Susan Collins

Ms. COLLINS

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. I completely agree with my colleague. These are the questions, when asked of the senior citizens whom I talked to, they find very intrusive. The nurses who are treating them are offended that they have to pry into matters that have no connection to the reason for the home health visit. Moreover, as I pointed out earlier to my friend and colleague, this is time that is being spent on unnecessary paperwork, on intrusive questions that alienate and destroy the relationship between the nurse and the patients that could better be used for actually caring for the patient. Agencies are not reimbursed for this time. Moreover, in a State such as Maine, which is very rural, our home health providers have to spend a lot of time traveling from patient to patient. This is time that is lost from the system. Another issue, which the Senator has also raised, which is inexplicable to me, is why is HCFA collecting this data for non- Medicare patients? I don't understand that. Am I correct? The Senator from Kansas is much more knowledgeable about the OASIS system than I am. Am I correct that it actually applies to non-Medicare patients as well?

Ms. COLLINS. That is correct.

Ms. COLLINS. Mr. President, Senate Republicans are committed to enacting legislation to preserve, strengthen, and save Medicare for current and future generations. In addition to addressing the long-term issues facing Medicare, it is absolutely critical that this Congress also take action this year to remedy some of the unintended consequences of the Balanced Budget Act of 1997, which have been exacerbated by a host of ill-conceived new regulatory requirements imposed by the Clinton administration. These problems are the subject of the issue my colleague from Kansas and I wish to address today, for these problems are jeopardizing access to critical home health services for millions of our Nation's most vulnerable and frail senior citizens. America's home health agencies provide invaluable services that have enabled a growing number of our vulnerable senior citizens to avoid hospitals, to avoid nursing homes, and receive the care they need and want in the security and privacy of their own homes--right where they want to be. In 1996, however, home health was the fastest growing component of the Medicare budget, which understandably prompted Congress and the Clinton administration to initiate changes that were intended to make the program more cost effective and efficient. There was strong bipartisan support for the provisions that called for the implementation of a prospective payment system for home care. Unfortunately, until this system is implemented, home health care agencies are being paid under a critically flawed interim payment system known as IPS, that penalizes those home health agencies that historically have been the most cost effective.

Ms. COLLINS. I am happy to yield to my colleague.

Ms. COLLINS. Unfortunately, that is exactly right. Unbelievable though it may seem, the formula that is being used actually penalizes those agencies in our two States that have done a good job of holding down costs. It rewards those home health agencies that have provided the most visits, that have spent the most Medicare dollars. It is totally backwards. In fact, home health agencies in our two regions of the country, the Northeast and the Midwest, are among those that have been particularly hard hit by this inexplicable formula, the IPS, that the Senator just mentioned. The Wall Street Journal observed last year--this could be said of agencies in the Midwest as well--that if New England had just been a little greedier, its home health agencies would be a whole lot better off now. Ironically, the regions, yours and mine, are getting clobbered by the system because they have had a tradition of nonprofit community service and efficiency. Even more troubling--and I commend the Senator from Kansas for his leadership on this issue; I know this troubles him as well--is the fact the flawed system is restricting access to care for the very senior citizens who need the care the most. Those are our seniors who are the sicker patients, who have complex chronic care needs, such as diabetic wound care patients whom I visited in northern Maine during a home health care visit, or IV therapy patients who require multiple visits. Indeed, according to a recent survey by the Medicare Payment Advisory Commission, almost 40 percent of home health agencies have said there are patients who they no longer serve due to the flawed interim payment system and the regulatory overkill on the part of the Clinton administration. I show the distinguished Senator from Kansas and the distinguished Presiding Officer, who is also committed to this issue, and my other colleagues, a chart that demonstrates the dramatic impact the IPS, this flawed payment system, has had in my own State of Maine. As you can see, the number of Medicare beneficiaries who have been served by home health care agencies has dropped dramatically. It has dropped by 13 percent, from 49,458 to 42,858; 6,600 senior and disabled citizens in my State have lost their access to home health care services in 1 year. This is so troubling to me. The number of visits has plummeted by more than 420,000, and reimbursements to our home health agencies have dropped by an astounding $20 million in a year. Keep in mind that Maine has some of the least costly home health care agencies in the country. They have been very prudent in their use of resources. They were low cost to begin with. So when this formula went into effect, it put such a squeeze on them, they had no choice but to close offices, lay off staff, and stop serving some of the most vulnerable, ill senior citizens in my State. The point is, cuts of this magnitude, that we have seen in the State of Maine and throughout the country, cannot be sustained without hurting senior citizens.

