Physician Payment and Therapy Relief Act of 2010

Madam Speaker, I thank Mr. Pallone for his constant leadership on health care matters, and the Energy Committee and its full complement of members, as well as Mr. Stark for his continued strength on the issues of providing fairness and balance in the health care system of America. To the managers, my colleagues on the other side of the aisle, I appreciate the recognition that we have a bipartisan crisis and that we all have to address the pending concern of a potential cut as we move forward into 2011. But during the Thanksgiving holiday as I was in my district, I saw a table of doctors in a restaurant who felt compelled to come and ask me to support what is called the doctor fix, the Medicare fix. I had to assure them that Members of Congress were equally concerned about the providers of health care, the implementers of good health for America having to face this kind of dastardly crisis.

In the State of Texas it is crucial, a State that has the highest number of uninsured and a rising number of impoverished who do not have access to health care, this kind of disaster would be more than a hurricane. And so I rise today to support this legislation to acknowledge the fact that doctors and Medicare go together and they equal good health for our constituents.

Seniors have to go to doctors and expect good health care. Doctors are in fact those who take the oath to ensure that they care for the sick and the feeble. The Houston Chronicle reported that more than 300 Texas doctors have dropped the Medicare program in the last 2 years, 50 in the first 3 months of 2010, because of this crisis. Many people think of doctors as rich and able; but many of our doctors are in rural areas and inner city areas and their goal is to serve patients who are in need, many without any other means other than Medicare and Medicaid. According to Dr. Susan Bailey, president of the Texas Medical Association, the Medicare system has to be fixed and action must be taken to ensure that Medicare payments to physicians are not drastically cut. It is a shame to say, doctors have overhead, they have offices, they have nurses, they have equipment that they have to pay for, and that is part of good health care. And so I think it is important that we look at this legislation as it comes to us, and that the final physician rule, the Centers for Medicare and Medicaid Services, modify the MPPR policy to apply a 25 percent reduction rather than the proposed 50 percent reduction to physician Medicare payments. However, I think the reduction in itself is an oxymoron because the question is what are the needs of the patients and how can the doctors care for them and how do we ensure that doctors and Medicare work together to make sure that good health is promoted across America.

While that reduction shows movement in the right direction, any reduction will hinder the ability of doctors to effectively treat patients who need their care and who are the most vulnerable--pregnant women, children, the elderly and, of course, the feeble, who are suffering from preexisting diseases or chronic illnesses. So it is important that H.R. 5712, the Physician Payment and Therapy Relief Act of 2010, is passed.

What I would ask, Madam Speaker, is: Who are we if we cannot take care of the least of those?

I don't consider doctors wanting more than they deserve. I consider doctors getting what they deserve to help care for the sick of this Nation. I hope that we will have a bill that the President can sign and that we will be able to address the question of good health care in America.

Madam Speaker, I rise today in support of the amendment to H.R. 5712, ``The Physician Payment and Therapy Relief Act of 2010.''

Under the current health care law, more than 32 million additional Americans are expected to get insurance, either through an extension of Medicaid, the state-federal program for the poor, or through exchanges where low- and moderate-income individuals and families will be able to purchase private insurance with federal subsidies. The measure will require most Americans to have health insurance coverage; and it will regulate private insurers more closely, banning practices such as denial of care for pre-existing conditions. A key part of the new health law also encourages the development of ``accountable care organizations'' that would allow doctors to team up with each other and with hospitals, in new ways, to provide medical services. There are some very good provisions that seek to ultimately benefit the public.

Today, however, increasing numbers of doctors are not accepting Medicare patients because the payments they are receiving are inadequate to cover basic expenses of administering care. In fact the Houston Chronicle reported that more than 300 Texas doctors have dropped the program in the last two years, including 50 in the first three months of 2010. According to Dr. Susan Bailey, president of the Texas Medical Association, the Medicare system is on the verge of imploding unless action is taken by Congress to ensure that Medicare payments to physicians are not cut drastically.

