Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, I send an amendment to the desk.

Ms. COLLINS. I ask for the yeas and nays.

Ms. COLLINS. With that, let me yield my 1 minute. But let me make one point. My amendment is endorsed by the National Association for Home Care and the Visiting Nurses Association of America. Those are the two organizations representing home health care providers. I yield the remainder of my time to the Senator from Missouri.

Ms. COLLINS. Mr. President, first let me make clear that the amendment I am offering does not change the amendment offered by the distinguished Senator from Louisiana. What it would do instead is add to the tax cut $70 billion in order to cover the following: A tax credit for small businesses to help them purchase health insurance. This is based on legislation that the Senator from Louisiana--the other Senator from Louisiana, Ms. Landrieu--and I recently introduced to address the problem of small businesses having a difficult time in affording health insurance for their employees. It would provide for full deductibility of health insurance for the self-employed, an issue that I know is something the Senator from Illinois, Mr. Durbin, and the Senator from Missouri, Mr. Bond, have worked on. And it would provide for long-term care insurance above the line deduction to help people and encourage them to purchase long-term care insurance. The combined total of those provisions would be approximately $70 billion over the next 10 years. That would bring the total tax cut to approximately $1.3 trillion. I reserve the remainder of my time.

Ms. COLLINS. I ask unanimous consent the reading of the amendment be dispensed with.

Ms. COLLINS. Mr. President, I have offered an amendment that we will soon vote on that is intended to eliminate a further cut in Medicare reimbursements for home health agencies. The statistics tell the story. The combinations of cutbacks in Medicare payments and the onerous regulations imposed by the Clinton administration have cost some 900,000 Medicare patients--often our most frail and vulnerable senior citizens, as well as those citizens with considerable disabilities--to lose access to their home health care. In Maine, more than 11,000 seniors and disabled citizens have lost their home health care services. Nationwide, 3,300 home health agencies have closed their doors or have stopped serving Medicare patients. And looming on the horizon is yet another 15-percent cutback in Medicare payments to home health agencies. It is scheduled to go into effect on October 1 of next year. If it does go into effect, it will have a devastating impact that will further jeopardize access to home health services for our senior citizens. The cutbacks have already caused tragedies. I discussed last night an elderly woman with advanced Alzheimer's disease in the State of Maine who had a number of other problems, who lost access to her home health care services, and as a result died from an untreated infection in her foot. Surely, one of the dedicated home health nurses would have been able to treat that infection before it got out of control. That is just typical of the problems being created by the cutbacks in home health care. My amendment establishes a $13.7 billion reserve fund that can be used only to restore Medicare payments to home health agencies. And it protects every dime of the Medicare HI trust fund. By contrast, my colleague from Michigan has also offered an amendment that would take the money set aside for tax relief and place it in the Medicare budget account. Once there, the funds could be used for any purpose under the Medicare program. Under the amendment of my colleague, there is absolutely no guarantee whatsoever that the funds would be used for home health care. Indeed, there is no mention at all of home health care in the text of the amendment of my friend from Michigan. In contrast, my amendment would bring us significantly closer to restoring Medicare home health payments. It sets aside $13.7 billion for home health--and home health alone. It also provides a mechanism to move subsequent legislation to eliminate the scheduled 15-percent reduction without being subject to a budget point of order. I want to make a point clear. Under either approach, subsequent legislation will be needed to repeal the 15-percent reduction. That is precisely the situation that the reserve fund is designed to address. We have used this approach before. We set aside funds in a reserve account just last year for the cervical and breast cancer program, and subsequently passed authorizing legislation that, because of the reserve account, was passed last year. Mr. President, I see that my colleague from Missouri, who has been a tremendous leader on this issue, is on the floor as well. I want to make sure I leave some time for him. Could the Presiding Officer inform me how much time I have remaining?

Ms. COLLINS

Ms. COLLINS. Mr. President, today the Senate will immediately resume consideration of the budget resolution. There will be 10 minutes of debate on the Stabenow and Collins amendments with back-to-back votes to occur at 9:30. Following the votes, Senator Conrad will be recognized to offer his amendment regarding debt reduction. As a reminder, first-degree amendments to the resolution must be filed by 2 p.m. today. Senators should expect another late session with votes into the night. Votes also will occur throughout the day tomorrow. I thank my colleagues for their attention.

Ms. COLLINS. I thank the Senator for that clarification.

Ms. COLLINS

Ms. COLLINS. I appreciate the Senator yielding. Mr. President, I ask unanimous consent that the only first-degree amendments in order on Friday be those amendments submitted at the desk by 2 p.m. on Thursday, with the exception of an amendment to be offered by the minority leader and an amendment to be offered by the majority leader.

