starttime 1259937035.06183
SENATE ON C-SPAN2.
THE PRESIDING OFFICER: THE
SENATE WILL COME TO ORDER.
WILL LEAD THE SENATE IN PRAYER.
THE CHAPLAIN: LET US PRAY.
OUR FATHER.
WE BOW IN YOUR SACRED
PRESENCE TO ACKNOWLEGE OUR NEED??
OF YOU.
WE CAN DO WITHOUT MANY THINGS,
BUT WITHOUT YOU WE CAN'T LIVE.
MEET THE NEEDS OF THE MEMBERS OF
THIS LEGISLATIVE BODY.
WHEN SORROW AND SHADOWS FALL ON
THEIR PATH, FILL THEM WITH YOUR
JOY AND LIGHT.
WHEN THEY FEEL PERPLEXED,
PROVIDE THEM WITH YOUR BOUNTIFUL
WISDOM.
WHEN THEIR HEALTH FAILS, BE FOR
THEM THE GREAT PHYSICIAN.
LORD, WE ALSO ASK YOU TO PROTECT
THEIR LOVED ONES WITH THE SHIELD
OF YOUR FAVOR.
GIVE OUR LAWMAKERS COURAGE FOR
HARD TIMES AND STRENGTH FOR
DIFFICULT PLACES.
WE PRAY IN YOUR LOVING NAME.
THE PRESIDING OFFICER: PLEASE
JOIN ME IN RECITING THE PLEDGE
OF ALLEGIANCE TO THE FLAG.
I PLEDGE ALLEGIANCE TO
THE FLAG OF THE
UNITED STATES OF AMERICA
AND TO THE REPUBLIC
FOR WHICH IT STANDS,
ONE NATION UNDER GOD,
INDIVISIBLE,
WITH LIBERTY AND
JUSTICE FOR AL
THE PRESIDING OFFICER: THE
CLERK WILL READ A COMMUNICATION
TO THE SENATE.
THE CLERK: WASHINGTON D.C.,
DECEMBER 4, 2009.
TO THE SENATE:
UNDER THE PROVISIONS OF RULE 1,
PARAGRAPH 3, O
RULES OF THE SENATE, I HEREBY
APPOINT
THE HONORABLE MARK
A SENATOR FROM THE
COMMONWEALTH OF VIRGINIA,
TO PERFORM THE DUTIES OF THE SIGNED: ROBERT C. BYRD, PRESIDENT
PRO TEMPORE.
MR. THE PRESIDING OFFICER: THE
MAJORITY LEADER.
MR. REID: FOLLOWING LEADER
REMARKS THE SENATE WILL RESUME
CONSIDERATION OF THE HEALTH CARE
BILL.
THE TIME UNTIL
DIVIDED AND CONTROLLED BETWEEN
THE LEADERS OR THEIR DESIGNEES.
THE MAJORITY WILL CONTROL THE
FIRST HALF, REPUBLICANS THE
SECOND HALF.
WE HAVE A NUMBER OF VOTES THAT
WE'RE GOING TO TRY TO ARRANGE
THIS AFTERNOON.
WE'LL LET ALL SENATORS KNOW AS
SOON AS WE HAVE THIS WORKED OUT.
BUT THERE WILL BE SOME VOTES
TODAY AND TOMORROW.
MR. PRESIDENT, THE AMENDMENT
PROCESS CONTINUES TO CRAWL
FORWARD.
WITH THIS HISTORIC HEALTH
FOREMAN BILL CONTINUES TO EVOLVE AND IMPROVE.
THIS IS A GOOD BILL.
IT SAVES LIVES, SAVES MONEY AND
SAVES MEDICARE.
IT MAKES HEALTH INSURANCE MORE AFFORDABLE.
IT MAKES HEALTH INSURANCE
COMPANIES MORE ACCOUNTABLE.
IT MAKES OUR ECONOMY STRONGER.
THE DEMOCRATS KNOW WE CAN MAK
IT EVEN BETTER.
THIS IS HAPPENING BECAUSE OF THE
DEDICATED HARD WORK THROUGHOUT
THE DEMOCRATIC CAUCUS FROM
VETERAN SENATOR
SENATORS, BY THE HANDS OF MEN
AND WOMEN FROM THE DIVERSE PARTS
OF THE COUNTRY AND GOOD PUBLIC
SERVANTS FROM ALL POINTS OF THE
POLITICAL SPECTRUM.
SENATOR MIKULSKI OF MARYLAND WHO
FOR DECADES HAS BEEN A CHAMPION
FOR WOMEN'S HEA
BETTER BY MAKING SURE WOMEN CAN
GET THE MAMMOGRAMS, CHECKUPS AND
PREVENTIVE CARE THEY NEED TO
STAY HEALTHY AND GET THEM AT NO
COST.
SENATOR BENNET OF COLORADO WHO
SERVED SKILLFULLY H IN THIS BODY
FOR LESS THAN
BETTER BY REAFFIRMING OUR
COMMITMENT TO MEDICARE, MADE IT
BETTER BY ENSURING THAT SENIORS
GET THE CARE THEY NEED AND THE
QUALITY OF LIFE THEY DESERVE.
THAT POSITIVE TREND WILL
CONTINUE TODAY.
SENATOR WHITEHOUSE OF RHODE
ISLAND WHO CAME TO CONGRESS WITH
A CLASS OF SENATORS ELECTED WITH
A STRONG MANDATE TO CHANGE THE
WAY WASHINGTON WORKS HAS
PROP
COMMON SENSE AND ACCOUNTABILITY.
IT SAYS THAT
TO THE HEALTH CARE OF AMERICAN
SENIORS AND PEOPLE
DISABILITIES CAN BE USED ONLY
FOR THOSE PRECISE PURPOSES.
UNFORTUNATELY, SOME REPUBLICANS
ARE LESS INTERESTED IN SOLVING
PROBLEMS THAN THEY ARE IN
CREATING THEM.
THE DAY BEFORE THIS
DAY BEFORE THIS FLOOR DEBATE
BEGAN, MR. PRESIDENT, THE
ASSISTANT REPUBLICAN LEADER, THE
JUNIOR SENATOR FROM ARIZONA,
SAID -- AND I QUOTE -- "THERE'S
NO WAY TO FIX THIS BILL."
OF COURSE HE'S ABSOLUTELY
TOTALLY WRONG.
ALL SENATORS KNOW THERE IS A
VERY RELIABLE WAY
LEGISLATION, TO IMPROVE THIS BILL.
IT'S BEEN IN USE FOR 220 YEARS.
IT'S CALLED THE LEGISLATIVE
PROCESS.
IT'S CALLED DOING OUR JOBS.
AS THIS BILL CONTINUES TO
IMPROVE, I ONCE AGAIN REMIND MY
COLLEAGUES NOT TO LOSE SIGHT OF
THE BIGGER PICTURE.
AS WE DELVE INTO THE DETAILS AND
DEBATE THE FINE PRINT, LET'S NOT
FORGET WHY WE'RE HERE.
OUR GOAL REMAINS THE SAME AS IT
WAS THE DAY WE BEGAN THIS DEBATE
MANY MONTHS AGO.
IT REMAINS THE SAME AS IT WAS A
YEAR AND A HALF AGO WHEN SENATE
FINANCE CHAIR MAX BAUCUS FIRST
HELD A SERIES OF HEARINGS THAT
LED TO THE LEGISLATION THAT I
NOW BEFORE US.
OUR GOAL REMAINS THE SAME AS IT
WAS LAST NOVEMBER WHEN THE
AMERICAN PEOPLE CALLED IN A LOUD
AND CLEAR VOICE FOR CHANGE.
IT REMAINS THE SAME AS IT DID 31
YEARS AGO WHEN SENATOR TED
KENNEDY CALLED IT SHAMEFUL THAT
-- AND I QUOTE -- "IN OUR
UNBELIEVABLY RICH LAND, THE
QUALITY OF HEALTH CARE AVAILABLE
TO MANY OF OUR PEOPLE IS
UNBELIEVABLY POOR AND THE COST
IS UNBELIEVABLY HIGH."
IT REMAINS THE SAME AS IT DID
THE DAY PRESIDENT TRUMAN SOUNDED
A CALL TO ENSURE THAT AMERICAN
FAMILIES ARE PROTECTED IN WHAT
HE CALLED THE ECONOMIC EFFECTS
OF SICKNESS.
THAT WAS MORE THAN 64 YEARS
AND MORE THAN HALF OF TODAY'S
UNITED STATES SENATORS WEREN'T
EVEN BORN BY THEN.
THAT CONSTANT GOAL HAS BEEN AND
REMAINS THIS: WE MUST MAKE IT
POSSIBLE FOR EVERY AMERICAN,
EACH AND
AFFORD TO LIVE A HEALTHY LIFE.
EACH MOMENT IN THIS FIGHT IS HISTORIC.
NO BILL TO PUT HEALTH CARE
DECISION IN THE HANDS OF PEOPLE
HAS EVER COME THIS FAR.
BUT THE MOST HISTORIC DAYS OF
WE CAN ONLY SEIZE THAT
OPPORTUNITY IF THIS DEBATE IS
ABOUT FACTS, NOT ABOUT FEAR.
I REMIND MY COLLEAGUES THAT IF
WE'RE TRULY TO HELP THE AME
PEOPLE AND THE AMERICAN ECONOMY,
WE'RE TO SINCERELY DO THE WORK
OUR NEIGHBORS SENT US HERE TO DO.
WE'RE TO LEAVE OUR CHILDREN AND
GRANDCHILDREN A BETTER INHERITANCE.
IF WE'RE TO DO ANY OF THESE
THINGS, WE MUST WORK TOGETHER
AND NOT AGAINST EACH OTHER.
LET'S WORK PARTISANS.
THIS IS NOT THE FIRST TIME I'VE
ASKED MY REPUBLICAN FRIENDS TO
THK OF THE REAL FAMILIES
ACROSS THIS NATION WHO FACE REAL
PROBLEMS, FAMILIES WITH REAL
DISEASES, REAL SICKNESSES, REAL
MEDICAL
IT IS NOT THE FIRST TIME I'VE
WARNED THAT AMERICA HAS NO PLACE
FOR THOSE WHO HOPE FOR FAILURE.
EXTENDED MY HAND ACROSS THE
AISLE AND ASKED MY REPUBLICAN
FRIENDS TO ABANDON THEIR
SHORTSIGHTED STRATEGY TO BRING
THE SENATE TO A SCREECHING HALT,
FOR
MEDICATIONAL GUIDE -- INFOMATIONAL GUIDE ON HOW TO
STOP AND SLOW THINGS. MR. PRESIDENT, THAT DOESN'T
WORK.
WE NEED A STRATEGY THAT SAYS WE
CAN WIN WITH BECAUSE THAT WILL MEAN -- WE CAN WIN BECAUSE THAT
WILL MEAN THE AMERICAN PEOPLE
WILL NOT LOSE.
SO I HOPE THAT FOR
TIME WE'LL HAVE PEOPLE OF
GOODWILL ON THE REPUBLICAN SIDE
OF THIS CHAMBER WALK OVER AND
SAY "LET'S WORK TOGETHER TO GET
SOME OF THESE THINGS DONE."
I'VE HAD A COUPLE OF GOOD
CONVERSATIONS IN THE LAST FEW
DAYS WITH SOME OF MY COLLEAGUES
ON THE OTHER SIDE OF THE AISLE.
I HOPE WE CAN MOVE FORWARD.
THIS IS A BILL THAT DOESN'TOOK
AT A PERSON BEING SICK OR HURT
OR AFRAID BEING A DEMOCRAT
REPUBLICAN OR
THEY'RE AMERICANS.
THEY'RE FROM VIRGINIA, THEY'RE
FROM MONTANA, THEY'RE FROM NEVADA.
THEY'RE FROM ALL OVER AMERICA.
THEY'RE PEOPLE WHO ARE CALLING
UPON US TO DO THE THE PRESIDING OFFICER: UNDER
THE PREVIOUS ORDER, LEADERSHIP
TIME IS RESERVED, UNDER THE PREVIOUS ORDER, THE SENATE WILL
RESUME CONSIDERATION OF H.R.
3590 REPORT.
THE CLERK: CALENDAR NUMBER
175, H.R. 3590, AN ACT TO AMEND
THE INTERNAL REVENUE CODE
1986 TO MODIFY THE FIRST-TIME
HOME BUYERS CREDIT IN THE CASE
OF MEMBERS OF THE ARMED FORCES
AND CERTAIN OTHER FEDERAL
EMPLOYEE
PURPOSES.
MR
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: MR. PRESIDENT, WE
ARE BEGINNING OUR FIFTH DAY OF
CONSIDERATION OF THE HEALTH REFORM BILL.
WE'LL BE IN A PERIOD
ONLY UNTIL ABOUT 11:30.
PENDING NOW IS THE AMENDMENT BY
THE SENATOR FROM RHODE ISLAND,
SENATOR RESPONSIBILITY.
ALSO PENDING IS A MOTION TO
COMMIT BY THE SENATOR FROM UTAH
ON MEDICARE
IT WOULD BE MY HOPE THAT THE
SENATE WOULD VOTE ON
MATTERS TODAY.
MR. PRIDENT, I ASK CONSENT
THAT THE FOLLOWING STAFF BE
ALLOWED ON THE SENATE FLOOR FOR
THE DURATION OF THE DEBATE ON
ALAN, RYAN
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BAUCUS: MR. PRESIDENT
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: I SUGGEST THE
ABSENCE OF A
CLERK WILL CALL THE ROLL.
QUORUM CALL:
THE PRESIDING OFFICER: THE SENATOR FROM MONTANA.
MR. BAUCUS: I
PROCEEDINGS UNDER THE QUORUM
CALL BE DISPENSED WITH.
THE PRESIDING OFFICER: WITHOUT OBJECTION.
UNDER THE PREVIOUS ORDER, THE
TIME UNTIL 11:30 A.M. WILL BE
FOR DEBATE ONLY WITH THE TIME EQUALLY DIVIDED AND CONTROLLED
BETWEEN THE TWO LEADERS OR THEIR
DESIGNEES, WITH THE MAJORITY
CONTROLLING THE FIRST PORTION OF
TIME.
MR. BAUCUS: MR. PRESIDENT? THE PRESIDING OFFICER: THE
MR. BAUCUS: MR. PRESIDENT,
EXPERTS AND ECONOMISTS OF EVERY
POLITICAL STRIPE AGREE THAT
PRESERVING AMERICA'S LONG-TERM
ECONOMIC SECURITY MEANS
REFORMING THE WAY WE PROVIDE AND
PAY FOR HEALTH CARE.
HEALTH CARE SPENDING MAKES UP
ONE-SIXTH OF THE U.S. ECONOMY
TODAY.
IN FUTURE GENERATIONS -- AND
FUTURE GENERATIONS CAN EXPECT
INSURMOUNTABLE DEBT IF WE FAIL TO ACT.
FISCAL CHALLENGES WE MAY FACE IN
YEARS TO COME PALE IN COMPARISON
TO THE THREAT OF UNCONTROLLED
FEDERAL HEALTH CARE SPENDING.
THE CHART BEHIND ME ESSENTIALLY
THE CHART SHOWS THAT THE
PERCENTAGE OF ANNUAL GROWTH
RATES BEGINNING
RED IS THE ECONOMY.
THE BLUE IS HEALTH CARE COSTS.
AND, CLEARLY, OVER TIME,
ESPECIALLY AS THE ECONOMY DIPPED
DURING THIS GREAT RECESSION, THE
GAPETWEEN ECONOMIC GROWTH AND
HEALTH CARE SPENDING HAS
WIDENED, AND THE PROJECTIONS ARE
IN FUTURE YEARS THEY'LL START TO
YOU CAN SEE OUT TO THE YEAR
2018, THE TOTAL ECONOMY IS
PROJECTED IN THE YEAR 2018 TO BE
7%, CLOSER TO
THE ECONOMY IS GOING TO
4% AND THE HEALTH CARE I SPENDING
IS GOING TO BE ABOUT 7% OR 8%.
DOING NOTHING MEANS INTIELT
SPENDING MORE THAN DOUBLES IN
THE YEAR -- MEANS ENTITLEMENT
SPEND MORE THAN DOUBLES IN THE
YEAR 2015.
BUT IT'S NOT SIMPLY THE FEDERAL
BUDGET ON
IT'S THE FAMILY BUDGET, TOO.
INCREDIBLY, IN TOTAL, WE SPEND
80 TIMES AS MUCH ON HEALTH CARE
TODAY AS WE DID FIVE DECADES AGO
-- 80 TIMES.
80 TIMES MORE IN HEALTH CARE
TODAY, 80, THAN WE DID FIVE
DECADES
BREAKING UNDER THE STRAIN --
ALREADY.
AND THAT'S GOING TO GET WORSE IF
WE DO NOTHING.
THE COST TO THE AVERAGE FAMILY
HEALTH CARE PLAN WILL REACH
$24,000 IN THE YEAR 2016.
THAT'S NOT TOO MANY YEARS AWAY
FROM NOW.
THIS REPRESENTS AN
OVER 2008 PREMIUM LEVELS.
THAT MEANS IF WE DO NOTHING, IN
FEWER THAN TEN YEARS, MOST
FAMILIES WOU HAVE TO DEDICATE
HALF OF THEIR HOUSEHOLD BLUGHT
-- HOUSEHOLD BUDGET TO HEALTH CARE.
EVERY DAY WE HEAR FROM FOLKS
BACK HOME THAT SIMPLY CANNOT
AFFORD THE CARE THAT THEY NEED.
WE HAVE AN OPPORTUNITY TO ACT.
WE HAVE AN OBLIGATION TO ACT.
AND NOW WE HAVE AN OPPORTUNITY
TO ACT.
THE COUNTRY'S
AND FEDERAL BUDGET EXPERTS HAVE
LAID OUT STRATEGIES AND OPTIONS
FOR GETTING COSTS UNDER CONTROL.
WE'VE ALL TAKEN THEIR
RECOMMENDATIONS TO HEART.
THERE REALLY IS A LOT OF
AGREEMENT AMONG THOSE WHO STUDY
THESE ISSUES AS TO WHAT WE MUS
DO, AND NOW WE HAVE A BILL THAT
DOES WT THEY SUGGEST, AND IT
ALSO PASSES THE TEST OF FISCAL
RESPONSIBILITY.
HAVE MANY REASONS TO
THIS BILL.
IT PROTECTS AND EVEN INCREASES
MEDICARE BENEFITS FOR SENIORS.
IT ACHIEVES NEAR-UNIVERSAL
COVERAGE IN LESS
THAT MEANS IT ACHIEVES THE GOAL
OF VIRTUALLY EVERYBODY HAVING
HEALTH INSURANCE IN THAT PERIOD
OF TIME.
IT SLOWS THE GROWTH OF FEDERAL
HEALTH CARE SPENDING.
IT STOPS INSURANCE INDUSTRY DISCRIMINATION.
AND BASED ON INDEPENDENT
NONPARTISAN ANALYSIS, IT MAKES A
SERIOUS DENT IN OUR FEDER
DEFICIT.
MR. PRESIDENT, I'D LIKE TO CEASE
MY STATEMENT AND PICK IT UP AT A
LATER TIEVMENT
MINORITY LEADER IS ON THE FLOOR
AND IN DEFERENCE DEFERENCE TO HIRNLINGS I THINK
IT IS ONLY APPROPRIATE THAT --
AND IN DEFERENCE TO HIM, I THINK
IT IS ONLY APPROPRIATE THAT HE
BE
MR. McCONNELL: MR. PRESIDENT,
I THANK THE SENATOR FOR YIELDING
FOR MY COMMENTS.
I WOULD ASK THAT MY COMMENTS
APPEAR AT THE APPROPRIATE PLACE
IN THE RECORD, NOT TO INTERRUPT
SENATOR BAUCUS'S
WE'VE NOW HAD A VERY, VERY
CLARIFYING VOTE ON THE SENATE
FLOOR ABOUT THE DIRECTION OF OUR
FRIENDS ON THE OTHER SIDE WITH
REGARD TO OUR HEALTH CARE SYSTEM.
YESTERDAY ALL BUT TWO OF THEM
VOTED TO PRESERVE NEARLY HALF A
MILLION DOLLARS IN CUTSO
MEDICARE, THE HEALTH PROGRAM FOR
OUR SENIORS.
IN THE RUN-UP TO THAT VOTE, THEY
SAID THESE CUTS WEREN'T REALLY
CUTS APPEARED THAT MEDICARE
ADVANTAGE IN PARTICULAR ISN'T
REALLY A PART OF MEDICARE,
ARGUMENTS PLAINLY CONTRADICTED
BY
BY THE DEPARTMENT OF HEALTH A
HUMAN SERVICES, BY THE
INDEPENDENT CONGRESSIONAL BUDGET
OFFICE, AND BY THE EXPERIENCE OF
SENIORS THEMSELVES.
SENIORS DO NOT WANT SENATORS
FOOLING WITH MEDICARE
LET ME SAY THAT AGAIN.
SENIORS DO NOT WANT SENATORS
FOOLING WITH MEDICARE.
THEY WANT US TO FIX IT, TO
STRENGTHEN IT, TO PRESERVE IT
FOR FUTURE GENERATIONS, NOT RAID
IT LIKE A GIANT PIGGY BANK IN
ORDER TO CREATE SOME ENTIRELY
NEW GOVERNMENT PROGRAM.
YESTERDAY'S VOTE WAS
PARTICULARLY DISTRESSING FOR THE
MILLIONS OF SENIORS ON MEDICARE
ADVANTAGE.
SO TODAY MEMBERS WILL HAVE AN
OPPORTUNITY TO UNDO THE DAMAGE
THEY VOTED TO DO TO THIS
PROGRAM.
WITH YESTERDAY'S VOTE -- WITH
YESTERDAY'S VOTE, PROPONENTS OF
THIS MEASURE AUTHORIZED $120
BILLION IN CUTS TO MEDICARE
ADVANTAGE, AND IN THE
THEY EXPRESSLY VOTED TO VIOLATE
THE PRESIDENT'S PLEDGE THAT
SENIORS WHO LIKE THE PLANS THEY
HAVE CAN KEEP THEM.
THERESIDENT HAS SAID
WHO LIKE
KEEP THEM.
BECAUSE YOU CAN'T CUT $120
BILLION FROM A BENEFITS PROGRAM,
OBVIOUSLY, WITHOUT CUTTING
BENEFITS.
THE CONGRESSIONAL BUDGET OFFICE
HAS BEEN CRYSTAL CLEAR ON THIS MATTER.
WHEN ASKED ABOUT THE EFFECT
THESE CUTS WOULD HAVE ON
MEDICARE ADVANTAGE, THE DIRECTOR
OF UNEQUIVOCAL.
HE SAID THAT APPROXIMATELY HALF
-- APPROXIMATELY HALF -- OF
MEDICARE ADVANTAGE BENEFITS WILL
BE CUT FOR NEARLY 11 MILLION
SENIORS ENROLLED IN THIS PROGRAM
UNDER THIS BILL.
NOW, THIS IS THE DIRECTOR OF THE CONGRESSIONAL BUET OFFIC
BEING
HE SAID THAT APPROXIMATELY HALF
OF MEDICARE ADVANTAGE BENEFITS
WILL
MILLION SENIORS ENROLLED IN THIS
PROGRAM UNDER THIS BILL.
THAT'S WHAT OUR FRIENDS ON THE
OTHER SIDE VOTED FOR YESTERDAY,
AND THEY KNOW IT.
ONE DEMOCRAT LAST NIGHT WAS EXPLICIT.
HE ADMITTED THAAFTER
YESTERDAY'S VOTES, DEMOCRATS
WON'T BE ABLE TO SAY THAT --
QUOTE -- "IF YOU LIKE WHAT YOU
HAVE, YOU CAN KEEP
THIS IS ONE OF OUR DEMOCRAT
COLLEAGUES YESTERDAY SAYING, "IF
YOU LIKE WHAT YOU HAVE, YOU CAN
KEEP IT" CAN TO LONGER BE SAID.
AND HE WENT ON TO SAY -- QUOTE
-- "THAT BASIC COMMITMENT THAT A
LOT OF US AROUND HERE HAVE MADE
WILL BE CALLED INTO QUESTION."
I THINK TT'S HIGHLY LIKELY.
SO OUR FRIENDS HAVE A COUPLE OF
CHOICES HERE TODAY.
THEY CAN REAFFIRM THEIR PLAN TO
CUT BENEFITS FOR NEARLY
ONE-FOURTH
ENROLLED IN MEDICARE, THEY CAN
ADMIT THAT THE PRESIDENT'S
PLEDGE ABOUT
LIKE -- ABOUT KEEPING THE PLAN
YOU LIKE NO LONGER APPLIES, OR
THEY CAN REVERSE PART OF
YESTERDAY'S VOTE LATER TODAY BY
VOTING WITH REPUBLICANS TO
RESTORE THOSE CUTS TO MEDICARE
ADVANTAGE.
MR. PRESIDENT, I YIELD THE
FLOOR.
MR. BAUCUS: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: [
SOME REMARKS RECORD.
THE PRESIDING OFFICER: WITHOUT
OBJECTION. MR. BAUCUS: AGAIN,
MR. PRESIDENT, THAT MEANS IF WE
DO NOTHING IN FEWER THAN TEN
YEARS
TO DEDICATE HALF OF THEIR
HOUSEHOLD BUDGETS TO HEALTH
INSURANCE.
FOR YEARS WE HAVE HEARD THE
WARNINGS FROM FEDERAL BUDGET
EXPERTS AND EVERY DAY WE HEAR
SIMPLY CANNOT AFFORD THE HEALTH
CARE THAT THEY NEED.
NOW WE HAVE THE OPPORTUNITY TO ACT.
AS I MENTIONED, THE NATION'S
LEADING ECONOMISTS AND FEDERAL
BUDGET EXPERTS LAID OUT STRATEGIES AND OPTIONS FOR
GETTING COSTS
WE TOOK THOSE RECOMMENDATIONS IN
THIS BILL TO HEART, AND NOW WE
HAVE A TBHAIL PASSES THE T
AND NOW WE HAVE A BILL THAT
PASSES THE TEST ALSO OF FISCAL
RESPONSIBILITY.
DOING NOTHING MEANS HEALTH CARE
SPENDING CONTINUES GROWING
FASTER THAN OUR ECONOMY.
DOING NOTHING MEANS ENTITLEMENT
SPENDING MORE THAN DOUBLES BY
THE YEAR 2050, TACKING ONE-FIFTH
OF OUR G.D.P. -- TAKING
ONE-FIFTH OF OUR G.D.P.
BUT IT IS NOT SIMPLY THE FEDERAL
BUDGET ON
IT IS THE FAMILY BUDGET, TOO.
AS I MENTIONED A FEW MOMENTS
AGO, IN TOTAL, WE TODAY SPEND E8 80
TIMES AS MUCH ON HEALTH CARE AS
WE DID FIVE DECADES AGO -- 80 TIMES.
AND NOW FAMILY BUDGETS ARE
BREAKING UNDER THE STRAIN.
THE COST TO TH OF THE AVERAGE FAMILY
HEALTH CARE PLAN WILL REACH
$24,000 IN THE YEAR 2016.
THAT REPRESENTS AN 84% INCREASE
OVER 2008 PREMIUM LEVELS.
IT'S DANGEROUS STOPPING IN THE
MIDDLE OF A SPEECH.
YOU HAVE TO FIGURE OUT WHERE YOU
WERE.
WE HAVE MANY REASONS TO VOTE FOR
THIS BILL.
IT PROTECTS AND EVEN INCREASES
MEDICARE BENEFITS FOR SENIORS.
IT ACHIEVES NEAR-UNIVERSAL
COVERAGE IN LESS THAN TEN YEARS.
IT SLOWS THE GROWTH OF FEDERAL
HEALTH CARE SPENDING.
IT STOPS INSURANCE INDUSTRY
DISCRIMINATION AND BASED ON
INDEPENDENT NONPARTISAN
ANALYSIS, IT MAKES
DENT
THIS CHART BEHIND ME REPRESENTS
THAT
TWO WEEKS AGO
BUDGET OFFICE AND THE JOINT
COMMITTEE ON TAXATION CONFIRMED
IN NO UNCERTAIN TERMS THAT
DEFICITS GO DOWN UNDER THIS PLAN
AND THE OFFICIAL COST ESTIMATE
READS AS FOLLOWS:
THE CONGRESSIONAL BUDGET OFFICE
AND THE JOINT CMITTEE ON TAX
ESTIMATE THAT, ON BALANCE, THE
DIRECT SPENDING AND REVEN
EFFECTS OF ENACTING
LEGISLATION WOULD YIELD
REDUCTION IN FEDERAL DEFICITS OF
$130 BILLION OVER THE YEARS 2010
TO 2019.
THAT'S REPRESENTED
BAR THERE ON THE LEFT.
IT IS A NET $130 BILLION
REDUCTION DURING THE FIRST TEN
YEARS OF THIS B
IN ADDITION, -- IN ADDITION TO
REDUCING THE FEDERAL DEFICIT,
THE C.B.O. ALSO CONFIRMS THIS
BILL IS FULLY PAID FOR.
IT DOES NOT ADD ONE DIME
FEDERAL DEFICIT.
IN FACT, IT REDUCES, AS I
MENTIONED, OUR DEFICIT BY $130
BILLION OVER THE NEXT TEN YEARS.
BUT IT ALSO STANDS THE TEST OF
TIME.
THE SECOND DECADE, THE DEFICIT
DECREASES BY ANOTHER AMOUNT,
THIS TIME BY A MUCH GREATER
AMOUNT -- BY $650 BILLION.
AND BY THE END OF THE THIRD
DECADE, OUR CHILDREN WOULD
BENEFIT FROM A REDUCTION EQUAL
TO -- CLOSE TO 2% OF GROSS
DOMESTIC PRODUCT.
THAT'S MUCH MORE THAN THE SECOND
DECADE, WHICH IS A QUARTER --
.25 -- PRODUCT.
YOU CAN SEE IN EACH OF THE
DECADES -- THE FIRST DECADE,
$130 BILLION, THE SECOND
THE REDUCTION OF THE D.V.D. $650
BILLION, AND IN THE -- AND THE
THIRD SENIOR SENATOR MUCH MORE THAN THAT.
I CAN'T DO THE C
BUT R
ROUGHLY IT WOULD BE HUNDREDS OF
BILLIONS OF DOLLARS GREATER THAN
THE REDUCTION IN THE SECOND
DECADE.
THIS IS SERIOUS DEFICIT
REDUCTION.
IN TODAY'S DOLLARS, THAT WOULD
MEAN THAT THERE WOULD BE MORE
THAN -- THAT WOULD BE MORE THAN
WE SPEND ON THE ENTIRE MEDICAID
PROGRAM THIS YEAR.
ACCORDING TO C.B.O. THIS BILL
ALSO SLOWS THE GROWTH IN
MEDICARE COSTS, WHICH HAS BEEN A PRINCIPAL GOAL IN OUR HEALTH
CARE DEBATE FROM DAY
MEDICARE SPEND WOOING GROW 6%
ANNUALLY INSTEAD OF 8%
IN OTHER WORDS, MEDICARE WOULD
CONTINUE TO GROW BUTNLIKE
TODAY IT WOULD GROW AT A
SUSTAINABLE RATE.
OF COURSE, NO PROJECTIONS, EVEN
FROM THE CONGRESSIONAL BUDGET
OFFI
WE CAN SAFELY SAY THIS BILL WILL
PUTS ON THE RIGHT TRACK.
I CAN SAFELY SAY THIS BILL IS
BETTER THAN DOING NOTHING.
NO HONEST ASSESSMENT CHALLENGES
THE CASE FOR ENACTING IT GNA GNAW TO
SLOW THE GROWTH -- IT NOW TO
SLOW THE GROWTH OF SPENDING.
D NO HONEST ASSESSMENT OF THIS
BILL CHALLENGES THE C.B.O. ANALYSIS.
I HAVE NOT HEARD AN HONEST
CHALLENGE TO THIS -- TO THE
C.B.O. ANALYSIS, NOR HAVE I
HEARD OF AN HONEST CASE FOR NOT
ACTING NOW TO SLOW THE GROWTH OF SPENDING.
WHICH MEANS WE HAVE MANY REASONS
TO PASS HEALTH CARE REFORM, NOT
THE LEAST OF WHICH IS THE
LONG-TERM COST OF RESTORING THE
HETION OF OUR NATION.
FORCED INTO BANKRUPTCY BY
MEDICAL TRAGEDY, THIS IS ABOUT
STOPPING INSURANCE INDUSTRY DISCRIMINATION.
THIS IS ABOUT SAVING MEDICARE
FOR OUR SENIORS AND REDUCING THE
DEFICIT FOR OUR GRANDCHILDREN.
MR. PRESIDENT, I DON'T KNOW WHAT
OTHER SENATORS WE HAVE.
I GUESS SENATOR BINGAMAN WOULD
LIKE TO SEEK
THE TIME WE HAVE.
HAVE AND HOW MANY SPEAKERS WE HAVE.
THE PRESIDING OFFICER: 40
MINUTES.
MR. BAUCUS: 40 MINUTES.
HOW MANY SPEAKERS?
OKAY, 15.
GO FOR IT.
MR. BINGAMAN: MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM NEW MEXICO.
MR. BINGAMAN: LET ME FIRST
THANK SENATOR BAUCUS FOR HIS
LEADERSHIP ON THIS ISSUE.
I MENTIONED TO HIM MANY TIMES
AND STRONGLY BELIEVE THAT
WITHOUT HIS LEADERSHIP, WE WOULD
NOT BE WHERE WE ARE TODAY IN OUR
EFFORT TO REFORM HEALTH CARE IN THIS COUNTRY.
SO I CONGRATULATE HIM ON THE
SUPERB EFFORT HE'S MADE.
I WANT TO SPEND A FEW MINUTES
TALKING ABOUT HEALTH CARE REFORM
BOTH AS IT AFFECTS THE COUNTRY,
BUT ALSO AS IT AFFECTS MY HOME
STATE OF NEW MEXICO.
FIRST I'D LIKE TO DISCUSS THE
CONTEXT FOR THIS HEALTH REFORM
BILL, AND THAT IS THE VERY
SERIOUS PROBLEM THAT WE FACE AS
A COUNTRY WITH GROWING COSTS OF
HEALTH CARE IF THE CONGRESS FAILS TO ACT.
NOW WE HAVE A CHART THAT I'LL
PUT UP, SINCE EVERYONE'S GOT
CHART.
THIS IS A CHART
WHAT'S HAPPENING TO
CARE COS
HAPPENING SINCE 1960.
AND YOU CAN SEE THAT AS
PERCENT OF THE GROSS DOMESTIC
PRODUCT, BACK IN 1960 WE WERE
SPENDING RIGHT AT 5% OF OUR
GROSS DOMESTIC PRODUCT ON ALL
HEALTH CARE IN THIS COUNTRY.
TODAY WE ARE SPENDING MUCH MORE
LIKE 16% OF THE GROSS DOMESTIC
PRODUCT ON HEALTH CARE.
AND THE PROJECTIONS FOR THE
FUTURE IF WE DO NOT ACT TO
REFORM THE HEALTH CARE SYSTEM,
THE PROJECTIONS FOR THE
ARE VERY SERIOUS INDEED.
LET ME ALLUDE TO AN ARTICLE THAT
WAS IN THE MORNING "NEW YORK
TIMES."
THIS IS BY OUR, BY
AWARD-WINNING, THE NOBLE
AWARD-WINNING ECONOMISTAUG
PAUL KRUGMAN AT PRINCETON UNIVERSITY.
HE TALKS ABOUT THIS ISSUE OF
FISCAL RESPONSIBILITY AND THE
IMPACT OF HEALTH CARE REFORM ON
THE DEFICIT AND TALKS ABOUT HOW
SOME SENATORS SEEM TO BELIEVE
THAT THEY HAVE CONCERNS ABOUT
GOING AHEAD WITH THIS HEALTH
CARE REFORM BILL BECAUSE OF WHAT
IT MIGHT COST.
HE MAKES THE POINT, HE SAYS "IF
THEY ARE REALLY CONCERNED WITH
FISCAL RESPONSIBILITY, THEY
SHOULD NOT BE WORRIED ABOUT WHAT
WOULD HAPPEN IF HEALTH REFORM PASSES.
THEY SHOULD INSTEAD BE WORRIED
ABOUT WHAT WOULD HAPPEN IF IT
DOES NOT PASS.
FOR AMERICA CAN'T GET CONTROL OF
ITS BUDGET WITHOUT CONTROLLING
HEALTH CARE COSTS.
AND THIS IS OUR LAST BEST CHANCE
TO DEAL WITH THESE COSTS IN A
RATIONAL WAY."
MR. PRESIDENT, I'D ASK THAT HIS
FULL COLUMN FROM "THE NEW YORK
TIMES" THIS MORNING BE INCLUDED
IN THE RECORD FOLLOWING MY REMARKS.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BINGAMAN: AS AS THIS CHART
DEMONSTRATES, THE ONE HERE ON MY
LEFT, ACCORDING TO THE
CONGRESSIONAL BUDGET
WE DON'T ACT -- IF WE DON'T ACT
TO DEAL WITH THE GROWTH IN
HEALTH CARE COSTS, FEDERAL
SPENDING ON MEDICARE AND
MEDICAID COMBINED WILL GROW FROM
5% OF G.D.P. TODAY TO ALMOST 10%
BY 2035.
BY 2080, THE GOVERNMENT WOULD BE
SPENDING ALMOST AS MUCHS A
SHARE OF THE ECONOMY ON JUST ITS
TWO MAJOR HEALTH CARE PROGRAM
AS IT HAS SPENT ON ALL OF ITS
PROGRAMS AND SERVICES IN RECENT YEARS.
LET ME PUT UP ANOTHER CHART THAT
DEMONSTRATES THAT
INCREASE IN COST IS NOT THE
RESULT OF OUR AGING POPULATION.
WE DO HAVE AN AGING POPULATION,
AND THAT DOES ADD TO THE COST OF
HEALTH CARE, BECAUSE AS PEOPLE
GET OLDER THEY TEND TO NEED
HEALTH CARE.
BU WHAT THIS CHART SHOWS IS THE
DARK BLUE HERE SHOWS THE
INCREASE THAT IS EXPECTED IN
HEALTH CARE COSTS BY VIRTUE OF AGING.
BUT THE LIGHTER BLUE TALKS ABOUT
THE EFFECT OF EXCESS COST GROWTH.
AND THAT IS NOT RELATED TO AGING.
THAT IS JUST THAT THE GROWTH
THAT HEALTH CARE COSTS ARE OUT
OF CONTROL IN OUR CURRENT
SYSTEM.
SUCH SPENDING IS UNSUSTAINABLE.
IT HAS LED THE CONGRESSIONAL
BUDGET OFFICE TO SAY THAT
SLOWING THE GROWTH RATE OF
OUTLAYS FOR MEDICARE AND
MEDICAID IS THE CENTRAL
LONG-TERM CHALLENGE FOR FISCAL
POLICY.
MOREOVER, ACROSS THE COUNTRY
PREMIUMS CONTINUE TO INCREASE.
THEY'RE BECOMING MORE AND MORE
UNAFFORDABLE FOR INDIVID
FOR BUSINESSES.
I HEAR ON A REGULAR BASIS AS I
GO AROUND NEW MEXICO -- AND I'M
SURE ALL MY COLLEAGUES HEAR FROM
THEIR CONSTITUENTS AS THEY
TRAVEL IN THEIR STATES -- THAT
PEOPLE CANNOT CONTINUE TO PAY
MORE AND MORE EACH YEAR FOR
THEIR HEALTH CARE COVERAGE.
ACCORDING TO AN AUGUST REPORT BY
THE COMMONWEALTH FUND,
NATION
EMPLOYER-SPONSORED HEALTH
INSURANCE INCREASED 119% BETWEEN
1999 AND 2008.
AND IF COST GROWTH CONTINUES ON
ITS CURRENT COURSE, THOSE
PREMMS COULD INCREASE ANOTHER
94% TO AN AVERAGE OF $23-RBGZ
84 -- $23,842 PER FAMILY BY 20.
I'M NOT SURE WHAT THE
CIRCUMSTANCE IS IN MANY STATES
BUT I KNOW IN THE STATE OF NEW
MEXICO, THERE ARE MANY FAMILIES
THAT CANNOT AFFORD TO BE PAYING
$23-RBGZ -- $23,800 IN HEALTH
CARE PREMIUMS.
NOWHERE IS THE GROWTH FELT MORE
ACUTELY THAN IN MY STATE.
WITHOUT HEALTH REFORM IN MY
STAT THESE ARE THE PROJECTIONS.
WE ARE EXPECTED TO EXPERIENCE
THE GREATEST INCREASE IN HEALTH
INSURANCE PREMIUMS OF ANY STATE
IN THE UNION.
FOR EXAMPLE, THE AVERAGE
EMPLOYER-SPONSORED INSURANCE
PREMIUM FOR A FAMILY IN NEW
MEXICO WAS ABOUT $6,000 IN THE
YEAR 2000.
BY 2006, THIS RATE HAD ALMOST
DOUBLED, OR THE COST HAD ALMOST
DOUBLED TO $11,000.
BY 2016, THE AMOUNT IS EXPECTED
TO RISE TO AN ASTONISHING
IN ADDITION, HEALTH INSURANCE
LARGER PERCENTAGE OF NEW
MEXICO'S INCOME, THE INCOME OF
THE AVERAGE NEW MEXICO FAMILY
THAN ALMOST ALL OTHER STATES.
WE ARE PAYING 31.18%, OVER 31%
OF THE AVERAGE INCOME OF A
FAMILY IN INCOME INCOME IS GOING
TO PAY -- FAMILY IN NEW MEXICO
IS GOING TO
THIS IS EXPECTED TO GROW TO 66%
IF WE DO NOT REFORM OUR HEALTH
CARE SYSTEM.
IT'S IMPORTANT TO HIGHLIGHT THAT
THE HIGHER SPENDING ON HEALTH
CARE IN THE UNITED STATES DOES
NOT NECESSARILY PROLONG LIVES.
I HEAR A LOT OF SPEECHES AROUND
HERE ABOUT HOW WE HAVE THE
GREATEST HEALTH CARE SYSTEM IN THE WORLD.
WE'RE THE ENVY OF THE WORLD, AND
PEOPLE WILL JUST LOVE TO HAVE
ACCESS TO OUR HEALTH CARE
SYSTEM.
THIS CHART ILLUSTRATES THAT IN
2000, THE UNITED STATES SPENT
MORE ON HEALTH CARE THAN ANY
OTHER COUNTRY IN THE WORLD, AN
AVERAGE OF $4,500 PER PERSON.
THAT WAS IN 2000.
SWITZERLAND WAS THE SECOND
HIGHEST AT $3,300, SUBSTANTIALLY LESS.
ESSENTIALLY PAY, IN SWITZERLAND
THE COST PER PERSON WAS 71% OF
WHAT IT WAS IN THE UNITED STATES
RING THAT YEAR.
NEVERTHELESS, THE AVERAGE U.S.
LIFE EXPECTANCY COMES OUT AT
27th IN THE WORLD.
OUR LIFE EXPECTANCY AVERAGE IS
77 YEARS.
MANY COUNTRIES -- 26 TO BE
EXACT -- ACHIEVE HIGHER LIFE
EXPECTANCY RATES WITH
SIGNIFICANTLY LOWER SPENDING ON
HEALTH CARE.
DATA FROM THE MACKENZIE GLOBAL
INSTITUTE CLEARLY INDICATES THAT
THERE IS A CONSIDERABLE LEVEL OF
WASTE IN OUR CURRENT SYSTEM.
MACKENZIE ESTIMATES THAT THE
UNITED STATES SPENDS NEARLY $500
BILLION ANNUAL IN EXCESS OF
OTHER SIMILARLY SITUATED NATIONS.
OF THIS, ABOUT $224 BILLION IN
EXCESS COSTS ARE FOU IN
HOSPITAL CARE.
ABOUT $178 BILLION ARE FOUND IN
OUTPATIENT CARE.
TOGETHER THESE ACCOUNT FOR MORE
THAN 80% OF U.S. SPENDING ABOVE
THE LEVELS OF OTHER NATIONS.
HERE'S ONE OTHER CHART.
THIS IS ONE THAT I'VE USED
BEFORE HERE ON THE SENATE FLO.
NOT SURPRISINGLY, AS COSTS AND INEFFICIES CONTINUE TO
BUILD, ACCESS TO HEALTH CARE IS
BECOMING MORE AND MORE DIFFICULT
FOR MIDDLE- AND LOWER-INCOME AMERICANS.
THIS CHART INDICATES THE RATE OF
UNINSURANCE THROUGHOUT THE
COUNTRY.
FIRST, ON THE LEFT-HAND SIDE,
THIS IS IN THE YEAR
ON THE RIGHT-HAND SIDE, THE YEAR IS 2008.
YOU CAN SEE THE DARK COLOR, THE
DARK BLUE STATES ARE STATES
WHERE 23% OR MORE OF THE
POPULATION AGE 18 TO 64 ARE
UNINSURED.
BACK IN THE YEAR 2000, NEW
MEXICO AND TEXAS WERE THE ONLY
TWO STATES WHERE THE RATE OF
UNINSURANCE EXCEEDED 23%.
NOW YOU CAN SEE THAT THE RATE OF
UNINSURANCE EXCEEDS 23% FOR MANY
OF THE STATES, PARTICULARLY
ACROSS THE SOUTHERN PART OF OUR COUNTRY.
SO, WE HAVE A VERY SERIOUS
PROBLEM THAT NEEDS ADDRESSING.
IT'S CLEAR THAT THE U.S. HEALTH
CARE SYSTEM IS FAILING MANY
AMERICANS, AND THE SITUATION IS
BECOMING MORE AND MORE URGENT.
ACCORDING TO A STUDY PUBLISHED
BY THE HARVARD MEDICAL SCHOOL IN
AUGUST, MEDICAL COSTS HAVE LED
TO ALMOST TWO-THIRDS OF THE
BANKRUPTCIES IN THIS COUNTRY.
MORE THAN 62% OF THE
BANKRUPTCIES ARE ATTRIBUTABLE TO HEALTH CARE PROBLEMS.
THE STUDY FOUND THAT MOST
MEDICAL DEBTORS WERE WELL
EDUCATED, OWNED THEIR OWN HOMES,
HAD MIDDLE-CLASS OCCUPATIONS,
AND SHOCKINGLY THREE-QUARTERS
HAD HEALTH INSURANCE.
SO THESE WERE PEOPLE WHO HAD
COVERAGE, BUT THE COVERAGE WAS
NOT ADEQUATE TO MEET THE NEEDS.
UNFORTUNATELY FOR MANY
INDIVIDUALS, T VERY HIGH COST
OF MEDICAL CARE LEAVES THEM TO
DEY OR TO AVOID RECEIVING
MEDICAL CARE ALTOGETHER.
THE URBAN INSTITUTE REPORTS THAT
137,000 PEOPLE IN THIS COUNTRY
DIED BETWEEN 2000 AND 2006
BECAUSE THEY LACKED HEALTH
INSURANC
THAT INCLUDES 22,000 P
THE YEAR 2006.
SO CLEARLY, THE NEED FOR HEALTH,
NATIONAL HEALTH REFORM HAS NEVER
BEEN SO GREAT.
THE PATIENT PROTECTION AND
AFFORDABLE CARE ACT, WHICH IS
THE LEGISLATION WE ARE DEBATING
HERE ON THE FLOOR, WHICH WAS
INTRODUCED BY SENATOR REID AND
OTHERS A FEW WEEKS AGO AND
INCLUDES THE KEY REFORMS THAT WE
HAVE COME UP WITH AND THAT THE
EXPERTS HAVE COME UP WITH THAT
ARE AIMED AT ADDRESSING SHE THESE
VERY SERIOUS PROBLEMS WHILE
PROTECTING THE ASPECTS OF OUR
SYSTEM THAT ARE WORKING TODAY.
FIRST, THIS BILL INCLUDES LONG
OVER DUE REFORMS TO INCREASE THE
QUALITY OF THE HEALTH CARE
SYSTEM WHILE REDUCG OVERALL
COSTS.
THE LEGISLATION INCLUDES PAYMENT
REFORMS THAT I'VE CHAMPIONED TO
SHIFT FROM A FEE-FOR-SERVICE
PAYMENT SYSTEM TO A BUNDLE
PAYMENT SYSTEM.
THIS WILL RESHAPE OUR HEALTH
CARE REIMBURSEMENT SYSTEM TO
REWARD BETTER CARE AND NOT
SIMPLY MORE CARE AS IT DOES
TODAY.
SECOND, IT INCLUDES A BROAD NEW
FRAMEWORK TO ENSURE THAT ALL
AMERICANS HAVE ACCESS TO QUALITY
AND AFFORDABLE HEALTH CARE.
THIS INCLUDES THE CREATION OF A
NEW HEALTH INSURANCE EXCHANGE IN
EACH STATE WHICH WILL PROVIDE
AMERICANS A CENTRALIZED SOURCE
OF MEANINGFUL PRIVATE INSURANCE
AS WELL REFUNDABLE TAX CREDITS
TO ENSURE THAT COVERAGE IS
AFFORDABLE.
AND FINALLY, THESE NEW HEALTH
INSURANCE EXCHANGES WILL HELP
IMPROVE CHOICES BY ALLOWING
FAMILIES AND BUSINESSES TO
COMPARE INSURANCE PLANS ON THE
BASIS OF PRICE AND PEFORMANCE.
THIS PUTS FAMILIES RATHER THAN
THE INSURANCE COMPANIES OR THE
GOVERNMENT BUREAUCRATS IN CHARGE OF HEALTH CARE.
IT HELPS PEOPLE TO DECIDE WHICH
QUALITY, AFFORDABLE INSURANCE
OPTION IS RIGHT FOR THEM.
THE CONGRESSIONAL BUDGET OFFICE,
WHICH IS CITED HERE -- AND I
THINK IT'S HEALTHY, QUITE
FRANKLY, I NOTICE THAT THE CONGRESSIONAL BUDGET OFFICE IS
CITED BY BOTH THE DEMOCRATS AND
THE REPUBLICANS IN THIS DEBATE.
THAT IS A CREDIT TO THE
CONGRESSIONAL BUDGET OFFICE.
THEY ARE SEEN AS NONPARTISAN.
THEY ARE NONPARTISAN, AND I
CONGRATULATE DOUG ELMENDORF FOR
THE GOOD WORK THAT THE C.B.O.
HAS BEEN DOING IN SUPPORTF OUR
EFFORTS TO COME TO THE RIGHT
ANSWER ON HEALTH CARE REFORM.
BUT THE C.B.O. FORECASTS THAT
THIS LEGISLATION WOULD NOT ADD
TO THE DEFICIT, AS THE CHART
THAT SENATOR BAUCUS HADP HERE
JUST A FEW MINUTES AGO CLEARLY
INDICATES, THE DEFICIT WOULD BE
REDUCED IN THE FIRST TEN YEARS
BY $130 BILLION.
IT WOULD BE REDUCED IN THE
SECOND TEN YEARS, GOING UP TO
2029, BY SOMETHING OVER $600
BILLION.
LET ME JUST ALSO POINT OUT THE
CONTRAST HERE.
WE'RE TALKING HERE ABOUT A BILL
WHICH
OFFICE SAYS WILL REDUCE THE SIZE
OF THE DEFICIT IN FUTURE DECADES.
I CAN REMBER A COUPLE OF
CONGRESSES AGO WHEN WE HAD
DEBATE HERE ON ADDING SUBPART-D
TO MEDICARE, PART-D TO
AND THERE WERE MANY ON THE FLOOR
HERE WHO ARE CONCERNED ABOUT
COSTS TODAY -- AT LEAST THEY SAY
SO IN THEIR SPEECHES -- WHO WERE
VERY ANXIOUS TO ADD THAT
LEGISLATION TO MEDICARE, ADDING
ANOTHER $500 BILLION -- THAT WAS
ESTIMATED BY THE C.B.O. AT THAT
TIME -- ANOTHER
OVER A TEN-YEAR PERIOD TO THE
COST THA MEDICARE WAS MARRIED.
THE EFFORTS TO BRING THE COSTS
DOWN IN MEDICARE IS ESSENTIAL IF
WE'RE GOING TO KEEP MEDICARE
SOLVENT IN THE FUTURAND PART
OF THE SOLVENCY PROBLEM MEDICARE
HAS IN THE FUTURE FRANKLY IS
RELATED TO WHAT WE DID IN SUBPART-D.
MR. PRESIDENT, I SEE MY TIME IS
UP.
AND THE ARE OTHER WAITING TO
SPEAK.
LET ME
UNANIMOUS CONSENT THAT THE
BALANCE OF MY STATEMENT BE
INCLUDED IN THE
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
THE SENATOR FROM
BUT HOW MUCH TIME REMAINS UNDER THE
TIME OF THE MAJORITY?
THE PRESIDING OFFICER: 24 MR. BAUCUS: I YIELD TEN
MINUTES TO THE SENATOR FROM
MASSACHUSETTS.
A SENATOR: THANK YOU.
MR. BAUCUS: WE MIGHT BE ABLE
TO FIND EXTRA TIME.
RIGHT NOW THAT'S ALL WE HAVE IN
THIS FIRST BLOCK.
BUT SOMETIMES WE CAN WORK THINGS
OUT IF Y LONGER.
BUT RIGHT NOW IT IS TEN.
MR. KIRK: THANK YOU,
MR. PRESIDENT.
TODAY APPROXIMATELY 2 MILLION OF
-- 200 MILLION OF OUR CITIZENS
ARE ELDERLY.
THEY ARE FAMILY MEMBERS AND
LOVED ONCE -- VALUABLE,
CHALLENGED AND OFTEN FORGOTTEN
BUT THEY WERE N FORGOTTEN BY
THEIR FRIEND AND ADVOCATE,
SENATOR TED KENNEDY.
HE UNDERSTOOD THAT A FAIR AND
CIVILIZED SOCIETY SHOULD BE
JUDGED ON HOW IT TREATS ITS MOST
VULNERABLE CITIZENS.
SADLY, MILLIONS OF SENIORS AND
PERSONS LIVING WITH DISABILITIES
STRUGGLE TO OBTAIN THE SERVICES
AND SUPPORTS THEY NEED TO LIVE
FULFILLING LIVES AND TO REMAIN
IN THEIR COMMUNITIES, AMONG
THEIR FRIENDS AND FAMILIES, IN
WHAT THEY HOPED WOULD BE THEIR
PRODUCTIVE, GOADEN YEARS.
SENATOR KENNEDY UNDERSTOOD IT IS
MORALLY WRONG FOR SO MANY ME
AND WOMEN WHO NEED ASSISTANCE TO
BE FORCED TO FACE THE
HEARREAKING DECISIONS -- DO I
GIVE UP MY AMERICAN DREAM IN
ORDER TO QUALIFY FOR MED CAIRKSD
THE ONLY GOVERNMENT PROGRAM THAT
CAN PROVIDE ME WITH THE SUPPORT
I NEED?
OR DO I FOREGO MY INDEPENDENCE
AND RESIGN MYSELF TO LIVING THE
REST OF MY LIFE CONFINED TO A FACILITY?
SENATOR KENNEDY ALSO UNDERSTOOD
THAT IT IS MORALLY WRONG WHEN
THAT INFIRMED OR ELDERLY
INDIVIDUAL'S FRIENDS OR LOVED
ONES MUST ALSO FACE
HEARTBREAKING CHOICES.
DO I GIVE UP MY JOB AND COMMIT
MY TIME TO CARE FOR MY INFIRMED
PARENT AT THE EXPENSE OF MY OWN
FAMILY AND CHILDREN, OR DO I
RESIGN MYSELF TO CONFINING MY
AILING MOTHER OR FATHER TO A FACILITY?
FAMILIES ACROSS
UNDERSTAND THIS HARSH CRISIS
TOO WELL.
A RECENT POLL FOUND THAT
60% OF THOSE SURVEYED HAD A
PERSONAL EXPERIENCE
LONG-TERM CARE.
AND AS THIS CHART DEMONSTRATES,
NEARLY
TO SUPPORT HEALTH CARE REFORM IF
-- IF -- IT INCLUDED A LONG-TERM
CARE PROGRAM.
THESE FAMILIES KNOW THAT THE
CURRENT LG-TERM CARE DRY IS
NOT MEETING THEIR CURRENT NEEDS
AND THAT CHANGE MUST COME.
AS ALWAYS, SENATOR KENNEDY CARED
HOW OUR SOCIETY WOULD BE JUDGED.
HE DIDN'T JUST SIT BY.
HE ACTED.
HE DRAFTED THE COMMUNITY LIVING
ASSISTANCE SERVICE AND SUPPORTS
ACT, KNOWN AS THE CLASS ACT,
WHICH WE ARE DEBATING THIS
MORNING.
THIS PROGRAM WAS AT THE HEART OF
HIS EFFORT TO HELP PEOPLE WITH
FUNCTIONAL LIMITATIONS AND THEIR
FAMILIES TO OBTAIN THE SERVICES
AND SUPPORTS THEY NEED.
IT GIVES THEM THE CHANCE TO
MAINTAIN THEIR INDEPENDENCE AND
REMAIN ACTIVE, PRODUCTIVE
MEMBERS OF THEIR COMMUNITIES.
UNDER THE CLASS ACT, A WORKER IN
MASSACHUSETTS OR ANY OTHER STATE
CAN CHOOSE TO PAY A PREMIUM INTO
THIS VOLUNTARY INSURANCE PROGRAM
THROUGH AFFORDABLE PAYROLL
DEDUCTIONS.
AFTER CONTRIBUTIN
YEARS, THEY BECOME ELIGIBLE FOR
A CASH BENEFIT OF AT LEAST
DAY
THAT CASH
DIFFERENCE IN ALLOWING A
DISABLED PERSON TO LIVE WITH
INDEPENDENCE, SELF-RESPECT, AND DIGNITY.
FOR EXAMPLE, IT CAN PAY FOR
HAVING A RAMP INSTALLED TO THEIR
HOME OR TO PAY FOR NEEDED
TRANSPORTATION OR TO PURCHASE A
COMPUTER TO WORK FROM HOME AND
REMAIN SELF-SUFFICIENT.
IT CAN ALSO PAY FOR A CARE GIVER
TO COME TO THEIR HOME, HELP THEM
BATHE, GET DRESSED, AND COOK
MEALS, SERVICES THAT OTHERWISE
OFTEN FALL TO FAMILY AND FRIENDS
WHO ARE FORCED TO WORK REDUCED
HOURS ON THEIR OWN JOBS
THOSE JOBS ALTOGETHER TO PROVIDE
THAT NEEDED CARE.
CURRENTLY, LONG-TERM CARE AS
KNOW IT IS PAID FOR THROUGH A
FRAGMENTED COMBINATION OF
SOURCES INCLUDING FAMILY
BUDGETS, MEDICAID, MEDICARE, AND
PRIVATE INSURANCE.
WITHOUT A PRIOR AND VOLUNTARY
INSURANCE INVESTMENT, WHICH THE
CLASS ACT OFFERS, PAYING FOR
LONG-TERM CARE CAN BE THE
FINANCIALLY -- CAN BE
FINANCIALLY CATASTROPHIC SINCE
NURSING HOMES AND HOME CARE CAN
COST THOUSANDS OF DOLLARS A YEAR.
ONLY O IN FIVE INDIVIDUALS CAN
AFFORD PRIVATE LONG-TERM CARE
INSURANCE AND MANY ARE EXCLUDED
BECAUSE OF PREEXISTING
CONDITIONS.
MEDICARE'S ROLE IN PROVIDING
LONG-TERM SERVICES IS EXTREMELY
LIMITED COVERING ONLY
SHORT-TERM, SKILLED NURSING
CARE, AND HOME HEALTH.
THIS LACK OF OPTION FORS MANY
PEOPLE TO TURN TO MEDICAID,
WHICH IS OUR NATION'S PRIMARY
PAYER AND SOLE SAFETY NET
PROGRAM PROVIDING COMPREHENSIVE
LONG-TERM SERVICES AND SUPPORTS.
BUT WHO IS ELIGIBLE FOR MEDICAID?
PEOPLE ONLY QUALIFY FOR MEDICAID
IF THEY ARE OR BECOME POOR.
THIS CRITERION FCES MANY
FAMILIES TO IMPOVERISH
THEMSELVES TO OBTAIN THE
MEDICAID SUPPORT THEY NEED.
WE HAVE ALL HEARD THE STORIES.
A FAMILY MEMBER WORKS HARD ALL
HIS OR HER LIFE AND THEN, DUE TO
AN ACCIDENT, TY CANNOT AFFORD
TO PAY FOR NEEDED SERVICES AND
SUPPORTS OUT OF THEIR POCKET.
SO THEY NOW MUST GIVE UP THEIR
SAVINGS TO BECOME ELIGIBLE, TO
TURN TO THE GOVERNMENT AND TO
MEDICAID TO PROVIDE THE PROPER
CARE THEY NEED TO SUR
NO ONE
ELDERLY PARENT, NOT THE FAMILY
CAREGIVER, NOT THE GOVERNMENT,
AND NOT MEDICAID.
I HAVE A LETTER FROM A WOMAN WHO
LIVES ON CAPE COD IN
MASSACHUSETTS.
SHE KNOWS FIRST IFIRSTHAND HOW POWERFUL
THE CLASS ACT CAN BE FOR
FAMILIES.
SHE IS CARING FOR A FAMILY
MEMBER THAT IS LEGALLY BLIND AND
INCONTINENT.
SMEE WRITES, "CAYING FOR MY
SISSER AT HOME HAS SAVEDHE
STATE THOUSANDS AND THOUSANDS OF
DOLLARS EVERY YEAR AND WE HAVE
DONE THIS FOR 38 YEARS.
WE ARE HOLDING DOWN FULL-TIME
JOBS WHICH ALSO SUPPLEMENT MY
SISTER'S CARE.
THIS IS WRONG.
INSTEAD OF ENCOURAGE FAMILIES
WHO WANT TO KEEP THEIR LOVED
ONES AT HOME," SHE WRITES, "AND
SAVE THE STATE MONEY, THEY WORK
AGAINST US.
SO I BELIEVE W WILL GIVE UP AND
JUST PLACE THEM IN A NURSING
HOME, WHICH IN TURN COSTS THE
STATE MONEY.
IS THIS NOT CRAZY," SHE ASKS.
SHE IS ASKING THE RIGHT
QUESTION.
THE CLASS ACT WILL HELP TURN
THIS SERIOUS
INTO AN EVERYONE-WINS RESULT.
IT GIVES INDIVIDUALS WITH DISABILITIES AND THEIR FAMILIES
THE FUNDS THEY NEED TO OBTAIN
SOME OF THE SERVICES THEY NEED.
WITHOUT HAVING TO RETURN OR
RETORT TO MEDICAID.
THE CURRENT RELIANCE ON MEDICAID
IS NOT ONLY A STRAIN ON OUR
FAMILIES; IT IS ALSO A STRAIN ON
OUR ALREADY OVERBURDENED
MEDICAID SYSTEM.
TODAY MEDICAID SPENDS NEARLY $50
BILLION A YEAR ON LONG-TERM
SERVICES AND SUPPORTS.
ESTIMATES INDICATE THAT BY 2045,
THAT SPENDING COULD EXCEED $2 BILLION.
OBVIOUSLY, THIS IS UNSUSTAINABLE.
IN ADDITION, THE PRIVATE
ENOUGH TO MEET THE GROWING
DEMAND FOR SUCH CARE.
AGING BABY BOOMERS AND A LONGER
LIFE SPAN WILL INCREASE THE
DEMAND FOR
YET 95% OF PEOPLE OVER 45 DO NOT
HAVE LONG-TERM CARE INSURANCE
AND FEWER AND FEWER PEOPLE ARE
ABLE TO BUY SUCH
MAKE NO MISTAKE, AS IT STANDS
TODAY, IF SOMEONE WITHOUT
ADEQUATE LONG-TERM CARE BECOMES
DISABLED, THEY WILL HAVE TO TURN
TO THE MED
THE HELP THEY NEED.
THE CLASS ACT IS DESIGNED
SPECIFICALLY TO REMEDY THIS
LOOMING CRISIS BY GIVING PEOPLE
AN AFFORDABLE OPTION OTHER THAN
MEDICAID, THE ACT WILL SAVE THE
SYSTEM OVER $1.6 BILLION OVER
THE FIRST FOUR YEARS THAT PEOPLE
START RECEIVING BENEFITS.
NOW SOME
ACT ARGUE THAT THE PROGRAM WILL
NOT BE SUSTAINABLE OVER TIME AND
THAT IT WILL BECOME INS
AND END UP COSTING TAXPAYERS
LARGE AMOUNTS.
THAT ARGUMENT COULD NOT BE
FURTHER FROM THE TRUTH.
AND LET'S GIVE PROPER CREDIT
WHERE IT'S DUE.
WITH THE HELP OF OUR FRIENDS ON
THE OTHER SIDE OF THE AISLE, WE
HAVE TAKEN REAL STEPS TO ENSURE
THAT THE PROGRAM REMAINS SOLVENT
FOR YEARS TO COME.
THE ACT STE ESTABLISHES A STRONG
WORK REQUIREMENT TO MAKE SURE
THAT FUNDS CONTINUE TO COME INTO
THE PROGRAM FROM THE PAYROLL TAX
DEDUCTION OR FROM AN
INDIVIDUAL'S VOLUNTARILY PAID PREMIUM.
IT REQUIRES THE SECRETARY OF
PREMIUMS ANNUALLY, TO ENSURE
THAT THE PROGRAM WILL REMAIN
SOFLTS FOR THE NEXT -- WILL
REMAIN SOLVENT FOR THE NEXT 75
YEARS T DIRECTS THE
IN
PROJECTIONS 25 YEARS IN THE
FUTURE
TAXPAYER FUNDS WILL BE
PAY BENEFITS.
LET ME REPEAT THAT FINAL POINT
SINCE I HAVE OFTEN HEARD IT
MISREPRESENTED.
NO TAXPAYER FUNDS WILL BE USED
TO PAY BENEFITS.
BENEFITS WILL BE PAID THROUGH
SELF-FUNDED AND VOLUNTARY
PREMIUMS.
DURING THE PARKUP IN THE "HELP"
COMMITTEE THIS SUMMER, SENATOR
PROGRAM.
WITH THE HELP OF THE REPUBLICANS
ON THE COMMITTEE, ESPECIALLY
SENATOR GREGG OF NEW HAMPSHIRE,
ADDITIONAL SAFEGUARDS WERE
INCLUDED TO ENSURE THAT THE ACT
WILL STAND ON STRONG FINANCIAL
FOOTING FOR YEARS TO COME.
AFTER THE COMMITTEE ADOPTED
SENATOR GREGG'S 75-YEAR SOLVENCY
AMENDMENT, THE PROGRAM
STRONG WORDS OF SUPPORT FROM
BOTH PARTIES.
WE C
CONSTRUCTIVE CONTRIBUTION.
THIS CLASS ACT WILL DO ALL THE
THINGS IT SHOULD DO:
PROVIDE FINANCIAL AND HEALTH
SECURITY TO ELDERLY AND INFIRMED AMERICANS.
IT'LL STRENGTHENEDICARE.
AND IT'LL MAKE HEALTH REFORM THE
EXACT THING THAT THE AMERICAN
PEOPLE NEEDED.
AND WITH THAT, I YIELD THE FLOOR
AND THANK YOU, MR. PRESIDENT.
THE PR
SENATOR FROM MONTANA.
MR. BAUCUS: MR. PRESIDENT, I
YIELD TO THE SENATOR FROM
WISCONSIN, THE CHAIRMAN OF THE
SPECIAL CO
MR. KOHL: THANK YOU VERY MUCH,
SENATOR BAUCUS.
THE PRESIDING OFFICER: THE
SENA
MR. KOHL: I COME TO THE FLOOR
TODAY TO TALK ABOUT THE MANY
WAYS IN WHICH THIS BILL WILL
HAVE A POSITIVE IMPACT FOR SENIORS.
OVER THE PAST YEAR WE'VE SEEN
CONFUSION ABOUT WHAT HEALTH CARE
REFORM WILL MEAN FOR AMERICANS,
AND PARTICULARLY FOR SENIORS.
I HAD HOPED THAT ONCE THE SENATE
VOTED TO MOVE FORWARD WITH
DEBATE ON ONE MERGED BILL WE
COULD ANSWER WHY HEALTH REFORM
WILL HELP THEM.
UNFORTUNATELY, HERE WE ARE ON
THE FLOOR CONTINUING TO SEND
MIXED PLEDGE MESSAGES ABOUT SOME VERY
CONCRETE PROVISIONS.
I WANT TO HELP SET THE RECORD
STATE FOR OLDER AMERICANS.
THIS HEALTH REFORM BILL IS NOT
GOING TO CUT MEDICARE BENEFITS. INDEPENDENT GROUPS SUCH AS THE
AARP AND THE NATIONAL COMMITTEE
TO PRESERVE SOCIAL SECURITY AND
MEDICARE HAVE SAID THAT THIS
BILL WILL STRENGTHEN MEDICARE
AND NOT HARM IT.
AARP BELIEVES THAT THIS BILL
WILL TRANSITION MEDICARE TO A
MORE EFFICIENT SYSTEM WHERE
QUALITY HEALTH CARE OUTCOMES ARE
REWARDED AND WASTE WHICH
ACCOUNTS FOR UP TO 30% OF
MEDICARE SPEND SOMETHING REDUCED.
IN TERMS OF THE CUTS TO MEDICARE
ADVANTAGE, THIS BILL WILL ONLY
CUT BACK ON OVEAYMENTS TO
THESE PRIVATE MEDICARE PLANS,
BENEFITS WILL NOT BE AFFECTED.
AARP ALSO SUPPORTS THESE CUTS
BECAUSE THEY UNDERSTAND THAT
MOST OF THE OVERPAYMENTS ARE
GOING TO INSURANCE COMPANY
PROFITS, NOT TO SENIORS'
BENEFITS AND THAT THIS
OVERSPENDING IS PUTTING MEDICARE
ON A FASTER PATH TO INSOLVENCY.
EXPERTS SAY THAT HEALTH REFORM
WILL EXTEND THE SOLVENCY OF
MEDICARE TRUST FUND FOR FIVE
YEARS WITHOUT MAKING ONE CUT TO
GUARANTEED BENEFITS.
I UNDERSTAND THAT PEOPLE
COMPLAIN THAT THIS BILL IS TOO LONG.
BUT ANY BILL THAT SEEKS TO OFFER
CHOICE AND MEET THE NEEDS OF SO
MANY AMERICANS IS, BY NECESSITY,
COMPLEX. WE CANNOT GLOSS
OVER THESE VITAL ISSUES, SO I'D
LIKE TO TAKE A MOMENT TO SHARE
WITH YOU SOME OF THE ISSUES THAT
HAVE NOT RECEIVED AS MUCH
ATTENTION BUT ARE NEVERTHELESS
CRUCIAL TO IMPROVI HEALTH CARE SYSTEM.
THERE IS A LOT IN THIS BILL FOR
OLDER AMERICANS, RETIREES AND
THOSE PLANNING AHEAD FOR A
HEALTHY AND HAPPY LONG LIFE.
THE AGING COMMITTEE HAS WORKED
CLOSELY WITH THE LEADERSHIP OF
THE "HELP" AND FINANCE
COMMITTEES TO INCLUDE SEVERAL OF
OUR PROVISIONS, MOST OF WHICH
HAVE BIPARTISAN SUPPORT.
I'D LIKE PARTICULARLY TO THANK
SENATOR BAUCUS, SENATOR DODD,
SENATOR HARKIN, AND MAJORITY
LEADER REID FOR BEING SO WILLING
IMPORTANT ISSUES.
WE HAVE ENLISTED HELP FROM
SENIORS' GROUPS OF EVERY STRIPE
TO ENSURE THAT HEALTH REFORM
MAKES COMMONSENSE IMPROVEMENTS
THAT IN SOME CASES ARE
DESPERATELY NEEDED.
THIS BILL WILL SIGNIFICANTLY
IMPROVE THE STANDARD OF CARE IN
NURSING HOMES NATIONWIDE FOR THE
FIRST TIME IN 22 YEARS, AND I
THK MY KHRAOERBGS SENATOR
GRASSLEY -- MY COLLEAGUE,
SENATOR GRASSLEY, FOR WORKING
TOGETHER TO MAKE SURE THIS
IMPORTANT ISSUE WAS NOT
OVERLOOKED AS PART OF HEALTH REFORM.
IN AND OF ITSELF, THIS IS A
UNDERTAKING BUT IT'S JUST ONE
PIECE OF THE PUZZLE TO
COMPREHENSIVELY REFORM OUR
HEALTH CARE SYSTE
THIS BILL WILL ALSO TRAIN AND
EXPAND THE HEALTH CARE WORKFORCE
SO THEY ARE PPARED TO CARE FOR
THE GROWING ELDERLY POPULATION.
BY IMPLEMENTING RECOMMENDATIONS
FROM THE INSTITUTE OF MEDICINE,
WE WILL BEGIN TO ADDRESS THE
SEVERE SHORTAGE WE FACE OF
DIRECT CARE WORKERS.
THIS BILL WILL PROTECT
VULNERABLE PATIENTS BY CREATING
A NATIONWIDE SYSTEM OF
BACKGROUND CHECKS FOR LONGTERM CARE WORKERS.
THIS POLICY IS MORE THAN JUST A
GOOD IDEA IN THEORY.
WE HAVE IMPLEMENTED IT IN SEVEN
STATES AND SEEN ITS RESULTS.
COMPREHENSIVE BACKGROUND CHECKS
ARE ROUTINE FOR THOSE WHO WORK
WITH YOUNG CHILDREN AND WE
SHOULD BE PROTECTING VULNERABLE
SENIORS AND DISABLED AMERICANS
IN THE SAME WAY.
THIS BILL WILL MAKE IT EASIER
FOR SENIORS TO GET THE CARE THEY
NEED IN THEIR OWN HOMES BECAUSE
WHEN IT
ONE SIDE DOES NOT FIT ALL.
THE GOAL OF LONG-TERM CARE
SHOULD BE TO ALLOW OLDER OR
DISABLED AMERICANS TO LIVE AS
INDEPENDENTLY AS POSSIBLE.
THIS BILL WILL HELP UPDATE OUR
CURRENT LONG-TERM CARE SYSTEM IN
ORDER TOFFER CHOICES TAILORED
TO AN INDIVIDUAL'S NEEDS.
IT WILL ALSO HELP TO ALLEVIATE
THE HUGE FINANCIAL AND EMOTIONAL
BURDEN ON MARRIED COUPLES WHO
NEED LONG-TERM CARE.
I WORKED WITH MY COLLEAGUE,
SENATOR CANTWELL, TO ENSURE THAT
MARRIED COUPLES WHO RECEIVE CARE
IN THEIR HOME AND COMMUNITY ARE
NOT REQUIRED TO SPEND THE VAST
MAJORITY OF
RECEIVE ASSISTANCE.
INCLUDE A PROVISION THAT WILL
BENEFIT ALL AMERICANS REGARDLESS
OF AGE BY HELPING TO LOWER THE
COST OF PRESCRIPTION DRUGS AND
MEDICAL DEVICES.
OUR POLICY AIMS TO MAKE
TRANSPARENT THE INFLUENCE OF
INDUSTRY GIFTS AND PAYMENTS TO DOCTORS.
THESE ARE ONLY A FEW OF THE
AGING COMMITTEE'S PRIORITIES.
THIS BILL MAKES MANY OTHER
IMPROVEMENTS IN OUR CURRENT
HEALTH CARE SYSTEM FOR OLDER AMERICANS.
OF THE SENATE BILL WILL REDUCE
THE COST FOR PREVENTIVE SERVICES
AND ADD A NEW FOCUS ON PAYING
DOCTORS TO KEEP PATIENTS WELL
AND NOT JUST PAYING THEM FOR
WHEN THEIR PATIENTS GET SICK.
TODAY'S SENIORS PAY 20% OF THE
COST OF MANY PREVENTIVE SERVICES
WHILE ELIMINATING THE CO-PAYMENT
AND DEDUCTIBLES IN MEDICARE FOR
IMPORTANT SERVICES SUCH AS
IMMUNIZATIONS, CHOLESTEROL
SCREENING, BONE CALCIUM LEVEL
SCREENING AND COLONOSCOPIES, WE
WILL HELP SAVE LIVES AS WELL AS
LOWER HEALTH CARE COSTS.
THE BILL WILL ALSO PROVIDE FOR
THE FIRST TIME AN ANNUAL
WELLNESS VISIT AT NO COST TO THE
MEDICARE BENEFICIARY.
PATIENTS WILL BE ABL TO RECEIVE
A PERSONALIZED HEALTH RISK
ASSESSMENT FOR CHRONIC DISEASE,
HAVE A COMPLETE REVIEW OF THEIR
PERSONAL AND FAMILY MEDICAL
HISTORY, AND RECEIVE A PLAN FOR
THEIR CARE.
THIS BILL WILL REMOVE THE
ABILITY OF INSURANCE COMPANIES
TO DENY ACCESS TO CONSUMERS
BASED ON PREEXISTING CONDITION.
WE KNOW THAT HAVING HEALTH CARE
IS ESSENTIAL THROUGHOUT ONE'S
LI
BUT MANY OLDER AMERICANS COUNT
THE DAYS UNTIL THEY BECOME
ELIGIBLE FOR MEDICARE BECAUSE
THEY'RE NOT ABLE TO FIND
INSURANCE COVERAGE AT ANY COST
DUE TO A HEALTH CONDITION IN THEIR PAST.
I COULD GO ON ABOUT THE MANY
OTHER IMPROVEMENTS SMALL AND
LARGE THAT WILL BENEFIT OUR
NATION'S SENIORS, BUT I'LL STOP
HERE AND SIMPLY URGE MY
COLLEAGUES TO WORK TO EDUCATE
SENIORS AND NOT SCARE THEM ABOUT
THE IMPORTANT CHANGES THIS BILL
WILL MAKE TO PROVIDE THEM WITH
BETTER HEALTH CARE AT LOWER COST.
THANK YOU,
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA. MR. BAUCUS: HOW MUCH TIME IS
LEFT FOR
THE PRESIDING
MINUTES. MR. BAUCUS: MR. PRESIDENT, I
ASK CONSENT THERE BE
ADDITIONAL FIVE MINUTES UNDER
THE CONTROL OF THE MAJORITY AT
THIS TIME AND THERE BE AN
ADDITIONAL SIX
FOR EACH SIDE.
THE PRESIDING OFFICER: WITHOUT OBJECTION.
MR. BAUCUS: MR. PRESIDENT I
NOW YIELD TO THE SENATOR FROM
OREGON THE REMAINING TIME, WHICH
WILL BE TEN MINUTES.
MR. WYDEN: MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM OREGON.
MR. WYDEN: I WANT TO SPEND A
FEW M ABOUT MEDICARE ADVANTAGE AND
PARTICULARLY TO HIGHLIGHT THE FACT THAT I THINK IT IS
IMPORTANT TO SUPPORT THE
LANGUAGE PUT TOGETHER BY THE
CHAIRMAN OF THE FINANCE
COMMITTEE ON MEDICARE ADVANTAGE
AND TO REJECT THE AMENDMENT
OFFERED BY OUR FRIEND FROM UTAH, SENATOR HATCH.
AND I WANT TO BEGIN MY COMMENTS
WITH RESPECT TO MEDICARE
ADVANTAGE BY POINTING OUT THAT
IT IS CLEAR THAT NOT ALL
MEDICARE ADVANTAGE IS CREATED
EQUAL.
SOME MEDICARE ADVANTAGE IS A
MODEL OF EFFICIENCY AND SOME OF
IT IS PRETTY MUCH A RIP-OFF OF
BOTH TAXPAYERS AND SENIORS.
AND I'D REFER, AS IT RELATES TO
THE ABUSIVE PLANS, TO THE VERY
IMPORTANT HEARINGS CHAIRED BY
SENATOR BAUCUS IN THE FINANCE COMMITTEE.
I RECALL ON ONE OCCASION SITTING
NEXT TO OUR FRIEND FROM
ARKANSAS, SENATOR LINCOLN, WE
HAD WITNESSES DESCRIBE HOW
MEDICARE ADVANTAGEAS BEING
SOLD DOOR TO DOOR IN HER PART OF
THE COUNTRY BY INDIVIDUALS
DRESSED UP IN SCRUBS AS
PHYSICIANS AND HEALTH CARE PROVIDERS.
AND IN THE DISCUSSION OF HOW TO
HANDLE IT, WE LOOKED AT VARIOUS
KINDS OF REFORMS TO REIN IN ABUSIVE PRACTICES.
I CAME TO THE CONCLUSION, WHEN
YOU DO SOMETHING LIKE THAT, THE
C.E.O.'S OUGHT TO BE PUT IN
SKWRAEUFPLT THAT IS WHAT IS
DOCUMENTED ON THE R
RELATION TO THE COMMITTEES HELD
IN THE SENATE FINANCE COMMITTEE
AND WHY I COME TO THE FLOOR.
