[Congressional Record (Bound Edition), Volume 159 (2013), Part 1]
[House]
[Pages 892-895]
[From the U.S. Government Publishing Office, www.gpo.gov]




      CHILDREN'S HOSPITAL GME SUPPORT REAUTHORIZATION ACT OF 2013

  Mr. PITTS. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 297) to amend the Public Health Service Act to reauthorize 
support for graduate medical education programs in children's 
hospitals.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 297

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Children's Hospital GME 
     Support Reauthorization Act of 2013''.

     SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       (a) In General.--Section 340E of the Public Health Service 
     Act (42 U.S.C. 256e) is amended--
       (1) in subsection (a), by striking ``through 2005 and each 
     of fiscal years 2007 through 2011'' and inserting ``through 
     2005, each of fiscal years 2007 through 2011, and each of 
     fiscal years 2013 through 2017'';
       (2) in subsection (f)(1)(A)(iv), by inserting ``and each of 
     fiscal years 2013 through 2017'' after ``2011''; and
       (3) in subsection (f)(2)(D), by inserting ``and each of 
     fiscal years 2013 through 2017'' after ``2011''.
       (b) Report to Congress.--Section 340E(b)(3)(D) of the 
     Public Health Service Act (42 U.S.C. 256e(b)(3)(D)) is 
     amended by striking ``Not later than the end of fiscal year 
     2011'' and inserting ``Not later than the end of fiscal year 
     2016''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Pennsylvania (Mr. Pitts) and the gentleman from New Jersey (Mr. 
Pallone) each will control 20 minutes.
  The Chair recognizes the gentleman from Pennsylvania.


                             General Leave

  Mr. PITTS. Mr. Speaker, I ask that all Members may have 5 legislative 
days to revise and extend their remarks and insert extraneous material 
into the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Pennsylvania?
  There was no objection.
  Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, Pennsylvanians are fortunate to have several excellent 
children's hospitals in the State. One of these hospitals is the 
Children's Hospital of Philadelphia, the country's first hospital to 
exclusively care for children, and they have remained one of the best 
for over 150 years.
  In a recent survey, the hospital was rated number one in six separate 
pediatric specialties and ranked no lower than fourth in another four 
specialty categories.
  Other children around the country aren't so fortunate to have access 
to excellent doctors. A study in the journal Pediatrics found that more 
than 8 million children have no pediatrician in their area. Many other 
sick children have to drive hundreds of miles to see a doctor who 
specializes in treating their condition.
  Children aren't just miniature adults, and treating them isn't just a 
matter of working on a smaller scale and shrinking the equipment. A 
doctor who is experienced in treating adults may not be able to apply 
that same expertise to a child. Treating children is both a medical and 
an emotional challenge. Often, doctors have to correctly diagnose an 
illness in little patients who haven't even learned to speak. It takes 
a special person to go into pediatrics.
  For a time in the 1990s, our Nation was facing an acute shortage of 
pediatricians. With much of government assistance to train doctors 
being funneled through the Medicare program, it was becoming 
significantly more expensive for a doctor to choose to be trained in 
pediatrics.
  To help correct this imbalance, Congress created the Children's 
Hospital Graduate Medical Education program. This is a program that was 
created, and has been sustained, with bipartisan support.
  Unfortunately, the program is facing elimination. President Obama's 
budget for the 2012 fiscal year called for elimination of the program, 
despite the positive results.
  I support getting rid of programs that are duplicative, unproven, or 
unnecessary, especially with the budget pressures we are facing now; 
however, CHGME has a proven track record. Over 40 percent of 
pediatricians in the United States are trained through CHGME.

