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Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2008

Location: Washington, DC



Mr. HARE. Madam Chairman, I offer an amendment.

The CHAIRMAN. Without objection, the Clerk will report the amendment.

The Clerk read as follows:

Amendment offered by Mr. Hare:

At the end of the bill (before the short title), insert the following:

Section __X. (a) Section 9320(k) of the Omnibus Budget Reconciliation Act of 1986 (42 U.S.C. 1395k note), as amended by section 6132 of the Omnibus Budget Reconciliation Act of 1989, is amended by adding at the end the following:

``(3) Any facility that qualifies as a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act) shall be treated as being located in a rural area for purposes of paragraph (1) regardless of any geographic reclassification of the facility, including such a reclassification of the county in which the facility is located as an urban county (also popularly known as a Lugar county) under section 1886(d)(8)(B) of the Social Security Act.''.

(b) The amendment made by subsection (a) shall apply to calendar years beginning on or after the date of the enactment of this Act (regardless of whether the geographic reclassification of a critical access hospital occurred before, on, or after such date).


Mr. HARE. Madam Chairman, I yield myself such time as I may consume.

Madam Chairman, my amendment deals with critical access hospitals and their ability to provide crucial surgical services to rural communities.

Recently, three of these hospitals in my district have fallen prey to a narrow interpretation by the Centers for Medicare and Medicaid Services that now prevents them from providing basic surgical services.

The CAH program was created as a Federal reimbursement system for small rural hospitals. Providing cost-based reimbursement through Medicare allows CAHs to be a vital part of the safety net for my small communities in my district. This reimbursement allows these rural hospitals to provide both emergency and primary care services for the elderly and disadvantaged. In particular, CAH reimbursements for Certified Registered Nurse Anesthetists enable tens of thousands of citizens in medically underserved areas to access surgical services every year.

Until December 31, 2006, the CAHs were being reimbursed for CRNA services. Now, in 2007, a new interpretation of the law excludes CAHs whose counties have gone through a reclassification process due to a new census process known as ``Lugar counties.''

No new law has said that these CAHs should no longer be reimbursed for CRNA services, however. Now CAHs are being denied their CRNA pass-through payments. Most hospitals affected expect to average losses between $45,000 and $100,000; a drop in the bucket in overall health care dollars. But to these hospitals, this effectively terminates their ability to provide emergency surgical services. My amendment would fix the law to ensure that if a hospital is designated as a critical access hospital, then it is reimbursed for CRNA services.

Congress intended for CAHs to assist rural communities with limited access to health care services. I am committed to rectifying this unfair and harmful application of the law.

I would now like to yield to the gentleman from Wisconsin, the chairman of the Appropriations Committee, Mr. Obey.

Mr. OBEY. Well, let me simply say I would like to be helpful to the gentleman, but my problem is that the gentleman's amendment, I believe, is subject to a point of order. I would hope that the gentleman would withdraw the amendment and we could try to work together with the committee of jurisdiction to try to help get a favorable result for the gentleman's concerns.

Mr. HARE. I thank you, Mr. Chairman.

Reclaiming my time, I want to thank Chairman Obey for his wonderful work as the leader of our Appropriations Committee, and I look forward to working with you and this Congress to address this serious issue.

Madam Chairman, I ask unanimous consent to withdraw my amendment.


Mr. HARE. Madam Chairman, I thank the gentleman for yielding.

For 13 years, I cut men's suits at Seaford Clothing Factory in Rock Island, Illinois. I wouldn't be here as a Member of Congress if it were not for my union. My membership in UNITE HERE Local 617 afforded me access to higher wages, good benefits, and invaluable workplace safety protections.

Under the Souder amendment, the NLRB could not enforce either party's obligation to bargain in good faith following a voluntary recognition. This would undermine the rights of potentially millions of workers who have already organized under voluntary recognition agreements and already engaged in collective bargaining relationships.

Majority Sign-Up has been available under the National Labor Relations Act since 1935. It's proven to reduce strife in the workplace, resulting in better labor-management relations. Majority sign-ups also reduce coercion and pressure, compared to NLRB elections, which is why I'm a strong proponent of the Employee Free Choice Act.

As my colleague mentioned, the Souder amendment would force all workers into the broken, unfair, undemocratic election system and strip away the freedom of contract.

I ask all of my colleagues to vote against the Souder amendment which would take a huge step backwards for the rights of American workers, and I thank the gentleman for yielding.


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