Making further continuing appropriations for the fiscal year 2003, and for other purposes.

Mr. Speaker, I yield myself 5 minutes.

Mr. Speaker, this is the eighth continuing resolution to come before this body necessitated by the fact that we are now in the fifth month of the new fiscal year and still do not have a budget. We have not provided the funds that should be provided for homeland security. The Congress has not provided the funds that should be provided for first responders, for education, to deal with some Medicare and Medicaid problems, and there are many other concerns as well associated with the late action of the Congress on the appropriation bills.

None of that fault lies with the chairman of the Committee on Appropriations. He has tried his dead level best to bring appropriations bills to the floor in a timely fashion. He has been shut off by decisions made at a higher pay grade. At this point, this House has no choice except to once again extend the continuing resolution.

But there are, nonetheless, some items which I think are necessary to take action on because time is running out. The clock is running on a number of crucial problems. For that reason, and I will take the time to explain it now so I do not have to do it twice in the interest of saving time. For that reason, at the appropriate time I will offer a motion to recommit which instructs the Committee on Appropriations to report back an amended version of the continuing resolution that adds two urgent provisions related to payment rates for medical services to Medicare patients.

The existing continuing resolution already contains several provisions relating to entitlement benefits, including extensions of the Transitional Assistance to Needy Families program, TANF, and the transitional Medicaid benefits program. This motion simply adds two more time-sensitive items relating to Medicare.

First, the motion calls for continuation of Medicare payment rates for doctors at the current level, thereby suspending the 4.4 percent cut now scheduled to take place on March 1.

There has already been a 5.4 percent cut in Medicare payments to doctors that took effect in January, 2002. These payment cuts make it difficult for doctors to meet their expenses and can only make it harder for Medicare patients to find a doctor willing to treat them. The problem is especially acute in rural areas which are already suffering from shortages of doctors and other health care providers.

Second, the motion would take a first step toward redressing the imbalances in the Medicare payments rate that right now puts rural hospitals at a serious disadvantage. Under current law, hospitals in large urban areas receive a base payment rate that is higher than the rate for all other hospitals. The Medicare Payments Advisory Commission has recommended eliminating this differential, noting that Medicare operating margins for rural hospitals are now substantially lower than for large urban hospitals. That just confirms what many of us have been hearing back home, that most rural hospitals are facing serious financial difficulty that jeopardizes their ability to provide quality care.

This motion calls for raising base payment rates for rural and small city hospitals up to the rate for large urban areas. These two provisions are just first steps toward redressing imbalances in Medicare payment rates. Congress needs to overhaul the faulty formulas that led to the steep cuts in payment rates and to address a range of issues that place rural areas and many States at a disadvantage. But to gain time for the appropriate committees and the Congress to deal with these broader issues, we need immediate fixes to the immediate problem. That is what this motion seeks to do.

Both of these items in the motion are also included in the Senate- passed omnibus appropriations package that is now in conference, the conference to which the gentleman from Florida (Mr. Young) just referred. Hopefully, a conference agreement on that measure will be finished quickly and with these items included. But we should also include these measures in the continuing resolution as a backup, which is what this motion would do.

Furthermore, adoption of this motion would also send a strong signal to House conferees on the omnibus appropriations package and to the House leadership regarding the sentiment of the House on the urgent need to fix Medicare payment rates. Even though the 4.4 percent cut in Medicare physician payments is just weeks away, the House has done nothing effective to forestall that cut. The problem is urgent. The House needs to act now. That is what this motion will attempt to do.

Mr. Speaker, I yield 4 minutes to the gentleman from California (Mr. Stark).

Mr. Speaker, I yield 4 minutes to the distinguished gentleman from Pennsylvania (Mr. Murtha), well known for his objection to short debates.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I offer a motion to recommit.

Without the motion's adoption, Mr. Speaker, I certainly am.

Mr. Speaker, I will not take the 5 minutes. I have already explained the motion. Let me simply say I think the need for it is self-evident. It is certainly obvious that small rural hospitals are in a tough financial situation and need relief, and it is certainly obvious that if the scheduled reduction in physician payments under Medicare goes into effect that it will negatively affect many, many Medicare patients.

I might not offer this amendment if I thought that the conference was going more smoothly than it is, but certainly in a number of subcommittees there are raging controversies yet to be resolved, and I think under those circumstances it is important that we go on record in support of this proposition.

Mr. Speaker, will the gentleman yield on that point?

Mr. Speaker, tell me then, is the gentleman objecting to the fact that the Republican chairman of the Committee on the Budget and the Republican chairman of the Senate Finance Committee has asked us to take this action?

Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. Speaker, I thank the chairman for yielding the time.

