William Roth

Mr. ROTH

Mr. ROTH. I now yield 5 minutes to the distinguished Senator from Wyoming.

Mr. ROTH. Mr. President, I withdraw the point of order and ask that the matter be laid aside.

Mr. ROTH. Mr. President, the pending amendment is not germane to the provisions of the reconciliation measure. I therefore raise a point of order against the amendment under section 305(b)(2) of the Budget Act.

Mr. ROTH. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

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

Mr. ROTH. I yield 5 minutes to the distinguished Senator from Illinois.

Mr. ROTH. How long would the Senator from Illinois like?

Mr. ROTH. Two minutes?

Mr. ROTH. It could come up tomorrow but we cannot limit debate at the present time.

Mr. ROTH. I have to tell my good friend, no, we cannot agree at this time.

Mr. ROTH. Mr. President, I ask unanimous consent to lay it aside.

Mr. ROTH. I ask the Chair this question: Do I understand correctly that the second-degree amendment which I offer is by virtue of today's order of the Senate considered adopted?

Mr. ROTH. I ask unanimous consent that the reading of the amendment be dispensed.

Mr. ROTH. I now send to the desk a second-degree amendment pursuant to the order of the Senate agreed to today which incorporates the provisions of the Roth and Chafee amendments on the children's health initiative.

Mr. ROTH. Mr. President, I ask unanimous consent reading of the amendment be dispensed with.

Mr. ROTH. Mr. President, I now send to the desk the amendment that was reported out by the Finance Committee regarding the children's health insurance initiative. This amendment provides $8 billion over 5 years for children's health insurance coverage.

Mr. ROTH. Mr. President, I ask unanimous consent that at 9:30 a.m., on Thursday, there be an additional 20 minutes for debate equally divided between Senator Murkowski and Senator Bumpers, and immediately following that debate time, Senator Murkowski be recognized to raise a point of order against the Bumpers amendment; and further, immediately following a motion to waive, the Senate proceed to a vote in relation to the Bumpers amendment; to be immediately followed by 20 minutes of debate equally divided in the usual form prior to a vote on or in relation to the Dorgan amendment No. 517; to be followed by 10 minutes of debate equally divided in the usual form on the Dorgan motion to refer, with Senator Roth being recognized to raise a point of order against the Dorgan motion to refer; and, further, immediately following a motion to waive, the Senate proceed to a vote in relation to the Dorgan amendment.

Mr. ROTH. No. We are still waiting for clearance on the Democratic side.