I THINK IT IS IMPORTANT TPO
DISTINISH BETWEEN THE
GOOD-QUALITY MEDICARE ADVANTAGE
PLANS AND THOSE THAT HAVE BEEN
LIVING HIGH ON THE HOG THROUGH
SOME OF THE OVERPAYMENTS THAT WE
HAVE DOCUMENTED ON THIS FLOOR.
MR. PRESIDENT, MY STATE HAS THE
HIGHEST PERCENTAGE OF OLDER
PEOPLE IN MEDICARE ADVANTAGE IN
THE COUNTRY.
AND I HAD AN OPPORTUNITY TO WORK
CLOSELY WITH CHAIRMAN BAUCUS IN
TERMS OF
ADVANTAGE, AND I THINK WITH THE
CHAIRMAN'S LEADERSHIP IT'S BEEN
FIND SAVINGS IN THE MEDICARE
PROGRAM WITHOUT HARMING OLDER
PEOPLE, WITHOUT REDUCING THEIR
GUARANTEED
ESSENTIAL BENEFITS, AS WE HAVE
LEARNED WITH MEDICARE ADVANTAGE.
THE WAY CHAIRMAN BAUCUS GOES
ABOUT DOING THAT IS BYORCING
THE INEFFICIENT MEDICARE
ADVANTAGE PLANS TO FOLLOW THE
MODEL OF THE EFFICIENT ONES.
AND THE WAY WE HAVE BEEN ABLE TO
DO THAT IS ESSENTIALLY THROUGH A
TWO-PART STRATEGY.
FIRST, ENCOURAGE COMPETIVE
BIDDING.
AND, SECOND, PROVIDE INCENTIVES
FOR QUALITY, WHICH IS DONE
THROUGH THE BONUS PAYMENT
PROVISIONS THAT ARE IN THE
LEGISLATION.
SO FIRST, ON COMPETIVE
BIDDING, YOU HAVE PLAN BIDS --
YOU USE THE PLAN BIDS TO SET
MEDICARE ADVANTAGE BENCHMARKS
WHICH WOULD ENCOURAGE THE PLANS
TO COMPETE MORE DIRECTLY ON THE
BASIS OF PRICE AND QUALITY
RATHER THAN ON THE LEVEL OF
EXTRA BENEFITS OFFERED TO THOSE
WHO ARE ENROLLING.
WITH COMPETITIVE BIDDING, PLANS
COMPETE TO BE THE MOST EFFICIENT
AND HOLD DOWN COSTS.
I WANT TO COMMEND CHAIRMAN
BAUCUS FOR MAKING THIS A CENTRAL
ADVANTAGE WOULD BE HANDLED, AND
CERTAINLY OUR PART OF THE
COUNTRY HAS SHOWN THIS IS A PATH
TO GET MORE VALUE FOR THE
MEDICARE ADVANTAGE DOLLAR IN THE
DAYS AHEAD.
IN ADDITION, IN THE FINANCE
COMMITTEE, I OFFERED AN
AMENDMENT WITH SEVERAL KAOEGZ
THAT --
SEVERAL COLLEAGUES THAT WOULD
BOOST THE PAYMENT TO THOSE PLANS
THAT ACCORDING TO THE
GOVERNMENT -- AND THE GOVERNMENT
USES A SYSTEM OF STARS IN EFFECT
TO REWARD QUALITY.
OUR AMENDMENT WOULD BOOST THE
PAYMENTS TO THOSE MEDICARE
ADVANTAGE PLANS WITH FOUR- AND
FIVE-STAR QUALITY RATED.
SO IN EFFECT WITH OUR
LEGISLATION, THERE ARE BOTH
CARROTS AND STICKS.
COMPETITIVE BIDDING PLUS BONUS
PAYMENTS OFFERS BOTH, SO THAT
THE PLANS COMPETE TO PROVIDE THE
BEST VALUE FOR SENIORS BY
ENCOURAGING THE PLANS TO BE MORE
EFFICIENT, IT'S POSSIBLE TO
ACHIEVE SIGNIFICANT SAVINGS FOR
OLDER PEOPLE, HELP SHORE UP THE
SOLVENCY OF THE MEDICARE TRUST
FUND AND MEET THE COST-SAVING
GOALS OF THE LEGISLATION.
ONE FINAL POINT THAT HAS BEEN
DISCUSSED BY COLLEAGUES ON THE
FLOOR OF THE SENATE, AND THAT IS
THIS MATTER OF INDIVIDUALS BEING
ABLE TO KEEP WHAT THEY HAVE.
AND I HAVE HEARD THAT THAT IS
NOT THE CASE WITH MEDICARE
ADVANTAGE PLANS.
THAT SOMEHOW UNDER THE
LEGISLATION THAT HAS BEEN
OFFERED BY THE FINANCE
COMMITTEE, OLDER PEOPLE WOULD
NOT BE ABLE TO KEEP WHAT THEY
HAVE, ACCORDING TO SOME ON THE
FLOOR.
THAT IS SIMPLY ICCURATE.
SENIORS WHO HAVE MEDICARE
ADVANTAGE PLANS UNDER THE BAUCUS
LEGISLATION WILL BE ABLE TO KEEP THOSE PLANS.
THEY'LL BE ABLE TO STAY WITH
WHAT THEY HAVE, KEEP THEIR
GUARANTEED ESSENTIAL BENEFITS,
AND THROUGH THE LANGUAGE THAT
HAS BEEN AUTHORED NOW IN THE
LEGISLATION BEFORE US, THERE
WILL BE LOWER COSTS FOR TAXPAYERS.
LAST POINT, MR. CHAIRMAN, I'VE
HEARD A LOT OF TALK ABOUT
GRANDMA ON THE FLOOR OF THE
UNITED STATES SENATE.
I SPENT THE BULK OF MY
PROFESSIONAL LIFE IN EFFECT
WORKING WITH GRANDMA.
I WAS THE COFINDER OF THE OREGON
GRAY PANTHERS, RAN
PROGRAM FOR OLDER PEOPLE IN OUR
HOME STATE FOR A NUMBER OF
YEARS, AND I WANT IT UNDERSTOOD
THAT I THINK WITH THE BAUCUS
LEGISLATION ON MEDICARE
ADVANTAGE THAT PROVES THAT IT IS
POSSIBLE
MEDICARE PROGRAM WITHOUT CUTTING
ESSENTIAL BENEFITS, USING
COMMONSENSE PRINCIPLES OF
COMPETITIVE BIDDING, NUMBER ONE,
AND
THINK GRANDMA'S GOING TO BE JUST
FINE UNDER OUR LANGUAGE FOR
MEDICARE
MR. PRESIDENT W-RBGS THAT,
YIELD THE FLOOR.
-- MR. PRESIDENT, WITH THAT, I
YIELD THE
MR. BAUCUS: HOW MUCH TIME
REMA
THE PRESIDING OFFICER: THREE MINUTES.
SIDE?
THE PRESIDING OFFICER: 55
MINUTES.
MR. BAUCUS: I RESERVE T
BALANCE OF THE MAJORITY T
SENATOR FROM
MR. ALEXANDER: MR. PRESIDENT,
DURING THE
WE'LL HAVE SEVERAL REPUBLICAN
SENATORS COME TO THE FLOOR.
AND I ASK UNANIMOUS CONSENT THAT
DURING THAT TIME SENATOR
McCAIN BE ALLOWED TO BE THE
MANAGER OF A COLLOQUY AMONG THE
REPUBLICAN SENATORS.
THANK YOU, MR. PRESIDENT.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. ALEXANDER: BEFORE SENATOR
McCAIN BEGINS, I'D LIKE TO, IF
I MAY TAKE A MOMENT JUST TO
ESTABLISH WHERE WE
WHAT HAPPENED YESTERDAY, AND AS
A LEAD-IN TO WHAT HE'S ABOUT TO DISCUSS.
YESTERDAY SENATOR McCAIN
OFFERED AN AMENDMENT ON THE
FLOOR OF THE SENATE THAT WOULD
DO TWO THINGS.
IT WOULD SEND BACK TO THE
FINANCE COMMITTEE THIS, THE
DEMOCRATIC HEALTH CARE BILL,
WHICH IS THE 2,000-PAGE BILL
RIGHT HERE.
AND IT WOULD SAY TO THEM, ONE,
TAKE OUT THE CUTS INEDICARE.
AND, TWO, ANY SAVINGS IN
MEDICARE MUST GO TO MAKE
MEDICARE MORE SOLVENT.
THAT WAS THE McCAIN AMENDMENT.
THAT WAS DEFEATED.
58 DEMOCRATS SAID YES TO THE
CUTS IN MEDICARE.
THEY SAID NO TO USING -- THEY
SAID YES TO USING THE MONEY THAT
COMES FROM THESE CUTS TO CREATE
A NEW ENTITLEMENT PROGRAM.
40 REPUBLICANS SAID NO, WE DON'T
WANT TO DO THAT, AND TWO
DEMOCRATS JOINED IN THAT AS WELL.
SO YESTERDAY WE MADE IT CLEAR
THAT THE CENTRAL CORE OF
BILL INCLUDES NEARLY $500
BILLION IN CUTS IN MEDICARE.
THERE'S NO QUESTION ABOUT THAT.
EVERYONE CONCEDES THAT.
THE PRESIDENT HAS SAID THAT WHEN
HE ADDRESSED US. THE CONGRESSIONAL BUDGET OFFICE
SAYS THAT.
THE QUESTION IS WHETHER IT'S A
GOOD IDEA OR BAD IDEA.
AND YESTERDAY BY 58 VOTES THE
DEMOCRATS SAID YES TO THESE CUTS
IN M
TODAY WHAT WE WANT TO DO IS TALK
ABOUT ONE OF THOSE CUTS AND TO
TRY TO DO IT IN A CAREFUL,
ACCURATE WAY SO THAT 11 MILLION
SENIORS WHO HAVE MEDICARE
WHAT THE RISK IS TO THEIR
YOU CAN SEE THAT UNDER THE CUTS
APPROVED, AGAIN, YESTERDAY IN
THIS BILL ARE $120 BILLION OVER
THE NEXT TEN YEARS IN CUTS TO
MEDICARE ADVANTAGE.
WHAT IS MEDICARE ADVANTAGE?
MEDICARE
THAT SENIORS HAVE.
MEDICARE, IF YOU CHOOSE THAT
OPTION, PAYS A FIXED AMOUNT FOR
YOUR CARE EVERY YEAFOR
COMPANIES THAT MIGHT COME TO YOU
AND OFFER A MEDICARE ADVANTAGE
PLAN WHICH YOU CAN
INSTEAD OF THE ORIGINAL MEDICARE
PLAN.
MANY SENIORS CHOOSE THESE PLANS.
11 MILLION SENIORS, NEARLY ONE
OUT OF FOUR SENIORS IN AMERICA,
WHO IS PART OF MEDICARE, CHOOSES
THE MEDICARE ADVANTAGE PLAN N MY
HOME STATE OF TENNESSEE, THE
NUER IS TENNESSEANS.
WHY DO THEY CHOOSE IT?
WELL,
THAT THEY MAY NOT HAVE IN THE
ORIGINAL MEDICARELAN.
THESE ARE DENTAL CARE, VISION
CARE, HEARING COVERAGE, REDUCED
HOSPITAL DEDUCTIBLES, INCLUDES
LOWER CO-PAYMENTS, LOWER
PREMIUMS, COORDINATED CHRONIC
CARE MANAGEMENT,ND PHYSICAL
FITNESS PROGRAMS.
NOW, THE DISTINGUISHED SENATOR
FROM OREGON WAS ON THE FLOOR.
HE MENTIONED
I'VE MENTIONED GRANDMA A FEW TIMES.
NO DISRESPECT TO GRANDPA.
HE IS IN THE SAME BOAT.
AND HE SAID THAT GRANDMA DIDN'T
NEED TO WORRY ABOUT HER MEDICARE
ADVANTAGE PLAN BECAUSE NONE OF
THE BENEFITS WOULD BE CUT.
BUT, MR. PRESIDENT, THAT'S NOT
WHAT THE DIRECTOR OF THE
CONGRESSIONAL BUDGET OFFICE,
WHO'S OFTEN SITED CITED BY THE BUDGET
OF THE COMMITTEE.
HE SAID THAT NEARLY HALF OF THE
BENEFITS CURRENTLY PVIDED TO
SENIORS WOULD DISAPPEAR UNDER
THE FINANCE COMMITTEE PLAN WHICH
IS MUCH LIKE THE PLAN WE'RE CONSIDERING.
THESE WOULD INCLUDE THOSE I WAS
MENTIONING.
SO TODAY, MR. PRESIDENT, WITH
SENATOR McCAIN LEADING THE
DISCUSSION, WE'D LIKE TO TALK
ABOUT THE MEDICARE ADVANTAGE
PLAN AND WHY IT'S SUCH A
ESSENTIAL PART OF THIS BILL.
THIS IS A $2.5 TRILLION BILL.
THAT'S WHAT IT WOULD COST OVER
TEN YEARS.
AND ABOUT HALF IT
THESE MEDICAID CUTS AND THE --
MEDICARE CUTS
TALKING ABOUT TODAY IS THE
MEDICARE ADVANTAGE PLAN.
I UNDERSTAND THERE WILL BE AN
AMENDMENT BY SENATOR HATCH, WHO
I'M SURE WILL TALK ABOUT HIS OWN AMENDMENT.
HE OF COURSE WAS PRESENT ON THE
FINANCE COMMITTEE, A L
MEMBER, WHEN MEDICARE ADVAN
WAS CREATED -- THAT THERE WILL
BE AN AMENDMENT TODAY TO SAY
SEND BACK TO THE FINANCE
COMMITTEE AND SAY DON'T CUT
MEDICARE ADVANTAGE.
MR. McCAIN: I LISTENED TO
SENATOR HATCH'S VERY IMPORTANT
STATEMENT LAST NIGHT, WHICH HE
WILL ADD TO TODAY.
HE WAS ABLE TO TAKE US DOWN
TRIP ON MEMORY LANE.
IN JUNE 2003 WHEN THE MEDICARE
MODERNIZATION ACT WAS BEFORE
SENATE, SEVERAL OUR COLLEAGUES,
INCLUDING SENATOR SCHUMER AND
KERRY, OFFERED A BIPARTISAN
AMENDMENT ON THE FLOOR TO
PROVIDE ADDITIONAL FUNDING FOR
BENEFITS UNDER THE MEDICARE
ADVANTAGE PROGRAM.
BUT AMNESIA IS NOT CONFINED TO
ONE SIDE OF THE AISLE AROUND
HERE.
BUT
FRIEND FROM
-- YOU KNOW, THIS DISCUSSION
ABOUT MEDICARE ADVANTAGE.
WE HAVE TO BETTER UNDERSTAND,
WHAT IS
IT SO
IS IT BECAUSE IT OFFERS SENIORS
A CHANCE TO GET ADDITIONAL
BENEFITS?
MAYBE YOU COULD JUST GIVE ME A
SHORT DEFINITION OF THAT BECAUSE
I THINK THE AMERICAN PEOPLE MAY
NOT BE TOTALLY CLEAR OF WHAT
WE'RE DISCUSSIN DISCUSSING HERE AND WHY
MILLION MEN'S -- 300,000
CITIZENS IN MY OWN STATE -- HAVE
CHOSEN MEDICARE AANTAGE AND
HAS PROMPTED, ACCORDING TO
BLOOMBERG, SENATOR CASEY OF
PENNSYLVANIA TO SAY, QUOTE,
"WE'RE NOT GOING TO BE ABLE TO
SAY, IF YOU LIKE WHAT YOU HAVE,
YOU CAN DEEP," SAID SENATOR BOB
CASEY, A PENNSYLVANIA DEMOCRAT.
THAT BASIC COMMITMENT THAT A LOT
OF US AROUND HERE HAVE MADE WILL
BE CALLED
THE QUESTION IS "DEEM SENATOR
SAYS MEDICARE ADVANTAGE CUTS
BREAK A PRESIDENT'S PLEDGE."
SO MAYBEF THE SENATOR FROM
TENNESSEE WOULD JUST GIVE ME A
BRIEF OUTLINE OF WHAT SENIORS
GET UNDER MEDICARE ADVANTAGE AND
WHY IT IS SO
SENIOR CITIZENS IN MY STAT
11 MILLION ALL OVER THE COUNTRY.
MR. ALEXANDER: I
THE SENATOR FROM ARIZONA IS
EXACTLY CORRECT.
IF SENATOR CASEY SAID THAT, HE'S
MERELY REPEATING WHAT THE
BUDGET OFFICE, WHEN HE SAID THAT
FULLY HALF THE BENEFITS OF
MEDICARE ADVANTAGE WOULD BE
LOST.
BUT IN ANSWER TO YOUR QUESTION,
THE MEDICARE ADVANTAGE IS AN
OPTION THAT 11 MILLION OF THE 40
MILLION SENIORS WHO ARE ON
MEDICARE HAV
AND THE REASON THEY CHOOSE IT IS
BECAUSE THE PLANS THAT ARE
OFFERED BY PRIVATE COMPANIES ARE
OFTEN IN RURAL COMMUNITIES,
LOWER-INCOME AMERICANS CHOOSE THESE.
THEY OFTEN CHOOSE THEM BECAUSE
THE PLANS GENERALLY OFFER THESE
BENEFITS:
DENTAL CARE, VISION CARE,
HEARING COVERAGE, REDUCED
HOSPITAL DEDUCTIBLES, LOWER
CO-PAYMENTS, LOWER PREMIUMS,
COORDINATED CHRONIC CARE
MANAGEMENT, AND PHYSICAL FITNESS
PROGRAMS.
SO THOSE ARE SOME OF THE
BENEFITS THAT THESE PLANS
GENERALLY OFFER SENIORS.
MR. McCAIN: WELL, I THANK MY FRIEND.
AND THE REASON I ASK IS YOU
MENTIONED THAT MEDICARE
ADVANTAGE ALLOWS SENIORS TO HAVE
DENTAL CARE, VISION CARE,
HEARING CARE, PHYSICAL --
PHYSICAL FITNESS -- PHYSICAL
FITNESS.
YOU
THIS ALLOWS OUR SENIOR CITIZENS
TO HAVE DENTAL, VISION,
CARE, PHYSICAL
YOU KNOW, THAT'S A LITTLE
STRANGE BECAUSE, AS WAS POINTED
OUT TO ME, THAT'S EXACTLY WHAT
WE
STATES SENATE.
ABOUT 100 PACES FROM HERE, IF I
NEED SOME DOCTOR CARE
IMMEDIATELY, IF I NEED
VISION CARE, IF I NEED SOME
DENTAL CARE, NEC NEXT TO MY OFFICE
IN THE SENATE RUSSELL OFFICE
BUILDING -- AND I DON'T KNOW AT
WHAT COST -- I'D KE TO GET
ENTERED INTO THE RECORD HOW MANY
TENS OF MILONS OF DOLLARS IT
IS
SO -- SO, MY COLLEAGUES
YESTERDAY VOTED AGAINST KEEPING
THE
WHEN WE'VE GOT RIGHT HERE THE
BEST MEDICARE ADVANTAGE PROGRAM
THAT I'VE EVER HEARD OF IN THE WORLD:
FREE HEARING, FREE VISION, FREE
DENTAL, FREE -- AND EXPANDING A
GYMNASIUM IN A MANY MONTH-LONG
PROJECT AND I WILL GET THE COST,
ALTHOUGH IT MAY BE HARD TO DO.
SO LET ME GET
AGAIN, THE AMERICAN PEOPLE
SHOULD UNDERSTAND, WE JUST VOTED
TO CUT DRASTICALLY A PROGRAM
THAT SENIORS HAVE TAKEN
ADVANTAGE OF
ADDITIONAL
DENTAL, AND PHYSICAL FITNESS
CARE WHILE WE PRACTICE IT HERE
EVERY SINGLE DAY -- EVERY SINGLE
DAY THERE IS A PHYSICIAN ON DUTY
-- OR MORE THAN ONE -- NOT VERY
FAR FROM WHERE I SPEAK WHO IS
READY TO GIVE US INSTANT CARE.
IF HOSPITALIZATION IS NEEDED,
INSTANT TRANSPORTATION TO THE
BETHESDA NAVAL HOSPITAL WHERE WE
WILL GET FREE CARE.
AND, INCREDIBLY --
THE SENATE, ON LARGELY PARTISAN
LINES, YESTERDAY VOTED AGAINST
SENIOR CITIZENS IN THIS COUNTRY,
MOST OF WHOM HAVE MADE A LOT
MORE INTO THE PROGRAM THAN WE HAVE.
WE'RE GOING TO DEPRIVE THEM OF
WHAT WE HAVE EVERY SINGLE DAY WE
ARE MEMBERS OF THE UNITED STATES
SENATE.
THAT, MY FRIENDS, IS AN
IN HYPOCRISY. THE SENATOR FROM PENNLVANIA
HAS IT RIGHT.
HE SAYS BECAUSE THE PRESIDENT
TIME AFTER TIME SAID TO THE
AMERICAN PEOPLE, IF YOU LIKE THE
INSURANCE POLICY YOU HAVE TODAY,
YOU CAN KEEP
HOW MANY HUNDREDS OF TIMES HAVE
WE SEEN HIM SAY THAT AT TOWN
HALL METTINGS AND HIS
ADMINISTRATION -- AT TOWN HALL
MEETINGS AND HIS ADMINISTRATION
MOUTH SPEOSES SAY THE SAME THING.
SENATOR CO-PAYSCY IS RIGHT WHEN
HE SAYS WE'RE NOT GOING TO BE
ABLE TO SAY, IF YOU LIKE WHAT
YOU HAVE, YOU CAN KEEP IT, SAID
SENATOR BOB CASEY, A
PENNSYLVANIA DEMOCRAT.
THAT COMTMENT A LOT OF US MADE
WILL BE CALLED INTO QUESTION.
I'D LIKE TO SAY A COUPLE OF WORDS.
I WILLE TALKING A LITTLE BIT
MORE ABOUT IT LATER.
EVERY TIME THE SENATOR FROM
MONTANA IS ON THE FLOOR AND
OTHERS, THEY TALK ABOUT THE FACT
THAT AARP NOW SUPPORTS THIS
BLATANT TRANSFER OF FUNDING FROM
THE MEDICARE PROGRAM, WHICH THE
SENIORS HAVE EARNED, INTO A
BRAND-NEW ENTITLEMENT -- $2.5 TRILLION ENTITLEMENT PROGRAM.
THAT'S WT
ABOUT.
SO JUST FOR YOUR INFORMATION,
AARP HAS RECEIVED $18 MILLION IN
STIMULUS MONEY.
NOW, THERE'S A JOB CREATOR FOR YOU.
THERE'S A JOB CREATOR FOR YOU.
AARP, WHICH HAS GIVEN ITS FULL
SUPPORT TO DEMOCRATIC HEALTH
CARE LEGISLATION, EVEN THOUGH
SENIORS REMAIN LARGELY OPPOSED,
RECEIVED AN $18 MILLION GRANT IN
THE ECONOMIC STIMULUS PACKAGE
HAS NOT CREATED ANY JOBS,
ACCORDING TO THE OBAMA
ADMINISTRATION'S RECOVERY.GOV WEB SITE.
THAT IS
BECAUSE EVERYTHING I'VE EVER
SEEN, THEY'VE CREATED MILLIONS
OF JOBS, INCLUDING IN THE NINTH CONGRESSIONAL DISTRICT OF
ARIZONA WHERE THEY SAID THEY
CREATE SOME THOUSANDS OF JOBS,
WHICH UNFORTUNATELY FOR ME WE
ONLY HAVE EIGHT CONGRESSIONAL DISTRICTS.
BUT THAT'S OKAY.
BUT THAT'S OFNLGT SO IN FEBRUARY
THE "POLITICO" REPORTED THAT
AARP WAS PUTTING PRESSURE ON
REPUBLICAN MEMBERS OF CONGRESS
TO SUPPORT THE STIMULUS PACKAGE.
SINCE THEN, AARP HAS MOVED ON TO
LOBBYING FOR PASSAGE OF HEALTH
CARE LEGISLATION, EVEN THOUGH
DEMOCRAT PROPOSALS HAVE CALLED
FOR SEVERAL HUNDRED BILLION
THRARS DOLLARS IN CUTS TO MEDICARE, A
PROGRAM THAT THEY OPPOSE WHEN
REPUBLICANS PROPOSE IT.
AARP
FINANCIAY B
LOSING CUTS TO MEDICARE
ADVANTAGE WILL BE FORCED TO BUY
MEDIGAP POLICIES, WHICH IS THE
MAIN SOURCE OF AARP REVENUE.
BARRY RAND, THE CHIEFXECUTIVE
OF AARP, WAS A BIG DONOR TO THE
OBAMA CAMPAIGN AND HAS RAINED
COZY RELATIONSHIP WITH THE ADMINISTRATION.
THAT'S SHOCKING NEWS.
SHOCKING NEWS.
SO, MY
THAT IN 2006 -- IN 200 6, THE
AARP RECEIVED $18 MILLION FROM
THE FEDERAL GOVERNMENT AND WE
ARE RESEARCHING ADDITIONAL
FEDERAL MONEYS THAT THEY GET.
BUT THE MT IMPORTANT THING IS
THAT, LET'S MAKE IT CLEAR.
AARP WILL
BENEFITS BECAUSE SENIORS WHO
HAVE THEIR CUTS IN MEDICARE
ADVANTAGE AND OTHER MEDICARE
PROGRAMS CAN BUY,
A MEDIGAP INSURANCE POLICY -- IN
OTHER WOR, TO COVER THE THINGS
THAT ARE BEING CUT BACK UNDER
THIS LEGISLATION -- AND IT COSTS
$175 A MONTH.
MEDICARE ADVANTAGE PREMIUMS, FOR
MOST SENIORS, ARE ZERO OR $35 A
MONTH.
SO IF THE MEDICARE ADVANTAGE
PLANS GO AWAY, PEOPLE WOULD HAVE
TO BUY MEDIGAP PLANS
YOU GOT IT, THE AARP.
AND SOME LOW-INCOME SENIORS
COULDN'T AFFORD $175 MONTH.
THAT'S WHY WHAT THE SENATOR
TENNESSEE HAS STATED -- IF WE
DRIVE PEOPLE OUT
ADVANTAGE, WE ARE
LOW-INCOME SENIORS ALL OVER THIS
COUNTRY.
WE ARE HARMING THEM.
WE ARE DOING THEM A DISSERVICE.
AND IF YOU THINK WITH 17% REAL
UNEMPLOYMENT IN MY STATE THAT
SENIORS WHO ARE UNEMPLOYED AND
DOWN ON THEIR LUCK ARE GOING TO
BE ABLE TO AFFORD THE AARP
MEDIGAP PROGRAM -- POLICY FOR
$175 A MONTH, THEN COME AND
VISIT MY STATE, AND I'LL TELL
YOU THEY CAN'T.
THEY CAN'T.
SO IT'S INTERESTING THE
CONVERSATION ABOUT HOW WE'RE --
ABOUT HOW HIGH-INCOME SENIORS
AND HOW WE'RE GOING TO TAX
PEOPLE WITH CADILLAC PLANS AND
ALL OF THOSE THINGS, WHEN WE
REALLY WHAT WE'RE DOING -- WHAT
WE'RE REALLY DOING IS HARMING
THE LOWEST -
SENIORS IN RURAL AREAS
AMERICA.
MR. KYL: MY COLLEAGUE WAS
TALKING EARLIER MAKING THE POINT
THAT Y
OUT OF THE PROGRAM WITHOUT
HURTING
THOSE ON THE OTHER SIDE OF THE
AISLE SAID, WELL, WE THAT.
WE CAN CUT BY $120 BILLION AND
STILL WON'T HURT ANYBODY.
MY COLLEAGUE ASKED THE SENATOR
FROM TENNESSEE EXACTLY WHAT SOME
OF THE BENEFITS WERE AND
REPEATED THOSE.
SO I WENT BACK TO GET THE ACTUAL
STATISTICAL NUMBER HERE OF HOW
MUCH IT WILL ACTUALLY REDUCE
BENEFITS IN TERMS OF ACTUARIAL
VALUE, AND ACCORDING TO THE
CONGRESSIONAL BUDGET OSTLES IN
THE YEAR 2019 WHEN THIS IS FULLY
IMPLEMENTED, HERE'S THE
STATISTIC:
THE ACTUAL ACTUARIAL VALUE OF
THE REDUCTION IN BENEFITS UNDER
MEDICARE ADVANTAGE IS 64%.
IN DOLLAR NUMBERS, IT GOES FROM
MONTH.
IN OTHER WORDS, THE VERY THINGS
MY COLLEAGUE IS TALKING ABOUT --
THE VISION CARE, THE DENTAL
CARE, ALL OF THOSE THINGS, AS
WELL --
MR. McCAIN: THINGS THAT WE
ROUTINELY U
THE UNITED STATES SENATE.
I WOULD HOPE THAT THOSE WHO
VOTED TO HARM THE SENIORS IN
THIS COUNTRY AND NOT ALLOW THEM
TO HAVE DENTAL, VISION, OTHER
HEALTH CARE, WOULD UNILATERALLY
DISAVOW THE USE OF THE PHYSICIAN
CARE AND VISION CARE AND HEARING
CARE THAT'S AVAILABLE TO ALL OF
2US 4 HOURS A DAY RIGHT HERE --
24 HOURS A DAY RIGHT HERE IN THE UNITED STATES
MR. KYL: JUST A LAST POINT.
I'D LIKE TO SAY THAT I HEAR MY
COLLEAGUE LOUD AND CLEAR AND I
HOPE THAT THE AMERICAN PEOPLE
DO, TOO.
BECAUSE YOU CAN'T CALL A120
BILLION CUT SOMETHING THAT
DOESN'T HURT PEOPLE AND
ESPECIALLY WHEN THE
CONGRESSIONAL BUDGET OFFICE
ITSELF SAYS, YES, THAT REDUCES
THESE VERY BENEFITS FROM A VALUE
OF $135 A MONTH DOWN TO $49 A
MONTH.
THAT IS -- THAT IS A
HUGE CUT IN THE VALUE OF THE
SERVICES THAT THEY RECEIVE UNDER
MEDICARE ADVANTAGE.
AND THAT'S WHAT WE ARE
PREVENT BY THIS AMENDMENT.
MR. McCAIN: COULD I JUST
MENTION ONE OTHER THING?
I'M NOT GOING TO SPEND THAT MUCH
MORE TIME ON AARP.
BUT THE REASON WHY I DO IS
BECAUSE EVERY TIME THE SENATOR
FROM MONTANA STANDS UP, HE TALKS
ABOUT THAT AARP HAS ENDORSED
THIS RIP-OFF OF THE AMERICAN
PEOPLE.
SO, LET ME JUST QUOTE AGAIN FROM
A BLOOMBERG ARTICLE ENTITLED
"AARP'S STEALTH FEES OFTEN STING
NIORS WITH COSTLIER INSURANCE."
AND I COAT FROM THE BLOOMBERG
ARTICLE -- AND I QUOTE FROM THE
BLOOMBERG ARTICLE.
ARTHUR LAPOS JOINED AARP BECAUSE
HE THOUGHT THE NONPROFIT SENIOR
CITIZEN ADVOCACY GROUP WOULD
MAKE HIS RETIREMENT YEARS
EASIER.
HE SIGNED UP FOR AN AUTO
INSURANCE POLICY ENDORSED BY
AARP BELIEVING THE ADVERTISING
THAT SAID HE WOULD SAVE MONEY.
HE DIDN'T.
WHEN LOPAS, 71, COMPARED HIS CAR
INSURANCE RATE WITH A
OTHER COMPANIES HE FOUND OUT HE
WAS PAYING TWICE THE AVERAGE. WHY?
ONE REASON HE LEARNED WAS
BECAUSE AARP WAS TAKING A CUT
OUT OF HIS PREMIUM BEFORE
SENDING THE MONEY TO HARTFORD
FINANCIAL SERVICES GROUP, THE
PROVIDER OF THE COVERAGE.
AARP USES THE ROYALTIES AND FEES
TO FUND ABOUT HALF THE EXPENSES
THAT PAY FOR ACTIVITIES SUCH AS
PUBLISHING
HEALTH CARE AND CONSUMER FRAUD
AS WELL
MILLION BOND DEBT THAT FUNDED
THE ASSOCIATION'S MARBL AND
BRASS-STUDDED WASHINGTON HEADQUARTERS.
IN ADDITION, AARP HOLDS CLIENTS'
INSURANCE PREMIUMS FOR AS LONG
AS A MONTH AND INVESTS THE MONEY
WHICH ADDED $40.4 MILLION TO
REVENUE IN 2007.
DURING THE PAST DECADE,
ROYALTIES AND FEES HAVE MADE UP
AN INCREASING PERCENTAGE OF
AARP'S INCOME, RISING TO 43% OF
ITS $1.17 BILLION IN REVENUE IN
2007 FROM 11% IN 1999, ACCORDING
TO AARP DATA."
THIS IS A BLOOMBERG ARTICLE.
THIS ISN'T FROM THE REPUBLICAN
POLICY COMMITTEE.
SO THE POINTS WHO GAINS?
WHO GAINS FROM THIS LEGISLATION?
WHO'S GOING TO MAKE HUNDREDS OF
MILLIONS DOLLARS MORE BECAUSE
THEY PROVIDE THE MEDIGAP
POLICIES THAT PEOPLE WILL BE
DEPRIVED OF WHEN WE KILL OFF
MEDICARE ADVANTAGE? AARP.
MR. KYL: --
MR. ALEXANDER: I SEE THE
SENATOR FROM TEXAS, THE SENATOR
FROM IDAHO AND THE SENATOR FROM
WYOMING HAVE COME TOHE FLOOR
IN ADDITION TO THE SPONSOR OF
THE AMENDMENT, SENATOR HATCH.
I'M SURE THEY ARE PREPARED TO
REFLECT ON WHO'S HURT BY THESE
CUTS.
THE ONLY THING I WOULD EMPHASIZE
WITH WHAT YOU HAVE SAID IS THAT
DISPROPORTIONATELY LOW-INCOME
AMERICANS IN TEXAS AND IN IDAHO
AND IN TENNESSEE AND IN WYOMING
AND IN UTAH ARE HURT.
ONLY A THIRD OF ELIGIBLE WHITE
SENIORS WHO DON'T HAVE MEDICAID
OR EMPLOYER-BASED INSURANCE ARE
ENROLLED IN MEDICARE ADVANTAGE.
BUT THE NUMBER INCREASES TO 40%
FOR AFRICAN-AMERICANS AND 53% FOR
MR. McCAIN: COULD I ASK THE
SENATOR AGAIN, HE DESCRIBED THE
BENEFITS PROVIDED UNDER THE
MEDICARE ADVANTAGE PROGRAM THAT
SENIORS CAN HAVE IF THEY WANT; RIGHT?
ARE THOSE SAME ABILITY --
DENT, VISION, HEARING AND
FITNESS CARE --HAT AVAILABLE
UNDER REGULAR MEDICARE TODAY?
MR. ALEXANDER: MY
UNDERSTANDING IS THE ANSWER IS
NO TO THAT.
THAT'S THE REASON 11 MILLION
AMERICANS CHOOSE MEDICARE
ADVANTAGE IS BECAUSE THESE
BENEFITS ARE NOT AVAILABLE UNDER
THE ORIGINAL MEDICARE.
MR. McCAIN: IN
ARE 27,000 ENROLLEES WHO WILL
SEE A 24% DECREASE.
IN CONNECTICUT, THERE'S 94,000
ENROLLEES WHO WILL SEE A 14% DECREASE.
BY THE WAY, SOME SPECIAL DEALS
HAVE BEEN CUT FOR THREE STATES,
I UNDERSTAND: OREGON, NEW YORK,
WE'RE GOING TO TRY TO FIX THAT.
THERE'S NO REASON WHY ONE STATE
SHOULD BE SHIELDED ANYMORE THAN
ANOTHER FROM THESE DRACONIAN
MEASURES.
WE'RE GOING TO TRY TO FIX THAT.
BUT THE REASON WHY I BRING UP
THIS ISSUE, PRESENT-DAY MEDICARE
BENEFICIARIES DON'T HAVE VISION.
THEY DON'T HAVE DENTAL CARE.
THEY DON'T HAVE FITNESS.
YET, WE HERE IN THE UNITED
STATES SENATE
SINGLE DAY.
SO YESTERDAY WHAT WE DID WAS WE
VOTED TO DEPRIVE SENIORS FROM
THE ABILITY TO HAVE THE SAME
PRIVILEGES THAT WE ENJOY EVERY
SINGLE DAY IN THE UNITED STATES
SENATE.
I WOULD ARGUE THAT'S AN EXERCISE
IN HYPOCRISY.
MRS. HUTCHISON:
WE'RE OPERATING UNDER A C
MANAGED BY SENATOR McCAIN, AND
SO THE REPUBLICAN SENATORS ARE
FREE TO ENGAGE IN A DISCUSSION.
MRS. HUT
APPRECIATE WHAT THE SENATORS
HAVE BEEN TALKING ABOUT, BECAUSE
WHAT YOU'RE SAYING, SENATOR
McCAIN, IS THAT TSE SENIORS
WHO ARE LOW-INCOME HAVE AN
AFFORDABLE OPTION, AND IT'S LESS
EXPENSIVE THAN THE AARP OPTION
THAT WOULD GIVE THEM THIS EXTRA
CARE: THE EYE CARE, THE DENTAL
CARE, THE HEARING AIDS.
IT'S AN
IN TEXAS, WE
SENIORS ENROLLED IN MEDICARE
ADVANTAGE, AND ONE OF THE GREAT
THINGS ABOUT MEDICARE ADVANTAGE
IS THAT IT IS AVAILABLE IN RURAL
AREAS AND IT GIVES THEM CHOICES
THAT THEY MIGHT NOT BE ABLE
AFFORD WITH OTHER PROGRAMS THAT
ARE MEDIGAP.
THIS ONE IS AFFORDABLE.
AND THAT'S WHY WE'RE FIGHTING SO
HARD TO RESTORE T CUTS TO
MEDICARE ADVANTAGE.
MEDICARE ADVANTAGE COSTS ABOUT
14% MORE THAN
MEDICARE BECAUSE IT PROVIDES A
WIDE RANGE OF THESE EXTRA
BENEFITS THAT WE HAVE DISCUSSED:
DENTAL, EYE CARE, HEARING AIDS,
AND IN MANY CASES IT PAYS
PROVIDERS MORE.
REPUBLICANS, OF COURSE, ARE OPEN
TO DISCUSSING HOW TO IMPROVE THE
MEDICARE ADVANTAGE PAYMENT FORMULA.
WE WANT TO BE MORE EFFICIENT
WITH TAXPAYER DOLLARS.
BUT DO WE WANT TO DO THAT IN THE
CONTEXT OF CREATING A MASSIVE
NEW ENTITLEMENT PROGRAM AND ASK
MEDICARE TO PAY FOR IT?
OR TO CUT LIFESAVING
FOR SENIORS?
IS THAT WHAT WE WANT TO DO?
SENATOR CRAPO?
MR. CRAPO: THANK YOU.
MR. PRESIDENT, THAT'S THE CASE.
I'D LIKE TO POINT OUT WHEN WE
HAD THE FINANCE
MARKUP, I ASKED THE C.B.O.
DIRECTOR ELMENDORF DIRECTLY
WHETHER THE PROVISIONS IN THE
BILL, WHICH ARE STILL IN THE
BILL, WOULD REDUCE THE
THAT MEDICARE RECIPIENTS RECEIVE.
AND HIS RESPONSE WAS FOR THOSE
WHO WOULD BE ENROLLED OTHERWISE
UNDER THE
THERE'S BEEN A LOT OF TALK HERE,
WELL, WE'RE NOT CUTTING MEDICARE
BENEFITS OR WE ARE, OR IT'S THIS
OR THAT.
THE BOTTOM LINE IS THE C.B.O.
DIRECTOR SAID IT DIRECTLY, YES,
WE'RE CUTTING BENEFITS.
I'D LIKE TO ASK THE SPONSOR OF
THIS AMENDMENT A QUESTION,
BECAUSE I KNOW THERE ARE SOME
WHO ARE SAYING THE REASON WE'RE
CUTTING MEDICARE ADVANTAGE IS
THAT IT'S SO EXPENSIVE, AND WE
SHOULD BE CUTTING MEDICARE AND
CONTROLLING ITS
LIKE 14% MORE EXPENSIVE THAN
FEE-FOR-SERVICE MEDICARE.
SOME PEOPLE SAY, IF YOU'RE
DEFENDING MEDICARE ADVANTAGE,
YOU'RE DEFENDING OVERPAYMENTS IN HEALTH CARE PLANS.
WOULD THE SENATOR FROM UTAH LIKE
TO RESPOND TO THAT CRITICISM
THAT SOME ARE MAKING?
MR. HATCH: I'D BE DELIGHTED TO
DO THAT.
TO BE CLEAR, THE SO-CALLED
OVERPAYMENTS TO MEDICARE
ADVANTAGE PLANS DO NOT GO TO THE PLANS.
AS A
THE SENIORS IN THE FORM OF BENEFITS.
THAT'S A PRETTY IMPORTANT THING
THAT A LOT OF PEOPLE MISS.
75% OF THE ADDITIONAL PAYMENTS
TO MICARE ADVANTAGE PLANS ARE
USED TO PROVIDE SENIORS WITH
EXTRA BENEFITS, INCLUDING
CHRONIC CARE MANAGEMENT.
YOU WOULD THINK YOU'D WANT TO DO
THAT.
HEARING AIDS, EYEGLASSES.
THE OTHER 25% OF ANY EXTRA
PAYMENTS ARE RETURNED TO THE
FEDERAL GOVERNMENT.
I MEAN, I CAN'T IMAGINE WHY
ANYBODY WOULDN THAT.
MRS. HUTCHIS
I WOU
SENATOR FROM UTAH: LET ME ASK
YOU TO ALSO RESPOND TO THE
ARGUMENTS THAT CLAIM THAT THE
GOVERNMENT REALLY CAN'T AFFD
NOW TO CONTINUE
PRIVATE PLANS AND THAT THE
MEDICARE TRUST FUND IS GOING BROKE.
OF COURSE WE'RE TRYING -- WE
TRIED ACTUALLY SEVERAL YEARS
TO SHORE UP THE MEDICARE
PROGRAM, TRYING TO DO IT IN A
RESPONSIBLE WAY, NOT CUTTING OUT
TH MEDICARE BENEFITS THAT THESE
SENIORS
AFFORDABLE
BUT WHAT DO YOU SAY TO THAT?
MR. HATCH: YOU POINTED OUT THE
MEDICARE TRUST FUND IS GOING
YET, WHAT DO WE HAVE FROM THE
OTHER SIDE?
TAKE ALMOST $500 BILLION OUT OF
NOW,O TRUST ME,
CONCERNED ABOUT THE SOLVENCY OF
MR. McCAIN: IT'S MY
UNDERSTANDING THAT
S ACTUALLY SEEN MEDICARE
ADVANTAGE PATIENTS, HE AND
DR. COBURN ARE PROBABLY THE
TWO.
AND MAYBE WE COULD GIVE HIM THE
BENEFIT -- GIVE US THE BENEFIT
OF HIS EXPERIENCE AND ALSO NOT
ONLY BENEFIT OF HIS EXPERIENCE,
BUT I'M SURE HE'S GOING TO TELL
US WHAT'S THE IMPACT GOING TO BE
ON THESE -- ON THE LOW-INCOME
SENIORS FROM HIS
MR. BARRASSO: I AGREE WITH THE
SENATOR FROM ARIZONA THAT PEOPLE
CHOOSE TO BE ON MEDICARE ADVANTAGE.
11 MILLION PEOPLE HAVE CHOSEN TO
BE ON MEDICARE ADVANTAGE BECAUSE
IT'S A WISE CHOICE TO MAKE,
BECAUSE THEY GET BETTER
BENEFITS.
THEY GET DENTAL CARE.
THEY GET THE VISION CARE.
THEY GET THE HEARING.
THEY GET THE
MR. McCAIN: AS WE DO.
MR. BARRASSO: JUST AS WE DO.
IT
COORDINATED CARE.
MR. McCAIN: I DON'T THINK THEY
HAVE AS NICE A GYMNASIUM AS
WE'RE GOING TO GET.
MR. BARRASSO: IT'S ALSO NO
SURPRISE THAT WHEN PEOPLE READ
ABOUT IT AND LEARN ABOUT IT THAT
THEY WOULD WANT TO BE ON
MEDICARE ADVANTAGE.
WHAT THE SENATOR FROM UTAH HAS
SAID AND THE SPONSOR OF THIS
AMENDMENT, THE MONEY THAT GOES
INTO THIS PROGRAM IS FOR THE
BENEFIT OF THE SENIORS.
IT'S FOR SERVICES FOR THE
SENIORS ON MEDICARE.
THIS IS -- TO ME, THIS WHOLE
BILL BASICALLY GUTS MEDICARE,
RAIDS MEDICARE TO START A WHOLE
NEW PROGRAM.
TODAY, AS THE SENATOR FROM
ARIZONA HAS MENTIONED, IN THESE
ARTICLE, TODAY'S ASSOCIATED
PRESS AND "USA TODAY" "SENATE
DEMOCRATS CLOSED RANKS THURSDAY
BEHIND $460 BILLION IN
POLITICALLY RISKY MEDICARE CUTS
AT THE HEART
LEGISLATION."
IT GOES ON TO SAY "APPROVAL
WOULD HAVE STRIPPED OUT MONEY TO
PAY FOR EXPANDING COVERAGE TO
TENS OF MILLIONS OF UNINSURED AMERICANS."
THEY'RE GOING TO TAKE $460
BILLION, THIS SAYS, AWAY FROM
OUR SENIORS WHO DEPEND UPON IT
FOR THEIR MEDICARE AND START A
WHOLE NEW GOVERNMENT PROGRAM.
IT SAYS -- "WASHINGTON TIMES,"
FRONT-PAGE STORY, HEADLINES,
"DEMOCRATS WIN CUTS OF $400
BILLION TO MEDICARE."
McCAIN PUSHED FOR ANOTHER WAY
TO PAY.
SO I LOOK AT THIS AND SAY THIS
IS NOT FAIR TO OUR SENIORS, NOT
FAIR TO THE PATIENTS THAT I HAVE
TAKEN CARE OF FOR 25 YEARS IN
WYOMING, TAKEN CARE OF FAMILIES,
TAKEN CARE OF FOLKS WHEN GRANDMA
BREAKS HER HIP AND WHAT WE NEED
TO DO FOR OUR PATIENTS.
THESE ARE CHOICES THAT PEOPLE
HAVE MADE.
11 MILLION AMERICANS HAVE CLO
MEDICARE ADVANTAGE BECAUSE THERE
IS AN ADVANTAGE TO THEM FOR THE
HEALTH CARE THEY GET.
THE ADDITIONAL SERVICES, THE
COORDINATED CARE, THE PREVENTIVE
CARE.
ANYONE WHO LOOKS AT THIS AND
STUDIES IT SAYS I WANT TO SIGN
UP FOR THIS.
IT'S
AREAS, WONDERFUL IN BIG CITIES.
THIS HAS HELPED A LOT OF PEOPLE
IN THE COUNTRY.
SO IT'S NOT SURPRISING THAT ONE
OUT OF FOUR PEOPLE IN THE
COUNTRY ON MEDICARE HAVE CHOSEN
MEDICARE ADVANTAGE.
BUT YET WHAT WE'RE SEEING HERE
IS THE DEMOCRATS WANT TO GET
OF MEDICARE
MR. McCAIN: SO LET ME GET THIS STRAIGHT.
SO BASICALLY BY REMOVING THE
CHCES THAT SENIORS HAVE AS A
PART OF MEDICARE ADVANTAGE --
DENTAL, VISION, HEARING,
FITN
TAKING AWAY FROM THEM WHAT WE
OURSELVES ENJOY EVERY SINGLE DAY
HERE IN THE UNITED STATES SENATE?
MR. BARRASSO: WE ARE TAKING IT
AWAY FROM SENIORS, AND WE'RE
USING ALL OF THAT MONEY TO START
A NEW GOVERNMENT PROGRAM WHEN WE
KNOW THAT MEDICARE ITSELF IS
GOING TO GO BROKE BY THE YEAR -- MR. HATCH: I THINK WE OUGHT TO
BE LISTENING TO ONE OF THE ONLY
TWO DOCTORS IN THE UNITED STATES
SENATE WHO REALLY KNOWS, WHO'S
BEEN ON THE GROUND, WHO'S MET
WITH THE PEOPLE, WHO UNDERSTANDS
WHAT THIS MEANSO SENIOR CITIZENS.
A QUARTER OF WHOM ARE ON
MEDICARE ADVANTAGE.
AND IN THE END, I BELIEVE WE
ACTUALLY NOT ONLY HELP THE
SENIORS TO BE MORE HEALT
WE SAVE A LOT OF MONEY IN THE END.
TRUST ME, I'M DEEPLY CONCERNED
ABOUT THE SOLVENCY OF THE MEDICARERUST FUND.
AS YOU KNOW, WE'VE BEEN SOUNDING
THAT ALARM FOR YEARS, FOR YEARS.
THAT'S WHY IT'S SO SHOCKING THAT
WE AREEBATING A
HEALTH REFORM BILL THAT DOES
ALMOST NOTHING TO MAKE SURE THAT
MEDICARE IS SOUND.
IN FACT, DOES A LOT OF THINGS TO
MAKE IT U
NOTHING TO MAKE SURE THAT
MEDICARE IS AROUND FOR FUTURE GENERATIONS.
INSTEAD WE'RE ST CREATING
ANOTHER FEDERAL ENTITLEMENT
PROGRAM THAT WE CANNOT AFFORD
WHILE MEDICARE'S $38 TRILLION IN
UNFUNDED LIABILITIES. A SENATOR: A LOT OF PEOPLE
TRYING TO DEFEND THESE CUTS ARE
SAYING THESE EXPERT COSTS IN THE
GOING
COMPANIES PROFITS BIGGER AND TO
HELP LARGE C.E.O. SALARIES AND
SO FORTH.
MR. CRAPO: BUT NOTHING COULD
BE FURTHER FROM THE TRUTH.
THE REALITY IS, AS THE SENATOR
FROM UTAH HAS INDICATED, THAT
75% OF THIS 14% EXTRA PAYMENT
GOES TO -- IN THESE PLANS GO TO
PROVIDE THE SENIORS WITH THE
EXTRA BENEFITS THAT WE ARE
TALKING ABOUT HERE.
AND THEN 25% IS RETURNED TO THE
FEDERAL
NOT TO INSURANCE COMPANIES.
NOT TO C.E.O.'S.
AND I HAVE A CHART HERE.
WE'RE GOING TO MAKE THIS INTO A
BIGGER ONE.
BUT WHEN THOSE WHO SUPPORT THIS
PROGRAM SAY THAT WE ARE NOT
CUTTING MEDICARE BENEFITS, THIS
CHART -- I APOLOGIZE, IT'S A
LITTLE BIT SMALL -- BUT THIS IS
A CHART OF THE UNITED STATES AND
IT SHOWS YOU WHAT'S HAPPENING TO
THE
ADVANTAGE
THE DARK RED IS MORE THAN 350%
REDUCTION OF THE PEOPLE IN --
MORE THAN 50% REDUCTION OF THE
PEOP IN KNOWS DARK RED STATES.
THE MEDIUM COLORS IS A 25%
REDUCTION.
THE ONLY STATES WITHOUT A
REDUCTION ARE THE WHITE ONES. THREE OR FOUR STATES THAT ARE
NOT SEEING DEEP CUTS IN MEDICARE
ADVANTAGE BENEFITS.
AND THOSE WHO SAY, LIKE THE
PRESIDENT SAID WAS ONE OF HIS
GOALS, THAT IF YOU LIKE WHAT YOU
HAVE, YOU CAN KEEP IT, NOTF
YOU LIVE IN ONE OF THE STATES
THAT'S NOT IN WHITE ON THIS
CHART.
BECAUSE YOUR BENEFITS WILL BE
CUT. MR. ALEXANDER: I WONDER IF I
MIGHT ASK THE SENATOR FROM IDAHO
TO GO BACK OVER A POINT HE MADE
JUST A
WENT OVER IT QUICKLY BUT IT IS
SUCH AN IMPORTANT POINT AND IT
IS THE ONE REFLECTED BY THE
CHART BEHIND HIM AND BY WHAT
JUST SAID.
REPEATEDLY WE'RE TOLD THAT
SENIORS WON'T LOSE BENEFITS TO
BE CUT NEARLY A HALF TRILLION IN
MEDICAID.
SO IF YOU COULD TAKE A MOMENT --
I BELIEVE YOU WERE IN THE
FINANCE COMMITTEE MARKUP WHERE
THE BILL WAS BEING WRITTEN THAT
WAS OFFERED BY THE DISTINGUISHED
FINANCE COMMITTEE CHAIRMAN.
AND I BELIEVE YOU WERE TALKING
TO THE HEAD OF THE CONGRESSIONAL
BUDGET OFFICE, WHO IS OFTEN
CITED BY OUR FRIENDS ON THE
OTHER SIDE AS THE NONPARTISAN
THORITY FOR EXACTLY WHAT THE
BILL DOES.
AND I BELIEVE YOU ASKED HIM
WHETHER BENEFITS OF MEDICARE
ADVANTAGE SIFT RECIPIENTS WOULD BE CUT.
WOULD YOU DESCRIBE TT IN A
LITTLE MORE DETAIL SO PEOPLE
UNDERSTAND
MR. CRAPO: YES, I WOULD.
THIS CHART SHOWS THE LAST TWO
SENTENCES OF OUR COLLOQUY WHEN
WE WERE IN THE FINANCE COMMITTEE.
BUT IT WENT WENT ON FOR SOMETIME.
I WAS ASKING THE DIRECTOR OF
C.B.O. WHETHER THE CUTS TO
MEDICARE ADVANTAGE THAT ARE IN
THE BILL WOULD REDUCE BEFITS
TO SENIOR CITIZENS.
AND HE SAID, YES.
AND THE REASON HE HAD THIS
PHRASE THAT SAID "FOR THOSE WHO
WOULD BE ENROLLED OTHERWISE
UNDER CURRENT LAW" -- THE REASON
HE PREFACED
REST OF WHAT HE SAID WAS THAT
FOR FUTURE SENIORS, IT'S NOT
GOING TO BE A VIABLE OPTION.
SO THEY IN THE FUTURE, THOSE WHO
ARE NOT ON IT NOW, WON'T HAVE A
REALLY SIGNIFICANT, VIABLE
OPTION TO GET ON IT BECAUSE IT'S
GOING TO BE GUTTED.
SO WHAT HE WAS SAYING FOR THOSE
75% -- BY THE WAY, MEDICARE
ADVANTAGE IS THE MOST POPULAR
PART OF MEDICARE IN AMERICA TODAY.
THE FASTEST OF-GROWING PART OF
MEDICARE BECAUSE IT IS SO
POPULAR, BECAUSE IT PROVIDES
THESE ADDITIONAL BIFORTS THAT
SENIORS HAVE TO PAY SO
SIGNIFICANTLY FOR TO GET IN
SUPPLEMENTAL INSURANCE THAT AARP
IS GOING TO
AND WHAT THE C.B.O. DIRECTOR
SAID WAS THAT FOR THE FUTURE,
THOSE WHO AREN'T ALREADY ON IT
DON'T GET IT.
MR. McCAIN: COULD THE SENATOR
FROM TEXAS AND I GO BACK A
SECOND TO ONE OF THE THINGS I
MENTIONED EARLIER, BECAUSE IN
TEXAS, I ASK HOW MUCH ARE UNDER
MEDICARE CARE?
HUTCH 500,000 OF MY CONSTITUENTS.
MR. McCAIN: 500,000 SENIOR
CITIZENS IN YOUR STATE.
THERE IS NO -- QUOTE --
"SHIELDINSHIELDING."
ACCORDING TO THIS BLOOMBERG
ARTICLE, IT SAYS "SENATORS'S
SENATORS CHARLES SCHUMER, BILL
NELSON OF FLORIDA AND RON WYDEN
OF
SECURED SPECIAL PROVISIONS CUTS."
CASEY -- THAT'S SENATOR CASEY
SAYS HE
COMPARABLE PROTECTIONS FOR HIS STATE."
SURPRISINGLY ENOUGH.
"WHERE MORE THAN ONE-THIRD OF
MEDICARE BENEFICIARIES
PARTICIPATE IN MEDICARE
ADVANTAGE."
QUOTE -- "IT IS THE KIND OF
THING THAT WILL LIKELY BE
ADDRESSED ON
"I EAGERLY LOOK FORWARD TO
WORKING ON THE OTHER SIDE OF THE
AISLE WITH ALL THE MEMBERS FROM
THOSE STATES WITH THE EXCEPTION
OF NEW YORK, FLORIDA, AND OREGON
WHO HAVE EARNED SPECIAL
SHIELDING FROM THESE CUTS.
I LOOK FORWARD TO WORKING WITH
THEM AND LET'S FIX IT FOR ALL OF US.
RIGHT, SENATOR?
MR. HATCH: THAT'S RIGHT.
GO AHEAD.
MRS. HUTCHISON: I WOULD JUST
SAY TO THE SENATOR
I WAS WONDERING IF EVERY STATE
COULD HAVE THE SAME
WHY NOT HAVE EVERY STA
THIS SHIELDING FOR THEIR
MEDICARE ADVANTAGE?
THAT IS 11 MILLION PEOPLE IN
THIS COUNTRY WHO
HELPED BY A FAIR ASSESSMENT ALL
OVER THE
BUT MEET ME JUST POINT OUT ONE
-- BUT LET ME JUST POINT OUT ONE
OTHE
THE WAY THEY HAVE BEEN SHIELDED
IS GRANDFATHERING.
CANE INAND
-- AND MAY I ASK, WAS THAT
SHIELDING DONE ON THE FLOOR OF
THE SENATE IN OPEN DEBATE AND
DISCUSSION OF THE ISSUE?
MR. HATCH: OH, NO.
MRS. HUTCHISON: OH,
NOW AMISSIONLY
MR. McCAIN: ITY IT WAS DONE IN
AN OFFICE HERE WHERE WE STILL
AWAIT THE WHITE SMOKE.
MRS. HUTCHISON: THE WHITE SMOKE.
THAT'S CORRECT.
BUTHEN THE QUESTION ARISES,
WELL WHAT ABOUT FUTURE MEME SAY,
THAT'S WHAT I CAN AFFORD, IT IS
WHAT I WANT TO HAVE.
OH, BUT GRANDFATHERING DOESN'T
INCLUDE ANYONE THAT MIGHT WANT
TO JOIN IN THE FUTURE.
IT'S ONLY THE PEOPLE WHO ARE
ALREADY IN THE SYSTEM, AND
FOREEVER HOW LONG THEY LAST AND
LIVE, THAT'S GREAT.
BUT WHAT ABOUT THE FUTURE?
SO THIS IS A GREAT
IT IS AFFORDABLE FOR THE
LOWER-INCOME PEOPLE.
IT'S ONLY FOR THREE STATES NOW
BUT I'D LIKE TO SEE US HAVE ALL
THE SAME CAPABITIES FOR OUR CONSTITUENTS.
BUT WHAT ABOUT OUR FUTURE
CONSTITUENTS?
MR. GREGG: WOULD THE SENATOR
ELD ON THAT POINT?
I THINK THE SENATOR FROM ARIZONA
HAS RAISED AN EXTRAORDINARY POINT.
BECAUSE IF THIS IS SUCH A GRUED
PROGRAM FOR THESE FOUR STATES,
WHY ISN'T IT SUCH A GOOD PROGRAM
FOR EVERYBODY?
THE SENATOR IS THE EXPERT AROUND
HERE ON EARMARKS.
IS THIS NOT A CLASSIC EARMARK?
AND DIDN'T WE HEAR FM THE
OTHER SIDE OF THE AISLE HOW WE
WERE GOI TO HAVE AN OPEN GOVERNMENT, HOW WE W
GOING TO HAVE THIS TYPE OF
EXERCISE OCCUR WITHIN MAJOR
BILLS, THAT BILLS WEREN'T GOING
TO BE LOADED UP WITH SPECIAL
INTEREST EARMARKS, ASSISTING ONE
MEMBER OR ANOTHER?
AS THE EXPERT ON THE ISSUE OF
EARMARKS --
MR. McCAIN: I'D SAY THIS IS
PROBABLY
PROTECTIONISM THAT WE SEE IN THE
EARMARKING AND BENEFITS THAT WE
SEE IN THE EARMARKING PROCESS.
BUT ALSO I WOULD
SENATOR FROM NEW HAMPSHIRE, AS
WE'VE ALL DISCUSSED SEVERAL
TIMES, IN OCTOBER OF LAST YEAR
-- A YEAR AGO LAST OCTOBER, THE
THEN-CANDIDATE FOR PRESIDENT
SAID, IT'S GOING TO BE ON C
SPAFNONC-SPAN.
THE C-SPAN CAMERAS ARE STILL
WAITING TO FILM THESE NEGOTIATIONS.
SO ALL AMERICANS CAN SEE WHO IS
ON THE SIDE OF THE
PHARMACEUTICAL COMPANIES AND
WHO'S ON THE SIDE OF THE
AMERICAN
C-SPAN, KEEP WAITING.
WE'RE GOING TO TRY GET YOU IN.
MR. GREGG: IF I COULD ASK ONE
MORE QUESTION.
I CAME OVER BECAUSE I WANTED TO
PARTICIPATE A LITTLE BIT BECAUSE
I THINK IT'S BEEN SUCH AN
EXCELLENT AND INFORMATIVE
DEBATE.
BUT I'VE BEEN LOOKING AT THE
NUMBERS HERE.
AND I KNOW THE NUMBERS ARE BIG,
PERIOD, ALMOST $500 BILLION IN
REDUCTIONS IN MEDICARE SPENDING.
BUT I THINK THE POINT WE NEED TO
MAKE IS THAT IT DOESN'T END THERE.
IT DOESN'T END THERE.
THOSE MEDICARE SPENDING
REDUCTIONS, THEY GO ON INTO THE
NEXT
AND OVER THE FIRST TWO DECADES
OF THIS BILL, MEDICARE SPENDING
REDUCTIONS WILL ACCOUNT FOR $3
ILLION -- $3 TRILLION.
MR. McCAIN: AND ISN'T --
MR
ARGUE AGAINST WHAT THE SENATOR
FROM IDAHO SAID, WHICH IS THAT
THIS TRANSLATES
REDUCTIONS IN MEDICARE SPENDING?
MR. McCAI
IMPORTANT POINT HERE IN THIS
DISCUSSION IS THIS MASSIVE MONEY
TH
NOT BEING USED TO SAVE MEDICARE?
IT IS CREATING A
ENTITLEMENT PROGRAM.
SO HERE WE ARE WITH MEDICARE
GOING BROKE IN SEVEN YEARS.
WE'RE TAKING MONEY OUT OF IT IN
ORDER TO CREATE NEW PROGRAM.
THAT'S -- THAT'S WHAT THE CRIME
IS BEING COMMITTED HERE.
MR. GREGG: THE SENATOR IS ABSOLUTELY RIGHT.
THE NEW PROGRAM BY THE WAY WILL
NOT BE SOLVED EITHER.
SO WE'RE COMPOUNDING THE
INSOLVENCY OF THE FUTURE TH
WE'RE PASSING CHILDREN.
MR. HATCH: WE'RE TAKING
A-BILLION OUT OF A PROGRAM
THAT'S GOING TO BE INSOLVED
BEFORE
MR. GREGG: $3 TRILLION -- MR. HATCH: BEFORE THE END OF
THIS PROGRAM.
AND WE'RE GIVING TO ANOTHER
PROGRAM THAT'S ALREADY INSOLVENT.
MR. GREGG: TAXPAYER BE
INSOLVENT.
MR. HATCH: IT IS ALMOST INSANE WHAT THEY'RE DOING.
AMERICAN PEOPLE ARE HAVING SUCH
A DIFFICULT TIME, WHY WE HAVE
%, YOU KNOW, UNEMPLOYED, HAVE
THE UNDEREMPLOYMENT IS 17% IN
THIS COUNTRY.
THOSE ARE PEOPLE WHO TRY TO GET
PA-TIME JOBS BECAUSE THEY
CAN'T GET FULL-TIME JOBS.
THAT'S WT THE REAL PERCENTAGE IS.
AND THEY -- AND THEY --
-- YOU KNOW, THIS WHOLE PROGRAM
IS ABOUT HELPING LOW-INCOME
PEOPLE AND MINORITIES.
WHEN YOU STOP AND THINK ABOUT
IT, TH
ADVANTAGE IS ABOUT.
THEY CAN'T AFFORD THESE -- AS
THE DISTINGUISHED SENATOR FROM
ARIZONA HAS SAID, THEY CAN'T
AFFORD THESE SUPPLEMENTAL
POLI
MAKE A LOT OF MONEY OFF IF THEY
CAN -- IF THEY CAN -- IF THEY
CAN KILL THIS PROGRAM.
THERE ARE A LOT OF GAPS IN
TRADITIONAL MEDICARE BENEFITS,
INCLUDING
NO OUT-OF-POCKET LIMITS.
THAT'S ABOUT 89% OF SENIORS HAVE
SOME
COVERAGE ON TOP OF MEDICARE.
FOR MANY LOW-INCOME AMERICANS
AND MINORITIES, MEDICARE
ADVANTAGE IS THE ONLY WAY THAT
THEY CAN AFFORD THE SUPPLEMENTAL COVERAGE.
I WANT TO COMPLIMENT AL ALL OF MY
COLLEAGUES HERE ON THE FLOOR --
THE DISTINGUISHED SENATOR FROM
ARIZONA, THE DISTINGUISHED
SENATOR FROM IDAHO, THE
DISTINGUISHED SENATOR FROM
TEXAS, OUR OWN DOCTOR AND ONE OF
ONLY TWO IN THE SENATE, SENATOR
BARRASSO FROM WYOMING, OF COURSE
OUR LEADER IN THE SENATE BOTH
THE BUDGET COMMITTEE, SENATOR
GREGG, AND OF COURSE SENATOR ALEXANDRIA.
YOU GUYS HAVE REALLY SUMMED THIS
UP.
MR. McCAIN: WE'VE HAD SPIRITED
DEBATE AND DISCUSSION ON THE FLOOR.
IT IS CLEAR THAT THE MAJORITY OF
THE AMERICAN PEOPLE DO NOT
SUPPORT THE PROPOSAL THAT IS
BEFORE US.
SO -- AND THEY DON'T
MEETINGS IN PRIVATE, MOSTLY IN
SECRET, C
AGAIN, I RENEW OUR OFFER TO THE
DEMOCRATS AND TO THE
ADMINISTRATION:
LET'S GET TOGETHER IN A ROOM
WITH THE C-SPAN
OTHER OUTLET
AND DO SOME SERIOUS NEGOTIATIONS
WHICH THERE ARE MANY, AND LET'S
SAVE MEDICARE, AND LET'S FIX THE
SYSTEM IN THE WAY THE AMERICAN
PEOPLE WANT US TO DO IN
BIPARTISAN FASHION, NOT BEHIND
CLOSED DOORS BUT SO THAT THE
AMERICAN PEOPLE CAN SEE US WORK TOGETHER FOR A CHANGE.
AND I THANK ALL OF M
FOR THEIR MANY CONTRIBUTIONS.
WE'RE READY TO TALK.
BUT WE WON'T BE
MRS. HUTCHISON: MR. PRESIDENT,
I WOULD JUST LIKE TO RETURN TO A
POIN
ABOUT THE PRESIDENT PROMISING IT,
IT BEING UNDERSTOOD BY EVERYONE
THAT IF YOU LIKE WHAT YOU HAVE,
YOU CAN KEEP IT.
BUT ON MEDICARE ADVANTAGE, ONCE
AGAIN THE C.M.S. HAS ESTIMATED
-- AND I WOULD ASK THE
DISTINGUISHED SENATOR FROM UTAH
TO VERIFY -- THAT ENROLLMENT IN
MEDICAREDVANTAGE WILL DECREASE
BY 64% UNDER THIS BILL.
MR. HATCH: A LOT OF SENIORS
ARE GOING TO BE VERY BADLY HURT
BY THIS.
MRS. HUTCHISON: 8.5 MILLION
SENIORS.
MR. HATCH: A LOT ARE
MINORIES, BY THE WAY, AS WELL.
THIS IS AMAZING TO ME HOW WE GOT
THROUGH ALL KINDS OF DEMAGOGUING
ABOUT LOW-INCOME PEOPL AND
MINORITIES AND YET THEY'RE GOING
TO TAKE ONE OF THE MOST
IMPORTANT BENEFITS AWAY FROM
THEM, AND THAT BENEFIT IS
MENTIONED IN THE MEDICARE
HANDBOOK FOR 2010.
AND THEY ACT LIKE IT'S NOT PART
OF MEDICARE.
I CAN'T BELIEVE SOME OF THE
ARGUMENTS THAT HAVE COME FROM
THE OTHER SIDE.
MR. McCAIN: CAN I ASK THE
SENATOR FROM NEW HAMPSHIRE
HAPPENS -- WHAT HAPPENS
SENIOR MEMBER ON THE BUDGET
COMMITTEE, A PERSON THAT IS
WELL-PHONE FOR HIS KNOWLEDGE OF
THE COMIRKS OF THE BUDGETARY
SITUATION IN AMERICA -- WHAT
HAPPENS, WHAT HAPPENS, I ASK THE
SENATOR FROM NEW HAMPSHIRE, IF
WE PASS THIS MASSIVE
WHAT HAPPENS TO AMERICA'S
ECONOMY?
MR. GREGG: WELL, MY VIEW IS THIS:
FIRST OFF WE KNOW A COUPLE OF
FACTS.
THAT WE GROW THE GOVERNMENT
$2.5 TRILLION OVER A TEN-YEAR
PERIOD WHEN THIS BILL IS FULLY
IMPLEMENTED.
WE ALSO KNOW THAT THE TAX
INCREASES DURING THAT PERIOD
WILL BE APPROXI
TRILLION, TAX TAX INCREASES AND
FEES.
AND THEY AREN'T GOING TO FALL ON THE WLTY.
THEY ARE GOING TO FALL O
SMALL BUSINESS PERSON TRYING TO
CREATE THE
WE ALSO KNOW THAT THERE WILL BE
AN ENTIRE SEED CHANGE IN THE WAY
PEOPLE GET THEIR HEALTH CARE. THE GOVERNMENT WILL BE STEPPING
IN BETWEEN YOU AND YOUR DOCTOR
AND BASICALLY MAKIN A DECISION
TO WHAT YOUR DOCTOR CAN TELL
YOU WHAT YOU CAN
CARE, WHAT THE PROVIDER GROUP
CAN TELL YOU YOU CAN HAVE FOR
HEALTH CARE.
SOMETHING ELSE HASN'T BEEN
DISCUSSED MUCH, WHICH IS T
INNOVATION IN HEALTH CARE WHICH
HAS DONE SO MUCH TO MAKE AMERICA
THE BEST PLACE TO GET HEALTH
CARE IN THE WORLD, WHICH HAS PUT
US ON THE CUTTING EDGE OF DRUGS,
WHICH WHO IS IMPROVED THE LIVES
OF NOT ONLY THOSE IN THE UNI
STATES
IT WILL BE SIGNIFICANTLY CHILLED
BUS THERE WILL NOT BE AN
INTEREST IN INVESTING CAPITAL IN
A MARKET THAT IS SO CONTROLLED
BY THE GOVERNMENT.
IN THE END, IT'S FAIRLY OBVIOUS
THAT ANYBODY WHO'S BEEN AROUND
THIS PLACE, THERE AREN'T GOING
TO BE $3 TRILLION OF REDUCTIONS
IN MEDICARE
NEXT 20 YEARS.
AND THERE AREN'T GOING TO BE
$500 BILLION IN THE
YEARS.
AND SO ALL OF THAT SPENDING IS
GOING TO FALL ON THE BACKS OF
OUR CHILDREN IN THE FORM OF
DEBT.
AND WE ALREADY HAVE A NATION
THAT IS ON AN UNSUSTAINABLE PATH
UNDER THE PRESENT BUDGET
SCENARIO WITHOUT THIS HEALTH
CARE BILL.
OUR DEFICITS ARE $1 TRILLION A
YEAR, ON AVERAGE, FOR THE NEXT
TEN YEARS, THAT'S WITHOUT THIS
BILL.
OUR PUBLIC DEBT GOES FROM 35% OF
THE GROSS NATIONAL PRODUCT TO
85% OF THE GROSS NATIONAL
PRODUCT.
WE BECOME INSOLVED AT THE END OF
THIS DECADE.
NOT THIS DECADE BUT THE DECADE
STARTING TODAY, TEN YEARS FROM TODAY.
MR. HATCH: SENATOR, WOULD YOU YIELD ON THAT?
MR. GREGG: AND THAT'S ALL
AGGRAVATED DRAMATICALLY BY
EXODING THE SIZE OF THE
GOVERNMENT UNDER THIS BILL
RATHER THAN TAKING THE
STEP-BY-STEP APPROACH THAT HAS
BEEN APPROACHED BY OUR SIDE TO
REFORM HEALTH CARE AND MAKE IT
MORE EFFECTIVE AND MAKE IT
DELIVER MORE SERVICES TO MORE
PEOPLE AT A BETTER COST THE.
THERE IS NOTHING IN THIS BILL --
I HAVE HEARD PEOPLE ON THE OTHER
SI
TIMES GET UP AND SAY, THE C.B.O. SAYS THIS BILL REDUCES THE
HEALTH CARE SPENDING OF THE
FEDERAL GOVERNMENT.
JUST THE OPPOSITE.
JUST --
THE C.B.O. LETTER SPECIFICALLY
SAID THAT
FEDERAL GOVERNMENT OF HEALTH
CARE GO UP, GO UP, UNDER THIS
BILL.
IN THE TEN-YEAR PERIOD.
AND
DOWN THE COST OF HEALTH CARE.
IT DOES EXPLODE THE SIZE OF
GOVERNMENT.
IT DOES PUT THE GOVERNMENT INTO
THE BUSINESS OF MAN
HEALTH CARE.
AND, AS A RESULT, I THINK IT'S
GOING TO REDUCE THE QUALITY OF
LIFE OF OUR
HATCH WILL THE SENATOR YIELD ON
THAT POINT?
MR. GREGG: I DON'T HAVE THE FLOOR.
MR. McCAIN: GO AHEAD.
MR. HATCH: OKAY.
WELL, THE SENATOR HAS POINTED
OUT THAT YOU REALLY DON'T
BELIEVE THEY CAN AFFORD ALL
THESE PROGRAMS.
YOU DO
YOU'RE NOT SUGGESTING THIS IS A
GAME, ARE YOU?
MR. GREGG: I -- I AM SUGGESTING
THAT IT IS VERY DIFFICULT UNDER
ANY SCENARIO TO BELIEVE THAT
THIS CONGRESS IS GOING TO DO
ANYTHING OTHER THAN SPEND THE
MONEY THAT IS PUT IN THIS BILL.
IT'S CERTAINLY NOT GOING TO END
UP MAKING THE REDUCTIONS IN
MEDICARE THAT IT PROPOSES IN
THIS BILL.
IF IT DOES MAKE THOSE
REDUCTIONS, THOUGH, I THINK THE
SENATOR FROM UTAH HAS BEEN
ABSOLUTELY RIGHT IN SAYING THOSE
REDUCTIONS SHOULD GO TO MAKING
THE MEDICARE SYSTEM SOLVENT.
THEY SHOULDN'T GO TO CREATING A
BRAND-NEW ENTITLEMENT.
MR. McIN McCAIN: ON THAT POINT, I
THINK SENATOR CRAPO WOULD LIKE
EXACTLY TO EMPHASIZE SENATOR
GREGG'S POINT.
MR. CRAPO: YEAH, I'D LIKE TO
ENGAGE -- MAKE A COMMENT OR TWO
AND THEN ENGAGE AGAIN WITH THE
CHAIRMAN -- OR THE RANKING
MEMBER OF THE BUDGET COMMITTEE.
THE COST CURVE DOWN, AND,
FRANKLY, WHEN YOU TALK TO AMERICANS ABOUT WHAT THEY WANT
IN HEALTH CARE REFORM, THE VAST
MAJORITY OF THEM SAY THE REASON
WE NEED HEALTH CARE REFORM IS
BECAUSE OF THE SKYROCKETING
COSTS OF HEALTH CARE AND HEALTH
CARE INSURANCE.
AND THOSE WHO ARE PROMOTING THIS
BILL SAY THAT THEY ARE BENDING
THAT COST CURVE DOWN.
MY QUESTION IS: THIS COST CURVE
ARE THEY TALKING ABOUT?
IS IT THE SIZE OF GOVERNMENT?
ARE THEY BENDING THE SIZE OF
GOVERNMENT GROWTH DOWN?
NO, AS THE SENATOR FROM NEW
HAMPSHIRE SAID, THEY'RE GROWING
GOVERNMENT BY $2.5 TRILLION FOR
THE FIRST TRUE TEN-YEAR PERIOD
OF THE BILL.
ARE THEY DRIVING PERSONAL HEALTH
CARE COSTS DOWN? NO.
THE C.B.O. REPORT THAT WE
RECENTLY GOT SAID THAT 30% OF
AMERICANS WILL SEE THEIR HEALTH
INSURANCE GO UP.
AND THE OTHER 70% WILL, AT BEST,
SEE IT STAY JUST ABOUT WHAT IT
IS TODAY, RISING AT THE SAME
LEVEL AS IT IS TODAY.
AR
FEDERAL DEFICIT?
WELL, THE CHAIRMAN OF THE BUDGET
COMMITTEE HAS JUST INDICATED TO
US THAT WE'RE GOI
SKYROCKETING DEFICITS, AND THOSE
WHO CLAIM THAT THIS BILL'S GOING
TO REDUCE THE DEFICIT CAN SAY SO
ONLY IF THEY TAKE INTO ACCOUNT
ALL OF THEIR BUDGET GIMMICKS,
LIKE NOT COUNTING THE FIRST FOUR
YEARS OF THE SPENDING, OR THE
HUNDREDS OF BILLIONS OF DOLLARS
IN TAXES THAT ARE GOING TO BE
IMPOSED ON THE AMERICAN PEOPLE,
ARE OR THE MEDICARE CUTS THAT
WE'VE BEEN TALKING.
YOU CAN TAKE ANY ONE OF THOSE
THREE OUT OF THIS BILL AND IT
DRIVES THE DEFICIT UP IN THE
SKYROCKETING FASHION.
IS THAT NOT CORRECT, SENATOR?
MR. McCAIN: AND AS THE SENATOR
FROM -- HAS THE SENATOR FROM NEW
HAMPSHIRE EVER HEARD OF
LEGISLATION WHERE YOU PAY IN THE
FIRST FOUR YEARS BEFORE A SINGLE
BENEFIT COMES ABOUT?
YOU KNOW, NOWADAYS, I SEE THESE
ADVERTISEMENTS THAT YOU CAN BUY
A CAR AND YOU DON'T HAVE TO MAKE
A PAYMENT FOR A YEAR AND THEN
YOU START MAKING PAYMENTS.
ON THIS DEAL, IT'S THE REVERSE.
YOU MAKE PAYMENTS AND THEN
PERHAPS YOU GET THE BENEFITS
AFTER SOME YEARS.
AND THE SENATOR FROM TENNESSEE I
THINK WOULD LIKE TO COMMENT TOO.
MR. ALEXANDER
COMMENT TO THE SENATOR FROM NEW HAMPSHIRE TOO.
THE PRESIDENT OF THE UNITED
STATES SAID
WEEKS AGO THAT I THOUGHT WAS
PROFOUND AND THAT I AGREE WITH, WHICH -- HE SAID THAT THIS
DEBATE IS NOT JUST ABOUT HEALTH
CARE, IT'S ABOUT THE ROLE OF THE
FEDERAL GOVERNMENT IN THE
EVERYDAY LIVES OF THE AMERICAN PEOPLE.
AND I BELIEVE HE'S EXACTLY RIGHT
ABOU THAT, WHICH IS WHY SO MANY
AMERICANS ARE TURNING AGAINST
THIS BILL. WOULD THE SENATOR FROM NEW
HAMPSHIRE AGREE THAT -- THAT THE
PRESIDENT WAS CORRECT, THAT THIS
DEBATE IS ABOUT, IN MY WORDS NOW
NOW, WASHINGTON TAKEOVERS, MORE
TAXES, MORE SPENDING, MORE DEBT,
TAKING OVER CAR COMPANIES?
THIS -- IT'S NOT JUST ABOUT
HEALTH CARE.
THE ENORMOUS INTEREST ACROSS THE
COUNTRY IN THESE VOTES COMES
FROM A MUCH
JUST THIS HEALTH CARE BILL.
