Kent Conrad

Mr. CONRAD

Mr. CONRAD. I say to my colleague, as I indicated, we on this side moved to accelerate that relief in 2001. In fact, I offered the amendment.

Mr. CONRAD. I am happy to yield.

Mr. CONRAD. Mr. President, I am constrained to object. We hope to have agreement in the very near future, but apparently somebody needs to be contacted who has not yet been contacted. I say to my colleagues, I apologize. I thought we had agreement, but I am just informed we need to wait another few minutes before we can reach agreement.

Mr. CONRAD. Mr. President, the Senator is correct on that. I have no interest in saying it is something it was not. The Senator is correct on that. But I would say to the Senator, this was our best chance to put in place a budget framework to give the Appropriations Committee an indication of what was available to them to spend and not to spend more than that and to put in place the pay-as-you-go restrictions and to put in place the other budget enforcement mechanisms so that the functioning of the Congress could go forward. I understand the Senator, for whatever reason, decided to oppose that. I just say to him, that was our best chance of putting in place the framework for a budget. It didn't happen. All of us can take responsibility. I will take my share of responsibility. I regret very much that the budget that I took out of the committee didn't come to the floor and we didn't have a chance to conclude action on it. I was pleased that we were able to get bipartisan agreement, at least with respect to that budget framework. I wish it would have passed. I think that would have been a good thing. But it did not. I yield 15 minutes to the Senator from Massachusetts.

Mr. CONRAD. It is the situation. And what is most stunning about it is that it is all done at the worst possible time: at a time we are at war, the cost of which none of us can know; and also on the eve of the retirement of the baby boom generation, a cost we do know because the number of people eligible for Social Security and Medicare are going to double. And I believe this proposal is very clear. If this is adopted, this will head us in the direction of massive cuts in Medicare, in Social Security, and most of the rest of Government as we know it. I think it is absolutely foreordained, if this is adopted, you will see proposals that will be cloaked in the soft language of reform which will hide deep cuts in Social Security, in Medicare, and all other parts of Government. You can really have no other outcome because you have record budget deficits now; and what this proposal is, is to cut taxes by $1.3 trillion, not counting the interest cost, to increase spending by $1.1 trillion over the so-called baseline, including the interest cost. What you are left with, then, is even deeper deficits, right on the brink of the retirement of the baby boom generation which starts in 2008, which we all know what it will lead to. And I will show, as we go through this presentation, where that leads.

