Commerce, Justice, Science, And Related Agencies Appropriations Act, 2010 - Continued

Floor Speech

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Mr. GRASSLEY. Mr. President, as I stated earlier today, I had worked to put together a bipartisan package with my colleague, Finance Committee Chairman Baucus, to address some time-sensitive matters that need to be considered.

I was under the impression that the Senate Democratic leadership genuinely wanted to work on a bipartisan basis but, unfortunately, I was mistaken.

Although the majority leader was deeply involved in the development of our bipartisan bill, as soon as it was released he announced that he would not take it up, and he arbitrarily decided to replace it with a bill he plans to jam through the Senate.

I addressed my concerns earlier about the removal of the tax extender provisions.

Now I want to discuss another significant change between the bipartisan package Chairman Baucus and I put together and the Senate Democratic leadership's bill that we will be voting on this week.

A package of expired and expiring Medicare health provisions has been removed without any explanation. These bipartisan provisions are essential to the health and well-being of Medicare beneficiaries. They have been routinely supported by both sides and passed repeatedly in recent years.

So where does that leave us? We are now less than a week away from the end of February, and Medicare beneficiaries around the country will suffer from the Senate Democratic leader's decision to remove these provisions without any explanation. Medicare beneficiaries should not be held hostage to whatever partisan goals the Senate Democratic leadership envisions.

To make matters worse, they have decided to ``fill the tree,'' as the procedure is called, so there will be no opportunity to offer these essential health provisions known as ``Medicare extenders'' as amendments to his bill.

The decision to abandon a bipartisan approach is especially ironic considering the fact that later this week President Obama is hosting a bipartisan meeting with Senators and Members of the House to discuss health care reform.

It is too early to tell if that meeting will lead to a true bipartisan effort to address health care reform issues, at least in some areas where there is broad agreement on both sides. But I commend the President for his bipartisan outreach and invitation to meet and discuss these important issues. It is an approach that the Senate Democratic leadership abandoned last year.

Apparently, political games have become more important than ensuring that critical legislation is passed to protect Medicare beneficiaries' access to health care.

Many individuals, in fact, are already in jeopardy of suffering adverse consequences to their health because of the failure by the Senate Democratic leadership to ensure that these critically needed Medicare provisions would be enacted by the end of last year. These are the same provisions that had broad, bipartisan support when they were considered by the Finance Committee and included in the health care bill the committee reported last fall.

I am going to review some of these provisions and the impact they have on Medicare beneficiaries and their access to health care.

First, there is the need for a physician payment update, what we commonly refer to as the ``SGR'' or the ``doc fix.'' A 2-month extension that was passed in December is scheduled to expire on February 28, just 5 days from now. Unless a physician update is enacted by March 1, physicians, nurses, and other health care practitioners will experience severe payment cuts of 21 percent as of that date.

These payment cuts would be even more disastrous for physicians in rural States, such as Iowa, where Medicare reimbursement is already about 30 percent lower than in other areas. But payment cuts of this magnitude will severely impact physicians and health care practitioners throughout the country, and they will significantly threaten beneficiary access to care.

Should these cuts occur and continue for any length of time, they will have a truly disastrous effect on the ability of seniors to find, or keep, physicians who take Medicare patients.

I am appalled that Medicare beneficiaries' access to physicians and other needed medical care is being jeopardized because of the political games that are being played by the Senate Democratic leadership.

Let's look at beneficiaries who are already being affected by other Medicare provisions that should have been extended, as they have been in the past, but that were allowed to expire at the end of last year.

One of the most pressing is an extension of the exceptions process for therapy caps. The law puts annual payment limits or financial caps on therapy services. There are annual dollar limits on outpatient physical therapy and speech-language pathology therapy combined and on occupational therapy.

While the law provided for an exceptions process to these caps when additional therapy was medically necessary, that provision expired at the end of 2009. Medicare beneficiaries who have suffered strokes or serious debilitating injuries, such as a hip fracture, have significant rehabilitation needs. Some of these beneficiaries have already exceeded their therapy limits for 2010.

Since the exceptions process that would have allowed these patients to receive more needed therapy has expired, beneficiaries with the greatest need for therapy will be the hardest hit. Congress must address this issue immediately.

A second issue of major concern is the need for additional payment for mental health services. A provision that expired at the end of last year provided an additional 5-percent payment for Medicare mental health services provided by psychologists and mental health counselors. This provision has been key to improving access to mental health care services for veterans and other military personnel suffering from post-traumatic stress and other disorders since TRICARE coverage is based on Medicare rates.

Significant shortages of mental health personnel have made it exceedingly difficult for Medicare beneficiaries and some of our military returning from overseas to find this critically needed help. The expiration of this provision has made it even more difficult for them to obtain these services. Congress needs to act immediately to help Medicare beneficiaries and members of the Armed Forces in need of mental health services.

A third issue concerns additional payments for ambulance services that are routinely extended, year after year. Many ambulance providers need them to survive. But those provisions also expired at the end of last year.

Another provision would ensure that Medicare beneficiaries can continue to get vital medical supplies such as diabetic test strips, canes, nebulizers, and wound care products from their local community pharmacies.

Under current law, suppliers of durable medical equipment, prosthetics, orthotics, and other supplies must get accredited to prove they comply with quality standards. Many eligible professionals, such as physicians, nurse practitioners, physical therapists, and others are specifically exempted from this requirement. This provision would exempt pharmacies from being accredited under certain circumstances. Pharmacies must have been enrolled as a Medicare supplier with a provider number for at least 2 years, have DME billings that are less than 5 percent of their total sales, be in good standing with Medicare, and meet other criteria.

Medicare beneficiaries living in rural and underserved areas are particularly at risk of losing access to these critical medical products. This provision is essential to ensure they do not.

There are also a number of expired provisions in this package that improve payment for hospitals, especially rural hospitals. These hospitals rely on these provisions to keep their doors open.

The impact of a hospital shutting its doors would be especially hard on rural and underserved areas where hospitals are the only point of access for health care.

Our country is facing record unemployment and Americans are struggling to make ends meet. The failure to extend these essential Medicare provisions immediately will make access to health care or needed medical services simply unavailable for many beneficiaries. The impact will be even worse for those in rural areas already facing health care access problems.

These examples show some of the damage that failing to extend these Medicare provisions will do to our seniors' health care.

We need to get back to work on the bipartisan package that was in the works until the Senate Democratic leadership's dramatic change in direction.

Medicare beneficiaries are counting on us to work together and get this done.

Mr. President, I yield the floor, and I suggest the absence of a quorum.

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