Ms. COLLINS. The Senator is right. This is penny wise and pound foolish--not to mention the human toll that is being taken on our vulnerable senior citizens and our disabled citizens. I know the Senator shares my commitment. This is of highest priority. We must solve this problem before we adjourn.

Ms. COLLINS. I thank the Senator from Kansas. I appreciate his support and his compassion in making sure we are keeping our promise to our senior citizens. With his help and with our continuing partnership, I am convinced we can do the job and solve this problem before we adjourn. I yield the floor.

Ms. COLLINS. I know the Senator from Kansas has been such a leader and cares so much about this issue and has joined with me in introducing legislation, along with our colleague from Missouri, Senator Bond, and 31 of our colleagues. Both sides of the aisle have joined in legislation that we have introduced called the Medicare Home Health Equity Act. This solves the problem. For one thing, it eliminates another 15- percent cut that is scheduled to go into effect in October of next year. I am sure my friend, the Senator from Kansas, agrees with me if that goes into effect, it will sound the death knell for the remaining home health agencies. That means the ones that have been struggling to hang on will be forced to close their doors or refuse even more services to our senior citizens. This is totally unnecessary because we have already achieved the savings, the targets set by the Balanced Budget Act. The legislation includes a number of other provisions that affect a lot of the regulatory issues we have discussed today. I think it is absolutely critical we pass this legislation or similar provisions before we go home. I have visited senior citizens in my State who, if they lose their home health services, are going to be forced into nursing homes or hospitals. The irony is that is going to be at far greater cost.

Ms. COLLINS. The Senator worked closely with me and others last year in providing a small measure of relief in the omnibus appropriations bill. I am pleased that together we were able to take some initial steps to remedy this issue. However, I think it is evident from the overwhelming evidence that the proposal did not go nearly far enough in relieving the financial distress of these home health agencies. The ones that are paying the price are the good agencies, the cost- effective agencies that are serving our seniors. That is the tragedy.

Ms. COLLINS. The Senator has raised an excellent question. There is a very good answer. That is no. In fact, the regulatory overkill of the Clinton administration has already exceeded the savings projected by the balanced budget amendment. Medicare for home health fell nearly 15 percent last year, and CBO now projects the reductions in home health care will exceed $46 billion over the next 5 years. That is almost three times greater than the $16 billion estimate that the Congressional Budget Office originally estimated. It is yet another indication that these cuts are far too deep, and that they are hurting far too many people completely unnecessarily. They have been far too severe and much more far reaching than Congress ever intended when it was trying to bring a measure of fiscal restraint to the Medicare Program.

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. Unfortunately, I say to my friend, the Senator from Kansas, the answer is far longer than any of us in Congress ever anticipated. The problems with the IPS system, which the Senator has described so eloquently for his State, and we have seen in my State, are all the more pressing because the Clinton administration has missed the deadline for implementing the prospective payment system. As a consequence, home health care agencies throughout our Nation are going to be struggling under this unfair and flawed payment system far longer than Congress ever envisioned or intended when it passed the Balanced Budget Act.

Ms. COLLINS. I am glad to yield.

Ms. COLLINS. Yet another sample of what the Senator has described as policies being implemented, then pulled back, agencies not knowing whether they are coming or going, and being subjected to the confusing and conflicting and extensive requirements that are detracting from the ability of these agencies to provide essential care to our seniors. I want to give the Senator from Kansas yet another example of this regulatory overkill by HCFA. I don't know whether the Senator from Kansas is familiar with this, but it is the new 15 -minute incremental reporting requirement. HCFA is requiring nurses to act more like accountants or lawyers billing for every 15 minutes of their time. They are going to have to carry stopwatches to comply with this. Implementation is not only going to be very difficult for the staff to administer, but also, once again, it changes the very relationship between the patient and the nurse. It is very disruptive to a patient's care.