Madam Speaker, I urge my colleagues to support not only H.R. 5712 but also the overall health of many struggling Americans. I am an avid supporter of health care reform and I stand today in steadfast support of providing affordable health care for all Americans. However, if doctors are unwilling to accept patients with Medicare because they fear they will not receive payment for their services we face a serious dilemma. It is our duty as legislators to provide such payment guidelines for the legislation intended to provide affordable quality health care for all Americans to ensure that it achieves is purpose.

In the final physician rule, Centers for Medicare and Medicaid Services modified the MPPR policy to apply a 25 percent reduction, rather than the proposed 50 percent reduction to physicians Medicare payments. While that reduction shows movement in the right direction, any reduction will hinder doctors' ability to effectively treat patients who need their care the most like children and the elderly.

I ask my colleagues to please join me in supporting H.R. 5712, the Physician Payment and Therapy Relief Act of 2010.

Madam Speaker, I move to suspend the rules and concur in the Senate amendments to the bill (H.R. 5712) to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program.

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on concurring in the Senate amendments to H.R. 5712.

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

Madam Speaker, this bill is a stopgap measure to guarantee that seniors and military families can continue to see their doctors during December while we work on a solution for the next year. Without this legislation, the fees Medicare pays to physicians will be reduced by 23 percent on December 1, this Wednesday. And because TRICARE, the civilian health program for military families and retirees, uses Medicare rates, fees for physicians seeing TRICARE patients would be cut by 23 percent as well.

Madam Speaker, I have to say that kind of cut is obviously not reasonable. We have a responsibility to ensure that Medicare is a steady partner for physicians so that we are able to maintain the kind of excellent access to care that seniors and people with disabilities have come to expect from the program. Medicare enrollees still enjoy better access to care than anyone else in the country. The rate cuts created by the SGR would undermine that trust that seniors and physicians have historically had in the program.

The 111th Congress has passed into law three SGR extensions of less than a year, and this will be the fourth. I think we need to stop legislating SGR policy in 1 to 6 month intervals in order to provide some stability to the Medicare program for 2011. And I hope that before the 111th Congress adjourns, we can pass legislation addressing all of 2011 at a minimum.

I continue to be frustrated that we are unable to move beyond short- term fixes to this major problem facing the Medicare program. The House passed legislation in 2009 that I co-sponsored that would have dealt with this SGR problem for good; but until we have that long-term solution in hand, it is essential that Congress pass this legislation to ensure that seniors and military families do not experience a disruption in seeing their doctors this December.

This legislation, Madam Speaker, is completely paid for over 10 years. According to the rules of the statutory PAYGO law, we aren't supposed to pay for SGR bills; but this one is paid for despite that. It moved through the Senate by unanimous consent.

And so, Madam Speaker, there is no conceivable reason in my opinion to oppose this legislation. I would urge Members to vote ``yes'' on this bill and help me pursue a longer solution before Congress finishes business for this year.

I reserve the balance of my time.

Madam Speaker, I yield 3 minutes to the gentlewoman from Texas (Ms. Jackson Lee).

(Ms. JACKSON LEE of Texas asked and was given permission to revise and extend her remarks.)

I yield the gentlewoman another 30 seconds.

I yield myself such time as I may consume.

You know, Madam Speaker, I was very upset to hear the gentleman from California because I thought, for once--and it's very rare around here--as I heard the gentleman from Oregon suggest that he was supporting this bill, that we finally had some bipartisan support and some Republican support for the SGR doctors' fix; but now I listen to the gentleman from California, and he starts suggesting that somehow the Democrats are to blame. Well, let me suggest that the opposite is true.

Back in November of 2009, about a year ago, the Democrats in this House passed a permanent fix. We wouldn't be here today if that legislation had been supported by the Republicans. To his credit, only one Republican--Dr. Burgess, who is a member of my Health Subcommittee--did, in fact, support it, but he was the only one. It is the Republicans' fault that we are constantly dealing with these short- term fixes, because they don't want to take care of the doctors. They don't want to resolve this, and they refused to come to the table and resolve it with us while we were in the majority.

I don't want to go into it too much today because I know there is support on the Republican side of the aisle for this 60-day fix, until December 30; but in talking about the Democrats when the Republicans are the reason we are here today because they would not support the permanent fix and make it so that we didn't have to constantly go back to the table, I think it is totally inappropriate for the gentleman of California to lay blame when, in fact, it is his own party that is to blame.