Ms. COLLINS. Mr. President, how much time do I have remaining?

Ms. COLLINS. I yield as much time as the Senator wants.

Ms. COLLINS. I am sorry; I could not hear the Senator.

Ms. COLLINS. Mr. President, I am pleased to join with several of my colleagues, including Senators Bond, Hutchinson, Mikulski, Ensign, Snowe, Cochran, Gordon Smith, and Santorum, in introducing this amendment to eliminate the automatic 15-percent reduction in Medicare payments to home health agencies now scheduled to take effect on October 1 of next year. Our amendment will create a reserve fund of $13.7 billion that can be used solely to eliminate the 15-percent reduction in payments to home health agencies now scheduled to go into effect on October 1, 2002. Our amendment contains a safety mechanism that protects the Medicare HI trust fund for each year covered by the budget resolution. In other words--I want this to be clear--the Medicare trust fund will not be used to pay for the elimination of the scheduled reduction in home health payments. Health care has gone full circle. Patients are spending less time in the hospital, more and more procedures are being done on an outpatient basis, and recovery and care for patients with chronic diseases and conditions have increasingly been taking place in the home. Moreover, the number of older Americans who are chronically ill or disabled in some way continues to grow with each passing year as our population grows older. As a consequence, home health care has become an increasingly important part of our health care system. The kinds of highly skilled and often technically complex services that our Nation's home health nurses provide have enabled millions of our most frail and vulnerable elderly individuals to avoid hospitals and nursing homes and stay just where they want to be--in the comfort, security, and privacy of their own homes. The rapid growth in home health spending, from 1990 to 1997, understandably prompted the Congress and the Clinton administration, as part of the Balanced Budget Act of 1997, to initiate changes that were intended to slow the growth in spending and make this important program more cost effective and efficient. Unfortunately, these measures have produced cuts in home health spending far beyond what Congress ever intended. According to estimates by the Congressional Budget Office, home health spending dropped to $9.2 billion in the year 2000, just about half the amount we were spending in 1997. This is at a time when demand and the need for home health services have only increased. On the horizon and very troubling is an additional 15-percent cut that would put our already struggling home health agencies at risk and would seriously jeopardize access to critical home health services for millions of our Nation's seniors. The Medicare home health benefit has already been cut far more deeply and abruptly than any other benefit in the history of the Medicare program. It is now abundantly clear that the savings goals set for home health in the Balanced Budget Act of 1997 have not only been met but far surpassed. The most recent CBO projections show that the post- Balanced Budget Act reductions in home health services will amount to about $69 billion between fiscal years 1998 and 2002. This is more than four times the $16 billion that the CBO originally estimated for that time period and is a clear indication that the Medicare home health cutbacks have been far too deep. Moreover, the financial problems home health agencies have been experiencing have been exacerbated by a host of ill-conceived regulatory requirements imposed by the Clinton administration. As a consequence of these burdensome and costly regulations, as well as the reductions in reimbursements, approximately 3,300 home health agencies have either closed their doors or stopped serving Medicare patients. Moreover, the Health Care Financing Administration estimates that 900,000 fewer home health patients received services in 1999 than in 1997. That is 900,000 frail, elderly, ill individuals who have lost their access to home health services. This startling statistic points to the central and most critical issue: Cuts of this magnitude simply cannot be sustained without ultimately harming patient care. The impact of these cutbacks has been particularly devastating in my home State of Maine. The number of Medicare home health patients in Maine dropped by 23 percent in just 2 years' time. That translates into more than 11,000 home health patients no longer receiving services. There was also a 40-percent drop in the number of home health visits in Maine and a 31-percent cut in Medicare payments to home health agencies in the State. Keep in mind, Maine's home health agencies were already very prudent in their use of resources. They were low-cost agencies in the beginning. They simply had no cushion to absorb this cut. Indeed, these cutbacks cut to the bone and are harming care in the State of Maine. Last year I had the opportunity to meet and visit with a number of home health patients and nurses throughout my State. I heard heartbreaking stories about the impact of Medicare cutbacks and how regulatory restrictions have affected both the quality and the availability of home health care services, jeopardizing the health and well-being of numerous senior citizens. For example, a nurse told me of the tragic story of one of her patients, an elderly Maine woman who suffered from advanced Alzheimer's disease, pneumonia, and hypertension, among other illnesses. This patient was bedbound, verbally nonresponsive, and had a series of other troubling health problems, including infections and weight loss. This woman had been receiving home health services for approximately 2 years. During that time, due to the care of the skilled and compassionate home health nurse, her condition had stabilized. Unfortunately, the care provided to this patient had to end when the home health agency received a Federal notice indicating that this poor woman no longer qualified for home health care. Mr. President, less than 3 months later this woman died as a result of a wound from an untreated infection in her foot. One cannot help but speculate that this tragedy might well have been prevented had this woman continued to receive home health care. This is only one of the heart-wrenching stories that I have heard from both patients and dedicated home health nurses throughout the State of Maine. I am, therefore, extremely concerned that there is yet another cut in home health care looming on the horizon, that an additional automatic 15-percent cut is scheduled to go into effect on October 1 of next year. This cut would sound the death knell for many of our already struggling home health agencies, and it would further jeopardize access to critical home health services for millions of our Nation's seniors. Since we have already surpassed the savings target set by the Balanced Budget Act of 1997, further cuts simply are not necessary. Mr. President, the fact that Congress has delayed the automatic 15- percent cutback for 3 straight years demonstrates that the cut is not justified, it is not warranted. To simply keep delaying this cut 1 year at a time, year after year, is to leave a ``sword of Damocles'' hanging over the heads of these home health agencies. It makes it impossible for them to plan how they are going to serve their patients. It causes them to turn down patients who are complicated and costly to serve because they can't count on the reimbursement. This further cut is not needed, and it should be eliminated altogether once and for all. Mr. President, the amendment we are introducing today will enable us to eliminate this cut once and for all. It will provide a needed measure of relief and certainty for cost-effective home health care providers across this country that are experiencing serious financial difficulties that are inhibiting their ability to deliver much needed care, particularly to those chronically ill elderly with complex care needs. I urge all of my colleagues to support my amendment. I reserve the remainder of my time.

