Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, the gentleman makes a very good case for rural health care, and I commend him for that and because we have heard the same case made time and time again, and this is why…
Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the gentleman makes a very good case for rural health care, and I commend him for that and because we have heard the same case made time and time again, and this is why we have provided an approximately $25 billion increase in payments to rural providers.
Before I go into that, I would advise the gentleman through the Chair, if I may, that I certainly agree with him regarding wellness, preventive health care and whatnot, and for something like 60 years or 30 years after Medicare was devised, we did not have, in Medicare, provisions for preventive health
care. And it was not until a few years ago, in the 1990s, in the late 1990s, when finally a group of us got together on a bipartisan basis and finally for the first time put some preventive health care coverage reimbursement, if you will, in order to cover those areas.
In the House bill, in the House bill, the gentleman has not referred to this, we have a provision to the effect that when a person is about to go under Medicare, there is a reimbursement coverage. In other words, provided payment by Medicare, for a one-time physical. It is a voluntary type of a thing, but a one-time physical to encourage people to take that physical before they go into Medicare, and with the idea, of course, that many problems, many illnesses, prospective illnesses might be picked up at a real early stage and thus save not only an awful lot of money, of course, to the taxpayer ultimately, but certainly save an awful lot of money and inconvenience and pain for the beneficiary.
This is what is in the House bill, as I understand it. It is not the Senate bill. It is one of those provisions that we, on the Member level in conference, are going to have to address. The American Cancer Society supports that provision, and it is my idea, and so, certainly, I support it. So I agree with the gentleman about preventive health care, and it is something we are trying to do.
This is, as the gentleman indicated, the fourth time the minority has offered this motion to instruct conferees. I do find it perplexing that they continue to offer this motion, and for one reason only, and that is because by definition, by definition, it would reduce the amount of funding available for the new Medicare prescription drug benefit by 10s of billions of dollars.
So, yes, do we want to increase and are we, in fact, increasing the reimbursements to rural Medicare providers? Yes, we are doing that. If we increase that amount, we are taking it from where? We are taking it, of course, from the prescription drug benefits available to seniors.
The author would have the Medicare conferees accept every rural provider increase contained in both bills, as he indicated. I would note for my colleagues, and I have already said this, that the House has already recognized the need to ensure the rural Medicare providers are paid fairly. In fact, the House-passed bill contains a $24.9 billion increase in payments to rural providers, which will help rural hospitals and physicians, among others, continue to provide care to rural Americans. So, if the House bill goes down, or if we do not have a bill, let us say both bills go down because we want perfection, the rural hospitals will lose $25 billion as a result of that decision.
Since the authors of this motion continue to emphasize that their motion will not cause us to exceed the $400 billion laid out in the budget resolution, we would have to reallocate funds, I have already said it, away from beneficiaries and towards whom? Towards rural providers.
Would we like to do that? Yes. Would we like to take it away from prescription drug benefits? The answer is no. I do not support it. I think the House bill strikes the right balance between providing a meaningful prescription drug benefit and helping ensure that providers, especially those in rural areas, continue to serve Medicare beneficiaries.
This motion would also, in some cases, require a type of government- run fallback. Although the House passed legislation, both bills have a fallback. The House passed legislation has a fallback. It already guarantees that every Medicare beneficiary will have a choice of the least two Medicare prescription drug plans.
In fact, the Congressional Budget Office tells us, and they are, of course, as bipartisan as you can be, that under both acts, CBO estimates that all Medicare beneficiaries would have access to prescription drug coverage. In spite of that, both bills have a fallback. They are good fallbacks. As time goes on, if, God forbid, we might have to fall back, if you will, to a fallback, and it looks like it is not working, then, of course, that is something that can be adjusted. But there really is not that much of a difference in terms of what the fallbacks are as I understand it. It is just the case of the Senate bill fallback would immediately fall back to the government picking up 100 percent of risk whereas the House bill affords flexibility, if you will, from the standpoint that one fallback may result in government picking up a certain percentage of risk in some areas and in some other areas and pick up a larger risk or smaller risk or something of that nature.
We have found that, in order to control costs, it is important that Medicare prescription drug sponsors share some of the risk associated with providing this new benefit. I am uncomfortable asking the Federal taxpayer to completely shoulder the weight of this new entitlement. That is why I do not think we need the government running prescription drug plans. But the fact of the matter is the fallback is there, and there is a guarantee in the House bill that a plan will be available for all beneficiaries.
