WASHINGTON – Tonight, U.S. Senator Jerry Moran (R-Kan.) voted in favor of legislation to repeal the broken Medicare Sustainable Growth Rate (SGR) that passed the Senate 92-8 with strong, bipartisan support. More than a decade of short-term “SGR patches” have frustrated health care providers, threatened access for Medicare beneficiaries, and created budgetary problems for Congress. During this time, Congress has allocated nearly $150 billion on temporary patches that did not address the fundamental problems with the SGR. Sen. Moran did not support the formula when it was created and has long urged Congress to permanently repeal and replace the flawed SGR.

“For more than a decade, the broken SGR formula has frustrated health care providers, threatened access for Medicare beneficiaries, and created budgetary dilemmas for Congress,” Sen. Moran said. “This especially jeopardizes patients’ access to health care in Kansas where our hospitals, physicians, and other medical professionals care for an increasingly aging population across a wide area. The reality is patient care suffers when providers are forced to endure an exasperating wait-and-see game every few months to find out what amount they will be reimbursed for the care they provide. It is good that Congress has finally come together permanently address this issue.”

In late March, the House of Representatives passed H.R. 2, the Medicare Access and Chip Reauthorization Act, with a bipartisan vote of 392-37. The legislation now heads to the President’s desk for his signature.

Sen. Moran recently spoke on the Senate floor about the urgent need to permanently repeal and replace the SGR formula. Click here to view his remarks.

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WASHINGTON – Today, the U.S. Senate unanimously passed an amendment (#356) to the Budget Resolution (S. Con. Res. 11) authored by U.S. Senator Jerry Moran (R-Kan.) that makes clear the Senate’s strong support for requiring the Department of Veterans Affairs (VA) to implement the Veterans Access, Choice and Accountability Act of 2014 (the Choice Act) as Congress intended. By passing Amendment #356 by a vote of 100 to 0, the Senate has called on the VA to provide veterans access to non-VA health care when the nearest VA medical facility within 40 miles drive time from a veteran’s home is incapable of offering the care sought by the veteran. The VA is currently forcing thousands of veterans to choose between traveling hours to a VA medical facility, paying out of pocket, or going without care altogether.

The amendment passed by the Senate today mirrors Sen. Moran’s Veterans Access to Community Care Act of 2015 (S. 207), legislation cosponsored by a bipartisan group of 18 Senators. Sen. Moran is hopeful that the strong support conveyed by the Senate’s passage of his budget amendment will encourage a passage of S. 207 out of the Senate Veterans Affairs Committee and a vote on the Senate Floor.  

S. 207 has been endorsed by numerous veterans’ organizations including the American Legion, Veterans of Foreign Wars, AMVETS, Vietnam Veterans of America and the National Guard Association of the United States as well as the National Rural Health Association.

Sen. Moran spoke on the Senate floor prior to the vote on Amendment #356, describing the ongoing problem veterans’ face accessing the care they were promised through the Choice Act because the VA is not considering whether the VA facility within 40 miles of where a veteran lives actually offers the care a veteran needs.

Highlights from Sen. Moran’s remarks may be found below, along with links to the video download:

(4:23) “If there is an outpatient clinic within that 40 miles, even though it doesn't provide the service that you as a veteran need, the VA says you don't qualify for the Choice Act. Now, I'm of the view they have the ability to interpret that law differently. They say it takes a legislative change. I'm not sure that there is a lot of value in continuing to have the debate about who's right about that… 

(7:22) “What I do know is that veterans who are entitled to care are not receiving it and, in a sense, false promises were made. If we get this issue correct, the VA then implements the Choice Act as intended. 

(7:37) “This is an important issue… one of the areas in which [the Senate] did come together and pass significant legislation is the Choice Act. Now we need to make certain that that accomplishment results in… those who are entitled to those benefits receiving them. 

(8:00) “Who, I would ask, who in this country would we expect to have the best quality health care? I think it would be those who served our country, our military men and women, those who retired and became veterans... I ask for support when considered during the budget consideration, and I would ask my colleagues to join me in cosponsoring the underlying legislation that will follow… 

(9:00) “The quality of life of our veterans is affected, not because we don’t want to care for them, but because we lack coming sense to implement a law when we know how it should work, we know what it should say, and yet we're impeded from accomplishing what matters so much. This is not a Republican issue, this is not a Democrat issue. This is an American issue that mostly calls for common sense.”

