicians that 
provide services to Medicare beneficiaries so that they and their 
practices can adequately plan for the expenses they incur in treating 
patients.
  In addition to extending current Medicare physician payment rates for 
1 year, the legislation includes extensions of important expiring 
health care provisions, including extending the Medicare therapy caps 
process, Transitional Medical Assistance which allows low-income 
families to maintain Medicaid coverage as they transition into 
employment, and the Qualifying Individual program that allows Medicaid 
to pay the Medicare Part B premiums for low-income Medicare 
beneficiaries.
  I am also pleased that the legislation extends for 2 years the 
Special Diabetes Program for Type I Diabetes and the Special Diabetes 
Programs for Native Americans. Though the Special Diabetes Program 
doesn't expire

[[Page 19393]]

until the end of 2011, early reauthorization is vital so that NIH can 
continue existing research projects. Otherwise, NIH would have to shut 
down those projects and the potential to develop new treatments for 
Type I Diabetes would be lost.
  Mr. Speaker, I urge my colleagues to support this legislation.
  Mr. HOLT. Mr. Speaker, I rise in support of H.R. 4994, the Medicare 
and Medicaid Extenders Act, which would provide a one year extension 
for Medicare reimbursement rates for physician services.
  The Balanced Budget Act of 1997 established a new way to determine 
Medicare physician payments: the Sustainable Growth Rate, SGR, formula. 
Since 2002, this formula has called for an automatic decrease in 
Medicare physician payments each year, potentially limiting physician 
access for Medicare patients. The formula goes beyond Medicare and also 
affects TRICARE, the insurance plan for active and retired military 
personnel and their families, and its reimbursements for civilian 
physicians.
  According to the Medicare Payment Advisory Commission, there is a 
broad consensus that this physician payment formula is flawed. These 
parts of the Balanced Budget Act should not have been passed in the 
first place and should be repealed and rewritten anew. The health 
reform legislation passed by the House of Representatives last year, 
which I supported, included a provision that would have repealed and 
replaced the SGR formula with a new Medicare physician payment plan. 
Unfortunately, the final health reform bill that was signed into law 
did not include this provision, which would have been a permanent 
solution to the SGR formula.
  Unless Congress acts, this formula would lead to a 25 percent cut in 
doctor's payments in 2011, discouraging many doctors from continuing to 
accept Medicare patients.
  The Medicare and Medicaid Extenders Act would freeze the current 
rates for physician services through December 31, 2011, giving Congress 
time to work on a permanent solution. Further, this piece of 
legislation would extend the 5 percent increase in Medicare payments 
for mental health providers that is set to expire at the end of 2010. 
This provision would expand access to mental health care for millions 
of Medicare patients.
  Additionally, this bill would extend funding for the special diabetes 
program through 2013. Without this bill, the special diabetes program, 
which funds 35 percent of all Federal research on Type I diabetes and 
supports research and prevention diabetes programs for Native Americans 
and Alaska Natives would expire at the end of 2011.
  This bill is completely paid for by making small changes to the 
health reform law.
  I am frustrated by these continuing short-term extensions. This is 
unfair to physicians who must plan their office budgets and unfair to 
patients who face unnecessary anxiety about the availability of the 
doctors on whom they depend. I will continue to advocate for 
legislation that eliminates the broken SGR formula and replaces it with 
a system that fairly compensates physicians for treating Medicare 
patients. Until we have a new system, we must pass this one-year fix to 
ensure that American seniors and military families have the access to 
their physicians.
  Mr. PALLONE. I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Stark) that the House suspend the rules 
and concur in the Senate amendments to the bill, H.R. 4994.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. HERGER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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