Ms. COLLINS. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Ms. COLLINS. Mr. President, I send an amendment to the desk.

Ms. COLLINS. Mr. President, I am pleased to join my distinguished chairman, Senator Warner, in cosponsoring this amendment to increase the budget for defense by $8.5 billion in fiscal year 2002. This amendment would help address current readiness shortfalls that the Department of Defense faces today, even as the new administration continues its strategic review. I am hopeful that this strategic review will not only examine these current readiness challenges, but also take a hard look at the current shipbuilding rate and our shrinking industrial base. The numbers are astonishing: the U.S. Navy has shrunk from a fleet of 594 ships in 1987 to 315 ships today, while, during the same period, deployments have increased more than 300 percent. Regional Commanders-in-Chief have repeatedly warned that the fleet is stretched perilously thin and needs to be increased to 360-ships to meet present mission requirements. Numbers do matter; on a typical day about half the ships in the Navy are at sea, with one-third deployed in the Mediterranean, the Persian Gulf, and the Western Pacific, putting wear and tear on our ships and sailors. In addition to combat over the last 10 years, naval forces have conducted 19 non-combat evacuation operations, 4 maritime intercept operations with more than 5,000 boardings in support of United Nations sanctions or U.S. drug policy, 32 humanitarian assistance operations, and 20 shows of force to send powerful messages to friends and foes alike. Even though our deployments are at an exceptionally high rate, the U.S. shipbuilding industry is at risk of deteriorating if the current inadequate build rate for the Navy continues. At the current low rate of production, the cost for per ship will go up and the efficiency at the yard will go down. The new administration and this Congress will be faced with the challenge of rebuilding and re-capitalizing the Nation's naval fleet. The numbers are just as clear as can be: At the present rate of investment our Navy is heading toward a 220-ship fleet, which is alarmingly inadequate. A few other critical areas that have seemed to get little attention in a budget constrained environment are research and development and training. Steps need to be taken today to attract and retain a highly- skilled workforce necessary to build the complex warships required for our U.S. naval ships to operate against the emerging and traditional threats in the 21st century. Regardless of the result of the strategic review, forward deployed combat power will not only be required, but will continue to be a key element to our strategic posture. I am standing here before you to support Senator Warner's amendment and to highlight that the readiness issues facing our Nation's defense are only the tip of the iceberg in terms of the defense challenges facing the new administration and this Congress. Today's shipbuilding account is woefully under-funded and does not provide the financial support necessary to maintain a viable industrial base. We, as the legislative body, need to take aggressive steps to ensure that our armed forces are equipped with the most capable and advanced ships in the world to defend our Nation's interests.