Ms. COLLINS. I am happy to.

Ms. COLLINS. I am glad to.

Ms. COLLINS. Well, the Senator has put his finger on yet another problem. As I understand it--and the Senator is the expert on the OASIS system--OASIS collects information on the patients' medical history. We can understand that part, but also on the patient's living arrangements, sensory status, medications, and emotional state.

Ms. COLLINS. Most agencies are reporting that it takes a nurse between 1 and a half and 2 hours per patient. Now, I point out, that is 2 hours that could be used on direct patient care, on tending to the problems that caused the home health visits to be necessary in the first place. Instead, as the Senator has so ably described, it is being spent on unnecessary paperwork.

Ms. COLLINS. The Senator is exactly correct. Let me give you a specific example. In 1998, HCFA instituted a new policy for sequential billing. Under this policy, home health agencies are required to submit claims in a sequential order to Medicare. Now, this required a substantial investment in computer software, a lot of process changes on behalf of the home health agencies and the fiscal intermediaries. Moreover, the way the system was set up, if there were subsequent claims for a particular patient, they could not be paid until all previous claims relating to this patient were settled. This caused enormous cash flow problems for home health agencies. They experienced delays as long as 120 days before they could get the payment they were due. One witness at my hearing testified that her agency was still owed about $20,000 for fiscal '98, and other agencies reported they had to obtain bridge loans, or tap into their credit lines, solely because of this ill-conceived policy. Now, due to the objections raised by the Senator from Kansas, myself, other Members, and the home health care industry, HCFA finally decided to suspend the policy this past July. But, in the meantime, we have had over a year of turmoil because of this policy, and home health agencies had already spent time, energy, training, and effort to comply with a misguided policy that now is, as you put it, in ``HCFA purgatory.''

Ms. COLLINS

Ms. COLLINS. Thank you, Mr. President.

Ms. COLLINS. First, I thank the Senator for his kind comments and for bringing to the Senate's attention a very important issue. I ask unanimous consent that the Senator from Kansas and I be allowed to proceed in morning business in a colloquy for as much time as we may consume.

Ms. COLLINS

Ms. COLLINS. That is certainly acceptable to the Senator from Maine, assuming the Senator from Oregon does not take more than 10 minutes.

Ms. COLLINS. The Senator from Kansas and I have a colloquy into which we are going to enter. It is my understanding the Senator from Oregon has just a few brief remarks to make. I wonder if he wants to go before the Senator from Kansas and myself, since we anticipate using approximately a half-hour.

