Medicare Access and Chip Reauthorization Act

Floor Speech

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Mr. WYDEN. Madam President, it is my hope that soon the Senate will be about to start voting on legislation that in one fell swoop will improve health care for millions of Americans. This discussion should start with a Medicare milestone. That milestone is abolishing once and for all the outdated, inefficiency-rewarding, commonsense-defying system of paying physicians under the Medicare Program.

As my colleague from New Hampshire knows, what I am talking about in the technical lingo of health care is the SGR, the sustainable growth rate. It is a horrendously flawed formula for paying doctors and providers who treat our Medicare patients. Yet despite this very sour pedigree, it has dominated much of the discussion about Medicare since 1997.

I wish we had put this flawed reimbursement system in the dustbin of history last year. As some of my colleagues know, I had sought to do that, along with the support of others. But I think now we have reached the point, on a bipartisan basis, where we have a chance for seniors and their providers to cross the victory line and be better off and have a better system for all Americans.

I thought I would take a minute or two before discussing some of the other health care efforts that I hope will go forward today to describe how this happens. A little over a year ago, there was not much reason to think we would not just keep passing this leaky boat. That is essentially what the Senate had been doing for years and years with this flawed program.

In fact, I remember one of our younger Members of this body was where the Presiding Officer of the Senate is sitting. I said: At this rate, we are probably going to be on patch No. 70 or 80 by the time we get around to really fixing this. So people were not very optimistic a little over a year ago. Since then, however, since that 17th patch, we saw Members on both sides of the aisle saying: It is time to start getting serious and getting traction for a permanent repeal-and-replace of this flawed reimbursement system.

In January of this year, momentum finally began to grow. In other words, we used that period in 2014 as a springboard. Discussions began with Speaker Boehner and Leader Pelosi. Their discussions were really based on the bipartisan, bicameral framework that was developed in 2014 when leaders in the other body and the Senate got together: Finance Members, Ways and Means Members, the Energy and Commerce Members. The combination of that work and Speaker Boehner and Leader Pelosi coming together leads us to where I hope we will be here before long, and that is, once and for all abolishing this flawed reimbursement system.

If we did not take this action--and in effect it really has to be done now--without taking people through the root canal work of how the reimbursement system works at the Medicare center, what is called CMS, we do know that if Congress does not intervene, we would see physicians cut 21 percent. That would, in my view, cast a very strong shadow over our ability to serve America's older people. I mean, particularly in the rural areas of this country, we have a lot of those practices that serve older people walking on an economic tightrope right now. They are trying to figure out how to pay the staff and pay for equipment and lighting and everything else. A 21-percent cut would be enough, in my view, to really put some of those small rural practices out of business. So it was the judgment of this bicameral group that worked through 2014, that Leader Pelosi and Speaker Boehner picked up on this year, to come up with a very different kind of model to replace the Medicare reimbursement system that was so flawed, the SGR, with a merit-based incentive payment that rewards those who provide high-quality, high-value care. That, in my view, is how we get the best value for America's seniors who, of course, want to get the right amount of care at the right time. They want it to be of high quality.

A major part of this legislation will, in my view, help to promote better coordination of care. American health care is so fragmented and so strewn, kind of hither and yon, very often a senior can be treated by a variety of providers. No one really rides point on it. The senior ends up in the hospital emergency room.

At that point, when providers say: Who should we be in contact with? The senior is not even sure of all of the people, particularly if that senior has multiple chronic conditions--perhaps diabetes and a heart problem--the senior will not even know the array of providers they have seen, let alone have someone coordinate their care.

The good thing about this reform is it promotes that kind of care coordination. Also, physicians, as part of this, will have clear incentives to enter alternative payment models that are going to promote team services, services where there is a team of health care providers. It will require more Medicare transparency, more information about various services that are provided to older people so that there is some sunlight on this incredibly complicated system, particularly the Medicare Program that takes over $500 billion a year and spends it in a way that has not been particularly transparent.

I want to thank Senator Grassley for working with me closely on this for a number of years.

Finally, this legislation also makes permanent what is called the QI Program, again fancy health care lingo for an important program that pays the premiums, the outpatient premiums, for low-income older people. I think that is especially important, because it says for older people, particularly those of modest income, that there is going to be some assistance for the outpatient services, what is called Part B, which are so critical in terms of keeping older people out of long-term care facilities.

My guess would be in New Hampshire and Oregon--like in my home State of Oregon--having that kind of assistance for low-income people in the community is really key to avoiding institutional care.

I do want to note that I think all of us are going to say this bill does not meet the test of perfection. I happen to believe the bill would have been stronger had this body been involved in all of the negotiations. But clearly to have a milestone for Medicare--and that is what I think you get when you eliminate what really pretty much is a fraud. The Medicare reimbursement system has been honored more in the breach than in the observance. Every year it is waived, it is patched. I think to replace it with what I have described really is something that when the history of Medicare is written, people are going to look back and say: This was an important day. These were sensible changes. Improving care coordination, putting a new focus on quality, data transparency, coordination of health care teams, the kinds of things that this proposal does, are very much in the interests of seniors, providers, and taxpayers. I think this day will be remembered for making a very important contribution in the history of Medicare.

