Concurrent Resolution on the Budget, Fiscal Year 2016

Floor Speech

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Mr. MORAN. Mr. President, I thank the Senator from Virginia for
yielding to me.

First of all, I would like to talk for a moment about the budget. I
am pleased that the Senate is debating a budget. We are required by law
to pass one by April 15. It has been a while since we have been able to
accomplish that. I am hopeful that the budget will be reconciled with
the House-passed budget, giving us the opportunity to develop 12
appropriations bills within this budgetary outline.

It is unfortunate that by the nature of a budget, it is a partisan
endeavor. The expectation is that no Democrat will vote for the budget
that ultimately will pass the Senate today. I hope that doesn't
continue to be true in another issue that I am encouraging and am
encouraged to know will be considered by the Senate, and that is the
sustainable growth rate fix, the so-called SGR fix.

Back in 1997, a budget act was passed that created a formula by which
physicians are reimbursed under Medicare. That formula has been very
damaging to the practice of medicine--the ability to sustain a practice
of medicine--particularly in areas of the country in which the
population is elderly and patients are generally on Medicare and most
of the physicians' income is then derived from reimbursement from the
Medicare system.

The SGR has created a series of problems. At least annually, there
has been a problem we have had to fix. Over a decade, we have spent
millions of dollars--in fact, $150 billion in short-term so-called doc
fixes.

What I hope happens after consideration of the budget today, tonight,
in the morning, is that there will be unanimous consent and agreement
that we take a vote on finally permanently fixing the problems created
by this SGR, the formula.

In my State of Kansas, there are 127 community hospitals across our
State that care for patients every day, every hour. Most of those
hospitals have a significant volume of Medicare patients. The
physicians who admit patients to those hospitals and see patients on an
ongoing basis in those communities see a significant portion of their
patients, and their bills are paid by Medicare.

In the last several years, the reduction in payment for a physician,
that Medicare reimbursement, has been in the neighborhood of 20 percent
to 30 percent. The reality, I think all of us know--in fact, it is
evidenced by the fact that every year we do a patch, we fix this
issue--what we know is that in the absence of fixing that formula
either on a periodic basis or today potentially permanently, physicians
will no longer be able to see Medicare patients. In many of the
communities I represent, the physicians are employed by the hospital.
So this becomes not just a physician issue, not just a hospital issue--
the reality is, it is a patient issue. Will you have a doctor in your
community who is willing to see, who is able to see a patient who is of
the age at which Medicare is providing Medicare health care benefits?

The opportunity we have today is important. We can do so many things
by permanently fixing the SGR. The outcome is that communities across
our country and communities across my State of Kansas have a much
brighter hope that their hospital doors remain open and physicians
continue to practice medicine in their communities.

Our health care providers face tremendous challenges today related to
the Affordable Care Act, related to the ever-increasing amount of
regulatory burden placed upon hospitals and doctors, upon the costs
associated with moving toward computerized medical records. Our health
care providers in many instances are hanging on by a thread, and
whether or not a community has a doctor, has a hospital determines
whether that community has a future.

I know that in my own hometown of Plainville, the ability of my
parents--who lived into their nineties--to remain in their hometown was
determined by whether there was an active, quality medical community,
quality physicians who cared about their patients and hospitals, who
were there to admit their patients when that care was needed. Only
because that existed in our hometown were my parents, into their
nineties, able to continue to live in a community they called home.

The SGR fix is a significant component to make certain that no people
have to move, no senior citizens have to move someplace closer to a
doctor or a hospital because their hospital no longer is in existence
or their physician no longer cares for folks who have Medicare.

The SGR, which I did not support when it was created, has caused a
volatile and unsustainable system for both patients and health care
providers. The uncertainty of knowing when and if Congress is going to
fix by a patch creates problems in and of itself, in addition to the
ultimate reimbursement rate that physician receives.

The time to act is now. We are as close to a permanent SGR fix as we
have been in my time in Congress. It would be a very sad occurrence if
we let this opportunity slip by, and one more time, in a few months, we
will be back trying to figure out how to patch the SGR once again. We
will spend more money. We will create greater uncertainty. We will
hasten the day in which citizens of our country--Medicare recipients--
are no longer able to see a physician of their choice or be admitted to
the hospital in their community.

I am of the view that we ought not move on to other business. We
ought not recess for this April period of time until we make sure that
tonight or in the morning the SGR fix is permanently put in place.

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Mr. MORAN. Mr. President, the Moran amendment is an attempt to
address the issue--in fact it is addressing the issue--of the 40-mile
requirement contained in the choice act that Congress passed in August.
Senators may recall that in August we were successful in coming
together and passing legislation to give veterans greater options if
they live more than 40 miles from a VA facility or if they cannot get
the services within 30 days, the VA should provide those services, if
they choose, at home.

This amendment makes clear that the VA should provide those services
in the circumstance where there is a VA facility within 40 miles, but
it does not provide--if it does not provide the service the veteran
needs, it does not count against the 40 miles. This is a commonsense,
very bipartisan amendment. I ask that it be adopted.

I ask for the yeas and nays.

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