Susan Collins

Ms. COLLINS

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. As the Senator's rhetorical question implies, these are not necessary. The fact is that it now appears the savings goals set for home health have not only been met but far exceeded. According to CBO, spending for home health care fell by 35 percent in 1999, and CBO cites the larger-than-anticipated drop in the use of home health services as the primary reason that total Medicare spending actually dropped, overall Medicare spending, by 1 percent last year. The CBO now projects that the post Balanced Budget Act reductions in home health care will be approximately $69 billion. That is over four times the $16 billion Congress expected to save. It is a clear indication that the cutbacks have been far deeper and far more wide reaching than Congress ever intended.

Ms. COLLINS. The Senator has spent a lot of time understanding OASIS. One of the complaints I have heard is that OASIS even requires, in some cases, the collection of data for non-Medicare patients; is that correct?

Ms. COLLINS. Will the Senator yield on that point?

Ms. COLLINS. That has been the experience of the nurses in Maine, that the patients believe this is unnecessarily intrusive. We are not talking about patients, in these cases, who are receiving home health because of emotional problems. Obviously, those questions might be appropriate in some cases, but they are clearly not in these cases. What the nurses explained to me is that the patients say: What does this have to do with what you are treating me for? The nurses expressed concern that this ``exercise of Olympian endurance'' inevitably elicits a negative response from their patients. That is a problem because that patient-nurse relationship is very important. It is a relationship that respects the confidentiality and the privacy of patients, or it should. Unfortunately, the OASIS information mandated by HCFA immediately erects a barrier that is often difficult to overcome. There is one example I want to share with my colleague from Kansas, one 76-year-old Medicare patient about whom I was told was being treated for a wound to his left shoulder. The wound care and teaching provided by the home health nurse took approximately 30 minutes. Completing the OASIS form took an hour and a half. The patient understandably asked: What does all this have to do with my shoulder? A very common response.

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. Mr. President, Senate Republicans are committed to enacting legislation to preserve, strengthen, and save Medicare for current and future generations. It is also critical that Congress take action this year to address some of the unintended consequences of the Balanced Budget Act of 1997 which has been exacerbated by a host of ill-conceived regulatory requirements imposed by the Clinton administration. The combination of regulatory overkill and budget cuts is jeopardizing access to critical home health care services for millions of our Nation's seniors. If one thinks about it, health care has really come 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 increasingly takes place at home. Moreover, the number of older Americans who are chronically ill or disabled in some way continues to grow each year. As a consequence, home health care has been an increasingly important part of our health care system, and I know the Senator from Kansas has been a very strong supporter of ensuring that these vital services are provided for our senior citizens. The kind of highly skilled and often technically complex services our Nation's home health care agencies provide have enabled millions of our most frail and vulnerable older citizens to avoid hospitals and nursing homes and receive care right where they want to be--in the comfort and security of their own homes. In 1996, however, home health care was the fastest growing component of Medicare spending. This understandably prompted consideration of some changes as part of the Balanced Budget Act that were intended to slow the growth in spending to make the program more cost-effective and efficient.

Ms. COLLINS. I will be happy to yield.

Ms. COLLINS. The Senator, as always, is entirely correct. I know how concerned he has been that inadequate reimbursements under Medicare, plus regulatory overkill by HCFA, are really jeopardizing the provision of care in our rural hospitals and our home health care agencies. In fact, we know the Balanced Budget Act is already producing--or expected to produce--four times the savings that we intended when the 1997 Balanced Budget Act was passed. Moreover--and I know the Senator from Kansas shares my deep concern about this--looming on the horizon, believe it or not, is an additional 15-percent cutback in home health care reimbursements. That will put our already struggling home health agencies at risk. I know the Senator from Kansas shares my belief that it would, if allowed to go into effect, seriously jeopardize access to care for millions of our Nation's seniors. The effects of these home health care cuts have been particularly devastating to the State of Maine. In Maine, I would inform my colleague from Kansas, nearly 7,500 Maine seniors have lost access to home health care due to the cutbacks and the regulatory overkill by HCFA. Those 7,500 seniors did not get well. That is not why they lost their access to home health care. In fact, what has happened is some of them have been forced prematurely into nursing homes or they are at risk of increased hospitalization, which ironically costs the Medicare trust fund more money than if they were still receiving home health care. Some of them--and this is most tragic of all--are going without care altogether. Cuts of this magnitude, particularly for the home health agencies in your section of the country and mine, which were historically low cost to begin with, cannot be sustained without ultimately adversely affecting patient care.

