Thursday, October 30, 2003

Mr. President, home health care is an important part of Medicare in which seniors and the disabled can get basic nursing and therapy care in their home. I rise today to urge the Senate Medicare conferees to stand firm against provisions in the House passed prescription drug and Medicare reform bill (H.R.1), that would make further cuts in the Medicare home health benefit by reducing the home health inflation update and imposing a new copayment on home health beneficiaries.

Home health care is convenient, but much more importantly, patients love it. I’ve seen this first hand as I’ve had the privilege of visiting with many of my constituents who rely on this benefit. They love home health care because it is the key to fulfilling what is virtually a universal desire among seniors and those with disabilities – to remain independent and within the comfort of their own homes despite their health problems.

Since the passage of the Balanced Budget Act of 1997 (BBA), no other group of Medicare patients and providers have endured as many difficulties. This is a big claim, given the many horror stories we’ve heard about the Balanced Budget Act. But absolutely nobody has suffered like home health patients and home health agencies. True reform means more than just ratcheting down payments to providers and services to patients.

Since 1997 Medicare home health spending has been reduced by over forty percent and the number of beneficiaries by 1.3 million, or about a third. Forty percent of the agencies in my state have closed down or quit serving Medicare patients.

In a move to modernize the Medicare program, Congress eliminated the home health copay in 1972 to encourage the provision of health care in the home rather than in more costly institutions. With all the cuts in home health care that have occurred since 1997 -- including the loss of venipuncture (blood drawing) as a qualifying service, the imposition of per beneficiary limits under the interim payment system, cuts in the market basket inflation update, a “15%” cut in October of last year, and the loss of the 10% rural add on in April of this year—MedPAC has recently confirmed an alarming trend toward greater use of nursing home care. The re-imposition of a home health copayment now would be a step backward that would exacerbate this recent trend.

Home health beneficiaries already must pay the Part B deductible and a 20% copay for preparation of a home health plan of care and ongoing home health care oversight by a physician. Over half of home health patients come directly from the hospital and must pay the Part A deductible of over $800 in order to receive the home health benefit. Often they and their families must pay out of pocket for personal care services to assist with activities of daily living.

Our nation’s dedicated home health providers – and you know they are dedicated if they have stuck with it through the difficulties of the last few years – deserve to be left alone and given a rest. They, and the patients they serve, deserve to be left alone to recover from the post-BBA chaos. They deserve to be left alone in order to adjust to a new home health payment system.

In passing the Senate prescription drug and Medicare reform legislation (S.1), the Senate wisely chose to forgo further cuts in the home health benefit. I urge my colleagues on the Medicare conference committee to oppose the provisions in H.R.1 that would further cut and destabilize the home health benefit.