MR. GREGG: WELL, I THINK THE
SENATOR FROM TENNESSEE IS ONCE
AGAIN -- HAS ONCE AGAIN HIT THE
NAIL ON THE HEAD.
AND I -- AND I READY THE
PRESIDENT'S FORTHRIGHTNESS,
BECAUSE THE PRESIDENT HAS SAID
VERY SIMPLY, HE BELIEVES THAT
PROSPERITY COMES FROM GROWING
THE GOVERNMENT.
AND WHEN THIS BILL PASSES, WE
WILL SEE THE LARGEST GROWTH IN
GOVERNMENT IN THE HISTORY OF OUR COUNTRY.
THIS IS GOING TO BE 16% OF OUR
ECONOMY BASICALLY MANAGED BY THE
FEDERAL GOVERNMENT.
AND YOU'RE GOING TO SEE THE
GOVERNMENT EXPLODE IN SIZE.
DOES THAT LEAD TO PROSPERITY?
I DON'T HAPPEN TO THINK IT DOES.
IT CERTAINLY DOESN'T LEAD TO
PROSPERITY IF ALONG WITH THAT
MASSIVE EXPANSION IN THE SIZE OF
GOVERNMENT, YOU'RE GOING TO SEE
YOUR D
U'RE GOING TO SEE THE DEFICITS
GO UP SIGNIFICANTLY.
OR YOU'RE GOING TO SEE YOUR TAX
BURDEN GO UP SIGNIFICANTLY,
WHICH REDUCES PRODUCTIVITY.
OR IF YOU'RE GOING TO TAKE A
LARGE SEGMENT OF OUR SOCIETY --
OUR SENIORS, 35 MILLION A DAY,
70 MILLION BY THE YEAR 2019 --
AND SAY TO THEM, THEY'RE NOT GOING TO HAVE THE ABILITY TO
HAVE A SOLVENT MEDICARE SYSTEM
BECAUSE THE WAY THAT SYSTEM
MIGHT HAVE BEEN MADE MORE
SOLVENT IS NOW BE USED TO CREATE
A BRAND-NEW ENTITLEMENT, A
MASSIVE NEW ENTITLEMENT FOR A
WHOLE GROUP OF PEOPLE WHO NEVER
PAID INTO THE INSURANCE POLICY
AND NEVER PAID INTO THE MEDICARE
INSURANCE FUND.
SO I -- I THINK THE SENATOR'S
HAS TOUCHED T BASE.
YOU KNOW, WE'VE SEEN
AUTOMOBILES, WE'VE SEEN FINANCIAL INSTITUTIONS, WE'VE
SEEN THE STUDENT LOANS AND NOW
WE'RE SEEING HEALTH CARE ALL
TAKEN OVER BY THE GOVERNMENT.
PARTIALLY TAKEN OVER BY THE
GOVERNMENT.
AND, CLEARLY, THE GOAL IS, AS
THE PRESIDENT SAID, EXPAND THE
SIZE OF THE GOVERNMENT, YOU
CREATE PROSPERITY.
USE THE EUROPEAN MODEL.
I DON'T HAPPEN TO BE ATTRACTED
TO THE EUROPEAN MODEL.
I THINK THE AMERICAN MODEL WORKS
BETTERMENT WHERE Y HAVE A
GOVERNMENT THAT YOU CAN AFFORD
AND YOU GIVE ENTREPRENEURS A
CHANCE TO GO OUT AND TAKE
-- RISKS AND CREATE JOBS.
MR. McCAIN: SENATOR HUTCHISON CONCLUDES.
MRS. HUTCHISON: MR. PRESIDENT,
WE'VE BEEN TALKING ABOUT
MEDICARE ADVANTAGE AND LOSING
THIS GREAT OPTION FOR OUR
LOWER-INCOME SENIORS IS SO IMPORTANT.
I WAS REMINDED THAT LOOKING HOSPITALS, WE HAVEN'T EVEN
TALKED ABOUT THE $135 BILLION
THAT WOULD BE TAKEN OUT OF
HOSPITALS IN THIS AMENDMENT -- I
MEAN, THI IN THIS BILL, AND THAT IS
THE CARE PROVIDERS.
SO WE'
AWAY THEIR OPTIONS, AND EYE CARE
AND DENTAL CARE AND HEARING
AIDS
SENIORS NEED, BUT ALSO
UNDERCUTTING THE HOSPITALS THAT
READ IT THEM STHAT THE CARE IN
THE HOSPITALS THEMSELVES WOULD
ALSO HAVE TO BE CUT BACK.
MR. PRESIDENT, IT JUST DOES NOT
PASS COMMON SENSE
MEDICARE IN ORDER TO CREATE A
NEW, BIG ENTITLEMENT PROGRAM.
WE'VE ALL THAT SAID M
ON LIFE SUPPORT ANYWAY, THAT
EVERYONE UNDERSTANDS
YOU TAKE HALF A TRILLION DOLLARS
OUT OF A PROGRAM THAT IS WORKING
FOR SENIORS, THAT GIVES OPTIONS
TO SENIORS, LIKE MEDICARE
ADVANTAGE, AND YOU TAKE AWAY
THEIR CARE TO PAY FOR ANOTHER
ENTITLEMENT PROGRAM THAT
SPECIFICALLY DESIGNED FOR THEM.
MR. PRESIDENT, I WANT TO THANK
THE SENATOR FROM ARIZONA, AND I
WOULD ASK HIM TO -- TO FINISH
THE COMMENT ON -- ON
HAPPENING TO THIS BILL IN THIS
COUNTRY TO OUR SENIORS AND WE
NEED TO STOP IT.
MR. McCAIN McCAIN: I THANK MY COLLEAGUES.
ITS BEEN A LOT OF
I YI
MR. BROWN: MR. PRESIDENT?
MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM OHIO. MR. BROWN: YEAH.
MR. PRESIDENT, I ASK UNANIMOUS
CONSENT TO --
THE PRESIDING OFFICER: THE
SENATOR FR
MR. BAUCUS:
CONSENT THAT WE EXTEND FOR
ADDITIONAL HOUR THE PERIOD FOR
DEBATE ONLY.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BAUCUS: THERE'S MORE TO IT.
WITH NO FURTHER AMENDMENTS OR
MOTIONS IN ORDER DURING THE HOUR
AND THAT THE TIME BE EQUALLY
DIVIDE BETWEEN THE TWO SIDES,
WITH THE REPUBLICANS CONTROLLING
THE FIRST 30 MINUTES, THE
MAJORITYONTROLLING THE SECOND
30 MINUTES.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BAUCUS: BUT THERE ARE THREE
MINUTES REMAINING ON THE FIRST
BLOCK ON THE MAJORITY SIDE.
THE PRESIDING OFFICER: 2 MINUTES
AND 20 SECONDS.
MR. BAUCUS: THAT'S CLOSE ENOUGH.
MR. PRESIDENT, I ASK CONSENT
THAT SARAH FELD OF SENATOR
HARKIN'S STAFF BE GRANTED FLOOR
PRIVILEGES FOR THE DURATION OF
TODAY'S SESSION.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BROWN: MR. PRESIDENT? THE PRESIDING OFFICER: THE
MR. BROWN: MR. PRESIDENT, I ASK
UNANIMOUS CONSENT TO BEDDED AS
A COSPONSOR TO THE COBURN
AMENDMENT NUMBER 278 REQUIRING
ALL MEMBERS OF CONGRESS -- 2789 REQUIRING ALL MEMBERS OF
CONGRESS TO ENROLL IN THE NEW PUBLIC INSURANCE OPTION.
I WANTED TO ADD MY NAME TO
SENATOR COBURN'S AMENDMENT.
17 YEARS AGO WHEN I FIRST RAN
FOR CONGRESS, I PROMISED I'D PAY
MY OWN HEALTH INSURANCE UNTIL
CONGRESS PASSED HEALTH INSURANCE
FOR EVERYONE.
I LOOK FORWARD -- I'VE PAID IT
OUT OF MY POCKET SINCE THEN.
I LOOK
EAGERNESS TO JOIN THE PUBLIC
OPTION COME AS SOON AVAILABLE.
THANK YOU, MR. PRESIDENT.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
THINK I'LL USE MY THREE
JUST TO SAY THIS. MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: 2 MINUTES AND 20 SECONDS.
THE PRESIDING OFFICER: 15
SECONDS.
MR. BAUCUS: OKAY.
WELL
I JUST WANT TO MAKE A PRETTY
BASIC POINT.
THE SENATOR FROM ARIZONA TALKS
ABOUT, GEE, ALL THESE MEDICARE
ADVANTAGE PLANS HAVE DENTAL AND
VISION COVERAGE AND -- AND HE
GOES ON TO SAY, SO DO MEMBERS OF
CONGRESS.
WELL, THE FACT IS, THAT'S NOT
AUTOMATICALLY TRUE.
THE FACT IS THAT THE MEMBERS OF
CONGRESS CHOOSE AMONG VARIOUS
PRIVATE PLANS.
SOME PLANS OFFER DENTAL AND VISION.
SOME DON'T.
AETNA IS A COMPANY THAT MEMBERS
OF CONGRESS CAN CHOOSE FROM
UNDER FEHBP AND HUMANA IS
ANOTHER ONE THAT MEMBERS OF
CONGRESS CAN CHOOSE FROM.
THOSE COMPANIES DO PROVIDE
DENTAL AND VISION COVERAGE, BUT
THERE ARE OTHERS, I THINK
BLUECROSS BLUESHIELD DOES NOT
PROVIDE DENTAL AND VISION VERAGE.
AND I MAKE THAT POINT BECAUSE
THIS IS EXACTLY WHAT WE'RE
TRYING TO SET UP IN THESE
EXCHANGES, THAT IS, PEOPLE CAN
PARTICIPATE IN THE EXCHANGES,
THEY CAN -- WHERE THEY WOULD BUY
PRIVATE COVERAGE AND THEY COULD
CHOOSE AMONG VARIOUS PRIVATE
PLANS WHICH COVERAGE THEY WANT.
DO THEY WANT A PLAN THAT COVERS
DENTAL AND VISION OR NOT.
IT'S EXACTLY WHAT WE'RE TRYIN
TO DO ON THE EXCHANGE.
AND AS IS THE CASE FOR MEMBERS
OF CONGRESS.
AND IT'S -- AND MEDICARE ADVANTAGE ANS DO PROVIDE
DENTAL AND VISION.
THAT'S -- I THINK THAT'S
I SEE MY TIME'S EXPIRED.
AT THE APPROPRIATE TIME, I WOULD
LIKE TO
EXPLAIN WHY WHAT WE DO IN THIS
BILL I THINK MAKES EMINENT
SENSE.
A SENATOR: MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM IOWA.
MR. GRASSLEY: I WOULD YIELD
MYSELF SUCH TIME AS I MIGHT TAKE, AND I DON'T THINK I'M
GOING TO SPEAK MORE THAN SIX OR
SEVEN MINUTES, FOR THE BENEFIT
OF MY
SOME OF THIS TIME.
I WANT TO TELL MY COLLEAGUES WHY
I'M SUPPORTING THE HATCH
AMENDMENT.
IN MY HOME STATE OF IOWA, THERE
ARE 64,000 SENIORS ENROLLED IN
MEDICARE ADVANTAGE.
THESE ARE SENIORS THAT HAVE COME
TO RELY
PARTICULARLY ADDITIONAL BENEFITS
THAT MEDICARE ADVANTAGE PROVIDES
AS OPPOSED TO TRADITIONAL
MEDICARE.
YESTERDAY, I CAME TO THE FLOOR
TO POINT OUT THAT MY COLLEAGUES
ON THE OTHER SIDE OF THE AISLE
ARE PLAYING WORD GAMES TO COVER
UP THE FACT THAT THEY ARE
RAIDING MEDICARE, CUTTING
BENEFITS BY 64% FOR THESE
11 MILLION SENIORS THAT HAVE
CHOSEN VOLUNTARILY TO GO ON
MEDICARE ADVANTAGE AS OPPOSED TO
TRADITIONAL MEDICARE.
SO LET ME REPEAT, THIS BILL CUTS
MEDICARE BENEFITS, OR LET'S SAY
RAIDS MEDICARE, BY 64% FOR 11 MILLION MICARE
BENEFICIARIES
MY FRIENDS ON THE OTHER SIDE OF
THE AISLE KEEP SAYING THAT
THEY'RE NOT CUTTING, AND THEY
USE THESE WORDS -- THEY'RE NOT
CUTTING GUARANTEED BENEFITS.
BUT THIS ISN'T EVEN THE CASE,
BECAUSE WE HAVE THIS NEW
INDEPENDENT MEDICARE ADVISORY
BOARD THAT'S SET UP IN THIS LEGISLATION.
IT'S GIVEN VERY SPECIFIC
AUTHORITY TO CUT PAYMENTS TO MEDICARE PART-D.
THIS WILL RESULT IN HIGHER COSTS
AND LESS GUARANTEED BENEFITS FOR
MEDICARE BENEFICIARIES ENROLLED
IN MEDICARE PART-D.
BUT I WANT TO LEAVE THAT DEBATE
FOR LATER.
I WANT TO VISIT WITH MY
COLLEAES NOW JUST ABOUT
MEDICARE ADVANTAGE.
64,000 S
11 MILLION SENIORS NATIONWIDE
DON'T CARE ABOUT THE
GOBBLEDYGOOK TYPE WORDS WE USE
HERE IN TOWN, AS LEGAL AS THEY
ARE, GUARANTEED BENEFITS ON THE
ONE HAND AND THE WORDS
"ADDITIONAL BENEFIT" ON THE
OTHER HAND.
IN OTHER WORDS, "GUARANTEED
BENEFITS," OR, AS THE OTHER SIDE
WANTS US TO
SOMEHOW ADDITIONAL BENEFITS
PROVIDED UNDER MEDICARE.
SO I SAY THAT'S WASHINGTON
NONSENSE AND I WANT TO BRING A
LITTLE BIT OF MIDWESTERN
COMMONSENSE TO THIS DEBATE.
BECAUSE OUR CONSTITUENTS JUST
WANT TO KNOW THAT CONGRESS ISN'T
CUTTING MEDICARE BENEFITS THAT
THEY HAVE COME TO RELY UPON, AND
THAT WOULD INCLUDE UNDER
MEDICARE ADVANTAGE.
DENTAL CARE, EYEGLASSES, HEARING
AIDS AND OTHER ADDITIONAL
BENEFITS PROVIDED BY THIS
PROGRAM THAT THEY VOLUNTARILY
CHOOSE MEDICARE ADVANTAGE.
NOW, I KNOW THAT TO BE THE CASE
BECAUSE I JUST HAVE -- I HAVE AT
LEAST A THOUSAND LETTERS
RECEIVED LAST SUMMER -- SINCE
LAST SUMMER ON THIS POINT.
BUT I JUST WANT TO READ ONE FROM
MISS GALARDO OF IOWA CITY, IOWA.
"I AM WRITING TO URGE YOU TO
OPPOSE CUTS TO MEDICARE ADVANTAGE.
THIS PLAN WAS A GREAT HELP TO ME
WHEN MY LATE HUSBAND, WHO PASSED
AWAY IN MAY, WAS HOSPITALIZED.
I WAS ABLE TO AFFORD TO PAY THE
HOSPITAL WITHOUT GOING BANKRUPT.
INCOME DEPEND ON OUR BENEFITS
FROM MEDICARE ADVANTAGE.
I AM RETIRED AND I DON'T --" FOR
A QUOTE -- "I AM RETIRED AND
DON'T KNOW HOW I WOULD HAVE
MANAGED WITHOUT MEDICARE
ADVANTAGE."
EN
LETTER.
NOW, SOME OF MY COLLEAGUES ON
THE OTHER SIDE OF THE AISLE
DON'T WANT SENIORS, EVEN PEOPLE
LIKE MY CONSTITUENT FROM IOWA
CITY, IOWA, MS. GALADO, TO KNOW
THAT THIS 2W06R
THEIR PAYMENTS.
THEY'RE CUTTING THEIR PAYMENTS
IN THE MEDICARE ADVANTAGE PLAN.
THAT DOESN'T MAKE A DIFFERENCE
TO MS. GUARDO.
BUT THAT THESE PAYMENTS MUST BE
SPENT ON ADDITIONAL
NOT JUST FREE MONEY FOR A
COMPANY TO USE OR FREE MONEY
THAT BENEFITS A MEDICARE
ADVANTAGE RECIPIENT WITHOUT ANY
CONCERN ABOUT WHAT IT COSTS.
75% OF THESE PAYMENTS MUST BE
SPENT FOR ADDITIONAL
AND THEN WHERE DOES THE REST OF
IT GO?
THE REST OF IT COMES BACK TO THE
FEDERAL TREASURY.
CUTS TO THESE MEDICARE ADVANTAGE
PAYMENTS ARE, IN FACT, CUTS IN
MEDICARE BENEFITS.
I'M MORE THAN HAPPY TO HAVE
DEBATE ON HOW TO REFORM MEDICARE
ADVANTAGE PAYMENTS.
WE SHOULD ALWAYS BE LOOKING FOR
WAYS TO MAKE PAYMENTS MORE EFFICIENT.
BUT THE SOLUTION IS NOT TO CUT
BENEFITS BY 64% THAT SENIORS
HAVE COME TO RELY ON TO FUND AN
ENTIRELY NEW ENTITLEMENT PROGRAM
THAT THIS COUNTRY CAN'T AFFORD.
AT A TIME WHEN SENIORS ARE IN
THE MIDST OF THE BIGGEST
ECONOMIC CRISIS SINCE THE GREAT
DEPRESSION, WE SHOULDN'T BE
DEBATING A BILL THAT SPENDS THEM
TO SPEND MORE MONEY ON HEALTH
CARE, BUT THAT IS EXACTLY WHAT
THIS 2,074-PAGE BILL WILL DO.
SENIORS THAT LOSE THEIR MEDICARE
ADVANTAGE AS A RESULT OF THIS
BILL MAY BE FORCED TO BUY A
MEDI-GAP PLAN TO FILL ALL THE
HOLES IN THE TRADITIONAL
MEDICARE PLAN.
THAT'S WHY MORE LOW-INC
SENIORS ENROLL IN MEDICARE ADVANTAGE.
THE SO-CALLED OVERPAYMENTS THAT
MY COLLEAGUES ON THE OTHER SIDE
OF THE AISLE KEEP DECRYING HELP
FILL IN A SIGNIFICANT COST
SHARING AND PREMIUMS THAT EXIST
IN TRADITIONAL MEDICARE.
SO THIS BILL WILL FORCE
LOW-INCOME SENIORS THAT PAY
LITTLE TO NOTHING UNDER MEDICARE
ADVANTAGE TO COME UP WITH $175
PER MONTH TO BUY A MEDI-GAP
PLAN.
THAT DOESN'T SOUND LIKE THAT'S A
VERY GOOD WAY TO HELP SENIORS.
THAT SOUNDS LIKE THIS BILL IS
PAYING FOR AN ENTIRELY NEW
ENTITLEMENT PROGRAM.
AND PAYING FOR IT, QUITE
FRANKLY, ON THE BACKS OF
11 MILLION MEDICARE
BENEFICIARIES.
SO I SUPPORT THE HATCH AMENDMEN
LET'S TAKE THE DZ
CUTS TO MEDICARE BACK TO THE
FINANCE COMMITTEE AND FIND A
WHICH TO IMPROVE THE PROGRAM
WITHOUT HURTING 11 MILLION SENIORS.
I WOULD LIKE TO AT THIS POINT,
MR. PRESIDENT, AS I YIELD THE
FLOOR TO YIELD FIVE MINUTES AS
MANAGER ON THIS SIDE
HU
MRS. HUTCHISON: THANK YOU, MR.
PRESIDENT.
MR. PRESIDENT, I APPRECIATE WHAT
THE DISTINGUISHED SENATOR FROM
IOWA HAS JUST TALKED
BECAUSE I SPECIFICALLY LIKE THE
FACT THAT HE'S RELATING THIS TO
WHERE WE ARE TODAY.
SOMETIMES IT'S -- IT SEEMS LIKE
WE'RE IN A
HOW STRETCHED PEOPLE ARE RIGHT
NOW.
WE ARE IN A TIME OF
PEOPLE WORRIED ABOUT KEEPING
THEIR JOBS OR WORRIED ABOUT
HAVING LOST THEIR JOBS.
WHERE ARE THEY GOING TO GET
HEALTH CARE?
YOUAVE SENIORS THAT ARE
STRETCHED BECAUSE THEY'RE NOT
ABLE TO EARN ANYTHING THAT WILL
HELP THEM VERY MUCH.
WE'RE IN A DISTRESSED TIME IN
THIS COUNTRY.
THERE'S NO DOUBT ABOUT IT.
AND TO TK ABOUT
MEDICARE $500 BILLION IS JUST
ASTOUNDING.
NOW, I'M CONCERNED ABOUT
HOSPITALS.
BECAUSE WE TALKED FOR THE LAST
45 MINUTES ABOUT THE CUTS TO
SERVICES, THE HEARING AIDS, THE
DENTAL WORK THAT SENIORS NEED,
THE EYE CARE
WE'VE TALKED ABOUT THE
BENEFITS, BUT WHAT ABOUT THE
CUTS TO
EVERY HOSPITAL IN TEXAS TREATS
PEOPLE WHO HAVE NO INSURANCE
AND, THEREFORE, GET
DISPROPAYMENTS THAT MAKE UP FOR
THE LOW REIMBURSEMENT RATES OF
MEDICARE.
A MAJOR COMPONENT
LESSENED PAYMENTS
PROVIDERS, TO DOCTO
TO HOSPITALS, TO
ADVANTAGE, WE TALKED ABOUT,
THAT'S A CUT OF $120 BILLION,
AND THEN HOME HEALTH AGENCIES.
ALL OF THESE SERVE OUR SENIORS.
-- OUR SENIORS IN SUCH GREAT WAYS.
AND LOOK AT THE
TRILLION DOLLARS OVER 10 YEARS.
THIS IS NOT
YOU CANNOT TAKE AWAY FROM
MEDICARE
REIMBURSEMENTS TO
BECAUSE WHAT'S GOING TO HAPPEN
TO A
HAPPEN TO A HOSPITAL IN A RURAL
AREA THAT IS BARELY HANGING ON
RIGHT NOW BECAUSE THEY'RE TRYING
TO MAKE ENDS MEET IN A MORE
EXPNSIVE TREATMENT AREA, --
EXPENSIVE TREATMENT AREA, AND
THEY LOSE THAT ADDED BENEFIT --
IT'S NOT A
PAYMENT, THAT WOULD MAKE THEM
WHOLE IN THE TREATMENT OF OUR
SENIORS, OUR LOW-INCOME SENIORS
AND OUR SENIORS?
THE TEXAS HOSPITAL ASSOCIATION
ESTIMATES THAT $2 BILLION WILL
BE CUT IN THE PAYMENTS TO
HOSPITALS FOR MEDICARE PATIENTS.
NOW, $2 BILLION OUT OF OUR
ECONOMY.
254 COUNTIES
MORE THAN O-FOURTH DO NOTAVE
AN ACUTE CARE HOSPITAL WITHIN
THEIR BOUNDARIES.
WITH THESE KINDS OF CUTS TO OUR
RURAL HOSPITALS, WE ARE TALKING
ABOUT LOSING MORE HOSPITALS,
THERE'S NO DOUBT ABOUT IT.
BECAUSE THEY'RE ALREADY
STRUGGLING.
WHY WE PAY FOR HEALTH CARE
REFORM ON THE BACKS OF OUR
SENIOR CITIZENS?
WHY WOULD WE
PROGRAM THAT THEY HAVE THAT IS
ORDER TO PAY FOR ANOTHER BIG
GOVERNMENT PROGRAM THAT IS GOING
TO COST $2.5 TR
$2.5 TRILLION, MOST OF WHICH IS
GOING TO BE ADDED TO
DEFICIT, ADDED TO THE DEBT IN
OUR COUNTRY.
AND WE'RE ALREADY HITTING THE
CEILING OF THE DEBT A
AT $12 TRILLION.
WE'RE IN A VERY TOUGH FINANCIAL TIME.
WE ARE IN A TIME THAT IS HARD
FO PEOPLE WHO HAVE LOST THEIR
JOBS, HARD FOR SENIORS WHO ARE
STRETCHED TO MAKE ENDS MEET.
HARD FOR HOSPITALS THAT
SERVING THESE SENIORS.
AND
COST OF THE TREATMENT AND, YET,
WE'RE TALKING ABOUT
THESE SERVICES.
OF
MEDICARE, $20 BILLION ARE FOR
THE REIMBURSEMENT RATES THAT
WILL NO LONGER BE
HOSPITALS WHOLE.
I'VE TALKED TO -- IN FACT, I
WENT TO THE MAJOR MEDICAL
CENTERS IN TEXAS, IN DALT DALLAS, IN
HOUSTON, AND THEN I WENT OUT TO
RURAL AREAS, AND IT IS THE TOPIC
OF CONVERSATION.
ANYONE WHO IS DEALING WITH A
HOSPITAL IN A RURAL AREA,
THEY'RE ALL SAYING: WHAT ARE YOU
DOING?
WELL, OF COURSE, WE'RE NOT DOING ANYTHING.
WE'RE FIGHTING THESE HEALTH CARE
CUTS.
BUT THEY'VE GOT TO KNOW WHAT IS
HAPPENING HERE SO WE
THAT RESULT.
MR. PRESIDENT, I UNDERSTAND THAT
MY TIME IS UP, AND I THINK THE
SENATOR FROM OKLAHOMA HAS THE
REST OF THE TIME ON OUR SIDE AND
I YIELD TO HIM.
THE PRESIDING OFFICER: THE
SENATOR FRO
MR. INHOFE: FIRST OF ALL, I
THANK THE SENATOR FROM TEXAS.
I YIELD MYSELF THE REMAINDER OF
YOUR TIME, WHICH I UNDERSTAND IS
UNTIL 10 AFTER THE HOUR.
MR. PRESIDENT, I WANT TO TALK
ABOUT THE TAX HERE TODAY, WHICH
IS OUR SUBJECT IN MAYBE A LITTLE
DIFFERENT WAY THAN SOME OF THE
OTHERS DID.
THE STATED PURPOSE OF THE
DEMOCRATS' HEALTH CARE PROPOSAL
IS TO DO TWO THINGS, LOWER COSTS
AN INCREASE COVERAGE.
-- AND INCREASE COVERAGE.
NOW, THIS BILL IS A MISERABLE
FAILURE UNDER BOTH COUNTS.
UNDER THE PLAN THE PREMIUMS ARE
EXPECTED TO INCREASE AS A RESULT
OF THE NEW TAXES, NEW
REGULATIONS AND RESTRICTIONS.
IN GENERAL YOU'RE GOING TO PAY
MORE FOR YOUR HEALTH INSURANCE
THANKS TO THE
2,000-PAGE BILL.
THAT IS IN DIRECT CONTRADICTION
OF THE STATED GOALS OF THE BILL ITSELF.
I'M GOING TO BE SPECIFIC ABOUT
THAT IN A MOMENT.
THE SECOND ISSUE IS COVERAGE.
AGAIN, WE FIND A MISERABLE
FAILURE, THE MOSS OFTEN CITED
NUMBER OF UNINSURED
47 MILLION AMERICANS THAT WOULD
BE UNINSURED.
I SAW SOME INTERESTING NUMBERS
IN "THE WASHINGTON POST" OPINION
PIECE THE OTHER DAY, WHICH KIND
OF RANKS OUT THE UNINSURED AND
HOW THEY'RE BROKEN DOWN.
THIS IS VERY SIGNICANT.
OF THE 47 MILLION, 39% RESIDE IN
THE FIVE STATES OF CALIFORNIA,
FLORIDA, NEW MEXICO, ARIZONA,
AND TEXAS.
OF COURSE THOSE ARE BORDER STAT.
INDEED, IT IS ESTIMATED THAT
9.1 MILLION OF THE 47 MIION
ARE ILLEGAL IMMIGRANTS, PEOPLE
HERE IN THIS COUNTRY ILLEGALLY.
NOW,
47 MILLION, 9.7 MILLION HAVE
INCOMES ABOVE $75,000 AND CHOOSE
NOT TO PURCHASE HEALTH
INSURANCE.
THIS BILL WOULD SOLVE THAT ISSUE
BY USING A COERCIVE POWER OF THE
FEDERAL GOVERNMENT TO FORCE
THESE CITIZENS TO ALLOCATE THEIR
RESOURCES IN A MANNER THAT MEETS
THE BUREAUCRATS IN WASHINGTON
AND THE POLITICIANS.
THE BILL MAKES IT A CRIME NOT TO
HAVE HEALTH INSURANCE SO -- AND
IF YOU DON'T GET IT, YOU GET
TAXED.
LASTLY, A TOTAL OF 14 MILLION OF
THE 47 MILLION ARE CURRENTLY
ELIGIBLE FOR CURRENT GOVERNMENT
PROGRAMS, MEDICAID, MEDICARE,
SCHIP AND SO FORTH AND CHOOSE
NOT TO SIGN UP.
NOW, IF YOU DO THE MATH, THAT
REDUCES THAT 47 MILLION DOWN --
IF YOU TAKE OUT THE ILLEGALS AND
THE OTHERS FOR THE REASONS I
STATED TO ABOUT 14 MILLION.
SO THIS BY AND LARGE IS WHAT
PEOPLE ARE TALKING ABOUT WHEN
THEY MENTION THE 47 MILLION
UNINSURED AMERICANS.
I THINK THESE NUMBERS SHED SOME
INTERESTING LIGHT ONHE
COMPENSATION OF THE UNINSURED
AM AROUND.
PRESIDENT OBAMA, INTERESTINGLY,
USES A DIFFERENT NUMBER.
HE DOESN'T USE 47 MILLION.
HE USES 30 BILLION -- DISCUSS ME -- 30 MILLION.
BECAUSE I THINK HE WANTS TO
AVOID THE EMBRACING ISSUE, AND I
THINK THAT'S PROBABLY WISE OF
HIM TO DO THAT.
HE DOESN'T WANT TO BE ACCUSED OF
GIVING RICH BENEFITS TO THOSE
WHO ARE HERE ILLEGALLY.
HE'S NOT USING 47 MILLION, BUT
30 MILLION UNINSURED AMERICANS.
I NOTED WITH GREAT INTEREST THE
C.B.O.'S ESTIMATE OF THE NUMBER
OF AMERICANS WHO WILL NOT HAVE
HEALTH INSURANCE EVEN IF THIS
BILL WERE TO BE ENACTED OVER THE
WISHES OF THE MAJORITY OF THE
AMERICAN PEOPLE, 24 MILLION.
THIS BILL STILL
24 MILLION AMERICANS UNINSURED
AFTER SPENDING $2.5 TRILLION TO
DO JUST THAT WHILE AT THE SAME
TIME MAKING HEALTH CARE MORE
EXPENSIVE FOR THE REST OF US.
YOU KNOW, I LIKE TO USE -- I
HEAR THE OTHER SIDE OFTEN
THROWING NUMBERS AROUND WITHOUT
ANY DOCUMENTATION.
AND ISED THE C.B.O. AND OTHERS
NONPARTISAN, CREDIBLE SOURCES SO
THAT WE CAN AVOID DOING THAT.
PRESIDENT OBAMA WANTS TO SPEN SPEND $2.5 TRILLION IN NEW
HEALTH CARE PROMISES AT A TIME
WHEN THE COUNTRY CAN'T AFFORD
THE PROMISES WE'VE ALREADY MADE
AND WE HAVE A RECORD ONE-YEAR
BUDGET DEFICIT OF $1.4 TRILLION.
WHICH, BY THE WAY, MEANS THAT 47
CENTS OUT OF EVERY SINGLE DOLLAR
THAT THE FEDERAL GOVERNMENT
SPENDS THIS YEAR IS BORROWED.
IN 10 YEARS, 16% OR NEARL
OUT OF EVERY $5 THAT THE
GOVERNMENT SPENDS, WILL BE SPENT
SOLELY ON INTEREST PAYMENTS ON
THE DT.
OBAMA'S BUDGET DOUBLES THE
FEDERAL DEBT IN FIVE YEARS AND
TRIPLES IT IN 10 YEARS.
WE TALKED ABOUT THIS ON THE
FLOOR.
I DON'T THINK THERE'S
DISAGREEMENT ON THIS.
ON TOP OF THIS WE FACE
FACED $60 BILLION FROM THE
CURRENT ENTITLEMENTS OF SOCIAL
SECURITY, MEDICARE, AND
MEDICAID.
THIS HEALTH CARE PLAN LAYERS
ANOTHER UNAFFORDABLE ENTITLEMENT
ON TOP OF MEDICARE AND MEDICAID
AND SOCIAL SECURITY AND THE
OTHER ENTITLEMENTS THAT WE HAVE.
ON A SYSTEM THAT'S ALREADY --
ALREADY CRUMBLING.
IT SEEMS TO ME THAT THIS BILL IS
WHAT THE AMERICAN PEOPLE DO
NEED AND I THINK THAT THAT'S WHY
MOST AMERICANS ARE REPORTING
THAT THIS BILL IS SOMETHING THAT
THEY DON'T WANT AT THIS TIME OR
EVER.
I THINK IT'S COMMON SENSE.
NOW, READING THROUGH THE
LEGISLATION, ONE IS STRUCK BY A
MYRIAD OF WAYS THIS BILL RAISES
TAXES ON AMERICAN CITIZENS.
FROM JOB-CREATING SMALL
BUSINESSES TO MIDDLCLASS
FAMILIES, I COUNT ABOUT A DOZEN
OF THEM ADDING UP TO
ABOUT $500 BILLION IN TAX
INCREASES OVER THE NEXT FEW
YEARS.
HALF A TRILLION DOLLARS IN NEW TAXES.
SO EVERYONE SHOULD GET READY TO
PAY HIGHER TAXES, HIGHER HEALTH
CARE BILLS AND HIGHER TAX BILL
SHOULD THIS MEASURE BECE LAW.
AND SOME MIGHT BE INCLINED TO
SAY BUT PRESIDENT OBAMA PROMISED
WE WOULDN'T RAISE TAXES.
THAT WAS INDEED A CAMPAIGN
PROMISE, AND THE ADMINISTRATION
THAT NO ONE MAKING UNDER
UNDER $250,000 PER YEAR WOULD
SEE THEIR TAXES GO UP.
LET ME GO AHEAD AND QUOTE THAT.
THIS IS WHAT PRESIDENT OBAMA
SAID DURING THE CAMPAIGN, AND
I'M QUOTING -- "I CAN MAKE A
FIRM PLEDGE.
NO FAMILY MAKING LESS THAN
THAN $250,000 WILL SEE THEIR
TAXES INCREASE.
NOT YOUR INCOME TAXES, NOT YOUR
PAYROLL TAXES, NOT YOUR CAPITAL
GAINS TAXES, NOT ANY TAXES."
SO WE STARTED ANALYZING THIS
BILL, AND GUESS WHAT WE FOUND OUT.
WHEN THE BILL IS FULLY ENACTED,
THE NONPARTISAN JOINT COMMITTEE
ON TAXATION -- NOW, KEEP IN
MIND, MR. PRESIDENT, I'M VOTING
SOURCES HERE THAT ARE CREDIBLE
SOURCES AND NONPARTISAN SOURCES.
THE JOINT COMMITTEE ON TAXATION
FOUND THAT THE AVERAGE
INDIVIDUAL MAKING $50,000 AND
FAMILIES MAKING $75,000 WOULD
SEE THEIR TAXES GO UP.
LET ME REPEAT THAT.
FAMILIES MAKING $50,000 AS AN
INDIVIDUAL OR $75,000 AS A
FAMILY WOULD HAVE THEIR TAXES GO
UP UNDER THIS BILL.
AND INDEED, ACCORDING TO THE
JOINT COMMITTEE ON TAXATION,
42 MILLION MIDDLE-CLASS FAMILIES
AND INDIVIDUALS, THOSE MAKING
LESS THAN $200,000 ON AVERAGE,
WILL PAY HIGHER TAXES IN THIS BILL.
PRESIDENT OBAMA'S HEALTH CARE
REFORM BILL CURRENTLY UNDER
CONSIDERATION IN THE SENATE
RAISES REVENUES TO A LARGE
EXTENT ON THE BACKS OF
MIDDLE-CLASS AMERICANS, DESPITE
THE CANDIDATE OBAMA'S PLEDGE NOT
TO DO THAT.
SO LET'S LOOK AT SOME OF THESE
INSTANCES WHERE WE GET TAXED.
BEGINNING THIS AGAIN.
THIS IS FROM THE JOINT TAX
COMMITTEE AND FROM THE C.B.O.
IF YOU HAVE HEALTH INSURANCE, IF
YOU HAVE INSURANCE, IF YOU GET
TAXED, ACCORDING TO THE
NONPARTISAN CONGRESSIONAL BUDGET
OFFICE, NEW EXCISE
TO HEALTH INSURANCE PROVIDERS
WILL END UP TAXING THE BENEFICIARIES.
THIS TAX ALSO HAS THE EFFECT OF
INCREASING PREMIUMS AS WELL, SO
YOU'RE DOUBLE TAXED ON THIS
DEAL.
NOW, THAT'S IF YOU DO HAVE
HEALTH INSURANCE.
WHAT IF YOU DON'T HAVE HEALTH
INSURANCE?
YOU STILL GET TAXED.
UNDER THIS BILL, YOU GET TAXED
IF YOU DON'T CARRY HEALTH
INSURANCE AS A PENALTY.
AND HOW DOES THIS -- WHERE DOES
THIS BURDEN FALL?
YOU GUESSED IT, IN MIDDLE-CLASS AMERICA.
C.B.O. HAS SAID THAT HALF OF THE
AMERICANS AFFECTED BY THIS
PROVISION MAKE BETWEEN $22,000
AND $68,000 FOR AAMILY OF
FOUR.
THAT'S $22,000 TO $68,000 FOR A
FAMILY OF FOUR.
THAT'S IN MIDDLE-CLASS AMERICA,
MR. PRESIDENT. IF YOU TAKE PRESCRIPTION DRUGS,
YOU GET TAXED, ANOTHER AREA.
ACCORDING TO THE JOINT -- THE
J.C.T. AND THE C.B.O., NEW TAXES
IN THIS BILL APPLIED TO THE
PROVISIONS OF PRESCRIPTION DRUGS
WILL END UP RAISING THE COSTS OF THOSE DRUGS.
SO YOU'RE TAXED AGAIN.
IF YOU HAPPEN TO NEED A MEDICAL DEVICE.
THIS IS SOMETHING I'M REALLY
SENSITIVE TO BECAUSE -- AND I
VICE PRESIDENT HEARD MUCH
DISCUSSION OF THIS ON THE FLOOR
SO FAR, BECAUSE IT'S A DIFFICULT
THING.
PEOPLE -- I WAS TALKING TO SENATOR ENZI.
HE SAID PEOPLE DON'T REALLY KNOW
WHAT MEDICAL DEVICES ARE.
THE STENTS, THE -- THESE ARE
THINGS THAT YOU CAN -- THAT ARE
AVAILABLE HERE IN AMERICA.
YOU CAN'T FIND IN MANY OF THE
OTHER COUNTRIES.
SO IF YOU NEED A MEDICAL DEVICE,
YOU GET TAXED.
IF YOU HAVE HIGH OUT-OF-POCKET
MEDICAL BILLS, YOU GET TAXED.
MY SENATE LAW, BRAD -- MY
SON-IN-LAW, BRAD SWAN, INSTALLS
PACEMAKERS AND DEFIBRILLATORS.
I CAN NEVER SAY THAT RIGHT.
AT 1:00 THIS MORNING -- I WAS
TALKING TO HIM THIS MORNING WHEN
HE TOLD ME WHAT HAPPENED LAST NIGHT.
HE SAID AT 1:00 THEY GOT A CALL
TO GO OUT TO THE EMERGENCY ROOM
IN ST. FRANCIS HOSPITA IN MY
CITY OF TULSA, OKLAHOMA.
THEY HAD AN-YEAR-OLD BOY WITH NO
HEARTBEAT.
HE WAS BORN WITH CONGENITAL
HEART DISEASE, AND HE PUT IN A
PACEMAKER AT THAT TIME AND HE
WAS PERFECTLY HEALTHY IN THE MORNING.
THAT'S SOMETHING I THINK MOST
DOCTORS WOULD AGREE THAT THAT
CHILD WOULD NOT HAVE LIVED.
MY OLDER SISTER MARILYN FACED A
SIMILAR SITUATION NINE YEARS AGO
AND SHE IS ALIVE TODAY AND SHE
IS HEALTHY TODAY, AND SHE WOULD
NOT BE ALIVE TODAY.
THAT'S HOW SERIOUS THIS IS.
I TALKED TO HIM THIS MORNING
ABOUT THE SIGNIFICANCE OF THE --
THE MEDICAL DEVICES, AND
GOING TO QUOTE HIS ANSWER.
I QUOTE IT DOWN.
HE SAID THE DECISION OF WHO
NEEDS A PACEMAKER COULD BE
COMPLICATED, PARTICULARLY THE
DECISION TO PUT IN A PACEMAKER
ON SOMEONE WE MIGHT CONSIDER
QUITE ELDERLY, BUT IT'S FALSE
ECONOMY TO DENY PUTTING ONE IN
BECAUSE OF THEIR RISK OF
FALLING, BREAKING A HIP OR
SHOULDER IN THE CASE WHERE THEY
FALL THE COSTS WOULD BECOME MUCH HIGHER.
THE COSTS OF A PACEMAKER PALES
IN COMPARISON WITH THE COST OF A
STROKE OR MULTIPLE FRACTURES.
THE PACEMAKER, BY THE WAY,
MR. PRESIDENT, COSTS ABOUT
ABOUT $5,000 AND LASTS ABOUT A
YEAR.
THAT'S $500 DEAL.
SO I THINK, MR. PRESINT, THIS
IS A QUALITY OF LIFE ISSUE THAT
WE COULD LOSE WITH ONE OF THE --
WITH THE DOCRATS'
GOVERNMENT-RUN HEALTH CARE SCHEMES.
SO THOSE ARE THE -- JUST SOME
EXAMPLES OF WHAT WE CAN DO TO
PAY HIGHER TAXES UNDER THIS
BILL.
IF YOU HAVE HEALTH INSURANCE,
YOU PAY HIGHER TAXES.
IF YOU DON'T HAVE IT, YOU PAY
HIGHER TAXES.
IF YOU PURCHASE A MEDICAL
DEVICE, YOU HAVE HIGHER TAXES.
IF YOU PAY YOUR OWN MEDICAL
BILLS OUT OF YOUR POCKET, YOU
HAVE HIGHER TAXES.
IF YOU TAKE PRESCRIPTION DRUGS,
YOU HAVE HIGHER TAXES.
ALL THESE ACTIVITIES ARE TAXED
UNDER THIS LEGISLATION.
I WANT NOW TO TURN TO EXAMINE
ONE TAX PROVISION IN PARTICULAR
THAT I FIND STRIKINGLY
DISHONEST, DAMAGING AND
EXPENSIVE TO THE TAXPAYER.
AN ADDITIONAL MEDICARE PAYROLL
TAX THAT'S IN THIS LEGISLATION.
IT'S A PERFECT EXAMPLE OF HOW
YOU GET THE BILL -- YOU HAVE TO
GO INTO IT TO FIND THESE THINGS.
THERE ARE CLAN CLANDESTINE TAXES
IN THE BILL THAT WILL HIT YOU
WHEN YOU BASICALLY DON'T EXPECT IT.
THE BILL SAYS THAT PEOPLE MAKING
MAKING $200,000 A YEAR ARE GOING
TO PAY AN ADDITIONAL PAYROLL TAX
CALLED A HOSPITAL INSURANCE
PAYROLL TAX.
THAT RAISES OVER $53 BILLION.
NOW, KEEP IN MIND, THIS IS ABOVE
THE TAXES THAT WE'RE ALREADY
PAYING.
WE'RE GETTING THESE PEOPLE $200,000.
YOU MIGHT THINK THAT'S A LOT OF
MONEY, BUT THERE'S A CATCH TO
THIS AND THEY DIDN'T INDEX IT.
IF YOU DON'T INDEX THE $200,000,
THEN THE PERIOD OF TIME GOES BY,
IT'S FAR GREATER THAN THE AMOUNT
THAT -- THAT IT WOULD SOUND LIKE
TODAY.
IN FACT, I WOULD SAY THAT IN TEN
YEARS FROM NOW, THAT $200,000
WOULD PRETTY MUCH FIT A LOT OF
THE MIDDLE-CLASS PEOPLE IN
ERICA.
SO THERE IS THIS INCREASE OF
ADDITIONAL MEDICARE AND PAYROLL TAX.
THIS BILL THAT
RAISES $50 BILLION IS NOT
INDEXED, AND WE KNOW WHAT -- HOW
THAT'S GOING TO EXTEND TO OTHER
PEOPLE NOW.
I REMBERANDIDATE OBAMA
MAKING A FIRM PLEDGE NOT T
RAISE TAXES ON MIDDLE-CLASS
AMERICANS.
HOWEVER, THIS HEALTH CARE REFORM
BILL BEFORE US BREAKS THAT
PLEDGE ON NUMEROUS OCCASIONS.
BUT IT'S NOT UIKE THE NEW
TAXES WHICH WILL BE IMPOSED ON
OTHER MEASURES THE DEMOCRAT
CONGRESS AND PRESIDENT OBAMA
WOULD LIKE TO ENACT.
I JUST MENTIONED THE
THE $500 BILLION IN NEW TAXES ON
THE HEALTH BILL IT RAISES.
THERE'S ANOTHER TAX AND ANOTHER
PROGRAM GOING ON I'VE TALKED
ABOUT ON THIS FLOOR MANY TIMES,
AND THAT IS THE CAPTAIN.
THAT'S STILL ON THE FLOOR.
THAT COULD COME UP AT ANY TIME.
OF COURSE, THAT'S NOT SOMETHING
THAT WOULD BE $500 BILLION OVER
A TEN-YEAR PERIOD.
THAT WOULD TAX THE AMERICAN
PEOPLE IN EXCESS OF $300 BILLION
EVERY YEAR.
AND I QUOTE AS MY SOURCES THERE,
THE WHARTON SCHOOL OF ECONOMICS,
HAVE DONE EVALUATIONS.
SO IT'S NOT JUST THIS BILL, EVEN THOUGH TS IS WHAT WE'RE
TALKING ABOUT TODAY.
WE STILL
OTHER LGZ THAT ARE BEING
PROMOTED -- OTHER LEGISLATION
THAT ARE BEING PROMOTED BY THE
PRESIDENT AND BY THE DEMOCRATS
IN HERE, AND THE -- PRESIDENT
OBAMA'S ADMINISTRATION'S OWN
TREASURY DEPARTMENT ESTIMATED
THAT A CAPTAIN LEGISLATION WOULD
COST EACH FAMILY IN AMERICA
AMERICA $1,761 A YEAR.
NOW, THAT'S REALLY MUCH MORE
THAN THAT IN HEARTLAND AMERICA.
IN OKLAHOMA, IT WOULD BE CLOSER
TO $3,300 A YEAR.
SO WE'RE TALKING ABOUT SOME
VERY VERY LARGE TAX INCREASES,
BUT AGAIN, BACK TO THE -- THE HEALTH BILL.
I NOTED EARLIER THAT THE
GOVERNOR -- THE GOVERNMENT-RUN
HEALTH CARE SYSTEM
BY THE PRESIDENT AND BY THE
DEMOCRATS IS EXPECTED TO COST
COST $2.5 TRILLION ON TOP OF THE
ALREADY EXPLODING RECORD DEFICITS.
THIS BILL WILL INCREASE
PAYMENTS.
WE MAKE ON OUR COUNTRY'S
EVER-EXPLODING FEDERAL DEBT.
THE DEMOCRAT CONGRES AGENDA
CLEARLY INCLUDES MORE TAXES ON
AMERICA.
THEY MAY BE HIDDEN BUT THEY ARE
THERE.
IT'S DISINGENUOUS, IT'S COSTLY,
AND IT'S ANOTHER REASON THIS
BILL SHOULD NOT BE PASSED BY THE
U.S. SENATE.
I SAY ANOTHER.
THE OTHER REASON AND THE MAIN
REASON IS THAT A GOVERNMENT-RUN
HEALTH SYSTEM DOESN'T WORK.
I YIELD THE
MR. BAUCUS: MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: MR. PRESIDENT, I
UNDERSTAND THAT WE'RE NOW UNDER
THE ORDER WHERE THE HALF-HOUR IS ALLOCATED TO THE MAJORITY SIDE,
IS THAT CORRECT? THE PRESIDING OFFICER: THAT'S
CORRECT.
WE HAVE 30 MINUTES, SENATOR.
MR. BAUCUS: MR. PRESIDENT, I
RESERVE MYSELF TEN MINUTES. THE PRESIDING OFFICER: WITHOUT
OBJECTION, SO ORDERED.
MR. BAUCUS: MR. PRESIDENT, I
JUST WANT TO JUST HELP PEOPLE
UNDERSTAND THIS LEGISLATION.
I'M SURE MANY DO, BUT I'M
THERE ARE SOME WHO DON'T WITH
RESPECT TO THE CHOICES THAT
PEOPLE WILL HAVE.
WE HAVE A UNIQUELY AMERICAN
SYSTEM OF HEALTH CARE IN
AMERICA.
IT'S ROUGHLY HALF PUBLIC, HALF PRIVATE.
AND THE GOAL OF THIS LEGISLATION
IS TO RETAIN WHAT WE HAVE.
IT IS BASICALLY THAT SAME
BALANCE OF PUBLIC AND PRIVATE.
IT'S WORKED PRETTY WELL FOR
AMERICA, IT'S UNIQUELY AMERICAN.
WE'RE NOT CANADA.
WE'RE NOT GREAT BRITAIN.
WE'RE NOT SWITZERLAND.
WE'RE THE UNITED STATES OF AMERICA.
I THINK IT'S JUST GOOD TO BUILD
ON OUR CURRENT SYSTEM, MAKE OUR
CURRENT SYSTEM WORK BETTER.
I'M PROMPTED TO EXPLAIN THE
CHOICES IN PART BY THE STATEMENT
BY THE SENIOR SENATOR FROM
ARIZONA WHO SAID THAT MEDICARE
ADVANTAGE
GET EYEGLASSES AND DENTAL CARE,
AND THAT'S TRUE.
HE WENT ON TO SAY THAT, GEE,
SHOULDN'T MEMBERS OF CONGRESS
LIKE ALL THAT AND WANT TO KEEP
ALL THAT BECAUSE MEMBERS
CONGRESS GET FREE
FREE EYEGLASSES.
WELL, THAT'S REALLY NOT TRUE.
MEMBERS OF CONGRESS DON'T GET
THAT.
BUT IT IS TRUE THAT MEMBERS OF
CONGRESS
FEDERAL EMPLOYEES, ALL FEDERAL
EMPLOYEES, MEMBERS OF CONGRESS,
PEOPLE OF T FOREST SERVICE,
ALL AROUND THE COUNTRY, ALL THE
FEDERAL EMPLOYEES PARTICIPATE IN
THE SAME SYSTEM.
IT'S CALLED FEHBP, FEDERAL
EMPLOYEES HEALTH BENEFITS PLA
WHERE FEDERAL EMPLOYEES AND
MEMBER OF CONGRESS, ALL
TOGETHER, THE SAME, CAN CHOOSE
AMONG MANY DIFFERENT PRIVATE
HEALTH INSURANCE PLANS.
THERE IS AN OPEN ROLLMENT SEON.
IN FACT, WE'RE IN THE MIDDLE OF
IT RIGHT NOW WHERE MEMBERS OF
CONGRESS AND ALL FEDERAL
EMPLOYEES CAN LOOK TO SEE
WHETHER THEY WANT TO CHOOSE A
DIFFERENT INSURANCE COMPANY OR
NOT.
NOW, SOME OF THOSE COMPANIES DO
PROVIDE DENTAL AND VISION COVERAGE.
SOME DON'T.
SO IF A FEDERAL EMPLOYEE WANTS
TO CHOOSE A PLAN THAT COVERS
DENTAL AND VISION, HE OR SHE CAN DO SO.
JUST PAY THE PREMIUM AND YOU'RE
COVERED WITH DENTAL AND VISION.
AND WE'RE SETTING UP UNDER THIS
LEGISLATION AN EXCHANGE VERY
FEHBP WHERE PEOPLE WHO DON'T
HAVE HEALTH INSURANCE CAN GO
LOOK ON THE EXCHANGE, CHOOSE
AMONG PRIVATE COMPANIES, WHICH
ONE MAKES THE MOST SENSE TO THEM.
SOME MAY HAVE DENTAL, SOME MAY
HAVE EYEGLASS COVERAGE, SOME MAY NOT.
THAT'S JUST A CHOICE PEOPLE
COULD MAKE.
AND IF THEY -- IN ADDITION TO
THAT, THERE IS EVEN MORE CHOICE
BECAUSE CURRENTLY A FEDERAL
EMPLOYEE DOES NOT HAVE TO JOIN FEHBP.
A FEDERAL EMPLOYEE CAN CHOOSE
NOT TO GET HEALTH INSURANCE IF
HE WANTS TO OR MAYBE THROUGH HIS
OR HER SPOUSE SOMEPLACE ELSE.
THE SAME WOULD BE TRUE WITH THE
EXCHANGE SET NEWSPAPER THIS
LEGISLATION.
THE PERSON COULD BUY AMONG
DIFFERENT COMPETING PRIVATE
PLANS THAT OFFER HEALTH
INSURANCE ON THE EXCHANGE, OR A
PERSON COULD GO OUTSIDE THE
EXCHANGE BECAUSE HE OR SHE
THINKS HE CAN GET A BETTER DEAL
IF THAT'S WHAT THAT PERSON WANTS.
SO I JUST WANT TO MAKE IT CLEAR
HERE THAT WE'RE ENCOURAGING
CHOICE, WE'RE ENCOURAGING
COMPETITION, AND I MIGHT SAY
THAT UNDER THE LEGISLATION,
DEMOCRATS OF CONGRESS FULLY
PARTICIPATE IN
CO-EQUAL WITH OTHERS.
IF THERE IS A PRIVATE OPTION,
MEMBERS OF CONGRESS CAN
CONTRIBUTE -- CAN PARTICIPATE IN
THAT AS WELL.
IN FACT, WE ARE REQUIRING
SENATORS AND THEIR STAFFS --
THEY DON'T HAVE TO PARTICIPATE
IN THE EXCHANGE, BUT IT'S
CERTAINLY AVAILABLE TO THEM AND
THEY CAN OPT OUT IF THEY WANT
TO.
NOW, LET ME JUST SAY A LITTLE
BIT ABOUT MEDICARE ADVANTAGE,
AND WHAT DOES MEDPAC SAY ABOUT
MEDICARE ADVANTAGE?
SEVERAL YEARS AGO, CONGRESS
ESTABLISHED AN ADVISORY BOARD,
IT'S NOW CALLED MEDPAC, TO
ADVISE ON HOW MEDICARE SHOULD
PAY PROVIDERS AND TRADITIONAL
FEE-FOR-SERVICE AND PRIVATE
MEDICAL INSURERS AND MEDICARE ADVANTAGE.
AGAIN, MEDICARE ADVANTAGE ARE
PRIVATE COMPANIES.
THEY HAVE EXECUTIVES, STOCKHOLDERS.
IT'S A PRI
AND MEDPAC ADVISES HOW MUCH
CONGRESS SHOULD PROVIDE --
SHOULD PAY MEDPAC AND OTHER
MEDICARE PROVIDERS AND
TRADITIONAL FEE-FOR-SERVICE.
IT'S AN INDEPENDENT AGENC IT'S
EXPERTS, NONPARTISAN, HIGHLY
RESPECTED.
EACH REPORTS TO CONGRESS AND
EXAMINES ISSUES ON MEDICARE.
HERE IS WHAT MEDPAC HAD TO SAY
ABOUT THE CURRENT STATE OF
MEDICARE ADVANTAGE IN ITS 2009,
JUNE, REPORT.
I'M GOING TO QUOTE NOW FROM THIS
INDEPENDENT ADVISORY PANEL --
"FIRST WE ESTIMATE THAT IN 2009,
MAYOR PAYS ABOUT $12 BILLION
MORE FOR ENROLLEES IN BENEFIT
PLANS THAN IT WOULD IN
FEE-FOR-SERVICE MEDICARE.
SECOND, CURRENT HIGH PAYMENTS
HAVE RESULTED IN SOME PLANS THAT
BRING NO INNOVATION BUT SIMPLY MIC FEE-FOR-SERVICE MEDICARE
AT A MUCH HIGHER COST TO THE PROGRAM. IN OTHER WORDS, THEY'RE SAYING
THAT MEDICARE ADVANTAGE PLANS
GET PAID FOR A LOT MORE BUT WITH
NO INNOVATION THAN -- THAN THE
FEE-FOR-SERVICE MEDICARE.
AND THEY ALSO SAY, SM, MEDPAC --
"THEY'RE NOT ENROLLED IN
MEDICARE ADVANTAGE WHICH ARE SUBSIDIZED."
IN ADDITION, THEY SAY, "THESE
EXCESSIVE PAYMENTS OFTEN
ENCOURAGE INEFFICIENT PLANS TO
ENTER THE PROGRAM, FURTHER
RAISING COSTS TO MEDICARE."
BECAUSE THERE'S SO
CURRENTLY GIVEN TO MEDICARE
ADVANTAGE PLANS, ACCORDING TO
MEDICATIONSPAC, THAT --
MEDMAC THAT ENCOURAGE
INEFFICIENT PLANS TO ENTER THE
PROGRAM.
WHY NOT?
THEY'RE NOT ALL THIS EXTRA MONEY.
FURTHER QUOTED FROM MEDPAC, "THE
COST OF
SUBSIDIES IS BORNE BY TAXPAYERS
WHO FINANCE THE MEDICARE PROGRAM
AND BY ALL MEDICARE
BENEFICIARIES THROUGH PAR
PREMIUMS."
OR TO SAY IT DIFFERENTLY, ABOUT
78% OF AMERICANS WHO ARE NOT IN
MEDICARE ADVANTAGE PLANS ARE
PAYING
$90-PER-YEAR TAX FOR WHICH THEY
GET NO BENEFIT, WHICH GOES INTO
THE MEDICARE ADVANTAGE PLANS.
IN ADDITION, THE PART-B PREMIUM
FOR ALL BENEFICIARIES IS
INCREASED BY ABOUT $3
REGARDLESS OF WHETHER YOU
RECEIVE ANY OF THE BENEFIT.
THAT'S ANOTHER QUOTE FROM MEDPAC.
I MIGHT SAY A COUPLE MORE QTES
FROM MEDPAC.
"ADDITIONAL MEDICARE ADVANTAGE
PAYMENTS HASTEN THE INSOLVENCY
OF THE MEDICARE PART-A TRUST
FUND BY 18 MONTHS."
THAT'S AN INTERESTING STATEMENT.
"THE ADDITIONAL M.A. PAYMENTS
HASTEN THE INSOLVENCY
MEDICARE PART-A TRUST FUND BY 18 MONTHS."
THAT'S THE HOSPITAL VERSION.
GOING ON QUOTES FROM MEDPAC,
"ALTHOUGH MANY PLANS ARE
AVAILABLE, ONLY SOME ARE OF HIGH
QUALITY IN ADDITION," CONTINUING
THEIR QUOTE, "ONLY ABOUT HALF OF
THE BENEFICIARIES NATIONWIDE
HAVE ACCESS TO A PLAN THAT
C.M.S. RATES AS ABOVE AVERAGE IN
OVERALL PLAN QUALITY."
THIS IS WHAT MEDPAC SAYS, THAT'S
THE NONPARTISAN EXPERTS THAT
HELP ADVISE CONGRESS IN WHAT
REIMBURSEMENT LEVELS, WHAT THEY SHOULD BE.
NOW, WE'VE HEARD DAY AFTER DAY
THIS THIS BILL IS CUTTING
MEDICARE BENEFITS FOR OUR SENIORS.
WHAT MY COLLEAGUES ON THE OTHER
SIDE OF THE AISLE REALIZE THAT
THIS BILL DOES NOT CUT, REDUCE,
OR ELIMINATE A SINGLE GUARANTEED
BENEFIT.
THEY TURN THEIR ARGUMENT TO MEDICARE ADVANTAGE.
I THINK THEY FINALLY RECOGNIZE
THAT THERE ARE NO GUARANTEED
BENEFITS CUT IN THIS LEGISLATION
SO THEY TURN TO MEDICARE
ADVANTAGE AND THEY ARGUE THAT
THE EFFICIENCIES AND SAVINGS
WOULD BE ACHIEVED BY ENDING
BILLIONS OF DOLLARS OF
OVERPAYMENTS TO THESE PRIVATE
PLANS WILL EITHER END THE
PROGRAM OR DRAMATICALLY CUT
SERVICES TO BENEFICIARIES.
BUT LET'S JUST LOOK AT THE
NUMBERS.
THIS CHART SHOWS THE YEARLY
SPENDING FOR MEDICARE ADVANTAGE
IN BILLIONS OF DOLLARS.
SO YOU CAN SEE FROM THE CHART
THAT IN THE YEAR, SAY, 2009,
$110 BILLION WILL BE SPENT ON MEDICARE ADVANTAGE PLANS.
AND MOVING TO THE RIGHT TEN
YEARS LATER, IN THE YEAR 2019,
IT'S ABOUT $204 BILLIO
EXCUSE ME, THE -- IS SPENT.
SO IF YOU TOTAL IT ALL UP, IT'S
ABOUT $1.7 TRILLION THAT WILL BE
SPENT ON MEDICARE ADVANTAGE
PLANS OVER THE NEXT TEN YEARS.
NOW, YOU SEE THAT LITTLE -- WHAT
COLOR IS THAT?
IT'S KIND OF ANRANGE, IT'S
KIND OF AN INTERESTING SORT OF
RED, WHATER IT IS, AT THE TOP
OF THAT CHART?
THAT REPRESENTS THE REDUCTION IN
MEDICARE ADVANTAGE PLANS
PAYMENTS UNDER THIS LEGISLATION.
IT'S NOT VERY MUCH, AS YOU CAN
TELL BY LOOKING AT THE CHART.
IT AVERAGES OUT I THINK AROUND
10% REDUCTION IN MEDICARE
ADVANTAGE PAYMENTS.
SO WHEN YOU HEAR THE CROCODILE
TEARS HOW MEDICARE ADVANTAGE IS
BEING CUT, HEAR ALL THESE
DRAMATIC STATEMENTS THAT SO MUCH
IS GOING TO BE TAKEN AWAY FROM
SENIORS BECAUSE CONGRESS IS
CUTTING MEDICARE ADVANTAGE, THE
FACT IS WE'RE REDUCING THE RATE
OF INCREASE IN MEDICARE
ADVANTAGE PAYMENTS BY ONLY ABOUT
10%, AND UNDER THIS LEGISLATION,
ABOUT $1.7 TRILLION WILL BE
SPENT ON MEDICARE ADVANTAGE
PLANS.
REMEMBER, MEDPAC SAYS THESE ARE
OVERPAYMENTS.
MEDPAC SAY THAT THIS 10% IS
ABOUT -- REDUCTION IS WHAT THEY
SHOULD BE PAID.
AND REMBER, TOO, THAT THESE
ARE PRIVATE PLANS.
THESE ARE PRIVATE COMPANIES.
IT'S NOT MEDICARE.
THESE ARE PRIVATE COMPANIES
RECEIVING THESE -- THESE PAYMENTS.
AND THEY'RE INSURANCE COMPANIES. IT'S INTERESTING TO ME,
MR. PRESIDENT, THAT A LOT OF
MEMBERS OF CONGRESS
WILD ABOUT INSURANCE COMPANIES.
WELL, MEDPAC -- EXCUSE ME.
THE MEDICARE ADVANTAGE COMPANIES
ARE INSURANCE COMPANIES. THEY'RE PRIVATE COMPANIES.
THAT'S WHAT THEY ARE.
THEY'RE INSURANCE COMPANIES.
THEY'VE GOT THEIR PRIVATE
INSURANCE COMPANY CHIEF EXECUTIVE.
THEY'VE GOT THEIR PRIVATE
INSURANCE COMPANY OFFICERS.
THEY'VE GOT THEIR PRIVATE
INSURANCE COMPANY STOCKHOLDERS.
THEY'VE GOT THEIR PRIVATE
INSURANCE COMPANY ADMINISTRATIVE
COSTS AND MARKETING EXPENSES.
THEY'RE PRIVATE INSURANCE COMPANIES.
THAT'S WHAT THEY ARE.
AND IT'S -- IT'S -- THAT -- WE
SHOULD NOT LOSE SIGHT OF ALL OF
THAT.
NOW, I WANT TO ALSO POINT OUT
THAT AS PRIVATE INSURANCE
COMPANIES, THESE MEDICARE
ADVANTAGE PLANS ARE DOING PRETTY WELL.
LET ME QUOTE FROM AN OPEN HIERM OPPENHEIMER??
CAPITAL ANALYST ABOUT MEDICARE
ADVANTAGE PLANS.
"BETWEEN 2006 AND 2009, WE
ESTIMATE THAT MEDICARE" HE MEANT
ADVANTAGE COUNTED FOR NEARLY 79%
OF THE GROSS PROFITS IN THE
INDUSTRY HIGHLIGHTED BY AN
ESTIMATED GROSS PROFIT INCREASE
OF $1.9 BILLION IN 2009 RELATIVE
TO COMMERCIAL RISK EARNINGS GAINS."
NOW, COMMERCIAL RISK EARNINGS
GAINS ARE THE ORDINARY HEALTH
INSURANCE COMPANIES BUT 75% OF
THE GROSS PROFIT INCREASE WAS
UNDER MEDICARE ADVANTAGE PLANS
NOT TRADITIONAL HEALTH
INSURANCE.
I MIGHT SAY TOO -- I DON'T HAVE THE PAPERS HERE.
MAYBE I CAN FIND THEM.
JUST WORTH NOTING.
THESE ARE PRIVATE COMPANIES.
THEY'RE NOT -- IT'S NOT
KNOW, TRADITIONAL MEDICARE.
OH, HERE IT IS.
LET'S LOOK AT -- THIS IS
INTERESTING.
YOU KNOW, WHAT IS THE
COMPENSATION OF THESE INSURANCE
COMPANIES' EXECUTIVES, THESE
MEDICARE ADVANTAGE PLANS?
AETNA'S -- OF THE C.E.O., THE
TOTAL COMPENSATION OF THE C.E.O.
OF AETNA IS $24 MILLION A YEAR.
THE TOTAL COMPENSATION OF THE
C.E.O. OF COVENTRY IS $89 MILLION.
WELLCARE IS $8 MILLION
HUMANA, $4. MILLION A YEAR.
UNITED HEALTHCARE, $3 MILLION.
NOW, PEOPLE SHOULD BE ABLE TO
MAKE SOME MONEY AND OFFICERS OF
COMPANIES SHOULD BE ABLE TO, YOU
KNOW, DO OKAY, BUT HERE WE'RE
TALKING ABOUT VERY HIGH SALARIES
THAT THESE INSURANCE COMPANIES
PAY TO THEIR TOP EXECUTIVES
AND, FRANKLY, IF THERE'S A 10%
REDUCTION IN $1. TRILLION OVER7 TRILLION OVER
TEN YEARS, THEY COULD, YOU
THINK, TAKE SOME OF THAT 10%
MAYBE IN SALARY REDUCTION OR
DIVIDEND TO STOCKHOLDERS, MAKE
OTHER COST SAVINGS.
IT DOESN'T HAVE T COME OUT OF
THEIR -- THE BENEFICIARIES.
AND IT'S , THEY THE EXECUTIVES,
THAT ARE MAKING THESE DECISIONS
OF WHERE THE 10% --
AND
THAT ARE MAKING THESE DECISIONS
OF WHERE THE 10% IS ALLOCATED.
I JUST BOTTOM LINE WANT TO SAY
I'M NOT OPPOSED TO MEDICARE
ADVANTAGE PLANS.
FRANKLY ARE I THINK IT'S GOOD
THAT WE HAVE MEDICARE ADVANTAGE PLANS.
MEDICARE ADVANTAGE PLANS PROVIDE
A LITTLE COMPETION TO
MEDICARE.
THEY JUST -- THEY HELP MAKE --
KEEP THE SYSTEM ON ITS
BUT WE HAVE ANBLIGATION HERE
AS MEMBERS OF THIS SENATE, TO
TAXPAYERS, TO SENIORS TO CUT
WASTE AND TO -- AND CUT
OVERPAYMENTS IN A WAY THAT DOES
NOT HARM BENEFICIARIES.
AND THESE ARE REDUCTIONS
RECOMMENDED TO CONGRESS BY THE
BEST EXECUTIVE, BEST ADVISORY
BOARD OF EXPERTS WE COULD FIND.
THEY
MEMBERS OF THIN AIR, MEMBERS OF
CONGRESS THINK THIS UP.
THEY WERE RECOMMENDED TO US BY
THE MEDPAC ADVISORY BOARD.
AND, SECOND, THERE IS NO
REDUCTION IN GUARANTEED BENEFITS
TO SENIORS.
THAT'S JT -- THAT'S ABSOLUTELY ABSOLUTE. THERE'S NO REDUCTION IN
GUARANTEED BENEFITS TO MEDICARE
ADVANTAGE PARTICIPANTS.
SO, A, WE'RE BEING FAIR.
THIS CHART SHOWS IT.
WE'RE TRYING TO FIND THE RIGHT
LEVEL
A WAY SO THERE'S NO REDUCTION IN
IN -- IN BENEFICIARIES' BENEFITS.
IN FACT, UNDER THIS LEGISLATION,
WE ADD MORE BENEFITS FOR ALL
MEDICARE -- MEDICARE ADVANTAGE
AS WELL AS TRADITIONAL FEE-FOR-SERVICE MEDICARE.
AND I MIGHT ADD IN THIS
LEGISLATION, WE
TO MEDICARE ADVANTAGE PLANS THAT
SHOW DEMONSTRATED IMPROVEMENT IN
QUALITY.
AS I MENTIONED, MEDPAC SAID A
LOT OF THESE PLANS ARE TOTALLY
INEFFICIENT, A LOT OF THESE
PLANS HAVE NO COORDINATED CARE,
A LOT OF THESE PLANS DO NOT HAVE
ANY QUALITY BUT THEY GET THE
EXTRA MONEY.
SO WE'RE SAYING, LET'S GET THE
COMPENSATION LEVEL FAIR, WE DO
IT IN A COMPETIVE BIDDING BASIS.
I THINK THE AVERAGE BID FOR AN
AREA WHERE WE ALSO SAY LET'S
MAKE SURE THAT THERE'S NO
REDUCTION IN -- IN GUARANTEED
BENEFITS AT THE SAME TIME.
I THINK THAT'S THE RESPONSIBLE
THING TO DO.
SO ALL THESE ARGUMENTS, THESE
SOUND BITES, FRANKLY, THAT YOU
HEAR ON THE OTHER SIDE OF THE
AISLE ARE JUST THAT, THEY'RE
SOUND BITES.
THEY'RE NOT REALLY AN HONEST
ANAL HERE.
SO I JUST ENCOURAGE US TO KEEP
IN MIND, KEEP IN PERSPECTIVE
WHAT WE'RE DOING HERE SO WE CAN
HELP PROVIDE A BETTER HEALTH
CARE SYSTEM FOR OUR COUNTRY.
THIS IS ONLY ONE PART OF IT.
THERE ARE MANY OTHER PARTS BUT
THIS IS JUST ONE.
MR. PRESIDENT, I'D NOW LIKE TO
YIELD TO THE SENATOR FROM
MICHIGAN.
MS. STABENOW: THANK YOU.
THANK YOU. MR. PRES
THE PRESIDING OFFICER: YOU HAVE
14 1/2 MINUTES.
I'M SORRY, 13 1/2 MINUTES.
MR. BAUCUS: I SEE SENATOR DODD'S
ON THE FLOOR.
COULD YOU, SENATOR, MAYBE FIVE
MINUTES?
WE COULD PROBABLY GET SOME MORE.
MS. STABENOW: SEVEN MINUTES
WOULD DO.
MR. BAUCUS: TAKE WHAT YOU WANT.
WE'LL FIND THE TIME.
MS. STABENOW: THANK YOU.
MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM MICHIGAN IS RECOGNIZED.
MS. STABENOW: THANK YOU,
MR. PRESIDENT.
AND, FIRST, I WANT TO THANK OUR
DISTINGUISHED CHAIRMAN THE
FINANCE COMMITTEE FOR DEBUNKING
WHAT HAS JUST BEEN SAID ON THE
FLOOR
OTHER SIDE OF THE AISLE, LAYING
T THE FACTS OF WHAT IS AND IS
NOT HAPPENING WITH MEDICARE ADVANTAGE.
AND I'D LIKE TO BUILD ON THAT AS
WELL.
I WOULD ENCOURAGE ANYONE WHO IS
INTERESTED TO GO TO THE WEB SITE
OF AARP.
ONE OF THE ORGANIZATIONS WE KNOW
TAKE A LOOK AT WHAT THEY SAY
ABOUT T MYTH THAT HETH CARE
REFORM WILL HURT
AND THEY LAY OUT SEVERAL THINGS.
ONE IS "NONE OF THE HEALTH CARE
REFORM PROPOSALS BEING
CONSIDERED BY CONGRESS WOULD CUT
MEDICARE BENEFITS OR INCREASE
YOUR OUT-OF-POCKET COSTS FOR
MEDICARE SERVICES."
AND THEN JUST THIS
SUPPORTING OUR
PUT OUT A STATEMENT THAT -- A
LETTER THAT AT THE END, AGAIN,
THEY REITERATED, "MOST
IMPORTANTLY, THE LEGISLATION
DOES NOT REDUCE ANY GUARANTEED
MEDICARE BENEFITS."
I FIND IT INTERESTING,
MR. PRESIDENT, THAT OUR
COLLEAGUES WHO A FEW YEARS AGO
QUOTED AARP ALL THE TIME WHEN WE
WERE DEBATING THE MEDICARE
PRESCRIPTION DRUG BILL.
I WOULD GUESS THAT EVERY SINGLE
ONE OF OUR REPUBLICAN COLLEAGUES
USED THEIR SUPPORT IN PUTTING
FORWARD THEIR BILL.
NOW THEY ARE TRYING TO
DISPARAGE, WHICH I
WHICH IS A VERY CRICIAL
ORGANIZATION BECAUSE THEY DON'T
A-- CREDIBLE ORGANIZATION
BECAUSE THEY DON'T AGREE WHAT
ARE AARP IS SAYING.
BUT THE MILLIONS OF PEOPLE THAT
BELONG TO AARP WILL BE THROICHG
WHAT THEY ARE SAYING --
LISTENING TO WHAT THEY ARE
SAYING BECAUSE WE ARE NOT, IN
FACT, CUTTING THE GUARANTEED MEDICARE BENEFITS.
AND IN ADDITION TO THAT, WE HAVE
THE ALLIANCE FOR
AMERICANS, THE NATIONAL
COMMITTEE T PRESERVE SOCIAL
SECURITY AND MEDICARE ALL SAYING
THAT THEY SUPPORT WHAT WE ARE
DOING AND THAT THEY HAVE
DEBUNKED THE REPUBLICAN SCARE
TACTICS POINT BY POINT.
SO WHAT IS REALLY HAPPENING HERE, MR. PRESIDENT?
THE REALITY IS THAT COLLEAGUES
ON THE OTHER SIDE OF THE AISLE,
SINCE THE INCEPTION OF MEDICARE,
HAVE BEEN FIGHTING EVEN THE
EXISTENCE OF MEDICARE.
IT WAS DEMOCRATS AND A
DEMOCRATIC PRESIDENT IN 1965 OR
19 -- 1965 THAT PASSED MEDICARE
OVER THE OBJECTIONS, THE SAME
ARGUMENTS WE'RE HEARING TODAY WE HEARD THEN.
NOW EVERYONE SEES THAT
MEDICARE'S A GREAT AMERICAN
SUCCESS STORY.
BUT WE HAVE SEEN SO MANY EFFORTS
EFFORTS.
IN THE 1990'S, WHEN I WAS A
MEMBER OF THE HOUSE, SPEAKER GINGRICH INSIDE HIS "CONTRACT
WITH AMERICA" IN 1994 THAT THEY
WANTED TO COME IN, THEY WANTED
TO -- TO CHANGE MEDICARE, THEY
COULDN'T DIRECTLY DO IT SO THEY
WOULD DO IT THROUGH THE BACK
DOOR AND LET IT WITHER ON THE
VINE, THOSE FAMOUS WORDS THAT WE
HEARD AT THAT TIME, IN TERMS OF
TRYING TO PRIVATIZE MEDICARE,
WHICH IS WHAT I BELIEVE MEDICARE
ADVANTAGE REALLY RECENTLY IN THE DEBATE ON THE
HOUSE OF
80% OF THE HOUSE REPUBLICANS
SUPPORT AN EFFORT TO DO AWAY
WITH MEDICARE AT ALL AS WE KNOW
IT AS A GUARANTEED BENEFIT.
AND, INSTEAD, GIVE VOUCHERS TO
SENIORS TO GO BUY FROM PRIVATE
FOR-PROFIT INSURANCE COMPANIES.
SO WE KNOW WHAT THE REALITY OF
THIS IS.
THIS IS ABOUT THE FOR-PROFIT
INSURANCE INDUSTRY THAT RIGHT
NOW IS
EVERY -- WHETHER IT'S
CONGRESSIONAL BUDGET OFFICE,
WHETHER IT'S MEDPAC, ANY
ANALYSIS WILL SAY THAT THEY ARE
RECEIVING OVERPAYMENTS RIGHT NOW
AND WE ARE TRYING TO RATCHET THAT BACK.
AND WHAT IS HAPPENING?
WHY SHOULD FOLKS CARE?
OF COURSE,
OVERPAYMENTS MUCH BUT WE HAVE
ABOUT MAYBE 15% OR SO, 15% TO
20% OF SENIORS RIGHT NOW THAT
ARE IN THE MEDICARE ADVANTAGE
PROGRAM, AND WE'VE BEEN TOLD BY
THE BUDGET OFFICE THAT THE 80%
TO 85% THAT HAVE NOT, HAVE SEEN
THEIR PREMIUMS GO UP TO PAY FOR
OVERPAYMENTS TO FOR-PROFIT
INSURANCE COMPANIES.
THAT'S NOT FAIR, MR. PRESIDENT.
THAT IS NOT FAIR THAT THE VAST
MAJORITY OF SENIORS AND PEOPLE
WITH DISABILITIES WOULD SEE
THEIR PREMIUMS GO UP UNDER
MEDICARE TO PAY FOR FOR-PROFIT
INSURANCE COMPANIES TO GET A
PIECE OF THE ACTION UNDER
MEDICARE.
SECONDLY, WE KNOW THAT THE
MEDICARE ADVANTAGE PROGRAM, AS
THE CHAIRMAN HAS SAID IN READING
THE REPORT,AS ACTUALL
THE SOLVENCY OF THE MEDICARE
TRUST FUND WORSE.
IT'S GOING TO RUN OUT OF MONEY
SOONER IF WE DON'T STOP THESE OVERPAYMENTS.
OUR LEGISLATION, RATHER THAN
HAVING IT RUN OUT OF MONEY 18
MONTHS EARLIER, WILL INCREASE
THE SOLVENCY BY FIVE YEARS.
AND WE ARE COMMITTED TO INCREASE
AND CONTINUING THE SOLVENCY OF
THE TRUST FUND AND PROTECTING
MEDICARE FOR THE FUTURE BECAUSE
WE DO BELIEVE IT IS A GREAT
AMERICAN SUCCESS STORY.
AND WE'RE QUITE PROUD THAT
DEMOCRATS CREATED MEDICARE
A DEMOCRATIC PRESIDENT.
AND WE'RE PROUD THAT IT'S
DEMOCRATS NOW COMING FORWARD TO
MAKE SURE THAT WE PROTECT
MEDICARE FOR THE FUTURE.
SO WHAT IS REALLY HAPPENING HERE
IS THAT WE ARE SEEING A VARIETY
OF STALLING TACTICS, A
OF EFFORTS ON THE OTHER SIDE,
NOT ONLY TO STOP US FROM MOVING
FORWARD ON HEALTH INSURANCE
REFORM, BUT EFFORTS TIME AND
TIME AGAIN TO PROTECT THE
FOR-PROFIT INSURANCE COMPANIES.
AND SO FOR THE RECORD, MR.
PRESIDENT, I JUST WANT TO READ
TO YOU THAT THE LIST OF MEDICARE
BENEFITS THAT EVERYONE RECEIVES
NOW AND THE BENEFITS THAT WILL
CONTINUE REGARDLESS OF THIS.
REGARDLESS OF WHETHER WE CUT
BACK ON SOME OF THE PROFITS OF
THE FOR-PROFIT INSURANCE
COMPANIES.