FTP LINK: Click here to download Sen. Moran’s remarks (save to desktop). 

YOUTUBE: Click here to watch Sen. Moran’s remarks on YouTube.

Background

Sen. Moran’s amendment is cosponsored by Sens. Roy Blunt (R-Mo.), Susan Collins (R-Maine), John Hoeven (R-N.D.), Angus King (I-Maine), Jon Tester (D-Mont.), Pat Toomey (R-Pa.) and David Vitter (R-La.).

On Feb. 25, 2015, 42 senators joined together in calling on VA Secretary Bob McDonald to ease the burden of travel and access to care for millions of veterans who deserve such access through the Choice Act. The group of Senators pointed to two concerns with the way the Choice Program was being implemented. First, the VA is not considering whether the VA facility available within 40 miles of where a veteran lives offers the care a veteran needs. Secondly, VA was calculating the 40-mile distance in a straight line and not by driving distance. 

Although the VA made the decision on March 24, 2015, to change the calculation used to determine 40-mile distance to driving distance through regulatory action, they have not taken action on the issue of a VA facility being incapable of offering the care sought by the veteran. Sen. Moran’s amendment provides a solution and would allow veterans to utilize their Choice Cards to access non-VA care if the VA facility within 40 miles driving distance to their home does not offer the medical service they need. 

As a member of the Senate Veterans’ Affairs Committee, Sen. Moran has questioned VA Secretary Bob McDonald and other VA officials for months in hearings, personal meetings, phone calls and correspondence about the VA’s flawed interpretation of the 40-mile rule and what can be done to fix the problem.

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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.

Mr. President, I would remind the Presiding Officer of the hearing we had yesterday dealing with veterans affairs and the opportunity we had to discuss the implementation of something we now refer to as the Choice Act.

One of the successes and, in my view, one of the few successes we had last term--in fact, with Senator Sanders being on the floor as well--was the passage of the Choice Act. That legislation was Congress responding to scandal within the Department of Veterans Affairs--the fraudulent wait lists, the lack of services available to veterans who were waiting, and a number of veterans falling through the cracks. Congress responded and passed legislation now referred to as the Choice Act.

What that choice act said in simple terms is that if you are a veteran and you are unable to receive the services you need from the Department of Veterans Affairs within 30 days or if you are a veteran who lives more than 40 miles from a VA facility, the Choice Act allows you--in fact, requires the Department of Veterans Affairs to provide you with services at home if you so choose. It is your choice.

That bill was passed by Congress in August of 2014, signed by the President in September, implemented since then beginning in November, and it is now March of 2015. What we have discovered during that period of implementation is there are a number of pitfalls by which veterans are not receiving the care we indicated they would receive following the passage of that legislation. A lot of that problem is related to the 40-mile provision. Again, if you live more than 40 miles from a VA facility, the law says the Department of Veterans Affairs will provide you with service, if you so choose, with a local provider.

A couple of things have happened. The interpretation by the Department of Veterans Affairs of a couple of provisions has precluded a significant number, in my view, of veterans from being able to utilize this choice program.

Yesterday, the Department of Veterans Affairs, to their own credit, decided that they had been interpreting the law incorrectly. That provision related to “as the crow flies,” meaning that the 40 miles was to be computed “as the crow flies,” and that was the way the VA determined they were required to interpret that provision. Yesterday, the Department of Veterans Affairs decided they had the authority to make that 40 miles highway miles. So if you happen to live on one side of a lake or one side of a mountain, it is no longer as the crow flies. That is a piece of good news.

But here is the issue I have raised numerous times, and here is the issue that still remains a problem for many veterans. I smile when I say this because there are not many lakes in Kansas and there are no mountains in Kansas, so “as the crow flies” is not a significant issue to most Kansans as it is in many other places in the country. But yesterday's decision by the Department does increase the number of veterans who may qualify for the Choice Act.

Among other things, what is still missing is the idea of a facility within 40 miles. The problem is this: The Department of Veterans Affairs has interpreted and continues to interpret that to mean even though there is a VA facility within the 40 miles that does not provide the service the veteran needs, it is still a facility within 40 miles, and thus the veteran will be required to transport themselves to a hospital 2, 3, 4 hours away.