I do want to mention several other amendments that I hope will be offered. I also feel very strongly about the need for this legislation to reaffirm and strengthen health care in America for our most vulnerable children. There are more than 100,000 of these youngsters in my home State alone. I am talking about the Children's Health Care Insurance Program, what is known as CHIP. My hope is we will have a chance here to vote to expand on what the other body has done and have a children's health program that will be extended for 4 years and not just 2.

The CHIP program has the support of almost 40 Governors. They span the philosophical spectrum. They have achieved such strong support because these Governors who are right on the front lines with a program that involves very close coordination by the Federal Government and the State governments want some certainty and predictability.

They don't want vulnerable kids and their families to be in limbo.

So I am very hopeful that amendment will be offered and that it will get the support of our colleagues.

Third, I hope there will be an amendment to improve health care for women. I believe we have all followed this debate that I think is needlessly divisive. There are so many Senators who want to find common ground to improve health care.

We have gotten bogged down and somehow virtually all the bills now seem to be a magnet for a debate about abortion. My colleague, Senator Murray, wishes to offer a very important amendment to expand health care services and the availability of reproductive health services for women, community-based care. I am very hopeful that will be offered as well.

Finally, on a bipartisan basis, Senators CARDIN and COLLINS wish to offer legislation to really set aside what are very outdated approaches with respect to how Medicare provides services, therapy services, for our citizens. We are talking about physical therapy, occupational therapy, services with respect to speech.

Senators CARDIN and COLLINS want to get rid of these arbitrary therapy caps. I am very hopeful their amendment will be able to be offered as well.

One last point, on a matter that is not health care related, this legislation carries an additional program that is particularly important to the people whom I represent, and that is the Secure Rural Schools Program would be extended for 2 years.

I wrote this law in 2000 with our former colleague, the Senator from Idaho, Mr. Craig, because in most of our States--States where the Federal Government owns much of the lands, heavily forested--as a result of changes in environmental policy and other changes, a lot of these rural communities didn't have the money they needed for schools, roads, law enforcement, and basic services.

We have extended it since 2000. We have had testimony indicating we are going to need that safety net for some time, even as you try to get the harvest up in a sustainable way.

I am very pleased this program, an economic lifeline to rural communities across Oregon and other States, is going to be extended for 2 years. I think that provides us an opportunity to come up with fresh strategies, both with respect to the safety net.

I would like to--in the future, in the Senate Budget Committee--support it. I believe my colleague, the Presiding Officer, was interested to link Secure Rural Schools with the Land and Water Conservation Program and the PILT Program. We have bipartisan support for that.

I would like to see us use these 2 years to strengthen the safety net and get the harvest up in a sustainable way.

I wanted to make mention of that before I wrap up.

In closing, I think the health legislation--that I hope will be voted on shortly--represents one of those rare moments on a major issue.

I mean, I would go so far as to say--having worked with older people since my days with the Gray Panthers--I think what we are doing with the abolition of this outdated Medicare reimbursement system is laying the foundation for what will be the future of Medicare. The future of Medicare is not going to be what it was about in the 1960s when it began--a senior in New Hampshire might need the hospital for a serious injury, maybe they would see a physician, get Medicare Part B if they broke their ankle. The future of Medicare is going to be about dealing with chronic disease. It is going to be about diabetes, cancer, heart disease, and stroke.

The reality is that Medicare has not kept up with the times. I think it is worth noting that in the big debate about the Affordable Care Act, chronic disease was hardly mentioned at all, not by anybody. That is going to be the foundation of Medicare for the future. More than 90 percent of the Medicare dollars in the future, based on the challenge of dealing with older people with these chronic conditions, is going to be about chronic disease.

The reality is, when you abolish this flawed Medicare reimbursement system and start promoting coordinated care, what would happen in the State of New Hampshire is you would start seeing teams--perhaps a nurse, a physician, a pharmacist--a team in New Hampshire or in Oregon come together, particularly where there aren't the Medicare Advantage plans, and say we can give, as our colleague from Georgia noted not long ago, Senator Isakson, better care at lower cost and do it for what is likely to be the type of health care services that dominates Medicare in the future, which is chronic disease. We will be better able to tackle that with the abolition of SGR.

So my hope is shortly we will vote to take that action that I believe constitutes a Medicare milestone, reaffirms our commitment to America's youngsters, improves health care services for women--from one end of America to another--and gets rid of this outdated system of therapy caps that are restricting what those who need physical therapy, occupational therapy, and others could get.

This could finally be a punctuation mark in this, the 50th year of Medicare, and an opportunity for all Senators to see that they were part of adopting a fresh set of policies to provide a brighter and healthier future for all our people.

I yield the floor.

I suggest the absence of a quorum.

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