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. The Senator has, as always, summarized the situation exactly right. The real losers are the sickest seniors because what is happening is, because they are more expensive to treat, our home health agencies are turning away some of the more expensive patients because they simply cannot afford to provide them care. I met recently with a group of very dedicated and highly skilled, compassionate home health nurses from the Visiting Nurse Service in Saco, ME. That is southern Maine's largest independent, not-for-profit home health agency. It performs more than 250,000 home visits per year. During my discussions with these nurses, I heard absolutely hard- breaking stories of how recent cutbacks and regulatory restrictions have affected both the quality and the availability of home health services. Let me tell my colleague of just one example the nurses related to me. Consider this case. It involves an elderly Maine woman who suffered from advanced Alzheimer's disease, pneumonia, and hypertension, among many other illnesses. She was bedbound, verbally nonresponsive, and had a series of serious health issues, including serious infections. This woman had been receiving home health care for approximately 2 years, and that had allowed her condition to stabilize through the care and coordination of a skilled nurse. Unfortunately, the care provided to this patient abruptly came to an end when HCFA'S intermediary sent out a notice denying further home health care for this woman. That is an example of the kinds of regulatory problems that the Senator was talking about. Let's look at what happened in this case. The fact is, it produced a tragedy. Less than 3 months later, this woman died. She died as a result of a wound on her foot that went untreated. Undoubtedly, the home health nurse would have caught that problem before it got out of control. That is just one of the heart-wrenching stories that I have heard not only during that visit but in discussions with patients and health care providers throughout my State.

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. The Senator is entirely correct. I could not agree with his point more. What I heard from the home health nurses is not only do all these excessive regulatory requirements and paperwork cost a lot of money to the agency, but they detract from the time that otherwise would be spent caring for patients. Instead of focusing on patients, they have to complete paperwork. Indeed, at that visit in Saco, ME, that I mentioned, the nurses--to illustrate the OASIS paperwork which the distinguished Senator from Kansas has just talked about--put it up all over the room. It covered the walls of the entire room. That was just one OASIS questionnaire. Last year, I chaired a subcommittee hearing of the Permanent Subcommittee on Investigations. We heard about the problems that excessive regulation was imposing. We heard about the cash-flow problems that agencies across the country are experiencing. One nurse from Maine, who runs a home health agency, terms HCFA's approach as being one of ``implement and suspend.'' In other words, HCFA requires these agencies to go through all these regulatory hoops to fill out all this paperwork and then says: Never mind. This really isn't what we meant. Meanwhile, tremendous cost and energy has gone into complying with these burdensome regulations.

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. I inform the Senator from Kansas that the testimony at my hearing indicated that it generally takes a nurse as long as 2 hours to complete these forms with one patient. The patients do not welcome this intrusive questionnaire in any way.

Ms. COLLINS. I am happy to yield.

Ms. COLLINS. Mr. President, this is one of the problems. The Senator from Kansas has put his finger right on it. OASIS collects information not only about the patient's medical condition or history, but about living arrangements, medications, sensory status--I am not even sure what that means--and emotional status as well. That raises a host of problems.

Ms. COLLINS. I thank the Senator from Kansas for his kind comments and his strong support and leadership. He clearly understands the issues involved. Time is of the essence. I appreciate the opportunity to discuss this issue this morning. I yield the floor.

Ms. COLLINS

Ms. COLLINS. I thank the Chair, and I thank the Senator from Texas for arranging the time this morning.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the Senator from Wisconsin and I be allowed to proceed as if in morning business for a period of not to exceed 25 minutes.

Ms. COLLINS. Thank you, Mr. President. (The remarks of Ms. Collins and Mr. Feingold are located in today's Record under ``Morning Business.'')