I have said this before on the Senate floor. As a House Member before coming to the Senate, I represented a congressional district made up of tens of thousands of square miles, larger than the state of Illinois. There is no VA hospital within that congressional district. We worked hard to create outpatient clinics where routine services could be provided closer to home for those veterans. Now we are saying: If you can't access the care that is more than 40 miles from your home, the VA is going to give you the option of seeing your hometown doctor, being admitted to your hometown hospital. But here is one of the problems: If there is an outpatient clinic within that 40 miles, even though it doesn't provide the service you as a veteran need, the VA says you don't qualify for the Choice Act.

I am of the view that they have the ability to interpret that law differently. They say it takes a legislative change. I am not sure there is a lot of value in continuing to have the debate about who is right about that. What I do know is there are many veterans in Kansas and across the country who are not receiving the services promised by the Choice Act because there is an outpatient clinic within the 40 miles, but it doesn't provide the service they need.

To give folks an understanding of what I am talking about, most outpatient clinics don't provide colonoscopies. So we have a veteran who needs a colonoscopy. The VA is to provide that service. Yet, in the case of where I come from, my hometown, the VA hospital is 3 hours away and the outpatient clinic is half an hour away, and because there is an outpatient clinic half an hour away, that veteran can't utilize the Choice Act. But the outpatient clinic doesn't provide colonoscopies, so that veteran is told by the VA that he or she has to drive the 3 hours to the hospital in Wichita to get the colonoscopy. Well, there is a community hospital within that area, within that veteran's hometown that provides colonoscopy.

That situation is what the Choice Act was designed to accomplish--service provided at home. So this amendment creates a deficit-neutral reserve fund that requires the VA to utilize its current authorities to offer community care to veterans who are currently unable to receive the health care services they need from a VA medical facility within 40 miles of where they live because the facility they have won't or can't provide the services they need. This is something we ought to be able to resolve. This amendment is widely supported.

There is legislation--S. 207--which I have introduced and which has many cosponsors, Republicans and Democrats, and we will continue to push this legislation. In fact, the Committee on Veterans' Affairs has indicated they will not only have the hearing we had yesterday on this topic, but also the chairman and the ranking member and their staffs will work over the recess to get this legislation front and center in our committee and, presumably, on the Senate floor.

This amendment is cosponsored by Senator Collins and Senator King of Maine. Senator Tester, Senator Blunt, Senator Toomey, Senator Hoeven, and Senator Vitter--Republicans and Democrats from states across the country--realize this is something which needs to be resolved.

While I believe the Department of Veterans Affairs should resolve this, they haven't. While the Department of Veterans Affairs believes Congress should resolve this, we haven't. What I do know is veterans who are entitled to care are not receiving it, and, in a sense, false promises were made until we get this issue corrected and the VA then implements the Choice Act as intended.

This is an important issue. I would say to my colleagues, particularly those who served in the Senate with me in the last 4 years, in my view, we haven't accomplished much in those 4 years, but one of the areas in which we did come together and did pass significant legislation was the Choice Act. Now we need to make certain that accomplishment results in those who are entitled to those benefits receiving them.

Who, I would ask, in this country would we expect to have the best quality health care? Who would we expect? I think it would be those who served our country--our military men and women, those who retired and became veterans. And I would say that the employees and Members of Congress have the opportunity of choosing a hospital or a doctor, and our veterans ought to have the same opportunity.

Mr. President, I appreciate the opportunity to explain this amendment. I ask for support when it is considered during the budget consideration. I would ask my colleagues to join me in cosponsoring the underlying legislation that will follow.

I thank my colleagues on the Committee on Veterans' Affairs, particularly the chairman, the Senator from Georgia, Mr. Isakson, and the ranking member, the Senator from Connecticut, Mr. Blumenthal, for their commitment to seeing that this is accomplished.

I appreciate the opportunity to explain one more time why this is something of significance and how the quality of life of our veterans is affected not because we don't want to care for them but because we lack common sense to implement a law when we know how it should work, we know what it should say, and yet we are impeded from accomplishing what matters so much. This is not a Republican issue; this is not a Democratic issue; this is an American issue that mostly calls for common sense.