                              {time}  1710

  Forty-three percent of those in subspecialities are trained through 
the program.
  The Children's Hospital of Philadelphia runs the largest pediatric 
residency program in the country. Their residents will treat children 
in my community and then move across the country to practice in other 
communities. We need their expertise now more than ever.
  Last Congress, I worked with my Democratic counterpart on the Energy 
and Commerce Health Subcommittee, Representative Frank Pallone, to 
introduce legislation to renew the program. Our legislation passed the 
House of Representatives twice in the 112th Congress, both times by 
voice vote.
  Unfortunately, the bill was tied up in the Senate and was not 
considered. Congressman Pallone and I wasted no time in reintroducing 
the bill this year, and I'm proud to say that in the very first meeting 
of the Energy and Commerce Committee, on January 22, the bill was 
reported out unanimously. The bill is a very simple, 5-year 
reauthorization of the CHGME program at current funding levels.
  H.R. 297 is supported by the Children's Hospital Association, the 
American Hospital Association, the Academic Pediatric Association, the 
American Academy of Pediatrics, the American Pediatric Society, the 
Association of Medical School Department Chairs, the Society for 
Pediatric Research, the Association of American Medical Colleges, the 
American Osteopathic Association, and the American College of Surgeons, 
among others.
  Far too many children in our Nation already lack access to a 
pediatrician or doctor trained in a pediatric subspecialty. Without 
CHGME, we will once again be discouraging medical residents from 
choosing pediatrics.
  On a personal note, nearly 2 years ago, I met Anna Lipsman, who was 
receiving treatment for leukemia at the Children's Hospital of 
Philadelphia. Today, thanks to the excellent care she received, she is 
happy, energetic and in school full time. She continues to remind me 
about what is really at stake.
  I urge all of my colleagues to vote ``yes'' on H.R. 297 and reserve 
the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I'm pleased to rise in support of H.R. 297, the 
Children's Hospital Graduate Medical Education Support Reauthorization 
Act of 2013.

[[Page 893]]

