November 19, 2008 CONGRESSIONAL RECORD — SENATE S10625 

These facilities are the same ones in 

my State who provide the lion’s share 

of uncompensated care to the uninsured. 

One of the hardest hit hospitals in 

my State is Mt. Sinai Medical Center 

in Manhattan. They stand to lose $4.1 

million by 2010. 

This lost funding means Mt. Sinai 

Medical Center will be forced to take 

cost cutting steps: 

First, delay completion of their inpatient electronic medical record rollout; 

second, they won’t be able to expand 

their already crowded emergency room 

that provides over 100,000 patient visits 

a year; and third, they will scale back 

many free medical screenings and 

other programs for patients. 

These are not the actions we want 

hospitals to take. 

Hospitals need our help. The Medicare Payment Advisory Commission, 

MedPAC—which is a nonpartisan 

group—has said that in 2006, hospitals’ 

Medicare margins nationwide were in 

the red at negative 4.8 percent. 

In New York in 2006, rural hospitals 

were hit the hardest by low Medicare 

reimbursements with even lower margins of negative 8.2 percent. 

After 7 consecutive years of overall 

negative margins, the hospitals in my 

State did little better than break even 

in 2006. It doesn’t make sense to me 

that we would gut a source of training 

for high-paying jobs in this country at 

a time when we are bleeding jobs. 

This is not just a New York issue. In 

July, 51 Senators signed a bipartisan 

letter to the Centers for Medicare and 

Medicaid Services, CMS, that opposed 

implementation of the capital IME. We 

need to pass my bill so that these cuts 

don’t hurt all U.S. hospitals. 

Now I want to speak briefly about 

the Medicaid Outpatient Clinic Regulation that my bill places a 6-month moratorium on. 

For months I fought with CMS about 

this regulation. Unfortunately, they finalized it last week. 

But, I am pleased that in the final 

version free-standing health clinics 

were saved from massive cuts. There 

were many clinics in New York that 

were saved from either closing their 

doors or saying no to their patients. 

I want to talk about Ed, a 62-year-old 

Buffalo resident, who can only move 

his head due to his cerebral palsy. With 

the help of a free-standing clinic in 

Buffalo, called Aspire, Ed learned to 

operate his power wheelchair with his 

chin. 

Even more amazing he can operate a 

computer using his chin. Ed spent 5 

years mastering desktop publishing 

and then formed his own successful 

business. 

If free-standing clinics were included 

in the final regulation, Ed could not attend Aspire of WNY’s wheelchair clinic, 

where physical, occupational and 

speech therapists customize all sorts of 

things for him. Without that service, 

Aspire tells me that he would be completely immobile and not as independent. 

Let me discuss another New Yorker 

that the Buffalo-based Aspire Clinic 

helped. In 1998, Aspire wanted a woman 

named Alice to have a colonoscopy. 

When she did, it was revealed that she 

had colon cancer. But luckily they 

found it in time and she had surgery to 

remove the cancer and now, 10 years 

later, she is doing fine. 

Alice is just one of hundreds of individuals who receive primary medical 

care through these essential primary 

care clinics. 

Enable, a Syracuse agency that 

serves children and adults with disabilities, told my office that they would 

have to stop providing physical and occupational therapy to more than 300 

clients on Medicaid if the Rule had included freestanding clinics. 

I wish CMS hadn’t made this regulation final, but at least it isn’t as bad as 

it could be. We will know the extent of 

pain that other clinics and hospital 

outpatient services may face on December 8, when the rule must be implemented. 

Therefore, I hope that the Senate 

will pass the PATH Act. As we have 

heard, there are just too many terrible 

cuts underway in health care, and we 

need to be doing all we can right now 

to stop the bleeding. 

I understand my colleague has objected. That is unfortunate. To wait 

another 3 months or 6 months at a time 

when our economy is in such dire shape 

will do severe damage to health care 

throughout the country. In my State of 

New York, for instance, the new Medicare Hospital Capital Indirect Medical 

Education payment policy is a disaster 

for teaching hospitals. It runs counter 

to what works in American medicine. 

It affects large and small communities. 

We have a desperate shortage of physicians, from primary care to surgeons. 

The country relies on academic medical centers. This clobbers them at a 

time when it should not have happened. Many of us believe this regulation was not within the purview of 

CMS to enact. They went ahead and did 

it. I would hope that maybe my colleague will reconsider. We will return 

to this issue when we come back in 

January, but some damage, unfortunately, will be done. 

I understand why my colleague has 

objected. I regret it. There was no time 

to move in the Finance Committee because this regulation didn’t take effect 

until very recently, having many bad 

affects. I will work hard and not rest 

until we overturn the regulation. 

I yield the floor and suggest the absence of a quorum. 

The PRESIDING OFFICER. The 

clerk will call the roll. 

The legislative clerk proceeded to 

call the roll. 

Mr. REID. I ask unanimous consent 

that the order for the quorum call be 

rescinded. 