Well, here we go again. I heard the gentleman from Wisconsin say that he was opposed to the continuing resolution without the motion to recommit added to it. If you read the motion to recommit very carefully, it uses a word

which, if that word is used and the motion to recommit passes, it will kill the continuing resolution. I know one word sometimes does not mean a lot. If you say ``I you'' and do not say ``love'' or ``hate,'' you really do not get the meaning of what you are trying to say.

The word the gentleman from Wisconsin included in his motion to recommit is ``promptly.'' What in the world is the difference between ``promptly'' or, let us choose another word, ``forthwith''? The difference is the difference between ``I love you'' and ``I hate you.'' Why? Because if you include ``forthwith'' in the bill, it means it would be immediately changed as the gentleman says he wants, it is reported right back on the floor, and we go forward. If you include the word ``promptly,'' it kills the bill.

So do not pay attention to anything that is said after the word ``promptly,'' because it does not mean anything. If you pass the motion to recommit with ``promptly'' in it, it kills the measure.

Let us examine what he says he wants. He has picked two items out of the motion to recommit. There are more provisions, you can imagine the Senate could not limit itself to two provisions, that they would want to try to legislate on an appropriations bill. They also said, Let's help Home Health Services, $40 million. Let's put $492 million in for bioterrorism. Let's put $120 million in for community access. Those are not in here.

So if you really want to help folks, they should have put everything in that the Senate did. The trouble is, it is all headed with ``promptly,'' which means it does not make any difference what you put in here.

My friend and colleague, the chairman of the Committee on Appropriations, made an offer to my friend from Wisconsin about future motions to recommit. I will give you a flat-out promise. If you will change ``promptly'' to ``forthwith'' and if you will heed the advice of our friend, the gentleman from Pennsylvania (Mr. Murtha), and say, Let's have malpractice reform, and you put that in your motion to recommit, the House has passed it a number of times; the Senate will not.

If we really wanted to make a difference, we would not stand up here with a motion that kills the bill and say, This is what we want. Let us get serious. Do we have to address problems in Medicare? Of course we do. Do we have to do something about the flawed physicians formula? Of course we do. Will we? Yes, we will.

What we should not be doing is holding out a false promise of part of what the Senate wants to do under a motion to recommit, that if you believe the promise is real and vote for the motion to recommit, you in fact kill the continuing resolution.

I yield briefly to the gentleman from Wisconsin.

Mr. Speaker, reclaiming my time, if the term ``promptly'' is in a motion to recommit, you kill the CR. You do not help it. You do not nurture it. You do not defend positions that the Senate has placed in the appropriations. You kill it.

If the gentleman had put ``forthwith,'' he would have been helping. I cannot believe, based upon the time and experience the gentleman from Wisconsin has had in this body, that he does not know that ``promptly'' kills it and ``forthwith'' helps it. That is the difference between ``I love you'' and ``I hate you.''

Mr. Speaker, I yield to the gentleman from Iowa (Mr. Nussle), the chairman of the Committee on the Budget.

The gentleman is absolutely correct. It not only kills the bill; it stops the government.

Mr. Speaker, pursuant to the previous order of the House, I call up the joint resolution (H.J. Res. 18) making further continuing appropriations for the fiscal year 2003, and for other purposes, and ask for its immediate consideration.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, the legislation before the House, H.J. Res. 18, will extend the current CR and allow the government to continue to operate until February 20, 2003. I think all Members know that we are currently working to conclude the conference agreement for an omnibus appropriations bill for fiscal year 2003. It is our hope that we are finally reaching a point in this process where we can look forward to having a vote on that conference report.

It is our plan to meet in formal conference on Monday evening, to conclude that conference as soon as possible, and to have this conference report before the House either Tuesday or Wednesday. We do hope to conclude fiscal year 2003 business. It has been a long time coming. There have been a lot of reasons why the fiscal year 2003 bills have not reached conclusion, but I will tell Members that the Committee on Appropriations in the House reported all of our bills except two which we introduced directly to the floor. I would stand in strong support and commendation of the Committee on Appropriations on both sides of the aisle because, as a committee, we did our job.

There were other obstacles placed in our path as we moved along the process. Hopefully, we have overcome those, and we are now deciding how to settle the differences between the House and the Senate.

Mr. Speaker, I think it might be interesting for Members to see this. This is not a copy of the bill. This in small, fine print is merely a copy of thousands of differences between the House and the Senate that we have been working with diligently for the last couple of weeks. I hope that we can expedite this process.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself the balance of my time.

Mr. Speaker, again, this continuing resolution merely extends the date of the previous CR until February 20 to give us time to conclude the conference meetings. For those who were not on the floor when I made the point before, what I am holding in my hand here is not a copy of the bill. It is a copy of the thousands of differences that we have in this bill between the two bodies. We are closing in on this. We plan to have the conference meeting on Monday evening. I would really not like to interrupt the process that is ongoing now that looks like it might give us a successful conclusion. So when we get to the issue of the motion to recommit with instructions, I would hope that the membership would understand that we are at that delicate stage now. We are about to wrap up the fiscal year 2003 business. We are already beginning the fiscal year 2004 process. Let us defeat the motion to recommit with instructions.