Ms. COLLINS. Mr. President, let's get this straight. Whether the amendment of the Senator from Michigan passes or whether my amendment passes, the Senate Finance Committee is still going to have to report legislation repealing the 15-percent cut. There is no absolute guarantee under either version. The fact is, under the Collins amendment there is far more likelihood that we will see repeal of the 15-percent cut because I specifically set aside the $13.7 billion in a reserve fund that can only be used to restore the 15-percent cut to eliminate the cut. By contrast, the amendment of my friend and colleague from Michigan just increases funding in the Medicare account, with no guarantee that the money goes for home health care. Instead, she takes money out of the tax cut. The approach I have sets aside the $13.7 billion specifically for the purpose of eliminating the 15-percent cut. There is far more of a ``guarantee'' that we will repeal the 15-percent cut under the Collins amendment than under the amendment offered by the Senator from Michigan. I think it is unfortunate the Senator from Michigan has not joined on to the Collins amendment. I am very pleased to say, and appreciative of the fact, she is a cosponsor of the legislation that I have introduced, which more than 30 Members have cosponsored, to eliminate the 15- percent cut. If we are talking about what version of the amendment is more likely to bring about the goal that we both share, it is clearly the version I have offered which says that the money can only be used for home health care and for eliminating the 15-percent cut. I also find it ironic that the amendment is being criticized now for exempting and providing a mechanism of safeguard for the Medicare HI trust fund. That has been an issue that has been repeatedly raised by Members of the minority party, by Members of the Democratic Party, as a concern about these amendments. In an attempt to respond to that concern, I make sure we shield the Medicare trust fund so it could not be tapped for this purpose and that this would be new money. To now hear criticisms of the amendment because we put in those safeguards strikes me as puzzling, to say the least. Again, my goal is to make sure every elderly American who needs home health care, who wants to receive services in the privacy, security, and comfort of their own homes is able to do so. Home health care has become so important and we must ensure that our frail, vulnerable elderly receive the services they need. I yield the floor but reserve the remainder of my time.

Ms. COLLINS. Mr. President, I have a unanimous consent request. Senator Burns would like to be added as a cosponsor of the amendment. I ask unanimous consent that he be so added.

Ms. COLLINS. Mr. President, how much time do I have remaining?

Ms. COLLINS. Mr. President, Senator Domenici has been extremely helpful in drafting this amendment. I am grateful for his help. Senator Roberts has also been a real leader in this area. I must say I am very disappointed to hear the comments of my friend and colleague from Michigan, Senator Stabenow. There is no one who has worked harder than I on home health care during the last few years. It was the legislation I introduced that was incorporated into the Medicare Refinement Act that we passed that restored some of the cuts to home health agencies. I have been honored to work with the trade associations representing our Nation's home health agencies and have been very humbled and privileged to receive their awards as legislator of the year. For my colleague to suggest that I am offering a sham or phony amendment and to somehow question my sincerity in trying to restore home health care is really most unfortunate and most disappointing. This is, as the distinguished chairman of the Budget Committee said, a very real amendment. In fact, a reserve account is the fairest way to address this problem. We are still going to have to pass legislation, whether it is the amendment of the Senator from Michigan that is adopted or whether my version is adopted, to actually carry out the elimination of the 15-percent reduction. But my reserve fund amendment provides a mechanism to bring us closer to that goal by reserving those funds that we need, that $13.7 billion that is necessary. As I said, I am very disappointed and think it is very unfortunate to have my efforts misrepresented. I have worked extremely hard on this issue. I have introduced legislation that has bipartisan support, that has more than 30 cosponsors expressing support for home health care. I have visited elderly people in Maine who are receiving home health care, and I know how absolutely critical it is to them. On my most recent home health visit, I accompanied a very dedicated, professional, and compassionate home health nurse to a town outside of Bangor. This woman was receiving home health care while living with her daughter. She had lung cancer. But home health care allowed her to spend her final months of her life in her daughter's home--not in a nursing home, not in a hospital, but surrounded by her loving family. I do not want anything to jeopardize the ability of such a woman and so many other Maine citizens and citizens across this country to receive the home health care services they need. I visited another couple in my hometown of Caribou. They were both in their mid-eighties. One was in a wheelchair. Each of them had very serious health problems. Home health care allowed this elderly couple to stay together in their own home where they had lived for more than 60 years rather than be separated and having one sent to a nursing home. That is how important home health care is, and there is no one who is more committed than I to making sure we undo the damage that was inadvertently done by the Balanced Budget Act of 1997 and the very burdensome and onerous regulations imposed by the Clinton administration. I urge my colleagues to support the amendment that I and many others have offered so that we can bring ourselves a step closer to making sure we eliminate once and for all this 15-percent ill-advised cut in Medicare home health care reimbursements. I reserve the remainder of my time.

Ms. COLLINS. I believe the Senator from Nevada knew that before I did.

Ms. COLLINS. I would like at this time to reserve my time, but if other Senators wish to speak I have no objection.

Ms. COLLINS. Mr. President, is all the time yielded back on the amendment on the other side?

Ms. COLLINS. Mr. President, I would just like to make certain there are no Members on our side----

Ms. COLLINS. In view of those assurances, even though this is one of my favorite topics and I would like to continue to talk about it, as a courtesy to my colleagues, I will yield the remainder of my time.