And, finally, the motion instructs conferees to recede to the Senate and remove the hospital market-basket update adjustment contained in the House bill. I would note for my colleagues that we are not cutting hospital reimbursement. We are not cutting hospital reimbursement. We have hospitals all over, whether it be urban areas or rural areas, my area is somewhat in between, if you will, but we are not getting hospital reimbursements.
According to the Medicare Payment Advisory Commission, which we call MedPAC, it is the nonpartisan panel of experts that advises Congress on Medicare policy, hospitals currently make a 10 percent profit for Medicare inpatient services and a 5 percent profit, on average, for all services provided to Medicare patients.
So I have already emphasized, if you will, MedPAC unanimously advised Congress to increase payments by 3 percent, which is what the House bill does. We have gone along with basically the experts in that regard, MedPAC.
The $25 billion approximate increase in provider payments in rural areas is based on certain formulas. Iowa hospitals would receive a certain percentage, Hawaii hospitals receive a certain percentage, increases above and beyond that 3 percent I might add.
Additionally, and it has not been mentioned in the motion to instruct, but under the current law, Medicare providers would have reduced their reimbursement by 4.4 percent. The House bill increases that by 1.5 percent. You are talking about a swing of 5.9 percent to Medicare providers, M.D.-type providers, if you will, which would take place if we enact this legislation into law. If we defeat this legislation and defeat any version of this type of legislation, those providers would be hurting. The rural providers would be hurting considerably more than they are now. And obviously, the beneficiaries, to whom we have promised prescription drugs of a sort, would be hurting.
Mr. Speaker, given the progress the conferees have made toward reaching an agreement, progress is being made, it is slow, there is no question about it, but it is moving, I would hope that conferees are given the opportunity to work through their differences between both bills. After all, that is what the system is all about. There are differences between the House version and the Senate version. And conferees were appointed on a bipartisan basis in order to try to work out those differences.
Basically what we are saying to the gentleman and to the entire House is give the conferees the opportunity to work, and hopefully we will be able to successfully address the many competing issues in a satisfactory way.
And more importantly, in addition to helping the rural providers and rural hospitals, all providers, et cetera, we will be providing our seniors with a prescription drug benefit that they need so very desperately.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield myself such time as I may consume to respond to the gentleman, and I appreciate his comments because he is so very much concerned about health care for our seniors; but I mentioned the conference is taking place on a bipartisan basis, and the truth is it is. We have two United States Senators from the other party who are part of that conference, on an everyday basis, I might add.
Mr. Speaker, I yield such time as he may consume to the gentleman from Texas (Mr. Burgess).
Mr. Speaker, I yield myself such time as I may consume.
Just to respond very briefly to the gentleman from Alabama (Mr. Davis), this is my 21st year in the House. Virtually all of that time, I have been a member of the Subcommittee on Health, and the question of reimbursements to rural providers has always been there. If it were simple to correct, it could have been corrected. It could have been corrected when the other party was in charge. It could have been corrected when this party has been in charge, which is a lot less years than when the other party was in charge. It is very difficult, but it is being addressed. The conferees are spending a lot of time on that particular issue, and, hopefully, they will reach agreement.
Again, I would say to my colleagues, I have talked to members of the AARP who have come into my office back home. Yes, we have all received a seven-page letter to the effect of what they want in that bill, but they say we want a bill which will help some people now, and, hopefully, provide a foundation we can improve upon as we go on.
If all of us are just going to stand fast and say this is not in the bill or that is not in the bill, or this is in the bill and I do not like it and we want perfection, we are not going to have a bill. As I said before, at least the rural providers are receiving some benefit, some help out of this bill. That $25 billion is certainly not chicken feed.
It is significant that we have a piece of legislation that is going to be of some help to the rural providers. It may not be enough, it may not be as much as the gentleman would like, and I do not blame him. This is a representative system of government, and they are representing their people, and they are doing a good job of it insofar as wanting to help their rural communities. But again, we have to have a bill, and it is critical that we all try to work together as much as we can.
All of the conferees are not always meeting together in every conference that we have. That is unfortunate, but there are some Members who have indicated that they are against anything at all involving this type of legislation; and, consequently, I suppose those are the reasons. I do not make those decisions, but it is unfortunate. But a lot of work is being done every day at 3 p.m., Monday through Friday, on a bipartisan basis.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I have no further requests for time, and I yield back the balance of my time.