IN-PATIENT HOSPITAL CARE AND
NURSES, DOCTORS' OFFICES, LAB
TESTS, PREVENTE SCREENING,
SCHOOL NURSING, HOSPICE CARE,
HOME HEAH, DURABLE MEDICAL
EQUIPMENT, EMERGENCY ROOM,
KIDNEY ANALYSI OUT-PATIENT
MENTAL HEALTH, PHYSICAL THERAPY,
IMAGING, X-RAYS, AND SO ON,
ORGAN TRANSPLANTS AND WELCOME TO
MEDICARE PHYSICAL.
THEY'RE COVERED NOW AND THEY
WILL BE COVERED UNDER THIS
LEGISLATION MUCH THE DIFFERENCE
IS WE WILL TAKE THE OVERPAYMENTS
TO THE FOR-PROFIT INSURANCE
COMPANIES AND PUT IT BACK INTO
MEDICARE TO REDUCE THE COST FOR
PRESCRIPTION DRUGS, WHAT'S NOW
BECOME THE INFAMS DOUGHNUT
HOLE, THE GAP IN COVERAGE.
WE'RE GOING TO BEGIN TO CLOSE
THAT BY TAKING THE EXCESS
PROFITS OF THE FOR-PROFIT
COMPANIES, PUTTING IT BACK INTO MEDICARE.
WE'RE GOING TO REDUCE THE
PREMIUMS THAT SENIORS PAY FOR
DRUGS AND MEDICAL CARE,
ELIMINATE CO-PAYS SO THAT PEOPLE
CAN GET PREVENTIVE CARE WITHOUT
A FEE AND WE'RE GOING TO
STRENGTHEN MEDICARE FOR THE FUTURE.
MR. PRESIDENT, I WOULD JUST
WRAP-UP BY
LEGISLATION IN TOTAL IS ABOUT SAVING LIVES.
IT'S ABOUT SAVING MONEY.
IT'S ABOUT SAVING MEDICARE.
WE ADMIT OUR GOAL IS NOT TO SAVE
THE PROFITS OF FORROFIT
INSURANCE COMPANIES.
WE'RE GUILTY OF THAT.
WE ARE FOCUSED ON MAKING SURE
MEDICARE IS STRONG, VIBRANT,
SOLVENT FOR THE FUTURE, FOR OUR
FUTURE GENERATIONS AS WELL AS
OUR SENIORS TODAY.
AND, BY THE WAY, WE'RE GOING TO
MAKE SURE THAT WE ARE SAVING
LIVES AND SAVING MONEY IN THE
PROCESS.
SO I WOULD STRONGLY URGE US TO
OPPOSE ANY EFFORT THAT IS PUT
FORWARD THAT WOULD BE DONE IN
THE INTEREST OF THE INSURANCE
INDUSTRY AT THE EXPENSE OF
SENIORS IN AMERICA.
THAT'S WHAT THESE EFFORTS TO
RECOMMIT -- TO COMMIT ARE ALL
ABOUT.
AND I HOPE THAT WE WILL
THEM.
THANK
MR. DODD: MR. PRESIDENT? THE PRESIDINOFFICER: THE
SENATOR FROM CONNECTICUT IS
COGNIZED.
COLLEAGUE FROM MICHIGAN WHO IS A
MEMBER OF THE FINANCE COMMITTEE
AND STALWART DEFENDER OF THE
MEDICARE PROGRAM AND THE ELDERLY
NOT ONLY IN HER STATE, BUT
AROUND THE COUNTRY.
SHE HAS OFFERED COMING ENTER AND
WORTH -- COGENT AND WORTHWHILE
INFORMATION ON THIS SUBJECT MATTER.
WE KEEP GOING AROUND AND AROUND
AND AROUND IN THIS DEBATE.
AND IT'S A LITTLE BIT
FRUSTRATING BECAUSE WE'RE
TALKING ABOUT
OR NOT WE'RE GOING TO LIMIT TO
PRIVATE INSURANCE COMPANIES THAT
ARE UNDER THE RULE OF SOMETHING
CALLED MEDICARE ADVANTAGE.
AGAIN, THESE ARE PRIVATE
COMPANIES THAT ARE RECEIVING
SUBSIDIES SUPPORTED BY MEDICARE
BENEFICIARIES AND THE TAXPAYE
OF THIS COUNTRY.
AND WE'RE TALKING ABOUT
ELIMINATING MEDICARE
BUT RATHER RESTRAINING.
WE HAD A GREAT CHART UP HERE A
FEW MINUTES AGO
BAUCUS HAD.
I'LL GET IT UP HERE IN A PEW
MINUTES MUCH IT -- IF -- IN A FEW MINUTES.
WE'RE NOT ELIMINATING
WE'RE WHERE BASED ON PERFORMANCE
AN QUALITY, WE GIVE
MEDICARE ADVANTAGE.
SO CONTRARY TO THE ARGUMENT
YOU'VE HEARD BY THOSE WHO ARE
HERALDING MEDICARE ADVANTAGE,
DESPITE THE FACT THAT THE VERY
COMPANIES WHO ARGUED FOR
TO BEGIN WITH PROMISED TO REDUCE
COSTS, BE RE EFFICIENT, IN
FACT, TODAY, IT'S OPPOSITE.
YOU'RE LOOKING AT A SITUATION
WHERE YOU HAVE PEOPLE ACTUALLY
PAYING
THE GOVERNMENT PAYS THESE
MEDICARE ADVANTAGE INSURANCE
COMP
THINGS FOR SENIORS THAT MEDICARE
DOES FOR $1.
THAT'S BASICALLY ON AVERAGE WHAT
IT AMOUNTS TO.
THE QUESTION IS: CAN WE REDUCE
THE COST OF THESE OVERPAYMENTS
WHICH ARE BASICALLY ENDING UP
THE POCKETS OF THE PEOPLE
LOOKING FOR THE PROFIT.
THERE'S NOTHING WRONG WITH
PROFITS AT ALL IN THESE PRIVATE COMPANIES.
BUT LET'S DECLARE THEM WHAT THEY ARE.
THIS IS NOT TRADITIONAL MEDICARE.
THESE ARE PRIVATE COMPANIES THAT
ARE ANXIOUS NOT ONLY, I
TO PROVIDE BENEFITS TO THEIR
BENEFICIARIES, BUT ARE ALSO
LOOKING TO
THERE'S NOTHING WRONG ABOUT THAT.
BUT SINCE THE PREMIUMS WERE SET
BY STATUTE, AS THEY HAVE BEEN IN
THIS AREA, AND BASICALLY WE HAVE
AN OBLIGATION TO TRY KEEP OUR
COSTS DOWN, WE'RE TRYING TO DO
SO BECAUSE THE PROMISES
INITIALLY MADE HAVE NOT BEEN KEPT.
IN FACT, T COSTS ARE VASTLY
EXCEEDING THE PROMISES THAT WERE MADE.
THE AMENDMENT THAT WE'RE GOING
TO BE HEARING ABOUT FROM OUR
FR
COMPILATION, MR. PRESIDENT, OF
SOME OF THE GREATEST HITS WE'VE
HEARD, STALLING WITH, OF COURSE,
ARCANE OBSTRUCTION PRACTICES,
STANDING UP FOR THE PRIVATE
COMPANIES HERE, AT OUR
I HAVE NO TROUBLE WITHSTANDING
UP FOR PRIVATE COMPANIES THAT DO A GOOD JOB
WHEN YOU DO SO
SCARING SENIORS WITH BASELESS
CLAIMS, THEN I DO OBJECT.
AND THAT'S WHAT'S GOING ON HERE.
QUITE FRANKLY TODAY, OVER 80% OF
OUR ELDERLY ARE PAYING $90 A
YEAR IN ADDITIONAL PREMIUM COSTS
WITHOUT GETTING ANY BENEFIT FROM
IT WHATSOEVER TO PROVIDE
BENEFITS UNDER T PROGRAM.
THAT'S NOT EQUITABLE.
THE 80% OF OUR ELDERLY NEED TO
KNOW IN ALL OF THIS THAT YOU'RE
BEING DISADVANTAGED BY
WHAT THE FINANCE COMMITTEE IS
TRYING TO
LEADERSHIP OF MAX BAUCUS, IS
TRYING TO BRING EQUITY BACK.
NOTHING IN THIS BILL DOES AWAY
WITH MEDICARE ADVANTAGE.
NOTHING.
IT BACK TO A SENSE OF REALITY
AND NOT, AGAIN, DISADVANTAGE --
TALK ABOUT ADVANTAGE --
DISADVANTAGE 80% OF OUR SENIORS.
RIGHT NOW IT'S MEDICARE
DISADVANTAGE IT OUGHT
CALLED BECAUSE THAT'S WHAT IT DOES.
IT DISADVANTAGES.
WHY SHOULD 8
THIS COUNTRY PAY HIGHER PREMIUMS
AND NO BENEFITS AT THE EXPENSE
OF THE 20% WHO ARE GOING TO GET
SOME ADVANTAGE OUT OF THIS.
GET VERY LITTLE ADVANTAGE.
WITH THE PROFITS.
I'LL TELL YOU WHY THAT HAPPENS
IN A MINUTE HERE.
JUST TO MAKE MY POINT, ACCORDING
TO THE OPPENHEIMER ANALYST CARL
McDONALD, IN A REPORT ISSUED
LESS THAN A MONTH AGO, BETWEEN
2006 AND 2009 -- THIS IS A
REPORT, NOW, FROM THEM,
OPPENHEIMER CAPITAL, WE
ESTIMATE, A
ADVANTAGE ACCOUNTED FOR 75% OF
THE INCREASE IN GROSS PROFITS
AMONG THE LARGER PLANS IN THE INDUSTRY.
HI LIGHTED BY AN -- A GROSS
PROFIT INCREASE OF $1.9 BILLION
IN 2009 RELATIVE TO COMMERCIAL
RISK EARNINGS WITH GAINS
OF $600 MILLION.
I KNOW THE CHAIRMAN OF THE
FINANCE COMMITTEE MADE THAT
POINT, BUT IT DESERVES TO BE
MADE OVER AGAIN.
35% OF THE INCREASE IN GROSS
PROFITS CAME IN THE MEDICARE
ADVANTAGE PLAN.
THESE PROFITS COME OUT OF THE
POCKET OF
BECAUSE OF OUR
OFURS, THE MEDICARE
BENEFICIARIES WHO ARE PAYING
THOSE EXTRA DOLLARS.
-- EVERY
YEAR WITHOUT RECEIVING ANY OF
THE BENEFITS AT ALL.
SO THE -- OUR BILL WILL
AND STRENGTHEN MEDICARE AND
EXTEND THE LIFE OF THE TRUST
FUND, AS YOU HEARD OVER AND OVER
AGAIN.
BUT IT DESERVES TO BE REPEATED.
THAT'S NOT A FACT TO DISPUTE.
THAT IS A FACT.
WE EXTEND
MEDICARE PROGRAM.
IT'S PART OF THE WAY OUR BILL
ADDS TO THE USE OF MEDICARE IS
BY ELIMINATING WASTEFUL
OVERPAYMENTS AND THAT'S WHAT THESE ARE.
THESE ARE
FAR BEYOND WHAT WAS ANTICIPATED
WHEN THE PROGRAM WAS WRITTEN.
AND, AS I MENTIONED A MOMENT
AGO, THE GOVERNMT PAYS
INSURANCE COMPANIES IN MEDICARE
ADVANTAGE PROGRAM, $1.14 TO DO
THE VERY SAME THING FOR SENIORS
THAT TRADITIONAL MEDICARE DOE
FOR $1.
SO THOSE ARE
WE'RE TRYING BRING BACK.
THERE'S NO EVIDENCE THAT THE WASTEFUL OVERPAYMENTS DO
ANYTHING TO IMPROVE THE CARE OF
OUR SENIORS.
AT THE SAME TIME THEY SPEED
MEDICARE'S DISSENT INTO
BANKRUPTCY AND RAISE PREMIUMS
FOR ALL MEDICARE BENEFICIARIES,
AS I MENTIONED.
OUR BILL WOULD END THAT WASTE,
USE THE MONEY THEY SAVE TO HELP
SENIORS PAY FOR PRESCRIPTION
DRUGS, BY CLOSING THE DOUGHNUT HOLE.
FOR THE SECOND TIME IN LESS THAN
A WEEK, OUR FRIENDS ON THE OTHER
SIDE ARE USING TACTICS
PROGRESS FOR -- THE PAYMENTS
THAT COM OUT OF THE HIDE OF OUR
TAXPAYERS AND ELDERLY.
THAT'S ALL THAT IT DOES.
IFOU LOOK AT THE CHART, IF
GO TO 2019, ALMOST 10 YEARS FROM
NOW, WHAT IS THE DIFFERENCE
BETWEEN WHAT OUR BILL DOES AND
WHAT THOSE WHO WANT NO CHANGE IN
THIS WHATSOEVER DO?
THE DIFFERENCE
WE ALLOW THIS IN THE POST-REFORM
PERIOD IN 2019 FOR $183 BILLION
GOING TO MEDICARE ADVANTAGE.
WHAT THE OPPOSITION WANTS IS TO
HOLD IT AT $204 BILLION IN 2019.
THAT'S $20 BILLION.
THAT'S A SAVINGS WE'RE LOOKING
FOR IN THAT YEAR.
-- IN ORDER TO REDUCE THE
OVERPAYMENTS AND, AGA
THOSE RESOURCES SO THAT OUR
ELDERLY CAN AFFORD PRESCRIPTION
DRUGS.
NOW, YOU WANT TO SIDE WITH THESE
COMPANIES, THEY'RE STILL GOING
TO MAKE A PROFIT, MR. PRESIDENT.
THIS IS NOT DEPRIVING THEM OF
THAT AT ALL.
IT'S BRINGING DOWN THE PROFIT
MARGINS TO FAR MORE REALISTIC
LEVELS AN ELIMINATING THE NEEDS
FOR THE
ABOUT OR AT LEAST REDUCE THE
WELL AS THE PAYMENTS BEING MADE
BY THE
NOTHING UNDER THIS PROGRAM AT ALL.
LET ME MAKE MY CASE TO YOU ON
THIS POINT.
AGAIN,
ENLISTED THE GUARANTEED BEN -
LISTED THE GUARANTEED BENEFITS,
AND I KNOW THE
WELL.
WE ADD BENEFITS.
IN ADDITION TO THE IN-PATIENT
HOSPITAL CARE AND DOCTORS'
OFFICE VISITS AND KIDNEY
DIALYSIS, EMERGENCY CARE,
OCCUPATIONAL THERAPY, ORGAN
TRANSPLANTS, ALL OF THESE
ISSUES, WE ALSO DO THINGS UNDER
OUR BILL THAT PRESENTLY AREN'T AVAILABLE.
ONE, WE ARE REDUCE THE SIZE OF
THE MEDICARE DOUGHNUT HOLE.
WHICH IS HUGE FOR PEOPLE.
WE REDUCE PREMIUMSOR SENIORS
TO PAY FOR DRUGS AND MEDICAL CARE.
THAT'S A HUGE BREAKTHROUGH.
WE ELIMINATE THE CO-PAYS.
ASK IF YOU WOULD LIKE TO
ELIMINATE CO-PAYS OR
PRIVATE COMPANIES MAKE AN
ADDITIONAL $20 BILLION IN 10 YEARS.
WHICH IS THE BETTER CHOICE?
YOU ASK THE OVERWHELMING
MAJORITY OF OUR
WOULD THEY RATHER HAVE?
TO ELIMINATE THE CO-PAYS THEY'RE
PAYING TODAY OR CONTINUE TO
PROVIDE EXCESS PROFITS FOR THE
COMPANIES HERE THAT HAVE MADE SO
MUCH UNDER THE MEDICARE
ADVANTAGE PROGRAM AND, LASTLY,
OF COURSE, AND MOST IMPORTANTLY,
WE
LET ME MAKE TWO CASES TO YOU.
PEOPLE SAY, GIVE ME EXAMPLES OF
WHAT YOU'RE TALKING ABOUT ON WHY
THESE DIFFERENC
I'VE GOT A COUPLE OF EXAMPLES,
MR. PRESIDENT, FROM MY HOME
STATE THAT HIGHLIGHT THE POINT.
ONE, THE
NONPROFIT ORGANIZATION AS MOST
OF MY COLLEAGUES KNOW THAT DOES
CASEWORK ON BEHALF OF
INDIVIDUALS WHO NEED ASSISTANCE
DEALING WITH MEDICARE ADVANTAGE PLANS.
THEY GAVE ME -- I SAID ARE THERE
CASES OUT HERE THAT CAN
TWEEN MEDICARE AND MEDICARE ADVANTAGE?
SO THEY PROVIDED TWO
MY STATE.
I PRESUME MOST OF MY COLLEAGUES
COULD FIND CASES IN THEIR OWN
STATE.
A WOMAN LIVING IN MADISON, CONNECTICUT.
A CONNECTICUT.
SHE HAS LOU GEHRIG'S DISEASE, A.L.S.
WE'RE ALL FAMILIARITH A.L.S.
THE STORIES OF WHAT PEOPLE GO
THROUGH WITH THAT.
SHE WAS IN A MEDICARE ADVANTAGE
PLAN.
HEALTH CARE BECAUSE SHE IS SAID
TO BE
THAT WAS THE QUOTE, SHE IS
STABLE.
IT'S NOT A
DENIAL, AND SHE WAS HARDLY
STABLE WITH A.L.S.
C.M.A., THE CENTER FOR MEDICARE
ADVOCACY, HAD TO GO TO FEDERAL
COURT TO GET HER CASE -- HER
CARE COVERED DESPITE FIRM,
MEDICAL CONDITION AND THE CARE
OF HER DOCTORS.
SO HERE'S THE WOMAN AGAIN UNDER
MEDICARE ADVANTAGE WITH A.L.S.
BEING DECLARED BY MEDICARE
ADVANTAGE SHE WAS STABLE.
HER DOC
THE CASE.
SO WHEN MY
ABOUT A RATIONING OF CARE UNDER
THE PRESENT SYSTEM, THERE'S
SOMEONE AT MEDICARE ADVANTAGE, A
PRIVATFIRM MAKING A MEDICAL
DECISION BETWEEN SHE AND HER
DOCTOR THAT SHE WAS STABLE WHEN
THEY SAID ANYTHING BUT WAS THE
NOW, THEY EVENTUALLY GOT IT
OVERTURNED BUT THEY HAD TO GO TO
FEDERAL COURT TO GET I
OVERTURNED.
THAT WOULD NOT HAVE HAPPENED
UNDER MEDICAID.
HAD SHE BEEN JUST UNDER
MEDICARE, SHE WOULD HAVE GOTTEN
THAT HELP, NO QUESTIONS ASKED.
SO WHEN PEOPLE TELL ME THERE'S
NO DISTINCTION, THERE IS A LIVE
CASE FOR YOU.
LET ME GIVE YOU THE SECOND ONE.
A WOMAN FROM VERNON,
CONNECTICUT, AND HER HUSBAND
TRAVELED TO FLORIDA TO VISIT
THEIR DAUGHTER WHO WAS LIVING THERE.
ON THAT TRIP TO FLORIDA, WHEN
SHE GOT TO FLORIDA,
DOWN
INJURIES, PHYSICAL INJURIES.
WHILE BEING TREATED IN FLORIDA
AT THE HOSPITAL FOR THE
INJURIES, IT WAS DISCOVERED
HAD A BRAIN TUMOR WHICH IS THE
REASON SHE HAD THE FALL.
SHE HAD NO IDEA THIS BEFOREHAND.
MEDICARE ADVANTAGE PLAN COVERED
TREATMENT FO
EMERGENCY, WHICH MEDICARE
ADVANTAGE PLANS MUST COVER EVEN
IF OUT OF NETWORK, BY THE WAY,
BUT NOT ANY DIAGNOSIS OR
TREATMENT FOR THE CANCER, FOR
THERAIN TUMOR.
THE WOMAN HAD ANOTHER DAUGHTER
THAT LIVED IN UTAH, A NURSE
THERE, SO THEY TRAVELED FROM
FLORIDA TO UTAH WHERE THEY WENT
FOR THE CANCER TREATMENT FOR THE
BRAIN TUMOR.
WHILE UNDERGOING CHEMOTHERAPY,
THIS WOMAN HAD A
LIFE-THREATENING REACTION TO ONE
OF THE MEDICATIONS FROM WHICH
SHE ALMOST DIED.
THE MEDICARE ADVANTAGE
DENIED COVERAGE FOR ALL OF THIS
CARE BECAUSE IT W OUT OF NETWORK.
SHE WAS IN UTAH.
THEY SAID NO.
LEAVING THE CLIENT AND HER
HUSBAND
NOW, AGAIN, THE CENTER
MEDICARE ADVOCACY WENT TO COURT
AGAIN AND BATTLED IN COURT, AND
THEY WERE SUCCESSFUL
RECOVERING $90,000 OUT OF THE THE $100,000.
NOW, THIS WOMAN IS NOW DECEASED,
MR. PRESIDENT, BUT SHE AND HER
FAMILY WERE LEFT WITH OVER
OVER $10,000 IN BILLS, ALL OF
WHICH WOULD HAVE BEEN COVERED
UNDER TRADITIONAL MEDICARE, BUT
SHE HAD G
ADVANTAGE PLAN.
IN BOTH INSTANCES, THEY WOULD
HAVE AVOIDED HAVING TO BE IN
FEDERAL COURT, HAVING TO FIGHT
AS HARD AS THEY DID, GOING
THROUGH THE TRAUMA AND THE
BAD ENOUGH YOU'VE GOT TO WRESTLE
WITH CANCER.
BAD ENOUGH YOU
WITH A BRAIN TUMOR.
BUT THEN YOU GET SADDLED WITH
WITH $10 MEDICARE WOULD HAVE TAKEN
ADVANTAGE OF YOU.
THIS MEDICARE ADVANTAGE PROGRAM
DISADVANTAGED HER IN THE
PROCESS.
AND THESE ARE EXAMPLES OF HOW
PRIVATE MEDICARE ADVANTAGE DON'T
ALWAYS OPERATE
THEY'RE NOT ALWAYS THERE WHEN
YOU NEED THEM IF YOU'RE OUT OF
THE SAME AREA.
SO THERE ARE SIGNIFICANT
DIFFERENCES.
TRADITIONAL MEDICARE, YOU
WHAT SERVICES YOU GET.
AND I'LL ASK CONSENT TO PUT THIS
LIST OF SERVICES IN THE RECORD
SO PEOPLE CAN
PEOPLE HAVEN'T ALREADY DONE
THAT.
ALL NECESSARY HOSPITAL AND
DOCTORS' OFFICE VISITS ARE
COVERED IN MEDICARE.
YOU KNOW YOU CAN GET THESE
SERVICES FROM ANY MEDICARE
PROVIDER A
COUNTRY, NOT OUT OF NETWORK.
YOU GET THIS KIND OF HELP.
WHETHER IT BE IN UTAH, FLORIDA,
OR VERNON, CNECTICUT, WHERE
SHE WAS FROM, MEDICARE WOULD
HAVE PROVIDED THAT.
HERE THEY ARE BOUNCING AROUND
THE COUNTRY AND BEING DENIED AT
ONE PLACE AFTER ANOTHER UNDER MEDICARE ADVANTAGE.
THEY DON'T HAVE TO WORRY ABOUT A
PRIVATE INSURANCE PLAN PLAYING
GAMES WITH THEIR COVERAGE.
MEDICARE ADVANTAGE, THESE PLANS
RUN THE SHOW.
THEY CHANGE THE BENEFITS.
COST SHARING GOES ON.
THIS IS WHY MEDICARE ADVANTAGE
IS NOT LIKE TRADITIONAL
MEDICARE.
SO WHEN PEOPLE SAY IT'S JUST
LIKE MEDICARE, NO, IT'S NOT JUST
LIKE MEDICARE.
AND IF YOU DOUBT ME, THEN YOU
CALL THAT FAMILY IN
CONNECTICUT, OR YOU CALL THAT
WOMAN'S FAMILY FROM VERNON,
CONNECTICUT, ASK THEM WHETHER OR
NOT MEDICARE ADVANTAGE WAS JUS
LIKE MEDICARE.
YOU'LL GET AN
ABOUT WHAT THEY WENT THROUGH.
WE SHOULD BE CLEAR THAT WE'RE
NOT ELIMINATING MEDICARE ADVANTAGE.
AND AGAIN, I APPRECIATE SENATOR
BAUCUS MAKING THIS POINT.
IT NEEDS TO
OVER AGAIN.
WE'RE NOT ABOUT ELIMINATING IT
AT ALL.
WE ARE REDUCING THE OVERPAYMENTS
TO PRIVATE PLANS AND MAKING THE
SYSTEMORK MORE UNIFORMLY.
WE ACTUALLY GIVE THOSE PLANS
BONUS PAYMENTS FOR CARE,
COORDINATION AND QUALITY
IMPROVEMENTS, AND THEY CAN
USE -- THESE PLANS CAN USE THOSE
PAYMENTS TO
THEIR BENEFICIARIES.
SO HARDLY ELIMINATING IT AT ALL.
I HAVE SERIOUS RESERVATIONS
ABOUT HOW THIS PLAN OPERATES,
I'LL TELL YOU THAT,
MR. PRESIDENT, BUT I WOULD NOT
ADVOCATE ON THE FLOOR OF THE
UNITED STATES SENATE THE
ELIMINATION OF MEDICARE ADVANTAGE.
BUT I DO WANT TO MAKE IT WORK
BETTER AND I DO WANT TO CUT BACK
WHEN YOU HAVE OVERPAYMENTS
OCCURRING, AND I DON'T THINK
IT'S FAIR THAT 80% OF THE
SENIORS IN MY STATE OR ELSEWHERE
ARE PAYING $90 A YEAR EXTRA TO
COVER THIS PROGRAM AND GET NONE
OF THE HELP FROM IT, AND THAT
PEOPLE UNDER MEDICARE ADVANTAGE
COULD HAVE BEEN PROTECTED OR NOT
BEUSE THEY OPTED TO BE IN THAT
PLAN AND THEN FIND
ANYTHING BUT WHAT THEY THOUGHT IT
SO, MR. PRESIDENT, YOU'RE GOING
TO HEAR THESE ARGUMENTS OVER AND
OVER AGAIN ABOUT MEDICARE ADVANTAGE.
A LITTLE TRUTH IN ADVERTISING
NECESSARY HERE SO PEOPLE
UNDERSTAND IT'S NOT MEDICARE AND
IT'S NOT AN ADVANTAGE, NOT IN
ITS PRESENT SYSTEM, NOT AT ALL,
AND THAT'S WHAT WE HAVE BEEN
TRYINGO SAY OVER AND OVER AND
OVER AGAIN HERE SO THE PEOPLE
UNDERSTAND. THIS IS A GOOD BILL.
THIS IS
THIS TOOK A TREMENDOUS AMOUNT OF
WORK IN THE FINANCE COMMITTEE
THAT HAD THE RESPONSIBILITY IN
CRAFTING THESE PROVISIONS WHICH
ARE HIGHLY COMPLICATED AND VERY
DELICATE IN WHAT YOU DO, BUT
WHAT WE'VE DONE HERE IS PRESERVE
AND STRENGTHEN OUR MEDICARE
SYSTEM, EXPANDING THE BENEFITS
FOR PEOPLE, ELIMINATING CO-PAYS,
ALLOWING THOSE PREVENTATIVES, SCREENING SERVICES TO BE
AVAILABLE TO OUR ELDERLY, SEEING
TO IT THEY'LL HAVE THE
PRESCRIPTION DRUGS AT LOWER COSTS.
THAT'S ALL IN THIS BILL.
THAT A GREAT ADVANTAGE.
WHAT A TRAGEDY IT WOULD BE IF IN
THESE NEXT FEW DAYS WHEN WE HAVE
TO DEBATE ALL OF THIS WE WOULD
LOSE ALL OF THE WORK THAT HAS
BEEN DONE HERE TO MAKE THESE
KIND OF IMPROVEMENTS IN OUR
HEALTH CARE SYSTEM, AND I
COMMEND AGAIN MY COLLEAGUE FROM
MONTANA AND HIS COLLEAGUES IN
THE COMMITTEE THAT WORKED SO
HARD TO PUT THIS TOGETHER, THIS
BALANCE TOGETHER HERE THAT CAN
MA
PEOPLE'S LIVES.
SO W
ALSO WANT TO THANK OUR COLLEAGUE
FROM RHODE ISLAND FOR OFFERING
HIS AMENDMENT WHICH WE'RE GOING
TO BE CONSIDERINGT SOME POINT
HERE WHEN WE GET TO VOTE
OCCASIONALLY ON SOME MATTERS
AROUND HERE.
AND AGAIN, I HOPE AT SOME POINT
WE CAN START TO DO THAT.
WE'VE DONE IT A COUPLE OF TIMES,
BUT FRANKLY, THIS HAS BEEN OVER
A YEAR OF DEBATE AND DISCUSSION.
I THINK THE AMERICAN PEOPLE
WOULD LIKE TO SEE SOME ACTION
AND THEY DESERVE TO HAVE IT.
WE THINK WE HAV A GOOD BILL ON
THE CLASS ACT WHICH I KNOW HAS
BEEN HOTLY DEBATED AND
DISCUSSED.
IT'S GOING TO TAKE ON AN
IMPORTANT HEALTH INSURANCE
MARKET REFORM THAT WILL ENSURE
THAT AMERICANS WILL GET ACCESS
TO HEALTH CARE PROMISED BY THEIR
INSURANCE PLANS.
SOMEONE LOSES HIS OR H
THEY CAN
IT'S GOING TO IMPROVE THE
QUALITY OF HEALTH CARE AND FOCUS
OUR SYSTEM MORE ON P
AND WELLNESS.
ON TOP OF ALL THESE THINGS, IT'S
GOING TO REDUCE THE
AS WE'VE HEARD OVER AND OVER
AGAIN, C.B.O. IS TALKING ABOUT SAVING $
TEN YEARS
THE SECOND.
YOU KNOW, I'VE GOT TO SAY
SOMETHING, MR. PRESIDENT.
THE OTHER DAYS WHEN WE GOT THE
NEWS THAT C.B.O. HAD SAID THAT
THE PREMIUMS ON THE INDIVIDUAL
PLANS, THE SMALL GROUP -- OR
SMALL BUSINESS PLANS AND THE
LARGE GROUP PLANS WERE ACTUALLY
GOING TO REDUCE PREMIUM COSTS BY
20% IN ONE AREA AND AS LITTLE AS
3% IN ANOTHER.
I WOULD HAVE THOUGHT THERE WOULD
HAVE BEEN
EVEN THOSE THAT OPPOSED THE BILL
WOULD HAVE SAID ISN'T THAT GREAT
NEWS?
WHAT YOU GOT HERE WAS ALMOST A
SENSE OF DEEP DISAPPOINTMENT
THAT C.B.O. HAD COME OUT
GIVEN US A REPORT HERE THAT
ACTUALLY PEOPLE WERE GOING TO
SAVE MONEY UNDER THIS BILL AND PROPOSAL.
AND THEN ALL OF A SUDDEN TO
ATTACK C.B.O. BECAUSE YOU DIDN'T
LIKE THE RESULTS COMING OUT OF C.B.O.
I'LL GUARANTEE YOU THAT
COME BACK AND SAID WE'RE GOING
TO INCREASE PREMIUMS, WE WOULD
ALL BE TALKING ABOUT THAT.
SO HERE WE GET REPORTS THAT
PREMIUM COSTS, REDUCE THE COSTS
OF THE FEDERAL BUDGET AS HAS
BEEN POINTED OUT.
AND NOW SENATOR WHITEHOUSE IS
GOING TO OFFER AN AMENDMENT THAT
MAKES
TALKING ABOUT USED
SOCIAL SECURITY, REDUCE THE
DEFICIT AND CONTRIBUTE TO THE
LONG-TERM SOLVENCY OF THE CLASS
ACT WILL BE FOR THAT PURPOSE AND
THAT PURPOSE ALONE.
AND THE THIRD PART OF HIS
AMENDMENT IS PARTICULARLY IMPORTANT.
MANY OF OUR COLLEAGUES HAVE COME
TO THE FLOOR IN THE LAST FEW
DAYS TO CLAIM THAT CLASS ACT
WILL BE A LONG-TERM DRAIN ON THE
BUDGET.
IT'S JUST NOT TRUE,
MR. PRESIDENT, THANKS TO OUR
COLLEAGUE FROM NEW HAMPSHIRE.
SENATOR GREG, THE CLASS ACT WILL
BE REQUIRED BY LAW TO BE SOLVENT
FOR 75 YEARS.
WHICH IS NOT IN OUR ORIGINAL PROPOSAL.
IT WAS ADDED IN THE HEALTH
COMMITTEE MARKUP BY
GREGG AND I THANK HIM FOR IT.
IT WAS UNANIMOUSLY ADOPTED BY
SENATOR GREGG IN OUR
THE C.B.O. SAYS IT PRODUCES PRODUCES $72 BILLION IN SINGS
FOR THE FEDERAL GOVERNMENT OVER
THE FIRST TEN YEARS OF ITS
EXISTENCE AND IT WILL SAVE
NEARLY $2 BILLION FROM MEDICAID.
THEY FURTHER ADDED LANGUAGE TO
THE BILL TO REQUIRE THE
SECRETARY TO MAINTAIN ENOUGH
RESERVES AFTER THE FIRST TEN
YEARS TO BE ABLE TO PAY OUT ANY
CLAIMS THAT MAY
AND WE HAVE INCLUDED LANGUAGE TO PREVENT FEDERAL APPROPRIATIONS
FROM BEING USED TO PAY BENEFITS
TO ENSURE THE PROGRAM IS SELFFUNDED.
AND FINALLY, AT THE
SEVERAL SENATORS, THE
DISTINGUISHED MAJORITY LEADER
MADE SURE THAT WE DID NOT LOSE
ANY OF THE SAVINGS FROM THE
CLASS ACT FOR ANY OTHER PURPOSE
OTHER THAN TO
ACT ITSELF.
THIS AMENDMENT OFFERED BY
SENATOR WHITEHOUSE WILL GIVE
SENATORS A CNCE TO COMMIT
THEMSELVES TO THAT PURPOSE.
SENATORS WHO CLAIM THE CLASS ACT
WILL HURT THE
COURSE SHOULD VOTE FOR THIS
AMENDMENT BECAUSE STATUTORILY IT
WILL PROHIBIT ANY OF THOSE FUNDS
FROM BEING
PURPOSE OTHER THAN FOR THE CLASS
ACT AND THE RECIPIE
WHO WANT TO USE IT.
SO I COMMEND HIM
AND WE THANK
WHEN THAT VOTE OCCURS, I WOULD
URGE MY COLLEAGUES TO VOTE FOR
THE WHITEHOUSE AMENDMENT.
MR. PRESIDENT, I LASTLY WOULD
LIKE TO ASK TO BE INCLUDED AS A
COSPONSOR ALONG WITH MY
COLLEAGUE FROM MARYLAND, SENATOR
MIKULSKI, OF SENATOR COBURN'S
AMENDMENT NUMBER 2789 WHICH ADDS
MEMBERS OF CONGRESS TO THE
PUBLIC OPTION.
WE HAD
THAT PROVISION TO THE "HELP"
COMMITTEE BILL.
SENATOR COBURN OFFERED THAT AMENDMENT.
SENATOR KENNEDY AND MYSELF AND
OTHERS VOTEDOR THAT AMENDMENT.
I THINK IT MAY HAVE SHOCKED THE
SENATOR FROM OKLAHOMA THAT WE
ACTUALLY VOTED FOR HIS AMENDMENT
AT THE TIME.
I KNOW THAT SENATOR BROWN HAS
BEEN ADDED AS A COSPONSOR.
I HAVE NO OBJECTION TO THAT
AMENDMENT.
THAT'S HOW MUCH THAT I THINK THE
PUBLIC OPTION WILL BE WORTH.
IF WE HAVE A PUBLIC OPTION IN
THIS PLAN -- AND MY HOPE IS THAT
WE WILL -- THEN I THINK THERE IS NOTHING WRONG WITH INSISTING
THAT MEMBERS OF CONGRESS BE
INCLUDED IN THAT PUBLIC OPTION
PROPOSAL.
AND SO HIS
THAT.
WE SUPPORT IT IN OUR COMMITTEE,
AND I'M PREPARED TO SUPPORT IT
AGAIN HERE ON THE FLOOR OF THE
UNITED STATES SENATE.
AND AGAIN, I POINT OUT THAT I
THINK THAT'S A WONDERFUL --
JUST WISH WE COULD GET MEMBERS
AS WELL WHO ARE RELUCTANT TO
SUPPORT
THAT AS MEMBERS OF CONGRESS
TODAY, WE ALL HAVE PRETTY GOOD
HEALTH CARE PLANS UNDER THE
FEDERAL EMPLOYEES BENEFIT
PACKAGE, SOME 23 DIFFERENT
OPTI
AVAILABLE TO US ALONG WITH THE
EIGHT MILLION FEDERAL EMPLOYEES
IN THIS COUNTRY UNDER THOSE
PLANS.
I JUST WISH WE COULD GET OTHERS
TO RECOGNIZE HOWALUABLE THAT
IS TO ALL OF US AND OUR FELLOW
EMPLOYEES WHO ARE FEDERAL
EMPLOYEES.
UNFORTUNATELY,HAT DOESN'T SEEM
TO BE THE CASE, BUT
BEFORE THIS IS CONCLUDED WE'LL
HAVE FAR MORE SUPPORT FOR THIS
EFFORT THAT WE HAVE CRAFTED AND
PROVIDED TO OUR COLLEAGUES FOR
THEIR
AGAIN, I COMPLIMENT THE FINANCE
COMMIT
FRIEND FROM MONTANA FOR THE
HE HAS DONE ON THIS ISSUE.
IT'S VERY WELL THOUGHT OUT, VERY
BALANCED, VERY FAIR.
AND AGAIN, I'VE SAID THIS
AND OVER AGAIN.
I CHALLENGE ANY MEMBER TO COME
TO THE FLOOR AND IDENTIFY A
SINGLE GUARANTEED BENEFIT UNDER
MEDICARE THAT IS CUT OUT IN THIS BILL.
THERE IS NOT ONE
AND WAIT TO GO THIS DAY.
THREE DAYS HAVE GONE
IDENTIFY A SINGLE GUARANTEED
BENEFIT UNDER MEDICARE THAT WE CUT.
YOU WILL NOT FIND ONE, NOT ONE, MR. PRESIDENT.
MR. PRESIDENT, I SEE MY FRIEND
FLOOR, AND I KNOW
PROBABLY GONE OVER A LITTLE BIT
OF TIME HERE,
FLOOR.
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA IS
RECOGNIZED.
MR. BAUCUS: WE'RE KIND OF
PLAYING THINGS BY EAR.
I WOULD ASK UNANIMOUS CONSENT
THAT THE SENATOR FROM WYOMING BE
ALLOWED TO SPEAK -- BE
RECOGNIZED TO SPEAK FOR DEBATE
ONLY, AND AT A LATER POINT WE'LL
FIGURE OUT ALLOCATION OF TIME ON BOTH SIDES.
IF HE WISHES TO SPEAK NOW?
MR. ENZI: YES, MR. PRESIDENT, I
WOULD LIKE TO SPEAK.
THE PRESIDING OFFICER: THE
SENATOR FROM WYOMING IS
RECOGNIZED.
WITHOUT OBJECTION.
THE SENATOR FROM WYOMING.
MR. ENZI: MR. PRESIDENT, THANK
YOU. IT WAS MY UNDERSTANDING I WOULD
BE IN CHARGE OF THE NEXT 30
MINUTES AND THEN IT WOULD REVERT
TO THE OTHER SIDE FOR 30 MINUTES
AFR THAT.
AT SOME POINT,
MR. BAUCUS: THE NEXT 30 AFTER
THAT. THE PRESIDING OFFICER: WITHOUT
OBJECTION, SO ORDERED. MR. ENZI: IT'S ALSO MY
UNDERSTANDING THAT AT ANY TIME
THERE IS AN AGREEMENT FOR A
VOTE, WE'LL KIND OF CANCEL OUT
WHAT WE'RE DOING HERE, BUT THERE
IS NO AGREEMENT YET, AND I'M NOT
NOT -- SO I -- I WANTED TO THANK
THE SENATOR FROM CONNECTIC
SETTING UP MY SPEECH SO WELL.
HE SAID THAT THERE WASN'T
ANYPLACE THAT ANYBODY CAN SHOW
ANY DECLINE IN GUARANTEED
BENEFITS.
IN WHAT
TRY TO DO THAT.
OF COURSE, THE WORD GUARANTEED
BENEFITS REALLY DOESN'T SHOW UP
ANYWHERE IN WHAT WE'
BENEFITS DOES BUT NOT GUARANTEED BENEFITS.
AND IN MY OPINION, GETTING TO BE
IN A NURSING HOME OR BEING ABLE
TO SEE A DOCTOR, SOME OF THOSE
OUGHT TO BE KIND OF CONSIDERED
GUARANTEED BENEFITS, BUT ILL
GET -- BUT I'LL GET INTO THAT IN
MY SPEECH HERE AND COVER
THESE AREAS THAT
VERY IMPORTANT TO SENIORS,
BECAUSE I AM OPPOSED TO THE HALF
A TRILLION DOLLARS IN MEDICARE
CUTS IN
NOT GOING ONLY TO SOLVE
MEDICARE.
NOW, SOME OF MY DEMOCRATIC
COLLEAGUES HAVE ATTEMPTED TO
ARGUE THAT THIS BILL DOESN'T CUT
THE MEDICARE
THEY HAVE FURTHER SAID THAT SUCH
CUTS ARE JUSTIFIED AND WILL NOT
RM THE PROGRAM.
THEY HAVE ALSO ARGUED THAT NO
BENEFICIARIES WILL LOSE THEIR
BENEFITS, THEIR GUARANTEED
BENEFITS -- AND THEY'RE VERY
CAREFUL ON THAT AND I UNDERSTAND
WHY THEY ARE VERY CAREFUL ON
THAT BECAUSE THERE ARE OTHER
BENEFITS THAT ARE BEING CUT THAT
WILL BE CONSIDERED BY THOSE
PEOPLE WHO LOSE THAT BENEFIT TO
BE A GUARANTEED
UNFORTUNATELY, ALL OF THOSE
STATEMENTS ARE FALSE T. DOES NOT
MATTER HOW M
FALSE.
IT DOES NOT MATTER HOW MANY
TIMES MY COLLEAGUES REPOET THESE
CLAIMS, THEY DO NOT -- REPEAT
THESE CLAIMS, THEY DO NOT BECOME
ANY MORE ACCURATE.
THIS BILL CUTS $464 FROM
MEDICARE PROGRAM.
IT SLASHES PAYMENTS TO
HOSPITALS, NURSING
HEALTH AGENCIES AND HOSPICE.
THE MONEY FROM THESE CUTS DOES
NOT GO TO
THE MONEY GOES TO NEW PROGRAMS
FOR OTHERS.
THESE CUTS WILL AFFECT THE CARE
PROVIDED TO MEDICARE
BENE
THE AMERICAN HEALTH CARE
ASSOCIATION, WHICH REPRESENTS
NURSING HOMES, S
CUTS IN THE REID BILL WOULD
FORCE LAYOFFS, LOWER SALARIES,
REDUCE BENEFITS, AND ULTIMATELY
WOULD HURT PATIENTS' QUALITY OF
CARE.
A
EVEN MORE CUTS TO SAVE MEDICARE.
IT'S IN THE BILL.
THERE'S A COMMISSION IN THERE.
SO WITH THE SIDE DEALS, THOUGH,
THAT HAVE BEEN MADE WITH
LOBBYISTS, THE ONLY PLACE THESE
CUTS CAN COME FROM IS FROM
SENIORS,
A LITTLE MORE DETAIL LATER.
I'VE HEARD SIMILAR STATEMENTS
FROM HOME HEALTH
THAT'S MORE THAN $40 BILLION IN CUTS.
HOSPICE PROVIDERS, THAT'S
$8 BILLION IN CUTS.
AND HOSPITALS, THAT'S
$130 BILLION IN CUTS.
NOW, IF THESE MEDICARE CUTS GO
INTO EFFECT, IT COULD DRIVE MAN
PROGRAM.
THAT WILL MEAN PATIENTS DO NOT
HAVE
THEY NEED.
SOME OF MY DEMOCRATIC COLLEAGUES
THAT ACCUSED US OF TRYG TO
SCARE MEDICARE BENEFICIARIES.
IF SENIORS ARE SCARED BY OUR
STATEMENTS, THEY SHOULD BE
TERRIFIED BY WHAT THE
ADMINISTRATION HAS TO SAY ABOUT
THE DEMOCRATS' HEALTH REFORM
BILL.
THE ADMINISTRATION'S OWN CHIEF
ACTUARY, RICHARD FOSR,
RECENTLY WROTE THAT THE STEEP
MEDICARE CUTS IN THE
HOUSE-PASSED HEALTH REFORM BILL
WOULD MAKE IT DIFFICULT FOR MANY
PRIDERS TO REMAIN PROFITABLE
AND CAUSE TM TO END THEIR
PARTICIPATION IN MEDICARE.
HE WENT ON TO NOTE THAT THIS
COULD JEOPARDIZE MEDICARE'S
BENEFICIARIES' ACCESS TO CARE.
AS THE SENIOR SENATOR FROM
TENNESSEE NOTED YESTERDAY, IT'S
THE MEDICARE CUTS IN THE REID
BILL THAT ARE
SENIORS. MEDICARE BENEFICIARIES
UNDERSTAND THAT IF PROVIDERS ARE
NO LONGER ABLE TO TAKE MEDICARE
PATIENTS, THEY, THE SENIORS,
WILL NOT GET CARE.
A LOT OF GRANDMAS AND GRANDPAS
HAVE FIGURED IT OUT AND THEY'RE
NOT GOING TO STAND FOR IT.
NOW, THE CHAIRMAN OF THE FINANCE
COMMITTEE HAS REPEATEDLY SAID
THAT THIS BILL WILL NOT CUT OR
REDUCE ANY GUARANTEED MEDICARE
BENEFIT.
THAT STATEMENT SEEMS TO IGNORE
WHAT THIS BILL WILL DO TO
PROVIDERS.
IF A MEDICARE PATIENT CANNOT GET
INTO A NURSING HOME, THEY DON'T
HAVE NURSING HOME BENEFITS.
IF THEY CAN'T FIND A HOME HEALTH
AIDE WILLING TO TAKE MEDICARE
PATIENTS, THEY DON'T HAVE HEALTH
HOME BENEFITS.
WHICH YOU CAN'T GET A DOCTOR TO
SEE YOU, IS NOT HEALTH CARE
YOU DON'T HAVE BENEFITS IF YOU
CAN'T GET A PROVIDER TO TREAT
YOU AND, UNFORTUNATELY, THAT'S
EXACTLY WHAT THIS BILL WILL DO.
SOME OF MY DEMOCRATIC COLLEAGUES
HAVE ALSO ATTEMPTED TO JUSTIFY
THE MEDICARE CUTS IN THE REID
BILL BY ARGUING THAT MANY OF THE TRADE ASSOCIATIONS REPRESENTING
HEALTH CARE PROVIDERS HAVE
ENDORSED THIS BILL.
THEY'RE CORRECT THAT SEVERAL
WASHINGTON-BASED TRADE
ASSOCIATIONS AND THEIR LOBBYISTS
HAVE ENDORSED THE REID BILL.
IT'S PROBABLY WORTH EXPLORING
WHY SOME OF THE GROUPS HAVE
CHOSEN TO END
LEGISLATION.
IN SOME CASES, MOTIVATIONS ARE OBVIOUS.
SOME DRUG MANUFACTURERS ARE
SELF-INTEREST AND GREED.
THEY NEGOTIATED A SECRET DEAL
WITH THE WHITE HOUSE THAT WILL
ACTUALLY INCREASE HOW MEDICARE
SPENDS ON BRAND-NAME DRUGS. BRAND-NAME DRUGS.
THEY DIDN'T TOUCH THE GER ERICS,
THEY'RE INTERESTED -- GENERICS,
THEY'RE INTERESTED IN THE
BRAND-NAME DGS.
UNDER THE DEAL, THE DRUG
MANUFACTURERS WILL PROVIDE
DISCOUNTS ON BRAND-NAME
PRESCRIPTION DRUGS WHEN THE
SENIORS WILL IN THE MEDICARE
COVERAGE GAP, KNOWN AS THE
DOUGHNUT HOLE, NOW, THEY MAKE
THE PAYMENTS DIRECTLY TO THE CUSTOMER.
IT DOESN'T GO THROUGH MEDICARE,
DIRECTLY TO THE CUSTOMER.
THAT WAY THEY CAN
CUSTOMER CONTACT AND KEEP THEM
ADDICTED TO THE BRAND NAME.
GENERICS ARE CHEAPER.
A LOT OF PEOPLE WHEN THEY GO
INTO THE DOUGHNUT HOLE SWITCH TO GENERICS.
THAT SAVES THEM MONEY AND IT
SAVES US BECAUSE WHEN THEY GET THROUGH
THE DOUGHNUT HOLE, THEY WILL
STAY WITH WHATEVER THEY'RE ON IN
THE DOUGHNUT HOLE.
SO IF THEY'RE FORCED TO STAY ON
A BRAND NAME TO GET A LITTLE
EXTRA DISCOUNT AS THEY GO
THROUGH THE DOUGHNUT HOLE,
THEY'LL STAY WITH THE BRAND NAME
WHEN THE
FOR IT WHEN IT GOES ABOVE THE
DOUGHNUT HOLE, WHICH IS THE REST
OF THE YEAR.
THAT COULD BE A HUGE NUMBER.
SO WHILE IT LOOKS GENEROUS
THE DRUG COMPANIES, BEWARE.
THEIR GENEROSITY IS SUSPECT WITH
WHAT THEY WILL MAKE WHEN IT GETS
THROUGH THE DOUGHNUT HOLE
UNDER THE TERMS OF THE
SWEETHEART DEAL BETWEEN THE
WHITE HOUSE AND THE DRUG MAKERS,
DISCOUNTS ARE PROVIDED FOR THESE
BRAND-NAME DRUGS.
THIS WILL ENCOURAGE SENIORS TO
CONTINUE TO GET THOSE MORE
EXPENSIVE DRUGS AND IT WILL
ACTUALLY COST THE TAXPAYERS
$15 BILLION BECAUSE THE DEAL
WILL ACTUALLY INCREASE MEDICARE
COSTS.
IN OTHER CASES, PROVIDER GROUPS
WERE PROMISED SPECIAL DEALS IF
THEY AGREED TO SUPPORT THE REID
BILL, OR WHATEVER BILL WE WERE
WORKING ON AT THAT TIME.
FOR INSTANCE,
REPORTS HAVE DESCRIBED HOW THE
AMERICAN MEDICAL ASSOCIATION HAS
PROMISED -- WAS PROMISED A
PERMANENT FIX TO THE MEDICARE
PAYMENT FORMULA FOR DOCTORS IF
THEY AGREED T
BILL.
OR A ONE-YEAR FIX IF THERE WAS
AN END TO JUNK LAWSUITS.
UNDER CURRENT LAW,
MEDICARE PAYMENTS ARE SCHEDULED
TO BE CUT BY MORE THAN 40% OVER
THE NEXT DECADE. THAT'S ALREADY IN PLACE.
THAT'S NOT A PART OF THE BILL.
THE COST OF FIXING THIS FLAWED
GOVERNMENT
BE MORE THAN
WE KNOW THAT BECAUSE WE'VE
DEBATED IT ON THE FLOOR AND WE DECIDED THAT WE WERE GOING TO
HAVE TO PAY FOR THAT IF WE WERE
GOING TO DO IT.
LET'S SEE, WITH $464 BILLION IN
MEDICARE MONEY THAT WE'RE USING
ON OTHER THINGS.
THAT'S WHY I KEEP SAYING THAT
MEDICARE MONEY ONLY OUGHT TO GO
TO MEDICARE BENEFITS.
AND THAT $250 BILLION IN FIXING
THE DOCTORS
POSSIBLE FOR PEOPLE TO SEE THE
DOCTORS.
NOW, I CAN UNDERSTAND WHY
DOCTORS WANT TO FIX THIS FLAWED
GOVERNMENT PRICE-CONTROL SYSTEM,
AND THAT'S WHAT IT IS.
THEY'RE TELLING THE DOCTORS WHAT
THEY C CHARGE A CUSTOMER,
REGARDLESS OF HOW LONG A TIME
IT'S GOING TO TAKE THEM TO TAKE
CARE OF THAT PATIENT.
AND
DISCOVERED THAT IT COSTS MORE
AND IF THEY CONTINUE TO DO THAT,
THEY HAVE TO GO OUT OF BUSINESS.
THAT'S KIND OF A SMALL BUSINESS
PHILOSOPHY.
YOU TAKE IN LESS MONEY THAN WHA
IT COSTS YOU TO BE IN BUSINESS,
YOU'RE OUT OF BUSINESS.
SO I DON'T THINK THE
KIND OF A GOVERNMENT PRICE-CONTROL SYSTEM.
AND AS A RESULT, 40% OF THE
DOCT
MEDICAID, AND IT'S -- IT'S
GROWING IN PERCENTAGE NOW ON
MEDICARE THE SAME WAY.
WHEN YOU FIX THE PRICE, SOME
PEOPLE CAN'T AFFORD TO PROVIDE
IT FOR THAT.
THEY CAN'T TAKE THOSE PATIENTS.
TALKING TO A FRIEND OF MINE FROM
FLORIDA WHO SAID, EVERY TIME YOU
CALL A DOCTOR NOW, THEY SAY, ARE
YOU O
IF YOU SAY YOU'RE ON MEDICARE,
THEY SAY, "WE'RE NOT TAKING ANY NEW PATIENTS."
IF YOU CAN'T SEE A DOCTOR, YOU
DON'T HAVE A BENEFIT.
NOW, IT SHOWS THE EXACT PROBLEMS
IS A RESULT FROM LETTING
CONTROLS TO SET PAYMENT RATES.
WHAT I DON'T UNDERSTAND IS WHY
THE A.M.A. CONTINUES TO SUPPORT
THE BILL WHEN THEY GOT NOTHING
FOR THEIR DEAL.
WE DIDN'T FIX THE
PROBLEM AND WE HAVEN'T FIXED THE
JUNK LAWSUITS PROBLEM.
I REMEMBER
APPEARING AT THE NATIONAL
CONVENTION OF
MEDICAL ASSOCIATION AND
PROMISING THAT THE
TORT REFORM, THAT THERE WOULD BE
AN TONED THESE JUNK LAWSUITS.
ALL OF OUR ATTEMPTS, EITHER IN
THE "HELP" COMMITTEE OR IN THE
FINANCE COMMITTEE TO EVEN --
EVEN BRING THAT UP HAVE BEEN
EITHER VOTED DOWN OR DENIE, AND
AS A RESULT, THERE'S NOTHING IN
THIS BILL THAT'S GOING TO SOLVE
THAT PROBLEM.
NOW, THE BILL DOES NOTHING TO
FIX THE MEDICARE PAYMENT FORMULA
FOR THE DOCTORS.
INSTEAD, IT CUTS $464 BILLION
FROM MEDICARE AND USES THAT
EVEN IF THESE CUTS CAN BE MADE
WITHOUT HURTING SENIORS, THE
REPUBLICANS ARE SAYING USE THE
MONEY ONLY
MEDICARE MONEY FOR MEDICARE.
MEDICARE FUNDS SHOULD BE USED TO
FIX MEDICARE'S PROBLEMS, SUCH AS
THIS FLAWED PAYMENT FORMULA
KEEPS DOCTORS FROM TAKING
SENIORS.
TAKING HUNDREDS OF BILLIONS OF
DOLLARS OUT OF A MEDICARE
PROGRAM NOW WILL ONLY GUARANTEE
THAT IT WILL BE MUCH HARDER TO
PERMANENTLY FIX THE DOCTOR
PAYMENT ISSUE IN THE FUTURE.
I CAN UNDERSTAND WHY THE A.M.A.
CONTINUES TO SUPPORT --
I CANNOT UNDERSTAND WHY THE
A.M.A. CONTINUES TO
TERRIBLE DEAL FOR DOCTORS.
IF YOU CAN'T SEE A DOCTOR, YOUR
BENEFITS, YOUR GUARANTEED
BENEFITS HAVE BEEN CUT.
APPARENTLY, THE MEMBERS OF THE
A.M.A. DON'T LIKE THE DEAL EITHER.
AT A RECENT CONVENTION, UP TO
40% OF THE CURRENT MEMBERSHIP OF
THE A.M.A. VOTED TO REJECT THIS
AL.
I KNOW THAT'S NOT A MAJORITY,
BUT MOST ASSOCIATIONS SURVIVE BY
CONSENSUS AGREEMENTS.
THAT MEANS THAT ALMOST ALL OF
THEIR MEMBERSHIP AGREES WITH THE
TACK THAT THEY'RE TAKING.
NOT JUST SLIGHTLY MORE THAN
HALF.
NOW THEIR
THAN 20% OF ALL DOCTORS.
IT'S A DWINDLING ASSOCIATION.
LET'S SEE, SO LE SO LESS THAN 20% OF
THE DOCTORS, HAD 40% THAT
OPPOSED IT.
WE'RE GETTING DOWN TO SOME
PRETTY SMALL PERCENTAGES OF ONES
THAT SUPPORTED WHAT THE A.M.A.
DID IN THEIR DEAL.
NOW, FINALLY, MANY PROVIDER
GROUPS HAVE BEEN RELUCTANT TO
SPEAKUT AGAINST THIS BILL
BECAUSE THEY'VE RECEIVED THREATS
FROM THE WHITE HOUSE AND
CONGRESSIONAL DEMOCRATS.
NURSING HOMES, HOME HEALTH
AGENCIES
HAVE ALL REPORTEDLY BEEN
THREATENED WITH FURTHER CUTS --
FURTHER CUTS -- IF THEY SPEAK
OUT AGAINST THE BILL.
IS THAT FREEDOM OF SPEECH OR IS
IT JUST BAD ETHICS?
THEY'VE REPORTEDLY BEEN TOLD
THAT ANY PUBLIC STATEMENTS OF
OPPOSITION TO THE REID BILL WILL
LEAD TO EVEN MORE SEVERE CUTS.
THESE PROVIDERS HAVE HAD TO MAKE
THE CHOICE TO SILENTLY ACCEPT
DEVASTATING CUTS RHER
OPPOSE THEM AND RISK BEING
UTTERLY DESTROYED.
NOW, ONE OF THE MEDICARE
ADVANTAGE PROVIDERS IS HUMANA,
AND I'LL USE THEM AS AN EXAMPLE.
C.M.S. SAID THEY COULDN'T LET
THEIR CUSTOMERS KNOW WHAT WAS
ABOUT TO HAPPEN AND CHASTISED
THEM FOR SENDING OUT A LETTER.
I THOUGHT THE
TO KNOW AND THAT WE WERE IN A
NEW ERA OF TRANSPARENCY.
THAT DOESN'T SOUND VERY
TRANSPARENT TO ME.
SO HOW CAN THAT HAPPEN I
AMERICA?
AT ANY RATE, I HOPE MY
COLLEAGUES AND THE AMERICAN
PEOPLE WILL TAKE THESE FACTS
INTO ACCOUNT WHEN THEY HEAR
SENATORS TALK ABOUT PROVIDER
GROUPS SUPPORTING THIS BILL.
PROVIDER SUPPORT FOR THIS BILL
IS BEING DRIVEN PRIMARILY BY
GREED OR STUPIDITY OR FEAR.
WE KNOW THIS BILL
THE PROBLEMS IN THE AMERICAN
HEALTH CARE SYSTEM.
IT WILL NOT LOWER HEALTH CARE COSTS.
IT WILL NOT LOWER INSURANCE
PREMIUMS.
IT WILL STILL LEAVE 25 MILLION
PEOPLE UNINSURED.
WHAT THIS BILL WILL DO IS SPEND
$2.5 TRILLION AND GUARANTEE A
MUCH BIGGER ROLE FOR THE
GOVERNMENT IN DIG AT IN DICTATING HOW
HEALTH CARE WILL BE PROVIDED IN THIS COUNTRY.
IF YOU'RE NOT UNDER MEDICARE,
YES, YOUR GOVERNMENT IS GOING TO
TELL YOU WHAT IS ADEQUAT COVERAGE AND THEY'RE GOING TO
FORCE YOU TO BUY IT OR PAY A
PENALTY.
NOW, GIVEN THE RECENT
EXPERIENCES THE DOCTORS HAVE HAD
WITH MEDICARE PRICE CONTROLS,
THIS IS NOT AN OUTCOME THAT
BODES WELL FOR THE AMERICA'S
HEALTH CARE PROVIDERS OR THEIR
PATIENTS.
AND I REMIND EVERYBODY THAT IN
AUGUST, THERE WAS AN UPROAR AND
NOW, WE DON'T NOTICE IT AS MUCH
BECAUSE WE'RE NOT GOING TO GET
TO GO HOME THIS WEEKEND AND TALK
TO OUR CONSTITUENTS.
THAT MIGHT BE BY DESIGN BECAUSE
WE ALREADY KNOW WHAT OUR
CONSTITUENTS ARE SAYING
THEY'RE SAYING THIS BILL IS A
BAD DEAL FOR US. WHERE'S THE PROMISE THAT YOU
WERE GOING TO CUT COSTS FOR US?
WHERE ARE THE OTHER PROMISES
THAT WERE MADE WITH THIS HEALTH
CARE REFORM
I WOULD MENTION THAT THE C.B.O.
FOUND THAT PREMIUMS IN THE
INDIVIDUAL MARKET WILL RISE BY
10% TO 13%
DID NOTHING.
THAT'S C.B.O.
FAMILY POLICIES UNDER THE STATUS
QUO ARE PROJECTED TO COST
$13,100 ON THE AVERAGE, BUT
UNDER THIS HEALTH CARE BILL
SHOULD JUMP TO $15,200.
THAT'S NOT VERY GOOD NEWS FOR
THE PEOPLE IN MY STATE OR ANY
OTHER STATE.
NO BIG COST RISE IN U.S.
PREMIUMS IS SEEN IN THE STUDY,
SAID THE "NEW YORK TIMES."
"T WASHINGTON POST" DECLARED,
"S BOOST."
THE WHITE HOUSE CROWED THAT THE
C.B.O. REPORT WAS MORE GOOD NEWS
ABOUT WHAT REFORM WILL
FAMILIES STRUGGLING TO KEEP UP
WITH SKYROCKETING PREMIUMS UNDER
THE BROKEN STA
FINANCE CHAIRMAN, THE SENAT
FROM MONTANA, C
SENATE FLOOR THAT HEALTH CARE
REFORM IS FUNDAMENTALLY ABOUT
LOWERING HEALTH CARE COSTS
YEAH.
LOWERING COSTS IS WHAT HEALTH
CARE REFORM IS DESIGNED TO DO.
LOWERING COSTS.
BUT THEN HE SAID,
ACHIEVE THIS OBJECTIVE
EXCEPT IT WON'T.
C.B.O. SAYS IT
EXPECTS INSURANCE SPONSORED??
INSURANCE COSTS TO REMAIN
ROUGHLY IN LINE WITH QUO.
THAT IS A FAILURE UNDER THIS
BILL.
MEANWHILE FIXING THE INDIVIDUAL
MARKET I
AND UNSTABLE LARGELY BECAUSE IT
DOES NOT ENJOY THE FAVORABLE TAX
TREATMENT GIVEN TO YO JOB-BAS
COVERAGE.
IF YOU'RE BUYING INSURANCE ON
YOUR OWN, YOU'RE NOT GETTING A
TAX BREAK, IF A COMPANY BUYS
INSURANCE FOR THE PEOPLE WHO
WORK FOR THEM, THEY GET BREAK.
IN MY 10 STEPS TO SOLVE HEALTH
CARE, I MENTIONED AND WORKED ON
MAKING THAT FAIR.
YOU'VE GOT TO BE FAIR FOR BOTH
SIDES.
THE
FAIR FOR BOTH SIDES.
THIS BILL DOESN'T MAKE IT FAIR
FOR BOTH SIDES.
NOW
THE INDIVIDUAL MARKET AND THAT
IS EXPENSIVE AND IT'S LARGELY
UNSTABLE, AS I'LL SAY AGAIN, BUT
IT'S DUE TO THE FAVORABLE TAX
TREATMENT GIVEN TO JOB-BASED
COVERAGE, WHICH IS SUPPOSED TO
BE THE PURPOSE OF REFORM.
C.B.O. CONFIRMS THAT NEW
COVERAGE MANDATES WILL PROVIDE
PREMIUMS HIGHER.
DEMOCRATS ARE DECLARING VICTORY,
AND THAT THE CLAIMS DON'T COUNT
BECAUSE THEY'RE OFFSET BY NEW
GOVERNMENT SUBSIDIES.
57% OF THE PEOPLE WHO BUY
INSURANCE THROUGH THE BILL'S NEW
EXCHANGES THAT WILL SUB PLANT
TODAY'S MARKET WILL REQUIRE
SUBSIDIES THAT REQUIRE
TWO-THIRDS OF THE TOTAL PREMIUM.
THE BILL WILL INCREASE THE
COSTS, BUT DISGUISE THE COSTS.
HIGHER COSTS CAN BE CONJURED
AWAY BECAUSE THEY'RE SUDDENLY ON
THE GOVERNMENT BALANCE SHEET.
THE REID BILL HAS $371.9 BILLION
IN NEW HEALTH TAXES THAT
APPARENTLY ARE NOT A NEW COST
BECAUSE THEY CAN BE PASSED ALONG
TO CONSUMERS.
OR PERHAPS WILL BE HIDDEN IN LOST WAGES.
THIS IS THE PALIO-LIBERAL SCHOOL
OF BRUTE WEALTH, AWAY FROM THE
REPEATED WHITE HOUSE CLAIMS THAT
REFORM IS ALL ABOUT BENDING THE
COST CURVE.
THE ONLY THING BENT HERE IS THE
BUDGET TRUTH.
MOREOVER C.B.O. IS ALMOST
CERTAINLY UNDERESTIMATI THE
COST INCREASES BASED ON ITS
COUNTY-BY COUNTY ACTUARIAL DATA
THE INSURER WELLPOINT HAS
CALCULATED THAT THIS BILL WOULD
CAUSE SOME PREMIUMS TO TRIPLE IN
THE INDIVIDUAL MARKET.
I DON'T GO BY WELLPOINT.
I GO BY WHAT I FOUND OUT IN
WYOMING ITSELF.
AND THAT
PARTICULARLY FOR THE YOUNG
PEOPLE IN OUR
THOSE WHO ARE YOUNG AND HEALTHY
WILL SEE 300% INCREASE.
I THINK THEY' GOING TO NOTICE
THAT.
I DON'T THINK THEY'RE GOING TO
BE HAPPY WITH IT.
OTHER ASSOCIATIONS HAVE COME TO
SIMILAR CON
AND THE REASON FOR THAT IS THE
COMMUNITY RATING, WHICH FORCES
INSURERS TO CHARGE NEARLY
UNIFORM RATES REGARDLESS OF
CUSTOMER HEALTH STATUS OR HABITS.
HABITS IS AN IMPORTANT ONE ON
THAT.
C.B.O. DOESN'T THINK THIS WILL
HAVE MUCH OF AN EFFECT, BUT
COSTS INEVITABLY RISE WHEN
INSUREINSURERS ARE NOT ABLE TO PRICE
BASED ON RISK.
THAT'S WHY TODAY SOME 35 STATES
IMPOSE NO LIMITS ON PREMIUM
VARIATION AN SIX ALLOWED WIDE
DIFFERENCES AMONG CONSUMERS.
NOW, THAT'S NOT JUST WELLPOINT
THAT'S SAYING THAT.
I HAVE SOME PEER-REVIEWED
DOCUMENTS THAT ALSO SHOW THAT
SAME THING FROM PEOPLE FROM
DIFFERENT COLLEGES.
THEY HAVE FOUND THAT STATE
COMMUNITY RATING LAWS RAISED
PREMIUMS IN THE INDIVIDUAL
MARKET BY 21% TO 33% FOR FAMILIES.
AND 10% TO 17% FOR SINGLES.
IN NEW JERSEY, WHICHLSO
REQUIRES INSURERS TO ACCEPT ALL
COMERS, SO-CALLED GUARANTEED
ISSUE, PREMIUMS INCREASED BY AS
MUCH AS 227%. LET'S SEE.
WE JUST HAD SOME ELECTIONS IN
NEW JERSEY AND THINGS DIDN'T GO
WELL THERE.
PROBABLYASN'T JUST TYPE TWO INSURANCE COST.
THERE ARE PLENTY OF ALTERNATIVE
THAT'S REALLY WOULD REDUCE THE
COST OF INSURANCE.
NOW ACCORDING TO C.B.O.
IS ACCORDING TO CONGRESSIONAL
BUDGET OFFICE, WHICH WE QUOTE A
LOT, THEY DID A AN
THE RELATIVELY MODEST HOUSE
G.O.P. BILL.
THE REPUBLICANS IN THE HOUSE,
THEY WERE LIMITED TO JUST AN AMENDMENT.
THERE WERE THREE AMENDMENTS
TOTAL IN A ONE-DAY DEBATE AND
PASSAGE OF THE HEALTH CARE BILL OVER THERE.
THAT ROWED A LOT OF -- ROUSED A
LOT
IF YOU ONLY GET ONE AMENDMENT,
THEY AVOIDED WHAT WE'VE DONE.
WE HAVE FOUR DIFFERENT BILLS OUT
THERE THAT SOLVES WHAT THE
PRESIDENT SAID HE WANTED SOLVED,
AND THAT DOESN'T INCLUDE THE
WYDEN-BENNETT BILL THAT THE
PRESIDENT ALSO SAID THAT HE
WANTED, THAT'S NOT INCLUDED IN THIS BILL.
THE HOUSE PUT TOGETHER, IT IS
RELATIVELY MODEST.
IT WOULD REDUCE PREMIUMS
TO 8% IN THE INDIVIDUAL MARKET
IN 2016 AND 20% -- 10%
BUSINESSES.
THE G.O.P. REFORMS WOULD DO SO
WITHOUT IMPOSING HUGE NEW TAXES.
WE'VE CONCENTRATED THE LAST FEW
DAYS TALKING
MONEY THAT'S BEING STOLEN TO
PROVIDE FOR THE CHANGES.
WE HAVEN'T TALKED YET ABOUT THE
EXTRA TAXES THAT ARE GOING
PUT INTO PLACE.
THAT'S THE OTHER HALF OF THE
PACKAGE.
BUT
BECAUSE THIS BILL, THEY SAY, IS
REALLY ABOUT LOWERING COSTS.
NO, IT'S ABOUT PUTTING
WASHINGTON IN CHARGE OF HEALTH
INSURANCE AT
I SEE THAT THE SENATOR FROM
WYOMING IS HERE AND WE HAVE 10
MINUTES REMAINING ON OUR TIME IF
THE SENATOR WOULD LIKE TO MAKE
SOME ADDITIONAL COMMENTS.
HE AND I HAVE BEEN TRAVELING
WYOMING AND HEARING THE COMMENTS
FROM OUR PEOPLE.
THE PRESIDING OFFICER: 7 1/2
MINUTES.
MR. ENZI: 7 1/2 MINUTES.
I'LL YIELD THE TIME TO MY
COLLEAGUE.
THE PRESIDING OFFICER: THE
SENATOR FROM WYOMING IS RECOGNIZED.
MR. BARR MUCH, MR. PRESIDENT.
I WOULD ACTUALLY ASK MY
COLLEAGUEROM WYOMING, WHO I
HAVE THE PRIVILEGE OF SERVING
WITH, BECAUSE I SAW A -- A STORY
TODAY, A LARGE STORY, I"U.S.A.
TODAY", AND THIS STORY SAYS,
"SENATE KEEPS MEDICARE CUTIN
THE BILL."
THIS IS GOING TO CONTINUE.
AND WHAT IT SAID
DEMOCRATS CLOSED RANKS THURSDAY
BEHIND $460 BILLION IN
POLITICALLY RISKY MEDICARE CUTS
AT THE HEART OF HEALTH CARE LEGISLATION."
IT GOES ON TO SAY, "APPROVAL
WOULD HAVE STRIPPED OUT MONEY TO
PAY FOR EXPANDING COVERAGE FOR
MILLIONS TO TENS OF MILLIONS OF
UNINSURED AMERICANS."
SO I READ THIS AND IT SAYS THAT
THE REPUBLICANS TRIED TO KEEP
THE MEDICARE MONEY FOR PEOPLE ON
MEDICARE, BUT THE DEMOCRATS WANT
TO TAKE $460 BIION AWAY FROM
SENIORS WHO DEPEND UPON MEDICARE
AND USE IT TO START A WHOLE NEW GOVERNMENT PROGRAM.
AM I READING THIS CORRECTLY?
MR. ENZI: THAT'S THE WAY I READ IT.
THAT'S THE WAY THAT THE PEOPLE
IN WYOMING ARE READING IT.
AND THAT'S
PEOPLE ALL OVER THE COUNTRY ARE READING.
PARTICULARLY SENIORS.
IT'S THE SENIORS THAT ARE REALLY
UPSET ABOUT WHAT'S HAPPENING.
AND IT'S EASY TO SEE WHY.
EVEN THOUGH
THIS IS -- THIS IS GOOD BILL,
THEY'RE SAYING, WAIT A MINUTE.
NOW, WAIT A MINUTE.
I KNOW PEOPLE IN THE NURSING
HOME AND I KNOW PEOPLE -- I
REMEMBER -- SOME OF THEM ARE
SAYING, I'M IN A NURSING HOME.
I HEAR WHAT'S GOING TO HAPPEN TO
MY NURSING HOME IF THESE CUTS GO
INTO PLACE?
AS I SAID CONTINUALLY, WE CAN
CA
BUT THE SENIORS ARE SAYING,
THOSE ARE CUTS.
THOSE ARE CUTS IN MY BENEFITS.
THOSE ARE CUTS IN WHAT I EXPECT.
AND THAT'S
BEEN GETTING
SO WHETHER YOU CALL IT
GUARANTEED BENEFITS OR JUST
PLAIN OLD BENEFITS, OR WHATEVER
IT IS, THEY'RE SAYING, YEAH,
WE'RE BEING CUT.
MR. BARRASSO: MR. PRESIDENT, I
WOULD SAY THAT WHEN MY COLLEAGUE
FROM WYOMING AND I HELD TOWN
HALL MEETINGS AROUND THE STATE
OF WYOMING, PEOPLE SAID, DON'T
CUT OUR MEDICARE.
BUT YOU KNOW WHAT?
I SEE THIS BILL CUTTING OUR
MEDICARE AND SPECIFICALLY RIGHT
NOW THERE ARE THOUSANDS AND
THOUSANDS OF PEOPLE IN WYOMING
WHO ARE ON A PROGRAM CALLED
MEDICARE ADVANTAGE.
AND THE
PROGRAM AND THAT'S WHY SO MANY
AMERICANS HAVE SIGNED UP FOR THE
PROGRAM.
AS A MATTER OF FACT ABOUT ONE IN
FOUR AMERICANS WHO DEPEND UPON
MEDICARE FOR THEIR HEALTH CARE
IN THIS COUNTRY HAVE CHOSEN
MEDICARE ADVANTAGE BECAUSE
THERE'S SOME ADVANTAGES OF BEING
IN THIS PROGRAM CALLED MEDICARE
ADVANTAGE.
DENTAL VISION, HEARING, FITNESS.
ALSO AS A PRACTICING DOCTOR FOR
25 YEARS TAKING CARE OF FAMILIES
IN WYOMING, WHAT I SAW PEOPLE IN
WYOMING, THE REASON THEY LIKED
THIS IF THEY WERE ON MEDICARE,
BECAUSE IT DEALT WITH PREVENTION
AND IT HELPED COORDINATE CARE.
ONE OF THE THINGS THAT MEDICARE
DOESN'T DO AS WELL IS REALLY
COORDINATE CARE AND WORK WITH PREVENTION.
WELL, WE KNOW HOW IMPORTANT
PREVENTION IS IN HELPING PEOPLE
KEEP DOWN THE COST OF THEIR
CARE, HOW LONG -- HOW GOOD IT IS
IN TERMS OF GIVING PEOPLE
OPPORTUNITIES TO STAY HEALTHY.
I MEANS THAT WHY THEY CALL IT
PREVENTION.
WELL, THE -- THEILL IN FRONT
OF US, AS I SEE, AND I ASK MY
SENATE COLLEAGUE FROM WYOMING,
TO ME THIS IS A BILL THAT'S
GOING TO CUT $120 BILLION FROM
MEDICARE ADVANTAGE, THE PROGRAM
THAT THE PEOPLE IN OUR STATE LIKE.
MR. ENZI: MR.
SENATOR FROM WYOMING IS
ABSOLUTELY CORRECT.
AND WE'RE GETTING A LOT OF
CALLS, E-MAILS, AND LETTERS
ABOUT THAT.
ANOTHER -- ANOTHER THING THAT
THE PRESIDENT PROMISED, OF
COURSE, IS THAT EVERYBODY WOULD
HAVE CATASTROPHIC COVERAGE.
IT KIND OF FASCINATES ME THAT
THE WYOMING PEOPLE AND THE
PEOPLE ACROSS THE COUNTRY HAVE
FIGURED OUT THAT MEDICARE
DOESN'T HAVE CATASTROPHIC COVERAGE.
BUT MEDICARE ADVANTAGE PROVIDES
CATASTROPHIC COVERAGE AS WELL AS
A NUMBER OF OTHER THINGS THAT
MEDICARE DOESN'T COVER.
AND I THINK THEY REALIZE TOO
THAT IF
AWAY, YES, THEY CAN GET MEDIGAP,
BUT IT IS MORE EXPENSIVE AND
IT'S ALSO INTERESTING THAT THE
AARP SELLS MEDI-GAP.
MR. BARRASSO: I HEARD SOMEBODY
SAID THAT MEDICARE ADVANTAGE
ISN'T REALLY -- ISN'T REALLY
MEDICARE.
BUT IF YOU JUST TURN TO THE
CENTERS FOR MEDICARE AND
MEDICAID SERVICES 20 OFFICIAL
GOVERNMENT HANDBOOK -- YOU KNOW,
WE'RE GOING TO GO INTO 2010 IN
JUST NEXT MONTH, IF YOU GO TO
THE OFFICIAL HANDBOOK IN THE --
IT IS CALLED "MEDICARE AND YOU."
IT SAYS THAT A MEDICARE
ADVANTAGE PLAN IS ANOTHER HEALTH
COVERAGE CHOICE YOU MAY HAVE AS
PART OF MEDICARE.
IT'S A CHOICE YOU MAY HAVE AS
PART OF MEDICARE AND PEOPLE WHO
ACTUALLY LOOK AT THIS, THEY
CHOOSE THIS.
THEY MAKE THE CHOICE BECAUSE
THEY SAY, HEY, THIS IS A GOOD
DEAL FOR ME.
AN
THEY WANT TO GET VALUE FOR THEIR
MONEY.
A RECENT POLL SAID IN TERMS OF
AMERICANS WHEN THEY SEND MONEY
TO CONGRESS, HOW MUCH OF THAT DO
THEY GET IN VALUE?
THEY THINK ABOUT 50 CENTS ON THE
DOLLAR.
THAT'S A NATIONAL GALLUP POLL.
A GALLUP POLL ON THIS FOR A
LONG, LONG TIME, AND IT IS THE
HIGHEST NUMBER EVER OF WHAT
AMERICANS THINK IN TERMS OF THE
FACT THAT THEY'RE GETTING VERY
LITTLE VALUE FOR THEIR TAX
CONSIDER FOR THEIR TAX DOLLARS.
THEY SEE GAMES BEING PLAYED.
AND THAT'S WHAT I HEAR WHEN I
HAVE TELEPHONE TOWN HALL
MEETINGS IN WYOMING.
THEY KNOW THAT SENATOR REID'S
BILL STEALS $464 BILLION FROM
MEDICARE.
THEY KNOW THAT IT RAIDS THE
HEALTH CARE PROGRAM THAT THEY
DEPEND UPON.
NOT TO MAKE MEDICARE STRONGER,
KNOTS TO MAKE MEDICARE MORE
SOLVENT, BUT, AS MY COLLEAGUE
FROM WYOMING TELLS ME, TO CREATE
A BRAND-NEW ENTITLEMENT PROGRAM.
THEY ARE RAIDING MEDICARE TO
START ANOTHER GOVERNMENT PROGRAM
THAT IS -- THAT ITSELF IS GOING
TO BE INSOLVENT.
AND SO I ASK MY COLLEUE FROM
WYOMING, ARE YOU SEEING WHAT I'M
SEEING?
MR. ENZI: I'M SEEING.
I'M NOTICING THAT SOME PEOPLE
DON'T KNOW WHAT AN E
ACTUALLY IS.
THAT'S A BILL
FOREVER THAT THE SECRETARY OF
HEALTH AND HUMAN SERVICES HAS TO
MAKE SURE GETS PAID IN
PERPETUITY UNLESS THERE IS SOME
OTHER MAJOR CONGRESSIONAL ACTION
THAT HAPPENS.