  As every parent knows, it's very important to have a trusted doctor 
to turn to when their child gets sick. Since its inception in 1999, the 
Children's Hospital Graduate Medical Education program, known as CHGME, 
has helped to make sure that the doctor is there and prepared to 
diagnose any symptoms that our children face.
  In fact, the program has been a true success. In the 1990s, declines 
in pediatric training programs threatened the stability of the 
pediatric workforce, and CHGME helped to reverse these dangerous 
declines. Even then, Congress, in a bipartisan way, recognized that if 
we didn't create and fund programs that would train doctors to treat 
these children, there won't be anyone left to take care of them.
  That's why the House overwhelmingly supported reauthorization of the 
program in the 112th Congress, passing stand-alone legislation in 
September 2011 and also including the reauthorization in broader 
legislation in December 2012.
  With this Federal CHGME support, children's hospitals can play a key 
role in ensuring the continued growth of our Nation's pediatric 
workforce. In 2009, the program supported the training of 5,361 
resident physicians nationally. The program will also help to enhance 
hospitals' research capabilities and improve hospitals' ability to 
provide care to vulnerable and underserved children.
  Reauthorizing CHGME continues to be one of my top health priorities, 
and I want to thank Congressman Pitts, the chairman of our Health 
Subcommittee, for working with me on this bill. Together with his help 
and leadership, we were able to move this bill again swiftly through 
our committee and to the floor upon convening this Congress.
  Mr. Speaker, this program has proven results, and it's past time that 
we finally reauthorize CHGME so that we can provide certainty to 
hospitals, doctors, and their patients. Children in our communities are 
counting on this program to train a future generation of pediatricians, 
and I urge my colleagues to vote ``yes'' on the bill.
  Mr. Speaker, I would like to now yield 3 minutes to my colleague from 
Rhode Island (Mr. Cicilline).
  Mr. CICILLINE. I thank the gentleman for yielding.
  The reauthorization of the Children's Hospital Graduate Medical 
Education program is critically important and something we must do. But 
I rise today to express some frustration with the bill as presented.
  Specifically, while our Nation faces an acute need for additional 
health professionals trained in psychiatry, this reauthorization 
continues a glaring mental health parity failure within the Children's 
Hospital Graduate Medical Education program: the failure to include 
children's psychiatric teaching hospitals in the program. Because 
Medicare classifies these hospitals as psychiatric hospitals rather 
than as children's hospitals, child psychiatric hospitals are 
ineligible to participate in CHGME.
  This presents a particular burden to a spectacular pediatric hospital 
in my district, Bradley Hospital. And that is why, last Congress, I 
introduced the Children's Hospitals Education Equity Act, which was 
designed to fix this oversight by simply expanding the definition of a 
children's hospital to cover child psychiatric hospitals.
  I'm disappointed, therefore, that the CHGME reauthorization is being 
considered under suspension of the rules today, as it prevents 
consideration of amendments to improve the program and to correct this 
omission in the bill.
  Our Nation must fulfill its commitment to mental health parity, and 
Congress must do its part to enhance access to child and adolescent 
mental health care. Despite this shortcoming, I intend to support the 
bill, and I look forward to working with my colleagues in both parties 
and in both Chambers to correct this serious inequity. I thank the 
gentleman.
  Mr. PALLONE. I have no additional speakers. I yield back the balance 
of my time.
  Mr. PITTS. Mr. Speaker, I urge Members to support this legislation. 
It has tremendous bipartisan support, and, with that, I yield back the 
balance of my time.
  Mr. WAXMAN. Mr. Speaker, I rise today to support H.R. 297, the 
Children's Hospital GME Support Reauthorization Act of 2013.
  H.R. 297 reauthorizes the children's hospital graduate medical 
education--or CHGME--program at the program's current authorization 
level. This program provides ongoing and consistent financial support 
to hospitals such as Children's Hospital of Los Angeles for the 
training of doctors who want to specialize in pediatrics. Over the 
years, the CHGME program has been enormously successful in reversing 
the significant decline in the number of pediatrician trainees across 
the country. Indeed, today, children's hospitals nationwide that are 
supported by the program train 40% of all pediatricians and 43% of all 
pediatric specialists.
  Not surprisingly, the CHGME program has a decade-long history of 
bipartisan support. The program was first established in 1999 and has 
subsequently been reauthorized on two occasions. During the 112th 
Congress, the House passed legislation that would have reauthorized the 
CHGME program for another five years.
  I'm sure that Members of both sides of the aisle agree we want to 
make certain this important program remains in place, and we want to 
send a strong message about the importance of fully funding it.
  I want to commend the work of members of the Energy and Commerce 
Committee for advancing H.R. 297 to the floor today. I especially want 
to recognize and applaud the leadership of Ranking Member Pallone and 
Chairman Pitts on this bill. I know we are all hopeful the Senate will 
act quickly to enact H.R. 297, so we can send legislation to the 
President for his signature.
  I urge my colleagues to join me in supporting H.R. 297.
  Mr. GENE GREEN of Texas. Mr. Speaker, I strongly support the 
Children's Hospital Graduate Medical Education program and I am a 
cosponsor of H.R. 297. This successful program is the most important 
federal investment in the pediatric workforce and must be reauthorized. 
Failure to do so would be catastrophic to pediatric care in our 
country. Since this program began, it has allowed Children's Hospitals 
across the country, including Texas Children's Hospital in Houston, to 
increase training by 35%.
  I believe we must spend more on Graduate Medical Education entirely, 
but today we have the opportunity to extend the successful Children's 
Hospital program which, like other GME funds, is money well spent. 
Despite the successes of the program, there are still many pediatric 
specialties that are experiencing shortages. This bill will help 
address this and will continue to strengthen our pediatric workforce. I 
look forward to voting in favor of this bill and encourage my 
colleagues to do the same.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in 
support of H.R. 297, the Children's Hospital GME Support 
Reauthorization Act of 2013. The Children's Hospital Graduate Medical 
Education Program not only provides a critical investment in the 
pediatric health workforce, but also helps improve children's access to 
health care.
  The Children's Hospital Graduate Medical Education Program was first 
authorized in 1999 and has achieved incredible success. The program has 
enabled children's hospitals to host teaching programs while 
maintaining high-quality clinical care. It currently supports 56 
children's hospitals and is responsible for a significant increase in 
the number of physicians trained in children's hospitals.
  As the first registered nurse in Congress, I know firsthand that a 
well-trained primary care workforce is crucial to our health system. 
Only by ensuring the security of pediatric residency programs can we 
successfully work to promote the health of all Americans.
  Ms. JACKSON LEE of Texas. Mr. Speaker, I rise today in support of 
H.R. 297 the ``Children's Hospital Graduate Medical Education (GME) 
Support Reauthorization Act of 2013'' This legislation would authorize 
the appropriation of $110 million a year for 2013 through 2017, for 
payment toward the direct costs of graduate medical education in 
children's hospitals.
  As the Founder and Co-Chair of the Congressional Children's Caucus, I 
understand the important of this vital program. The Children's Hospital 
Graduate Medical Education Program (CHGME) trains 40 percent of our 
Nation's pediatricians and more than half of our Nation's pediatric 
subspecialists. Each year, over 5,000 residents take part in this 
program.
  We are all aware that we must continue to support the development and 
training of all medical professionals. Me must do more to ensure that 
we have enough qualified medical