I reserve the balance of my time.

Madam Speaker, I ask unanimous consent that the balance of my time on the majority side be controlled by Representative Stark of the Committee on Ways and Means.

I reserve the balance of my time at this point.

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

Mr. Speaker, I am pleased to announce, as a representative of the Energy and Commerce Committee, that we are not opposed to this bill and we're pleased with this these corrections. It is especially important that our veterans' access to care is not impeded or delayed and that these other corrections will improve the efficiency and effectiveness of some of the programs that our citizens depend on the most.

This bill, as the gentleman from California mentioned, is budget neutral. In fact, there may even be as much as a $50 million savings if everything goes right here, which I think is important. It's a small number with regard to the trillion-dollar deficit that we've already hit by the end of June and the

$1.5 trillion deficit that we may experience for this year.

I would like to see a budget where--I think we're missing an opportunity with items like this where we can save $50 million here, hopefully save $50 million here. If we had a budget, it could be part of a master plan to reduce our deficits and empower the private sector to create jobs.

These are technical corrections that are necessary. But this is what happens when the majority works in secret, crafts legislation that doesn't receive the input from others, the minority side. And, frankly, I wouldn't be surprised that, after drastically altering the health care system so quickly, we'll have many more technical corrections necessary as time goes on.

The technical errors, however, are hardly the biggest problems facing this country's health care system. Far worse are the looming ill effects of the majority's basic policy mistakes. Who doesn't know the problems in that they refuse to exercise the fundamental responsibility of the House to conduct oversight hearings on how this is set up. And the grandfathering clause has already been very confusing. This is what we'll have to look out for as the health care bill proceeds.

Now, just for the record, let's consider some of the problems that we face from this bill. The law will cut $575 billion out of Medicare. Concerning me equally as much is that it's with no direction from Congress, leaving these decisions to Health and Human Services and the Center for Medicare and Medicaid Services.

In Nebraska, in my district, many of my seniors rely on Medicare Advantage as a program, but $145 billion will be taken from Medicare Advantage, reducing the enrollment, according to the nonpartisan estimates, by as much as 50 percent.

It will raise spending nearly 90 percent for States in Medicaid programs, squeezing State taxpayers and crippling State budgets.

Despite the claims that the bill would lower health care costs and deficits, the Chief Actuary of Medicine has since concluded that spending won't go down, it will actually go up, as many people believed.

And remember the promise that if you like your coverage, you can keep it? With the new grandfathering rules that are being rolled out, it is now estimated that, and this is the administration's estimate, that as many as 66 percent of small businesses will not be eligible to keep what they have and will have to accept something from the exchange which will be pre-approved by HHS.

We're also learning the recession might worsen now because employers are hesitant to expand. We're hearing from many employers, articles in the Wall Street Journal, that they're sitting on cash because they don't want to spend now, be hit with these higher costs, and then have to lay off later. So it's arresting investment and hiring of new workers because businesses don't know the costs of implementation of this health care bill.

Now, the Democrats at every level are in hiding mode. They don't want a new public debate on this. We had a recess appointment of Donald Berwick, Dr. Donald Berwick, who is a great intellectual on medical savings, particularly in a British system that says that a rationing- type of system relies on a mathematical formula of age, as well as comparative effectiveness. And the comparative effectiveness provision in this bill provides Dr. Berwick carte blanche to implement those type of British policies.

This is probably--this won't be the last time that we hear about health care, but probably we won't hear about it until after November 2. The American people know why. I can only hope that we choose to conduct oversight of the new health care law and fix its disastrous effects.

Mr. Speaker, I have no further requests for time, and I yield back the balance of my time.

I yield myself such time as I may consume.

Madam Speaker, for the fifth time in the last year, Democrats' ability to properly manage the Medicare program is causing medical doctors to confront a looming massive cut in their Medicare reimbursement rates. In fact, when the cut went into effect in June, Medicare held physicians' payments for weeks, and it ultimately was forced to pay claims that cut physicians' rates by 21 percent, only to later send additional payments once the majority congressional Democrats decided to pass another patch. In practical terms, this meant for weeks doctors and other providers saw no or greatly reduced Medicare payments, but yet they still had to pay their rents, payrolls, and other overhead expenses.