WE KEEP PAYING THAT BILL OVER
AND OVER AND OVER AGAIN.
AND I THINK THE SENATOR FROM
WYOMING RECOGNIZES ENTITLEMENTS
AND SOME OF THE DIFFICULTIES
THAT THERE ARE INVOLVED WITH
THAT.
MR. BARRASSO: WELL, IT'S INTERESTING, MR. PRESIDENT,
BECAUSE AN ARTICLE IN BLOOMBERG
YESTERDAY SAID THAT THE KAISER
FAMILY FOUNDATION POLL RELEASED
THIS PAST MONTH FOUND THAT 60%
OF SENIORS SAID THAT THEY'D BE
BETTER OFF -- 60% OF SENIORS
SAID THEY'D BE BETTER OFF IF
CONGRESS DID NOT CHANGE THE
HEALTH CARE SYSTEM.
JUST NOT CHANGE AT
WELL, WE KNOW WE NEED TO DO SOME CHANGES.
BUT THIS MASSIVE BILL, THIS
2,000-PAGE BILL THAT WEIGHS
20 POUNDS IS NOT THE RIGHT
CHANGE THAT WE NEED.
AND FOR OUR SENIORS, PEOPLE WHO
RELY ON MEDICARE FOR THEIR
HEALTH CARE, TO JUST ABSOLUTELY
RAID DZ 4-DZ 64 BILLION --
-- $6,464,000,000,000 FROM
MEDICARE, ALMOST A HALF TRILLION
DOLLARS, THE BABY BOOMERS, MORE
AND MORE ADDED TO THE MEDICARE
ROLLS EVERY DAY, TO RAID THIS
PROGRAM TO START A NEW PROGRAM
IS NOT RIGHT PRESCRIPTION FOR
AMERICA.
IT'S NOT WHAT OUR SENIORS WANT.
IT'S NOT WHAT THEY SIGNED UP FOR.
IT'S NOT WHY THEY'RE CHOOSING
MEDICARE ADVANTAGE.
IT'S BECAUSE IT'S A CHOICE THAT
THEY MAKE AND THAT'S WHY WE
RIGHT NOW HAVE 11 MILLION
AMERICANS WHO ARE ON MEDICARE ADVANTAGE.
WE HAVE 11 MILLION SENIORS.
THAT REPRESENTS ALMOST
ONE-QUARTER OF ALL MEDICARE
PATIENTS IN TH COUNTRY.
MR. ENZI: WE'RE BEING NOTIFIED
WE'LL CONTINUE THIS AT A LATER
TIME.
AND I HAVE SEVERAL LETTERS FROM
WYOMING ORGANIZATIONS THAT WANT
TO BE PUT IN THE RECORD, TOO.
WE'LL DO THAT AT A LATER TIME.
I THANK THE PRESIDENT AND I
YIELD THE FLOOR.
MR. DODD: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM CONNECTICUT IS
RECOGNIZED.
MOMENTS AGO, I STARTED TO
DESCRIBE AN AMENDMENT THAT WOULD
BE OFFERED BY OUR COLLEAGUE FROM
RHODE ISLAND, SENATOR
WHITEHOUSE, REGARDING THE CLASS ACT.
LET ME TAKE A MOMENT OR SO.
FIRST OF ALL, A LITTLE BIT OF BACKGROUND.
THE CLASS ACT IS A PROPOSAL THAT
WAS ORIGINALLY CONCEIVED BY OUR
FORMER COLLEAGUE AND DEAR FRIEND
TED KENNEDY OF MASSACHUSETTS
YEARS AGO.
THE IDEA BEHIND IT BEING WE
OUGHT TO TRY TO FIGURE OUT A WAY
TO SUPPORT PEOPLE IN THIS
COUNTRY WHO END UP WITH
DISABILITIES, BUT THEIR
STABILITIES ARE NOT SO DRAMATIC
THAT IT WOULD DEPRIVE THEM OF
THE OPPORTUNITY OF CONTINUING
WORK, BUT ARE SERIOUS ENOUGH
THAT THEY WOULD REQUI
ADDITIONAL HELP IN ORDER TO
PROVIDE BASIC STANDARDS OF
LIVING CONDITIONS, EITHER A
DRIVER OR SOME HELP ON FOOD
ASSISTANCE, WHATEVER IT MA BE.
D SO THE IDEA WAS BECAUSE
UNDER PRESENT DISABILITY
FORMULAS WHICH ARE BASIC
INCOME REPLACEMENT BIL, THAT
IN ORDER TO GET SOME HEL
YOU'RE DISABLED, YOU ALMOST HAVE
TO GO THROUGH AND IMPOVERISH
YOURSELF TO QUALIFY FOR THEM AND
THEN BE RESTRAINED BY HOW MUCH
YOU CAN ACTUALLY EARN OUTSIDE IF
SO WHILE IT HAS BEEN A GOOD
PROGRAM, IT'S CERTAINLY HELPED A
LOT OF PEOPLE, IN
ARE CATCH-22'S IN IT, IN THE
SENSE THAT TO QUALIFY FOR IT,
YOU HAVE TO DIVEST WHATEVER YOU
HAVE ACQUIRED OR EARNED TO
IMPOVESH YOURSELF TO QUALIFY
FOR IT.
AND THEN EVEN THOUGH YOU MAY BE
CAPABLE OF CONTINUING TO
YOU'RE LIMITED ON HOW MUCH YOU
CAN ACTUALLY EARN UNDER THOSE PROGRAMS.
AND SO IT WAS THE VISION OF
SENATOR TEND YEARS AGO TO TRY TO
COME UP WITH A DIFFERENT IDEA
NOT TO REPLACE THAT BUT AN IDEA
THAT MIGHT ALLOW FOR
E DISABLED TO BE ABLE TO GET
SOME HELP DURING THAT PERIOD OF
DISABILITY, HOWEVER LONG IT
MIGHT LAST, WITHOUT NECESSARILY
HAVING TO THEN IMPOVERISH
YOURSELF
OUTSIDE EARNINGS, GIVEN THE FACT
THAT YOU MAY BE ABLE TO CONTINUE
TO PERFORM AND IN FACT WOULD
SO THE I
THIS, PARTICULARLY IN LIGHT OF
THE FACT THAT YOU DON'T WANT TO
NECESSARILY BE ADDING A COST TO
TAXPAYERS, AND SO IT WAS HIS
IDEA TO COME UP
VOLUNTARY PROGRAM, TOTALLY VOLUNTARY THAT INDIVIDUALS WOULD
HAVE TO CONTRIBUTE TO -- OUT OF
THEIR OWN POCKETBOOKS, NOT OUT
OF THE TAXPAYERS' POCKETBOOKS,
BY PUTTING ASIDE RESOURCES ON
MONTHLY BASIS OVER A PERIOD OF
YEARS -- FIVE IN THE CASE OF
THIS BILL -- WHERE THE PLAN
WOULD BECOME VESTED IN A SENSE,
AND THEN TO CONTRIBUTE THAT
AMOUNT THEREAFTER, AND THEN IN
SUCH CASE AS
DISABLED AND THEIR CRITERIA THAT
WOULD DETERMINE WHETHER OR NOT
YOU'VE MET
WOULD THEN QUALIFY BASED UPON
THE FACT THAT YOU PAID INTO THIS
PROGRAM CONTINUOUSLY WITHOUT
EXCEPTION OF YOUR OWN MONEY TO
RECEIVE AS MUCH
PROVIDING ASSISTANCE TO YOU SO
THAT YOU MIGHT GET
ABLE TO CONTINUE TO OPERATE
WITHOUT HAVING TO IMPOVERISH
YOURSELF OR PUT LIMITATIONS ON
YOUR WORK.
AND THAT WOULD PROVIDE AS MUCH
AS AROUND $18,000 TO $20,000 A
YEAR FOR THOSE INDIVIDUALS WHO
NE IT.
BUT AGAIN, ENTIRELY VOLUNTARY
YOUR MONEY, NO PUBLIC MONEY, NO
TAXPAYER MONEY GOES INTO THE
PLAN.
FIVE MILLION PEO
MR. PRESIDENT, UNDER THE AGE OF
65 LIVING IN THE COMMUNITY HAVE
LONG-TERM CARE NEEDS.
AND OVER 70,000 WORKERS WITH
SEVERE DISABILITIES IN THE
NATION TODAY WHO NEED DAILY
ASSISTANCE TO MAINTAIN THEIR
JOBS AND
LONG-TERM CARE SUPPORT AND
SERVICES ARE AN AREA THAT IS NOT
CURRENTLY AFFORDABLE OR
ACCESSIBLE FOR MILLIONS OF OUR
FELLOW CITIZENS.
IT IS ESTIMATED THAT 65% OF ALL
THOSE WHO ARE 65 TODAY
WILL SPEND SOME TIME AT HOME IN
NEED OF LONG-TERM CARE SERVICES
WHICH COSTS CAN RUN ROUGHLY
AROUND $18,000 A YEAR.
1.5 MILLION PEOPLE TODAY ARE IN
NURSING HOMES AND ROUGHLY NINE
MILLION OF OUR FELLOW ELDERLY
AMERICANS WILL NEED HELP WITH
ACTIVIES OF DAILY LIVING
DURING THE CURRENT
BY THE YEAR 2030, MR. PRESIDENT,
THAT NUMBER WILL INCREASE TO
14 MILLION, AS WE WATCH
BOOM POPULATION AND THEREAFTER,
ALONG WITH THE QUALITY OF CARE
AND LONGEVITY TABLES EXTENDING
THE LIFE OF INDIVIDUALS, AND
WHILE THAT LIFE WILL BE EXTENDED
AND HOPEFULLY THE QUALITY
IMPROVE, WE ALL ACCEPT THE
NOTION THAT AS WE GET OLDER, WE
HAVE GREER NEEDS PHYSICALLY,
AND THAT CERTAINLY IS SOMETHING
ANYONE OVER THE AGE OF 65 CAN
TELL YOU.
AND SO AS THE YEARS PROGRESS,
THE QUALITY OF CARE, LONGEVITY
TABLES
PEOPLE WHO WILL NEED SOME FORM
OF SERVICES OR ANOTHER WILL JUMP
FROM NINE MILLION TODAY TO
ROUGHLY 14 MILLION.
AND THOSE NUMBERS ARE APT TO
INCREASE.
MANY PEOPLE THAT NEED LONG-TERM
SERVICES,
SUPPORT RELY ON UNPAID FAMILY
AND FRIENDS TO PROVIDE THAT
CARE.
THEY'VE GOT
GRANDCHILDREN WHO ARE AROUND TO
PROVIDE THAT KIND OF ASSISTANCE.
A LOT CAN, OF COURSE.
BUT ULTIMATELY, MANY OF THESE
INDIVIDUALS WILL HAVE TO IMUPON
ISSUE THEMSELVES TO QUALIFY FOR MEDICAID.
YOU KNOW WHAT HAPPENS?
THEY TRANSFER THE HOUSE, THEY
TRANSFER THEIR ASSETS, THEY LOVE
EVERYTHING OVER TO THE
CHILDREN OR SOMEPLACE ELSE SO
THAT THEY QUALIFY FOR THAT TITLE
THEY BECOME
LEAST ON PAPER SO THEY CAN THEN
QUALIFY FOR THAT ASSISTANCE.
MEDICAID WHICH REMAINS THE
PRIMARY PAYER FOR THESE SERVICES.
THE CLASS ACT IS DESIGNED TO
AVOID THAT.
IT CAN IN AS MANY CASES AS
POSSIBLE BY PROVIDING A LIFETIME
CASH BENEFIT, VOLUNTARY, TOTALLY
PAID FOR BY
OFFERS SENIORS AND PEOPLE WITH
DISABILITIES SOME PROTECTION
AGAINST THE COSTS OF PAYING FOR
LONG-TERM CARE SERVICES AND
SUPPORTS AND HELP THEM OBTAIN
SERVICES AND SUPPORTS THAT WILL
ENABLE THEM TO REMAIN IN THEIR
HOMES, RESIDE IN THEIR
COMMUNITIES, AND IN MANY CASES
CONTINUE TO
LET ME TELL YOU HOW THE PROGRAM
WORKS.
CLASS -- THE PGRAM IS
VOLUNTARY, TOTALLY VOLUNTARY,
SELF-FUNDED INSURANCE PROGRAM
WITH ENROLLMENT FOR PEOPLE WHO
ARE CURRENTLY EMPLOYED.
AFFORDABLE PREMIUMS WILL BE PAID
THROUGH PAYROLL DEDUCTIONS IF
THE INDIVIDUAL'S EMPLOYER
DECIDES TO PARTICIPATE IN THE PROGRAM.
TOTALLY VOLUNTARY.
NOTHING REQUIRED WHATSOEVER.
IF THE EMPLOYER DOESN'T WANT TO
HAVE TO FIND SOME OTHER WAY TO DO IT.
IF THE
IT TO BE A PAYROLL DEDUCTION,
THEY CAN DO THAT, PURELY VOLUNTARY.
PARTICIPATION BY WORKERS, AGAIN,
ENTIRELY VOLUNTARY.
SELFEMPLOYED PEOPLE OR THOSE
WHOSE EMPLOYERS DO NOT OFFER THE
BENEFIT WILL ALSO BE ABL TO
JOIN THIS PROGRAM THROUGH A
GOVERNMENT PAYMENT MECHANISM.
INDIVIDUALS QUALIFY TO
SELFBENEFITS WHEN THEY NEED HELP
WITH CERTAIN ACTIVITIES OFAILY
LIVING AND THEY HAVE PAID
PREMIUMS FOR AT LEAST FIVE YEARS
AND HAVE WORKED FOR AT LEAST
THREE OF THOSE FIVE YEARS.
BENEFICIARIERECEIVE LIFETIME
CASH BENEFITS BASED ON THE
DEGREE OF IMPAIRMENT EXPECTED TO
AVERAGE ROUGHLY $75 A DAY OR $27,000 A YEAR.
BENEFITS CAN BE USED TO MAINTAIN
INDEPENDENCE AT HOME OR IN THE
COMMUNITY AND SHOULD BE
SUFFICIENT TO COVER TYPICAL
COSTS OF HOME CARE SERVICES
ADULT DAYCARE.
BENEFITS CAN ALSO BE USED TO
OFFSET THE COSTS OF
LIVING AND HOME HEALTH
THE ISSUE IS RAISED ABOUT ARE WE
GOING TO BE PROTECTED UNDER THIS PROGRAM.
ALL CLASS ACT BENEFITS ARE PAID
BY VOLUNTARY PARTICIPANTS, NOT
TAXPAYERS.
THE CLASS ACT ACTUALLY WILL SAVE
TAXPAYER DOLLARS BY REDUCING
MEDICAID COSTS.
ACCORDING TO THE C.B.O., ALMOST
ALMOST $2 BILLION.
THE CLASS ACT PREMIUMS MUST BE
SET AT A LEVEL SUFFICIENT TO
GUARANTEE ACTUARIAL
THE PROGRAM.
WE THANK SENATOR GREGG OF NEW
HAMPSHIRE FOR REQUIRING THAT
AMENDMENT IN THE DEBATE OF THE
CLASS ACT BILL WHEN IT CAME UP
IN OUR COMMITTEE.
THE CURRENT CLASS ACT INCLUDES
SIGNIFICANT IMPROVEMENTS OVER
EARLIER VERSIONS SUCH AS
ELIGIBILITY STANDARDS, A NEW
RESERVE REQUIREMENT AND AN
ABSOLUTE PROHIBITION ON THE USE
OF TAXPAYER DOLLARS TO PAY
BENEFITS.
THE CONGRESSIONAL BUDGET OFFICE
DETERMINED THAT THE IMPROVED
PROGRAM IS TOTALLY ACTUARIALLY SOUND.
THIS BILL, THE
PROTECTION AND AFFORDABLE CARE
ACT, OUR OVERALL BILL, CREATES A
VOLUNTARY INS
UNDER THE PROGRAM, WORKING
PEOPLE PAY PREMIUMS, AS I SAID,
FOR AT LEAST FIVE YEARS BEFORE
IT WOULD VEST.
AFTER THAT POINT, IF THE
INDIVIDUAL WHO HAS PAID
FIVE YEARS AND WORKED FOR AT
LEAST THREE OFHOSE FIVE YEARS
DEVELOPS A DISABILITY, THEY CAN
RECEIVE A CASH BENEFIT OF NO
LESS THAN $50 A DAY, AS MUCH
AS $75, FOR AS LONG AS THAT
DISABILITY PERSISTS.
CONTRARY TO POPULAR BELIEF,
MR. PRESIDENT, MEDICARE AND MOST
PRIVATE HEALTH INSURANCE ONLY
PAY FOR LONG-TERM CARE FOR A
SHORT PERIOD OF TIME, MEANING
THAT MOST PEOPLEAY OUT OF
THEIR OWN INCOME OR ASSETS OR
THEIR FAMILY'S ASSETS TO PROVIDE
THESE KIND OF BENEFITS.
THOSE WITH THE
NEEDS WILL FREQUENTLY EXHAUST AS
I SAID A MOMENT AGO THESE ASSETS
THAT THEY HAVE TO RELY ON
MEDICAID.
THUS IMPOVERISHING THEMSELVES IN
ORDER TO
THE CLASS ACT PROVIDES ESSENTIAL
OPTIONS FOR 65% OF THOSE AGED 65
AND OLDER WHO NEED LONG-TERM
CARE SERVICES AT SOME POINT IN
THEIR LIVES AS I MENTIONED
EARLIER, AND FOR THE 70,000
WORKERS WITH SEVERE DISABILITY
IN THE NATION TODAY WHO NEED
DAILY ASSISTANCE TO MAINTAIN
THEIR JOBS AND THEIR
INDEPENDENCE.
OOZE I SAID, THE PROGRAM -- AS I
SAID, THE PROGRAM IS NOT -- IS
NOT FINANCIALLY STABLE.
IT AMOUNTS TO NOTHING MORE THAN
A PONZI SCHEME AS
CALLED IT.
SOME SAY THIS WILL CREATE A NEW
GOVERNMENT ENTITLEMENT PROGRAM.
IT IS NOT A GOVERNMENT ENTITLE
PROGRAM. ANYTHING BUT.
THE CLASS ACT DOES NOT INFER
RIGHTS OR OBLIG
GOVERNMENT FUNDING NOR DOES IT
AFFECT RECEIPT OF OR ELIGIBILITY
FOR OTHER BENEFITS.
THE PROGRAM STANDS ON ITS OWN
FINANCIAL FEET.
AS I SAID EARLIER, IT HAS BEEN
DETERMINED BY THE C.B.O. TO BE
ACTUARIALLY SOUND FOR THE NEXT 75 YEARS.
THE CLASS ACT IS SOLVENT
ACCORDING TO THE CONGRESSIONAL
BUDGET OFFICE AS I MENTIONED.
THE PROGRAM WOULD RUN ON ONLY
ITS OWN CASH FLOWS.
C.B.O. ESTIMATES THE AVERAGE
MONTHLY PREMIUM OF $123 FOR AN
AVERAGE DAILY CASH BENEFIT OF
OF $75 FOR THOSE WHO QLIFY.
IT MAY NOT SEEM LIKE MUCH, $75 A
DAY, BUT OVER A YEAR, THAT WOULD
PROVIDE NEEDED, NEEDED
ASSISTANCE FOR THOSE WHO HAVE
ACHIEVED OR SUFFER UNDER THOSE DISABILITIES.
C.B.O. USED A VERY CONSERVATIVE
PARTICIPATION RATE.
C.B.O. ASSUMES PARCIPATION
RATES THAT DO NOT CONSIDER CLASS
BUT OFFER A LIFETIME CASH BENEFIT.
ENDORSED BY THE GOVERNMENT AND
PROVIDE A CONVENIENT WAY FOR
EMPLOYEES TO AUTOENROLL THROUGH
THEIR EMPLOYERS WITH A VOLUNTARY OPTOUT.
ALL OF THESE
INCREASE PARTICIPATION RATES
WHICH RESULT IN LOWER PREMIUMS,
ENURAGE ENROLLMENT, AND MAKE
THE PROGRAM EVEN STRONGER FINANCIALLY.
THE SOLVENCY OF THE PROGRAM IS
BOLSTERED BY FLEXIBILITY TO
ADJUST THE PROGRAM.
IN THEIR NOVEMBER 25 LETTER TO
THE CONGRESS, THE C.B.O.
ACKNOWLEDGES THAT THE
LEGISLATION
THE HEALTH AND HUMAN SERVICES
SECRETARY TO ADJUST PREMIUMS AND
BENEFITS WHERE OR EVER NEEDED.
THIS PROVIDES A LEVER TO ENSURE
THAT THE PROGRAM STAYS SOLVENT
EVEN IF REAL LIFE DOES
PERFECTLY MIRROR THE MODELS OF
THE C.B.O., AS GOOD AS THEY ARE. THE CONGRE
DISCUSSES THE CLASS ACT WOULD
FUNCTION JUST LIKE ANY OTHER
PRIVATE LONG-TERM CARE INSURANCE
PROGRAM WHICH FINANCES
BENEFITS -- WHICH FINANCES
BENEFIT PAYMENTS FOR A PREMIUM
RESERVE AND INTEREST INCOME OFF
THAT RESERVE.
DUE TO BUDGET SCOREKEEPING, THE
CONGRESSIONAL BUDGET OFFICE
FINDS THAT PREMIUM REVENUE
EXCEEDS BENEFIT PAYMENTS IN THE
THIRD DECADE BUT DOES NOT TAKE
INTO CONSIDERATION ACCUMULATED
RESERVES AND INCOME OFF THOSE
RESERVES THAT KEEP THE PROGRAM
FISCALLY INDEPENDENT.
BEYOND BEING SELFSUPPORTING AND
VOLUNTARY, MR. PRE
PROGRAM CAN ACTUALLY GENERATE
SAVINGS IN MEDICAID.
DIRECT OFFSET OF THE $75 DAILY
BENEFIT IS APPLIED TOWARD ANY
MEDICAID LONG-TERM CARE COSTS.
BEYOND THAT, THE CLASS ACT
PROGRAM WILL HELP PEOPLE LIVE
INDEPENDENTLY AT HOME OR IN
THEIR COMMUNITY, AND WHEN PEOPLE
WITH DISABILITIES GET THE
SERVICES THEY NEED, THEY ARE
LESS LIKELY TO SND DOWN TO GET
MEDICA
ENTER A NURSING HOME OR
HOSPITAL, ALL OF WHICH GENERATE
ADDITION
AND, OF COURSE, WHAT WE DON'T
CALCULATE HERE -- BECAUSE I
DON'T KNOW HOW YOU WOULD
CALCULATE IT -- IS THAT
OF INDEPENDENCE.
I SUSPECT MAYBE ALL OF US KNOW
PEOPLE WHO ARE ON MEDICAID, AND
TH FRUSTRATION PARTICULARLY F
SOMEONE WHO IS OTHERWISE HLTHY
BUT SUFFERS
THEY WOULD LIKE TO WORK AND WANT
TO KEEP INDEPENDENT, AND YET IF
YOU GO TO THE MEDICAID PROGRAM,
THERE ARE HUGE RESTRAINTS ON
YOUR ABILITY TO DO SO.
AND SO BY THIS PROGRAM, ASIDE
FROM FINANCIALLY REDUCING
MEDICAID COSTS, WE'RE
ACTUALLY -- WE'RE ACTUALLY
PROVIDING THAT ADDITIONAL SENSE
OF HUMAN DIGNITY AND DECENCY,
THAT JUST BECAUSE YOU HAVE A
DISABILITY AND YOU NEED HELP
DOESN'T MEAN YOU DON'T WANT TO
BE SELF-SUFFICIENT AND KEEP WORKING.
YOU HAVE THE GRATIFICATION OF
KNOWING YOU'RE CONTRIBUTING IN
SOME WAY, OTHER THAN BEING
SHUTTERED AWAY, HAVING
IMPOVERISHED YOURSELF BY GETTING
RID OF ALL YOUR ASSETS, RELYING
ON FAMILY OR OTHERS TO TAKE CARE
OF YOU BECAUSE YOU DON'T HAVE
THOSE
THIS IDEA THAT SENATOR KENNEDY
GENERATED YEARS
BEEN IMPROVED I THINK BECAUSE OF
THE AMENDMENTS AND IDEAS THAT
HAVE BEEN SUGGESTED BY A NUMBER
OF OUR COL
AS OTHERS, WE
STRENGTHENED I THINK THE CONCEPT
TO GIVE IT THE KIND OF
FINANCIALLY
INDEPENDENCE THAT MEMBERS WANT
TO HAVE, SHELTERING THESE
DOLLARS AGAINST BEING USED FOR
OTHER PURPOSES SUCH AS GOING OFF
TO SOME OF THEIR PROGRAMS THAT
PEOPLE MAY HAVE A GREAT DESIRE
TO RESOURCES.
WE PROHIBIT THAT FROM HAPPENING.
IF EMPLOYERS DON'T WANT TO HAVE
A PAYROLL DEDUCTION, THEY DON'T
HAVE TO.
NO ONE IS REQUIRED TO JOIN THE
PROGRAM.
WE BELIEVE, THOUGH, THAT WHEN
MEMBER
SOCIETY SEE THE BENEFITS OF
GRAVITATE TO IT AS A WONDERFUL
WAY TO ENSURE AGAINST THAT
OF -- PROBABILITY THAT ALL OF US
FACE, AND THAT IS BECOMING
DISABLED, UNABLE TO WORK AS MUCH
AS WE LIKE, NEEDING ADDITIONAL
ASSISTANCE AND HELP, AND OF
COURSE HAVING VERY FEW PLACES TO
TURN TO GET IT.
NOW, T
OTHERS WHO SUPPORT THIS, 275
ORGANIZATIONS,
GROUPS, DISABILITY ORGANIZATIONS
ACROSS THIS COUNTRY.
I'M NOT GOING TO READ ALL OF
THEM HERE BECAUSE 275 NAMES IS A
LOT, MR. PRESIDENT.
BUT I HAVE THE LIST OF ALL 275
ORGANIZATIONS THAT HAVE STRONGLY
SUPPORTED THIS PROPOSAL.
I CAN'T THINK OF ANY FINER WAY
TO CELEBRATE THE MEMORY OF OUR
FORMER COLLEAGUE, WHO CARED SO
MUCH ABOUT THIS BILL THAT WE'RE
NOW ENGAGED IN DEBATING.
AND WHO BROUGHT THIS IDEA YEARS
AGO TO THE TABLE AND TO HAVE
CHAMPIONED IT FOR SO MANY YEARS.
TODAY WE HAVE A CHANCE TO
INCLUDE THIS WONDERFUL CONCEPT,
THIS CREATIVE, INNOVATIVE IDEA
INDEPENDENCE FOR PEOPLE, GIVES
THEM A CHANCE TO LEAD GOOD
LIVES, PROVIDES THE KIND OF
SUPPORT FOR THEIR FAMILIES WHO
OTHERWISE HAVE TO BEAR A LOT OF THAT
AND NONE OF US WANT YOUR
CHILDREN OR YOUR GRANDCHILDREN
TO HAVE T
THEY'RE TRYING TO RAISE THEIR
OWN FAMILIES.
SO HERE'S A LITTLE IDEA THAT HAS
GENERATED SUPPORT TOTALLY BY
VOLUNTARY CONTRIBUTIONS.
NO GOVERNMENT MONEY INVOLVED AT
ALL.
YOU GIVE PEOPLE A CHANCE TO HAVE
TO LIVE OUT THE REMAINING TIMES
OF THEIR LIVES WITH DECENCY AND
DIGNITY, THE SENSE OF MAKING A
CONTRIBUTION, DIFFERENCE?
ALL OF THOSE FACTORS,
PUT A DOLLAR AMOUNT ON IT FOR.
I CAN'T TELL YOU
FINANCIAL BENEFIT IS OF SOMEONE
GETTING UP IN THE MORNING,
GETTING A LITTLE HELP OR
OFF TO A JOB AND KNOWING THAT
YOU'RE NEEDED, YOU HAVE WORTH
AND VALUE AS A HUMAN BEING.
WHAT BENEFIT, WHAT'S THE DOLLAR
AMOUNT ON THAT?
I CAN'T TELL YOU, MR. PRESIDENT,
EXCEPT I KNOW IT HAS
OUR COUNTRY.
OR THE ALTERNATIVE, GETTING RID
OF ALL YOUR ASSETS, IMPOVERISHING YOURSELF,
ON THAT FAMILY OR FRIENDS TO
TAKE CARE OF YOU IN ORDER TO TRY
AND SURVIVE,
DOING MORE.
SO, MR. PRESIDENT, I HOPE THAT
MY COLLEAGUES WILL SUPPORT
WHITEHOUSE AMENDMENT WHEN IT'S
OFFERED TO STRENGTH THEN PROGRAM
AND THAT THEY WILL RESOUNDINGLY
DEFEAT THE EFFORT TO CUT THIS
PROGRAM OUT OF THE BILL
ALTOGETHER.
I CAN'T THINK OF A WORSE THING
WE COULD DO WITH A PIECE OF
LEGISLATION THAT'S DESIGNED TO
BE CREATIVE, INNOVATIVE, REDUCE
COSTS AND MAKE A DIFFERENT FOR
MILLIONS OF OUR FELLOW CITIZENS.
AND A GROWING NUMBER, AS IS
POINTED OUT BY THE YEAR
14 MILLION AMERICANS IN OUR
COUNTRY, AND I SUSPECT MORE,
WILL BE INEED OF SERVICES LIKE THIS.
I SEE MY COLLEAGUE AND
FROM IOWA WHO'S BEEN AS STRONG A
CHAMPION AS THIS CONGRESS HAS
EVER HAD WHEN IT COMES TO THE
DISABLED IN OUR COUNTRY, HAVING
BEEN THE AUTHOR OF THE AMERICANS
WITH DISABILITIES ACT, ALONG
WITH OTHERS, BUT NONETHELESS THE
PRINCIPAL ARCHITECT OF THAT EFFORT.
AND HE CAN SPEAK MORE ELOQUENTLY
THA
KNOWN ABOUT W THIS PROGRAM IS
IMPORT
WHAT IT MEANS.
SO, MR. PRESIDENT, I'D ASK
CONSENT THAT THE 275
ORGANIZATIONS
ENDORSE AND SUPPORT SENATOR
KENNEDY'S CLASS ACT BE INCLUDED
IN THE RECORD AT THIS JUNCTURE.
THE PRESIDING OFFICER: WITHOUT OBJECTION.
MR. DODD: AND I YIELD THE FLOOR.
MR. HARKIN: MR. PRESIDENT?
THE PRESIDING OFFICER: THE SENATOR FR
MR. HARKIN MR. PRESIDENT, I
WANT TO THANK MY FRIEND AND OUR
LEADER ON THIS ISSUE, SENATOR
DODD, FOR HIS ELOQUENCE IN
SUPPORTING WHAT SO MANY OF OUR
ELDERLY IN THIS COUNTRY WANT
MORE DESPERATELY THAN JUST ABOUT
ANYTHING ELSE AND THAT'S THE
PEACE OF MIND OF KNOWING THAT IF
THEY SHOULD BECOME DISABLED,
THAT THEY WON'T BE FORCED TO GO
INTO A NURSING HOME, THAT
THEY'LL HAVE SOME SUPPORT THAT
THEY'LL BE ABLE TO LIVE IN THEIR
HOMES AND IN THEIR COMMUNITIES.
TALK TO ANYONE WITH A
DISABILITY, NOT JUST ELDERLY,
ANYONE WITH A DISABILITY.
AND THEY'LL TELL YOU HOW
IMPORTANT IT IS THAT THEY HAVE
THAT KIND OF ASSURANCE, THAT IF,
GOD
DISABLED, THAT THEIR ONLY HOPE
IS TO GO INTO A NURSING HOME FOR
THE REST OF THEIR NATURAL LIVES.
SENATOR KENNEDY HAS WORKED ON
THIS FOR YEARS, AND THE COUPLE
OF TIMES THAT I TALKED TO HIM
THIS SUMMER AND THIS SPRING,
THIS IS WHAT HE WANTED TO TALK
TO ME ABOUT, ABOUT MAKING SURE
THAT WE INCLUDED THIS IN THE
BILL.
THIS WAS HIS CAUSE
THAT WE HAD A PROGRAM
PEOPLE COULD CONTRIBUTE TO, THAT
WOULD AFFORD THEM SOME SUPPORT
IF, IN FACT, THEY BECAME
NOW, I DON'T UNDERSTAND THE MOVE
BY MY REPUBLICAN FRIENDS TO
THIS IS NOT A MANDATORY PROGRAM.
THIS IDOETHIS DOES NOT FORCE ANYONE TO
PAY A DIME. IT'S ALL VOLUNTARY.
WE SAY, IF YOU WANT TO PUT
MONEY ASIDE DURING YOUR WORKING
YEARS IN A FUND
AND THAT IF IN CASE YOU BECOME
DISABLED YOU CAN GET SOME
SUPPORT, TO STAY AT HOME MAYBE
WITH YOUR OWN
ENOUGH SUPPO
GET ANOTHER JOB AND WORK, EVEN
THOUGH YOU HAVE A DISABILITY.
THIS IS VOLUNTARY.
I ASK MY FRIENDS ON THE OTHER
SIDE OF THE AISLE: WHY ARE YOU
AGAINST A VOLUNTARY PROGRAM
WILL ENABLE PEOPLE TO HAVE THAT
KIND OF PEACE OF MIND?
WELL, YOU
SAID, WELL, YOU KNOW, MAYBE THE
TAXPAY
THIS AND EVERYTHING.
WELL, MR. PRESIDENT,
YOU THIS, THAT IN THE COMMITTEE,
SENATOR
FROM NEW HAMPSHIRE, REPUBLICAN
SENATOR GREGG, MY GOOD FRIEND --
OFFERED AN AMENDMENT TO MAKE IT
SURE THAT THE CONTRIBUTIONS WERE
THE ONLY THING THA THAT WOULD STHEAN
PROGRASUSTAIN THIS PROGRAM,
WOULDN'T BECOME
HE SAID, "I OFFERED AN AMENDMENT
THAT WOULD REQUIRE THAT THE
PREMIUMS BE BASED ON A
ANNUAL ACTUARIAL ANALYSIS OF THE
PROGRAM'S COSTS.
MY AMENDMENT
WE DON'T PROMISE MORE THAN WE
CAN OFFER AND THAT IT WILL BE
FISCALLY SOLVENT AND WE WON'T BE
PASSING THE BUCK TO FUTURE GENERATIONS.
I'M PLEASED THE "HELP" COMMITTEE UNANIMOUSLY ACCEPTED THIS
AMENDMENT."
AND, MR. PRESIDENT, THE C.B.O.
HAS SCORED THIS.
THIS IS
75 YEARS.
OVER 75 YEARS.
I -- I DON'T UNDERSTAND WHY
ANYONE WOULD WANT TO STRIKE
NOW,HAT SENATOR WHITEHOUSE HAS
SAID -- AND, AGAIN, I THINK THIS
IS VERY APPROPRIATE FOR THIS --
THAT ANY SAVINGS THAT WE
FROM THIS BE REINVESTED EITHER
IN THE CLASS ACT SO THAT
PEOPLE DO GET DISABLED, MAYBE THEY'LL GET A LITTLE BIT MORE
MONEY
SO WE HAVE SOME SAVINGS FROM THE
CLASS ACT.
WHAT SENATOR W
IS PUT THOSE SAVINGS BACK IN THE
CLASS ACT FOR SOCIAL SECURITY.
MAKES SENSE TO ME.
SO AGAIN, I THINK IT'S AN
IMPROVEMENT ON THE BILL SENATOR WHITEHOUSE HAS
SUGGESTED.
MR. PRESIDENT, I PLEAD, I PLEAD
WITH MY FELLOW SENATORS, DON'T
KILL THIS PROGR
WE STOOD HERE ON THIS FLOOR 19
YEARS AGO, JULY THE 20th, 1990 1990.
WE STOOD ON THIS FLOOR TO PASS
THE AMERICANS WITH DISABILITIES
ACT.
AND THERE WERE A FEW VOTES
AGAINST IT.
IN FACT, THERE WAS ONE OR TWO
PEOPLE STILL HERE THAT VOTED
AGAINST IT
I THINK -- I THINK IF YOU'D ASK
THEM NOW, I THINK THEY'D SAY
IT'S BEEN A PRETTY DARN GOOD BILL.
IT'S BROKEN DOWN A LOT OF
BARRIERS, OPENED A LOT OF DOORS
FOR PEOPLE WITH DISABILITIES IN
OUR COUNTRY, CHANGED OUR
ENVIRONMENT IN THIS COUNTRY.
NOT ONLY IN TERMS OF PHYSICAL
ACCESS BUT I THINK MORE
IMPORTANTLY IT'S CHANGED HOW WE
VIEW PEOPLE WITH DISABILITIES.
NO LONGER LOOKING AT PEOPLE WITH
THEIR DISABILITY.
WE NOW LOOK AT PEOPL
WHAT ARE YOUR ABILITIES, WHAT
ARE YOUR ABILITIES, WHAT CAN YOU
DO, NOT JUST LOOKING AT
SOMEONE'S D
SO WE'VE COME A LONG
THE ONE THING THAT WE'VE NEVER
BEEN ABLE TO REALLY DO IS TO SET
UP A FUNCTIONING SYSTEM SO
THAT -- THAT PEOPLE
SOME MONEY ASIDE
IN CASE THEY GOT DISABLED. WELL, THIS IS IT.
THIS IS OUR CHANCE.
THIS IS A BIG PART OF THIS
HEALTH CARE BILL, A BIG
WELL, MAYBE I SUPPOSE IF
TRYING TO KILL
YOU'RE TRYING TO KILL THE BILL,
I SUPPOSE THAT'S WHAT YOU'D WANT
TO DO, YOU'D WANT TO KILL THE
CLASS ACT.
BUT THIS IS VITALLY IMPOR
OUR COUNTRY
IT IS REALLY THE NEXT LOGICAL
STEP AFTER THE AMERICANS WITH
DISABILITIES ACT
IT'S GOING TO PROVIDE FOR SO
MANY PEOPLE IN THIS COUNTRY THAT
SECURITY AND THAT PEACE OF MIND
OF KNOWING THEY WON'T HAVE TO GO
TO A NURSING HOME OR AN
INSTITUTION IF THEY -- IF THEY
BECOME DISABLED.
AND IT CAN HAPPEN TO ANY ONE OF
US HERE ON THE SENATE FLOOR.
OUR FAMIES, OUR STAFF, OUR
LOVED ONES.
NO ONE KNOWS WHAT MIGHT HAPPEN
TO US
NO ONE KNOWS.
BUT SHOULDN'T WE AT LEAST
SOME PART OF THIS HEALTH CARE
BILL THAT PROVIDES THAT KIND OF
VOLUNTARY PROGRAM?
NO ONE'S FORCED INTO ANYTHING.
AND I GUESS THAT'S WHAT
PERPLEXES ME MORE THAN ANYTHING
SE IS WHY MY REPUBLICAN
FRIENDS WANT TO PREVENT
SOMETHING LIKE A VOLUNTEER
PROGRAM -- A VOLUNTARY PROGRAM
FROM GOING INTO EXISTENCE THAT
WOULD DO THIS.
THAT'S FISCALLY SOUND FOR 75 YEARS.
I JUST DON'T GET IT.
SO I HOPE -- I HOPE WE WILL
SUPPORT THE WHITEHOUSE
AMENDMENT, MAKE SURE THAT THIS
FUND IS TOTALLY SOLVENT.
I THINK HE'S ON THE RIGHT TRACK.
IF THERE ARE SAVINGS, PUT THE
MAYB THAT $75 A DAY COULD BE
MAYBE $80 A DAY OR SOMETHING
LIKE THAT TO HELP PEOPLE OUT.
AND I SEE, MR. PRESIDENT, WE NOW
HAVE A STATEMENT FROM THE
ABOUT THE CLASS PROGRAM AND
HERE'S WHAT THEY SAID.
THEY SAID THAT DECADES OF
TALKING TO OUR MEMBERS TELL US
THAT OLD AMERICANS WANT TO
LIVE IN THEIR HOMES AS THEY AGE.
THAT'S WHY AARP STRONGLY
SUPPORTS THE COMMUNITY LIVING
ASSISTANCE SERVICES AND SUPPORTS
PROGRAM, THE CLASS PROGRAM,
WHICH RECOGNIZES THAT OLDER
INDIVIDUALS AND PEOPLE WITH
DISABILITIES SHOULD HAVE THE
RIGHT TO LIVE INDEPENDENTLY IN
THEIR OWN HOMES AND COMMUNITIES
AND TO R
NEED WITHOUT HAVING TO SPEND
DOWN TO POVERTY."
SO, MR. PRESIDENT, I WOULD ASK
UNANIMOUS CONSENT TO HAVE THAT
LETTER FROM THE AARP PRINTED AT
THIS POINT IN THE RECORD.
THE PRES
OBJECTION.
MR. HARKIN: NOW, MR. PRESIDENT,
I'M GOING TO PUT THIS IN
PERSONAL TERMS.
PERSONAL
I'VE TOLD THIS STORY BEFORE AND
I'M GOING TO TELL IT AGAIN.
BECAUSE I THINK IT INDICATES WHY
WE NEED A PROGRAM LIKE THIS.
I HAVE A NEPHEW, KELLY, MY
SISTER'S BOY.
HE GOT INJURED AT A VERY YOUN AGE.
HE WAS ONLY 19 YEARS OLD.
MADE HIM A SEVERE PARAPLEGIC,
ALMOST QUADRIPLEGIC.
MY SISTER AND HER HUSBAND, THEY
DIDN'T HAVE ANY MONEY AT ALL AND
YET KELLY WAS ABLE TO GO TO
COLLEGE, GO TO SCHOOL, HE WAS
ABLE TO GET A JOB, ABLE TO LIVE
IN A HOUSE BY HIMSELF, HAD HIS
OWN LITTLE HOME, HAD HIS OWN VAN
THAT HE DROVE THAT HAD A LIFT ON
IT AND HE COULD GET HIS
WHEELCHAIR IN THERE AND DRIVE IT
TO WORK.
ACTUALLY SRTED A SMALL
BUSINESS, EMPLOYED SOME PEOPLE
AND HE'S LIVED A FULL LIFE.
HE'S NOW A MAN OF ABOUT 50.
HE'S HAD A GREAT LIFE.
EVEN WITH THAT DISABILITY,
BEEN ABLE TO GET AROUND AND DO
THINGS, A TAXPAYER.
HE'S PAID TAXES.
HE HAD EMPLOYED PEOPLE.
-- HE'S EMPLOYED PEOPLE.
EVERY NIGHT WHEN HE GOES HOME,
HE HAS TO HAVE A NURSE COME IN
THE AND GET HIM READY FOR BED
AND DO HIS EXERCISES AND THINGS
LIKE THAT.
THEN IN THE MORNING HE HAS TO
HAVE ANOTHER NURSE COME IN AND
GET HIM OUT OF BED AND TAKE CARE
OF HIS NEEDS,
GO.
ACTUALLY, KELLY GETS HIS OWN
MEALS AND STUFF, THEN HE GOES
OFF TO WORK, COMES BACK.
THIS HAPPENS EVERY DAY.
NOW, HOW IS HE ABLE TO AFFORD TO
DO THAT?
HE DOESN'T ANY MONEY, ANY
INSURANCE.
HOW IS HE ABLE TO AFFORD TO DO THAT?
HE GOT INJURED IN THE MILITARY.
SO FOR ALL OF THESE YEARS THE
VETERANS ADMINISTRATION'S BEEN
PAYING FOR THIS.
IT'SEEN WONDERFUL.
KEPT HIM OUT OF AN INSTITUTION.
KEPT HIM OUT OF A NURSING HOME.
ALLOWED HIM TO LIVE BY HIMSELF,
GO TO SCHOOL, WORK, BE WITH HIS
FAMILY, BE WITH HIS FRIENDS.
REICH OFTEN THOUGHT THIS IS
-- I'VE OFTEN THOUGHT, THIS IS
WONDERFUL.
BUT WHY SHOULD THAT JUST BE FOR
PEOPLE WHO ARE INJURED IN THE MILITARY?
WHAT ABOUT SO MANY OTHER PEOPLE
WHO GET INJURED LIKE MY NEPHEW
KELLY WHO ARE NOT IN THE MILITARY.
MAYBE EVEN INJURED BEFORE THEY
COULD GO TO THE MILITARY.
HE WAS ONLY 19 WHEN IT HAPPENED
TO HIM.
SO FOR ALL OF THESE YEARS I
THOUGHT WE SHOULD HAVE SOME
SYSTEM IN THIS COUNTRY THAT
WOULD ALLOW PEOPLE LIKE MY
NEPHEW WHO ARE NOT IN THE
MILITARY, BUT WHO, THROUGH AN
FORTUNATE ACCIDENT, BECAME DISABLED.
THAT THEY COULD HAVE THAT SAME
KIND OF LIFE WHERE THEY COULD
LIVE IN THEIR OWN COMMUNITIES,
WITH THEIR OWN FAMILIES, HAVE
THEIR OWN FRIENDS.
THAT'S WHY THIS IS SO IMPORTANT.
THIS IS PERHAPS ONE OF THE MOST
IMPORTANT THINGS THAT W HAVE
DONE SINCE THE PASSAGE OF THE
AMERICANS WITH DISABILITIES ACT.
TO MAKE SURE THAT PEOPLE
DISABILITY CONVICTION HAVDISDISABILIES HAVE A FULL,
ENJOYABLE, PRODUCTIVE, QUALITY
LIFE.
I HOPE THAT SENATORS WILL
DECISIVELY DEFEAT THE AMENDMENT
THAT WANTS TO STRIKE THIS.
SAY YES.
SAY YES TO SO MANY PEOPLE WITH
SABILITIES AND YOUNG PEOPLE
TODAY AND WORKING TODAY, SAY
YES, THAT WE'LL HAVE A SYSTEM
WHERE BY YOU'LL HAVE A PEACE OF
MIND OF KNOWING IF YOU WANT TO
CONTRIBUTE THE MONEY, YOU'LL BE
PROTECTED.
SAY NO TO THE AMENDMENT THAT
WOULD STRIKE THAT.
SAY YES TO THE WHITE HOUSE
AMENDMENT THAT ACTUALLY SUPPORT
THE CLASS ACT.
MAKE SURE THAT ANY SAVINGS FROM
IT IS REINVESTED IN THAT
PROGRAM.
I THANK THE PRESIDENT AND YIELD
THE FLOOR.
MR. DODD: MR. PRESIDENT, BEFORE
WE GO TO THE
THE PRESIDING OFFICER: THE
SENATOR FROM CONNECTICUT.
MR. DODD: IF I COULD REQUEST
THAT THE NEXT HALF-HOUR IS
EQUALLY DIVIDED.
IS THAT OKAY WITH MY --
THE PRESIDING OFFICER: THE
REPUBLICAN DEPUTY LEADER. MR. KYL: MR. PRESIDENT, I HAD
HOPED TO TAKE THE NEXT HALF-HOUR.
BUT IF WE COULD DO 40 MINUTES EQUALLY DIVIDED.
I COULD TAKE 20 AND I THINK I
COULD
MR. DODD: 40 MINUTES EQUALLY
DIVIDED?
MR. KYL: AND WOULD I BE ABLE TO
TAKE THE FIRST 20 MINUTES?
MR. DODD: THAT WOULD BE UNDER
THE SAME ORDER AS WE HAD BEFORE,
I ASK THE CHAIR?
THE PRESIDING OFFICER: IS THERE
OBJECTION?
WITHOUT OBJECTION.
MR. KYL: THANK YOU.
MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM ARIZONA.
MR. KYL: THANK YOU.
MR. PRESIDENT, WE ARE DISCUSSING
THE HATCH AMENDMENT TO PRESERVE MEDICA
AND I WANTED TO GIVE A LITTLE
BIT BACKGROUND ABOUT THE
MEDICARE ADVANTAGE PROGRAM.
IT WAS ESTABLISHED WITH THE GOAL
OF ENSURING THAT BENEFICIARIES
ALL ACROSS THE COURY WOULD
ACTUALLY HAVE MEDICARE CHOICES.
UNDER THE PROGRAM PRIVATE HEALTH
PLANS RECEIVE GOVERNMENT
PAYMENTS IN ORDER TO
MEDICARE BENEFICIARIES, IN
ADDITION TO OFFERING PART-A TO
HOSPITALS AND PART-B TO
PHYSICIANS SERVICES.
AND THERE IS PART-D.
THE CENTRAL GOAL IS TO ENSURE
THAT BENEFICIARIES ACROSS THE
NATION, NOT JUST THOSE IN
POPULOUS AREAS, WOULD HAVE
ACCESS TO HEALTH PLAN OPTIONS.
AND UNDER
ADVANTAGE PLANS MUST PROVIDE ALL
PHYSICIAN AND HOSPITAL MEDICARE
BENEFITS.
AND HERE'S THE KEY.
AND I HOPE MY COLLEAGUES WILL
THINK ABOUT THIS FOR A MOTEL
BECAUSE THIS HAS -- FOR A MOMENT
BECAUSE THIS HAS BEEN A LITTLE
BIT PERHAPS DISTORTED IN THE
CONVERSATION WE'VE HAD.
IF A PLAN'S COST TO PROVIDE ALL
OF THE MEDICARE BENEFIT
LESS THAN THE GOVERNMENT
PAYMENT, THEN BY LAW THE PLAN
MUST APPLY THE DIFFERENCEO
PROVIDE ADDITIONAL BENEFITS TO
THE BENEFICIARY OR TO REDUCE PREMIUMS.
AND IT SEEMS TO ME THAT'S WHAT
THIS WHOLE REFORM WAS ABOUT IN
THE FIRST
TO TRY TO ENSURE QUALITY CARE
AND REDUCE THE COST OF INSURANCE
TO BENEFICIARIES.
WELL, WHAT ARE THESE EXTRA
BENEFITS?
WE'VE HEARD THEM DISCUSSED.
THEY
LOWER COST SHA
INCLUDING OUT-OF-POCKET LIMITS
ON THE BENEFICIARY'S SHARE OF COSTS.
AS WELL AS SPECIFIC HEALTH
BENEFITS LIKE VISION, DENTAL,
CANCER SCREENINGS AND SO ON.
PLANS CAN OFFER MANAGEMENT
SERVICES, WHICH CAN BE
PARTICULARLY IMPORTANT TO
BENEFICIARIES WITH CHRONIC
ILLNESSES, AND THAT'S A
PROTECTION, BY THE WAKES THAT
DOES NOT EXIST IN REGULAR
FEE-FOR-SERVICE PROGRAMS.
SINCE 2003, A NUMBER OF MEDICARE
BENEFICIARIES ENROLLED IN
PRIVATE PLANS HAS NEARLY DOUBLED
OM $5.3 MILLION T
TO $10.2 MILLION IN THE
2009 ACCORDING TO KAISER FAMILY
FOUNDATION
SO THESE ARE VERY POPULAR PLANS
AND GROWING IN POP ALERTCY.
LET'S GO BACK IN TIME JUST -- POPULARITY.
LET'S GO BACK IN TIME IN HISTORY
BACK TO 1972.
BECAUSE IN PAST YEARS, MY
COLLEAGUES ON THE OTHER SIDE OF
THE AISLE WERE ALL FOR MEDICARE
ADVANTAGE.
OVER THE YEARS CONGRESS HAS
TRIED TO CONTROL SPENDING BY
REDUCING PAYMENTS TO PRIVATE
MEDICARE PLANS.
ONE PROBLEM WAS THAT SEVERE
PAYMENT REDUCTIONS RESULTED IN
THE ELIMINATION OF PLAN OPTIONS.
FOR EXAMPLE, IN 1997 THE
BALANCED BUDGET ACT REDUCED
PAYMEN
OVER 10 YEARS -- $4.5 BILLION
OVER 10 YEARS.
WHAT HAPPENED?
THREE-QUARTER OF THE
BENEFICIARIES FROM 1999
HAD TO CHANGE PLANS.
THIS
MORE RURAL AREAS OF THE COUNTRY,
BUT ALSO AREAS LIKE LONG ISLAND,
NEW YORK.
WELL, CONGRESS HEARD FROM THESE
SENIORS LOUD AND CLEAR AND THEY
WERE ANGRY ABOUT LOSING THEIR COVERAGE.
MANY REMBER THAT THE MEDICARE
MODERNIZATION ACT WAS A LANDMARK
ACHIEVEMENT, BUT IT WAS
NECESSARY FOR ANOTHER REASON AS
WELL, AND THAT WAS TO RESPOND TO
THE CAL
WANTED THEIR PRIVATE OPTIONS BACK.
SO IN 2003, THE MEDICARE
MODERNIZATION ACT EXPANDED PLAN
OPTIONS TO INCLUDE REGIONAL
P.O.'S AND RESTORED PLAN AND
PAISSMENTS IT WAS A DELIBERATE,
BIPARTISAN DECISION -- PAYMENTS.
IT WAS A DELIBERATE BIPARTISAN
DECISION TO INCREASE THE PLAN'S
PAYMENTS TO INCLUDE RURAL AREAS
AND SOME URBAN
MENTIONED LONG ISLAND.
LET ME REMIND MY COLLEAGUES,
FORMER SENATOR CLINTON FROM NEW
YORK, FOR EXAMPLE, SAID THAT
THESE MEDICARE PLUS CHOICE
PLANS, WE NOW CALL THEM MEDICARE
ADVANTAGE PLANS, AND I'M --
QUOTE -- "ING ARE FEELING THE
SQUEEZE IN A SYSTEM CAUGHT
BETWEEN RAPIDLY EXPLODING COSTS
AND RAPIDLY IMPLODING FINANCES.
WHILE WE DEBATE
NEED TO RECOGNIZE THERE ARE
PEOPLE IN OUR STATES WHO DEPEND
ON THESE PLANS TODAY.
AND THE CURRENT SENIOR SENATOR
FROM MASSACHUSETTS SAID AT THE
TIME, AND I QUOTE, I URGE MY
COLLEAGUES TO SUPPORT THE
ADDITIONAL FUNDING THAT IS
URGENTLY NEEDED TO STRENGTHEN
THE MEDICARE PLUS CHOICE PROGRAM
FOR SENIORS.
THIS SHOULD BE AMONG OUR HIGHEST
PRIORITIES IN THIS YEAR'S
MEDICARE DEBATE.
MR. PRESIDENT, IT WAS.
AND WE DID.
SO THESE -- THIS IS NOT
SOMETHING BAD THAT WE PROVIDED
WE PROVIDED IT SO THE PLANS
COULD PROVIDE THE BENEFITS TO
SENIORS, PARTICULARLY IN AREAS
WHERE OTHERWISE THEY WOULDN'T
HAVE THOSE CHOICES.
SO WHY HAS THIS ALL OF A SUDDEN
BECOME UNPOPULAR WITH OUR
FRIENDS ON THE OTHER SIDE OF THE
AISLE?
OBVIOUSLY FIRST AND FOREMOST
THEY NEED TRILLIONS OF DOLLARS
TO FUND THEIR BILL.
SO THEY LOOK AROUND WHERE THEY
CAN GET SOME MONEY.
THEY CAN GET $120 BILLION FROM
THIS AND THAT'S ONE WAY TO PAY
FOR THE NEW ENTITLEMENTS UND
THEIR BILL.
BUT THEN T
JUSTIFICATION TO TAKE THAT MONEY.
SO THE IDEA IS, WELL, IT'S NOT
FAIR THAT THE GOVERNMENT WOULD
PAY MONEY INTO THIS PROGRAM FOR
EXTRA BENEFITS FOR SENIORS WHEN
THAT MONEY COULD BE SPENT ON REGULAR FEE-FOR-SERVICE
MEDICARE.
OF COURSE,
PRESUPPOSES THAT GOVER
HEALTH CARE IS ALWAYS SUPERIOR
TO THE PLANS OFFERED IN THE
PRIVATE MARKET, WHICH THESE
SENIORS HAVE MADE CLEAR BY
DOUBLING THE ENROLLMENT IN THE
PRIVATE PLANS IS NOT THE CASE.
AS I SAID, THEY'VE MADE THEIR
PR
AND THEY ASKED US FOR CHOICES
LIKE MEMBERS OF CONGRESS
PRIVATE PLANS AND THESE
AND WE DELIVERED AS PROMISED.
WE GAVE THEM THE CHOICES,
REPUBLICANS AND DEMOCRATS ALIKE.
NOW THEY NEED THE MONEY, SO THEY
DECIDE THIS IS A WAY TO PAY FOR
THEIR NEW ENTITLEMENT.
OUR FRIENDS ON THE OTHER SIDE OF
THE AISLE HAVE BEEN TALKING
ABOU OVERPAYMENTS.
THERE IS NO SUCH THING AS AN
OVERPAYMENT IN THIS PROGRAM
UNDER THE LAW.
ANY MONEY DOESN'T GO TO THE PLANS.
IT'S NOT AS IF THE INSURANCE
COMPANIES GET THE MONEY FROM THE
GOVERNMENT.
THE INSURANCE COMPANIES, IF THEY
-- IF THEIR BID IS UNDER WHAT
THE TRADITIONAL MEDICARE IS,
THEY HAVE TO RETURN 25% OF IT TO
THE UNITED STATES GOVERNMENT.
AND THE OTHER
GO TO THEIR BENEFICIARIES.
EITHER
PREMIUMS OR ADDITIONAL BENEFITS.
SO THESE AREN'T OVERPAYMENTS TO
THE PLANS, AS HAS BEEN
REPRESENTED.
AS I SAID, 75% OF THE ADDITIONAL
PAYMENTS MUST BE MADE TO USE TO
PROVIDE SENIORS WITH EXTRA
BENEFITS WHI COULD INCLUDE
LOWERING PREMIUMS, INCLUDING
CHRONIC CARE MANAGEMENT AND SO
ON.
THE OTHER 25% IS RETURNED TO THE GOVERNMENT.
SO THERE IS NO OVERPAYMENT.
SOME ON THE OTHER SIDE ARGUE
THEY'RE PROTECTING GUARANTEED
BENEFITS
THIS IS HE IS
--
WHAT WE ARE POINTING OUT AND
WHAT THIS AMENDMENT WOULD
PREVENT FROM HAPPENING IS THAT
THE BENEFITS UNDER THE MEDICARE
ADVANTAGE WOULD NOT BE CUT.
AND THERE'S NO QUESTION.
NOBODY CAN DENY THAT THOSE
BENEFITS WOULD BE CUT.
IN FACT, ACCORDING TO THE C.B.O.
BY THE YEAR 2019, THEY WOULD
HAVE BEEN CUT BY 64%.
A HUGE ALMOST $90 -- OVER $90
ACTUARIAL
SO MY POINT HERE IS THAT
SENIORS, OF COURSE, WOULD LIKE
TO KEEP WHAT THEY HAVE.
AND I GUESS WHAT ABOUT THIS
PROME IF YOU LIKE WHAT YOU
HAVE, YOU GET TO KEEP IT.
SORRY, NOT IF YOU'RE ON MEDICARE ADVANTAGE.
AS I SAID, ACCORDING TO THE
CONGRESSIONAL BUDGET OFFICE THE
LEGISLATION WOULD CUT BENEFITS
FROM $135 A MONTH ACTUARIAL
VALUE TO $49 A MONTH ACTUARIAL VALUE.
THAT'S A REAL CUT.
IT MAY NOT SOUND LIKE A LOT TO
SOME PEOPLE, BUT TO OUR SENIORS,
IT'S A HUGE HIT.
THERE'S AN INTERESTING MEMO, MR.
PRESIDENT, BY JAMES CAPPARETTA
AND ROBERT BOOK, WHO WRITE FOR
THE HERITAGE FOUNDATION ON THE MEDICARE CUTS.
HERE'S WHAT THEY SAY, REFORMS
SHOULD MEAN MORE PATIENT CHOICE
AND HEALTH PLAN ACCOUNTABILITY.
BUT THE CURRENT PROPOSALS WOULD
LEAD IN THE OPPOSITE DIRECTION,
TOWARD A SYSTEM OF LESS CHOICE,
LESS ACCOUNTABILITY, AND
EVENTUALLY LOWER QUALITY HEALTH CARE.
THAT'S WHAT THE HATCH AMENDMENT
IS ATTEMPTING TO PREVENT, MR.
PRESIDENT.
TO PRESERVE THESE BENEFITS FOR SENIORS.
NOW, I HAVE GOTTEN TONS OF CALLS
-- ABOUT 500 CALLS JUST IN THE
LAST SEVERAL DAYS OPPOSING CUTS
TO MEDICARE ADVANTAGE.
AND I HAVEN'T, BY THE WAY,
RECEIVED A SINGLE CALL FROM A
SENIOR CITIZENS ASKING US TO
MAKE THESE CUTS.
LET ME JUST -- I'VE BEEN READING
FROM THESE LETTERS.
I READ ABOUT A DOZEN OF THESE
LETTERS.
AND LET ME JUST READ FROM A FEW
OF CONSTITUENTS WHO TELL YOU THE
REAL EFFECT THAT THESE CUTS
WOULD HAVE ON THEM.
AND BEAR IN MIND IN MY STATE WE
HAVE ABOUT 329,000 SENIORS WHO
ARE ENROLLED IN MEDICARE
ADVANTAGE PLANS.
ONE CONSTITUENT FROM PHOENIX
SAYS, F THE PAST MONTH I'VE
HEARD ABOUT CUTS.
FINALLY AFTER YEARS OF BEING
SELF-EMPLOYED AND ONLY AFFORDING
HIGH-DEDUCTIBLE INSURANCE, I NOW
HAVE MEDICARE AND IN THE
MEDICARE ADVANTAGE PLAN.
PLEASE TELL ME YOU'RE NOT CUTTING MEDICARE ADVANTAGE.
HAVE A HEART.
LEAVE MAIR AND MEDICARE
ADVANTAGE A-- LEAVE MEDICARE AND
MEDICARE ADVANTAGE A LOAN.
A CONSTITUENT FROM PEORIA,
ARIZONA, SAYS, I HAVE TWO
FAMILIES RECEIVING HEALTH CARE
UNDER PROGRAM.
THE CARE HAS BEEN CONSISTENTLY
OUTSTANDING DUE TO THE EFFORTS
OF OUR CASE MANAGER IN
COORDINATING PATIENT CARE
BETWEEN PRIVATES AND PATIENTS.
WE HAVE A VOICE IN DETERMINING
TYPEND SCOPE OF OUR CARE.
PLEASE DO NOT CUT MEDICARE
ADVANTAGE.
HERE'S A NOTE FROM A CONSTITUENT.
I HAVE HEARD REPORTS THAT THE
GOVERNMENT NEW -- THE NEW
GOVERNMENT PLAN WOULD DO AWAY
WITH MEDICARE ADVANTAGE.
IF SO, IT WOULD DOUBLE MY HEALTH
CARE CTS WITH MY CURRENT
HEALTH CARE PROVIDER.
I DO NOT WANT ANY LEGISLATION
PASSED THAT WOULD TAKE AWAY THE
MEDICARE OPTION FOR SENIORS.
END OF QUOTE.
ANOTHER CONSTITUENT FROM PEORIA.
PRESIDENT OBAMA HAS SAID THAT WE
CAN KEEP THE INSURANCE WE HAVE
IF WE LIKE IT.
BUT HAS SAID HE WANTS TO CUT OR ELIMINATE MEDICARE ADVANTAGE.
WHAT HAPPENS TO THE MILLIONS OF
PEOPLE WHO HAVE MEDICARE
ADVANTAGE?
THESE ARE ALL SENRS, MANY OF
WHOM CANNOT AFFORD TO PAY MORE.
WHY SHOULD SO MANY SENIORS HAVE
TO SACRIFICE TO -- I
HELP PAY FOR UNIVERSAL COVERAGE?
WHY DO WE NOT HEAR MORE ABOUT
DEBATE
WELL, TO MY
PEORIA, THAT'S WHAT THIS DEBATE
IS ALL ABOUT.
WE ARE TRYING TO PREVENT THESE CUTS.
HERE'S A CONST
PRESCOTT VALLEY.
I H
MY HUSBAND WANTS TO RETIRE FROM
HIS JOB WHERE HE HAS EXCELLENT
HEALTH COVERAGE FOR SERIO
HEALTH CONCERNS.
SO LONG
COVERAGE, HE DOES WELL.
SHOULD MEDICARE ADVANTAGE BE
CUT, HIS HEALTH WOULD
NECESSARILY SUFFER AFTER HIS RETIREMENT.
WE CANNOT AFFORD SUPPLEMENTAL
COVERAGE.
I DON'T WANT TO LOSE MY HUSBAND.
I HAVE SPENT MANY A SLEEPLESS
NIGHT WONDERING HOW TO KEEP HI
HUSBAND HEALTHY WHEN HE RETIRES.
I HAVE SEVERAL FRIENDS
UNDERGOING CHEMOTHERAPY AND
WONDER IF THEIR HEALTH IS IN
JEOPARDY ONCE MEDICARE ADVANTAGE IS CUT.
ARE WE NOT WORTH SAVING.
CLEARLY THERE ARE
TO SPEND MONEY ON THEIR OWN PRIORITIES.
THANK YOU FOR ADVOCATING ON OUR
BEHALF.
REAL PEOPLE.
THEY DON'T WANT US MEDICARE ADVANTAGE.
A FINAL POINT WANT TO MAKE IS,
ONE OF OUR COLLEAGUES WAS
TALKING ABOUT THERE ARE BAD
MEDICARE ADVANTAGE PLANS AND
GOOD MEDICARE ADVANTAGE PLANS.
HOW DO WE KNOW WHICH ONES ARE
GOOD AND BAD?
IT TURNS OUT THE SENIOR SENATOR
FROM FLORIDA DEVISED A FORMULA
WHICH PROTECTS A LOT OF FOLKS IN
COUNTY, MIAMI-DADE COUNTY AND
PALM BEACH BUT DON'T PROTECT
VERY MANY OTHER FOLKS, SO MAYBE
THIS IS THE DEFINITION OF GOOD
VERSUS BAD.
THERE ARE FEW THAT ARE PROTECTED
IN COLORADO, MARYLAND,
AND TEXAS.
FOR EXAMPLE, IN MY HOME STATE OF
ARIZONA, WITH A LOT OF RETIREES,
VERY FEW ARE EXEMPTED FROM THE CUTS.
THIS IS NOT GOING TO GO OVER WELL.
TO EXEMPT ONLY A FEW IN CERTAIN
KEY AREAS AND NONE OF THE
OTHERS.
AGAIN, WHAT HAPPENED TO THE
KEEP WHAT THEY HAVE?
MR. PRESIDENT, MY BOTTOM LINE
HERE IS IN SUPPORTING THE HATCH
AMENDMENT IS THAT WE SHOULD NOT
PUNISH SENIORS WHO HAVE SIGNED
UP TO HAVE THE CHOICE OF
MEDICARE ADVANTAGE.
THERE ARE BETTER WAYS TO REFORM
HEALTH CARE.
WE'VE TALKED ABOUT THOSE WAYS.
OUR SENIOR CITIZENS HAVE PAID
INTO THE PROGRAM, THEY HAVE
ASKED US FOR THIS PROGRAM.
DEMOCRATS AND BOTTOM LINES HAVE
SUPPORTED IT IN THE PAST, AND
NOW SIMPLY BECAUSE SOMEHOW OR
OTHER WE HAVE TO SCRAPE UP MONEY
FOR THE NEW
LEGISLATION, WE'RE GOING TO
ATTACK THE VERY PROGRAM THAT ALL
OF US INHE PAST HAVE
SUPPORTED.
IT'S UNFAIR, IT'S NOT RIGHT, WE
NEED TO DEFEAT THOSE CUTS IN MEDI
THAT'S WHY THE HATCH AMENDMENT
TO PRESERVE MEDICARE ADVANTAGE
SHOULD BE SUPPORTED BY MY
CO
MR. GRASSLEY: MR. PRESIDENT, DO
WE HAV
THE ESIDING OFFICER: SIX AND A
HALF MINUTES REMAIN.
MR. GRASSLEY: MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM IOWA.
MR. GRASSLEY: BEFORE THE SENATOR
FROM ARIZONA LEAVES -- BEFORE
THE -- BEFORE THE SENATOR FROM
ARIZONA LEAVES, THE POINT YOU
MADE AND THE EFFORTS BY THE
MEMBERS OF THE OTHER PARTY TO
STRIKE MEDICARE ADVANTAGE, I
HAVE A LETTER HERE THAT WAS SENT
TO MEMBERS OF THE MEDICARE
CONFERENCE SEPTEMBER 30, 2003,
WITH MORE DEMOCRATIC SIGNERS
THAT ARE STILL IN THE SENATE
THAN REPUBLICAN SIG
IN THE SENATE THAT SET OUT ALL
OF T
ADVANTAGE WAS
IMPORTANT AND WHY IT NEEDED TO
BE -- WHY IT NEEDED TO HAVE MORE
MONEY PUT IT IN THE YEAR 2003.
FOR INSTANCE, I WOULD READ FROM
THIS LETTER."
FOREARLY FIVE MILLION MEDICARE
BENEFICIARIES ACROSS AMERICA,
MEDICARE CHOICE "-- AND THAT'S
WHAT IT WAS CALLED BEFORE IT WAS
CALLED MEDICARE ADVANTAGE --" IS
AN ESSENTIAL PROGRAM THAT
PROVIDES COMPENSATION AFFORDABLE
HEALTH COVERAGE.
THESE SENIORS AND DISABLED
AMERICANS HAVE VOLUNTARILY
CHOSEN TO RECEIVE THEIR HEALTH
BENEFITS THROUGH MEDICARE
H.M.O.'S AND OTHER PRIVATE
SECTOR PLANS BECAUSE THEY HAVE
EXCELLENT VALUE.
TO PRESERVE THIS IMPORTANT
OPTION FOR SENIORS ACROSS THE
COUNTR
WAS INT
590 AT THAT TIME CALLED THE
MEDICARE CHOICE EQUITY AND
ACCESS ACT, COSPONSORED BY
SENATORS SCHUMER AND SANTORUM.
S. 590 SOUGHT TO INCREASE
REIMBURSEMENT RATES AND ADD NEW
REIMBURSEMENT OPTIONS."
ET CETERA, ET CETERA.
WE HAVE PLENTY OF HISTORY IN THE
UNITED STATES SENATE THAT'S A
BIPARTISAN HISTORY THAT WE OUGHT
TO MAINTAIN MEDICARE ADVANTAGE
RATHER THAN DO AN INJUSTICE TO
IT AS THIS PRESENT PIECE OF
LEGISLATION BEFORE THE SENATE IS
TRYING TO DO, AND I'D LIKE TO
PLACE THIS IN THE RECORD, MR. PRESIDENT.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. GRASSLEY: I WOULD -- DOES
THE SENATO FROM WYOMING WANT
THE REMAINDER OF OUR 20 THE PRESIDING OFFICER: THE
SENATOR FROM WYOMING.
MR. BARRASSO: THANK YOU,
MR. PRESIDENT.
I WOULD LIKE TO DO THAT, TO
FIRST CORRECT SOMETHING THAT I
HE
FLOOR TODAY WHEN THE SENR
SENATOR FROM CONNECTICUT HAD
SOME CONCERNS ABOUT -- HE
HIGHLIGHTED, HE SAID HOW PRIVATE
HEALTH PLANS DENY CLAIMS, AND
WHAT HIS STATEMENT WAS IS THAT
HE SAID THAT MEDICARE DOES NOT
DENY CLAIMS.
IN THE UNITED STATES OF AMERICA,
THE NUMBER ONE DEANER OF CLAIMS
FOR HEALTH CARE IS MEDICARE.
THE -- THE STUDY THAT'S OUT FROM
A FULL YEAR, MARCH, 2007, TO
MARCH, 2008, MEDICARE REJECTED
475,000 CLAIMS OF ITS
6.9 MILLION CLAIMS FILED.
THAT'S A RATE OF 6.85%.
WHEN YOU COMPARE THAT TO PRIVATE
INSURANCE COMPANIES, THE
INDUSTRY AVERAGE FOR THE CLAIMS
THAT ARE REJECTED IS ABOUT 4%, 4.05%.
SO MEDICARE REJECTS BY NUMBER
TEN TIMES MORE THAN THE LARGEST
PRIVATE INSURANCE COMPANY, AND A
LOT OF THESE CLAIMS -- AND I
FOLLOWED THIS CLOSELY BECAUSE I
HAVE BEEN THE MEDICAL DIRECTOR
OF SOMETHING CALLED THE WYOMING
HEALTH FAIRS WHERE PEOPLE CAN
GET THEIR BLOOD TESTED, IT'S
VERY LOW COST AND IT GIVES
PEOPLE AN OPPORTUNITY TO CHECK
HOW THEY'RE DOING, TO STAY
HEALTHY.
IT'S A PREVENTION DESIGNED
PROGRAM, BUT YET MEDICARE
REFUSES TO PAY FOR PREVENTION, REFUSES.
IT REFUSES TO PAY FOR THESE
BLOOD TESTS BECAUSE THEY ARE
PREVENTATIVE AS OPPOSED TO
DIAGNOSE A SPECIFIC PROBLEM AND
A SPECIFIC PATIENT WITH A
SPECIFIC SYMPTOM.
SO WHAT DO PEOPLE IN AMERICA DO?
WHAT DO OUR SENIORS DO?
THEY TURN TO A PROGRAM CALLED
MEDICARE ADVANTAGE BECAUSE IT'S
AN ADVANTAGE FOR THEM TO CHOOSE
THIS PROGRAM.
IT'S ONE OF THE CHOICES THEY
HAVE UNDER MEDICARE, AND AT THIS
POINT 11 MILLION AMERICANS HAVE
CHOSEN TO PARTICIPATE IN
MEDICARE ADVANTAGE TO RECEIVE
THEIR HEALTH CARE THROUGH
MEDICARE ADVANTAGE.
WE'RE TALKING ABOUT SENIORS WHO
DEPEND ON MEDICARE FOR THEIR
HEALTH CARE.
THE NUMBER OF PEOPLE SIGNING UP
FOR MEDICARE ADVANTAGE HAS
CONTINUED TO INCREASE OVER THE
YEARS TO NOW 11 MILLION PEOPLE,
ONE OUT OF EVERY FOUR SENIORS
MEDICARE IS IN THIS MEDICARE
ADVANTAGE PROGRAM, AND TY KNOW
WHO THEY ARE AND THEY LIKE THE
PROGRAM, AND THE REASON THAT
THEY LIKE T PROGRAM IS BECAUSE
THEY GET ADDITIONAL SERVICES,
SERVICES BEYOND WHAT SOMEONE ON
THE TRADITIONAL MEDICARE PROGRAM
RECEIVES.
DENTAL CARE, HEARING CARE, EYE
CARE, PREVENTATIVEARE,
COORDINATED CARE.
YOU KNOW, WE HEAR A LOT ABOUT
THE FAILINGS OF THE HEALTH CARE
SYSTEM AND THERE ARE MANY IN
THIS COUNTRY TODAY AND ONE OF
THE PROBLEMS IS THAT CARE IS NOT COORDINATED.
PEOPLE GO FROM SPECIALIST TO SPECIALIST.
WE NEED COORDINATED CARE.
MEDICARE ADVANTAGE DOES A MUCH
BETTER JOB AT COORDINATING CARE
THAN REGULAR MEDICARE, THAN THE
TRADITIONAL MEDICARE.
SO IT IS BAFFLING TO ME, MR. PRESIDENT, THAT THE PLAN IN
FRONT OF US TOD IN THE UNITED
STATES SENATE TRY -- IS TRYING
TO ELIMINATE MEDICARE ADVANTAGE
TO THE TUNE OF OVER OVER $100 BILLION.
WHEN ONE TAKES A LOOK AT THE
CUTS THAT ARE APPROVED IN THIS
PLAN,
CUTS, IS 35 BILLION FOR
HOSPITALS, $42 BILLION FOR HOME
HEALTH AGENCIES, $15 BILLION
FROM NURSING HOMES, $8 BILLION
FROM HOSPICE PROVIDE, BUT
BUT $120 BILLION FROM MEDICARE
ADVANTAGE.
THE PROGRAM, MR. PRESIDENT, THAT
MORE SENIORS AS THEY LEARN ABOUT
IT WANT TO SIGN UP FOR, BECAUSE
IT IS AN ADVANTAGE TO THEM TO
DEAL WITH IT, TO HAVE THEIR
HEALTH CARE THROUGH A PROGRAM
WHICH FOCUS ON PREVENTATIVE
CARE, COORDINATED CARE, HELPS
THEM STAY HEALTHY, HELPS THEM
LIVE LONGER, AND YET THIS SENATE
AND THIS SENATE BILL THAT
SENATOR REID HAS BROUGHT TO THIS
FLOOR IS TRYING TO COMPLETELY
GUT THAT PROGRAM AND DENY OUR
SENIORS WHO RELY UPON IT FROM
RECEIVING THE CARE THAT THEY
HAVE EARNED.
MR. PRESIDENT, I YIELD THE
FLOOR.
A SENATOR: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM
THE SENATOR FROM WISCONSIN.
MR. FEINGOLD: MR. PRESIDENT, I
RISE IN STRONG SUPPORT OF THE
COMMUNITY LIVING AND ASSISTANCE
SERVICES SUPPORT ACT OR CLASS
ACT WHICH WAS INTRODUCED BY THE
LATE SENATOR TED KENNEDY.
THE CLASS ACT WOULD CREATE AN
OPTIONAL INSURANCE PROGRAM TO
HELP PAY FOR HOME CARE AND OER
ASSIST
DISABLED, AND THOSE CHOOSING TO
PARTICIPATE WOULD PAY MONTHLY
PREMIUMS INTO AN INSURANCE
TRUST, AND AFTER FIVE YEARS
COULD ACCESS A CACHE IF THEY
BECOME DISABLED AND NEED
ASSISTANCE.
OVER TEN MILLION AMERICANS ARE
CURRENTLY IN NEED OF LONG-TERM
CARE, AND THAT NUMBER IS
EXPECTED TO RISE TO 15 MILLION
IN THE NEXT TEN YEARS.
THESE I
REMAIN INDEPENDENT WITH LIMITED
ASSISTANCE AND MAY TURN TO
MEDICAID AS AN INSURER OF LAST RESORT.
IN ORDER TO QUALIFY, HOWEVER,
PEOPLE NEED TO GO THROUGH A
SUBSTANTIAL SPENDDOWN OF THEIR
ASSETS AND COMMIT TO
UNEMPLOYMENT TO REMAIN ELIGIBLE.
MR. PRESIDENT, THIS IS TOTALLY
INEFFICIENT.
INSTEAD OF ENSURING THAT AN
INDIVIDUAL CAN REMAIN
INDEPENDENT AND A FUNCTIONAL
MEMBER OF SOCIETY, THE CURRENT
POLICY REQUIRES THAT TO RECEIVE
ASSISTANCE,
HAS TO BECOME A WARD OF THE STATE.
MEDICAID PAYS FOR HALF OF
LONG-TERM CARE COSTS AND
INCREASED EXPENDITURES ARE
EXPECTED TO ADD ANOTHER
ANOTHER $44 BILLION EA YEAR TO
MEDICAID OVER THE NEXT DECADE.
NOT ONLY IS THIS UNSUSTAINABLE,
IT'S ACTUALLY NONSENSICAL.
MR. PRESIDENT, THIS IS ABOUT AS
MUCH -- THIS IS ABOUT AS MUCH
ABOUT PROTECTING PEOPLE'S
DIGNITY AS IT IS ABOUT FISCAL RESPONSIBILITY.
TOO MANY AMERICANS FALL ON HARD
TIMES, BECOMING DISABLED FROM AN
ACCIDENT OR ILLNESS WITH NO
SAFETY NET TO HELP THEM STAY INDEPENDENT.
ENSURING THAT THESE PEOPLE HAVE
AN ALTERNATIVE TO MEDICAID SO
THAT THEY CAN REMAIN ACTIVE AND
INDEPENDENT WILL REDUCE THE
FEDERAL DEFICIT BY $73.4 BILLION
OVER TEN YEARS AND SAVE MEDICAID
MEDICAID $1.6 BILLION IN THE
FIRST FOUR YEARS THAT THE
BENEFITS ARE AVAILABLE.
MEDICAID SAVINGS WILL CONTINUE
TO GROW OVER TIME AS MORE
BENEFICIARIES UTILIZE THE CLASS
ACT BENEFITS INSTEAD OF
MEDICAID.
THANKS TO AMENDMENTS ACCEPTED IN
THE SENATE HEALTH EDUCATION AND
LABOR PENSIONS COMMITTEE, THE
BILL LANGUAGE IS STRONGER THAN EVER.
SENATOR GREGG, MY COLLEAGUE IN
THE BUDGET COMMITT, AMENDED
THE BILL TO REQUIRE THE
SECRETARY OF HEALTH AND HUMAN
SERVICES TO SET PREMIUMS THAT
ARE ACTUARIALLY SOUND FOR A
75-YEAR-OLD WINDOW AND MAINTAINS
A SUSTAINABLE
BENEFIT STRUCTURE.