The PRESIDING OFFICER. Without 

objection, it is so ordered. 

UNANIMOUS-CONSENT REQUEST— 

S. 3689 

Mr. REID. Madam President, with 

the daunting challenges we face on our 

road to economic recovery—and that 

will come; it is a question of when— 

there is no reason to wait for a new 

year, a new Congress and a new President. We could vote now. We could take 

action now. We can’t solve our economic challenges with one vote, but we 

could get started. So I say, why wait. 

Every day that goes by, thousands of 

Americans lose their jobs. Thousands 

of homes are lost. Scores of companies 

file for bankruptcy. So why don’t we 

staunch the bleeding, stop some of the 

pain, and begin to turn things around? 

We have before the Senate a comprehensive economic stimulus plan 

worked out with the Appropriations 

Committee, the Finance Committee, 

and the Agriculture Committee, that 

we could pass and we should pass. I 

wish to express my appreciation to the 

members of the Appropriations, Finance, and Agriculture Committees. 

They have worked very hard to put this 

package together under the leadership 

of Senators BYRD, BAUCUS, and HARKIN. 

What do I mean by ‘‘comprehensive’’? 

Instead of addressing just one part of 

our economic crisis, this legislation 

takes many steps that economists 

agree we need. 

I ask unanimous consent that the 

Senate proceed to the consideration of 

Calendar No. 1122, S. 3689; that the bill 

be read a third time, passed, and the 

motion to reconsider be laid on the 

table, and there be no intervening action or debate. 

The PRESIDING OFFICER. Is there 

objection? 

The Senator from Arizona. 

Mr. KYL. I object. 

The PRESIDING OFFICER. Objection is heard. 

Mr. REID. Madam President, we have 

a matter on which the objection was 

made. I did not cover it all, of course, 

in that matter. We have significant 

things in that piece of legislation that 

were objected to dealing with infrastructure; unemployment benefits; 

FMAP, which is the matter to give 

some fiscal relief to our States; and it 

would give help to the auto industry. 

So this is the type of issue on which I 

wish we could move forward. I understand my colleagues. They are not 

going to accept this. 

I think the provision we have dealing 

with taking the money out of the financial bailout that we have, that the 

White House has, the Treasury Department has—I have talked on the floor 

over the last 2 days about that. There 

is no need to belabor that point. But it 

is too bad we could not move forward 

on that basis. 

It is my understanding Senators 

LEVIN and BOND are going to try to 

come up with some alternative proposal. When they come up with that, I 

would be happy to see if there is any 

way we can move procedurally. That is 

not going to be easy with what is going 


rfrederick on PROD1PC67 with SENATE
S10626 CONGRESSIONAL RECORD — SENATE November 19, 2008 

on in the House and, actually, what is 

going on here. But I will confer with 

my counterpart, Senator MCCONNELL, 

and we will do what we can to move 

forward. 

f 

UNANIMOUS-CONSENT REQUESTS 

Mr. REID. Madam President, I ask 

unanimous consent that we move forward on this bill, S. 3689—there is a 

provision in that dealing with what we 

call FMAP—that the FMAP provision 

be taken out, that it be considered as 

separate legislation, be read three 

times and passed, the motion to reconsider be laid on the table, and there be 

no intervening action or debate. 

The reason that is so very important 

is that FMAP is something that every 

State—every State, all 50—is in desperate need of. No part of our country 

has proven immune from our economic 

struggles. We are all sharing the heavy 

burden of these difficult times. But few 

places are suffering, though, more than 

we are in Nevada. 

Budget shortfalls in Nevada are causing deep cuts in bedrock programs the 

Government must provide, programs 

that help and protect children, senior 

citizens, and people with disabilities. 

The State of Nevada has been forced 

to cap enrollment in Nevada Check-Up, 

our form of children’s health insurance. The State recently had to institute cuts to provider reimbursement. 

What is worse, these cuts will not end 

here unless we act to provide fiscal relief by increasing the Federal Medical 

Assistance Percentage; that is, FMAP. 

What are the consequences of inaction? It was reported in the media this 

weekend that due to the provider rate 

cut, University Medical Center in Las 

Vegas, our public hospital, is discontinuing outpatient cancer treatment. And that is not just for Medicaid 

patients, it is for all patients. It is not 

clear if all those patients will be able 

to afford chemotherapy elsewhere, but 

it is pretty clear they will not be able 

to. 

Low-income children who need orthopedic treatment will have to leave Las 

Vegas altogether for services elsewhere. They will likely have to leave 

the State. 

There is more to come. The cuts are 

not over. This is the way it is in many 

States around the country. The budget 

shortfalls are deep. When States have 

to cut provider reimbursement for 

some of the things I have outlined, 

they have real difficulties in making 

the safety net not be one that has big 

holes in it. States have found no choice 

but to look at cutting services such as 

mental health and cutting actual people from the program, adding to the 

ranks of the insured at the worst possible time. 