Mr. CONRAD

Mr. CONRAD. Mr. President, today, Senator Thomas and I would like to introduce the Health Care Access and Rural Equity, (H-CARE), Act of 2003. This proposal is the result of a tripartisan and Bicameral effort. We are proud to be joined by 24 Members who also support the bill, including--Senators Harkin, Grassley, Roberts, Daschle, Dorgan, Smith, Johnson, Lincoln, Domenici, Rockefeller, Burns, Bingaman, Jeffords, Cochran, Levin, Talent, Edwards, Bond, Pryor, Dayton, Snowe, Cantwell and Murray. I would also like to thank our House companions, led by Representatives Moran (R-KS), and Pomeroy. Working together, I believe we are taking important steps toward improving access to health care in our rural communities. In addition, I would like to thank the National Rural Health Association, the Federation of American Hospitals, the American Hospital Association, Premier Hospital Alliance and the Coalition representing Sole Community Hospitals for their support of this effort. As my colleagues may know, rural health care providers are often forced to operate with significantly less resources that larger, urban facilities. In my State of North Dakota, rural hospitals often receive only half the reimbursement of their urban counterparts--for treating the same patient. For example, a rural facility in North Dakota receives approximately $4,200 for treating pneumona, while a hospital in New York City can receive more than $8,500. This funding disparity is simply unfair and has placed many rural providers on shaky ground. Continued funding shortfalls have resulted in rural providers having much tighter inpatient cost margins than their urban counterparts--today, the average rural hospital operates with a slim 3.9 percent cost margin compared to 11.3 percent for urban providers). This situation has resulted in more than 43 percent of rural hospitals operating in the red. When you look at overall cost margins, the situation is even more bleak--rural providers are working with an average negative 2.9 percent Medicare margin, compared to 6.3 percent for urban hospitals). Our rural facilities cannot continue to provide high quality services if they lose nearly 3 percent on every Medicare patient they serve. To address these problems, the bill we are introducing today would take many important steps to improve the rural health care system. First, it would provide a much-needed low-volume adjustment payment. Today, it is nearly impossible for rural hospitals to take advantage of economies of scale realized by facilities located in larger communities. This situation has resulted in the majority of small facilities losing money. To address this problem, our bill would provide a new, extra payment to hospitals serving less than 2,000 patients per year. This provision would provide up to 25 percent in additional funding to help rural providers cover inpatient hospital services. Second, H-CARE would close the gap in payments hospitals receive for serving low-income patients. It would do this by allowing rural hospitals to receive the same level of special ``Disproportionate Share--or DISH Payments'' currently available to urban providers. Third, our legislation would take steps to permanently equalize the ``base payment amount,'' which has been 1.6 times higher for urban facilities. The recent Omnibus bill temporarily fixed this problem--but only until the end of FY03. Our bill finishes the job. Fourth, this legislation would help hospitals better meet labor costs by making some needed improvements to the Medicare ``wage index'' calculation. Across the Nation, rural hospitals have reported that the wage index does not accurately account for labor costs in their area. Our bill takes steps to address this problem. Fifth, our bill would ensure that rural hospitals continue to be paid fairly for outpatient services. It does this by extending a provision in current law that protects these hospitals against losses under the current Medicare payment system. It also includes measures to protect rural hospitals' access to lab services. I am happy to say that this set of proposals would go a long way toward placing rural facilities on much sounder financial footing. Let me provide some examples. Today, the average small hospital located in the Midwest receives $3,926 as an average payment for inpatient services. If all the changes laid out in our bill are enacted, this will improve payments to smaller rural hospitals by about 25 percent. If you look at a more specific service--such as treating pneumonia-- this same hospital would see payments increase from about $4,326 to $5,405. These increases are clearly big improvements, which will bring reimbursements for rural hospitals more in line with their costs. Before I close, I'd also like to mention that this bill would establish a new grant program to help rural hospitals repair crumbling buildings. Under this program, rural providers could apply for up to $5m in loan assistance. It is my hope these resources will help strengthen the infrastructure of our Nation's rural hospitals. Finally, our bill includes a set of provisions that will make small-- but important--changes to the Critical Access Hospital, CAH, program. These include measures to ensure CAHs have 24-hour emergency on-call providers and to ensure they can afford to provide quality ambulance care. In total, the changes laid out in our bill will bring more than $72 million in new resources to my State of North Dakota over the next ten years. The bill will provide similar benefits to other rural States. Thank you again to my Senate and House colleagues, as well as the organizations who worked with us, for your cooperation in developing this important health care proposal. It is my hope that this legislation will help to strengthen and sustain our Nation's rural health care system.