Mr. ROTH

Mr. ROTH. Mr. President, the Kennedy amendment would strike the $5 coinsurance payment, and I think that would be a mistake. Let me start out by pointing out that home health care has exploded in cost over the recent years. It has been a serious problem that this particular aspect of Medicare has become extraordinarily expensive. As I said yesterday, according to the Prospective Payment Assessment Commission, which is commonly called PROPAC, Medicare spending on home health services was only 1 percent of Medicare spending in 1968. By 1996, Medicare spending on home health care had increased to 14 percent of Medicare part A spending. In other words, it had gone from 1 percent to 14 percent. This is an increase that cannot be permitted in a program that is in financial difficulty. As we all know, Medicare is an extraordinarily successful program in providing health care to senior citizens. But we do face a serious problem with respect both to part A and part B if we do not bring the cost of these programs under control. As is well understood, part A will be in bankruptcy by 2001. If we don't correct it, it will be in debt to the tune of one-half trillion dollars by 2007. And we face the same kind of serious problems with part B. Part B--it is predicted-- will increase in cost roughly 8 percent a year in the coming year. So we have to bring these costs under control, and that is what we are seeking to do. As I said, home health care has exploded in cost. Just let me point out what has happened to the cost of this part of the program in the last several years. From 1989 to 1990, the cost went up 53 percent--in 1 year, the cost of home health care went up 53 percent. The pattern has been a little better since then. In 1990-91, it went up 44 percent; in 1991-92, 40 percent; in 1992-93, 30 percent; in 1993-94, it went up 30 percent; and in 1994-95, it went up 19 percent. Now, the reason home health care has exploded is because there are no adequate controls. For example, there has been a major increase in the number of beneficiaries using home health care. There has been an increase in the number of visits per beneficiary. I must also say that there has been a tremendous increase in the number of agencies providing home health care, and the Medicare payment system does not control the utilization of home care. So that is the nub of the problem. There is no reason for the beneficiaries to be concerned as to how they utilize this program because there are no copayments in the part B program, as there are in others. Let me point out that the cost growth of home care, due to the increase in visits per beneficiary, has indeed been very substantial. In 1983, 45 Medicare enrollees--let me put it this way. There were 45 Medicare enrollees per thousand that used this program, an average annual of 28 visits. This was in 1983. In 1995, the number of Medicare enrollees per thousand jumped to 97--that is, from 45 to 97--and they used this program for an annual of 70 visits. That is 70 visits as compared with 28 visits in 1983. So the question is, Why has the utilization of Medicare's home health benefit grown so rapidly? Essentially, there are two factors explaining the growth. First, the home health benefits for Medicare beneficiaries, for all practical purposes, have been unlimited since 1980. Prior to 1980, home health benefits were limited to 100 visits per beneficiary per year following a hospitalization. But in 1989, as a result of an agreement reached in a class action suit, Dougan versus Bowen, virtually all regulatory limitations on coverage were eliminated. And even today, based on Dougan, a beneficiary only needs to be homebound and under the supervision of a physician in order to receive home health care. Now, the cost growth in home care is partly due to the Medicare cost- based payment system. Medicare pays home care companies the cost of each home care visit up to a per visit cost limit. Medicare does not limit the total number of home care visits. And the cost results are predictable. There is a great incentive for agencies to get into the business. That is one of the reasons we see the explosion of the number of agencies now in the home health care business. Medicare payments per visit are estimated to have increased by 1.6 percent from 1993 and 1994, and the total number of Medicaid certified home health care agencies grew in 1991-95 by 52 percent from 5,949 agencies in 1991 to a total of 9,040 in 1995. So, Mr. President, this is the reason it was felt necessary that there be a copayment on the part of the beneficiary so that there is more prudent use of this care than has taken place in recent years. Beginning in 1998, financing for the home health benefits will begin to be transferred from the part A to the part B trust fund. This will establish 100 visits--after the hospital stay--for home health benefits under part A with all other visits considered part of a new part B home health benefit. Consistent with Medicare's treatment of other part B services, the mark establishes cost-sharing for part B home health service at $5 per visit billable on a monthly basis, and capped at an amount equal to the annual hospital deductible. I point out to my colleagues that creating this copayment is consistent with the way we handle part B. As a general rule, there is copayment of roughly 20 percent for services under part B. Five dollars per visit is substantially less than 20 percent. But it means that as beneficiaries utilize home health care they are going to be more careful in its utilization. Beneficiaries, I point out with respect to those who are under 100 percent of Federal poverty, will not have to pay this $5 copayment fee. They will not have to pay this copayment fee because it will be covered by Medicaid. Our Medicaid Program has been structured to protect the poor and impoverished. And under that program he or she who is under 100 percent of Federal poverty will be covered by Medicaid. So there will be no payment of the $5 fee by those who are impoverished under Federal standards. Privilege of the Floor Mr. President, I ask unanimous consent for unlimited floor privileges for the duration of S. 947 for the following members of the Senate Finance Committee staff: Julie James, Gioia Bonmartini, Dennis Smith, Deloris Spitznagel, and Alexander Vachon.

Mr. ROTH

Mr. ROTH. For the information of all Senators, tomorrow morning Senator Stevens will be recognized for up to 10 minutes. Following the remarks by Senator Stevens, the Senate will resume consideration of the reconciliation bill. At 9:30 a.m. the Senate will proceed to a series of back-to-back rollcall votes on or in relation to a number of amendments which have been offered this evening, beginning with Senator Gramm's amendment No. 444 and ending with final passage of S. 947 as previously ordered. Also, by consent there will be 2 minutes of debate equally divided on each amendment prior to each vote. Therefore, Members can expect a lengthy series of back-to-back rollcall votes as the Senate disposes of all the amendments in order to the budget reconciliation bill. Following final passage of S. 947, the Senate is expected to proceed to the consideration of S. 949, the Tax Fairness Act. All Senators wishing to offer amendments to S. 949 should be prepared to offer them during Wednesday's session of the Senate. Furthermore, Members can be expected to vote on amendments offered to the Tax Fairness Act beginning Wednesday afternoon. As previously announced, the next couple of evenings will be late ones as the Senate works to complete action on the Budget Act prior to the July 4 recess.

Mr. ROTH

Mr. ROTH. Mr. President, if there be no further business to come before the Senate, I now ask unanimous consent that the Senate stand in adjournment under the previous order.

Mr. ROTH

Mr. ROTH. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in adjournment until the hour of 9:20 a.m. on Wednesday, June 25. I further ask unanimous consent that on Wednesday, immediately following the prayer, the routine requests through the morning hour be granted, and Senator Stevens be recognized for up to 10 minutes as if in morning business; that following Senator Stevens' remarks, the Senate then immediately resume consideration of the budget reconciliation bill and begin voting on or in relation to the pending amendments in the order in which they were offered in alternating sequence between each side of the aisle.

Mr. ROTH

Mr. ROTH. Mr. President, I ask unanimous consent that the bill be considered read the third time and passed, the motion to reconsider be laid upon the table, and that any statements relating to the bill be placed at the appropriate place in the Record.

Mr. ROTH. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H.R. 1902 which was received from the House.

Mr. ROTH

Mr. ROTH. Mr. President, I ask unanimous consent there now be a period for the transaction of morning business with Senators permitted to speak for up to 5 minutes each.