We have been working in the Senate 

to provide help. The stimulus bill we 

introduced includes a temporary 8-percent FMAP increase to stave off these 

cuts. It will not fix the problem, but it 

may make a difference in ensuring that 

our children are not without the care 

they need. I hope we can take that 

step. 

The PRESIDING OFFICER. Is there 

objection? 

Mr. MCCONNELL. Madam President, 

reserving the right to object, this is a 

spending measure of $37.8 billion which 

has not been considered by the Finance 

Committee. We should be asking the 

States to pay it back. We should require the States to agree to not raise 

taxes. For all of those reasons, Madam 

President, I object. 

The PRESIDING OFFICER. Objection is heard. 

Mr. REID. Madam President, I have 

one final consent request on which I 

would like to move forward. This is the 

matter dealing with automobiles. We 

know the issue before this body. There 

have been speeches given the last several days about where the automobile 

industry is. We have watched on national TV the congressional hearings 

that have taken place on this side of 

the Capitol and on the other side of the 

Capitol. We need to try to figure out 

some way to move forward. 

We believe the best way to move forward is taking the money, as I have indicated, out of the so-called TARP 

money. I do not believe we need the 

legislation. I think—well, I don’t know. 

I have talked to Secretary Paulson 

twice today. He knows he has authority to take money out of that; he just 

does not want to do it. 

So I ask unanimous consent that the 

Senate proceed to the consideration of 

a bill I have at the desk, which is the 

text of title VI of S. 3689 regarding 

automotive industry assistance; that 

the bill be read a third time and 

passed, the motion to reconsider be 

laid on the table, and there be no intervening action or debate. 

The PRESIDING OFFICER. Is there 

objection? 

Mr. KYL. Madam President, reserving the right to object, the longer this 

legislation has been lying around, the 

more objections have been heard to it. 

So, yes, I do object. 

The PRESIDING OFFICER. Objection is heard. 

The Senator from Missouri. 

Mr. BOND. Madam President, the distinguished majority leader was kind 

enough to mention the fact that several of us on our side have been working with leading Members on his side of 

the aisle to come up with a compromise proposal that would come to 

the aid of the auto companies which 

are facing a very serious situation, 

without mentioning specific ones or 

others, but to say this is a critical time 

to move to prevent perhaps the bankruptcy or the disappearance of a major 

auto company, which would cause 

chaos in our country. Over 3 million 

jobs are related to the auto industry— 

from the auto assembly plants, to the 

auto dealerships, to the parts suppliers. 

So we have been working on a bipartisan basis. On my side of the aisle, 

Senator VOINOVICH and I have been 

working with others on the Democratic 

side. We took the basic construct of the 

measure the majority leader had introduced. We took the money out of a previously passed bill, which would not 

cause as much concern down Pennsylvania Avenue, and we provide that the 

money will go back into that program 

as it is returned. 

In my view, it is essential we work 

something out. I will tell the majority 

leader we have made great progress. We 

are down to the point now where wording challenges are about the only remaining things to deal with. I strongly 

believe it is in the interest of the country, particularly all of those families 

whose jobs depend upon the auto industry, and the States, the local governments, and the Federal Government to 

move something forward. 

So I ask unanimous consent that at a 

time to be determined on Thursday, 

November 20, the Senate proceed to the 

immediate consideration of a bill to be 

introduced by Senators BOND and 

VOINOVICH and others; I further ask 

that there be no amendments in order, 

with 2 hours of debate equally divided, 

and following the use or yielding back 

of the time, the bill be read a third 

time and the Senate proceed to a vote 

on passage, and that if there are not 60 

votes in the affirmative, the bill be 

placed on the Senate calendar. 

The PRESIDING OFFICER. Is there 

objection? 

Mr. REID. Reserving the right to object, Madam President, we have had no 

hearings. We have no text. I know my 

friend, Senator BOND, is a man of faith. 

I think I am too. But this is carrying it 

a little too far. We do not know anything about this. I look forward to a 

piece of legislation we can look at. 

Hopefully, it can be done tonight or tomorrow, and we will be happy to look 

at it. 

I have had many conversations today 

and yesterday with the senior Senator 

from the State of Kentucky, Mr. 

MCCONNELL, and we understand the importance of this issue. We will try to 

work to move forward on it. But I want 

everyone to understand, no matter how 

hard we work, how hard we try, the 

House of Representatives is going home 

tomorrow. OK. They are leaving. 

I understand the importance. But I 

would hope that in addition to understanding the importance, we have to 

face reality. The reality is, we have 

tried a number of different approaches. 

I will be happy to look at the approach my friend from Missouri has. He 

is a hard-working Senator. I understand how hard he works. He is a real 

advocate for doing what he thinks is 

appropriate for his State and our country. 

Senator LEVIN and I have had hours 

of conversation regarding this issue. 

Every conversation I have with him he 

mentions the name of the Senator from 

Missouri. So I understand what this is 

all about, but, recognizing we have had 

no hearings, we have no legislation, I 

object. 


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