[[Page 894]]

professional choosing to specialize in key fields in order to address 
the growth in both our baby boomers and child populations. I believe 
this legislation is a step in the right direction.
  In the early 90's, we witnessed a thirteen percent decrease in the 
amount of qualified graduate medical students entering into pediatrics. 
Upon the enactment of the Children's Hospital Graduate Medical 
Education program we saw a significant increase in the amount of 
qualified medical school graduates choosing to enter into pediatrics, 
their numbers increased by 35 percent.
  In 1999, Children's Hospital Graduate Medical Education, CHGME, was 
enacted as part of the Healthcare Research and Quality Act to provide 
freestanding children's hospitals with discretionary federal support 
for direct and indirect expenses associated with operating medical 
residency training programs. Since few children's hospitals receive 
Medicare funds, the program is designed to correct the exclusion of 
pediatric training in the Medicare Graduate Medical Education, GME, 
program.
  Under the Children's Hospital Graduate Medical Education Program, 
direct medical education funding is designed to cover costs associated 
with stipends for residents, salaries, salaries for faculty, overhead 
and other costs of running a training program. The CHGME also provides 
indirect medical education funds that are designed to assist in 
expenditures such as reduced productivity of staff training residents 
and the processing of additional diagnostic tests those residents may 
order.
  Graduate Medical Education, GME, begins upon graduation from medical 
school and passed the examination needed to obtain general board 
certification. GME in a specialty field (residency) and further 
specializations in a specific clinical field (fellowship) are generally 
provided in hospital settings with additional clinical experiences in 
non-hospital site. This can take between three and seven years to 
complete, depending on the medical, dental or podiatric specialty track 
chosen.
  Freestanding children's hospitals receiving Federal GME funds have 
increased the number of residents and fellows that they are training 
since 2000:
  The number of residents and fellows claimed for Federal support for 
the 2000 Federal fiscal year (FY) was about 4,263.
  In the latest Government Performance Results Acts, GPRA, report for 
Federal FY 2009, the hospitals described training 5,631 pediatricians, 
pediatric subspecialists, and other physicians in the clinical care of 
children within the U.S.
  Of the 5,631 resident FTEs being trained, about 48 percent were in 
general pediatrics, 24 percent were in pediatric subspecialties, and 28 
percent were non-pediatric residents.
  In FY 2009, 56 children's hospitals located in 30 states and Puerto 
Rico had nearly half a million inpatient discharges. Children's 
hospitals vary in size and service mix. The number of available beds at 
these hospitals varies from 30 to 456.
  These freestanding children's hospitals provide services ranging from 
outpatient ambulatory care to inpatient critical care.