WHILE SOME HAVE SUGGESTED THAT
THE CLASS ACT IS FISCALLY NOT
SOUND, THE GREGG AMENDMENT
SHOULD PUT THOSE CONCERN TO
REST.
MR. PRESIDENT, LONG-TERM CARE
REFORM HAS BEEN A CORNERSTONE O
MY WORK IN PUBLIC OFFICE SINCE
MY FIRST DAYS IN THE WISCONSIN
STATE SENATE.
I'VE SEEN HOW IMPORTANT IT IS TO
GIVE PEOPLE OPTIONS SO THEY CAN
MATCH THE LEVEL OF CARE AND
ASSISTANCE TO THEIR PERSONAL NEEDS.
PUSHING ANYONE AND EVERYONE INTO
MEDICAID OR INTO A NURSING HOME
IS A WASTE OF POTENTIAL, A WASTE
OF OPPORTUNITY AND A WASTE OF MONEY.
MEDICAID AND OUR NATION'S
NURSING HOMES HAVE A CRITICAL
HOLE TO PLAY FOR SOME AMERICANS,
BUT FOR MANY AMERICANS, IT'S
SIMPLY NOT THE RIGHT FIT.
THE CLASS ACT WILL ENSURE THAT
TAXPAYER DOLLARS ARE SPENT
ENROLLING ONLY THOSE WHO TRULY
NEED MEDICAID INTO THE PROGRAM
AND THEN HELP OTHERS SAVE FOR A
TIME WHEN THEY MIGHT NEED SOME
ASSISTANCE TO REMAIN
INDEPENDENT.
THE CLASS ACT IS A CRITICAL PART
OF THIS HEALTH CARE REFORM BILL,
AND I URGE MY COLLEAGUES TO
OPPOSE ANY EFFORT TO WEAKEN OR
STRIKE THE PROGRAM FROM THE
MR. PRESIDENT, I YIELD THE
FLOOR.
MR. DODD: MR. PRESIDENT, MY
WANTS TO BE HEARD.
MR. WHITEHOUSE: MR. PRESIDENT?
MR. PRESIDENT, I WILL JUST SPEAK
FOR A MOMENT BECAUSE I KNOW THE
DISTINGUISHED SENATOR FROM
PENNSYLVANIA WISHES TO SPEAK,
AND WHEN HE COMES TO THE FLOOR,
I WILL QUICKLY YIELD TO HIM, BUT
WHILE THERE IS A MOMENT IN
BETWEEN, I DID WANT TO SPEAK TO
SOME OF THE ARGUMENTS THAT WE
HAVE HEARD.
THERE IS
THE SUBSTANCE OF AN ARGUMENT.
THERE IS ALSO THE QUESTION OF
THE CREDIBILITY OF AN ARGUMENT,
AND I THINK AS PEOPLE WHO ARE
WATCHING THIS DEBATE DISCUSS THE
CREDIBILITY OF THE CONCERN
EXPRESSED BY OUR FRIENDS ON THE
OTHER SIDE OF THE AISLE ABOUT
THE DEFICIT IMPACT OF THE CLASS
ACT, IT'S WORTH CONSIDERING A
FEW FACTS JUST TO EVALUATE THAT.
THE FIRST THING IS THAT THE
CLASS ACT IS REQUIRED TO BE
ACTUARIALLY SELF-SUSTAINING.
PEOPLE PAY INTO IT AND FROM
THOSE FUNDS UNDER THE INSURANCE
PRINCIPLE, FUNDS COME BACK OUT.
IT IS REQUIRED TO BE
SELF-SUSTAING THAT WAY.
SECOND, IT IS VOLUNTARY.
NOBODY HAS TO CONTRIBUTE.
IF YOU WANT TO CONTRIBUTE, THEN
YOU BECOME EGIBLE FOR THE
BENEFIT ONCE YOU VEST IT, BUT
NOBODY IS FORCED INTO THIS.
IT IS ENTIRELY VOLUNTARY.
THE CONGRESSIONAL BUDGET OFFICE
ON WHICH WE RELY IN BIPARTISAN
OR NONPARTISAN FASHION HAS
THAT THIS ISOLVENT FOR 75
YEARS.
AND FINALLY, BECAUSE WE THINK AT
LEAST ON THIS SIDE THAT THIS
MATTERS, IT WILL HELP THE
DISABLED AND T ELDERLY AT THAT
CRITICAL POINT OF DECISION WHEN
YOUR ABILITY TO STAY HOME, YOUR
ABILITY TO STAY
YOUR ABILITY TO STAY AT WORK
DEPENDS ON JUST A LITTLE BIT OF
HELP TO ACCOMMODATE YOUR AGE OR
DISABILITY, AND IT'S AT THAT
POINT THAT THIS WILL REALLY MAKE
THE DIFFERENCE AND WHAT A
DIFFERENCE IT WILL MAKE IN HUMAN LIVES.
I KNOW THE DISTINGUISHED SENATOR
FROM CONNECTICUT WISHES TO USE
AN EXAMPLE, AND I WILL YIELD TO
HIM ON HIS SIGNAL.
BUT WE'VE SEEN THIS BEFORE.
WE SAW THIS NOT LONG AGO ON THE
PUBLIC OPTION.
THE PUBLIC OPTION WOULD COMPETE
WITH INSURERS HEAD TO HEAD ON
FAIR, LEVEL PLAYING FIELD.
IT WAS REQUIRED -- IT WAS
COMPLETELY VOLUNTARY.
NOBODY'S REQUIRED TO SIGN UP FOR IT.
COMPLETELY VOLUNTARY.
AND IT HAD TO BE ACTUARIALLY SELF-SUSTAINING.
IT HAD TO MEET THE SOLVENCY LAWS
OF THE STATE IN WHICH IT
OPERATED.
IN BOTH
CASES OUR COLLEAGUES ON THE
OTHER SIDES HAVE RUN TO THE
FLOOR TO TALK ABOUT DEFICITS AND
HOW THIS WOULD CONTRIBUTE TO THE
DEFICIT.
THESE ARE BOTH ACTUARIALLY SELF-SUSTAINING PROGRAMS
REQUIRED TO STAY SOLVENT.
AND YET, HERE THEY COME TO RAISE
THE SPECTER OF DEFICITS.
BUT THIS IS THE SAME PARTY THAT
PAYS FOR 14% SUBSIDIES TO
PRIVATE INSURERS TO COMPETE WITH
MEDICAID.
WELL, AS MY SON WOULD SAY,
"DUH," IF YOU'RE GETTING 14%
EXTRA, IT'S PRETTY EASY TO COMPETE.
WHEN THEY ASKED FOR THAT DEAL,
THEY PROMISED THEY'D DRIVE COSTS DOWN.
IN FACT, THEY'VE DRIVEN COSTS
UP, THEY'VE PUT THEM IN THEIR POCKETS.
AND IT ISN'T FAIR TO THE
PROGRAM.
IT IS GREEDY ON THEIR PART.
DO WE HEAR CONCERNS ABOUT THE
DEFICIT PROBLEM ON THE 14%
SUBSIDY FOR THE MEDICARE
ADVANTAGE PROGRAMS? NO.
DEAD SILENT.
GUESS WHAT?
BECAUSE IT HELPS THE INSURANCE INDUSTRY.
WHEN THE PART-D PROGRAM CAME IN,
OUR FRIENDS ON THE OTHER SIDE
FORCED THROUGH A PROVISION, A
UNIQUE PROVISION THAT GAVE THE
PHARMACEUTICAL INDUSTRY THE SPECIAL PRIVILEGE THAT THE
UNITED STATES GOVERNMENT
CODN'T NEGOTIATE WITH IT OVER PRICE.
COULDN'T NEGOTIATE WITH IT.
LORD KNOWS HOW MUCH THAT HAS
ADDED TO OUR DEFICIT.
BUT HAVE THEY EVER COME COMPLAIN?
NO, BECAUSE THE BENEFICIARY IS
THE PHARMACEUTICAL INDUSTRY.
BUT WHEN THINGS HELP REGULAR
PEOPLE, WHEN THINGS HELP
COMPETITION IN THE INSURANCE
MARKET, EVEN WHERE THEY'RE
REQUIRED TO BE ACTUARIALLY
SELF-SUSTAING AND SOLVENT,
THEN SUDDENLY THEY TURN UP.
THEY CAN DETECT THE THREAT IN
DEFICIT IN PARTS PER BILLION
WHEN IT HELPS SOM
BUT A PATENT ACTUAL, LIVING,
BREATHING DEFICIT-ENHANCING
SUBSIDY THAT IS ON THE BOOKS
RIGHT NOW, THEY DON'T CARE ABOUT
IF IT HELPS THE PHARMACEUTICAL
INDUSTRY OR THE INSURANCE
INDUSTRY.
I THINK SIN
DISCUSSION THAT IS A POINT WORTH
BEARING IN MIND BECAUSE IT IS
NOT THE SUBSTANCE OF AN
ARGUMENT, IT IS THE CREDIBILITY
OF AN ARGUMENT THAT COUS.
I SAID I WOULD YIELD TO THE
SENATOR FROM PENNSYLVANIA WHEN
HE ARRIVES, AND HE HAS
WITHOUT FURTHER ADD DUE, I YIELD
THE FLO.
-- WITHOUT FURTHER ADIEU, I
YIELD THE FLOOR. THE PRESIDING OFFICER: THE
SENATOR FROM PENNSYLVANIA.
MR. CASEY: I WANT TO THANK MY
COLLEAGUE FROM RHODE ISLAND WHO
HAS BEEN THE MOST FORTHRIGHT, IN
PARTICULAR TO WHAT BRINGS US TO
THE FLOOR AT THIS MOMENT.
PRINCIPALLY, HIS WORK AND THE
WORK OVER MANY YEARS THAT
SENATOR KENNEDY DID FOR THE
SO-CALLED CLASS ACT, THE
COMMUNITY LIVING ASSISTANCE
SERVICES AND SUPPORTS ACT.
WHAT IS THIS ALL ABOUT?
I WANTED TO TALK FOR A COUPLE OF
MINUTES ABOUT HOW IT WORKS.
I THINK SOMETIMES WHEN WE GET
LOST IN THE DISCUSSION ABOUT THE
FINER POINTS OF A POLICY OR
PROGRAM, WE TEND TO FORGET WHAT
IT MEANS.
HERE'S WHAT IT MEANS.
HERE'S WHAT IT MEANS FOR AN
AMERICAN WHO IS WORKING AND
WANTS TO CONTINUE WORKING TO
SUPPORT HIS OR HER FAMILY OR TO
SUPPORT HIMSELF, CONTRIBUTE TO
OUR ECONOMY, DEMONSTRATE THAT
PEOPLE WHO HAPPEN TO LIVE WITH A
DISABILITY OF ONE KIND OR
ANOTHER CAN BE SO SIGNIFICANT IN
OUR ECONOMY, CAN CONTRIBUTE SO
MUCH WITH THEIR ABILITY AND
THEIR BRAINPOWER AND THEIR
ABILITY TO CONTRIBUTE IN A VERY POSITIVE WAY
SO WE'RE TALKING ABOUT HERE THE
DIGNITY OF WORK, WHETHER OR NOT
THE UNITED STATES SENATE IS
GOING TO STAND UP AND SAY WITH
THIS ACT, WITH THIS PROGRAM FOR
SOMEONE WHO HAPPENSO HAVE A
DISABILITY AND WANTS TO WORK AND
WANTS TO
PREMIUMS SO THEY HAVE SOME, SOME
SECURITY, SOME PEACE OF MIND
DOWN THE ROAD IF THEY SHOULD
NEED THIS HELP, WE'RE TALKING
ABOUT THE DIGNITY OF THAT WORK.
AND THIS IS A TEST OF THE UNITED
STATES SENATE, WHETHER WE'RE
GOING TO STAND UP FOR PEOPLE WHO
HAVE A DISABILITY AND THEIR
OPPORTUNITY TO WORK OR NOT.
IT'S A VERY SIMPLE QUESTION.
YOU EITHER STAND WITH THEM OR
YOU DON'T.
IT'S ALSO ABOUT ONE IMPORTANT
WORD, I THINK: INDEPENDENCE,
WHETHER OR NOT WE'RE GOING TO
SAY TO SOMEONE WHO WANTS TO WORK
AND HAS
GOING TO HAVE THE INDEPENDENCE,
THE FREEDOM TO BE ABLE TO WORK
AND LIVE THE LIFE THAT THEY CHOOSE?
BUT HERE'S HOW IT WORKS.
THIS ISN'T COMPLICATED.
THIS ISN'T SOME MYSTERIOUS PROGRAM.
HERE'S HOW IT WORKS:
INDIVIDUALS -- HERE'S HOW THEY
QUALIFY TO GET THESE BENEFITS.
THEY QUALIFY TO RECEIVE BENEFITS
WHEN THEY DO ABOUT THREE THINGS.
FIRST OF ALL, WHEN THEY NEED
HELP WITH CERTAIN ACTIVITIES OF DAILY LIVING.
WE ALL KNOW WHAT THOSE ARE.
THERE ARE SO MANY PEOPLE OUT
THERE WHO CAN WORK AND CAN
CONTRIBUTE IF WE JUST GIVE THEM
A LITTLE HELP, JUST A LITTLE BIT
OF HELP THAT WE'RE TALKING ABOUT
HERE TODAY.
TO DO THE BASIC THINGS IN LIFE,
TO BE ABLE TO WAKE UP IN THE
MORNING AND MAYBE HAVE SOMEONE,
IF YOU HAVE A DISABILITY,
SOMEONE HELP YOU GET READY FOR
WORK WHR-RBGS THAT'S GOING TO
THE SHOWER OR SHAVING OR
WHATEVER YOU HAVE TPO DO TO
TKPW ET READY FOR WORK IN THE --
WHATEVER YOU HAVE TO DO TO GET
READY FOR WORK IN THE MORNING.
THAT'S THE FIRST THING YOU HAVE
TO HAVE, IS THAT NEED THAT WE
CAN ALL UNDERSTAND.
SECONDLY, THIS PERSON WOULD HAVE
TO PAY PREMIUMS FOR AT LEAST
FIVE YEARS BEFORE THEY COULD
BENEFIT FROM THE PROGRAM.
NOW, I SAID PREMIUMS.
I DIDN'T SAY A GOVERNMENT
SUBSIDY.
WE'RE TALKING ABOUT PREMIUMS HERE.
AND THIS IS A PROGRAM THAT
CERTAINLY HAS ITS ORIGIN IN
GOVERNMENT, BUT THIS ISN'T, THIS
ISN'T SIMILAR OR EXACTLY SIMILAR
TO THE CHILDREN'S HEALTH
INSURANCE PROGRAM, FOR EXAMPLE,
OR MEDICAID, WHERE IT IS A
GOVERNMENT PROGRAM THAT HELPS A
PARTICULAR PERSON, A PERSON WHO
HAPPENS TO HAVE A DISABITY OR
IS A CHILD N. THIS CASE
HAVE TO PAY THOSE PREMIUMS FOR
FIVE YEARS.
THIRDLY, IN ADDITION TO THE NEED
AND PAYING PREMIUMS, THE THIRD
REQUIREMENT IS THEY HAVE HAD TO
WORK AT LEAST
FIVE YEARS.
SO WE'RE TALKING ABOUT PEOPLE
WHO ARE EMPLOYED, WORKING
PEOPLE, WHO HAPPEN TO HAVE A DISABILITY.
AND THIS IS A CREATIVE PROGRAM
TO HELP THEM DO THAT.
WHY DO WE GET THE OPPOSITION WE
DO FROM ACROSS THE AISLE?
WELL, I THINK IT'S PRETTY
SIMPLE.
YOU'VE GOT A LOT OF FOLKS ACROSS
THE AISLE HERE WHO WANT TO KILL
THIS BILL.
SO THEY'RE GOING TO TRY TO
STRIKE THE CLASS ACT, WHICH IS
REALLY OUTRAGEOUS AND INSULTING.
THEY'RE GOING TO TRY TO STRIKE
WHATEVER THEY CAN IF THEY CAN TO
KILL THE BIL
SO THIS IS A BILL-KILLING
EXERCISE.
THIS ISN'T, YOU KNOW, A DEBATE
ABOUT THE FINER POINTS OF THE CLASS ACT.
THIS IS
IT'S VERY SIMPLE.
AND I THINK IT WILL TELL A LOT
ABOUT WHERE PEOPLE STAND.
LET ME GO INTO A COUPLE MORE
DETAILS.
I KNOW WE'RE ALMOST OUT OF TIME.
HERE'S WHAT HAPPENS TO THAT
BENEFICIARY.
PERSON WORKING, A PERSON WHO HAS
A NEED, AND A PERSON WHO HAS
PAID PREMIUMS.
THAT BENEFICIARY RECEIVES A
LIFETIME CASH BENEFIT BASED UPON
THE DEGREE OF IMPAIRMENT.
NOT JUST ANY OLD FORMULA HERE.
WE WANT TO MAKE SURE THAT THE
BENEFIT CORRESPONDS TO SOMEONE'S
IMPAIRMENT.
THEIR INABILITY TO DO THEIR JOB
OR LIVE THEIR LIFE THE WAY THEY
WOULD HOPE TO DO.
AND THE EXPECTED, EXPECTED TO
AVERAGE ABOUT $75 A DAY OR MORE
IN THE CASE OF AN INDIVIDUAL.
SO THAT'S WHAT WE'RE TALKING ABOUT HERE.
NOW WE'RE NOT TALKING ABOUT, IN
THIS CASE, A GOVERNMENT
ENTITLEMENT PROGRAM.
NOW, FEW PEOPLE ARE AS
PASSIONATELY SUPPORTIVE OF THE
CHILDREN'S HEALTH INSURANCE
PROGRAM OR MEDICAID AS I AM; OKAY?
I BELIEVE THAT THERE ARE
PROGRAMS THAT ARE FUNDED BY THE
GOVERNMENT, RUN BY THE
GOVERNMENT THAT WORK VERY WELL.
BUT IN THIS CASE WE'RE NOT
TALKING ABOUT THAT KIND OF A
QUESTION, OR THAT KIND OF A
PROGRAM.
WE'RE TALKING ABOUT A PROGRAM
THAT DOESN'T CONFER RIGHTS OR AN
OBLIGATION ON GOVERNMENT FUNDING.
NOR DOES IT AFFECT THE RECEIPT
OR ELIGIBILITY FOR OTHER BENEFITS.
THE PROGRAM STANDS ON ITS OWN
FINANCIAL FEET BECAUSE PEOPLE
ARE PAYING PREMIUMS OUT OF THEIR
OWN POCKET FOR FIVE YEARS TO BE
ABLE TO SAVE FOR THAT DAY WHEN
THEY HAVE A NEED BECAUSE THEY
HAVE SOME KIND OF DISABILITY.
AND IT'S SOLVENT; OKAY? SOLVENT.
OKAY?
AND IT'S A PROGRAM THAT
SIGN UP FOR VOLUNTARILY.
SO IT'S A VOLUNTARY PROGRAM.
SO, WHEN YOU LIN UP ALL OF THE
REASONS TO SUPPORT THIS PROGRAM
THAT SENATOR DODD, AS THE
CHAIRMAN OF OUR COMMITTEE, THE
HEALTH, EDUCATION, LABOR,
PENSIONS COMMITTEE, THIS SUMMER
WE'RE DEBATING THIS, HE CARRIED
THE BALL FOR SENATOR KENNEDY IN
THE CHAIRMANSHIP THIS SUMMER IN
OUR HEARINGS, BUT ALSO FOR THIS
PROGRAM.
SO I'M GRATEFUL FOR HIS LEADERSHIP.
ALSO GRATEFUL FOR SENATOR
HARKIN'S LEADERSHIP TO SUPPORT
THIS VOLUNTARY PROGRAM.
AND ALSO GRATEFUL THAT SENATOR
WHITEHOUSE HAS LENT HIS VOICE
AND HIS EXPERTISE AND HIS FOCUS
ON GETTING THIS PROGRAM AS PART
OF OUR HEALTH CARE REFORM BILL.
BUT IT MAKES A LOT OF SENSE.
IT'S SOLVENT, AND IT WILL HELP
JUST WANT TO WORK,
TO GO TO WORK EVERY DAY AND LIVE
A FULL LIFE.
AND WITH THAT, MR. PRESIDENT, I
WILL YIELD THE
MR. DODD: MR. PRESIDENT, I
YIELD WHATEVER TIME WE MAY HAVE,
HAVE LEFT HERE T
OF MASSACHUSETTS, WHO HAS DONE
AN INCREDIBLE JOB IN VERY
DIFFICULT CIRCUMSTANCES,
REPLACING OUR BELOVED FORMER
COLLEAGUE, TED KENNEDY FROM
MASSACHUSETTS.
AND HE'S BEEN A VALUABLE
CONTRIBUTION OVER THE DAYS HE'S BEEN HERE.
I KNOW HE'D LIKE TO SAY A FEW
WORDS ABOUT THIS AS WELL.
THE PRESIDING OFFICER: THE
SENATOR FROM MASSAUSETTS,
THERE'S THREE MINUTES LEFT.
MR. KIRK: THANK YOU, MR. PRESIDENT.
AND THANK YOU, SENATOR DODD, AND
ALSO SENATOR BAUCUS FOR YOUR
TIRELESS LEADERSHIP ON THIS
ENTIRE HEALTH CARE BILL.
JUST A WORD ABOUT THE CLASS
YOU'VE HEARD SENATOR DODD AND
OTHERS SAY THAT THIS WAS THE
CORE ELEMENT OF THIS HEALTH
REFORM BILL CHAMPIONED BY
SENATOR EDWARD KENNEDY.
I WOULD SAY IF HE WERE HERE
TODAY, HE WOULD SAY THIS IS NOT
ABOUT POLITICS.
THIS IS ABOUT THE CONTENT OF THE
CHARACTER OF OUR NATION.
AND HE BELIEVED, AS I DO -- AND
I KNOW SENATOR DODD DOES -- THIS
NATION IS JUDGED, OR SHOULD BE
JUDGED ON HOW WE TREAT THE
INFIRMED AND THE WEAKEST AMONG
US.
AND THIS CLASS ACT, AS WAS JUST
ELOQUENTLY POINTED OUT BY
SENATORASEY OF PENNSYLVANIA,
NO TAXPAYER FUNDS, FISCALLY
SOLVENT, AND DOES THE THINGS
THAT EVERYONE WOULD SAY WE MUST
DO, PROVIDING INDEPENDENCE,
SELF-RESPECT AND DIGNITY TO THE
INFIRMED IN OUR SOCIETY.
SECONDLY, KEEPING THE CAREGIVERS
AND THE LOVED ONES FROM CARRYING
THAT BURDEN ALL BY THEMSELVES,
AND NOT HAVING TO SACRIFICE
THEIR JOBS AND THEIR TIME AND
THEIR HEARTACHE TO BE ABLE TO
SHARE THEIR CHILDREN WITH THEIR,
WITH PERHAPS ONE OF THEIR
PANTS AND DIVIDING THAT FAMILY
IN THAT WAY.
THIS IS AT THE HEART OF WHAT OUR
COUNTRY SHOULD BE ABOUT.
IT'S NOT WHO WINS, THE
REPUBLICANS OR THE DEMOCRATS.
IT'S NOT A GOVERNMENT PROGRAM.
IT'SELF-FUNDED.
IT'S VOLUNTARY.
THERE'S NO TAXPAYER MONEY INVOLVED.
AND SO WHAT OTHER REASON COULD
THERE BE BUT POLITICS WOULD KEEP
PEOPLE FROM COMING TOGETHER ON THIS.
I URGE MY COLLEAGUES ALL ON THIS
SIDE AND MY REPUBLICAN
COLLEAGUES ON THE OTHER SIDE TO
THINK ABOUT THOSE FAMILIES WHO
ARE FACING THIS PLIGHT.
THEY ARE REPUBLICANS.
THEY ARE INDEPENDENTS, AND
THEY'RE DEMOCRATS FILIES AS WELL.
THIS IS AN AMERICAN PROGRAM FOR
SOME VETERANS AND OTHERS WHO
HAVE SACRIFICED.
AND I THINK THE ONLY THING WE
CAN DO, THE ONLY RIGHT THING WE
CAN DO IF THIS IS GOING TO BE A
REFLECTION OF THE CHARACTER OF
THIS NATION, IS TO SUPPORT THE
CLASS ACT.
AND I THANK SENATOR DODD ONCE AGAIN.
I'M PROUD TO BE STANDING AT THE
DESK OF SENATOR EDWARD KENNEDY,
WHO BELIEVED DEEPLY IN THIS,
STARTED WAY A LONG TIME AGO AND
WANTED TO SEE AFTERNOON.
I YIELD THE FLOOR, MR. PRESIDENT.
THE PRESIDING OFFICER: THE
TIME CONTROLLED BY THE MAJORITY
HAS
MR. DODD: MR. PRESIDENT, WHAT
IS THE -- OKAY.
I NOTE THE ABSENCE OF A
EQUALLY
THE PRESIDING OFFICER: THE
CLERK WILL CALL THE ROLL.
QUORUM CALL:
MR. DODD: MR. PRESIDENT, I ASK
UNANIMOUS CONSENT THAT THE CALL
OF THE QUORUM BE REAS I UNDERSTANDED.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. DODD: I AM BEA TO PROPOUND
A UNANIMOUS CONSENT REQUEST.
MR. PRESIDENT, I ASK UNANIMOUS
CONSENT THAT AT
THE SENATE PROCEED TO VOTE IN
RELATION TO THE FOLLOWING
AMENDMENTS AND MOTION TO COMMIT
AS LISTED IN THIS AGREEMENT,
THAT NO OTHER AGREEMENT --
AMENDMENTS, MOTIONS TOOMMIT,
OR ANY OTHER MOTION, EXCEPT A
MOTION TO RECONSIDER AND TABLE
UPON CONCLUSION OF
BEING IN ORDER DURING THE
PENDONNIVE THIS DPREAMENT.
FURTHER THAT PRIOR TO THE SECOND
AND SUCCEEDING VOTES, THERE BE
TWO MINUTES OF DEBATE WITH ALL
TIME CONTROLLED IN THE USUAL FORM
THAT ANY AMENDMENT OR MOTION
COVERED UNDER THIS AGREEMENT BE
SUBJECT TO AN AFFIRMATIVE
60-VOTE THRESHOLD, AND THAT IF
ANY ACHIEVE THAT THRESHOLD
THE AAGREED TO AND THE MOTION
TUBE TO RECONSIDER BE MADE AND
LAID ON THE ABLE THAT
NOT ACHIEVE THAT 60-VOTE
THRESHOLD HOLD, IT BE WITHDRAWN.
AFTER THE FIRST VOTE IN THE
SEQUENCE, THE SUCCEEDING VOTES
BE TEN MINUTES IN DURATION.
SENATOR WHITEHOUSE AMENDMENT RE
SOCIAL SECURITY, FISCAL
RESPONSIBILITY; THE REPUBLICAN
LEADER'S DESIGNEE OR THE
REPUBLICAN LEADER'S AMENDMENT,
FISCAL RESPONSIBILITY; SENATOR
STABENOW'S SIDE-BY-SIDE
AMENDMENT RE MEDICARE ADVANTAGE,
AND SENATOR
RECOMMIT MEDICARE ADVANTAGE.
FURTHER, ONCE THIS AGREEMENT IS
INTERKSD THE REPUBLICAN LEADER'S
DESIGNEE BE RECOGNIZED TO CALL
UP THE FISCAL RESPONSIBILITY
AMENDMENT AND THAT ONCE IT HAS
BEEN REPORTED BY NUMBER, SENATOR
STABENOW BE RECOGNIZED TO CALL
UP THE MEDICAL ADVANTAGE
SIDE-BY-SIDE AMENDMENT.
THAT UPON DISPOSITION OF THE
AMENDMENT AND THE MOTION TO THIS
AGREEMENT, THE NEXT TWO MATTERS
FOR CONSIDERATION WILL BE A
SENATOR LINCOLN AMENDMENT
REGARDING THE INSURANCE
EXECUTIVE COMPENSATION AND
REPUBLICAN LEADER'S DESIGNEE
MOTION TO COMMIT REGARDING HOME
HEALTH AGENCIES THAT.
FOR THE REMAINERDER OF TODAY'S
SESSION, NO FURTHER AMENDMENTS
OR MOTION TO COMMIT BE IN ORDER.
AT THE SAME TIME -- FOR THE SAME
TIME UNTIL THEN BE EQUALLY
DIVIDED BETWEEN THE LEADERS OR
THEIR DESIGNEES, WITH MEMBERS
PERMITTED TO SPEAK UP TO TEN
MINUTES EACH. THE PRESIDING OFFICER: IS
THERE OBJECTION?
MR. McCONNELL: MR. PRESIDENT,
RESERVING THE RIGHT TO OBJECT,
AND I WILL OBJECTING,
I SEE THE ASSISTANT MAJORITY LEADER ON THE FLOOMPLET I THINK
IT WOULD BE
THE MAJORITY LEADER OR SOMEONE
ON
WHAT POINT DURING THE DAY
TOMORROW AND AT WHAT POINT
DURING THE DAY ON SUNDAY WE
MIGHT BE HAVING ADDITIONAL VOTES.
IT MIGHT BE HELPFUL TO OUR
COLLEAGUES ON BOTH SIDE OF THE
NILE TERMS OF PLANNING FOR THE
WEEKEND.
MR. REID: MR. PRESIDENT, WEE
GOING TO COME IN AT 10:00 IN THE
MORNING. AT THIS TIME IT APPEARS THAT WE
WILL HAVE SENATOR LINCOLN OFFER
AN AMENDMENT AND WOULD HOPE
THAT WE CAN BE READY THAT THE
TIME TO HAVE WHATEVER THE
MINORITY WANTS TO IN REGARD TO
THAT AMENDMENT.
AND THEN WE ARE GOING TO HAVE AN
AMENDMENT OFFERED BY THE
REPUBLICANS, AND I WOULD HOPE
THAT WE
AMENDMENTS TOMORROW, MAYBE IN
THE EARLY AFTERNOON, BY MAYBE
2:00, MR. McCONNELL: SO AM I CORRECT
IN ASSUMING THAT THE VOTES ARE
MOST LIKELY GOING TO BE IN THE
AFTERNOON TOMORROW OR BOTH MORNING AND NIGHT?
MR. REID: YES, IN THE AFTERNOON.
I THINK WE'LL NEED SOME DEBATE
IN THE MORNING.
THEN SUNDAY MORNING, AT THE
REQUEST OF THE REPUBLICAN
LEADER, WE AREN'T GOING TO COME
IN UNTIL
MR. McCONNELL: I THINK WE'RE
PROBABLY GOING TO NEED SOME
DEBATE TIME, A
WELL, WE'RE HAPPY TO HAVE IT IN
THE AFTERNOON.
AND THEN ON SUNDAY, OBVIOUSLY,
WE WON'T GO IN UNTIL NOON ON
SUNDAY AND THEN
MR. REID: YES, THERE IS AN
EVENT IN WASHINGTON THAT A
NUMBER OF SENATORS ARE OBLIGATED
TO GO TO.
THAT'S IN THE EVENING.
SO WE'LL GET EVERYBODY OUT OF
HERE BY 6:00-6:30 THAT NIGHT AT
THE LATEST.
THE PRESIDING OFFICER: IS THERE OBJTION?
MR. REID: I WOULD ALSO SAY,
MR. PRESIDENT, THROUGH YOU TO MY FRIE, WE DEMOCRATS ARE GOING
TO HAVE A CAUCUS -- WE'RE
TTENTIVELY GOING TO HAVE ONE
SUNDAY AFTERNOON.
THE PRESIDING OFFICER: IS
THERE OBJ
WITHOUT OBJECTION, SO ORDERED.
MR. THUNE: THE PRESIDING OFFICER: THE
SENATOR FROM SOUTH
MR. THUNE: MR. PRESIDENT, I'D
LIKE TO CALL
AND ASK FOR ITS IMMEDIATE
CONSIDERATION.
THE PRESIDING OFFICER: THE CLERK WILL REPORT.
THE CLERK: THE SENATOR FROM
SOUTH DAKOTA, MR. THUNE,
PROPOSES AN AMENDMENT NUMBERED
2901 TO AMENDMENT NUMBERED 2786.
BEGINNING ON PAGE 1925, STRIKE
LINE 15 AND ALL THAT FOLLOWS
THROUGH LIN
MR. THUNE:
THE PRESIDING OFFICER: THE
SENATOR FROM SOUTH DAKOTA.
MR. THUNE: MR. PRESIDENT, I WOULD LIKE TO SPEAK TO THE
AMENDMENT THAT WE JUST FILED AT
THE DES
AND WHAT THIS AMENDMENT WOULD DO
-- IT'S VERY STRAIGHTFORWARD AND
VERY SIMPLE.
IT DOES WHAT A NUMBER OF MY
COLLEAGUES ON THE OTHER SIDE
HAVE ASKED TO DO, AND THAT IS TO
STRIKE THE CLASS ACT FROM THE
UNDERLYING HEALTH REFORM BILL --
THE HEALTH CARE REFORM BILL THAT'S BEING DEBATED ON THE
FLOOR OF THE SENATE RIGHT KNEW.
AND I WANT TO READ FOR YOU SOME
EXCERPTS FROM A LETTER THAT
SEVEN DEMOCRAT SENATORS,
INCLUDING THE CHAIRMAN OF THE
SENATE BUDGET COMMITTEE, SENATOR
CONRAD,
THIS CLASS ACT NOT BE INCLUDED
AS PART OF THIS LEGISLATION.
THEY SAID THIS, "WE URGE YOU NOT
TO INCLUDE THESE PROVISIONS IN
THE SENATE'S MERGED BILL, NOR TO
USE THE SAVINGS AS AN OFFSET FOR
OTHER HEALTH ITEMS IN THE MERGER.
WHILE THE GOALS OF THE CLASS ACT
ARE LAUDABLE, FINDING A WAY TO
PROVIDE LONG-TERM CARE INSURANCE
TO INDIVIDUALS, THE EFFECT OF
INCLUDING THIS LEGISLATION IN
THE MERGED SENATE BILL WOULD NOT
BE FISCALLY RESPONSIBLE FOR
SERAL REASONS.
" AND IT GOES ON TO SAY THAT
NEARLY ALL THE SAVINGS RESULT
FROM THE FACT THAT THE INITIAL
PAYOUT OF B
BEGIN UNTIL 2016 EVEN THOUGH THE PROGRAM BEGINS COLLECTING
PREMIUMS IN 2011.
IT IS ALSO CLEAR THAT THE
LEGISLATION INCREASES THE
DEFICIT IN DECADES FOLLOWING THE
FIRST TEN YEARS."
THEY GO ON TO SAY HAD THIS
LETT, MR. PRESIDENT, "WE
GRAVE CONCERNS THAT THE REAL
EFFECT OF THE PROVISIONS WOULD
BE TO CREATE A NEW FEDERAL
ENTITLEMENT PROGRAM WITH LARGE,
LONG-TERM SPENDING INCREASES
THAT FAR EXCEED REVENUES.
THIS IS ESPECIALLY THE CASE IF
SAVINGS FROM THE FIRST DECADE OF
THE PROGRAM
HEALTH REFORM PRIORITIES."
THAT, MR. PRESIDENT, IS A LETTER
THAT WAS SIGNED BY THE CHAIRMAN
OFHE SENATE BUDGET COMMITTEE,
SENATOR CONRAD FROM NORTH
DAKOTA, SENATOR LIEBERMAN,
SENATOR LANDRIEU, SENATOR
LINCOLN, SENATOR WARNER, SENATOR
NELSON, AND SENATOR BAYH.
SEVEN DEMOCRAT SENATORS WHO HAVE
GO ON THE RECORD SAYING THE
CLASS ACT SHOULDN'T BE INCLUDED
IN THIS LEGISLATION BECAUSE IT'S
NOT
THE FACT OF THE MATTER IS,
MR. PRESIDENT, THE SENATE -- THE
CHAIRMAN OF THE
COMMITTEE, SENATOR CONRAD, HAS
GONE ON TO SAY AND DESCRIBE THIS
AS A PONZI SCHEME OF THE FIRST
ORDER, SOMETHING
MADOFF WOULD BE PROUD OF. I'VE MY COLLEAGUES ON THE OTHER
SIDE GET UP AND TALK ABOUT HOW
SOLVENT THIS IS AND WHAT GREAT
PROGRAM THIS IS.
WELL, ERE ARE PROGRAMS OUT
THERE THAT ARE AVAILABLE FOR
PEOPLE TO BUY LONG-TERM CARE INSURANCE.
THE PROBLEM
TAKES ALL THE MONEY THAT COMES
IN IN THE EARLY YRS AND SPENDS
IT ON OTHER GOVERNMENT PROGRAMS,
IN THIS CASE HEALTH CARE REFORM,
BUT WHO KNOWS WHAT OTHER
GOVERNMENT PROGRAMS RADIO GOING
TO BE CREATED THAT OTHER GOVERNMENT PROGRAMS ARE
GOING TO BE CREATED THAT
USE THE REVENUE FROM THIS PLAN
THAT SUPPOSEDLY A LOT OF PEOPLE
ARE GOING TO SIGN UP FOR.
C.B.O. SAYS THAT FEWER
OF PEOPLE WILL ACTUALLY SIGN UP FOR IT.
IN FACT, NO SENIOR TODAY IS
GOING TO BENEFIT FROM IT BECAUSE
YOU HAVE TO WORK FOR FIVE YEARS.
IF YOU ARE A SENIOR WHO IS
RETIRED, YOU ARE NOT GOING TO
SEE ANY BENEFIT FROM THIS.
THIS DOESN'T IMPACT SENIORS,
CONTRARY TO THE ASSERTIONS OF
SOME OF MY COLLEAGUES ON THE
OTHER SIEVMENTD WHO IT WILL
IMPACT ARE FUTURE GENERATIONS OF
AMERICANS WHO ARE GOING TO BE
STUCK WITH THE DEFICITS AND THE
DEBT THAT GETS PILED ON THEM
LIABILITY IS INCURRED, PEOPLE
START GETTING PAI
HAVING PAID IN, THERE'S NO MONEY THERE.
IT IS -- IT IS A CLASSIC
DEFINITION OF A PONZI SCHEME.
THE MONEY COMES IN TODAY, GETS
SPENT ON OTHER THINGS, AND
SOMEDAY WHEN THE LIABILITY COMES
IN AND PEOPLE START SAYING, OH,
I PAID INTO THIS PROGRAM; I
SHOULD GET SOME BENEFIT, THERE'S
GOING TO BE NO MON THERE.
SO WE'RE GOING TOO BORROW FOR IT
OR TAX FOR IT OR SOMETHING ELSE.
BUT BECAUSE THEY SAY -- THEY SAY
WE'LL TAX YOU OVER 75 YEARS,
WELL, MAYBE BECAUSE YOU'RE
RUNNING SURPLUSES IN THE EARLY
YEARS BUT IN THE LATER YEARS
YOU'RE RUNNING HUGE OF THE DEFICITS.
IN THE EARLY YEAR, THE SURPLUSES
REASONABLE CARE SPENT.
PAYING BENEFITS OUT FOR THIS
PROGRAM WHEN THE BENEFITS START
BEING DEMAND BY THE PEOPLE WHO
PARTICIPATED IN THE PROGRAM.
BUT JUST LOOK WHAT THE OTHERS
HAVE SAID ABOUT THIS PROGRAM,
MR. PRESIDENT.
I'M -- I QUOTED FOR YOU WHAT THE CHAIRMAN OF THE BUDGET
COMMITTEE, SENATOR CONRAD, SAID
WITH REGARD TO THIS PROGRAM.
THAT IT
FIRST ORDER.
BUT THAT IS BEING ECHOED BY OTHERS.
THIS IS WHAT THE CHIEF ACTUARY
IN THE ADMINISTRATION -- THE
ADMINISTRATION'S CHIEF ACTUARY
SAID ABOUT THE CLASS ACT.
SAID IT WOULD RESULT IN A NET
FEDERAL COST IN THE LONGER TERM.
THE CHIEF ACTUARY ALSO
DETERMINED THE PROGRAM FACES A
SIGNIFICANT RISK OF FAILURE
BECAUSE THE HIGH COST WILL
ATTRACT SICKER PEOPLAND LEAD
TO LOW P
THE CONGRESSIONAL BUDGET OFFICE
AGREED, SAYING THE CLASS PROGRAM
INCLUDED IN THE BILL WOULD
GENERATE NET RECEIPTS FOR THE
PROGRAM IN THE INITIAL YEARS
WHEN TOTAL PREMIUMS WOULD EXCEED
TOTAL BENEFIT PAYMENTS BUT IT
WOULD EVENTUALLY LEAD TO NET
OUTLAYS WHEN BENEFITS EXCEED PREMIUMS.
IN THE DECADE FOLLOWING 2029,
THE CLASS PROGRAM WOULD BEGIN TO
INCREASE BUDGET DEFICITS.
NOW, THIS PARTICULAR QUOTE COULD
BECAUSE THIS COMES
C.B.O. OR THE C.M.S. ACTUARY,
BUT IT COMES FROM "THE
WASHINGTON POST."
"THE WASHINGTON POST" CALLED THE
CLASS ACT "A GIMMICK DESIGNED TO
FULLY PAID FOR."
THE "POST" G.N.P. GOES ON TO
SAY, MR. PRESIDENT, THAT THE
MONEY THAT FLOWS IN DURING THE
TEN-YEAR BUDGET WINDOW WILL FLOW
BACK OUT AGAIN.
"THESE ARE NOT SAVINGS THAT CAN
HONESTLY BE COUNTED ON THE
BALANCE SHEET OF
EVEN "THE WASHINGTON POST"
RECOGNIZES THIS FOR WHAT IT IS.
IT IS A SHAM.
THIS IS A BUDGET GIMMICK,
MR.
TO OBSCURE THE COST OF THIS
PROGRAM BY GEN
IN THE EARLY YEARS.
$72 BILLION IT'S SUPPOSED TO
GENERATE IN THE FIRST TEN-YEAR WINDOW
SO THAT COUNTS ON THE BALANCE
SHEET OF HEALTH CARE REFORM TO
KE IT LOOK BETTER.
BUT THIS PROGRAM IS GOIN
DEFICITS -- DEFICITS, AS FAR AS
THE EYE CAN SEE.
ONCE THE CHICKENS COME HOME TO ROOST.
AND WHO IS GOING TO PAY THE BILL
FOR THAT?
FUTURE GENERATIONS OF AMERICANS.
MR. PRESIDENT, THIS IS NOT GOOD
POLICY.
CERTAINLY, IF YOU LOOK AT
PROGRAMS THAT WE ALREADY HAVE ON
THE BOOKS, MEDICARE IS DESTINED
TO BE BANKRUPT IN THE YEAR 2017.
WE GOT BIG PROBLEMS DOWN THE
ROAD, UNFUNDED LIABILITIES IN
SOCIAL SECURITY.
WHAT THIS WOULD DO
HUGE NEW LIABILITY DOWN THE ROAD
THAT WOULD BE UNFUNDED BECAUSE
ALL THE MONEY THAT COMES IN IN
THE EARLY YEARS IS GOING TO BE SPENT.
THIS IS MORE OF BUSINESS-AS-USUAL IN WASHINGTON,
D.C., THAT THE AMERICAN PEOPLE
ARE FED UP WITH.
WE CAN MAKE PEOPLE HAPPY TODAY
BY SAYING WE'RE CREATING THIS
NEW PROGRAM
MAJORITY'S HEALTH CARE REFORM
BILL LOOK BETTER BECAUSE IT
OBSCURES THE REAL COST
THING BY ROLLING IN THESE
REVENUES IN THE EARLY YEARS, BUT
THE LONG-TERM IMPACT, ACCORDING
TO THE C.B.O., ACCORDING TO THE
ACTUARY AT HEALTH AND HUMAN
SERVICES, ACCORDING TO A LOT OF
OUR COLLEAGUES ON THE OTHER SIDE
-- SEVEN DEMOCRATS WHO SIGNED A
LETTER, INCLUDING THE CHAIRMAN
OF THE BUDGET COMMIEE, WHO, AS
I SAID, HAS CALLED THIS PROGRAM
A PONZI SCHEME OF THE FIRST
ORDER, SOMETHING THAT WOULD MAKE
BERNIE
NOW, I DON'T KNOW HOW MY
COLLEAGUES ON THE OTHER SIDE
WITH A STRAIGHT FACE COULD COME
OVER HERE AND SAY, WELL, THIS IS
A REALLY GREAT PROGRAM.
IT IS ACTUARIALLY SOUND.
AND SURE IT MAY BE OF BENEFIT TO
A FEW PEOPLE.
BUT I GOT TO TICIALTION
SOMEWHERE DOWN THE ROAD WHEN THE
CHICKENS COME TO ROOST, THERE IS
GOING TO A HUGE LIABILITY THAT
WILL BE FACING FUTURE TMTIO TAXPAYERS,
FUTURE
AS WE PILE UP MORE DEBT AS A
RESULT OF THIS PONZI SCEESM THAT IS SHAM, MR. PRESIDENT.
I HOPE THAT MY COLLEAGUES WILL
SUPPORT THIS AMENDMENT.
IT WOULD STRIKE THE CLASS ACT
FROM THE UNDERLYING BILL, NOT
ALLOW THOSE REVENUES TO BE
ASSUMED IN PAYING FOR OR
UNDERSTATING THE COST OF THIS
BILL AND NOT PILE MOUNTAINS OF
DEBT ON FUTURE GENERATIONS.
MR. PRESIDENT, I RESERVE THE
BALANCE OF MY TIME.
MR. DODD: MR. PRESIDENT, HOW
MUCH TIME REMAINS?
THE PRESIDING OFFICER: THE
SENATOR FROM CONNECTICUT.
19 MINUTES.
REPUBLICAN SIDE, 10 1/2.
MR. DODD: I SEE MY COLLEAGUE FROM MNESOTA.
DOES HE WISH TO BE HEARD?
HOW MUCH TIME DOES MY COLLEAGUE
NEED?
MR. FRANKEN: THANK YOU, SENATOR
DODD.
I NEED THREE MINUTES.
MR. DODD: TAKE FOUR.
MR. FRANKEN: I'LL TAKE IT.
MR. PRESIDENT, I RISE TODAY TO
ASK UNANIMOUS CONSENT TO BE
ADDED AS A COSPONSOR TO SENATOR
COBURN TOFS AMENDMENT NUMBER
2789 TO REQUIRE ALL MEMBERS OF
CONGRESS TO ENROLL IN THE PUBLIC OPTION.
I'M PLEASED TO COSPONSOR THIS
AMENDMENT BECAUSE I STRONGLY
SUPPORT THE PUBLIC OPTION, AND I
WILL HAVE NO QUALMS AT ALL
ENROLLING IN THIS PLAN.
YOU KNOW, THERE'S A LOT OF
MISINFORMATION ABOUT THE PUBLIC
OPTION, SO I WANT TO BE CLEAR
ABOUT WHY WEEED A PUBLIC
OPTION AND WHY I WOULD BE PROUD
TO ENROLL IN A PUBLIC HEALTH
INSURANCE PLAN.
WE NEED A PUBLIC OPTION BECAUSE
HEALTH INSURANCE PREMIUMS FOR
MINNESOTA RESIDENTS HAVE RISEN
90% SINCE 2000, BECAUSE 440,000
MINNESOTANS WENT WITHOUT HEALTH
INSURANCE IN 1998.
WE NEED A PUBLIC OPTION BECAUSE
INSURANCE EXECUTIVES CONTINUE TO
MAKE BLOATED, OBSCENE SALARIES
TPR-FPLT -- SALARIES.
FROM TWROU-2007 AMERICANS SAW
PREMIUMS DOU
DURING THAT SAME TIME WE SAW
AMERICANS BECOME UNINSURED.
DURING THAT SAME PERIOD
INSURANCE COMPANY PROFITS ROSE 428%.
428% IN EIGHT YEARS.
THEY'RE MAKING OUTRAGEOUS
PROFITS BY GOUGING AMERICAN
FAMILIES, AND THAT'S WHY WE NEED
A PUBLIC OPTION.
THE PUBLIC OPTION WILL OFFER
AFFORDABLE PREMIUMS AND A
COMPREHENSIVE BENEFITS PACKAGE
FOR AMERICANS STRUGGLING WITH
THEIR HEALTH CARE COSTS.
IT'S GOING TO PROVIDE THE KIND
OF COVERAGE THAT AMERICANS NEED
TO BE HEALTHY.
THE PUBLIC OPTION WILL FOSTER A
A COMPETITION AMONG PRIVATE
HEALTH INSURANCE COMPANIES AND
LOWER LONG-TERM COSTS FOR
MINNESOTANS AND FAMILIES ACROSS
THE COUNTRY.
AND THERE I NO COST FOR THE
PUBLIC OPTION TO THE TREASURY.
IN FACT, C.B.O. ESTIMATES IT
SAVES $3 BILLION.
IT'S A WIN-WIN SITUATION.
IT'S IMPORTANT TO REMBER THAT
THE PUBLIC OPTION DOESN'T MEAN THAT PRIVATE HEALTH INSURANCE
GOES AWAY.
IN FACT, AFTER HEALTH REFORM,
188 MILLION AMERICANS WILL HAVE
COVERAGE THROUGH A PRIVATE INSURER.
ONLY 2% OF THE OVERALL INSURED
POPULATION IS PROJECTED TO
ENROLL IN THEUBLIC OPTION.
THIS IS JUST ANOTHER OPTION THAT
YOU'LL HAVE.
IT
BECAUSE THAT'S WHAT THE BILL IS
ABOUT.
A SENATOR: WOULD THE SENATOR
FROM MINNESOTA YIELD?
MR. FRANKEN:ABSOLUTELY.
PWR-PB PWREUPB KNOW YOU JOINED
TO PUSH THIS AMENDMENT --
MR. BROWN: I
MEMBERS GO ON THE PUBLIC OPTION
PARTLY TO SHOW THAT WE BELIEVE
IN IT.
IT'S A LITTLE CURIOUS THAT TWO
OF THE SPONSORS AT LEAST --
SENATOR COBURN, SENATOR VITTER
AND SOME OTHERS -- ARE SO MUCH
AGAINST THE PUBLIC OPTION BUT
THEY WANT TO PAS THIS AMENDMENT.
IT SOUNDS TO ME
SERIOUS ABOUT GOING ON IT AS I
AM.
MR. FRANKEN:I TALKED TO MY FRANIE.
WE'VE BEEN MARRIED 34 YEARS NOW.
I SAID IF THIS PASSES, WE SHOULD
DO THE PUBLIC OPTION.
SHE SAID ABSOLUTELY.
SO, YEAH, I'M PERFECTLY SERIOUS
ABOUT THIS.
THE PRESIDING OFFICER: THE SENATOR FROM MINNESOTA HAS
CONSUMED THE FOUR MINUTES
ALLOTTED BY THE SENATOR FROM CONNECTICUT.
MR. GRASSLEY: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM MINNESOTA HAS THE
FLOOR.
MR. GRASSLEY: I'M SORRY.
THE PRESIDING OFFICER: WHO
YIELDS TIME?
THE SENATOR FROM UTAH IS
RECOGNIZED FOR FIVE MINUTES.
WITHOUT OBJECTION, THE SENATOR
FROM MINNESOTA'S REQUEST TO BE
ADDED AS A COSPONSOR OF THE
COBURN AMENDMENT ISPPROVED.
THE SENATOR FROM
MR. HATCH: MR. PRESIDENT,
THANK YOU SO MUCH.
WE'RE TALKING RIGHT NOW ABOUT A
PROGRAM THAT'S WELL THOUGHT OUT,
THAT WASEANT TO HELP THE POOR
AND MINORITIES, THAT WAS
REQUESTED BY BIPARTISAN
DEMOCRATS AND REPUBLICANS, AND
HAS WORKED AMAZINGLY WELL, WHICH
IS AVAILABLE TO ALL RECIPIENTS
OF MEDICARE.
MEDICARE ADVANTAGE CAME ABOUT IN
A BIPARTISAN WAY TO SOLVE REAL PROBLEMS.
WE WEREN'T GETTING HEALTH CARE
TO RURAL AMERICA.
WE WEREN'T GETTING HEALTH CARE
IN MANY RESPECTS TO SOME OF THE
POOR AND SOME OF THE MINORITY
FOLKS IN OUR COUNTRY.
I JUST WANT TO READ A SPECIAL
LETTER HERE.
IN RESPONSE TO THIS LETTER --
LET ME READ THIS LETTER, AEUPBD
KNOW IT MAY HAVE BEEN -- AND I
KNOW IT MAY HAVE BEEN READ BEFORE.
THIS IS DATED SEPTEMBER 30, 2003.
"DEAR MEDICARE CONFEREES" -- I
HAPPENED TO BE ON THAT
CONFERENCE.
I WAS ONE OF THOSE WHO LED THE
FIGHT FOR MEDICARE ADVANTAGE.
"WE ARE WRITING TO ASK YOU AS A
MEMBER OF THE MEDICARE
CONFERENCE COMMITTEE TO ENSURE
THE FINAL MEDICARE BILL INCLUDES
A MEANINGFUL INCREASE IN
MEDICARE-PLUS CHOICE -- THE
PREDECESSOR TO MEDICARE
ADVANTAGE -- FUNDING IN FISCAL
YEARS 2004 AND 2005.
WHILE THE SENATE BILL MAKES A
MODEST STEP TOWARD THIS GOAL, WE
HOPE THE STRONGER PROVISIONS IN
THE HOUSE BILL WILL BE PRESERVED
IN CONGRESS.
FOR NEARLY 5 MILLION MEDICARE
BENEFICIARIES ACROSS AMERICA,
MEDICARE-PLUS CHOICE, THE
PREDECESSOR, IS AN ESSENTIAL
PROGRAM THAT PROVIDES
HIGH-QUALITY, COMPREHENSIVE
AFFORDABLE HEALTH COVERAGE.
THESE SENIORS AND DISABLED
AMERICANS HAVE VOLUNTARILY
CHOSEN TO RECEIVE THEIR HEALTH
COVERAGE THROUGH MEDICARE
H.M.O.'S AND OTHER PLANS BECAUSE
OF THEIR EXCELLENT VALUE.
TO PRESERVE THIS IMPORTANT
OPTION FOR SENIORS ACROSS THE
COUNTRY, BIPARTISAN LEGISLATION
WAS INTRODUCED IN THE SENATE AS
S. 509, THE MEDICARE-PLUS CHOICE
EQUITY AND ACCESS ACT.
THAT BECAME MEDICARE ADVANTAGE.
COSPONSORS BY SENATORS SCHUMER
AND SANTORUM, IT SOUGHT TO
INCREASE REIMBURSEMENT RATES AND
ADD NEW REIMBURSEMENT OPTIONS
FOR MEDICARE-PLUS CHOICE
PROGRAMS.
IF GOES ON TO MAKE A COMPELLING
CASE FOR WHAT BECAME FROM THAT
CONFERENCE AS MEDICARE ADVANTAGE
TO THE UTTER PLEASING OF
EVERYBODY WHO SIGNED THIS
LETTER.
AND, BY THE WAY, LET ME JUST
MENTION THE DEMOCRATS WHO SIGNED
THIS LETTER, WHO WANTED MEDICARE ADVANTAGE.
JOHN KERRY, ARLEN SPECTER,
DIANNE FEINSTEIN, JOE LIEBERMAN,
PATTY MURRAY, CHARLES SCHUMER,
FRANK LAUTENBERG, HILLARY RODHAM
CLINTON, RON WYDEN, MARK DAYTON,
MARY LANDRIEU, MARIA CANTWELL,
AND CHRISTOPHER DODD.
14 DEMOCRATS SIGNED THIS LETTER
ALONG WITH A NUMBER OF
BIPARTISAN REPUBLICANS WHO
BELIEVED THAT WE REALLY NEEDED
TO
AND NOW TO TAKE ADVANTAGE, OUR
COLLEAGUES ON THE OTHER SIDE
WANT TO DO AWAY WITH MEDICARE
ADVANTAGE EXCEPT IN FOUR STATES
THAT ARE FOR THE MOST PART
DEMOCRAT STATES, WHILE LEAVING
ALL THE OTHER 46 STATES HIGH AND DRY.
NOW LET ME JUST SAY THIS LETTER
IS IN RESPONSE -- WAS A LETTER
GIVEN TO THE MEDICARE
MODERNIZATION CONFERENCE
COMMITTEE.
THIS CONFERENCE COMMITTEE GAVE
THEM EVERYTHING THEY WANTED IN
MEDICARE ADVANTAGE.
THIS LEGISLATIVE GRANT OF POWER
GAVE THE SENATORS THE MEDICARE
ADVANTAGE PROGRAM WHICH NOW 11
MILLION SENIOR CITIZENS ENJOY
TODAY.
NOW THOSE ON THE LEFT WANT TO DO
AWAY WITH THIS IMPORTANT PROGRAM
THAT BENEFITS SENIORS AND
MINORITIES IN AN AMAZING SET OF WAYS.
WELL, I'M AGAINST THAT.
I HOPE OUR COLLEAGUES ON THE
OTHER SIDE WILL REALIZE WHAT
THEY'RE DOING.
IT JUST ISN'T RIGHT.
VISION CARE AND DENTAL CARE AND
SO MANY OTHER APPROACHES THAT
REALLY WORKED FOR THIS PROGRAM
WILL BE TAKEN AWAY FROM THESE PEOPLE.
AND THEY'RE GOING TO HAVE TO
SPEND $175 TO $200 A MONTH TO
GET WHAT THEY GOT FOR AN AVERAGE
OF ABOUT $54 A MONTH.
AND THESE ARE PEOPLE WHO NEED OUR HELP.
LET ME JUST CHANGE THE SUBJECT
FOR A MINUTE BECAUSE I
UNDERSTAND MY COLLEAGUE FROM
OREGON WAS DISCUSSING MEDICARE
ADVANTAGE AND TALKING
C.E.O.'S OF MECARE ADVANTAGE
COMPANIES LIVING -- QTE --
"HIGH OFF THE HOG" SAYING THAT
THAT IS A RATIONALE FOR $120
BILLION IN MEDICARE ADVANTAGE CUTS.
I HAVE TWO RESPONSES TO MY GOOD
FRIEND FROM OREGON: THIS IS NOT
ABOUT MEDICARE INSURANCE MPANY
C.E.O.'S.
THIS IS ABOUT PRESERVING THE
CHOICE OF COVERAGE FOR SENIORS.
THE PRESIDING OFFICER: THE
SENATOR HAS USED THE FIVE MINUTES.
MR. HATCH: I WOULD ASK FOR
ANOTHER TWO MINUTES.
THE PRESIDING OFFICER: IS
THERE OBJECTION?
MR. DODD: HOW MUCH TIME
REMAINS, MR. PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM IOWA CONTROLS 4
MINUTES AND 46 SECONDS.
THE SENATOR FROM CONNECTICUT, 14
MINUTES AND 43 SECONDS.
MR. DODD: WE HAVE 4 LEFT.
MR. HATCH: I'LL PUT THE REST
OF MY REMARKS IN THE RECORD.
THE PRESIDING OFFICER: WHO
YIELDS TIME?
MR. DODD: FOUR MINUTES TO THE
SENATOR FROM MICHIGAN. THE PRESIDING OFFICER: THE
SENATOR FROM MICHI
RECOGNIZED FOR FOUR MINUTES.
MS. STABENOW: THANK YOU, MR. PRESIDENT.
I HAVE AN AMENDMENT THAT WILL BE
SENT TO THE DESK PURSUANT TO THE CONSENT AGREEMENT.
I WOULD NOW CALL UP MY AME 2899.
THE PRESIDING OFFICER: THE
CLERK WILL REPORT.
THE CLERK: THE SENATOR FROM
MICHIGAN, MS. STABENOW, PROPOSES
AN AMENDMENT NUMBERED 2899.
AT THE APPROPRIATE PLACE INSERT
THE FOLLOWING: SECTION, NO CUTS
IN GUARANTEED BENEF
NOTHING IN THIS
MS. STABENOW: I WOULD ASK THAT
THE AMENDMENT BE CONSIDERED
READ.
THE PRESIDING OFFICER: WITHOUT OBJECTION.
MS. STABENOW: THANK YOU,
MR. PRESIDENT.
MR. PRESIDENT, THIS IS A VERY
IMPORTANT AMENDMENT TO CLARIFY
ONCE AGAIN THAT WE ARE NOT
CUTTING ANY MEDICARE BENEFITS.
WE ARE NOT CUTTING ANY OF THE
GUARANTEED MEDICARE BENEFITS
THAT PEOPLE RECEIVE RIGHT NOW.
IN FACT, AARP WHO HAS BEEN
SAYINGHIS ON
FOR MONTHS HAS RELEASED A LETTER
NOW, AND IT QUOTES THIS
SENTENCE: "MOST IMPORTANTLY,
THE LEGISLATION DOES NOT REDUCE
ANY GUARANTEED MEDICARE
BENEFITS."
NOT ONLY AARP, BUT THE
ASSOCIATION FOR THEROTECTION
OF MEDICARE AND SOCIAL SECURITY,
ALLIANCE FOR RETIRED AMERICANS,
AND OTHER SENIOR ORGANIZATIONS
ALL AGREE.
WHAT WE ARE TALKING ABOUT IS
SAVING MEDICARE, MR. PRESIDENT.
CUTTING DOWN ON OVERPAYMENTS
THAT HAVE BEEN IN PLACE.
RIGHT NOW THE 80% TO 85% OF THE
SENIORS THAT GET THEIR BENEFITS,
THEIR HEALTH CARE THROUGH
TRADITIONAL MEDICARE ARE PAYING
MORE IN PREMIUMS, ACCORDING TO
THE CONGRESSIONAL BUDGET OFFICE,
THAN THEY OTHERWISE WOULD
BECAUSE MEDPAC ESTIMATES THAT WE
ARE PAYING ABOUT $12 BILLION
MORE FOR PEOPLE IN THE PRIVATE
FOR-PROFIT INSURANCE SYSTEM
RIGHT NOW THAT'S CALLED MEDICARE
ADVANTAGE.
SO THE MAJORITY OF SENIORS ARE
SUBSIDIZING HIGH INSURANCE
COMPANY PROFITS AND OVERPAYMENTS.
WHAT WE HAVE DONE IN THIS BILL
IS TAKE OUT THE OVERPAYMENTS AND
IN FACT PUT IN COMPETION,
COMPETITIVE BIDDING.
I THOUGHT THAT'S SOMETHING THAT
OUR COLLEAGUES ON THE OTHER SIDE
OF THE AISLE SUPPORTED.
COMPETITIVELY BIDDING FOR
REIMBURSEMENT SO WE'RE NOT
CONTINUING THE OVERPAYMENTS IN
MEDICARE ADVANTAGE THAT ARE
CAUSING MEDICARE TO GO BROKE
MORE SOONER AND CAUSING THE
MAJORITY OF SENIORS TO SUBSIDIZE
HIGH INSURANCE COMPANY PROFITS.
WHAT WE ARE SEEING ON THE
EFFORT, UNFORTUNATELY, FROM MY
FRIENDS ON THE OTHER SIDE OF THE
AISLE IS AN EFFORT TO SUPPORT
HUGE SUBSIDIES INSTEAD OF
SUPPORTING COMPETIVE BIDDING
THAT IS IN THE BILL.
THE REALITY IS, MR. PRESIDENT,
THAT THE GUARANTEED BENEFITS,
INPATIENT CARE, DOCTOR
LAB TESTS, PREVENTIVE
SCREENINGS, SKILLED NURSING
FACILITIES, HOME HEALTH CARE,
PRESCRIPTION DRUGS, AMBULANCE
SERVICES, DURABLE MEDICAL
EQUIPMENT, EMERGENCY ROOM CARE,
KIDNEY DIALYSIS, OUTPATIENT
MENTAL HEALTH CARE, OCCUPATIONAL
AND PHYSICAL THERAPY, IMAGING
LIKE X-RAYS.
E.K.G.'S, ORGAN
ALL COVERED AS THEY HAVE BEEN
FOR ALL MEDICARE BENEFICIARIES.
WHAT WE ARE DOING IS TAKING
OVERPAYMTS TO FOR-PROFIT
INSURANCE COMPANIES AND PUTTING
THAT BACK INTO INCREASED
BENEFITS FOR EVERY SENIOR,
CUTTING DOWN ON PRESCRIPTION
DRUG COSTS BY KHROEGS THE
DOUGH -- CLOSING THE
HOLE AND STRENGTHENING
PREVENTIVE CARE, AND THE MOST
IMPORTANT PIECE OF ALL
LENGTHENING THE SOLVENCY OF THE
MEDICARE TRUST FUND.
I WOULD URGE THE ADOPTION OF
AMENDMENT AT THE APPROPRIATE TIME.
THANK
YOU.
THE PRESIDING OFFICER: WHO
YIELDS TIME?
MR. GRASSLEY: MR. PRESIDENT, I
YIELD TWO MINUTES TO THE SENATOR
FROM THE PRESIDING OFFICER: THE
SENATOR FROM FLORIDA'S
RECOGNIZED.
A SENATOR: MR. PRESIDENT?
-- MR. PRESIDENT, I'D LIKE TO
ASK UNANIMOUS CONSENT --
MR. LeMIEUX AND IF MY
COLLEAGUE FROM MICHIGAN,
CONCERNING HER AMENDMENT.
THIS AMENDMENT, THAT I'VE BEEN
REVIEWING, IT'S VERY IMPORTANT
TO THE PEOPLE OF FLORIDA,
BECAUSE IT HAS TO DO WITH
MEDICARE ADVANTAGE.
AND MEDICARE ADVANTAGE IS A VERY
IMPORTANT PROGRAM.
AND IT ISOT JUST SOME EXTRA FRILS.
THE IDEA THAT -- FRILLS.
THE IDEA THAT OUR FOLKS IN
FLORIDA CAN GET EYE CARE,
HEARING CARE, DIABETIC SUPPLIES.
LAST WEEK I WENT DOWN TO A
MEDICARE ADVANTAGE CLINIC, THESE
ARE WONDERFUL PLACES WHERE OUR
SENIORS ARE GETTING WHO
WILLISTIC HEALTH CARE --
HOLLISTIC HEALTH CARE.
I THINK THIS IS TO GUARANTEE THE
BENEFITS IN MEDICARE ADVANTAGE.
I'M NOT SURE IT IS PHRASED THAT
WAY.
I'VE BEEN READING THE BILL.
ACT.
AND I CANNOT FIND THE PHRASE,
"GUARANTEED BENEFITS."
I WOULD ASK UNANIMOUS CONSENT,
MR. PRESIDENT, THAT THE
GUARANTEE BY LAW PHRASE IN THIS
AMENDMENT FROM MY COLLEAGUE FROM
MICHIGAN BE ELIMINATED SO THAT
WE WOULD ENSURE THAT BENEFITS OF
EYE CARE, DENTAL CARE,
PREVENTIVE CARE, DIABETIC
SUPPLIES, ALL OF THE THINGS
SUPPLIED IN THE MEDICARE
ADVANTAGE ARE ACTUALLY PRESERVED.
NO ONE IS OBJECTING TO LOWER COSTS.
NO ONE'S OBJECTING TO A
COMPETITIVE SITUATION WHERE WE
HAVE THESE COMPANIES PROVIDING
MORE SERVI
BUT WE WANT TO MAKE SURE THAT
THE SERVICES ARE STILL THERE.
I WOULD ASK UNANIMOUS CONSENT
TO HAVE THAT PHRASE GUARANTEED
BY LAW TO BE ELIMINATED FROM THE
AMENDMENT.
THE PRESIDING OFFICER: IS THERE
OBJECTION? MS. STABENOW: RESERVING THE
RIGHT TO
THE PRESIDING OFFICER: T
SENATOR'S TIME HAS EXPIRE.
IS THERE OBJECTION?
MS. STABENOW: RESERVING THE
RIGHT TO OBJECT.
I WOULD ASK THAT MY COLLEAGUE --
WE WERE HAPPY TO TALK ABOUT HOW
WE MIGHT ADDRESS WHAT HE'S
CONCERNED ABOUT, BUT,
UNFORTUNATELY, THE REALITY IS
THAT THE FOR-PROFIT COMPANIES
ARE OBJECTING TO COMPETIVE
BIDDING.
AND THE LANGUAGE THAT MY
COLLEAGUE HAS SUGGESTED, WOULD
INCLUDE ITEMS THAT HAVE BEEN
OFFERED TO GET PEOPLE IN
FOR-PROFIT PLANS, LIKE GYM
MEMBERSHIPS AND OTHER THINGS
THAT HAVE BEEN OF GREAT CONCERN.
AND,
HAVE TO OBJECT AT THIS POINT. THE PRESIDING OFFICER: OBJECTION
IS HEARD.
WHO YIELDS TIME?
THE SENATOR FROM OHIO IS RECOGNIZED.
MR. BROWN: THANK YOU, MR. PRESIDENT.
THANK YOU, SENATOR HARKIN.
I WATCHED FROM MY OFFICE ON
C-SPAN AND THEN ON THIS FLOOR
COUNT -- BEEN ON THIS FLOOR
COUNTLESS TIMES IN THE LAST
THREE OR FOUR DAYS, LISTENING TO
MY
THE AISLE CONTINUE TO DO THE
BIDDING OF THE INSURANCE COMPANIES.
AND, YOU KNOW, I HEAR THEM TALK
ABOUT MEDICARE ADVANTAGE, HOW
I WAS HERE, I WAS IN THE HOUSE
OF RRENTATIVES 10 YEARS AGO
WHEN
WHEN THE INSURANCE COMPANY SAID,
WE CAN SAVE MEDICARE 5% ON ALL
OF ITS COSTS BY BRINGING FORWARD
MEDICARE ADVANTAGE.
WELL, THEN WHEN THE REPUBLICANS
TOOK CONTROL OF EVERYTHING, THAT
SAVING 5%, THE INSURANCE
COMPANIES DECIDED, NO, WE CAN'T
SAVE 5% ANYMORE.
WE NEED A 13% BONUS.
THE CHICKENS HAVE COME HOME TO
ROOST F COMPANIES.
AN ARTICLE IN THE DOW JONES
STORY, ENTITLED HUMANA THIRD
QUARTER PROFITS
STRONG MEDICARE ADVANTAGE GAINS.
LET ME EXCERPT FROM THE FIRST
FEW PARAGRAPHS.
HUMANA'S FIRST THIRD QUARTER
EARNINGS ROSE 65%.
THE
FORECAST WHICH THE PROTECTS
SUBSTANTIAL MEDICARE ADVANTAGE
MEMBERSHIP GROWTH RESULTING I
IN $32 TO $34 BILLION, WELL
ABOVE THE ESTIMAT OF $29.6 BILLION.
TH
ACCOUNT REDUCTIONSF MEDICARE
ADVANTAGE
AS THE SENATOR FROM RHODE ISLAND
KNOWS AND SENATOR HARKIN
SENATOR STABENOW, ALL STRONG
SUPPORTERS OF MEDICARE.
WHEN WE SEE PEOPLE WHO OPPOSE
MEDICARE AND POSED THE CREATION
40 YEARS A.
THEY TRIED TO PRIVATIZE MEDICARE
WITH SPEAKER GINGRICH DOWN THE
HOWL IN THE HOUSE OF
REPRESENTATIVES A DOZEN AGO.
NOW THEIR MEDICARE'S BIGGEST
DEFENDERS, I DON'T THINK SO.
WHAT THEY HAVE BEEN IS THE
INSURANCE INDUSTRY'S BIGGEST DEFENDERS.
THAT'S REALLY WHAT THAT DEBATE
THE LAST THREE DAYS WAS ALL ABOUT.
WHAT'S IMPORTANT IS WE GUARANTEE
MEDICARE SERVICES AS WE WILL.
WE QUIT SUBSIDIZING INSURANCE
COMPANIES, AS WE SHOULD QUIT SUBSIDIZING THEM.
AN THEN THAT $90 TAX THAT EVERY
MEDICARE BENEFICIARY HAS TO PAY,
THAT $90 -- THAT $90 THAT GOES
TO INSURANCE SUBSIDI
TAKEN AWAY.
REGULAR MEDICARE MEMBERS, 81%,
82% OF MEDICARE BENEFICIARIES
WON'T PAY BE THE -- PAY THE
INSURANCE COMPANY REPUBLICAN TAX
THAT THEY HAD
SUBSIDIES TONSURANCE COMPANIES WERE INCREASED.
WE NEED TO GET THE BILL
THE
THE PRESIDING OFFICER: WHO WILL
YIELD TIME?
THE SENATOR FROM IOWA CONTROLS
SIX MINUTES
THE SENATOR FROM IOWA CONTROLS
TWO MINUTES AND 24 SECONDS.
MR. GRASSLEY: SENATOR CORKER HAS
ASKED
I YIELD -- ONE MINUTE. I YIELD IT.
THE PRESIDING OFFICER: THE
SENATOR FROM TENNESSEE IS RECOGNIZED.
MR. CORKER: THANK YOU, MR. PRESIDENT.
INTERESTING TO HEAR MY FRIEND
FROM OHIO A MINUTE AGO.
I WANT TO SAY THAT I PLAN T
SUPPORT THE HATCH AMENDMENT REGARDING MEDICARE ADVANTAGE.
BUT IT'S NOT BECAUSE THAT I
DON'T BELIEVE WE NEED TO DO SOME
THINGS TO CAUSE MEDICARE TO BE
MORE SOLVENT.
AND I DO BELIEVE THAT MEDICARE
ADVANTAGE DOES HAVE SOME
SUBSIDIES TO INSURANCE COMPANIES
THAT ARE HIGHER THAN THEY SHOULD
BE.
THE FACT IS, THOUGH, THAT THIS
BILL IS TAKING MONEY FROM A
PROGRAM THAT IS INSOLVENT,
MEDICARE, AND USING THAT TO CREATE AN ENTITLEMENT.
SO I'M GOING TO SUPPORT THE
HATCH AMENDMENT EVEN THOUGH I
WOULD LOOF TO WORK WITH -- LOVE
TO WORK WITH MY FRIENDS ON THE
OTHER SIDE OF THE AISLE TO DO
THOSE THINGS TO MAKE MEDICARE
MORE SOLVENT.
BUT I THINK WHAT IS SO
OBJECTIONABLE TO ALL OF US IS TO
KNOW THAT WE HAVE AN INSOLVENT
MEDICARE PROGRAM THAT THE
TRUSTEES HAVE SAID WILL BE
BANKRUPT IN THE YEAR 2017 AND MY
FRIENDS ON THE OTHER SIDE OF THE
AISLE ARE TAKING MONEY FROM THE
PROGRAM TO LEVERAGE A NEW ENTITLEMENT.
THANK YOU, MR. PRESIDENT. THE PRESID
YIELDS TIME?
THE SENATOR FROM ILLINOIS.
MR. DUIN: CHOICE.
WILL WE CONTINUE TO SUBSIDIZE PRIVATE HEALTH INSURANCE
COMPANIES WHO ARE OVERCHARGING
THE MEDICARE PROGRAM BY 14%?
WILL WE TAKE THAT MONEY OUT OF
MEDICARE TO CONTINUE THE SUBSIDY
FOR PROFITABLE, PRIVATE HEALTH
INSURANCE COMPANIES?
IT IS THAT BASIC.
I WOULD SAY TO THE SENATOR FROM
TENNESSEE,
BUDGET OFFICE TELLS US, YES,
UNTOUCHED THE MEDICARE PROGRAM
IN SEVEN
IN-- FACES INSOLVENCY.
BUT
SOLVENCY TO MEDICARE RIGHT OFF THE TOP.
RIGHT OFF THE TOP, FIVE MORE
YEAR
SOMETHING THAT YOU WON'T
ACKNOWLEDGE, BUT YOU SHOULD.
LET ME ALSO ADD, IF WE'RE GOING
TO BRING DOWN THE COST OF
MEDICARE SO THAT RECIPIENTS GET
QUALITY CARE, WE
OF THE OUTRAGEOUS SUBSIDIES TO
PRIVATE HEALTH INSURANCE
COMPANIES, THE MEDICARE
ADVANTAGE PROGRAM.
WE ALSO HAVE TO BE HONEST ABOUT
THOSE PROVIDERS OVERCHARGING
MEDICARE.
WHY DOES IT COST TWICE AS MUCH
IN MIAMI FOR THE SAME SERVICES
THAT GIVEN TO MEDICARE PATIENTS
IN ROCHESTER, MINNESOTA?
IT SHOULDN'T.
SOMEBODY'S RIPPING OFF THE SYSTEM.
IF WE CAN'T ASK THOSE HONEST
QUESTIONS, THEN'M AFRAID WE'RE
NOT GOING TO PUT MEDICARE ON
SOUND FINANCIAL FOOTING.
WE CAN DO THAT.
BUT WE CAN'T DO THAT BY SAYING
WE HAVE TO CONTINUE TO SUBSIDIZE
PRIVATE HEALTH INSURANCE
COMPANIES OUT OF MEDICARE.
THAT'S THE AMENDMENT.
I YIELD THE FLOOR.
THE PRESIDING OFFICER: WHO
YIELDS TIME?
THE SENATOR FRO
THE TIME.
FIVE MINUTES.
THE SENATOR FROM RHODE ISLAND IS
RECOGNIZED.
MR. WHITEHOUSE: I THANK THE
DISTINGUISHED SENATOR FROM IOWA
FOR THE RECOGNITION.
I WOULD MAKE ONE P
MINUTES, WHICH IS THAT THOSE OF
US WHO HAVE BEEN PRIVILEGED TO
HEAR OUR FRIENDS ON THE OTHER
SIDE DEBATE THE PUBLIC OPTION
HAVE SEEN A RELENTLS
INSISTENCE ON THE PUBLIC OPTION
OPERATING ON A LEVEL PLAYING
FIELD WITH THE PRIVATE INSURANCE
INDUSTRY.
I CAN'T TELL THE NUMBE
INDEED, EVEN WHEN WE DESIGNED
THE PUBLIC OPTION S
OPERATE ON A LEVEL PLAYING FIELD
WITH PRIVATE INSURANCE INDUSTRY,
THEY STILL COMPLAINED.
BUT NOW WE HAVE A SITUATION IN
WHICH WE HAVE PRIVATE INDUSTRY
OPERATING AT A 14% ADVANTAGE IN
SUBSIDY AGAINST MEDICARE.
AND SUDDENLY THE OTHER SIDE'S
INTEREST IN A LEVEL PLAYING
FIEL
SUDDENLY THEIR INTEREST IS IN
DOING WHAT IS, ONCE AGAIN, IN
THE ASTONISHING COINCIDENCE
CHARACTERIZED THIS DEBATE IN THE
INTEREST OF THE INSURANCE INDUSTRY.
I HAVE YET TO SEE AN ARGUMENT
MADE BY THE OTHER -- FROM THE
OTHER SIDE OF THE AISLE THAT
DOESN'T HAPPEN TO COINCIDE WITH
THE INTEREST OF THE INSURANCE INDUSTRY.
IT COULD NOT BE MORE STARK ON
THIS POINT.
IF IT'S A PUBLIC OPTION, THEY
WANT TO COMPETE ON A LEVEL
PLAYING FIELD.
EVEN THEN THEY'RE AGAINST IT.
IF IT'S PRIVATELY SUBSIDIZED
COVERAGE GETTING ADVANTAGE IN
THE SYSTEM, THEN F
THAT WE SUPPORT THE EFFORTS TO
BRING SOME DISCIPLINE TO
MEDICARE ADVANTAGE AS THE
PRIVATE INSURANCE INDUSTRY
PROMISED.
THEM TO THEIR
I YIELD THE FLOOR.
THE PRESIDING OFFICER: WHO
YIELDS TIME
THE SENATOR FROM TEXAS IS RECOGNIZED.
MRS. HUTCHISON: MR. PRESIDENT, I
ASK UNANIMOUS CONSENT TO SUBMIT
SENATOR KYL'S REMARKS FOR THE RECORD.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MRS. HUTCHISON: I YIELD 30
SECONDS TOENATOR THE PRESIDING OFFICER: THE
SENATOR FROM ARIZONA. MR. McCAIN: MR. PRESIDENT, I
UNDERSTAND THAT THE SENATOR
PENNSYLVANIA, SENATOR CASEY, HAS
AN AMENDMENT TO TWEND
TWEND $2.5 BILLION TO PROTECT
MEDICARE BENEFITS FOR PENNSYLVANIANS.
WHAT'S GOING ON.
WHY CAN'T WE PROTECT EVERY CITIZEN.
THAT'S FIVE STATES PROTECTED AND
SPENDING EXTRA DOLLARS.
LET'S HAVE AN AMENDMENT THAT
EVERY STATE IS TREATED THE SAME.
LET'S DO THAT.