Ms. COLLINS

Ms. COLLINS. Mr. President, the question before the Senate is, Are we going to make progress in reforming our campaign finance system or not? That is the simple question before us. In the 105th Congress, the Senate took up comprehensive campaign finance reform measures three times--in September of 1997, in March of 1998, and in September of 1998. Despite my support and the support of a majority of the Senate, these measures could not break the legislative logjam and move forward. So it was obvious it was time for a new approach, a new test that would allow the Senate to consider a more narrow piece of legislation and then work its will on the various components of the original McCain- Feingold bill. Now, I am a supporter of the more comprehensive approach. I am proud to have been an early cosponsor of the McCain-Feingold bill. The Shays- Meehan bill is, too, an excellent piece of legislation. It contains many provisions I wholeheartedly support. But the point is--and the Senator from New Jersey is well aware of it--the comprehensive approach will not garner the votes necessary to move through this Senate. So the question is, Do we want to make progress or don't we? It is difficult to think of a better example of the old adage of ``the perfect being the enemy of the good'' than the debate we are having this morning. So I rise in strong support of the underlying measure before us, the revised McCain-Feingold bill. The underlying bill closes the most glaring loophole in our campaign finance laws by banning the unlimited, unregulated contributions known as soft money. The legislation also takes an important step of codifying the Supreme Court's decision in the Beck case. This will preserve the rights of nonunion members who must pay fees to a union to have their money excluded from the union's political activity fund. In 1974, in the aftermath of Watergate, Congress passed comprehensive campaign finance reform measures that placed dollar limits on political contributions. In its Buckley v. Valeo ruling, the Supreme Court upheld those contributions limits reasoning they were a legitimate means to guard against the reality or appearance of improper political influence. Contribution limits remain on the books, but in reality, they have become a dead letter. The resourceful have found that the easiest way to circumvent the spirit of Federal election law is to provide huge sums to the political parties through soft money donations. For years, soft money contributions to the major political parties were used for party overhead and organizational expenses. But over time, the use of soft money has increased dramatically to include a wider range of activities which influence elections. Mr. President, in 1907, corporations were banned from directly contributing to Federal elections from their treasury funds. In 1947, Congress passed the Taft-Hartley Act, which banned labor unions from contributing treasury funds to candidates. Plain and simple, the soft money corporations and labor unions funnel through the parties clearly circumvents those laws. We in this body decry legal loopholes, but we have reserved a gaping one for ourselves. Indeed, the soft money loophole is more like a black hole, and that sucking sound you hear during election years is the whoosh of six-figure soft money donations gushing into party coffers. The soft money loophole in our Federal election laws has been exploited to the point where the legislative framework put in place in the 1970's has become a mere shell. In 1994, approximately $100 million was raised through soft money by the major parties. Four years later, that amount more than doubled--fully $224 million was raised in soft money. The problem with soft money was painfully evident during the 1997 hearings at the Senate Governmental Affairs Committee, in which the Committee heard from one individual who gave $325,000 to the Democratic National Committee in order to secure a picture with the President of the United States. We also heard from another individual, the infamous and clearly unrepentant Roger Tamraz who testified that next time he is willing to spend $600,000, rather than $300,000, to purchase access to the White House. In a July, 1997 interview with the Los Angeles Times, Johnny Chung, who gave $366,000 derived from illegal foreign sources to the Democratic National Committee and other Democrat organizations, cynically revealed the depth of the current problem; he said, ``I see the White House is like a subway--you have to put in the coins to open up the gates.'' This is what this debate is about. How long can public faith in a political system survive when the public perception exists that wealthy groups are given a stage, podium and a microphone to broadcast their concerns, while the voice of the vast majority remains muted? I hope Members will indulge me if I take a moment to explain the importance of this issue to the people of Maine. Time and time again, I hear it said on the Senate floor and elsewhere that the American people do not care about this issue. I can't speak for the citizens of other States, but I know the people of Maine care deeply about this issue--about reforming our campaign finance system. My home State has a deep commitment to preserving the integrity of the electoral system and ensuring that all Mainers have an equal political voice--and Mainers have backed their commitment to an open political process in both word and deed. In many regions of Maine, political life is dominated by town meetings and public forums in which all citizens are invited to share their concerns, and hash out critical political matters. This is unvarnished direct democracy where all citizens are a part of the process. People with more money do not get to speak longer or louder than people with less money. Perhaps it is our tradition of town meetings that explains why so many Maine citizens feel so strongly about reforming our Federal campaign laws, about reforming the current system. And that strong feeling is one I share. The bill before us today is not a broad sweeping reform such as the one we considered last year and the year before. Rather, it is a modest attempt to achieve some progress by tackling the biggest abuse in the system. This primary purpose of today's bill is to stem the growing reliance on huge soft money contributions. This is not a radical approach; rather, our proposal to eliminate political party soft money, endorsed by former Presidents Gerald Ford, Jimmy Carter and George Bush, is a measured step toward meaningful reform. Mr. President, when I ran for a seat in this body, I advocated major changes to our campaign finance law, but I recognize that goal must wait for another time. But surely we can take this initial critical first step. Although I remain personally committed to more comprehensive changes in the current law, I believe the revised McCain-Feingold bill before us today will serve as a building block on which we can build a much better election financing system. I look forward to the debate in the days ahead. My colleagues have several proposals to improve this bill. But at the conclusion of this debate, my guiding principle in casting my votes on the amendments before us, including the proposal by the Democratic leader, will be answering the question of whether we are moving forward and whether we are successfully ending the abuse of unregulated soft money in our campaign finance system. I urge my colleagues to join me in supporting this modest, commonsense first step to restore integrity and public confidence in our campaign system. Thank you, Mr. President. I yield the floor.