Madam Speaker, this is unacceptable and irresponsible. As a result of the Democrats' failure to address this issue in a timely manner, tens of millions of taxpayer dollars were wasted to reprocess physicians' claims and to send new checks to doctors all because the majority party could not finish its work on time.

Physician practices, like most small businesses, are hurt by this dereliction of duty. In a letter signed by 117 physician specialty and State medical societies, physicians detailed how many practices were forced to seek loans to make payroll expenses, to lay off staff or to cancel capital improvements and investments in electronic health records and other technology. Furthermore, when payments resumed, many physicians experienced long delays in receiving the retroactive adjustments. The physician group letter states, ``This is not the way to manage a program that seniors and the disabled rely on.''

The legislation before us provides for a 1-month postponement of the 23-percent cut; but in 1 month, the cuts return, this time even deeper, with payment cliffs expected to reach nearly 25 percent on January 1.

Madam Speaker, the Democrats' practice of missing deadlines, of withholding payments and reprocessing Medicare claims is no way to run the program. Furthermore, the Democrats' new health law cuts more than one half trillion dollars from Medicare but spends nothing on fixing the physician payment problem. It is one of the many reasons we should replace that flawed legislation with reform Americans can afford and that we should address a true long-term fix for our doctors and seniors. A Republican House will run this program differently.

We cannot miss deadlines. We must ensure doctors get paid on time for the services they provide. We cannot string them along not knowing from one month to the next what they will be getting paid by Medicare. As doctors are making decisions about whether or not to participate in Medicare next year, I want them to know that a Republican House will not leave them twisting in the wind as they have been this past year.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I would like to mention to my friend, the gentleman from New Jersey, that the legislation he speaks of, which they offered, had a $200 billion, non-paid-for bill on that. We have to begin living within our means, and through our legislation that we will be offering, we will be working to do that.

I reserve the balance of my time.

Madam Speaker, while I intend to support this bill and urge its passage, our work does not end here. We must find a long-term, stable and fiscally responsible solution to this problem.

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

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

Mr. Speaker, the majority is again bringing to the floor more fixes to the fatally flawed health care overhaul. The health care law was riddled with errors; some were oversights, the likes of which we are here today to address. However, the majority has failed to rectify the fundamentally flawed policies that threaten our economic stability and America's health care, all the while driving Federal and State budgets down a further unsustainable path.

Mr. Speaker, where is the fix for the up to 117 million Americans with health insurance from their employers that, by the administration's own estimates, will not be able to keep the plan they have and like? That promise was repeatedly made by President Obama and the Democratic majority to assure to the American people that health care overhaul would not force them into a one-size-fits-all government- approved insurance plan. Unfortunately, this has repeatedly proven to be false.

Where is the fix for the millions of small businesses that will be forced to file 1099 tax forms for each business from which they purchase more than $600 worth of goods and services during this year? The National Federation of Independent Business, NFIB, describes these new requirements as crippling, and they will further divert investment away from jobs, which should be our number one concern.

Mr. Speaker, where is the fix for seniors whose Medicare coverage is threatened by the health care overhaul? Medicare's own actuaries found that the $500 billion in Medicare cuts could jeopardize access to care for seniors. Furthermore, the actuaries predict millions of seniors will lose their Medicare plan because massive cuts to the program will result in ``about 50 percent'' of seniors no longer being in a plan.

Unfortunately, the merits of today's legislation pale in comparison to the merits of addressing the needs of the millions of Americans losing the plan they have and like, the small businesses facing burdensome new costs and regulations, and seniors relying on Medicare. When will these pressing needs be addressed?

Mr. Speaker, while I support the bill before us, it is not enough. We must move beyond mere technical corrections and fix the fundamental flaws of the Democrats' health care law by repealing it and replacing it with solutions that work.

Mr. Speaker, I yield the balance of my time to the gentleman from Nebraska (Mr. Terry).