I TELL MY COLLEAGUES I INTEND TO
INTRODUCE AN AMENDMENT THAT WILL
DO SO D THAT WILL TAKE AWAY
THE SPECIAL EXCEPTIONS THAT ARE
TAKEN FOR SPECIAL STATES WHO
HAVE
HERE.
MRS. HUTCHISON: MR. PRESIDENT,
JUST TO PUT THIS
PERSPECTIVE.
WHEN I HEAR ALL OF THIS DEBATE,
IT'S LIKE EVERYTHING HAS TO B
MORE GOVERNMENT, BIGGER
GOVERNMENT, GOVERNMENT IS BETTER
THAN THE
MR. PRESIDENT, MEDICARE
ADVANTAGE IS AN OPTION.
IT'S NOT A MANDATE.
IT'S AN OPTION THAT ALLOWS
SENIORS ANOTHER CHOICE TO GET
HEARING AIDS.
MR. PRESIDENT,
SENIORS HAVE AN OPTION.
WE NEED MORE COMPETION, NOT
LESS.
THANK YOU, PURCHASE.
AND I -- MR. PRESIDENT, AND I YIELD THE TIME.
THE PRESIDING OFFICER: WHO
YIELDS TIME?
MR. HARKIN: HOW MUCH TIME IS LEFT?
THE PRESIDING OFFICER: 2 1/2
MINUTES.
MR. HARKIN: MR. PRESIDENT, IT'S
INTERESTING TO HEAR THE LAST
SPEAKER SAY, DON'T TAKE AWAY THE
OPTION FOR SENIORS ON MEDICARE
ADVANTAGE.
YET, THEY HAVE AN AMENDMENT TO
TAKE AWAY THE OPTION FOR PEOPLE
TO BUY INSURANCE AGAINST HAVING
A DISABILITY SO THEY CAN STAY
THEIR OWN HOMES AND HAVE SUPPORT.
IT'S VOLUNTARY.
IT'S NOT MANDATORY.
NONE'S FORCING ANYBODY TO DO
ANYTHING M
FROM TEXAS, YET, THERE'S AN
AMENDMENT ON THAT SIDE TO TAKE
THAT AWAY.
TO TAKE AWAY THAT VOLUNTARY
PROGRAM, THE CLASS ACT, S THAT
PEOPLE CAN VOLUNTARILY PUT MONEY
INTO IT TO PROTECT THEMSELVES
AGAINST FUTURE
SO I -- LET'S KIND OF KEEP OUR
ARGUMENTS A LITTLE BIT STRAIGHT
AROUND HERE.
MR. PRESIDENT, A LOT OF PEOPLE
HAVE TALKED ABOUT MEDICARE
ADVANTAGE.
I'M GOING TO CLOSE ON THE
NECESSITY OF KEEPING THE CLASS
ACT IN THIS BILL.
I'VE SPOKEN MANY TIMES ABOUT THAT.
'S NOT PARTISAN ISSUE.
IT'S LIKE WHEN WE PASSED THE
AMERICANS WITH DISABILITIES ACT.
IT WAS NOT A PARTISAN ISSUE.
THIS SHOULD NOT BE A PARTISAN ISSUE.
WE SHOULD NOT L
INVOLVED IN IT.
OVER 275 GROUPS REPRESENTING
GROUPS FROM DISABILITIES, TO THE
INTERFAITH COALITION SUPPORT THE
CLASS ACT.
IT WAS UNANIMOUSLY ADOPTED BY
THE "HELP" COMMITTEE,
UNANIMOUSLY ADOPTED BY
REPUBLICANS AND DEMOCRATS.
SENATOR GREGG OFFERED AN
AMENDMENT TO MAKE -- INSIST THAT
IT BE YEARS.
AND IT IS ACTUARIALLY SOUND OVER
75 YEARS.
SECRETARY SEBELIUS HAS SUPPORTED
IT
BROAD BASE OF SUPPORT FOR THE
CLASS ACT.
MR. PRESIDENT, TODAY WE RECEIVED
SOME LETTERS FROM PEOPLE AROUND
THE COUNTRY.
I DON'T HAVE TIME TO READ THEM
ALL, BUT JUST A COUPLE MUCH
HERE'S ONE FROM -- COUPLE.
HERE'S ONE FROM ARKANSAS.
MY WIFE HAS A JOURNALISM DEGREE,
CEREBRAL PALSY
FROM STATE OF ARKANSAS WITH A
STAY-AT-HOME JOB.
SHE CAN STILL EARN MONEY UNDER
THE CLASS A
OF AN ATTENDANT RATHER THAN
HAVING TO GO TO A NURSING HOME.
HERE'S VIRGINIA, I DON'T
CURRENTLY NEED THE SERVICES
UNDER THE CLASS ACT, BUT HAVING
BEEN BORN WITH A DISABILITY, I
HAVE ALWAYS BEEN ACUTELY AWARE
OF THE POSSIBILITY OF SERIOUS
ISSUES DOWNS THE -- DOWN THE
ROAD.
IT WOULD BE A GOOD THING FOR ME,
A 30-YEAR-OLD WORKING PERSON TO
BE ABLE TO PUT SOME MONEY AWAY.
I BEG MY COLLEAGUES FOR THE SAKE
OF PEOPLE WITH DISABILITIES IN
THE AMENDMENT OF THE REPUBLICANS
TO TAKE AWAY THE CLASS ACT.
IT WAS SENATOR KENNEDY'S PREMIER GOAL --
THE PRESIDING OFFICER: THE SENATOR'S TIME HAS EXPIRED.
ALL TIME HAS EXPIRED.
UNDE
QUESTION OCCURS ON AMENDMENT
NUMBER 2870, OFFERED BY THE
SENATOR FROM RHODE ISLAND, MR. WHITEHOUSE.
IS THERE A SUFFICIENT
THERE APPEARS TO BE A SUFFICI SECOND.
THE YEAS AND NAYS ARE ORDERED.
THE CLERK WILL CALL THE ROLL.
VOTE:
THE PRESIDING OFFICER: ARE
THERE ANY SENATORS WHO WISH TO
VOTE OR CHANGE THEIR VOTE?
IF NOT, ON THIS VOTE THE YEAS
ARE 98.
THE NAYS ARE ZERO.
UNDER THE PREVIOUS ORDER
REQUIRING 60 VOTES FOR THE
ADOPTION OF THIS AMENDMENT, THE
AMENDMENT IS AGREED TO.
THE SENATE WILL
THE SENATE WILL COME TO ORDER.
PLEASE REMOVE CONVERSATIONS OFF
THE FLOOR.
MRS. HUTCHISON:
PARLIAMENTARY INQUIRY?
ARE THE
TEN-MINUTE VOTES?
THE PRESID
SENATOR FROM TEXAS IS CORRECT.
THEEXT THREE VOTES ARE
TEN-MINUTE VOTES.
MRS. HUTCHISON: THANK YOU.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
UNDER THE PREVIOUS ORDER, THERE
ARE TWO
WHO YIELDS TIME?
THE SENATE WILL COME TO ORDER.
UNDER THE PREVIOUS ORDER, THERE
ARE TWO MINUTES EQUALLY DIVIDED.
WHO YIELDS TIME?
MR. DODD:
THE PRESIDING OFFICER: THE
SENATOR FROM CONNECTICUT.
MR. DODD: MR. PRESIDENT, I
URGE MY COLLEAGUES TO SUPPORT
THE CLASS ACT AND TO VOTE
AGAINST THE, I BELIEVE IT IS THE THUNE AMENDMENT WHICH WOULD
STRIKE THE CLASS ACT FROM THE BILL.
AS YOU HEARD, I HOPE, THIS
AFTERNOON, THIS BILL IS TOTALLY
VOLUNTARY.
THERE IS NO REQUIREMENT BY
EMPLOYERS OR EMPLOYEES TO BE
INVOLVED IN THIS.
THIS IS A VERY C
USING INDIVIDUALS' MONEY TO
CONTRIBUTE TO THEIR OWN
LONG-TERM FINANCIAL SECURITY IF
THEY'RE FACED WITH DISABILITIES.
WE HAVE NOW, WITH THE ADOPTION
OF
SECURED THAT THESE FUNDS CAN
NEVER BE USED FOR ANY OTHER
PURPOSE THAN FOR THE CLASS ACT.
THAT WAS THE CONCERN MOST OF OUR
FUNDS DRIFT OFF.
AS A RESULT OF THE GREGG
AMENDMENT IOUR COMMITTEE, IT
HAS BEEN DETERMINED THESE
PROGRAMS WILL BE ACTUARIALLY
SOUND FOR 75 YEARS.
WE FIX
RAISED WITH IT.
IT IS A SOLID PROGRAM THAT CAN
MAKE A HUGE DIFFERENCE FOR
MILLIONS OF AMERICANS, ALLOWING
THEM TO LEAD INDEPENDENT LIVES
WITH DIGNITY.
IT IS DESERVING OF OUR SUPPORT.
I URGE APPROVAL OF THIS PROGRAM.
YIELDS TIME?
MR. THUNE: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM SOUTH
THE PRESIDING OFFICER:
MR. PRESIDENT, THE CLASS --
MR. THUNE: MR. PRESIDENT, THE
CLASS ACT IS THE SAME OLD
WASHINGTON, SAME OLD SMOKE AND
MIRRORS, SAME OLD GAMES.
I WANT TO READ WHAT THE CONGRESSIONAL BUDGET OFFICE AND
THE
ADMINISTRATION SAID.
"THE PROGRAM WOULD ADD TO FUTURE
FEDERAL BUDGET DEFICITS IN LARGE
AND GROWING
MR. PRESIDENT, IF WE DON'T TAKE
THIS OUT OF THIS LEGISLATION, WE
ALLOW THIS TO BECOME LAW, WE ARE
LOCKING IN FUTURE GENERATIONS TO
DEFICITS AND DEBT AS FAR AS THE
EYE CAN SEE.
THIS IS, AS HAS BEEN DESCRIBED
BY THE OTHER SIDE, A PONZI
SCHEME OF THE HIGHEST ORDER.
WE NEED TO TAKE IT OUT OF THIS
BILL.
I URGE MY COLLEAGUES TO ADOPT
THIS AMENDMENT.
THE PRESIDING OFFICER:
THE PREVIOUS ORDER, THE QUESTION
IS ON THE AMENDMENT NUMBER 2901
OFFERED BY THE SENATOR FROM
THE YEAS AND NAYS HAVE BEEN REQUESTED.
ARE THERE SUFFICIENT SONDS?
THERE APPEARS TO BE A SUFFICIENT
SECOND.
THE CLERK WILL CALL THE
VOTE:
THE PRESIDING OFFICER: ARE THERE ANY SENATORS IN THE
CHAMBER WISHING TO VOTE OR
CHANGE THEIR VOTE?
IF NOT, ON THIS VOTE, THE YEAS
ARE 51, THE NAYS ARE 47.
UNDER THE PREVIOUS ORDER
REQUIRING 60 VOTES FOR THE
ADOPTION OF THIS AMENDMENT, THE
AMENDMENT IS WITHDRAWN.
WITHOU
UNDER THE PREVIOUS ORDER, THERE
ARE TWO
WHO
THE
THE SENATOR FROM MICHIGAN.
MS. STABENOW: THANK YOU,
MR. PRESIDENT.
THIS AMENDMENT IS VERY CLEAR.
MY AMENDMENT STATES THAT NOTHING
IN THIS ACT SHALL RESULT IN THE
REDUCTION OR ELIMINATION OF ANY
BENEFITS GUARANTEED BY LAW TO
PARTICIPANTS IN MEDICARE
ADVANTAGE PLANS.
MR. PRESIDENT, RIGHT NOW C.B.O.
TELLS US $12 BILLION EXTRA --
THE PRESIDING OFFICER: THE
SENATOR WILL SUSPEND.
THE SENATE WILL COME TO ORDER.
PLEASE REMOVE YOUR CONVERSATIONS
OFF THE FLOOR SO THE SENATOR
FROM MICHIGAN CAN BE HEARD.
THE SENATOR FROM MICHIGAN. MS. STABENOW: THANK YOU,
MR. PRESIDENT.
MR. PRESIDENT, RIGHT NOW WE
UNDERSTAND FROM MEDPAC THAT
THERE'S $12 BILLION IN
OVERPAYMENTS TO FOR-PROFIT
INSURANCE COMPANIES THAT ARE
ADDITIONAL COSTS THAT WE PAY --
THE TAXPAYERS, MEDICARE
RECIPIENTS PAY -- BEYOND WHAT IS
TRADITIONAL MEDICARE.
85% OF OUR SENIORS --
MR. BAUCUS: MR. PRESIDENT, THE
SENATE IS NOT IN ORDER.
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA IS CORRECT.
PLEASE TAKE YOUR CONVERSATIONS
OFF THE FLOOR SO THAT THE
SENATOR FROM MICHIGAN CAN BE
HEARD AND ALSO THAT OTHER
SENATORS
THE SENATOR FROM MICHIGAN. MS. STABENOW: THANK YOU,
MR. PRESIDENT.
85% OF THE SENIORS IN MEDICARE
ARE IN TRADITIONAL MEDICARE, AND
RIGHT NOW WE'RE TOLD THAT EVERY
SINGLE SENIOR CITIZEN AND PERSON
WITH DISABILITY IN MEDICARE PAYS
$90 EXTRA, EVE
$90EXTRA TO PAY FOR THE
OVERPAYMENTS TO PRIVATE,
FOR-PROFIT INSURANCE COMPANIES.
AS AARP HAS SAID THIS
LEGISLATION DOES NOT REDUCE ANY
GUARANTEED MEDICAL BENEFITS.
ALL WE ARE DOING IS ASKING FOR
COMPETITIVE BIDDING FOR-PROFIT
CONDITIONS, COMPETIVE BIDDING,
BRING DOWN THE OVERAT E SAME OVERPAYMENTS AND
I WOULD ASK FOR SUPPORT SPONSOR
THE AMENDMENT. THAN
THE PRESIDING OFFICER: WHO
YIELDS TIME?
MR. LeMIEUX: MR. PRESIDENT?
THE PRESIDING OFFICER:
SENATOR FROM FLORIDA.
MR. LeMIEUX: THIS
MR. PRESIDENT, I HAD A
CONVERSATION WITH MY COLLEAGUE
FROM MICHIGAN, THE PHRASE IN
HERE "GUARANTEED BY LAW" DOESN'T GUARANTEE ANYTHING.
THIS ISN'T GOING TO PROTECT THE
BENEFITS OF MEDICARE ADVANTAGE.
THE BENEFITS THAT OUR SENIOR
CITIZENS ENJOY -- I CARE,
HEARING CARE, DENTAL CARE --
THEY'RE NOT PROTECTED BY THIS.
YOU CAN VOTE FOR IT IF YOU WANT TO.
IT SOUNDS GOOD BUT IT'S JUST
GIFT WRAPPING ON AN EMPTY BOX. THE PRESIDING OFFICER: UNR
THE PREVIOUS ORDER, THE QUESTION
OCCURS ON AMENDMENT NUMBER 2899,
OFFERED BY THE SENATOR FROM
THE YEAS AND NAYS HAVE BEEN ORDERED.
IS THERE A SUFFICIENT SECOND?
THERE APPEARS TO BE AUFFICIENT
SECOND.
THE YEAS AND NAYS
THE CLERK WILL CALL THE ROLL.
VOTE:
THE PRESIDING OFFICER: ARE THERE
MY SENATORS WHO WISH TO VOTE OR
CHANGE THEIR VOTE?
IF NOT, THE YEAS ARE 97, THE
NAYS ARE 1.
UNDER THE PREVIOUS ORDER
REQUIRING 60 VOTES FOR THE
ADOPTION OF THIS AMENDMENT, THE
AMENDMENT IS AGREED TO.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
THE SENATE WILL COME TO
UNDER THE PREVIOUS ORDER, THERE
ARE TWO MINUTES EQUALLY DIDED
PRIOR TO A VOTE IN RELATION TO
THE MOTION TO COMMIT OFFERED BY
THE SENATOR FROM MR. HATCH.
WHO YIELDS TIME?
THE SENATE WILL COME TO ORDER.
PLEASE REMOVE YOUR CONVERSATIONS
FROM THE FLOOR SO THE SENATOR
FROM MONTANA CAN BE HEARD.
THE SENATOR FROM MONTANA.
MR. BAUCUS: MR. PRESIDENT, THE
PENDING MOTION WOULD STRIKE THE
SAVINGS THAT THE BILL ACHIEVES
FROM MEDICARE ADVANTAGE.
WHY ARE WE SEEKING SAVINGS FROM
MEDICARE ADVANTAGE?
BECAUSE MEDPAC TELLS US THAT THE
GOVERNMENT PAYS THE PRIVATE
INSURANCE COMPANIES THAT PROVIDE
MEDICARE ADVANTAGE 14% MORE THAN
THEY PAY FOR TRADITIONAL
MEDICARE.
BECAUSE THESE EXTRA SUBSIDIES TO
MEDICARE ADVANTAGE CAUSE THE
FOUR-FIFTHS OF SENIORS TO
TRADITIONAL MEDICARE $90 PER
MONTH EVEN THOUGH THEY GET
ADDITIONAL ADVANTAGE.
BECAUSE MEDPAC SAYS THE
ADDITIONAL MEDICARE ADVANTAGE
PAYMENTS HASTEN THE SOLVENCY OF
MEDICARE PART-A TRUST FUND BY 18
MONTHS. BECAUSE THE PRIVATE INSURANCE
COMPANIES THAT PROVIDE MEDICARE
ADVANTAGE ARE MAKING
THREE-QUARTERS OF THEIR
FROM THESE GOVERNMENT
OVERPAYMENTS, THEY CAN FIND SOME
OF THE SAVINGS THERE. BECAUSE PRIVATE INSURANCE
COMPANIES WHO PROVIDE MEDICARE
ADVANTAGE ARE PAYING THEIR
C.E.O.'S $24 MILLION A YEAR,
$ MILLION, $8 MILLION AND THEY
CAN FIND SOME OF THE SAVINGS THERE.
AND BECAUSE NOTHING WE DO IN OUR
BILL REDUCES GUARANTEED BENEFITS UNDER MEDICARE.
THEREFORE, I URGE MY
TO OPPOSE THE MOTION. A SENATOR: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM UTAH.
THE SENATE WILL BE IN ORDER SO
THAT THE SENAT
BE HEARD
THE SENATOR FROM UTAH.
MRHATCH: MR. PRESIDENT, I URGE
MY COLLEAGUES TO SUPPORT MY MY
MOTION TO COMMIT.
IT PROTECTS MEDICARE
BENEFICIARIES CURRENTLY
PARTICIPATING IN THE MEDICARE
ADVANTAGE PROGRAM BY ELIMINATING
THE REID'S BILL $120 BILLION IN
CUTS TO THE MEDICARE ADVANTAGE
PROGRAM.
LET ME MAKE THIS POINT AS
CLEARLY AS I CAN.
A VOTE AGAINST MY AMENDMENT IS A
VOTE FOR SLASHING BENEFITS FOR
11 MILLION SENIORS AND
LOW-INCOME AMERICANS, INCLUDING
VISION BENEFITS, DENTAL
BENEFITS, HOME CARE FOR CHRONIC
ILLNESS, WELLNESS PROGRAMS,
DISEASE MANAGEMENT PROGRAMS,
LIMITS ON COST SHARING FOR
PRIMARY CARE, PHYSICIAN VISITS,
REDUCED PREMIUMS FOR PART-B,
REDUCED PREMIUMS FOR PART-D, 14
DEMOCRATS, WHEN WE DID THIS,
MANY OF WHOM ARE SITTING IN THE
SENATE RIGHT NOW SUPPORTED THIS
DEVELOPMENT OF MEDICARE
ADVANTAGE.
HAVE NO DOUBT WHEN YOU VOTE
AGAINST MY AMENDMENT, YOU WILL
BE VOTING TO CUT THESE
LIFESAVING AND LIFE ENHANCING
BENEFITS.
THE CHOICE IS YOURS AND THE
CHOICE IS CLEAR.
OUR NATION'S SENIORS ARE WATCHING MUCH.
THE PRESIDING OFFICER: WATCHING.
THE PRESIDING OFFICER: THE
QUESTION IS ON THE MOTION.
IS THERE A SUFFICIENT SECOND?
THERE ARE SECONDS.
THE CLERK WILL CALL THE ROLL.
VOTE:
THE PRESIDING OFFICER: ARE THERE
ANY SENATORS WHO WISH TO VOTE OR
CHANGE THEIR VOTE?
IF NOT, ON THIS VOTE, THE YEAS
ARE 41, THE NAYS ARE 57.
UNDER THE PREVIOUS ORDER
REQUIRING 60 VOTES FOR THE
ADOPTION OF THIS MOTION, THE
MOTION IS WITHDRAWN.
MR. BAUCUS: MR. PRESIDENT, I
MOVE TO RECONSIDER THE VOTE.
A
THE PRESIDING OFFICER: WITHOUT OBJECTION.
THE SENATOR FROM MONTANA.
MR. BAUCUS: MR. PRESIDENT, I
THINK THE -- EXCUSE ME.
THE SENATOR F
TO BE RECOGNIZED TO OFFER AN
AMENDMENT. THE PRESIDING OFFICER: THE
SENATOR FROM ARKANSAS.
MR. PRESIDENT.
I WOULD LIKE TO CALL UP MY
AMENDMENT.
THE CLERK: THE SENATOR FRO
ARKANSAS, MRS. LINCOLN, PROPOSES
AMENDMENT NUMBE
ON PAGE 2040, STRIKE
INSERT THE FOLLOWING --
MRS. LINCOLN: MR. PRESIDENT, I
ASK UNANIMOUS CONSENT --
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MRS. LINCOLN: THE FURTHER
READING OF THE AMENDMENT BE DISPENSED WITH.
THE PRESIDING OFFICER: WITHOUT
OB
MRS. LINCOLN: THANK YOU.
MR. PRESIDENT, I YIELD THE FLOOR.
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: I THINK THE SENATOR
RECOGNIZED.
THE PRESIDING OFFICER: THE
SENATOR FROM NEW MEXICO IS
RECOGNIZED.
MR. UDALL: THANK YOU, MR. PRESIDENT.
MR. PRESIDENT, TODAY I RISE TO
HONOR A BRAVE SON OF ANTHONY, NEW MEXICO.
ARMY CORPORAL ANTHONY COROSCO
JR. WAS KILLED NOVEMBER 4 AFTER
BEING HIT BY SNIPER FIRE WHILE
SERVING HIS COUNTRY IN IRAQ.
HE WAS 25 YEARS OLD.
CORPORAL COROSCO, OR TONY AS HE
WAS CALLED BY HIS FAMILY AND
FRIENDS, WAS A HUSBAND, FATHER,
AND SON.
HE AND HIS WIFE JOHANNA ARE
EXPECTING A CHILD, AND HE HAD
TWO SMALL STEPCHILDREN WHO
ADORED HIM.
TONY SERVED AS A TRUCK COMMANDER
FOR ARMORED VEHICLES.
IT WAS HIS JOB TO DIRECT HIS
VEHICLE DOWN STREETS INFESTED
WITH ROADSIDE BOMBS AND TARGETED
BY INSURGENTS, ATTACKING FROM
THE SHADOWS OF BUILDINGS.
TONY UNDERSTOOD THE DANGER.
HE ACCEPTED THE RISK,
DIED DOING WHAT HE LOVED --
SERVING A COUNTRY HE LOVED.
HIS FELLOW SOLDIERS DESCRIBE
TONY AS AN OPT
-- AS AN OPTIMIST.
HIS PLATOON SERGEANT PUT IT
BEST -- TONY SAW THE GOOD I
EVERYTHING.
HE WAS A SOLDIER WHO NEVER, EVER COMPLAINED.
SERGEANT BROWN CALLED TONY THE
BEST SOLDIER I EVER HAD.
AS SENATORS OR AS CITIZENS, WE
CANNOT FULLY EXPERIENCE THE
SADNESS THAT TONY'S FAMILY AND
FRIENDS ARE FEELING, BUT WHEN A
SOLDIER DIES, THE NATION AS A
WHOLE FEELS THE LOSS.
WE'RE LINKED TO CORPORAL COROSCO
BY THE TIES THAT BIND A GRATEFU
NATION TO ITS FAITHFUL SERVANT.
HIS LOSS IS OURS.
PLEASE JOIN ME
ANTHONY COROSCO IN EXTENDING OUR
SYMPATHIES TO HIS WIFE JOHANNA
AND HIS FATHER ANTONIO, HIS
MOTHER AND THE REST OF THE
COROSCO FAMILY.
BEFORE I CLOSE, I WANT TO
ACKNOWLEDGE THE RECENT PASSING
OF ANOTHER BRAVE NEW MEXICAN,
JOSEPH GIAGOS, A SPECIALIST WITH
THE NEW MEXICO ARMY NATIONAL
GUARD, DD OF A HEART ATTACK
WHILE SERVING IN IRAQ.
WHILE HIS DEATH WASN'T DUE TO
INJURIES SUFFERED IN COMBAT,
THAT FACT DOES NOT LESSEN THE
PAIN OF HIS LOSS.
SPECIALIST GIAGOS WAS 39 YEARS
OLD.
HE SERVED WITH THE GUARD AS A
LIGHT WHEEL VEHICLE MECHANIC.
WHILE NOT SERVING HIS COUNTRY,
HE WORKED FOR THE FOREST SERVICE
ON THE CARSON BACK HOME IN
QUESTA, NEW MEXICO.
THROUGHOUT HIS LIFE, HE ALSO
WORKED AS A FIREFIGHTER, AN
AMBULANCE DRIVER, A POLICEMAN.
SPECIALIST GIAGOS GRAVITATED
TOWARD WORK THAT ALLOWED HIM TO
HELP HIS FELLOW CITIZENS.
WHILE WORKING FOR THE FOREST
SERVICE, HE EVEN SAVED A LIFE.
SPOTTING A BURNING TRUCK ONE
DAY, HE SAW A MAN INSIDE AND
PULLED HIM TO SAFETY.
AS SPECIALIST GIAGOS' BROTHER
DONALD SAID, HE WAS ALWAYS
TAKING DIFFERENT JOBS, BUT THEY
ALWAYS PUT HIM IN THE SERVICE OF
OTHERS.
TODAY I ASK YOU TO JOIN ME IN
THANKING SPECIALIST GIAGOS'
FAMILY FOR HIS SERVICE AND F HIS SACRIFICE.
THANK YOU, MR. PRESIDENT.
I YIELD T A.
A SENATOR:: MR. PRESIDENT?
THE PRES
SENATOR FROM NEBRASKA. MR. JONES: I HAVE A MOTION AT
THE DESK.
THE CLERK: THE SENATOR FROM
NEBRASKA MOVES TO COMMIT THE
BILL BACK TO COMMITTEE WITH
INSTRUCTIONS ON CHANGES THAT DO
NOT INCLUDE CUTS IN PAYMENTS TO
HOME HEALTH AGENCIES TOTALING
NEGATIVE $42.1 BILLION.
MR. JOHANNS: THANK YOU.
MR. SPEAKER, I RISE TODAY TO
SPEAK IN FAVOR OF THE MOTION
THAT WAS JUST READ.
ONE OF THE THINGS THAT I SAY IS
SO VERY IMPORTANT ABOUT A DEBATE
ON THE SENATE FLOOR IS WE BEGIN
TO UNDERSTAND WHAT THIS
LEGISLATION DOES TO REAL PEOPLE,
AND WE HAVE COME TO REALLY
UNDERSTAND THAT $466 BILLION IN
MEDICA
OVER MY LEFT SHOULDER HERE HAVE
REAL CONSEQUENCES TO REAL PEOPLE
ALL ACROSS THE UNITED STATES.
THESE CUTS COMPROMISE CARE, THEY
COMPROMISE ACCESS TO SERVICES
THAT REAL PEOPLE NEED IN THEIR
DAILY LIVES.
ROBBING THESE FUNDS FROM
MEDICARE TO CREATE A DRAMATIC
NEW ENTITLEMENT PROGRAM, IN MY
JUDGMENT, IS NOT SOUND POLICY
AND IT'S NOT SOUND GOVERNMENT.
THAT'S ESPECIALLY TRUE IN THIS
CASE, MR. PRESIDENT, WHEN THE
IMPACT ON SENIORSR SENIORS'
HEALTH CARE IS SO PROFOUND.
THESE CUTS WILL REDUCE THE
QUALITY OF CARE THAT MANY
AMERICANS ARE RECEIVING TODAY
AND REDUCE THE CARE THAT THESE
AMERICANS DESERVE.
I HAVE TO TELL YOU, OUT OF ALL
OF THESE MEDICARE CUTS, ONE OF
THE LARGEST HEAD-SCRATCHING CUTS
IS THE ONE TO HOME HEALTH.
THE SENATE BILL CUTS
CUTS $42.1 BILLION FOR HOME HEALTH CARE.
HOME HEALTH IS ABOUT 3.7% OF THE
MEDICARE BUDGET.
IT'S AN IMPORTANT PROGRAM, YET
9.1% OF THE MEDICARE CUTS IN THE
SENATE BILL ARE TAKEN OUT OF
HOME HEALTH.
MEDICARE HOME HEALTH SPENDS LESS
TODAY THAN IT DID OVER A DECADE
AGO, WHILE SERVING A SIMILAR
NUMBER OF BENEFICIARIES AT LESS
COST PER PATIENT.
THAT'S THE KIND OF PROGRAM THAT
WE SHOULD CELEBRATE, YET THIS
BILL HAS THEM ON THE CHOPPING
BLOCK.
NOW, MAYBE THERE IS SOME
MISUNDERSTANDINGBOUT
HEALTH PROVIDES, SO LET ME CLEAR
UP THE CONFUSION.
HOME HEALTH CARE AGENCY CARES
FOR PATIENTS OF ALL AGES.
IT PROVIDES A BROAD RANGE OF
ESSENTIAL HEALTH CARE AND
SUPPORT SERVICES, REAL SECURITY
IN THE COMFORT OF A PATIENT'S
HOME.
9,000 MEDICARE APPROVED HOME
HEALTH AGENCIES EXISTED IN 2007.
I'M VERY PLEASED REPORT TO
YOU, MR. PRESIDENT, THAT 74 OF
THOSE ARE IN MY HOME STATE OF
NEBRASKA.
NURSES, THERAPISTS, HOME CARE
AIDS AND OTHERS WHO SERVE
ELDERLY AND DISABLED PATIENTS IN
EIR OWN HOMES DRIVE NEARLY
FIVE BILLION, FIVE BILLION MILES
A YEAR TO PROVIDE THESE
MUCH-NEEDED SERVICES.
THEY CARE FOR ABOUT 12 MILLION
REAL PEOPLE ANNUALLY WITH
428 MILLION VISITS.
EACH ONE PROVIDING THAT PERSONAL
TOUCH OF CARE.
THE SERVICES THAT ARE PROVIDED
TO THIS VERY, VERY ESSENTIAL
PROGRAM INCLUDE REHABILITATION
THERAPIES, TELEMEDICINE, WOUND
CARE, PAIN MANAGEMENT, AND
SKILLED NURSING.
WHO IS ELIGIBLE TO RECEIVE
MEDICARE HOME HEALTH SERVICES?
WE CAN ANSWER THAT QUESTION BY
GOING TO C.M.
ACCORDING TO C.M.S., TO QUALIFY
FOR MEDICARE HOME HEALTH
BENEFITS, A MEDICARE BENEFICIARY
MUST MEET ONE OF THE FOLLOWING
REQUIREMENTS -- THEY MUST BE
CONFINED TO HOME.
THEY MUST BE UNDER A DOCTOR'S CARE.
THEY MUST NEED SKILLED NURSING
ON A PERIODIC BASIS.
AND THEY MUST HAVE A CONTINUING
NEED FOR OCCUPATIONAL THERAPY.
THESERE TRULY SOME OF THE MOST
VULNERABLE AMERICANS, YET IN
ORDER TO FINANCE THIS NEW
ENTITLEMENT, THIS BILL TAKES
MONEY OUT OF THAT MUCH-NEED
PROGRA
ON THE BACKS OF THESE AMERICANS.
OUR MOST VULNERABLE
YET THESE CUTS RISK LEAVING THEM
WITHOUT CARE.
AND WHAT KIND OF CONDITIONS DO
PEOPLE WHO UTILIZE HOME HEALTH
AGENCIES SUFFER FROM?
WELL, I'LL TURN TO MY OWN STATE
TO
IN NEBRASKA, ONE OF OUR AGENCIES
IS IN RURAL CHERRY COUNTY.
CHERRY COUNTY IS A VERY LARGE
COUNTY IN WESTERN NEBRASKA.
IN FACT, LARGER THAN SOME
WHO GETS SERVED IN THAT COUNTY?
A GENTLEMAN WITH CLASS THREE
CONGESTIVE HEART FAILURE.
HE'S AWAITING A HEART TRANSPLANT.
A GENTLEMAN WHO JUST LOST A LEG
FROM COME PLAY OCCASIONS -- FROM
COMPLICATIONS FROM DIABETES.
THEY GET HOME HEALTH CARE SERVICES.
THESE FOLKS ARE NOT STRIVING TO
BILLEING THE SYSTEM.
THE PAYMENTS THAT ALLOW US TO
PROVIDE THIS MUCH-NEED SERVICE
TO THEM ARE NOT EXCESS PAYMENTS.
THESE A JUST AVERAGE FOLKS WHO
ARE STRIVING TO DO THEIR BEST TO
RECOVER FROM THEIR CONDITION AND
MANAGE THE BEST THEY CAN.
KEEPING THESE FOLKS OUT OF THE
EMERGENCY ROOM OR THE NURSING
HOME IS A BENEFIT TO EVERYBODY,
AND I DON'T SEE HOW ANYBODY
COULD ARGUE THAT THIS DOESN'T
SAVE TAX DOLLARS.
WELL, IN FACT, THERE ARE
STATISTICS THAT PROVE THAT STATEMENT.
ACCORDING TO THE NATIONAL
ASSOCIATION OF HOME HEALTH CARE
AND HOSPICE, AN AVERAGE
PER-VISIT MEDICARE CHARGE FOR
HOME HEALTH IS $132.
LET ME
COMPARE THAT CHARGE OF $132 TO
ONE DAY AT A HOSPITAL THAT WOULD
COST 43 TIMES AS MUCH,
LITERALLY.
$5,0766 PER DAY.
ACCORDING TO TO A STUDY, AND I'M
QUOTING, EARLY USE OF HOME
HEALTH CARE SERVICES FOLLOWING A
HOSPITAL STAY BY PATIENTS WITH
AT LEAST ONE CHRONIC DISEASE
SAVED MEDICARE $1.71 BILLION IN
THE TWO-YEAR PERIOD OF 2005 TO
2006. UNQUOTE. SAVED MEDICARE.
DOESN'T
STEP BACKWARDS WHEN WE TALK
ABOUT REFORM, WHEN REALLY WHAT
WE'RE DOING IS CUTTING A PROGRAM
THAT SERVES PEOPLE SO MUCH I
NEED AND YET SAVES MONEY IN OUR
MEDICARE PROGRAM.
HOME HEALTH AGENCIES IN NEBRASKA
HAVE BEEN VERY SUCCESSFUL IN
DOING EXACTLY WHAT WE WANT,
KEEPING PEOPLE AT HOME AND OUT
OF THE HOSPITAL AND NURSING
HOME.
OF SPECIAL INTEREST ARE PATIENTS
WITH CONGESTIVE HEART FAILURE.
ONE NEBRASKA WOMAN TURNED TO
HOME HEALTH AFTER FACING A BIG
STACK OF HOSPITAL BILLS FOR REHAB.
SINCE THEN, SHE HAS BEEN ABLE TO
REMAIN AT HOME SAFELY AT A
FRACTION OF THE COST.
THIS HOME HEALTH AGENCY CAN SEE
A PERSON FOR 60 DAYS AT A COST
OF ABOUT $2,500.
60 DAYS.
ONE HOSPITAL ADMISSION, BY
COMPARISON, WOULD COST MEDICARE
CONSERVATIVELY $20,000 TO TREAT
A PATIENT WITH CHRONIC HEALTH
FAILURE -- OR CHRONIC HEART
FAILURE.
SO,
COSTS A FRACTION OF HOSPITAL
CARE, ABOUT TEN TIMES LESS.
THERE ARE SO MANY STORIES FROM
PATIENTS WHO ARE ALIVE TODAY WHO
LOVE HOME HEALTH CARE.
AND THIS BILL THREATENS THEM.
SOMEWHERE IN THE NEXT HOURS,
MR. PRESIDENT, I'M GOING TO SEND
TO EVERY MEMBER OF THE UNITED
STATES SENATE ALL OF MY
COLLEAGUES, A
ANALYSIS OF WHAT THESE CUTS WILL
DO IN THEIR STATE, BECAUSE THEY
ED TO KNOW THE IMPACT.
THIS BILL THREATENS TO TAKE THAT
ALL AWAY.
YO CAN'T CUT $42 BILLION AND
JUST DESCRIBE IT AS EXCESS PAYMENTS.
YOU CAN'T CUT $42 BILLION AND
SAY, WELL, THAT'S JUST FIXING
THOSE WHO ARE BILKING THE SYSTEM.
WHEN YOU CUT $42 BILLION OUT OF
A PROGRAM LIKE HOME HEALTH CARE,
IT HAS REAL
EARLIER THIS WEEK,
MR. PRESIDENT, I DID A VIDEO
CONFERENCE WITH MEDICARE
PROVIDERS IN NEBRASKA.
THESE NEBRASKA HOME HEALTH
PROVIDERS REPORTED THIS
LEGISLATION WILL COST THEM $120
MILLION IN MY STATE.
WHAT DOES THAT MEAN?
$120 MILLION MAY NOT SOUND MUCH
AROUND HERE WHERE WE TALK ABOUT
TRILLION-DOLLAR PROGRAMS.
$120 MILLION TO THE PEOPLE OF
NEBRASKA IN HOME HEALTH CARE,
68% OF HOME HEALTH AGENCIES IN
NEBRASKA WILL BE IN THE RED BY
2016. 68%.
IN RURAL AREAS, AS HIGH AS 80%
WILL HAVE NEGATIVE MARGINS.
YOU LOSE THOSE SERVICES IN RURAL
AREAS, THEY ARE LOST.
THERE'S NOTHING THAT WILL STEP
IN FOR THOSE PEOPLE.
HOME HEALTH PROVIDERS ALREADY
HAVE TO WATCH THEIR BOTTOM LINE,
AND THEY'RE ALREADY MAKING VERY
HARD, PAINFUL DECISIONS.
DURING THIS VIDEO CONFERENCE, A
NURSE IN RURAL NEBRASKA
EXPLAINED THE REALITY TO ME THIS
WAY -- AND I'M QUOTING -- "I CAN
GIVE YOU A HUMAN STORY THAT JUST
HAPPENED YESTERDAY IN OUR
AGENCY.
WE HAD A REFERRAL FROM A PATIENT
THAT LIVES 90 MILES AWAY.
THE DRIVE TIME IS THREE HOURS.
TO DO THE ADMISSION TAKES ONE
AND A HALF TO TWO HOURS.
AND THEN YOU COME BACK TO THE
OFFICE, AND YOU DO AT LEAST
ANOTHER HOUR OF PAPERWORK.
IT WOULD TAKE ONE PERSON'S
ENTIRE DAY TO SERVE ONE PATIENT.
AND REGRETFULLY, WE HAD TO SAY
NO.
WE JUST COULD NOT SEE HER.
AND THERE IS NO OTHER AGENCY
CLOSE ENOUGH TO HELP THIS WOMAN." UNQUOTE.
CAN YOU IMAGINE, MR. PRESIDENT?
WE HAVE A PERSON WHO DESPERATELY
NEEDED THESE SERVICES, AND WE'RE
DEBATING WHETHER WE SHOULD CUT
$42 BILLION OUT OF THIS PROGRAM,
IMPACT A STATE LIKE MINE TO THE
TUNE OF $120 MILLION?
THESE AGENCIES AND THE SERVICES
THEY PROVIDE ABSOLUTELY ARE
RELIAN ON MEDICARE.
ACCORDING TO THE NATIONAL
ASSOCIATION OF HOME CARE AND
HOSPICE -- AND AGAIN I'M
QUOTING -- "MEDICARE IS THE
LARGEST SINGLE-PAYER OF HOME
HEALTH CARE SERVICES." UNQUOTE.
WHEN WE CUT THE PAYMENTS IN A
PROGRAM LIKE THIS, WE CUT ACCESS
CARE.
THESE ACCESS CONCERNS ARE ROOTED
IN REAL-LIFE EXPERIENCES.
BETWEEN 1998 AND 2000, MEDICARE
HOME HEALTH SPENDING FELL FROM
$14 BILLION TO $9.2 BILLION, OR
NEGATIVE 34% AS A RESULT OF
CONGRESSIONAL ACTION BETWEEN
1998 AND 2000.
THOSE ACTIONS TRIGGERED THE
CLOSURE OF 40% OF HOME HEALTH
AGENCIES ANDEAP DUED ACCESS
FOR -- REDUCED ACCESS FOR 1.5
MILLION MEDICARE BENEFICIARIES.
ACCESS BECOMES
IF THERE'S NO HOME HEALTH
AGENCY, HOMEBOUND PATIENTS END
UP WITH MORE EXPENSIVE CARE IN
HOSPITALS AND NURSING HOMES, AND
THAT COSTS MEDICARE MONEY.
BUT, YOU SEE, WE'RE ALSO CUTTING
HOSPITALS AND NURSING HOMES IN
THIS BILL.
IF THERE IS NO HOME HEALTH
PROVIDER NEAR THE AREA, NOT ONLY
ARE MEDICARE BENEFICIARIES HURT,
BUT ALL CITIZENS WHO NEED THE CARE.
YOU KNOW, MR. PRESIDENT, ANY
ANALYSIS IS GOING TO COME TO THE
SAME CONCLUSION.
AND I'LL QUOTE FROM ONE.
QUOTE -- "STUDIES FROM MEDPAC
AND THE GOVERNMENT
ACCOUNTABILITY OFFICE ALSO
SUGGEST THAT ACCESS IS A GROWING
PROBLEM FOR PATIENTS WHO REQUIRE
INTENSIVE SERVICES.
IN JUNE 2003, MEDPAC ISSUED A
REPORT INDICATING THAT SKILLED
NURSING FACILITIES CARE IS NOW
SUBSTITUTING FOR HOME HEALTH
CARE FOR SOME PATIENTS.
MOST LIKELY AT A MUCH HIGHER
COST FOR MEDICARE."
UNQUOTE.
WELL, I DON'T THINK THESE ARE TRANSFORMATIONAL REFORM.
THESE CUTS ARE NOT
TRANSFORMATIONAL REFORM.
THEY'RE JUST PLAIN CUTS TO START
A NEW ENTITLEMENT THAT HURT REAL
PEOPLE: SENIOR CITIZENS WHO
NEED OUR HELP.
THAT'S WHY I'M OFFERING THIS
AMENDMENT TO RECOMMIT THIS
LEGISLATION BACK TO THE FINANCE
COMMITTEE, TO STRIKE THESE
ILL-ADVISED HOME HEALTH CARE
CUTS FROM IT.
MR. PRESIDENT, I WILL FOLLOW UP.
I WILL MAKE SURE THAT EVERY
MEMBER SEES THE IMPACT OF THESE
CUTS IN THEIR STATE SO THEY CAN
MAKE AN
SHOULD THESE CUTS BE PUT IN
PLACE AND CAUSE THE KIND OF
DAMAGE THAT I'VE DESCRIBED THIS AFTERNOON?
THANK YOU,
I YIELD THE
SENATOR FROM MAINE.
MR. BAUCUS:
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: I YIELD TO SENATOR KLOBUCHAR TEN MINUTES.
MS. KLOBUCHAR: THANK YOU VERY MUCH.
THE PRESIDING OFFICER: THE
SENATOR FROM MINNESOTA.
MS. KLOBUCHAR: I ASK UNANIMOUS
CONSENT TO PEEK FOR UP TO 12 MINUTES.
THE PRESIDING OFFICER: WITHOUT OBJECTION.
MS. KLOBUCHAR: I RISE TODAY TO
SPEAK ABOUT TRUE HEALTH CARE
REFORM.
THE WAY I LOOK AT THIS IN MY
STATE IS IT'S A MATTER OF AFFORDABILITY AND COST.
WE HAVE ONE OF THE HIGHEST
PERCENTAGE OF PEOPLE COVERED IN
THE COUNTRY, MR. PRESIDENT, IN MINNESOTA.
BUT THE ISSUE IS IT'S BECOMING
MORE AND MORE EXPENSIVE FOR THE
PEOPLE OF OUR STATE TO AFFORD HEALTH CARE.
I TRY TO REMEMBER THREE SIMPLE
NUMBERS OF ALL THE NUMBERS WE'RE
GOING TO HEAR IN THE NEXT FEW WEEKS.
THOSE ARE THE NUMBERS 6, 12 AND 24.
TEN YEARS OF COLA COSTS
FOR AN AVERAGE FAMILY TO PAY FOR
THEIR HEALTH CARE A FAMILY.
NOW IT'S $12,000 WITH A LOT OF
PEOPLE PAYING A LOT MORE.
TEN YEARS FROM NOW IF WE DON'T
DO ANYTHING, IT'S GOING TO BE
$36,000 A YEAR, SOMETHING
REGULAR PEOPLE JUST CAN'T
AFFORD.
6, 12 AND 24.
IT'S NOT GOING IN THE RIGHT
DIRECTION, MR. PRESIDENT.
IF WE DON'T ACT, COSTS WILL
CONTINUE TO SKYROCKET.
THE COUNTRY SPENT $2.4 TRILLION
ON HEALTH CARE LAST YEAR ALONE.
THAT'S ONE OUT OF EVERY $6 SPENT
IN THE ECONOMY.
BY 2018 NATIONAL HEALTH CARE
SPENDING IS EXPECTED TO REACH
$4.4 TRILLION, OVER 20% OF OUR
ENTIRE ECONOMY.
DESPITE SPENDING ONE AND A HALF
TIMES MORE PER PERSON ON HEALTH
CARE THAN ANY OTHER COUNTRY,
MANY OF OUR PEOPLE DON'T EVEN
HAVE HEALTH CARE COVERAGE.
AND MANY OF THEM ARE LOSING
THEIR COVERAGE BECAUSE OF PREEXISTING CONDITIONS OR
BEUSE IT SIMPLY IS COSTING TOO MUCH.
THESE COSTS ARE BREAKING THE
BUSINESSES.
YOU CAN S
COVERAGE, 1999, $2,192.
IN 2008, THE LAST FIGURES WE
HAVE AVAILABLE, $4,704.
A
FAMILY COSTS $19 --
TKHR-RBS 5,791.
NOW WHAT ARE THEY PAYING?
$12,680.
NOW LOOK WHAT'S HAPPENING TO
SMALL BUSINESS, MR. PRESIDENT.
A STUDY BY THE COUNCIL OF
ECONOMIC ADVISORS FOUND SMALL
BUSINESSES PAY UP TO 18% MORE
THAN LARGE BUSINESSES TO PROVIDE
HEALTH CARE COVERAGE.
IN A RECENT NATIONAL SURVEY
NEARLY THREE-QUARTERS OF SMALL
BUSINESSES THAT DID NOT OFFER
BENEFITS CITED HIGH PREMIUMS AS THE REASON.
NOW LOOK AT IT THIS WAY,
MR. PRESIDENT, INFLATION USUALLY
RAISES THE COST OF MOST GOODS
AND SERVICES BETWE 2% TO 3%
PER YEAR.
HEALTH CARE PREMIUM COSTS
ALREADY HAVE BEEN GOING UP CLOSE
TO 8% A YEAR.
THAT'S AN INCREASE AMERICANS
JUST CAN'T AFFORD.
WAGES HAVE NOT KEPT PACE WITH AN
INCREASE IN PREMIUMS. WAGES.
LOOK AT THIS.
BETWEEN 1999 AND 2007, THE
AVERAGE AMERICAN WORKER SAW HIS
WAGES INCREASE 29%.
OBVIOUSLY THE LAST FEW YEARS IT
HAS NOT BEEN THAT ROSY.
BUT 29% BETWEEN 1999-2007.
HOW MUCH DID HIS INSURANCE
PREMIUMS GO UP?
120% DURING THE SAME TIME PERIOD.
SO, IN OTHER
CARE PREMIUMS ARE TAKING ON A
BIGGER
AVERAGE WORKER'S PAYCHECK.
AND THESE COSTS ARE BREAKING THE
BACKS OF THE AMERICAN
MY COLLEAGUE ACROSS THE AISLE
WAS TALKING ABOUT MEDICARE.
WELL, THE TRUTH IS THIS,
MEDICARE IS PROJECTED TO GO INTO
DEFICIT BY 2017 IF WE DON'T DO
ANYTHING ABOUT IT.
AND RECENT CONGRESSIONAL BUDGET
OFFICE ESTIMATES SHOW THAT THE
MAJORITY OF T PROJECTED $344
BILLION INCREASE IN FEDERAL
REVENUES ARE SCHEDULED TO
AUTOMATICALLY GO TO COVER RISING
HEALTH CARE COSTS.
MEDICARE, SOMETHING THAT PEOPLE
WHO ARE 55 WANT TO GET WHEN
THEY'RE 65.
PEOPLE WHO ARE 65 WANT TO KEEP
THEIR MEDICARE UNTIL THEY LIVE
TOHE RIPE OLD AGE OF 95.
BUT IF WE DON'T DO ANYTHING
ABOUT IT,
BY 2017.
HOW DO WE DO THIS?
HOW DO WE GET TO THE PLACE WE
WANT TO GO?
WE MUST GET OUR MONEY'S WORTH
FROM OUR HEAH CARE DOLLARS.
THE PROBLEM NOW IS WE'RE PAYING
TOO MUCH AND WE'RE NOT GETTING A
GOOD RETURN ON WHAT WE PAY.
THE SOLUTION MU BE TO GET THE
BEST VALUE FOR OUR HEALTH CARE
DOLLARS.
OTHERWISE, COSTS ARE GOING TO
CONTINUE TO WREAK MASSIVE SROBG
ON THE BUDGETS OF -- TO WREAK
HAVOC ON GOVERNMENTS, BUSINESS
AND INDIVIDUAL FAMILIES.
HEALTH CARE IS 57% OF ALL
FEDERAL HEALTH SPENDING.
IF WE WANT TO SUSTAIN MEDICARE,
WHICH WE ALL DO, TO PROVIDE THAT
KIND OF HIGH-QUALITY HEALTH CARE
THAT OUR SENIORS DESERVE, WE
MUST DO SOMETHING TO ADDRESS THE SCAL CHALLENGES.
THE ROOT OF THE PROBLEM IS THAT
MOST HEALTH CARE IS PURCHASED O
A
TESTS, MORE SURGERY MEANS MORE MONEY.
QUANTITY, NOT QUALITY PAYS.
ACCORDING TO RESEARCHERS AT
DARTHMOUTH MEDICAL
$700ILLION PER YEAR IS WASTED
ON UNNECESSARY, INEFFECTIVE
CARE.
NOW, MY FAVORITE EXAMPLE WITH
ALL THIS IS WHAT A CLINIC DID IN PENNSYLVANIA.
THEY WEREN'T HAPPY WITH HOW
THEIR DIABETES TREATMENT WAS
GOING.
THEY SAID WE'RE GOING TO HAVE
OUR ROUTINE PATIENTS SEE NURSES.
AND MORE DIFFICULT CASES WILL
SEE DOCTORS.
THEN THOSE EPIDEMIOLOGISTS WILL
REVIEW THE RECORDS OF THE NURSES
AND MAKE SURE THAT THE PATIENT
IS PROGRESSING AS WE WANT.
GUESS WHAT?
PATIENT QUALITY GOES WAY UP
BECAUSE THEY SEE NURSES AND THEY
SEE THEM MORE REGULARLY.
RESULTS GO WAY UP BECAUSE THE
EPIDEMIOLOGISTS ARE SPENDING
THEIR TIME ON THE MOST DIFFICULT
CASES AND REVIEWING THE RECORDS
OF THE OTHER.
COSTS GO DOWN $200 PER PATIENT
PER MONTH.
GUESS WHAT?
THEY GET PAID LESS, WAY, LESS
FOR THAT KIND
THAT'S WHY THE SYSTEM IS MESSED
UPND WE NEED TO CHANGE IT.
WE ARE REWARDING BASED ON RESULTS.
WE PUT THE PATIENT IN THE
IVERS SEAT SO WHEN THAT
PATIENT GETS BETTER RESULTS, WE REWARD WITH PAYMENTS.
IN MINNESOTA, WE HAVE SEVERAL
GREAT EXAMPLES OF THIS
COORDINATED OCOME SYSTEM.
AT A PLACE LIKE THE MAYO CLINIC,
PARK NICK LET, ST. MARY'S IN
DULUTH, IT IS VALUE, NOT VOLUME.
EVERYWHERE IN THE COUNTRY
MIRRORED THE EFFICIENT LEVEL OF
SPENDING IN THE MAYO'S CLINIC
HOME REGION IN MINNESOTA.
FOR THE LAST FOUR YEARS OF
CHRONICALLY ILL PATIENTS' LIVES
IF WE USED THAT SAME SYSTEM ALL
OVER
THIS SYSTEM IN TEXAS, FLORIDA,
WE WOULD SPEND -- SAVE $50
BILLION EVERY FIVE YEARS AND GET
HIGHER QUALITY CARE.
THIS IS NOT LIKE A HOTEL WHERE
YOU PAY MORE MONEY AND GET A
BETTER CARE.
IN THIS SYSTEM WHEN YOU PAY MORE
MONEY YOU GET LESS QUALITY CARE.
THAT IS WHE WE NEED TO BRING
THE COUNTRY, EFFICIENT CARE THAT
COSTS LESS BUT IS BETTER VALUE.
THAT'S WHAT WE
NEED TO DO.
LINKING REWARDS TO OUTCOMES
CREATES AN INCENTIVE FOR
PHYSICIANS AND HOSPITALS TO WORK
TOGETHER TO IMPROVE QUALITY AND
EFFICIENCY.
USING BUNDLING TO BILL FOR
BUNDLING SO YOU LOOK AT THE
WHOLE OUTCOME OF EVERYONE
WORKING TOGETHER, SO YOU RELY ON
NURSES WHEN YOU WANT TO RELY ON
NURSES, YOU RELY ON DOCTORS WHEN
YOU WANT TO RELY ON DOCTORS.
REDUCING HOSPITAL READMISSIONS
-- YOU WANTS TO GO BACK IN THE
HOSPITAL INFECTIONS.
WHEN THE GO BACK INTO THE
HOSPITAL, THE HOSPITAL GETS
REWARDED FOR THAT.
SO WE WANT TO PUT IN PLACE
PROTOCOLS THAT MAKE HOSPITALS
SAFER PLACES TO GET TREATS.
ONE-YEAR HOSPITAL READMISSIONS
COST MICARE $17.4 BILLION AND
IN 2007 REPORT BY MEDPAC FOUND
THAT MEDICARE PAID AN AVERAGE OF
$7,200 PER READMISSION THAT WAS
PREVENTABLE.
INTEGRATED CARE -- WHERE YOU'VE
GOT A QUAERBACK THAT'S THE
PRIMARY CARE PROVIDER WORKING
WITH A TEAM.
INSTEAD OF HAVING 15 SPECIALISTS
RUNNING AROUND THE FIELD RUNNING
OVER EACH OTHER, YOU HAVE A QUARTERBACK.
WELL, LET'S JUST SAY LIKE BRETT
PHASER OF THE MINNESOTA VIKINGS.
YOU HAVE ONE QUARTERBACK WHO IS
YOUR
IN CHARGE WITH A TEAM OF DOCTORS
WHO LOOK AT ALL THE RECORDS.
THAT'S INTEGRATED CARE.
THAT'S WHAT THIS BILL DOES.
YOU THINK ABOUT THE MONEY WE CAN SAVE.
MEDICARE FRAUD ALONE COSTE
TAXPAYERS MORE THAN $60 BILLION
A YEAR.
THE MONEY IS GOING TO CONMEN,
PEOPLE LEACHING OFF THE SYSTEM,
PEOPLE MAKING UP THAT THEY ARE
PROVIDING SERVICES WHEN THEY'RE NOT.
WE HAVE A BILL W WE'RE WORKING
TOGETHER TO BRING THAT DOWN SO
THAT MONEY CAN GO TO OUR SENIORS
INSTEAD OF GOING TO A BURCHL OF
PEOPLE WHO ARE RIPPING OFF THE
SYSTEM.
YOU LOOK AT HOW YOU SAVE MONEY,
YOU LOOK AT HOW YOU REDUCE
COVELETS IN MEDICARE.
WELL, YOU REDUCE COSTS IN
MEDICARE BY MAKING CHANGES TO
THE SYSTEM AND MAKING THIS WORK.
WE MUST LOOK TO THE FUTURE,
MR. PRESIDENT.
THAT'S WHY HEALTH CARE REFORM
THIS YEAR IS SO CRUCIAL.
THIS BILL IS NOT ABOUT TODAY OR
EVEN NEXT YEAR; IT'S ABOUT FIVE
YEARS, IT'S ABOUT TEN YEARS FROM NOW AND BEYOND.
WE CAN'T AFFORD FOR THE PEOPLE
OF THIS COUNTRY TO HOLD OFF ANY LONGER.
WE CAN BRING THESE COSTS DOWN.
WE CAN BRING THE QUALITY UP.
AND WE CAN REWARD THE PEOPLE OF
THIS COUNTRY FOR THE MONEY THAT
THEY'RE PUTTING INTO HEALTH
CARE.
THANK YOU, MR. PRESIDENT.
AND I YIELD THE FLOOR.
WE HAVE ONE CORRECTION TO THE
RECORD, WHICH I WILL SMIVMENT.
A SENATOR: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM SOUTH CONTRARILY. MR. DeMINT: ANK YOU,
MR. PRESIDENT.
I APPRECIATE THE COMMENTS FROM
THE SENATOR FROM MINNESOTA.
IT BROUGHT OUT A LOT OF
IMPORTANT ISSUES AS FAR AS THE
RISING COST OF HEALTH INSURANCE,
AND I CERTAINLY KNEW THAT, AS
SMALL BUSINESSMAN.
THERE'S ONLY ONE PROBLEM.
THE BILL THAT WE'RE GOING TO
VOTE ON DOESN'T SOLVE THOSE
PROBLEMS.
IN FACT, C.B.O. BASICALLY TELLS
US THAT INSURANCE WILL CONTINUE
TO INCREASE AT THE SAME RATE IT
IS NOW AND FOR THOSE WITH
INDIVIDUAL INSURANCE POLICIES,
IT'S VERY LIKELY TO GO UP.
MR. PRESIDENT, WE'RE HERE ON
FRIDAY EVENING BEING TOLD WE'RE
GOING TO WORK THROUGH THE
WEEKEND, MAYBE NEXT
THE WAY UP TO CHRISTMAS EVE,
WITH THE INTENT TO RUSH THROUGH
A BILL THAT MANY HAVE CALLED --
PIECES OF LEGISLATION AND ONE OF
THE BIGGEST
CARE THAT WE'VE EVER SEEN HERE
IN THIS COUNTRY.
AND APPARENTLY THE MAJORITY
WANTS TO RUSH THIS
HOPEFULLY I THINK INTIMIDATE THE
MINORITY INTO ALLOWING IT TO GO
THROUGH BY KEEPING US HERE ON
WEEKENDS OVER THE HOLIDAYS.
BUT I'M PROUD THAT REPUBLICANS
ARE STANDING TOGETHER AGAINST
THIS BILL AND STANDING WITH THE
AMERICAN PEOPLE TO STOP THE
DEMOCRAT GOVERNMENT TAKEOVER OF
HEALTH CARE IN A
STOP THEM FROM PAYING FOR IT BY
CUTTING NEARLY $500 BILLION FROM
MEDICARE AND RAISING TAXES ON
MILLIONS OF AMERICANS.
I HEARD FROM ONE OF OUR
CONSTITUENTS THAT WAS TALKING
ABOUT MEDICARE D THE CUTS IN
MEDICARE EXPLAING VERY SIMPLY
THAT MEDICARE IS SOMETHING HE
HAD PAID FOR HIS ENTIRE 40 YEARS
OF WORKING OUT OF HIS
TAXES, AND NOW HE COULD NOT
BELIEVE THAT WE WERE CONSIDERING
TANG ANY MONEY OUT OF MEDICARE
IN ORDER TO PAY FOR A NEW
GOVERNMENT PROGRAM.
AMERICANS WORK AND PAY FOR
MEDICARE SO THAT WHEN THE
RETIRE, THEY WILL HAVE
THAT GIVES THEM THE COVERAGE
THEY NEED.
I THINK THE MAJORITY MUST THINK
AMERICANS ARE NOT PAYING
ATTENTION OR MAYBE EVEN THEY'RE
NOT REAL SMART, THAT YOU CAN
TAKE $500 BILLION OUT OF A
PROGRAM THAT'S ALREADY BANKRUPT
AND EXPECT THE BENEFITS TO STAY
THE SAME WHEN ALREADY WE KNOW
WE'RE NOT PAYING DOCTORS ENOUGH
TO SEE OUR SENIORS AND MORE AND
MORE PHYSICIANS ARE NOT EVEN
WILLING TO SEE MEDICARE
PATIENTS.
IF THERE REALLY IS WASTE AND
FRAUD IN MEDICARE -- AND WE KNOW
THERE'S SOME -- WE SHOULD
IT AND PUT THAT MONEY BACK INTO
THE MEDICARE SYSTEM SO THAT WE
CAN KEEP OUR PROMISES TO
SENIORS.
EVERY DEMOCRAT HERE IN THE
SENATE HAS ALREADY VOTED FOR A
GOVERNMENT TAKEOVER OF HEALTH
CARE, TO CUT MEDICARE TO PAY FOR
IT, AND TO RAISE TAXES.
SOME OF THEM SAID THEY WERE JUST
MOVING THE DEBATE FORWARD.
BUT I ASK YOU, WHAT DEBATE?
WILL THERE BE ANY SERIOUS
CONSIDERATION TO TAKE THIS
GOVERNMENT-RUN PLAN OUT OF THIS
BILL?
THERE WON'T BE.
WE'VE ALREADY SEEN THAT THERE'S
NO SERIOUS CONSIDERATION TO STOP
TAKING MONEY OUT OF MEDICARE TO
PAY FOR IT.
IN FACT, WE'VE HAD A LOT OF
DEBATE ABOUT WHAT THIS IS GOING
TO DO, TO CUT FROM MEDICARE,
WHAT IT'S EVENTUALLY GOING TO DO
TO BENEFITS, CUT MEDICARE ADVANTAGE.
NOW WE'RE TALKING ABOUT CUTTING
HOME HEALTH, WHICH IS SO
IMPORTANT, PARTICULARLY IN RURAL
COMMUNITIES AND FOR THE MORE
ELDERLY CONSTITUENTS THAT WE
SERVE.
THERE'S NO WAY YOU COULD TAKE
THIS MONEY OUT OF MEDICARE
WITHOUT HURTING THE PROGRAMS.
INSTEAD, AS WE LOOK
MORE PEOPLE RETIRING THAN EVER
IN HISTORY AND MEDICARE BEING BANKRUPT, WE NEED TO BE LOOKING
AT WAYS THAT WE CAN SHORE UP IN
PROGRAM SO THAT IT WILL BE THERE
FOR GENERATIONS TO COME.
EVERY REPUBLICAN VOTED "NO."
EVERY REPUBLICAN IN THIS SENATE
HAS STOOD WITH THE AMERICAN
PEOPLE AND STAYED "NO" TO A
HEALTH CARE BILL THAT TAS OVER
THE MOST PERSONAL AND PRIVATE
PART OF OUR LIVES.
I'M PROUD OF OUR LEADERSH
AND AMERICANS HAVE BEEN ASKING
TO SEE THE DIFFERENCES BETWEEN
THE REPUBLICAN AND THE DEMOCRAT
PARTY, AND I THINK NOW MORE THAN
EVER ON THIS ISSUE THEY'RE GOING
TO SEE THE DEMOCRATSTANDING
WITH GOVERNMENT-CONTROLLED
HEALTH CARE, CUTS IN MEDICARE,
INCREASED TAXES, AND ON THE
OTHER SIDE REPUBLICANS WHO ARE
GOING TO STAY HERE THROUGH
CHRISTMAS OR NEW YEAR'S OR
WHATEVER IT TAKES TO STOP TS
BILL AND TO SIT DOWN AND REALLY
REFORM THE SYSTEM IN A WAY THAT
WILL LOWER COST AND IMPROVE CARE
TO ALL AMERICANS.
WE NEED TO CONTINUE TO TALK
ABOUT THESE BIGGER ISSUES,
PARTICULARLY H IT AFFECTS
MEDICARE.
AND WE'LL BE DOING THAT OVER THE WEEKEND.
BUT I THINK WE OWE IT TO THE
AMERICAN PEOPLE TO BEGIN TO OPEN
THIS BILL UP AND EXPLAIN WHAT'S
IN IT.
I CAN ALMOST GUARANTEE YOU THAT
THERE'S NOT ONE MEMBER OF THE
SENATE WHO'S READ IT YET.
WE'RE GOING TO TRY TO FIT THIS
IN SANTA'S SLAY TH SANTA'S SLEIGH THIS YEAR SO
IT'LL BE DELIVERED TO EVER AMERICAN.
I'VE GOT THE FIRST PART
1,000 PAGES, SMALL PRINT, FRONT
AND BACK.
STARTED GOING THROUGH IT PUTTING
TABS ON DIFFERENT PAGES SO WE
CAN TALK ABOUT THE DIFFERENT THINGS BECAUSE SOMETIMES THEY
SOUND SO EXTRAORDINARILY PEOPLE
DON'T REALLY BELIEVE THEY'RE IN
THERE.
I'M NOT SURE WE'LL EVER GET
THROUGH THE WHOLE THING, BUT I
JUST WANTED TO TAKE A COUPLE
PARTS TONIGHT AND JUST START
TALKING ABOUT WHAT IS REALLY IN
THIS BILL.
ON PAGE 17 IN SECTION 2713, IT
IS INTIELTDED "COVERAGE OF
PREVENTIVE HEALTH SFERTIONS"
WHICH IS REALLY OUR JARGON FOR
RATIONING IF SAYS A GROUP HEALTH
PLAN AND HEALTH INSURANCE ISSUER
OFFERING GROUP OR INDIVIDUAL
HEALTH INSURANCE COVERAGEERN
PROVIDE COVERAGE FROR
EVIDENCE-BASED ITEMS OR SERVICES
THAT HAVE IN EFFECT AN "A" OR
"B" RATING IN THE CURRENT
RECOMMENDATIONS OF THE UNITED
STATES PREVENTIVE SERVICES TASK
FORCE.
AND WE HEARD FROM THIS TASK
FORCE A FEW WEEKS AGO.
BUT THIS MAY SOUND HARMLESS
ENOUGH, AS YOU LOOK AT
BUT LET'S SEE WHAT THIS REALLY MEANS.
EVIDENCE-BASED.
"A" OR "B" WHAT'S NOT "A" OR "B"?
WELL, WE JUST FOUND OUT
SOMETHING THAT WAS NOT "A" OR
"B."
THE TASK FORCE CAME OUT AND SAI
IT SHOULD NOT BE COVERED ON
ANYONE UNDER 50 YEARS OLD.
NOW, THAT'S IN THE BILL THAT IT
WOULD NOT COVER MAMMOGRAMS FOR
FOLKS UNDER 50 YEARS OLD.
BECAUSE IT'S NOT "A" OR "B"
BECAUSE OF THE OUTCRY, WE HAD AN
AMENDMENT FROM THE OTHER SIDE TO
GIVE THEMSELVES A LITTLE BIT OF
COVER ON THAT ONE MEDICAL
PROCEDURE, MAMMOGRAMS.
AND WE PASSED IT WITH SOME
FANFARE YESTERDAY, BUT THE FACT
IS, THERE ARE GOING TO BE MANY
"C" RATINGS THAT AREN'T COVERED.
WHAT ARE WE GOING TO DO HERE IN
CONGRESS OVER THE NEXT SEVERAL
YEARS WHEN WE FIND CONSTITUENTS
ARE NOT COVERED FOR THINGS THAT
THEY NEED IN RETIREMENT FROM
MEDICARE?
ARE WE GOING TO PASS BILLS TO
TRY COVER THOSE INDIVIDUAL
THINGS?
WHAT WE SHOULD REALLY DO IS
THROW OUT THE BILL THAT'S
CAUSING THE PROBLEM.
WE SHOULD NOT BE RATIONING CARE
TO OUR SENIORS.
LET'S LOOK AT ANOTHER PAGE.
AND I KNOW THIS IS NOT AS
INTEREING AS TALKING ABOUT
THEORETICAL STUFF.
BU
CALLED "THE AAPPEALS PROCESS," A
GROUP HEALTH PLAN AND A HEALTH
ISSUANCE
OR INDIVIDUAL HEALTH INSURANCE
COVERAGE SHALL IMPLEMENT AN
EFFECTIVE APPEALS PROCESS TO
PROVIDE NOTICE TO ENROLLEES IN A
CULTURALLY AND
APPROPRIATE MANNER."
NOW, WHAT DO WE THINK THAT
MEANS?
WELL, IN FACT IN 2001, THIS TERM
HAS BEEN USED BEFORE IN THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES SPENT $10 MILLION TO
FIGURE OUT WHAT THAT PHRASE
MEANT -- MEANS.
AND WE STILL DON'T KNOW.
I MEAN, IT SAYS "HEALTH SERVICES
THAT ARE RESPECTFUL AND
RESPONSIVE TO CULTURAL AND
LINGUISTIC NEEDS."
BUT WHAT IT REALLY MEANS TO US
IN THE 2000 CENSUS IS THERE ARE
AT LEAST 20 LANGUAGES SPOKEN BY
AT LEAST 200,000 AMERICANS IN
THIS COUNTRY, AND WHAT WE'RE
PUTTING OUT THERE IS A LIABILITY
FOR EVERY INSURANCE COMPANY WHO
DOESN'T HAVE EVERY ASPECT OF
THEIR PLAN IN THOSE 20 LANGUAGES.
IT MAY SOUND LIKE A SIMPLE
THING, BUT EVERY PAGE OF THIS
BILL ALMOST AS YOU READ IT, YOU
REALIZE IT'S INCREASING
COMPLEXITY AND COST OF THE
SYSTEM HERE IN AMERICA.
I'LL JUST COVER ONE OF -- ONE
MORE OF THESE, AS I HEAR MY
COLLEAGUES URGING ME TO FINISH HERE IN THE BACKGROUND.
BUT I DO THINK WE OWE IT TO THE
AMERICAN PEOPLE TO GRIN TO TALK
ABOUT -- TO BEGIN TO TALK ABOUT
WHAT'S REALLY IN THIS BILL.
ON PAGE 39
"FUNDING CATEGORY" -- "OUT OF
ALL FUNDS IN THE TREASURY NOT
OTHERWISE APPROPRIATED, THEY'RE
APPROPRIATE TO THE SECRETARY
$250 MILLION TO BE AVAILABLE FOR
EXPENDITURES FOR GRANTS UNDER
PARAGRAPH 1 AND SUBPARAGRAPH 1."
AND WHAT THOSE SUBPARAGRAPHS ARE
ARE TO TRACK THE TRENDS IN
PREMIUM INCREASES OF HEALTH
INSURANCE ONCE THIS BILL GOES
INTO EFFECT.
$250 MILLION TO DO WHAT THE
CONGRESSIONAL BUDGET OFFICE HAS
ALREADY TOLD US IS GOING TO BE INCREASES.
BUT THIS KIND OF SPENDING AND
THIS TYPE OF BUREAUCRACY AND
COMPLEXITY THAT WE'RE CREATING
IS NOT GOING TO MAKE HEALTH CARE
MORE ACCESSIBLE AND MORE
AFFORDABLE FOR AMERICANS.
IT IS CREATING A COMPLEX
BUREAUCRACY WITH TENS OF
THOUSANDS OF WORKERS
BUREAUCRATS TO
DO -- TELL DOC
AND
US HOW TO MANAGE OUR HEALTH
CARE.
THE CONGRESSIONAL BUDGET OFFICE
HAS ALREADY RELEASE ADD REPORT
FINDING THAT THE PURCHASING
HEALTH INSURANCE EXCHANGES THAT
ARE IN THIS BILL COULD PAY UP TO
16% MORE FOR HEALTH CARE THAN WE
DO TODAY.
YET WE'RE MOVING AHEAD WITH THIS
BILL.
I'LL CONTINUE THROUGHOUT THIS
WEEKEND AND EVERY TIME I GET A
CHANCE TO SPEAK TO TALK ABOUT
MORE OF THESE THINGS THAT ARE IN
THIS BILL.
FOLKS, THIS IS NOT A BILL WE
SHOULD DELIVER TO THE ARICAN
PEOPLE FOR CHRISTMAS THIS YEAR.
TH IS A BILL THAT WE SHOULD
THROW OUT SO THAT WE CAN START
OVER AND HAVE A STEP-BY-STEP
APPROACH TO MAKE HEALTH
INSURANCE MORE AFFORDABLE AND
AVAILABLE TO EVERY A
WITH
YIELD BACK.
A SENATOR: MR. PREDENT?
A SENATOR: MR. PRESIDENT, I
THINK WE'RE GOING BAC BACK AND FORTH
HERE.
A SENATO
MR. BAUCUS: SORRY?
A SENATOR: THERE'S NO FORTH.
WE CAN GO BACK AND BACK AND THEN
FORTH AND
MR. BAUCUS: FORTH ANDORTH AND
TO AND FRO, AND THIS AND THAT.
THAT'S FINE WITH ME.
A SENATOR: MR. CHAIRMAN,
WASTING.
I
A SENATOR: MADAM PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM DELAWARE'S
RECOGNIZED.
MR. KAUFMAN: MR. PRESIDENT, I
ASK TO SPEAK IN MORNING BUSINESS
FOR UP TO FIVE MINUTES. THE PRESIDING OFFICER: WITHOUT
OBJECTION, SO ORDERED.
MR. KAUFMAN: MADAM PRESIDENT, I
GREAT FEDERAL EMPLOYEE.
HUMAN INGENUITY IS BOUNDLESS.
THIS IS ESPECIALLY TRUE IN
AMERICA, WHICH HAS ALWAYS BEEN
DRIVEN BY AN ENTREPRENEURIAL
SPIRIT AND BELIEF THAT NOTHING
IS IP POSSIBLE.
-- IMPOSSIBLE.
FROM THE ELECTRIC TELEGRAPH TO
THE REFRIDGE RATED RAILCAR, OUR
FOREBEARERS HELPED TO BUILD A NATION.
SUCH INVENTION CLOSED THE
WESTERN FRONTIER IN THE 19th CENTURY.
IN THE CENTURY THAT FOLLOWED
AMERICANS CONTINUED TO BE
PIONEERS ON THAT FRONTIER WHICH
HAS NO END, THE FRONTIER OF
SPBS.
-- SCIENCE.
67 YEARS AGO THIS WEEK, A TEAM
OF
FREDERICKO FERNI, THEY HUDDLED
UNDER THE STANDS OF A FOOTBALL
STADIUM IN THE UNIVERSITY OF
CHICAGO, THEY INITIATED THE
FIRST EVER CONTROLLED NUCLEAR
REACTION.
THAT EXPERIMENT CALLED THE
CHICAGO PILE ONE, MARKED THE
BEGINNING OF THE NUCLEAR AGE.
MADAM PRESIDENT, TODAY ALL
AMERICANS KNOW
DISCOVERY OF NUCLEAR POWER WAS A
MIXED BLESSING.
WITH IT CAME THE POTENTIAL FOR A
NEW FORM OF ENERGY TO POWER OUR
HOMES AN BUSINESSES.
FOR THE FIRST TIME OUR NAVAL
SHIPS COULD REMAIN AT SEA AND ON
GUARD FOR EXTENDED PERIODS
WITHOUT REFUELING.
WITH THE NUCLEAR ENERGY CAME
NUCLEAR WEAPONS, THIS LED TO THE
MASS DESTRUCTION OF HUNDREDS OF
CITIES WITHIN WEEKENDS.
THEY BROUGHT US THE GENERATION
OF DUCK AND COVER AND BACK YARD
FALLOUT
THANKFULLY, THOU OUR NATION
AND OTHERS CONTINUE
THESE WEAPONS IN OUR TIME, THE
COLD WAR IS OVER.
NO LONGER ARE WE MINUTES FROM
DESTRUCTION THE WAY WE ONCE
WERE.
TODAY PEACEFUL NUCLEAR ENERGY
PROVIDES ONE-FIFTH OF OUR
NUCLEAR ENERGY AND THERE ARE 104
NUCLEAR REACTORS ACROSS THE
COUNTRY.
DEVELOPING AND ENFORCING THE
REGULATION THAT'S KEEP THESE
REACTORS SAFE ARE THE MEN AND
WOMEN OF THE UNITED STATES
NUCLEAR REGULATORY COMMISSION.
I WANT TO RECOGNIZE THE
CONTRIBUTION OF DR. GARRITH
PERRY.
HE HAS A DISTINGUISHED CAREER AT
THE NUCLEAR REGULATORY
COMMISSION.
HE IS ALSO A 2004 RECIPIENT OF
THE DISTINGUISHED ARTHUR S.
FLEMING AWARD FOR PUBLIC SERVICE.
HE IMMIGRATED TO THIS COUNTRY
FROM THE UNITED KINGD HAS 30
YEARS OF EXPERIENCE FOR
DEVELOPING MODELS FOR
PROBLEMISTIC RISK ANALYSIS OR
N.P.R.A.
-- WITH THE OFFICE OF NUCLEAR
REACTOR REGULATION, HE WAS ONE
OF THE LEADING EXPERTS ON
ANALYZING COMMON CAUSE FAILURE
AND HUMAN RELIABILITY.
HIS WORK LED TO THE DEVELOPMENT
OF P.R.I. STANDARDS AND THE USE
OF P.R.A. TO PERFORM RISK
INFORMED MAKING WITH REGARD TO
NUCLEAR SAFETY.
GARRETH WORKED HARD TO ENSURE
THE SAFETY OF AMERICANS,
CIVILIAN NUCLEAR FITS.
THE KIND OF WORK HE PERFORMED IS
HIGHLY MATHEMATICAL AND COMPLEX.
AND IT MAY NOT SOUND GLAMOROUS
TO THE AVERAGE AMERICAN, BUT IT
IS CRITICAL AND CONTINUES
ENORMOUSLY TO THE SECURITY AND
ECONOMIC WELL-BEING OF OUR
NATION.
67 YEARS AGO, THERE WAS THE
POWER OF THE ATOM.
TODAY MEN AND WOMEN OF THE
NUCLEAR REGULATORY COMMISSION
THAT OUR MODERN NUCLEAR REACTORS
CONTINUE TO DO SO SAFELY.
I HOPE MY COLLEAGUES WILL JOIN
ME IN HONORING THE SERVICE OF
DR. GARRETH PERRY AND ALL WHO
HAVE WORKED AND CONTINUE TO WORK
AT THE NUCLEAR COMMISSION.
I YIELD
A SENATOR: MADAM PRESIDENT? THE PRESIDING OFFICER: THE
SENATOR FROM KANSAS IS RECOGNIZED.
A SENATOR: I TRULY APPRECIATE
IT, MADAM PRESIDENT.
MR. ROBERTS: I RISE TODAY IN
SUPPORT OF MY GOOD FRIEND FROM
NEBRASKA, MY COLLEAGUE FROM
NEBRASKA, SENATOR JOHANNS.
WITH HIS MOTION TO THE OFFICIAL
WORDS TO COMMIT THE BILL BACK TO THE SENATE FINANCE COMMITTEE
WITH THE INSTRUCTIONS TO CUT THE
HOME HEALTH CARE BENEFITS.
WHAT THE DISTINGUISHED SENATOR
IS TRYING TO BRING COMMONSENSE
CUTS TO BRING CARE TO NOT ONLY
RURAL AREAS, BUT ALL OVER THE COUNTRY.
THE BILL THAT WE'RE CONSIDERING
WOULD CUT HOME HEALTH -- THE
BILL SOMETIMES CALLED THE BEHIND
THE CLOSED DOOR BILL.
IT WOULD CUT HEALTH
CARE $32 BILLION.
NOW THE SENATOR FROM NEBRASKA
SAID THAT'S A HEAD SCRATCHER.
AND THAT CERTAINLY IS.
IT IS MORE THAN A HEAD
SCRATCHER, IT IS A LIZZIE BORDEN
AMPUTATION IN REGARDS TO A
VITAL, VITAL PROGRAM.
HOME HEALTH CARE IS CERTIFIED --
PARDON ME -- IS CRITICAL FOR OUR
SENIORS, OBVIOUSLY THAT'S THE
TRUE AND AS CO- CHAIR OF THE
RURAL HEALTH CARE CAUCUS, I CERTAINLY UNDERSTAND THAT.
SO DOES THE SENATOR FROM NEBRASKA.