I compliment my friend, the gentleman from Wisconsin (Mr. Obey). Every one of his motions to instruct is really appetizing and they are really inviting and they are really votes that you would like to cast; and he works hard at developing these really good motions. I would make a deal with him if we cannot conclude this by the 20th, then I think we will give serious consideration to his next motion to instruct, but I really feel confident that we are going to conclude this with this last

Mr. Speaker, I claim the time in opposition to the motion, and I yield such time as he may consume to the gentleman from California (Mr. Thomas), the chairman of the Committee on Ways and Means.

Mr. Speaker, knowing that we are not going to vote before 6:30 regardless of the situation, I thought I would put my suggestion in about Medicare reimbursement. I see the chairman of the committee here, my good friend, the gentleman from California (Mr. Thomas). There is no person that has more concern about the hospitals than him. In my latest campaign, all I heard from my hospitals, in a rural area, We need more reimbursement. I know this is not the right vehicle. I know the vehicle should be the Committee on Ways and Means. I understand that. But these hospitals are bleeding. They are losing money. The biggest employer in every single community that I have is the hospitals and people related to the hospitals. If we do not do something, and I do not have to tell the Members who are here on the floor, if we do not do something, the doctors' reimbursement is going to go down 4.4 percent.

This will raise, not a lot, but it will raise the percentage that rural hospitals get equal to the urban hospitals. There can be all kinds of excuses why urban hospitals ought to get better reimbursement, but their problem is, the facts of life, we are having a difficult time in Pennsylvania, in my district in western Pennsylvania. Because of malpractice, we are losing doctors. That has got nothing to do with this bill, but the other thing is reimbursement for small hospitals. I meet periodically, I would say every 6 months, with administrators from hospitals. These instructions do not mean anything. It is like some of the resolutions we pass. They do not mean a damn thing, and all of us know they do not mean anything; but the point is we would send a signal, hopefully, to the chairman of the Committee on Ways and Means that we have got to do something about this.

A lot of times we passed instructions by unanimous vote and we went into committee and we obviously had no jurisdiction; we did not do anything about it. But here where this is so serious and so many hospitals are suffering, we need to voice our concern about the reimbursement in rural hospitals. I would hope that my good friend, the chairman of the committee, would listen to us and when he comes into his first meeting, one of the first things that he does in the Committee on Ways and Means, and I hope he would join us today in urging that something be done about this. I know, I voted a lot against instructions, because I felt like we did not need to be instructed; but in this particular case, I think it is so important that I would hope that all the Members would join the gentleman from Wisconsin (Mr. Obey) in passing this instruction to the conferees to do something about Medicare.

Mr. Speaker, I thank the gentleman from Wisconsin (Mr. Obey) for bringing this bipartisan motion to recommit and giving us all an opportunity to correct some technical problems in Medicare that both parties have agreed to.

The physician payments were cut last year; and if nothing is done, they will be cut again. There is absolute agreement between the administration and those of us on the Subcommittee on Health of the Committee on Ways and Means that that was an error in the calculation formula and it must be fixed. There has been a great deal of gamesmanship over this area, but I think it is time to take care of it.

The Senate in its omnibus funding bill increased the Medicare payments for physicians and rural hospitals. This provision for physicians is temporary but would be in effect for the rest of this year.

I do not normally favor, much less encourage, legislating Medicare provisions in an appropriations bill; but it is clear that this is the only way to get this done in a timely fashion. The Senate has passed these provisions. And so it clearly need not hold up the CR. A few hours ago, in a hearing before the Committee on Ways and Means, when asked whether the President supports the Senate-passed physician fix, OMB Director Daniels testified that he did. In fact, he said yesterday that the President would support any number of measures to fix it.

I realize that the chairman of the Committee on Ways and Means may not be happy with this, but the Committee on Ways and Means has looked the other way when the leadership puts wage reclassifications and other targeted Medicare provisions in appropriations bills. So I would hope for those of you who come from rural districts, and we are only talking about $250 million for rural hospitals, it is a provision that was consistent with the nonpartisan adviser to the House,

MedPAC, who recommended that we help these rural hospitals with this small amount. It is consistent with the Health and Human Services provision that we must change the physician reimbursement. It is not permanent. It helps cure the problem for the remainder of this year.

I hope that all Members will take this opportunity to see this as a carefully crafted way to help our physician community and to provide for the rural hospitals this small amount that is needed. There is no reason to oppose it. I know of no reasonable opposition. It has been passed in the Senate overwhelmingly, I think unanimously; and it is under the Republican leadership. With the White House supporting it, with Health and Human Services supporting it, who could be against it? I urge all my colleagues to accept the motion to recommit.