Ms. COLLINS

Ms. COLLINS. Mr. President, health care has come 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 has 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 each year. Concerns about how to care for these individuals will only multiply as our population ages and is at greater risk of chronic disease and disability. As a consequence, home health 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 agencies provide have enabled millions of our most frail and vulnerable older persons to avoid hospitals and nursing homes and stay just where they want to be--in the comfort and security of their own homes. By the late 1990s, home health was the fastest growing component of Medicare spending. The program grew at an average annual rate of more than 25 percent from 1990 to 1997. The number of home health beneficiaries more than doubled, and Medicare home health spending soared from $2.5 billion in 1989 to $17.8 billion in 1997. This rapid growth in home health spending understandably prompted the Congress and the Administration, as part of the Balanced Budget Act of 1997, to initiate changes that were intended to slow this growth in spending and make the program more cost-effective and efficient. These measures, however, have unfortunately produced cuts in home health spending far beyond what Congress intended. Home health spending dropped to $9.7 billion in FY 1999--just about half the 1997 amount. And on the horizon 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. Last year, I chaired a hearing of the Permanent Subcommittee on Investigations where we heard about the financial distress and cash- flow problems that home health agencies across the country are experiencing. Indeed, over 2,500 agencies, about one-quarter of all home health agencies nationwide, have either closed or stopped serving Medicare patients. Others have laid off staff or declined to accept new patients with more serious health problems. Moreover, the financial problems of home health agencies have been exacerbated by a number of burdensome new regulatory requirements imposed by the Health Care Financing Administration. One witness, who is a CEO of a visiting nurse service in Saco, ME, termed HCFA's regulatory policy as that of being ``implement and suspend.'' No longer had the agency spent all this money and time and effort in complying with a new regulatory requirement, then the Federal Government decided: never mind; we really didn't mean it; we weren't ready to implement this. We also heard numerous complaints about OASIS, a system of data collection containing data on the physical, mental, and functional status of patients receiving care from home health agencies. Not only has this been a very expensive and burdensome paperwork process, but the process of collecting information invades the personal privacy of many patients, which they understandably are concerned about. I recently met with home health nurses in southern Maine and I heard complaints about the administrative burdens and paperwork requirements associated with OASIS and its effect on patient care. I also heard what the real impact of the budget cutbacks has meant for many of the people in the State of Maine. I call attention to a chart that shows the impact that we are already experiencing in the State of Maine. As shown in the chart, nearly 7,500 Maine citizens have lost access to home health services altogether. What has happened to those 7,500 senior citizens? Believe me, I know from my discussions with dedicated nurses who were providing home health services to them, it is not that they have recovered; it is not that they have gotten well. Rather, the loss of home health services has forced many of them into nursing homes prematurely or has put them at risk of increased hospitalization. Ironically, the Medicare trust fund pays far more for nursing home care or for hospitalization than it would continuing to provide home health care services to these individuals. The chart shows the financial burden in Maine in a year's time has suffered a 26-percent decrease in reimbursements for a 30-percent cut in visits. Again, it is our most vulnerable, frail, ill, elderly citizens who are bearing the brunt of these cutbacks. I heard very sad stories about the impact. Consider the case of one elderly woman who suffered from advanced Alzheimer's disease, pneumonia, and hypertension, among other illnesses. She was bed bound, verbally nonresponsive, and had a number of other serious health issues, including infections and weight loss. This woman had been receiving home health services for 2 years. That allowed her to continue to stabilize through the care and the coordination of a compassionate and skilled home health nurse. Unfortunately, the agency received a denial notice, terminating home health care for this woman. A true tragedy happened in this case. Less than 3 months later, after her home health care had been terminated, this woman died as a result of a wound on her foot that went untreated, a serious wound that undoubtedly her home health nurse would have recognized. This is only one of the heart-wrenching stories that I heard during that visit. It is only one of the countless testimonials that I have heard from both patients and home health providers across the State. It is now clear that the savings goals set forth for home health in the Balanced Budget Act of 1997 have not only been met but far surpassed. According to a recent study by the Congressional Budget Office, spending for home health care has fallen by more than 35 percent in the last year. In fact, CBO cites this larger than anticipated reduction in home health care spending as the reason why overall Medicare spending fell last year for the first time. The CBO now projects that the post-Balanced Budget Act reductions in home health will be about $69 billion between fiscal years 1998 and 2002. This is over four times the $16 billion that Congress expected to save as a result of the 1997 act. It is a clear indication, particularly when combined with the regulatory overkill of this administration, that the Medicare home health cutbacks have been far deeper and far wider reaching than Congress ever intended. I have introduced legislation which is cosponsored by the Senator from Wisconsin who, as I said, has been a leader in this area, with my colleague from Missouri, Senator Bond. In fact, both Senator Bond and Senator Ashcroft, as well as many of my other colleagues, are cosponsors of legislation that eliminates the further 15-percent reduction in Medicare payments to home health agencies that is currently scheduled to go into effect on October 1 of next year. If we do not act to eliminate this 15-percent cut that is looming on the horizon, it will sound the death knell for thousands of home health agencies. And ultimately the people, the true victims, will be those senior citizens who will no longer receive the care they need. I know the Presiding Officer has also been very concerned about the impact in his State; all Members who have rural States know the importance of home health care. As Congress prepares for action on Medicare, we should give top priority to providing much needed relief to our Nation's beleaguered home health agencies. The legislation I have introduced currently has 55 Senate cosponsors--32 Republicans and 23 Democrats. It has the strong backing of patient and consumer groups, ranging from the American Diabetes Association, the National Council on Aging, Easter Seals, the American Nurses Association, and the National Family Caregivers Association, as well as the two major industry groups representing home health care agencies with whom we have worked very closely. It is imperative we solve this problem before we adjourn this year. I appreciate the opportunity to address this issue. The remainder of the time will be reserved for the Senator from Wisconsin, with whom it has been a real pleasure to work on this issue.

