Arlen Specter

Mr. SPECTER

Mr. SPECTER. Mr. President, the education budget now is $4.5 billion over last year. We have increased IDEA by $1.3 billion. Sometimes we talk about big spenders. Adding $8.75 billion is going to put a burden on the biggest spenders in this Chamber to support this kind of an increase. I want to see a lot more funding in a lot more places, including IDEA, but this is just over the top. I say that with great respect for my esteemed colleague. Mr. President, I raise a point of order under 302(f) of the Budget Act that this amendment would exceed the subcommittee's 302(b) allocation and is not in order.

Mr. SPECTER. Mr. President, I would like to thank the Senator from Ohio for his kind remarks and his dedication on this most important matter. I, too, would agree that such an initiative would be most valuable.

Mr. SPECTER. Mr. President, I consider the interests of older Americans, particularly the issue of ensuring quality health care, to be among the most important matters that come before the subcommittee. The gentleman from Ohio has my commitment to support the project in conference. huntington's disease

Mr. SPECTER. Mr. President, on behalf of Senator Helms, I ask unanimous consent to vitiate the yeas and nays.

Mr. SPECTER. Mr. President, I want to thank my friend, the Senator from Pennsylvania, for his comments. He has been a tireless advocate of the coal workers in Indiana County, and I applaud his efforts on their behalf. I, too, am well aware of the situation being faced by the former employees of Consol Coal and wrote to the Department of Labor on January 31, 2000 to urge that federal retraining funds be made available. As my colleagues are aware, we face tight budget constraints in this legislation. I will continue working with my colleague from Pennsylvania in the coming weeks in an effort to identify sources of funding that may be available for this purpose. graduate medical education program

Mr. SPECTER. Please rest assured that during conference, I will try to keep MIP funding at the Senate recommended level of $680 million. I understand the importance of the MIP program to the integrity of the Medicare Trust Funds and will work with my colleagues to ensure full funding of this program. Regarding the Medicare contractor budget, I am committed to the Senate Appropriations Committee funding recommendation of $1.244 billion and will work in conference to keep the Senate's funding level. outreach services

Mr. SPECTER. I am familiar with the horrible effects of Huntington's disease. In my state, 1,200 people are affected. But I am optimistic about a cure. HD research is advancing rapidly and could be the Rosetta stone to treatments for Alzheimer's Parkinson's, and other neurodegenerative disorders that together strike millions of people and their families. I am also hopeful that through public and private medical research funding, we will soon approach a better understanding of, and perhaps even a cure for, this terrible disease. Researchers at the University of Pennsylvania are part of this effort. The federal government clearly has a significant role to play in this struggle. In Fiscal Year 1999, the National Institute of Neurological Disorders and Stroke at the National Institutes of Health (NIH) dedicated $62.5 million to Huntington's Disease research. Also commendable is the commitment of the Huntington's Disease Society of America (HDSA), which this year will allocate an estimated $2.8 million to research in this area.

Mr. SPECTER. As the Senator knows, we are entering the third year of a bipartisan effort to double funding for the NIH. Within that budget, we have been able to provide significant increases in the budget for the National Institute of Diabetes and Digestive and Kidney Diseases. It is my hope and intention that, with these additional funds, NIDDK will fully implement the Strategic Plan for PKD put forward by a panel of blue-ribbon experts which they convened in 1998. These expert scientists and doctors have stated that, with a total PKD research budget of $20 million, which we provide in this bill, they are confident that a treatment for PKD can be achieved in the very near future. In fact, I am very heartened by recent reports indicating that a drug currently used to treat cancer has been shown to actually stop the progression of PKD in laboratory animals. This discovery, coupled with statements from our leading genetic researchers to the effect that PKD is the most rapidly advancing area of genetic research, convinces me that the additional funds provided in this bill will allow NIDDK to produce a treatment and eventual cure for this devastating disease. May I say to my colleague that I intend to do everything in my power to ensure that NIDDK implements the Strategic Plan for PKD. This bill provides the budgetary means to do that, and I will be following up with NIDDK on the disposition of those funds.

Mr. SPECTER. I share the Senator's support for our Subcommittee's funding level for LEAP and will work during Conference to preserve it.

Mr. SPECTER. Senators Lugar and Bingaman make some very valid points with respect to the comprehensive school reform program. In conference with the House, I will make every effort to work with the Conferees to provide adequate resources for the CSRD.

Mr. SPECTER. Mr. President, I now ask for the adoption of the managers' package which has been cleared on both sides.

Mr. SPECTER. In the past, we have faced difficult choices in making a determination of funding priorities and this year promises to be no exception. We are aware of the request by Strengthen Our Sisters and commend their efforts toward expanding its program to serve more women in need. In conference, we will keep in mind your request as well as those with similar meritorious characteristics and goals.