Mr. CONRAD

Mr. CONRAD. Mr. President, today, Senator Thomas and I would like to introduce the Health Care Access and Rural Equity, (H-CARE), Act of 2003. This proposal is the result of a tripartisan and Bicameral effort. We are proud to be joined by 24 Members who also support the bill, including--Senators Harkin, Grassley, Roberts, Daschle, Dorgan, Smith, Johnson, Lincoln, Domenici, Rockefeller, Burns, Bingaman, Jeffords, Cochran, Levin, Talent, Edwards, Bond, Pryor, Dayton, Snowe, Cantwell and Murray. I would also like to thank our House companions, led by Representatives Moran (R-KS), and Pomeroy. Working together, I believe we are taking important steps toward improving access to health care in our rural communities. In addition, I would like to thank the National Rural Health Association, the Federation of American Hospitals, the American Hospital Association, Premier Hospital Alliance and the Coalition representing Sole Community Hospitals for their support of this effort. As my colleagues may know, rural health care providers are often forced to operate with significantly less resources that larger, urban facilities. In my State of North Dakota, rural hospitals often receive only half the reimbursement of their urban counterparts--for treating the same patient. For example, a rural facility in North Dakota receives approximately $4,200 for treating pneumona, while a hospital in New York City can receive more than $8,500. This funding disparity is simply unfair and has placed many rural providers on shaky ground. Continued funding shortfalls have resulted in rural providers having much tighter inpatient cost margins than their urban counterparts--today, the average rural hospital operates with a slim 3.9 percent cost margin compared to 11.3 percent for urban providers). This situation has resulted in more than 43 percent of rural hospitals operating in the red. When you look at overall cost margins, the situation is even more bleak--rural providers are working with an average negative 2.9 percent Medicare margin, compared to 6.3 percent for urban hospitals). Our rural facilities cannot continue to provide high quality services if they lose nearly 3 percent on every Medicare patient they serve. To address these problems, the bill we are introducing today would take many important steps to improve the rural health care system. First, it would provide a much-needed low-volume adjustment payment. Today, it is nearly impossible for rural hospitals to take advantage of economies of scale realized by facilities located in larger communities. This situation has resulted in the majority of small facilities losing money. To address this problem, our bill would provide a new, extra payment to hospitals serving less than 2,000 patients per year. This provision would provide up to 25 percent in additional funding to help rural providers cover inpatient hospital services. Second, H-CARE would close the gap in payments hospitals receive for serving low-income patients. It would do this by allowing rural hospitals to receive the same level of special ``Disproportionate Share--or DISH Payments'' currently available to urban providers. Third, our legislation would take steps to permanently equalize the ``base payment amount,'' which has been 1.6 times higher for urban facilities. The recent Omnibus bill temporarily fixed this problem--but only until the end of FY03. Our bill finishes the job. Fourth, this legislation would help hospitals better meet labor costs by making some needed improvements to the Medicare ``wage index'' calculation. Across the Nation, rural hospitals have reported that the wage index does not accurately account for labor costs in their area. Our bill takes steps to address this problem. Fifth, our bill would ensure that rural hospitals continue to be paid fairly for outpatient services. It does this by extending a provision in current law that protects these hospitals against losses under the current Medicare payment system. It also includes measures to protect rural hospitals' access to lab services. I am happy to say that this set of proposals would go a long way toward placing rural facilities on much sounder financial footing. Let me provide some examples. Today, the average small hospital located in the Midwest receives $3,926 as an average payment for inpatient services. If all the changes laid out in our bill are enacted, this will improve payments to smaller rural hospitals by about 25 percent. If you look at a more specific service--such as treating pneumonia-- this same hospital would see payments increase from about $4,326 to $5,405. These increases are clearly big improvements, which will bring reimbursements for rural hospitals more in line with their costs. Before I close, I'd also like to mention that this bill would establish a new grant program to help rural hospitals repair crumbling buildings. Under this program, rural providers could apply for up to $5m in loan assistance. It is my hope these resources will help strengthen the infrastructure of our Nation's rural hospitals. Finally, our bill includes a set of provisions that will make small-- but important--changes to the Critical Access Hospital, CAH, program. These include measures to ensure CAHs have 24-hour emergency on-call providers and to ensure they can afford to provide quality ambulance care. In total, the changes laid out in our bill will bring more than $72 million in new resources to my State of North Dakota over the next ten years. The bill will provide similar benefits to other rural States. Thank you again to my Senate and House colleagues, as well as the organizations who worked with us, for your cooperation in developing this important health care proposal. It is my hope that this legislation will help to strengthen and sustain our Nation's rural health care system.