Ms. COLLINS. Mr. President, it is absolutely critical that Congress take action this year to address some of the unintended consequences of the Balanced Budget Act of 1997, which has been exacerbated by a host of ill-conceived new regulatory requirements imposed by the Clinton administration. The combination of regulatory overkill and budget cutbacks is jeopardizing access to critical home health services for millions of our Nation's most frail and vulnerable senior citizens. Tonight, the Senator from Wisconsin and I are taking the opportunity to talk about this very important issue. The Senator from Wisconsin has been a real leader in helping to restore the cuts and to fight the onerous regulatory requirements imposed by the administration which have affected home health care services across the Nation. I also want to recognize that there have been many other Senators who have been involved in this fight. I am going to put a list of the cosponsors to the legislation that I have introduced into the Record. I ask unanimous consent a list of cosponsors, which exceeds 50 Senators, be printed in the Record, reflecting the contributions many of our colleagues have made to this fight.

Ms. COLLINS

Ms. COLLINS. Mr. President, international treaties and trade agreements are among the most complex issues to come before this body. Their complexity is increased by an order of magnitude when the country in question has a value system and history that are so unlike our own. Despite the fact that China is a country old enough that its history is counted by centuries rather than by decades, I believe that there is still much that we do not understand about that nation--and that lack of understanding appears to run both ways. For instance, I simply cannot understand the attitude of the Chinese leaders on issues that we consider to be basic human rights--like religious freedom. Nor can I understand their previous reluctance to comply with the terms of international trade agreements. As a result, I have found the decision on whether to vote to establish permanent normal trade relations with China to be one of the more difficult decisions I have made as a Senator. Ultimately, after much deliberation, I have decided that the opportunities afforded our nation by expanding the global marketplace and by supporting China's membership in the World Trade Organization make PNTR in the best interests of our nation. For the first time, this agreement will help ensure that China reduces trade barriers, opens its markets to American goods and services, and follows the rules of international trade. Nevertheless, this is a close call. I remain deeply concerned about China's record on human rights and its involvement in creating instability in the world through the proliferation of weapons technology. Consequently, I supported numerous amendments such as Senator Wellstone's amendment on religious freedom and Senator Helms' amendment relating to human rights. I was also proud to be a cosponsor and debate on behalf of Senator Thompson's nonproliferation amendment. Regrettably, the Senate did not adopt these amendments, but I hope that the lengthy and impassioned debate sent a message to China that we have not forgotten its record on human rights and nuclear proliferation. I have also been concerned about the impact that granting PNTR would have on American jobs, particularly those in my home state of Maine. I have considered very carefully the concerns of those who have suggested that granting PNTR for China would have an adverse effect on some of our domestic manufacturers. In fact, I wrote to U.S. Trade Representative Charlene Barshefsky to express these concerns and to inquire about the import surge protections included in the U.S.-China bilateral agreement. Ambassador Barshefsky's reply, which I will enter into the Record, discusses the measures in the bilateral agreement that will provide vulnerable U.S. industries with protection from surges in Chinese imports. Were it not for these protections, which are stronger than those in place with other WTO members, I would likely have opposed passage of this legislation. The agreement contains a textile-specific safeguard that provides protection from disruptive imports for our domestic producers three years beyond the expiration of all textile quotas in 2005 under the WTO Agreement on Textile and Clothing. I would also point out that, were we not to pass PNTR for China, our existing import quotas on Chinese textiles will expire at the end of the year with no hope of renewal through future negotiations with China. Those on both sides of this issue have published reports that attempt to project the impact on jobs of granting China PNTR. Given the vast and completely conflicting findings, it was particularly difficult to judge the validity of these reports. An Economic Policy Institute analysis suggests that Maine would lose 20,687 jobs by 2010 were Congress to approve PNTR for China. Closer inspection of the EPI projections for Maine, however, reveal fatal flaws in the analysis, as the University of Southern Maine's respected economist Charles Colgan has pointed out. For example, the EPI numbers for Maine, when broken down by industry, project that Maine will lose 18,091 jobs in the shoe industry over the next ten years. Yet, according to Maine Department of Labor figures, Maine has only 5,800 jobs in the entire industry. This one discrepancy alone reduces by more than 12,000 the projected number of Maine jobs affected, an inaccuracy that calls into question the validity of the entire EPI analysis. Conversely, the administration and industry groups have suggested that substantial export and job growth opportunities will accompany passage of PNTR. While these projections may be overly generous, I believe that PNTR represents, on balance, a net gain for my