Mr. SPECTER. I would be happy to consider a request from by colleague from New Jersey.

Mr. SPECTER. I thank my colleague from Kansas for his work on this issue.

Mr. SPECTER. Senator Brownback, I appreciate the work that you have put into this, and look forward to working with you on appropriate language which may be included in the Labor-HHS conference report.

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

Mr. SPECTER. Senator Stevens did an extraordinary job as we moved through this very tough process. Our distinguished ranking member of the full committee, Senator Byrd, has been a strong stalwart throughout the entire process. Other Senators are waiting to speak. I have already enumerated the great work done by our staff. I pay special tribute to the staff. Bettilou Taylor has been a very real stalwart.

Mr. SPECTER. Mr. President, I thank my distinguished colleague from Iowa for those very generous comments. We have a close working relationship. I learned a long time ago that if you want to get something done in this town, you have to be willing to cross party lines. This bill involving education funding, health funding, and the Department of Labor with job training and worker safety is a good bipartisan result.

Mr. SPECTER. Mr. President, I rise today to raise a very important issue concerning the vital safety-net hospitals in my state of Pennsylvania. As my colleagues are aware, the Medicare Disproportionate Share Hospital program consists of special supplemental payments made to hospitals to offset the costs for providing uncompensated care. I worked closely over the last few years with Pennsylvania hospitals and the Health Care Financing Administration to resolve a dispute concerning the inclusion of a State's General Assistance population as a part of its Medicare Disproportionate Share Hospital (DSH) payment calculation. In August 1998, HCFA asserted that Pennsylvania hospitals were incorrectly including General Assistance (GA) days in their Medicare DSH calculation, and claimed that they should only have included Medicaid days. These payments represent a significant portion of many hospitals' revenues, and any proposed reduction puts the Commonwealth's neediest populations at risk. The dispute raised further concerns about how HCFA interpreted its own rules and regulations. Medicare fiscal intermediaries had been reimbursing hospitals with the GA days included for the past twelve years. Yet, beginning in mid-1998, HCFA reversed its own intermediaries' interpretation and began recouping the so-called overpayments for certain years, as far back as fiscal year 1993. The impact to Pennsylvania's hospitals would have totaled in the hundreds of millions of dollars. Indeed, I was encouraged when Secretary Shalala and Administrator DeParle were able to work out a retroactive solution regarding the DSH calculations. As of October 1, 1998, Pennsylvania hospitals stopped including the GA days in their DSH calculations, but since the law was unclear enough for the fiscal intermediaries to have been confused for twelve years, they did not have to give back any reimbursements. I understand that 35 other States had been including General Assistance days in their Medicare DSH calculations, thus the resolution of this dispute was critical for many safety-net hospitals across the nation. However, Mr. President, it now appears that Pennsylvania hospitals are once again at a disadvantage with regard to their Medicare DSH reimbursements, as HCFA is graying the regulatory area we thought had been clarified last year. I understand from Pennsylvania hospitals that HCFA is unfairly applying the GA days and Medicare DSH calculation policy across States. Beginning in January of 2000, HCFA began allowing some States which operate under Medicaid Section 1115 waivers to include the GA population in the Medicare DSH calculation, thus significantly increasing those States' DSH reimbursements. Since Pennsylvania hospitals operate under a Section 1915 waiver rather than Section 1115, it has been made clear to them that they cannot count GA populations in their calculations. I urge my colleagues to join me in my commitment to ensure that HCFA clarifies once and for all how the GA population should be treated under the Medicare DSH program, thus assuring that Pennsylvania and all States will be treated fairly under one uniform and understandable policy.

Mr. SPECTER. I would yield to the Senator from Rhode Island.

Mr. SPECTER. We have rural states in need of programs which improve both access and quality of care. I believe these projects are worthy, and I will consider them during the conference agreement. I appreciate your bringing these issues of my attention.

Mr. SPECTER. I will be pleased to yield.

Mr. SPECTER. I understand the Senator's concerns and agree with him about the unique healthcare needs and problems with access in rural areas.

Mr. SPECTER. Senator Bingaman has made some very valid points with respect to the research on small schools. In conference with the House, I will make every effort to work with the Conferees to provide adequate resources for the smaller learning communities program. rural healthcare needs

Mr. SPECTER. I agree that Advanced Placement programs can be extremely valuable in raising standards in high schools and helping high school students to be better prepared for postsecondary education. I am glad that we were able to provide an increase in funding for this program and, in conference with the House, I will make every effort to work with the Conferees to maintain funding for this program. smaller learning communities funding in labor hhs appropriations bill