                                 TEXAS

  In Texas, excluding military and Veterans Affairs programs, there are 
currently 5,902 resident physicians in Texas training in 468 accredited 
graduate medical education (GME) programs.
  It is likely that many of these resident physicians will join the 
ranks of the 39,872 licensed physicians currently practicing in Texas.
  These practicing and resident physicians, together with 656 resident 
physicians training in Texas military and Veterans Affairs hospitals, 
provide health care to Texas 22,016,911 people.
  Texas ranks 40th nationally in the number of physicians per 100,000 
civilian population and faces serious challenges in attracting 
physicians to locate and practice in rural, remote, and urban 
underserved areas.
  With Texas' population increasing at both age ends of the population 
spectrum, the ratio of 158 direct patient care physicians per 100,000 
population ratio will likely not improve unless policy changes are 
implemented to encourage expansion of the Texas physician workforce and 
foster greater distribution of physicians across the state. As Texas 
continues to grow in general, pediatric and our aging population we 
will more physicians--and more specialized physicians--to care for our 
citizens.
  With 25 percent of Texas total population uninsured and 22 percent of 
its children uninsured, Texas has the highest number of uninsured 
individuals in the country. Which is one of the many reasons I 
supported the Affordable Health Care Act.
  The majority of under-insured Texans receive health care through the 
our network of locally tax-funded and privately funded teaching 
hospitals and clinics.
  Uninsured Texans play an important role in graduate medical 
education; they are one of the groups of patients that residents care 
for and treat, while honing their medical skills and expertise.
  Graduate medical education is just one piece, albeit an important 
piece, of the complex health-care delivery system. While ensuring the 
viability of the safety-net hospitals and clinics in Texas is important 
to the future of Texas, solving all of the problems associated with 
ensuring that viability is beyond the scope of this. The medical 
school/hospital partnerships responsible for training many of the next 
generation of Texas physicians are stressed financially. Especially 
Children's Hospitals.
  The GME and The CHGME programs both train resident physicians while 
providing essential health-care services to those who might not 
otherwise receive access to care.
  Currently, Five children's hospitals in Texas benefit from the CHGME 
program: Texas Children's Hospital (Houston), Children's Medical Center 
of Dallas, Driscoll Children's Hospital (Corpus Christi), Dell 
Children's Hospital (Austin) and Cook Children's Hospital (Fort Worth). 
Last year alone, more than $23 million in CHGME funds was allocated to 
Texas.
  I can say that Texas Children's is the largest pediatric hospital in 
the nation, providing medical care in more than 40 pediatric 
subspecialties. It also has the largest pediatric cancer and hematology 
research and treatment center in the country
  As an internationally recognized children's hospital it is the 
primary pediatric training site for Baylor College of Medicine, which 
has one of the largest pediatric residency programs in the country.
  Baylor College of Medicine, operates the nation's first Children's 
Nutrition Research Center, a U.S. Department of Agriculture facility 
that conducts research on the nutritional needs of pregnant and nursing 
women and their children.
  Since opening its doors in 1954, Texas Children's Integrated Delivery 
System has cared for more than one million children from every corner 
of the world and has more than 2 million patient encounters a year.
  Together with Baylor, Texas Children's participates in approximately 
400 research projects annually and received $59 million in research 
funding in 2003. Current projects include testing of medications to 
improve the quality of life for patients with HIV infection and AIDS; 
diagnostic methods based on DNA analysis for cystic fibrosis, muscular 
dystrophy, and other genetic disorders; development of treatments 
through human gene therapy; and other basic and applied research 
studies.
  I must also mention the Lyndon Baines Johnson General Hospital 
operated by the Harris County Hospital District, it is the second 
primary teaching facility or the University of Texas at Houston. They 
have been dedicated to serving the people of Houston for over two 
decades. Those who are fortunate enough to receive their training under 
the CHGME program may very well one day be treating children who arrive 
at this hospital.
  We must remember who these soon to be specialists will serve . . . 
our nation's children. Children like Audrina, who was born in October 
of last year. Little Audrina was born with her heart outside of her 
body. After six hours of surgery, baby Audrina is going home. 
Supporting funding for programs like the CHGME supports the training of 
specialists who will one day save the lives of countless children.


   FAST FACTS--CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION (CHGME)

  The Children's Hospital Graduate Medical Education, CHGME, Payment 
Program currently supports 56 children's hospitals in 30 States.
  Train about a third of the Nation's pediatricians.
  Trains about 50 percent of pediatric sub-specialists.
  The CHGME Payment Program has provided more than 2 billion dollars to 
eligible freestanding children's hospitals since its inception.
  Fifty-Six U.S. hospitals participate in the program, which enables 
them to:
  Provide GME to graduates of medical schools.
  Enhance research capabilities.
  Care for vulnerable and underserved children.
  A hospital is eligible to apply for CHGME Payment Program funding if 
it:
  Participates in an approved Graduate Medical Education (GME) program.
  Has a Medicare Provider Agreement.

[[Page 895]]

  Is excluded from the Medicare Inpatient Prospective Payment System, 
IPPS, under section 1886(d)(1)(B)(iii) of the Social Security Act, and 
its accompanying regulations.
  Operates as a ``freestanding'' children's teaching hospital.
  Ms. ESHOO. Mr. Speaker, the Children's Hospital Graduate Medical 
Education program was first created in 1999, because there were not 
nearly enough pediatricians and pediatric subspecialists to serve the 
children of our country. The program has been overwhelmingly 
successful, increasing the number of pediatricians by 35 percent. 
Today, CHGME provides funding to train more than 40 percent of 
pediatricians in the U.S. However, at current funding levels, we still 
don't have enough providers to treat the unique needs of children in 
our country.
  I cannot emphasize enough how critical this funding is to stand-alone 
children's hospitals, such as Lucile Packard Children's Hospital in my 
Congressional District. We have a responsibility to help train the next 
generation of pediatricians who will care for our children through the 
earliest, and often the most critical time of their lives. Under the 
Affordable Care Act, all Americans will have access to healthcare, but 
we have to ensure we have an adequate medical workforce to care for 
them.
  I look forward to the passage of CHGME reauthorization in the House, 
and I will continue to work with my colleagues in the Senate to see 
that we move forward with a bill that can swiftly pass both bodies and 
be sent to the President for his signature.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Pennsylvania (Mr. Pitts) that the House suspend the 
rules and pass the bill, H.R. 297.
  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. PITTS. 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, further 
proceedings on this motion will be postponed.

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