State. According to the International Trade Administration, Maine's exports to China increased by 58 percent from 1993 to 1998. Moreover, small and medium-sized businesses account for 63 percent of all firms exporting from Maine to China. Maine Governor Angus King put it well when he said, ``The potential for increasing Maine's already dynamic export growth--and creating more and better jobs here at home--will only increase if we can gain greater access to the Chinese market.'' Maine's best known export may be our world-renowned lobster, but the lobster industry is but one of many natural resource-based industries that will benefit from China's agreement to lower tariffs and reduce non-tariff barriers to its market. The paper industry, which employs thousands of people in my State, supports PNTR because the agreement would result in a reduction in the current average Chinese tariffs on paper and paper products from 14.2 percent to 5.5 percent. The concessions made by China regarding trading rights and distribution also will provide new market access to products manufactured in the paper mills of Maine. The potato industry, a mainstay of the northern Maine economy, is another example of a natural resource- based industry that stands to gain from improved access to China's market. More and more, the potato farmers of Maine are delivering their products not only to grocery stores, but also to processing plants that produce items such as french fries and potato chips. Tariffs on these products are now a prohibitive 25 percent, but will be reduced under the agreement by about 10 percent. The Maine Potato Board has endorsed PNTR and expects to see a significant expansion in the global french fry market as a result of these tariff reductions. The opening of China's markets also will benefit many of Maine's manufacturers. Companies such as National Semiconductor and Fairchild Semiconductor will benefit from the elimination of tariffs on information technology products and agreements to remove non-tariff barriers to the Chinese market. Pratt and Whitney, which manufactures jet engines in North Berwick, ME, is already a major exporter to China and considers PNTR a critical component for the future growth of its business. Moreover, enactment of PNTR will ensure that Pratt and Whitney can compete on equal footing with its European competitors to supply engines and parts for the 1000 commercial aircraft China will purchase by 2017. My support for PNTR reflects my belief that Maine workers will excel in an increasingly global economy. In Bangor, for instance, the community is developing the Maine Business Enterprise Park. The park is projected to create 2,500 new jobs in technology-intensive industries by providing new and expanding companies with the space and trained workforce needed for success and growth. Undoubtedly, the Chinese market will be a destination for some of the technology products and will help support Maine's transition into the new economy. Extending PNTR to China advances the cause of free trade, opens China and its market to international scrutiny, and binds it economically to the rules governing international trade. Ultimately, I believe we need to take advantage of the economic opportunities that PNTR represents for our Nation. Therefore, I will vote to grant PNTR to China. At this point, Mr. President, I ask unanimous consent that a letter from Ambassador Barshefsky expounding upon the protections contained in the bilateral agreement be printed in the Record. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to be a cosponsor of the Resolution Commemorating the 25th Anniversary of the Individuals with Disabilities Education Act. This law has had a very positive impact on the lives of millions of disabled Americans. In fact, since its enactment, the number of children with disabilities who complete high school has grown significantly, and the number who enroll in college has more than tripled. Academic achievement is increasing, along with the nation's expectations about the abilities of children with disabilities. Our commitment to a quality education for everybody now extends to America's six million students with disabilities. We know that special education is not a ``place'' or a ``label,'' but a set of services that allow children to succeed in school, go on to lead productive lives, and enter the world of work. This is something that matters to me because it means so much to the people in Maine who have been able to lead productive lives because the Individuals with Disabilities Education Act afforded them the quality education they deserved. This is why we need to increase consistently the Federal financial support for the Individuals with Disabilities Education Act--so that the Federal Government does, in fact, pay each school in America 40 percent of the national average per pupil expenditure for every special education student enrolled. Washington made that promise to our local communities when it passed IDEA. For example, this year in Maine, local schools will receive only $702 per special education student under IDEA--$1698 per student less than the $2400 it would receive if the Federal Government paid its share. In total, Maine will receive $60 million less than it was promised. According to the U.S. Department of Education, the unmet amount stands at an astounding $11 billion nationally. We cannot continue to shift this burden to our local communities. We must meet the Federal commitment to help pay for special education costs. Let us take the 25th anniversary of the Individuals with Disabilities Education Act to recognize the positive impact this law has on every community in the United States, but let us not forget our Federal commitment of 40 percent to help our schools and communities implement the Individuals with Disabilities Education Act.