Mr. CONRAD

Mr. CONRAD. Mr. President, it was with great sorrow that I learned last week of the death of our former colleague, Senator Daniel Patrick Moynihan of New York. Senator Moynihan, was an intellectual giant in the Senate and throughout his service to our Nation. The breadth of his interests--and his knowledge--was extraordinary. From questions about the architecture and urban development of Washington, D.C. to the problems created by single parent families to the workings of the International Labor Organization, Senator Moynihan had thought deeply and designed policy answers. I don't think there was a Senator who served with Pat Moynihan who didn't learn something from Senator Moynihan's vast stock of personal experience, understanding of history, and ability to draw parallels between seemingly unrelated topics to enlighten our understanding of both. I will always have fond memories of the several occasions on which I joined Senator Moynihan in the Senators' private dining room and was treated to a lunchtime tutorial. I could ask a question on virtually any topic and get a dissertation in response. Our conversations ranged from art history to baseball, American history, our Middle East policy, the history of science and scientific advancement, and more. Seemingly there was no topic on which Pat did not have unique insight, and I always came away from those lunches feeling like I had just emerged from an intellectually stimulating graduate seminar. I had the particular pleasure of serving with Senator Moynihan on the Finance Committee for eight years. As Chairman and as ranking member of the Finance Committee, Senator Moynihan was a true leader. Starting in 1993, when I took Senator Bentsen's seat on the Committee and Senator Moynihan claimed his chairmanship, Chairman Moynihan successfully guided the 1993 economic plan through the committee and the Senate. That budget, which I was proud to help shape and support, laid the foundation for the record economic expansion of the 1990s. After Republicans took control of the Senate in the 1994 election, Senator Moynihan was a fierce critic of their excessive tax cut proposals. We joined in opposing shortsighted proposals to have Medicare ``wither on the vine,'' turn Medicaid into a block grant, and destroy welfare rather than reforming it. Senator Moynihan was, as always, an especially passionate defender of teaching hospitals, warning that the plan to slash spending for Medicare's graduate medical education would threaten medical research in this country--a fear that has proved well-founded as teaching hospitals have struggled to survive the much smaller changes enacted as part of the compromise Balanced Budget Act that emerged in 1997. The Finance Committee--and the Senate--would not have been the same without him. Who else will be able to gently tutor witnesses on the relevance of the grain trade in upstate New York in the early nineteenth century to a current debate about health care policy? Who else will call for the Boskin and Secrecy Commissions of the future? And who else will educate his colleagues on the impact on our society of the demographic time bomb of the baby boom generation? The Senate has lost a legend. The country has lost a brilliant and unconventional thinker who contributed greatly to our society on fronts ranging across transportation, welfare and poverty, racism and civil rights, and architecture and urban planning. I will miss Pat Moynihan. I will miss his sly wit, his apt and splendidly diverse quotations, his sharp questioning and distrust of glib answers, and his fierce humanity. On behalf of myself and my wife Lucy, I want to express my deepest condolences to his wife Liz, their children and the rest of his family and friends. My heart goes out to them.

Mr. CONRAD

Mr. CONRAD. I now ask there be a period of morning business, with Senators permitted to speak for up to 10 minutes each.

Mr. CONRAD

Mr. CONRAD. Mr. President, first, I congratulate the chairman of our committee on successfully passing a budget resolution. As strongly as I disagree with the contents of this resolution, I feel equally as strongly about the way this process was conducted, and the chairman's leadership both in the committee and on the floor in terms of the tone that he set and in terms of the attitude he brought to the job. It makes a big difference, and we appreciate it. I will now take a moment to thank staff: Mary Naylor, my staff director; Jim Horney and Sue Nelson, my deputy staff directors; Lisa Konwinski, my counsel; Shelley Amdur, who handles education and appropriations; along with John Righter, who is our chief numbers man and handles appropriations as well; Steve Bailey, who does taxes; Sarah Kuehl, who handles Social Security and transportation; Jim Esquea, who handles Medicaid, welfare, and veterans; Tim Galvin, who handles agriculture; Mike Jones, homeland security and energy issues; Dakota Rudesill, who handles defense; Rock Cheung, international affairs; Lee Price, our chief economist; Kobye Noel, our chart master--as my colleagues know, we produced a lot of charts--and Stu Nagurka and Steve Posner, in charge of communications for me; and Jessie Lavine, Erin Keogh, and Lawrence Hershon, our staff assistants. We appreciate very much their hard work.

Mr. CONRAD. Mr. President, first let me thank the outstanding staffs on both sides. Hazen Marshall, staff director for Senator Nickles, and his able staff, thank you for the really good attitude that you all brought to this task and challenge. I thank also on our side my staff director, Mary Naylor, who has done such a superb job holding us all together. I think part of the reason this was well organized was because of Mary's talents. And to Jim Horney and Sue Nelson and Lisa Konwinski and all of the other staff members of the Budget Committee, thank you. Special thanks to the chairman of our committee. Thank you for the effort to organize these votes in a way that was comprehensive and that was understandable to people. Thanks, too, for the attitude and the tone you brought to the debate because we have had significant differences. But I think we have conducted ourselves in the way that our forefathers intended the Senate to be conducted--real debate on real differences without personal rancor of any kind. While this budget resolution has been substantially improved, we have now reduced the President's proposed tax cut of $1.6 trillion to $850 billion. Still I believe it is fatally flawed. I don't believe we can afford $850 billion of tax cuts that will add in this budget resolution over a trillion dollars of deficit to our country when we are already in record deficit and when we are right on the brink of the retirement of the baby boom generation. That does not make sense to me. I believe it threatens the long-term economic security of our country. I don't believe it will grow the economy. That view is buttressed by the report of the Congressional Budget Office today. They applied dynamic scoring and what they said is, the one thing that is going to grow under this budget is the deficits and the debt of our country. I urge my colleagues to vote no.

Mr. CONRAD. We have no objection on this side.

Mr. CONRAD. Mr. President, I am happy to yield to the majority leader for comments about the former chairman of the Senate Budget Committee, who did such a superb job over so many years.

Mr. CONRAD. Madam President, let me just say to my colleagues, the amendment of the Senator from Alaska has nothing to do with the child tax credit--zero. The amendment increases the tax cut by $47.9 billion and increases the instruction to the Finance Committee for outlays of $18.8 billion. It has nothing whatever to do with the child tax credit because the budget resolution does not make those decisions, as the chairman has indicated over and over. There will be a subsequent amendment by the Senator from Arkansas that will make clear there is plenty of room in the underlying tax cut to accommodate the child tax credit the Senator from Alaska is advocating. I urge my colleagues to vote no on this increase to the tax cut.

Mr. CONRAD. Will the Senator withhold for a moment. I think it would be wise for us to get in place an agreement on the amendment that would either be in the second degree or be side by side at this moment so that that is prepared at the end of the presentation of the Senator from Alaska. Otherwise, the second-degree amendment would be offered. I think it would be better if we did not do it that way.

Mr. CONRAD. Madam President, I ask for the yeas and nays.

Mr. CONRAD. Madam President, I suggest the absence of a quorum.

Mr. CONRAD. Madam President, I object.

Mr. CONRAD. So there are no new discretionary funds available through this amendment. With that understanding, there is no objection on this side to the Senator's amendment. He is quite correct that impact aid is underfunded, and it is important to virtually all our States and all our communities.

Mr. CONRAD. I thank the Senator. My further understanding is this is funded by an across-the-board cut in all other functions.

Mr. CONRAD. I heard the Senator say $112 billion.

Mr. CONRAD. Madam President, maybe my ears deceived me. I heard the Senator say $112 billion. My reading on the amendment is $112 million.

Mr. CONRAD. Mr. President, I suggest the absence of a quorum.

Mr. CONRAD

Mr. CONRAD. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. CONRAD. Madam President, I yield to the Senator from Massachusetts, Senator Kerry, to address amendment No. 281.