HE WAS SAYING YESTERDAY HOW MANY
TIMES HE VISITS HIS RURAL
HOSPITALS, RURAL CLINICS, RURAL
HOSPICES, AND YOU DO THAT A LOT
IF YOU'RE FROM NEBRASKA, IOWA,
OR TEXAS OR KANSAS.
AND SO AT ANY RATE IN MY HOME
STATE OF KANSAS AND IN OTHER
RURAL AREAS, MANY SENIORS LIVE
ALONE OUT IN THE COUNTRY, MILES
AWAY FROM A LOCAL HOSPITAL OR
DOCTOR'S OFFICE AND EVEN IF THEY
HAVE A VERY GOOD DOCTOR, THEY
COULDN'T GET THERE FROM HERE
BECAUSE OF
CONDITION.
SO HOME HEALTH CARE ALLOWS THAT
SENIOR THE FREEDOM AND
INDEPENDENCE, MR. PRESIDENT, TO
STAY IN THEIR HOME AND THE
COMFORT OF KNOWING SOMEBODY IS THERE ASSISTING THEIR HEALTH
CARE NEEDS.
MORE IMPORTANTLY HOME HEALTH
CARE IS -- IS THE COST EFFECTIVE
CARE, AS THE SENATOR FROM
NEBRASKA HAS POINTED OUT, THAT
KEEPS THE SENIOR OUT OF A
NURSING HOME OR HOSPITAL.
AND QUESTION GUESS WHAT?
SAVES THE GOVERNMENT MONEY.
OVER THE LONG TERM OF HEALTH
CARE, YOU WILL INCREASE THE COST
IN REGARDS TO NURSING HOMES.
NO QUESTION ABOUT IT.
IN MY STATE I'VE HAD THE
PLEASURE BEING ABLE TO SEE
FIRSTHAND, JUST LIKE THE SENATOR
FROM NEBRASKA, THE GREAT WORK
THAT OUR HOME HEALTH CARE
ASSOCIATION DOES EVERY DAY.
I WAS INVITED INTO THE HOME OF A
LOVELY COUPLE IN
CONCORDEGENTLEMAN, AND DESPITE
HAVING MULTIPLE HEALTH ISSUES
DUANE AND PHYLLIS WERE ABLE TO
STAY IN THEIR HOME WITH THEIR
LITTLE DOG JOSEY THANK TO A HOME
HEALTH CARE AIDE AND A NURSE.
WHAT'S GOING TO HAPPEN TO
SENIORS LIKE DUANE AND PHYLLIS
IF WE SLASH $32 BILLION FROM
HOME HEALTH CARE PARTICIPATES?
IT IS ONE OF THE LARGEST CUTS IN
THE WHOLE BILL NEXT TO MEDICARE ADVANTAGE.
THE SENATOR FROM NEBRASKA HAD
THAT CHART WITH ALL OF THE CUTS
TO ALL OF THE PROVIDERS.
DON'T FORGET THIS COMES ON THE
HEELS OF SEVERAL YEARS OF
ADDITIONAL CUTS TO HOME HEALTH CARE.
AROUND THE $35 BILLION ALL TOLD
THAT ALREA HAVE A LARGE
PERCENTAGE OF KANSAS HOME HEALTH
CARE AGENCIES OPERATING AT VERY
SLIM OR NEGATIVE MEDICARE
MARGINS.
I KNOW THE SAME IS IN IOWA.
I KNOW THE SAME IS IN MONDAY.
THE SAME IS IN TEXAS.
THE SAME IS IN NEBSKA.
ALL OVER THE COUNTRY.
I KEEP HEARING MY COLLEAGUES,
HOWEVER, ON THE OTHER SIDE OF
THE AISLE INSISTING THAT THEY'RE
HALF TRILLION DOLLAR CUT TO ALL
MEDICARE -- HERE'S THE QUOTE --
"WON'T AFFECT THE BENEFITS
GUARANTEED TO SENIORS." PLEASE STOP THAT.
THAT IS THE MOST DISINGENUOUS
SMOKE SCREEN IN THIS WHOLE DEBATE.
IT MAY BE TRUE.
IT MAY BE TRUE THAT THIS BILL
DOES NOT EXPLICITLY CUT
BENEFITS.
MY FRIENDS, HOWEVER, ACROSS THE
AISLE CANNOT DENY THAT THEIR
CUTS IN REIMBURSEMENT TO
PROVIDERS WILL AFFECT THOSE BENEFITS.
BECAUSE WHEN YOU CUT THE
REIMBURSEMENTS TO PROVIDERS,
GUESS WHO PACE THE PRICE?
THE PATIENT.
DAVID.
OR PARDON ME AND DUANE AND
PHYLLIS AND THEIR DOG JOSIE.
YOU COME TO THEIR HOUSE AND MAKE
THAT ARGUMENT THAT IF YOU CLOSE
DOWN OR MAKE CUTS TO HOME HEALTH
CARE, DUANE'S NOT GOING TO LIKE
IT, PHYLLIS' NOT GOING TO LIKE
IT AND JOSIE WILL BITE YOU ON
YOUR LEG.
MANY OF MY KANSAS HOME HEALTH
CARE AGENCIES ARE WORKING AT
NEGATIVE MARGINS.
THE CUTS AS PROVIDED BY THE
DISTINGUISHED SENATOR FROM
BRASKA, $240 MILLION.
THE GENTLEMAN FROM MONTANA, THE
DISTINGUISHED CHAIRMAN OF THE --
OF THE FINANCE COMMITTEE, MY
DEAR FRIEND, THAT'S $60 MILLION
IN MONTANA, IN NEVADA, WHERE THE
DISTINGUISHED MAJORITY LEADER
LIVES, THE CHART THAT'S JUST
BEEN PROVIDED TO ME BY THE
SENATOR, $263 MILLION.
TEXAS -- TEXAS WE HAVE SENATOR
CORNYN SITTING RIGHT BEHIND ME
HERE.
SENATOR CORNYN, YOU'RE IN TH
THE $6.8 BILLION CATEGORY.
WHAT WILL HAPPEN IF YOU GET CU
CUT $6.8 BILLION IN REGARDS TO
HOME HEALTH CARE, SIR?
MR. CORNYN: IF THE SENATOR WILL
YI
$6.8 BILLION WILL CUT NOT JUST
INTO THE MUSCLE, BUT INTO THE
BONE AND DENY A LOT OF PEOPLE --
A LOT OF
PARTICULARLY IN RURAL AREAS,
ACCESS TO CARE ENTIRELY.
MR. ROBERTS: I THANK THE SENATOR.
THE SENATOR FROM NEBRASKA HAS ALREADY POINTED OUT WHAT HAPPENS
IN NEBRASKA.
AND I KNOW WHAT WILL HAPPEN IN KANSAS.
NEARLY TWO-THIRDS OF KANSAS HOME
HEALTH CARE AGENCIES WILL HAVE
NEGATIVE MARGINS ONE FIVE YEARS,
PROBABLY TWO OR THREE, IF THESE
CUTS ARE ALLOWED TO OCCUR.
MR. PRESIDENT, HOW ARE THESE
AGENCIES SUPPOSED TO STAY IN
BUSINESS WITH THESE KINDS OF CUTS?
THE HOME HEALTH CARE BENEFIT
WILL BE WORTHLESS TO A KANSAS
MEDICARE PATIENT WHOSE HOME
HEALTH CARE AGENCIES WILL GO OUT
OF BUSINESS.
SO, YES, IN FACT, THIS BILL WILL
EFFECTIVELY CUT BENEFITS.
AGAIN, GET RID OF THE SMOKE
SCREEN.
AND THIS JUST DOESN'T APPLY TO
THE HOME HEALTH CARE BENEFIT.
THE SAME CAN BE SAID FOR THE
EFFECTS OF THE CUTS AS
DEMONSTRATED BY THE SENATOR FROM
NEBRASKA, TO REIMBURSEMENT FOR
HOSPITALS.
$1.5 BILLION, THIS BILL IS GOING
TO COST THE KANSAS HOSPITAL
ASSOCIATION.
BECAUSE SOME OUTSIDE EXPERTS CAME IN.
I ASKED THEM WHAT WILL BE THE
EFFECT OF THE CUTS.
THEY ALREADY HAVE CUTS.
THEY ONLY GET REIMBURSED 70%
NOW, AND $1.5 BILLION ON TOP OF THAT.
WE OUGHT TO HAVE A CHART, I'M
SURE THAT WE WILL HAVE A CHART
TO SAY TO IOWA, NEBRASKA OR ANY
STATE HERE, AND TEXAS
ESPECIALLY, BECAUSE OF THE
NUMBER OF FOLKS THAT WE HAVE.
SO HOSPITALS, HOSPICES, SKILLED NURSING FACILITIES AND ALL OF
THE REST.
I WANT EVERY SENIOR TO KNOW THAT
WHILE MAYBE IT IS TECHNICALLY
ACCURATE AGAIN FOR MY FRIENDS
ACROSS THE AISLE TO CLAIM THAT
THIS BILL DOESN'T CUT MEDICARE
BENEFITS THERE IS NO WAY -- NO
WAY THAT YOU CAN SLASH A HALF A
TRILLION DOLLARS FROM PAYMENTS
TO PROVIDERS WITHOUT AFFECTING
THEIR ABILITY TO KEEP THEIR DOOR OPEN.
ESPECIALLY IN RURAL AND
SMALL-TOWN AMERICA.
SENIORS SHOULD KNOW THEY WILL BE
LEFT WITH A WORTHLESS BENEFIT TO
PARAPHRASE MY FRIEND, SENATOR
ALEXANDER FROM TENNESSEE, IT
WILL BE LIKE HAVING A BUS TICKET
WITHOUT A BUS.
THANK YOU, SENATOR JOHANNS.
THANK YOU FOR THE WORK THAT YOU
ARE DOING.
THANK YOU FOR THIS MOTION.
I HOPE WE ARE SUCCESSFUL.
I HOPE PEOPLE WILL WAKE UP AND
UNDERSTAND THE SEVERITY OF WHAT
THESE CS WILL DO.
AND I URGE EVERY MEMBER OF THIS
SENATE TO SUPPORT SENATOR
JOHANNS WHEN WE COME TO A VOTE
ON THIS
THANK YOU, MR. PRESIDENT.
I YIELD THE FLOOR.
MR. BAUCUS: MR. PRESIDENT?
THE PRESIDING OFFICER: T
SENATOR FROM
MR. BAUCUS: I HEARD THAT THIS IS
GOING TO HEAR FROM SENATORS THAT
THIS WILL HURT SENIORS, WORDS
LIKE SMOKE SCREEN AND ALL OF THAT.
THIS IS A WELL THOUGHTOUT
CONSIDERED POLICY THAT I THINK
STRIKES A VERY GOOD BALANCE
BETWEEN GETTING CARE TO --
ESPECIALLY TO SENIORS AT HOME,
WHICH IS SO IMPORTANT, ON THE
ONE HAND AND MAKING SURE THAT
THERE'S NOT WASTE ON THE OTHER HAND.
I MEAN, THAT IS OUR
RESPONSIBILITY HERE IS TO MAKE
SURE THAT THE PROGRAM WORKS AN
WORKS WELL.
I HAVE SORT AFTER SPECIAL
INTEREST IN THIS.
MY MOTHER'S IN THE HOSPITAL,
ABOUT TWO WEEKSGO, AND SHE
FORTUNATELY IS DOING MUCH
BETTER.
SHE'S IN THE HOSPITAL.
I SPENT SOME TIME WITH HOME
HEALTH CAREGIVER, WHO IS DOING
-- WITH WHOM I WAS VERY, IMPRESSED.
THISOME HEALTH PERSON WAS JUST
DOING A GREAT JOB WITH MY MOTHER
AND -- AND I'VE SEEN OTHER
INSTANCES TOO.
BUT, PERSONALLY, I WAS VERY
HAPPY TO SEE MY MOTHER IN VERY,
VERY GOOD CARE FROM A HOME
HEALTH CARE NURSE.
I THINK IT IS ALSO IMPORTANT TO
JUST REMIND MY COLLEAGUES THAT
THIS AMENDMENT IS REALLY A
RETREAD ON THE McCAIN
AMENDMENT THAT WE DEBATED OVER
THE LAST FEW DAYS, GENERALLY.
THAT IS, ONCE AGAIN THE
OPPONENTS OF THIS BILL ARE
ENDORSING THE STATUS QUO OF
MEDICARE GOING ON THE BRINK OF
GOING BANKRUPT AND SENIORS
FACING
I REMIND MY COLLEAGUES AGAIN
WHAT WILL HAPPEN IF WE STICK TO
THE STATUS QUO, THAT IS NO BILL
WHICH THE OTHER SIDE IS
ADVOCATING.
IT MEANS MEDICARE WILL GO BROKE
IN EIGHT YEARS.
THAT'S THE STUS QUO. IN OUR LEGISLATION THAT IS
POSTPONED FOR AT LEAST FIVE MORE YEARS.
THE STATUS QUO, WITH NO BILL
WITH THE OTHER SIDES ADVOCATING,
MEANS SENIORS WILL CONTINUE
PAYING HIGHER AND HIGHER
PREMIUMS AND COST SHARING DUE TO
WASTEFUL OVERPAYMENTS TO A GOOD
NEWSROOM OF -- NUMBER OF HEALTH
CARE PROVIDERS.
THERE IS SO MUCH WASTE IN OUR
SYST
KNOW THERE IS A LOT OF WASTE IN
OUR SYSTEM, AND FRANKLY I'M
QUITE SURPRISED THAT NOT ALL OF
OUR COLLEAGUES WANT TO CUT OUT THE WASTE.
IN EFFECT, THEY WANT TO KEEP THE
WASTE.
THAT'S UNFORTUNATELY IN OUR SYSTEM.
THE STATUS QUO ALSO MEANS TT
EACH YEAR BILLIONS OF MEDICARE
DOLLARS WILL CONTINUE TO BE
WASTED ON LINING THE POCKETS OF
PRIVATE INSURANCE COMPANIES, AND
THAT MIGHT BE A BIT
STATEMENT, BUT THE FACT IS THAT
THAT -- IS THAT SOME CHIEF
EXECUTIVES OF PRIVATE INSURANCE
COMPANIES ARE PAID MILLIONS --
TENS OF MILLIONS OF DOLLARS TO
MANAGE MEDICARE PROGRAMS,
ESPECIALLY MEDICARE ADVANTAGE,
AND THAT THE STATUS QUO MEANS
THAT WILL CONTINUE.
THE STATUS QUO ALSO MEANS THAT
SENIORS WILL CONTINUE STRUGGLING
TO PAY FOR PRESCRIPTION DRUGS.
MR. PRESIDENT, THE STAKES OF
SENIORS IN THE MEDICARE PROGRAM
HAVE NEVER BEEN HIGHER.
WE HAVE A CHOICE HERE,
MR. PRESIDENT.
IT'S A VERY SIMPLE CHOICE.
EITHER ENDORSE THE STATUS QUO OR
STRENGTHEN MEDICARE.
LET'S TALK A LITTLE BIT ABOUT
HOME HEALTH CARE.
REGARDING MEDICARE CHANGES FOR
HOME HEALTH PROVIDERS LET ME
DESCRIBE WHAT IS IN THE SENATE BILL.
I DON'T THINK OUR COLLEAGUES
REALLY KNOW SPECIFICALLY WHAT'S
IN THE SENATE BILL.
THAT MAY BE A STRONG STATEMENT
TO MAKE, BUT I THINK IF THEY
KNEW WHAT WAS IN THE BILL, THAT
SOME OF THE STATEMENTS MADE
TONIGHT MIGHT BE A LITTLE BIT DIFFERENT.
AS MOST OF MY COLLEAGUES WOULD
AGREE, HOME HEALTH CARE IS
EXTREMELY IMPORTANT.
IT'S A VY IMPORTANT BENEFIT IN
THE MEDICARE PROGRAM.
WE ARE ALL VERY STRONG ADVOCATES
OF HOME HEALTH.
ACROSS THE COUNTRY, THERE ARE
MORE THAN 9,800 HOME HEALTH
AGENCIES THAT PROVIDE CARE
SENIORS IN THEIR HOMES.
THIS CARE HELPS SENIORS GET
BETTER, IT HELPS THEM AVOID
EXPENSIVE REHOSPITALIZATIONS.
WE'RE ALL CHAMPIONS OF HOME
HEALTH.
WE LIKE PEOPLEOT TO B INSTITUTIONALIZED.
IT'S MUCH BETTER WHERE
APPROPRIATE TO HAVE CARE IN THE
HOME AND HOME HEALTH CARE
AGENCIES HAVE PROVIDED THAT.
IT'S SO, SO IMPORTANT.
IN MY STATE OF MONTANA, HOME
HEALTH CARE PROVIDERS GO THE
EXTRA MILE, LITERALLY, TO
PROVIDE CARE TO PATIENTS ACROSS
VAST DISTANCES.
IN SOME CASES,OME HEALTH
PROVIDERS IN RURAL AREAS HAVE TO
DRIVE 100 MILES JUST TO SEE ONE PATIENT.
THEY'RE DEDICATED PEOPLE.
THEY GO GREAT DISTANCES AND
TRAVEL A LONG WAY TO SEE VERY
FEW PATIENTS.
HOME HEALTH PROVIDERS MAKE A
REAL DIFFERENCE IN IMPROVING
SENIORS' HEALTH AND WE SHOULD
SUPPORT THEIR EFFORTS, AND WE
ALL DO.
WE ALL VERY MUCH SUPPORT THEIR
EFRTS.
WE'LL HAVE GREAT RESPECT FOR THE
SERVICES OF HOME HEALTH -- THAT
HOME HEALTH PROVIDERS GIVE.
WE ALSO HAVE THE RESPONSIBILITY
TO PROTECT THE MEDICARE PROGRAM.
WE HAVE TO ROOT OUT WASTE.
AND UNFORTUNATELY, THERE IS
ALMOST ALWAYS SOME WASTE SOMEWHERE.
IT'S A MATTER OF JUDGMENT AS TO
HOW MUCH IS WASTE AND HOW MUCH
IS NOT.
WE MUST MAKE SURE MEDICARE IS
PAYING APPROPRIATELY.
THAT IS, MEDICARE IS NOT OVER
PAYING FOR MEDICARE SERVICES.
WE ALSO MUST TAKE ACTION TO ROOT
OUT FRAUD AND ABUSE GENERALLY
WHERE IT MAY OCCUR IN THE HOME
HEALTH INDUSTRY AS WELL.
THE POLICIES IN THIS SENATE BILL
I THINK ACHIEVE BOTH GOALS.
SO WHAT DO WE DO IN THE BILL?
FIRST, THE SENATE BILL WOULD
REBASE HOME HEALTH PAYMENTS TO
ENSURE PAYMENTS REFLECT ACTUAL
COSTS OF PROVIDING CARE.
THESE CHANGES ARE BASED ON
RECOMMENDATIONS BY MEDPAC, THE
INDEPENDENT ADVISORY COMMISSION
WHICH ADVISES CONGRESS ON MEDICARE REIMBURSEMENT.
IT'S A NONPARTISAN GROUP.
MEDPAC ADVISES REBASE HOME
HEALTH PAYMENTS.
WHAT DO WE MEAN BY THAT?
WHEN THE CURRENT HOME HEALTH
PAYMENTS WERE SET, SENIORS
RECEIVED AN AVERAGE OF 31 VISITS
PER EPISODE.
TODAY THEY RECEIVE 21, 22 VISITS
AS THEY GET PAID FOR
FRANKLY -- ACTUALLY GET PAID
ABOUT THE SAME FOR DOING LESS.
WE'RE TRYING TO MAKE SURE THE
PAYMENT REFLECTS THE ACTUAL
SERVICES PROVIDED.
SO THE SENATE BILL DIRECTS THE
C.M.S. TO REBASE PAYMENTS TO
REFLECT THIS CHANGE.
IT'S COMMON SENSE.
MEDPAC RECOMMENDED
MEDPAC THINKS IT'S GOT TO KEEP
UP WITH THE TIMES BECAUSE TIMES
HAVE CHANGED OVER THE YEARS AND
THAT THE PAYMENT SYSTEMS REFLECT
THAT CHANGE.
SOMETHING ELSE I THINK IS VERY
IMPORTANT AS MOS OF MY COLLEAGUES AGREE WITH.
THAT IS THE SENATE BILL ROOTS
OUT FRAUD THAT UNFORTUNATELY
EXISTS IN HOME HEALTH CARE AS
WELL AS SOME AREAS OF MEDICARE SPENDING.
IT ROOTS OUT THE
TRIES TO ROOT OUT THE FRAUD AND
MEDICARE PAYMENTS FOR OUTLI
CASES.
MEDICARE PROVIDES AN EXTRA
PAYMENT TODAY TO
HEALTH FOLKS WHO TREAT SICKER
PEOPLE OR OTHERWISE KNOWN AS
OUTLIER PATIENTS, REALLY SICK.
FORTUNATELY, THE -- UNFORTUNATELY, THE GENERAL
ACCOUNTING OFFICE FOUND THAT
SOME PROVIDERS WERE GAMING THE
SYSTEM AND GETTING MUCH MORE
OUTLIER PAYMENTS THAN THEY DESERVED.
FOR EXAMPLE, THE GENERAL
ACCOUNTING OFFICE FOUND IN ONE
FLORIDA COUNTY ALONE, HOME
HEALTH PROVIDERS WERE RECEIVING
60% OF ALL TOTAL OUTLIER PAYMENTS.
THAT'S NATIONWIDE, ONE COUNTY
GETTING 60%, EVEN THOUGH THE
COUNTY HAD LESS THAN 1% OF A
TOTAL MEDICARE POPULATION.
I DON'T WANT TO JUST SINGLE
FLORIDA, BUT THERE ARE SOME
OTHER COUNTIES, THEY TEND TO BE
IN THE SOUTHERN PART OF THE
COUNTRY WHICH CLEARLY HAVE
GROSSLY, GROSSLY
DISPROPORTIONATE AMOUNT OF
OUTLIER PAYMENTS, THEY ARE
GAMING T SYSTEM.
WE ADDRESSED THI PROBLEM
PLACING A CAP ON THE AMOUNT
PROVIDED BY THE PAYMENTS.
THE SENATE BILL ALSO MAKES
CHANGES IN 2007 AND 2012
RECOMMENDED BY MEDPAC.
WHY IS THAT IMPORTANT?
MEDPAC WAS ACTUALLY MUCH TOUGHER.
THEY WANTED TO START RIGHT AWAY IN 2010.
NO, WE'LL HOLD OFF A LITTLE BIT.
WE WANTED TO BE FAIR TO THE HOME
HEALTH PROVIDERS.
IN ADDITION, THE BILL
ESTABLISHES A PRODUCTIVITY
ADJUSTMENT FOR HOME HEALTH
PROVIDERS BEGINNING NOT RIGHT
AWAY, NOT NEXT YEAR, NOT THE
FOLLOWING YEAR.
IT DOESN'T BEGIN UNTIL THE YEAR
2015.
THESE CHANGES AS HOME HEALTH
MORE EFFICIENT AND HIGHER
QUALITY CARE OVER TIME.
BEING VERY FAIR ABOUT IT.
VERY IMPORTANTLY, IN MING
THESE CHANGES, WE WORKED VERY
CLOSELY WITH THE HOME HEALTH
INDUSTRY
CHANGES WERE REASONABLE AND THEY
WERE FAIR.
LET'S TAKE EACH OF THE POLICIES
AND WHAT THEY DO WITH RESPECT TO
THE AGENCIES TO MAKE SURE WE'RE
FAIR.
REBASING, MEDPAC RECOMMENDED
WE FULLY IMPLEMENT THESE CHANGES
IN THE YEAR 2011.
TO ENSURE THAT PROVIDERS COULD
ADAPT TO THE NEW PAYMENT RATES,
WE IN THE SENATE DECIDED WE
WOULD PHASE IN THESE CHANGES
OVER FOUR YEARS.
HO HEALTH PROVIDERS SUPPORT
THIS PHASE-IN.
THEY THINK IT'S A GOOD IDEA.
ON THE OUTLIER POLICY AND THE
FRAUD CHANGES, THESE POLICIES
WERE ACTUALLY SUGGESTED TO US BY
GUESS WHO?
BY THE HOME HEALTH INDUSTRY.
THEY CAME TO US AND SAID WE
SUGGEST THAT YOU MAKE SOME
CHANGES IN THE OUTLIERS BECAUSE
TOO MANY AGENCIES AND HOME
HEALTH PROVIDERS ARE GAMING THE SYSTEM.
MAKE SOME
STOP THAT GAMING.
MAKE SOME CHANGES TO STOP THE
FRAUD, SO THEY CAME TO US AND
THEY GAVE US SOME
OBVIOUSLY, THE HOME HEALTH
INDUSTRY FULLY SUPPORTS THE
CHANGES THATHEY RECOMMENDED TO US.
AND THEY'RE IN THIS BILL.
ON THE MARKET BASKET AND
PRODUCTIVITY CHANGES, THE SENATE
BILL
REDUCTIONS AS WE DELAY THESE
REDUCTIONS WHILE THE REBASING
POLICY IS TAKING EFFECT.
AGAIN, WE WANT TO BE FAIR.
THIS BILL GIVES HOME HEALTH
AGENCIES EXTRA TIME, MUCH MORE
TIME THAN IS RECOMMENDED BY VERY
AGGRESSIVE PROPOSED CHANGES,
PROPOSED BY MEDPAC, VERY
AGGRESSIVE CHANGES PROPOSED IN
THE HOUSE BILL AND BY THE ADMINISTRATION.
HE IS SAYING NO, THOSE ARE TOO
AGGRESSIVE, SO WE IN THE SENATE
DECIDE TO GIVE AGENCIES EXTRA
TIME TO ADAPT THESE PAYMENT
CHANGES AND THIS -- RATHER THAN
HAVING ALL THESE IMPLEMENTED AT
THE SAME TIME AS MEDPAC AND THE
HOUSE AND ADMINISTRATION ALL
WOULD -- WOULD RECOMMEND.
AND FINALLY, WITH RESPECT TO
RURAL HOME HEALTH PROVIDERS,
WE'RE ALL VERY SENSITIVE TO THE
RURAL -- THE SPECIAL NEEDS OF
RURAL AMERICA.
SO WHAT DO WE DO ABOUT THAT?
WELL, FROM THE
RURAL PROVIDERS RECEIVE 3% EXTRA
PAYMENT EACH YEAR.
THIS IS A PAYMENT THAT WILL
ENSURE THAT RURAL PROVIDERS ARE
PROTECTED AS WE REFORM THE
BROADER HOME HEALTH SYSTEM.
SO AN EXTRA 3% FROM THE PERIOD
2010-2015 FOR RURAL PROVIDERS.
SO IN TOTAL, THE HOME HEAH
BELIEVE, STRIKE A FAIR BALANCE
BETWEEN ENSURING SENIORS HAVE
ACCESS TO HOME CARE AND ALSO
ROOTINGUT INAPPROPRIATE
PAYMENTS FROM THIS SYSTEM.
NOW, I PREVIOUSLY HEARD MY GOOD
FRIEND SAY, WELL, GEE, THESE
CHANGES ARE REALLY GOING TO HURT SENIORS.
THEY'RE NOT GOING TO HURT SENIORS.
IN FACT, MOST OF THESE CHANGES
ARE CHANGES SUGGESTED BY THE
HOME HEALTH CARE INDUSTRY.
I THINK THAT ALL OF US WANT TO
ROOT OUT FRAUD AND WASTE.
OPPONENTS ALSO SOMETIMES CLAIM
THAT THE MEDICARE BENEFICIARIES
WILL BE HARMED IN LOTS OF WAYS BY THIS BILL.
THAT'S A SCARE TACTIC,
MR. PRESIDENT.
LET ME SAY WHAT THE AMERICAN
ASSOCIATION OF RETIRED PERSONS
SAYS ABOUT THESE KIND OF CLAIMS,
THAT IS THE CLAIM THAT THESE
CHANGES IN MEDICARE
REIMBURSEMENT ARE GOING TO HARM SENIORS.
THE AARP SAYS, AND I QUOTE --
"OPPONENTS OF HEALTH REFORM
WON'T REST.
THEY ARE USING MYTHS AND
MISINFORMATION TO DISTRUTH THE
TRUTH THAT MEDICARE WILL BE
HARMED.
AFTER A LIFETIME OF HARD WORK,
DON'T SENIO
THAT'S A STATEMENT BY THE AARP.
I DON'T SUGGEST HERE TONIGHT
THAT ANY OF OUR COLLEAGUES ARE
USING MYTHS AND MISINFORMATION
TO DISTORT THE TRUTH, BUT
MAIN POINT HERE IS AARP WHEN IT
HEARS CLAIMS THAT SENIORS ARE
ING TO BE HURT SAYS THAT'S NOT
TRUE, AND THEY SUPPORT THIS
BILL, THEY STRONGLY SUPPORT THIS LL, I MIGHT ADD.
SO LET ME REMIND MY COLLEAGUES
OF SOME OF THE POSITIVE CHANGES
IN THIS LEGISLATION.
THIS LEGISLATION APPROVES THE
SOLVENCY OF THE MEDICARE PROGRAM
BY FIVE YEARS.
IT PUTS $30 BILLION BACK INTO
THE POCKETS OF SENIORS IN THE
FORM OF LOWER MEDICARE PREMIUMS.
IT MAKES PRESCRIPTION DRUGS MORE AFFORDABLE.
THAT'S AN ADDED BILL THAT WOULD
NOT BE AVAILABLE IF THIS
LEGISLATION WAS NOT PASSED.
THE BILL GUARANTEES SENIORS CAN
CONTINUE TO SEE THE DOCTOR OF
THEIR CHOOSING.
THE BILL PROVIDES FREE WELLNESS
AND PREVENTION
THOSE ARE NEW BENEFITS THAT
DON'T CURRENTLY EXIST.
IT ALSO INCLUDES FAIR TO
APPROPRIATE CHANGES TO HOME
HEALTH AS I SUGGESTED
PROTECT ACCESS TO CARE.
I DON'T QUESTION THE MOTIVES OF
MY COLLEAGUES.
THEY BELIEVE THEY ARE STANDING
UP FOR SENIORS IN OPPOSING
HOME HEALTH CHANGES, BUTN
TRUTH THEY ARE REALLY GOING TO
HARM SENIORS BECAUSE THEY ARE
HURTING THE MEDICARE PROGRAM,
AND I DON'T THINK WE WANT TO
HURT THE MEDICARE PROGRAM.
RATHER, WE'RE
MEDICARE PROAM BY MAKING THESE CHANGES.
ONE OTHER POINT I WANT TO MAKE
THAT'S JUST KIND OF INTERESTING,
I THOUGHT, WHEN I
STILL HAVE IT.
IT'S KIND OF INTERESTING, THE
GROWTH RATE IN HOME HEALTH CARE
SPENDING WILL CONTINUE TO BE
VERY HIGH AFTER THIS LEGISLATION PASSED.
IT WILL
THE GROWTH RATE PER YEAR UNDER
THIS BILL
CURRENTLY, EXCUSE ME, CURRENTLY
THE GROWTH RATE OF HOME HEALTH
CARE INDUSTRIES IS ALMOST 11%
PER YEAR.
AFTER THIS LEGISLATION, IT WILL
BE ALMOST 8%.
8% ANNUAL GROWTH IN THE HOME
HEALTH CARE INDUSTRY, AND THAT'S
MUCH FASTER THAN NATIONAL HEALTH
EXPENDITURES.
SO I THINK -- MOST THINGS IN
LIFE ARE A JUDGMENT CALL.
I THINK WE WILL FAIRLY DECIDE
THE CHANGES WE MAKE IN THIS BILL
ARE GOOD FOR SENIORS, THEY ARE
GOOD FOR HOME HEALTH, BECAUSE
THEY ARE SENSITIVE TO THE NEEDS
OF THE INDUSTRY, SENSITIVE TO
PATIENTS, FRANKLY, BUT ALSO
RESPONSIBLE TO THE AMERICAN
TAXPAYERS BY MAKING SURE WE'RE
ROOTING OUT A LOT
MR. CORNYN: MR. PRESIDENT?
THE PRESIDING OFFICER: THE
SENATOR FROM TEXAS.
MR. CORNYN: THANK YOU,
MR. PRESIDENT.
MR. PRESIDENT, I THINK AS THE
AMERICAN PEOPLE ARE LISTENING TO
THE DEBATE WE'RE HAVING ON -- ON
HEALTH CARE REFORM, THEY ARE
BE
PRETTY IMPLAUSIBLE CLAIMS
ONE CLAIM THAT YOU CAN TAKE HALF
A TRILLION DOLLARS OUT OF
MEDICARE AND IT WON'T HAVE ANY
IMPACT ON THE DELIVERY OF
SERVICES TO MEDICARE
BENEFICIARIES.
HALF A TRILLION DOLLARS.
AND THE BIGGEST MISTAKE, I
THINK, ABOUT THE WAY THIS BILL
IS PAID FOR WITH THE HUGE TAX
INCREASES AND WITH HUGE CUTS IN
MEDICARE IS THAT THE PROPOSAL IS
TO LET'S TAKE HALF A TRILLION
DOLLARS OUT OF
INCLUDING $40 BILLION OUT OF
HOME HEALTH CARE, IN ORDER TO
PA
PROGRAM WHEN WE ALREADY KNOW
THAT MEDICARE ITSELF IS ON A
FISCALLY UNSUSTAINABLE PATH.
WELL, I WANT TO TALK PRIMARILY
ABOUT ANOTHER ASPECT OF -- OF
THIS -- OF THESE CUTS, AND THAT
IS THE 11 MILLION SENIORS,
INCLUDING 532,000 TEXANS WHO
WILL LOSE BENEFITS UNDER THEIR MEDICARE ADVANTAGE PROGRAM
BECAUSE THESE ARE NOT
INCONSEQUENTIAL CUTS IN THEIR
BENEFITS.
THEY'RE SERIOUS, AND I WANT TO
TALK ABOUT SOME REAL HUMAN
BEINGS, SOME REAL TEXANS WHO ARE
GOING TO BE AFFECTED IN THE
NEGATIVE -- NEGATIVELY BY THESE
CUTS.
FIRST OF ALL, I THINK IT'S
ABSOLUTELY CRITICAL FOR THE
AMERICAN PEOPLE TO UNDERSTAND
THAT PHER ITSELF DOES NOT
PROVIDE COMPLETE -- THAT
MEDICARE ITSELF DOES NOT PROVIDE COMPLETE COVERAGE.
THAT IS WHY SOME SENIORS BUY
MEDIGAP IN ORDER TO GET THEIR
BILLS PAID FOR BECAUSE MEDICARE
PAYS ON AVERAGE ABOUT 80% TO
PROVIDERS WHAT PVATE HEALTH
CARE INSURANCE DOES.
THAT'S THE REASON WHY WITHOUT
ADDITIONAL COMPENSATION MANY
DOCTORS WON'T SEE A MEDICARE
PATIENT BECAUSE THEY SIMPLY
CANNOT DO IT AND KP THEIR
DOORS OPEN TO THEIR OTHER PATIENTS.
THE TRUTH IS MEDICARE ADVANTAGE
WAS CREATED TO FIX SOME OF THE
FLAWS WITH MEDICARE
FEE-FOR-SERVICE TO GIVE SENIORS
MORE AFFORDABLE AND BETTER
COORDINATED HEALTH CARE, WHICH
NONE OF US ARE STANDING UP HERE
AND SAYING THAT THE PROPOSED
BILL IS ALL BAD, BECAUSE SOME OF
THE POSITIVE DEVELOPMENTS IN
THIS BILL CALL FOR GREATER
COORDINATION OF HEALTH CARE.
BUT, ON BALANCE, IT MAKES THINGS
WORSE THAN IT DOES BETTER
BECAUSE OF THESE CUTS IN THINGS
LIKE MEDICARE ADVANTAGE.
THE PRESIDENT OF THE UNITED
STATES HAS SAID THAT PROVIDING
AMERICANS WITH A CHOICE OF
QUALITY AFFORDABLE HEALTH CARE
WAS A GUIDING PRINCIPLE FOR HIM,
AND I AGREE WITH THAT STATEMENT
OF PRINCIPLE.
MEDICARE ADVANTAGE WAS CREATED
FOR THAT VERY PURPOSE, BECAUSE,
AS I SAID, MEDICARE ITSELF DOES
NOT ALWAYS WORK WELL FOR
PATIENTS.
WHERE I LIVE IN AUSTIN, TEXAS,
WHICH IS TRAVIS COUNTY, LAST
TIME I SAW A REPORT, ONLY 17% OF
PHYSICIANS WILL SEE A NEW
MEDICARE PATIENT BECAUSE
MEDICARE
SO LOW.
THOSE PROBLEMS ARE AVOIDED IN
LARGE PART BY MEDICARE ADVANTAGE
BECAUSE IT PAYS PHYSICIANS
PROVIDERS BETTER THAN MEDICARE FEE-FOR-SERVICE.
ACCORDING TO THE AMERICAN
MEDICAL ASSOCIATION'S 2008
NATIONAL HEALTH INSURANCE REPORT
CARD,
HEALTH INSURANCE -- BUT MEDICARE
HAD THE HIGHEST PERCENTAGE AND
THE LARGEST NUMBER OF DENIED MEDICAL CLAIMS.
IN FACT, MEDICARE DENIED TEN
TIMES MORE MEDICAL CLAIMS THAN
PRIVATE INSURERS.
THAT'S ANOTHER REASON WHY
SENIORS DESERVE A CHOICE BETWEEN
MEDICARE
WILL OFFER THEM BETTER BENEFITS.
AS I MENTIONED TODAY, 11 MILLION
AMERICANS HAVE MADE THAT CHOICE
OF BETTER BENEFITS AND BETTER
CARE COORDINATION THROUGH THE
MEDICARE ADVANTAGE PROGRAM.
THE PROPOSED BILL, THE REID BILL
WILL TAKE AWAY THOSE CHOICES AND
THE BENEFITS OF THOSE 11 MILLION
SENIORS BY CUTTING ABOUT $120
BILLION FROM THE PROGRAM.
NOW, MANY OF OUR FRIENDS ACROSS
THE AISLE WILL SAY WE CAN CUT
$120 BILLION OUT OF MEDICARE
ADVANTAGE AND IT WILL HAVE NO
IMPACT ON DELIVERY OF SERVICES,
BUT THE CONGRESSIONAL BUDGET
OFFICE DISAGREES WITH THEM, THE
DIRECTOR DOES, WHO SAID THAT
THEIR BENEFITS, THEIR AITIONAL
BENEFITS WILL BE CUT ROUGHLY IN HALF.
WE NEED TO SET THE RECORD
RAIGHT ON THESE SO-CALLED
OVERPAYMENTS ALLEGEDLY GOING TO
INSURANCE COMPANY PROFITS.
IT'S SIMPLY A FALSE STATEMENT.
IT'S NOT TRUE.
OUR COLLEAGUES KNOW THAT THE
SO-CALLED OVERPAYMENTS TO
MEDICARE ADVANTAGE PLANS DON'T
GO INTO THOSE PLANS.
THEY GO TO SENIORS IN THE FORM
OF ADDITIONAL BENEFITS.
THAT'S BECAUSE UNDER FEDERAL
LAW, 75% OF ADDITIONAL PAYMENTS
TO MEDICARE ADVANTAGE PLANS ARE
USED TO PROVIDE SENIORS WITH
ADDITIONAL BENEFITS, BENEFITS
WHICH THEY WOULD NOT GET UNDER
MEDICARE FEE-FOR-SERVICE.
THINGS LIKE CHRONIC CARE
MANAGEMENT, HEARING
EYEGLASSES, AND THE LIKE.
ANDED OTHER 25 -- AND OTHER 25%
OF ANY EXTRA PAYMENTS IS
RETURNED TO THE FEDERAL GOVERNMENT.
SO LET'S BE CLEAR, CUTS TO
MEDICARE ADVANTAGE WOULD BE
TAKING AWAY SENIORS' HEALTH
BENEFITS FOR THOSE 11 MILLION
SENIORS.
AS I MENTIONED 500,000 TEXANS
ARE ON MEDICARE ADVANTAGE AND
THE REID BILL WOULD CUT THEIR
BENEFITS BY WELL OVER HALF.
YOU DON HAVE TO TAKE MY WORD
FOR IT.
LISTEN TO WHAT THE C.B.O.
DIRECTOR, DR. ELMENDORF, SAID,
WHEN SENATOR
DURING THE FINANCE COMMITTEE
HEARING, HE SAID APPROXIMATELY
HALF OF THE ADDITIONAL BENEFIT
WOULD BE LOST TO THOSE MEDICARE
ADVANTAGE POLICYHOLDERS? DR. ELMENDORF SAID -- QUOTE --
"FOR THOSE WHO WOULD BE ENROLLED
OTHERWISE, UNDER CURRENT LAW,
YES."
NEARLY ONE OUT OF EVERY FOUR
SENIORS IN TEXAS WOULD LOSE
ABOUT $122 A MONTH IN HEALTH
CARE BENEFITS TO CREATE A NEW
$2.5 TRILLION ENTITLEMENT THAT
THEIR GRANDCHILDREN WILL
ULTIMATELY END UP HAVING TO PAY
FOR.
$122 A MONTH MAY NOT SOUND LIKE
A LOT TO PEOPLE INSIDE THE
BELTWAY, BUT A COUPLE FROM MY
HOMETOWN OF SAN ANTONIO RECENTLY
WROTE TO ME SAYING, "PLEASE VOTE
TO LEAVE OUR MEDICARE ADVANTAGE
PLANS ALONE.
WE CAN'T AFFORD ANYTHING ELSE AS
OUR PORTFOLIO IS WIPED OUT IN
THE STOCK MARKET CLAPSE LAST YEAR.
MY WIFE AND I HAVE HAD TO GO
BACK TO WORK, AND WE ARE IN OUR
70'S."
AND YET THIS BILL WOULD IMPOSE
ANOTHER $122 PER MONTH CUT IN
THEIR BENEFITS.
ANOTHER CONSTITUENT OF MINE FROM
CONROE, TEXAS, WROTE "PLEASE DO
WHAT YOU CAN TO PROBING THE
MEDICARE ADVANTAGE -- TO PROTECT
THE MEDICARE ADVANTAGE
I'M ON ONE.
IT'S SAVED ME AN ENORMOUS AMOUNT
OF MONEY AND GIVEN ME THE
BENEFITS THAT I'VE NEEDED."
SOME GROUPS THAT SUPPORT THESE
CUTS TO MEDICARE ADVANTAGE HAVE
A CONFLICT OF INTEREST, TO SAY
THE LEAST, BECAUSE THE BENEFITS
UNDER TRADITIONAL
FEE-FOR-SERVICE, AS I MENTIONED,
FOR MEDICARE IS ABOUT 80% OF
WHAT PRIVATE INSURANCE WILL PAY
IN ORDER T GET COVERAGE, IN
ORDER TO PAY THE BILLS MANY
SENIORS HAVE HAD TO BUY
ADDITIONAL INSURANCE COVERAGE.
FOR 11 MILLION SENIORS, MEDICARE
ADVANTAGE PROVIDES THOSE BENEFITS.
FOR MANY SENIORS, FORMER
EMPLOYERS SOMETIMES PROVIDE
WRAPAROUND PLANS
MILITARY, TRICARE PROVIDES A
WRAPAROUND PLAN.
FOR MANY VERY LOW-INCOME
SENIORS, MEDICAID HELPS WITH
COST SHARING AND PREMIUMS.
AND FOR MANY OTHER SENIORS THEY
PURCHASE A STANDALONE MEDIGAP POLICY.
WE HEARD FROM FRIENDS ACROSS THE
AISLE ABOUT AARP'S MEDICARE CUTS
IN THE REID BILL.
IF IT SOUNDS ODD THAT A S
ADVOCACY GROUP WOULD SUPPORT
TAKING NEARLY $500 BILLION FROM
AN ALREADY NEARLY BANKRUPT
MEDICARE PROGRAM, IT SHOULD.
THE FACT OF
"THE WASHINGTON POST" NOTED
OCTOBER 27, THE "POST" SAYS BUT
NOT ADVERTISED IN ITS LOBBYING
CAMPAIGN HAVE BEEN AARP'S
SUBSTANTIAL EARNINGS FROM
INSURANCE ROYALTIES AND THE POTENTIAL BENEFITS THAT COULD
COME ITS WAY FROM MANY OF THE
REFORM PROPOSALS.
DEMOCRATIC PROPOSALS TO SLASH
REIMBURSEMENTS FOR ANOTHER
PROGRAM CALLED MEDICARE
ADVANTAGE ARE WIDELY EXPECTED TO
DRIVE UP DEMAND
MEDIGAP COVERAGE, LIKE THE ONES
OFFERED BY AARP, ACCORDING TO
HEALTH CARE EXPERTS, LEGISLATIVE
AIDES AND DOCUMENTS."
SO AARP, THE SO-CALLED SENIORS'
ADVOCACY GROUP THAT'S ADVOCATED
FOR CUT IN THE BENEFITS TO 11 IS
MILLION BENEFICIARIES OF
MEDICARE ADVANTAGE, A SUGGESTION
IS ONE REASON THEY WILL DO SO IS
BECAUSE THEY WILL PROFIT FROM
THIS BILL BECAUSE THESE SENIORS
WILL, IF THEY CAN AFFORD IT,
HAVE TO GO OUT AND BUY MEDIGAP
COVERAGE FROM, LO AND BEHOLD,
ENTIES LIKE AARP.
THE FACT OF THE MATTER IS
MEDICARE ADVANTAGE ALLOWS
PRIVATE PLANS TO INNOVATE BETTER
AND PROVIDES BETTER COORDINATED
CARE FOR SENIORS.
GROUPS LIKE THE KELSEY SEABOLD
CLINIC IN HOUSTON, TEXAS, WHICH
IS BASICALLY NOT SEEING MEDICARE
FEE-FOR-SERVICE PATIENTS BUT IS
SEEING MEDICARE ADVANTAGE
PAENTS BECAUSE THEY CAN AFFORD
TO COORDINATE CARE, THE KINDS OF
THINGS WE KNOW THEY OUGHT TO BE
DOING TO PROVIDE BETTER CARE,
BUT THEY CAN'T AFFORD TO DO I
ON THE FEE-FOR-SERVICE OF MEDICARE.
WE'VE HAD THE MEDICARE PROGRAM
AROUND FOR MORE THAN 40 YEARS,
AND THE FACT IS THAT GOVERNMENT
BUREAUCRS ARE STILL TRYING TO
GET THE COMPLEX REIMBURSEMENT
FORMULAS RIGHT.
WE KNOW, CHAIRMAN OF THE FINANCE
COMMITTEE HAS SAID, THAT UNDER
THE FEE-FOR-SERVICE PROGRAM,
WHICH IS PART OF WHAT NEEDS TO
BE REFORMED IN THIS HEALTH CARE
BILL, MEDICARE PAYS FOR VOLUME
AND NOT VALUE.
NOW, SOME OF THE POSITIVE THINGS
WHICH I'VE COMPLIMENTED THE BILL
ON IS IT INCLUDES SOME SMALL
STEPS TO CHANGE OUR CURRENT PAY
FOR VOLUME PROGRAM TO A
PAY-PER-VALUE APTPROEFP THROUGH
VARIOUS DELIVER SYSTEM REFORM
DEMONSTRATION PROGRAMS.
THE IRONY IS MEDICARE DIDN'T
THINK OF THESE SYSTEM REFORMS.
RATHER, WASHINGTON IS FINALLY
CATCHING UP ON WHAT
PRIVATE-SECTOR INNOVATORS HAVE
BEEN DOING FOR YEARS.
WE HEARD THE DISTINGUISHED SENATOR FROM MINNESOTA TALK
ABOUT THE MAYO CLINIC.
MAYO CLINIC'S HAS BEEN DOING
THAT.
I MENTIONED KELSEY SEABOLD IN
HOUSTON, TEXAS.
PRIVATE-SECTOR INNOVATORS HAVE
BEEN DOING THIS THROUGH THE
MEDICARE ADVANTAGE PROGRAM ALREADY.
THE DELIVERY SYSTEM REFORMS IN
THE REID BILL WOULD ALLOW
MEDICARE TO EXPERIMENT WITH
DIFFERENT APPROACHES TO CHANGING
PHYSICIAN INCENTIVES SUCH AS
ACCOUNTABLE CARE ORGANIZATIONS
OR PHYSICIAN QUALITY REPORTING INITIATIVE.
WILL THEY WORK?
WELL, I HAPPEN TO THINK THEY WILL.
BUT WE DO KNOW THAT
PRIVATE-SECTOR INNOVATORS HAVE
ALREADY FIGURED OUT HOW TO
CHANGE PHYSICIAN INCENTIVES IN
THE SORTS OF WAYS THAT WE REALLY
OUGHT TO BE DOING MORE OF AND
NOT PUNISHING BY CUTTING
MEDICARE ADVANTAGE.
ONE MEDICARE ADVANTAGE PLAN
HEALTH SPRING SERVES 20,000
SENIORS IN MY STATE.
THEY HAVE BEEN A LEADER IN
CHANGING THE INCENTIVES FOR
PHYSICIANS TO FOCUS ON QUALITY
RATHER THAN QUANTITY.
I MET WITH THEIR LEADERSHIP AND
HEARD HOW THEY'VE DONE IT.
WHAT THEY'VE KNOLLED ME IS
THEY'RE -- TOLD ME IS THEY ARE A
COLLABORIVE PARTNERSHIP WITH
THEIR PHYSICIANS.
THEY CALL IT PARTNERSHIP FOR QUALITY.
PHYSICIANS ARE ACCOUNTABLE FOR
BOTH COST AND QUALITY BASED ON
EVIDENCE-BASED SETS OF QUALITY
MEASURES.
THE RESULTS ARE A WIN-WIN.
BETTER QUALITY CARE IS LEADING
TO HEALTHIER SENIORS AND
PHYSICIANS TO SUCCEED IN MEETING
EVIDENCE-BASED QUALITY STANDARDS
AND ULTIMATELY LOWER HEALTH CARE
COSTS, WHICH I THOUGHT WAS
SUPPOSED TO BE ONE OF THE GOALS
OF HEALTH CARE REFORM.
PARTICIPATING PHYSICIANS WERE
PAID FINANCIAL INCENTIVES FOR
MEETING THEIR GOAL, BUT AS A
RESULT OF COORDINATION OF CARE
AND EVIDENCE-BASED QUALITY
STANDARDS, THEY ACTUALLY ENDED
UP CHARGING LESS.
AND PATIENTS EXPERIENCED BETTER
RESULTS TOO.
MEMBERS NEEDED FEWER
HOSPITALIZATIONS AND EMERGENCY
ROOM VISITS.
PREVENTIVE MEASURES INCREASED
MAMMOGRAMS BY 80%, DIABETIC FOOT
EXAMS BY 360%, AND FLU
VACCINATIONS BY 246%.
I'VE HEARD ABOUT HEALTH SPRINGS
SUCCESS FROM A COUPLE AT FARMERS
BRANCHES, TEXAS, WHO RECENTLY
WROTE TO ME.
THEY SAID WE HAD A MEDICARE
SUPPLEMENTAL POLICY FOR SEVERAL
YEARS UNTIL THEY PRICED
THEMSELVES OUT OF THE MARKET.
FOR NOW WITH A MEDICARE
ADVANTAGE PLAN CALLED HEALTH
SPRING, AND WE'VE BEEN VERY
HAPPY WITH THIS PLAN AND THE WAY
THEY ARE SAVING US MONEY.
PLEASE DO NOT CHANGE OR
ELIMINATE THIS PROGRAM, THEY
SAID.
LET ME TELL YOU ABOUT ONE OTHER
TEXAS COMPANY CALLED WELLMED.
WHILE THE REID BILL WOULD
FINALLY GIVE MEDICARE THE
ABILITY TO EXPERIMENT WITH
MEDICAL HOMES AND CARE
COORDINATION, A SAN
ANTONIO-BASED COMPANY CALLED
WELL MED HAS BEEN USING A
MEDICAL HOME MODEL TO COORDINATE
PATIENT CARE AND EMPHASIZE
PREVENTION FOR NEARLY 20 YEARS.
TO QUOTE FROM AN ARTICLE LAST
MONTH IN "INSIDE SAN ANTONIO,"
THE HEALTH CARE DELIVERY MODEL
AT WELL MED PUTS THE PATIENT AT
THE CENTER OF THE TEAM DIRECD
BY A PRIMARY CARE PHYSICIAN.
THAT TEAM MAY INCLUDE A NURSE, A
HEALTH COACH, A HOSPITALLIST, A
SOCIAL SERVICE WORKER A A
PHYSICIAN ASSISTANT.
ACCORDING TO WELL MED'S C.E.O.,
WE REALLY DO HAVE TO BRING BACK
THE OLD-TIME PRIMARY CARE
DOCTORS WHO CARED FOR YOU, WHO
IS CONCERNED ABOUT YOU, WHO IS
PART OF YOUR FAMILY AND YOU WERE
PART OF THEIR FAMILY.
IT'S THE PRIMARY CARE PHYSICIAN
WHO KNOWS ALL ABOUT YOU.
SO IF YOU NEED A SPECIALT, IF
YOU KNOW -- THEY KNOW THE BEST
SPECIALIST TO SEND TO YOU.
IF YOU NEED TO GO TO THE
HOSPITAL, THEY MAKE SURE YOU GET
THE APPROPRIATE CARE AT THE RIGHT HOSPITAL.
THEY ARE A COORDINATOR OF YOUR CARE.
AND THAT'S REALLY THE CONCEPT OF
THE MEDICAL HOME.
THERE'S NO QUESTION IN MY MIND
THAT THIS MODEL HAS BEEN SAVING
LIVES IN MY STATE.
HERE'S A STORY ABOUT ONE TEXANS
WHOSE LIFE WAS SAVED BY
PHYSICIANS CARING FOR HIM AT
WELL MED.
"FOR YEARS CROHN'S DISEASE
WEAKENED" -- WE'LL CALL HIM
ED -- "AND LEFT HIM SUSCEPTIBLE
TO INFECTIONS.
ONE MORNING IN 2001 HE LACKED
ENERGY TO EVEN GET OUT OF BED.
HIS BREATHING BAKE LABORED AND
HE DEVELOPED -- BECAME LABORED
AND HE DEVELOPED A COUGH WHICH
SOUNDED WET.
HIS WORRIED WIFE CALLED HIS
PRIMARY PHYSICIAN AT WELL MED
WHO WANTED ED HOSPITALIZED
IMMEDIATELY SO SHE COULD ORDER A
NUCLEAR SCAN OF HIS LUNGS, BUT
HE PROTESTED.
SHE TOLD ME IF HE REFUSED TO GO
I SHOULD CALL 911 AND HAVE THE
PARAMEDICS COME GET HIM.
HIS WIFE, ANNETTE, SAID SHE
HEARD DR. SANCHEZ TALK TO GO ME.
THE URGENCY IN H
--
THE SCAN CONFIRMED THE DOCTOR'S
SUSPICION: A POTENTIALLY FATAL
BLOOD CLOT HAD TRAVELED FROM HIS
LEG TO HIS LUNGS.
FORTUNATELY, HE WAS SUCCESSFULLY
EATED AND RECOVERED AND ED AND
HIS WIFE RECENTLY CELEBRATED HIS
74th BIRTHDAY.
NOW, ANNETTE CREDITS DR. SANCHEZ
FOR SAVING HER HUSBAND, ED'S
LIFE AND FOR ACTING AS A
CATALYST THAT KEEPS HIM THRIVING
EVEN IN HIS GOLDEN YEARS.
SHE SAID, WE'VE SEEN AN
ABUNDANCE OF DOCTORS FROM THE
CANCER DOCTORS TO THE
DERMATOLOGIST, GASTRO
ENTEROLOGIST, THE BLOOD DOCTOR,
THE HEART SPECIALIST.
ED HAS GONE THROUGH IT ALL.
AND THEY'VE ALL BEEN COORDINATED
BY HIS PRIMARY CAREOCTOR.
I'VE BEEN TO OTHER DOCTORS
OUTSIDE OF WELL MED AND YOU
DON'T GET THE FEELING THAT THEY
ARE COMMUNICATING LIKE THIS.
WELL, MANY TEXAS SENIORS
CURRENTLIEN JOY THESE EXTRA
BENEFITS UNDER MEDICARE
ADVANTAGE LIKE ANOTHER BENEFIT
-- LIKE THE SILVER SNEAKERS
PROGRAM, THE NATION'S LEADING
EXERCISE PROGRAM FOR OLDER AMERICANS.
THIS PAST YEAR ONE OF THE SILVER
SNEAKERS MEMBERS PERSONALLY
VISITED MY TOFFS DELER
TESTIMONIALS FROM OTHER SILVER
SNEAKERS MEMBERS.
ONE SAID "AT MY AGE, I NEED A
PROGRAM TO STRENGTHEN ME ALL
OVER BUT PRIMARILY TO HELP ME
KEEP MY BALANCE AND
COORDINATION.
I NEED THESE SKILLS TO KEEP ME
FROM FALLING AND BREAKING MY BONES."
ANOTHER PARTICIPANT IN THE
SILVER SNEAKERS PROGRAM SAID,
"I'M 66 AND I'VE BEEN ON THE
PROGRAM FOR A YEAR.
PRIOR TO THAT I'D HAD HAD A
SEDENTARY LIFE WHICH INCLUDED
MANY PROBLEMS: HYPERTENSION,
MILD DEPRESSION, HIGH BLOOD PRESSURE.
SINCE COMING TO THE CLASS, MY
LIFE HAS IMPROVED IMMENSELY.
MY BLOOD PRESSURE HAS DROPPED,
MY CHOLESTEROL HAS BEEN LOWERED,
MY CHRONIC BLADDER CONDITION HAS
IMPROVED AND I JUST FEEL BETTER
ALL AROUND.
I'M NO LONGER DEPRESSED BECAUSE
I LOOK BETTER AND I LOOK FORWARD
TO GOING TO CLASS AND VISITING
WITH MY FRIENDS."
WELL, MR. PRESIDENT, THESE CUTS
IN MEDICARE ADVANTAGE ARE GOING
TO HAVE A DIRECT IMPACT ON THE
BENEFITS THAT MY CONSTITUENTS IN
TEXAS ARE BENEFITING FROM, THE
532,000 TEXANS WHO ARE CURRENTLY
ON MEDICARE VAFNLGT WHAT THEY'RE
ASKING ME AND WHICH I CAN'T
ANSWER THEM IS, WHY IN THE WORLD
WOUL WE WANT TO CUT MEDICAR
ADVANTAGE, WHICH IS ACTUALLY --
WHICH ACTUALLY WORKS AS OPPOSED
TO MEDICARE FEE-FOR-SERVICE
WHICH DOES NOT WORK WELL, TO
TAKE A FISCALLY UNSUSTAINABLE
PROGRAM LIKE MEDICARE, WHICH IS
GOING TO GO INSOLVED IN 2017 AND
USE THAT TO CREATE A $2.5
TRILLION NEW ENTITLEMENT PROGRAM?
NOW, MY CONSTITUENTS, THE
SENIORS WHO PAID INTO MEDICARE
ALL THESE YEARS, ARE SAYING,
IT'S NOT FAIR TO TAKE THE MONEY
THAT WE PAID INTO MEDICARE, TO
USE IT TO CREATE YET ANOTHER
ENTITLEMENT PROGRAM AND NOT TO
FIX MEDICARE ITSELF.
SO I BELIEVE THAT WE NEED TO FIX
MEDICARE'S NEARLY $38 TRILLION
IN UNFUNDED LIABILITIES.
WE NEED TO FIX THE IMPROPER
PAYMENT RATE OF ROUGHLY ONE OUT
OF EVERY TEN MEDICARE DOLLARS,
WHICH RESULTS IN PROBABLY
SOMEWHERE AROUND THE ORDER OF A
MINIMUM OF $60 BILLION OF
FRAUDULENT PAYMENTS EACH YEAR.
WE NEED TO PUT IT ON A FISCALLY
SUSTAINABLE PATH RATHER THAN
TAKING A HALF A TRILLION DOLLARS
FROM MEDICARE ON ANOTHER
ILL-CONCEIVED WASHINGTON HEALTH
CARE TAKEOVER.
I JUST DON'T BELIEVE,
MR. PRESIDENT, THAT MY
CONSTITUENTS BELIEVE THAT YOU
CAN TAKE A-A TRILLIONS OUT OF
THESE PROGRAMS SCWUS AS THEY
DON'T BELIEVE THAT YOU CAN TAKE
MORE THAN $100 BILLION OUT OF
MEDICARE ADVANTAGE AND IT WILL
HAVE NO IMPAC ON THERE -- ON
THEIR BENEFITS.
THEY JUST DON'T BUY IT.
THEY JUST DON'T BELIEVE IT AND I
DON'T EITHER.
MR. PRESID
FLOOR.
THE PRESIDING OFFICER: THE
SENATOR IOWA.
MR. GRASSLEY: MR. PRESIDENT,
IT IS LATE IN THE EVENING.
I WAS GOING TO ADDRESS THREE
DIFFERENT ISSUES TONIGHT, BUT
OUT OF RESPECT FOR SENATOR
BAUCUS, THE CHAIRMAN OF MY
COMMITTEE, I'M GOING TO ADDRESS
JUST ONE OF THE ISSUES AND I'LL
COME BACK TOMORROW MORNING ON
SATURDAY AND SPEAK ON THE REST
OF THE ISSUES.
SO I'M GOING TO -- THE ONE ISSUE
I'M GOING TO ADDRESS THIS
EVENING IS TO SUPPORT THE
SENATOR FROM NEBRASKA'S MOTION
TO COMMIT WITH INSTRUCTIONS ON
THIS 2,074-PAGE BILL.
THAT'S SENATOR JOHANNS' AMENDMENT.
WE'RE NOW CONSIDERING A BILL
THAT CUTS A HALF A TRILLION
DOLLARS FROM THE MEDICARE
PROGRAM TO FUND YET ANOTHER
UNSUSTAINABLE HEALTH CARE
ENTITLEMENT PROGRAM.
AROUND $42 BILLION COMES FROM
CUTS TO HOME HEALTH CARE PROVIDERS.
HENCE, THE PURPOSE OF SENATOR
JOHANNS' AMENDMENT THAT THAT NOT HAPPEN.
YOU'VE HEARD FROM MEMBERS ON
THIS SIDE OF THE GRAVE
CONSEQUENCES OF THESE CUTS.
SEVERAL SENATORS HAVE ALREADY ADDRESSED THESE.
THESE SEVERE CUTS POSE A
LEGITIMATE THREAT TO
BENEFICIARIES' ACCESS TO HOME
HEALTH SERVICES.
IN MY STATE OF IOWA ALONE, THERE
ARE AROUND 160 HOME HEALTH
AGEN
SEICES TO MEDICARE
BENEFICIARIES ACROSS
NOW, THANKS TO THESE HOME HEALTH
CARE PROVIDERS, SENIORS IN IOWA
ARE ABLE TO CONTINUE TO LIVE AT
HOME INSTEAD OF IN INSTITUTIONAL
SETTINGS LIKE NURSING HOMES.
THESE SENIORS PLACE GREAT VALUE
ON BEING ABLE TO STAY HOME, AND
I'D HAVE TO
THAT I'VE BEEN INVOLVED IN
SENIOR ISSUES, WHETHER IT'S BEEN
CHAIRMAN OF THE AGING COMMITTEE,
CHAIRMAN AND NOW
MEMBER OF THE FINANCE COMMITTEE,
I HAVEN'T RUN
SENIOR CITIZEN IN MY STATE THAT
SAID TO ME, I'M JUST DYING TO
GET INTO A NURSING HOME.
THEY DON'T WANT TO GO THERE.
SO, THAT'S THE PURPOSE OF HOME
HEALTH AGENCIES, TO SAVE MONEY
BUT ALSO TO RETAIN QUALITY OF
LIFE AND MAINTAIN QUALITY OF
LIFE.
FOR THESE CITIZENS.
I RARELY HEAR
ANYTHING ABOUT LIVING IN A
NURSING HOME EXCEPT NOT TO GO
THERE.
AND SINCE LIVING AT HOME HAS
BEEN FOUND TO BE A MORE
COST-EFFECTIVE ALTERNATIVE THAN
INSTITUTIONAL CARE, THIS RESULTS
IN MEDICARE SPENDING LESS.
THESE CUTS THAT ARE IN THIS
2,074-PAGE REID BILL WILL MAKE
IT EVEN HARDER FOR IOWA HOME
HEALTH CARE PROVIDERS TO CARE
FOR MEDICARE BENEFICIA
A GOOD PART OF MEDICARE
CUTS COME FROM PRODUCTIVITY ADJUSTMENT.
LET'S LOOK AT THE POSSIBILITY --
OR I'LL SAY, I'VE CONCLUDED, THE
IMPOSSIBILITY OF BRINGING
GREATER PRODUCTIVITY TO NURSING
HOME CARE.
YOU'VE HEARD THIS WEEK ABOUT HOW
MEDICARE'S CHIEF
THAT SAVINGS FROM THESE
PRODUCTIVITY
AND JUST SO YOU KNOW THAT THE
LETTER I REFER TO FROM THE CHIEF
ACTUARY IS REAL, JUST OBSERVE
THIS CHART.
YOU ALSO HEARD THIS WEEK HOW
THESE PERMANENT CUTS WOULD MAKE
IT HARDER TO PROVIDE FOR
PROVIDERS TO REMAIN IN THE BLACK.
AND YOU ALSO HEARD THESE
PROVIDERS MIGHT END THEIR
PARTICIPATION IN MEDICARE AND
POSSIBLY THEN JEOPARDIZE ACCESS
TO CARE FOR BENEFICIARIES AND
PROBABLY THEN MORE PEOPLE ENDING
UP IN THE MORE EXPENSIVE
ENVIRONMENT OF A NURSING HOME.
THE THREAT TO ACCESS HOME HEALTH
FROM THESE PERMANENT
PRODUCTIVITY CUTS ISN'T
THEORETICAL.
'S REAL.
LIKE MANY OTHER MEDICARE
PROVIDERS, HOME HEALTH AGENCIES
PROVIDE LABOR-INTENSIVE SERVICES.
AND BECAUSE OF THESE
LABOR-INTENSIVE SERVICES, THAT'S
WHY I RAISE THE QUESTION AND THE
POSSIBILIT-- AND I SAY IT ENDS
UP BEING AN IMPOSSIBILITY --
REALLY BE MORE PRODUCTIVE.
BECAUSE THERE ARE FEW
HOME HEALTH THAT WILL INCREASE
PRODUCTIVITY.
AND WHATEVER AVAILABLE GADTS
ARE UNAFFORDABLE FOR MANY IOWA
HOME HEALTH AGENCIES, BECAUSE
THEY ARE SMALL OPERATIONS WITH
LIMITED FINANCIAL RESOURCES.
HOME HEALTH CARE IS ABOUT
DOCTORS, IT'S ABOUT NURSES, AND
HOME HEALTH AIDES, AND IT'S
ABOUT ALL OF THESE PROVIDING
CARE TO THE MOST NEEDY.
SO, IT IS INCORRECT IN MY
JUDGMENT TO ASSUME THAT THESE
PROVIDERS WILL ACHIEVE THE
LEVELS OF PRODUCTIVITY, LIKE THE
REST OF THE ECONOMY.
THE H.H.S. ACTUARY'S -- CHIEF
ACTUARY'S FINDINGS CLEARLY APPLY
TO HOME HEALTH IN MY STATE OF
IOWA, LIKE THEY DO NATIONALLY.
JUST TO REMIND YOU, "THE
ESTIMATED SAVINGS MAY BE UNREALISTIC."
AND, "POSSIBLY JEOPARDIZING
ACCESS" FOR OUR SENIORS.
MORE PEOPLE IN NURSING
BE
PERCENT OF IOWA HOME HEALTH
AGENCIES THAT HAVE NEGATIVE
MEDICARE MARGINS WILL INCREASE
TO 75%.
SO OVER 120 OF THE 160 HOME
HEALTH PROVIDERS WILL
NEGATIVE MARGINS BECAUSE OF THIS
2,074-PAGE REID BIL
AND IOWA PROVIDERS ARE NOT ALONE ALONE.
FROM ONE HALF TO 90% OF HOME
HEALTH AGENCIE
THE COUNTRY WOULD HAVE NEGATIVE
MEDICARE MARGINS.
I HAVE A LETTER HERE -- I'M
GOING TO MAKE ONE REQUEST FOR
THREE INSERTS THAT
PUT IN AT VARIOUS PLACES IN MY REMARKS.
BUT SO I WOULD ASK THAT
PERMISSION, MR. PRESIDENT.
THE PRESIDING OFFICER: TWOWKS.
MR. GRASSLEY: I HAVE HERE A
LETTER DATED SEPTEMBER
-- FROM SEPTEMBER 23 OF THIS
YEAR FROM THE PRESIDENT OF THE
NATIONAL ASSOCIATION OF HOME
HEALTH AND HOSPICE.
THIS ORGANIZATION REPRESENTS
HEALTH AGENCIES ACROSS THE
COUNTRY.
HE WROTE THIS LETTER IN RESPONSE
TO THE $43 BILLION IN HOME
HEALTH CUTS IN
COMMITTEE PACKAGE, WHICH
PRESUMES TO BE THE SAME NUMBER
THAT IS USED IN THE REID BILL.
IN THIS LETTER, HE STATED, "IT
IS CRUCIAL TO THE SURVIVAL OF
HOME HEALTH SERVICES' DELIVERY
SYST
THE $43 BILLION IN CUT
CURRENTLY CONTAINED IN THE
SENATE FINANCE COMMITTEE'S
HEALTH REFORM PACKAGE.
OUR ANALYSIS INDICATES THAT BY
2016 THE PROPOSED CUTS IN HOME
HEALTH SERVICES PAYMENT RATES
WILL LEAD TO NEARLY 70% OF THE
PROVIDER'S NATIONWIDE AT RISK OF
CLOSING BECAUSE THEIR COSTS WILL
EXCEED MEDICARE PAYMENTS.
IF THAT OCCURS," THE LETR
SAYS, "PRESIDENT OBAMA'S PROMISE
THAT MEDICARE BENEFICIARIES WILL
NOT BE ADVERSELY AFFECTED BY
HEALTH CARE REFORM WILL BE BROKEN."
END
I HAVE YET TO HEAR FROM A HOME
HEALTH PROVIDER IN
THESE PERMANENT CUTS WILL MAKE
IT EASIER FOR THETO CARE FOR
THEIR MEDICARE BENEFICIARIES.
AND INSTEAD I HEAR THAT THESE
CUTS WOULD REDUCE ACCESS TO HOME
HEALTH
SO I HAVE THE SECOND LETTER THAT
I JUST ASKED TO HAVE INSERTED,
AND THAT LTER IS FROM THE IOWA
ASSOCIATION OF HOME CARE, AND
THEY WROTE, "ENSURING THAT
MEDICARE HOME HEALTH PAYMENTS
ARE NOT FURTHER REDUCE --
REDUCED FURTHER IS ESSENTIAL TO
AVOID THE RESULTING LIMITS OR NO
ACCESS TO HOME HEALTH SERVICES
FOR MANY IOWANS WHO PREFER TO
RECEIVE SERVICES IN THEIR HOME."
END OF QUOTE.
SO, AS THE C
THE CHART SHOWS, NOT JUST THE
CHIEF ACTUARY SAYING IT, BUT
PEOPLE THAT ARE CONNECTED WITH
THE BUSINESS OF HOME HEALTH CARE
SAY IT,
WILL IN FACT JEOPARDIZE ACCESS
TO HOME CARE IN IOWA.
SO, IF THE HOME HEALTH CUTS IN
THE REID BILL ARE ALLOWED TO GO
INTO EFFECT, THENOWA'S SENIORS
WHO PREFER TO LIVE FUL LIVES
FROM THEIR HOMES WILL BE FORCED
TO LIVE IN THE MORE EXPENSIVE
SETTINGS, LIKE NURSING HOMES.
I BELIEVE THAT MANY MEMBERS ON
BOTH SIDES OF THE AISLE SHARE MY
CONCERN ABOUT HOME HEALTH CARE
CUTS.
I HAVE HERE A LETTER -- THE
THIRD LETTER I REFERRED TO.
NOW, THIS LETTER IS FROM JULY
27, 2007, AND IT'S WRITTEN TO
SENATOR BAUCUS AND ME.
BUT THE REASON I USE THIS
LETTER, EVEN THOUGH IT'S TWO
YEARS OLD, WE WERE GETTING
ENTREATIES FROM 61 OF OUR
COLLEAGUES, OF WHICH 52 NOW
SERVE -- STILL SERVE IN THE
UNITED STATES SENATE, ABOUT A
LEGISLATIVE PROPOSAL TO CUT
MEDICARE
THAT YEAR, 2007, BY $
9.7 BILLION AND HOSPICE PAYMENTS
BY MORE THAN $1.1 BILLION.
THEY URGED ME AND SENATOR BCUS
AT THAT TIME TO ENSURE THAT HOME
HEALTH AND HOSPICE PROVIDERS
RECEIVE FULL MARKET BASKET
INFLATION ADJUSTMENTS.
THEY ALSO URGED US TO OPPOSE ANY
CUTS IN PAYMENT RATES THROUGH
ADMINISTRATIVE ACTIONS.
IN THE LETTER, THESE MEMBERS
STATED THAT HOME HEALTH AND
HOSPICE CARE -- QUOTE -- "HAVE
BEEN DEMONSTRATED TO BE
COST-EFFECTIVE ALTERNATIVES TO
INSTITUTIONAL CARE IN BOTH
MEDICARE AND MEDICAID PROGRAMS
AND THEY STATED THAT -- QUOTE --
"REDUCING MEDICARE HOME HEALTH
AND HOSPICE PAYMENTS WOULD PLACE
THE QUALITY OF HOME HEALTH CARE
AND HOSPICE AND THE HOME CARE
DELIVERY SYSTEM AT SIGNIFICANT
RISK
OF THESE 61 SENATORS THAT SIGNED
THIS LETTER TWO YEARS AGO, 52
ARE CURRENTLY HERE DEBATING THIS
BILL IN THE UNITED STATES SENATE.
AND OF THOSE 52 SENATORS, 37 ARE
ARE NOW PROPOSING $43 BILLION IN
CUTS INSTEAD OF $9.7 BILLION IN
HOME PAYMENT CUTS AND
$1.1 BILLION IN HOSPICE PAYMENT
CUTS, AS I WOULD THINK THAT THEY
WOULD FIND THESE KIND OF CUTS
THREE OR FOUR TIMES -- FOUR
TIMES WHAT WE WERE TALKING ABOUT
TWO YEARS
UNREALISTIC AND TO KEEP HOME
HEALTH AS A VIABLE ORGANIZATION
GOING.
WE ALSO MUST LOOK BEYOND HEALTH
CARE WHEN WE LOOK AT THE IMPACT
OF THESE PERMANENT CUTS.
I'VE ALSO HEARD FROM PROVIDERS
IN IOWA THAT PERMANENT CUTS LIKE
THIS WILL MAKE IT EVEN HARDER
FOR THEM TO KEEP THEIR DOORS
OPEN.
SO AROUND 3,500 IOWANS WHO WORK
IN HOME HEALTH AGENCIES ARE AT
RISK OF LOSING THEIR JOBS AT THE
TIME WE HAVE 10% UNEMPYMENT.
AT A TIME WHEN MORE OF THIS
COUNTRY IS CONCERNED THAT
CONGRESS OUGHT TO BE WORKING ON
CREATING JOBS, JOBS, JOBS
OPPOSED TO THE HEALTH CARE ISSUE
AND IN SOME CASES CUTTING JOBS
OUT.
THE LABOR DEPARTMENT REPORTED
YESTERDAY -- OR TODAY IT WAS
THAT UNEMPLOYMENTS 10%.
NOW IS NOT THE TIME TO CONSIDER
BILLS THAT INCREASE UNEMPLOYMENT
RATES.
SO ABOUT AN HOUR AGO, THE
SENATOR FROM NEBRASKA HAS
OFFERED THIS MOTION THAT I'M
SPEAKING IN FAVOR OF NOW TO SEN
THIS BILL TO THE FINANCE
COMMITTEE WITH INSTRUCTIONS TO
REPORT A BILL WITHOUT THESE VERY
ENORMOUS HOME HEALTH CUTS THAT
ARE IN IT.
WE SHOULD TAKE THIS OPPORTUNI
TO FIX THE BILL AND THEN COME
BACK IT FULL SENATE WITH A BETTER BILL.
THAT'S WHY I SUPPORT THE SENATOR
FROM NEBRASKA'S MOTION TO COMMIT
AND I URGE MY COLLEAGUES TO DO THE
I YIELD THE FLOOR.
MR THE PRESIDING OFFICER: THE
SENATOR FROM ALABAMA.
MR. SESSIONS SESSIONS: BEFORE THE SENATOR
LEAVES, HE'S A MAN OF GREAT
CHARACTER AND EXPERIENCE IN
THESE MATTERS, AND I HAVE A
LETTER FROM A CONSTITUENT WHO
WRITES TO URGE -- TO QUOTE --
"URGE YOU TO VOTE AGAINST THIS
HEALTH CARE BILL."
THIS IS FROM MR. BILL EBBERLY IN
HUNTSVILLE, ALABAMA.
HE SAYS, "THE WORST PART OF THIS
BILL IS THAT MOST OF THE CUTS
WILL BE PAID FOR BY CUTS TO MEDICARE."
I THINK THE SENATOR INDICATED HE
BELIEVES THAT ACCURATE.
HE GOES TO SAY -- QUOTE -- "I AM
68 YEARS OLD AND I HAVE PAID
INTO MEDICARE FOR 40 YEARS
BELIEVING IT WOULD COVER MUCH OF
MY HEALTH CARE COSTS WHEN I
BECAME 65.
NOW I AM BEING TOLD THAT THE
GOVERNMENT HAS FOUND PEOPLE WHO
NEED THE COVERAGE MORE THAN I DO DO.
AND THEY WILL CUT THE CARE FOR
WHICH I HAVE PAID FOR 40 YEARS
IN ORDER TO COVER PEOPLE WHO
HAVE PAID NOTHING INTO THE PROGRAM.
IT'S NOT THE GOVERNMENT'S MONEY.
THE MONEY BELONGS TO THOSE OF US
WHO PAID INTO FOR SO MANY YEARS
TAKEN AWAY FROM US."
AND I GUESS MY QUESTION TO YOU,
SINCE YOU'VE BEEN SO INTIMATELY
INVOLVED WITH MEDICARE OVER THE
YEARS, IS IT NOT TRUE THAT EVERY
WORKING AMERICAN HAS MONEY TAKEN
OUT OF THEIR PAYCHECK TO FUND
THEIR
THAT THEY BELIEVE AND WE HAVE A
COMPACT WITH THEM THAT WHEN THEY
REACH 75, THEY WILL HAVE THE
BENEFIT OF THAT.
MR. GRASSLEY: 65 THEY GET THE
BENEFIT OF IT.
MR. SESSIONS: 65, Y
MR. GRASSLEY: YES, TO THE TUNE
OF 2.9% OF PAYROLL.
THAT'S WHAT A SELF-EMPLOYED
PERSON WOULD PLAY.
AND AN EMPLOYEE
AND THE EMPLOYER WOULD PAY 1.45%
1.45%.
AND YOU KNOW THIS 2,074-PAGE
BILL ADDS A HALF A PERCENTAGE
APPOINT TO THOSE.
SO YOU'RE GOING TO GET IT TO A
POINT WHERE IT'S ALMOST 2% FOR
THE EMPLOYER, 2% FOR THE
EMPLOYEE AND IT WOULD BE ALMOST
4% FOR A SELF-EMPLOYED PERSON
PAYING INTO THIS FUND THAT IS
NOW GOING TO BE RAIDED TO -- TO
FINANCE A B
PROGRAM.
MR. SESSIONS: SO MY CONSTITUENT
IS FUNDAMENTALLY CORRECT INIS CONCERN?
MR. GRASSLEY: WELL, THERE'S A
GREAT -- I SENSE A GREAT DEAL OF
RESENTMENT IN THAT COMING
THROUGH IN THE WORDS OF THAT
WHAT HE'S PAID INTO
PROBABLY 40 YEARS THAT HE WAS
WORKING, OR MAYBE 45 YEARS THAT
HE'S WORKING BEFORE HE RETIRED,
THAT -- THAT
ALREADY BEING IN JEOPARDY BASED
ON THE TRUSTEES' REPORT WHICH
SAYS BY 2017 THAT THERE'S NOT
GOING TO BE ANY MONEY IN THE
TRUST FUND, AND THEN HAVING
$464 BILLION TAKEN OUT OF THAT
TRUST FUND TO HELP FINANCE A NEW
ENTITLEMENT PROGRAM AT A TIME
WHEN THE PRESENT ENTITLEMENT
PROGRAMS ARE IN SOME -- A GREAT
DEAL
MR. SESSIONS: I THINK YOU STATED
THAT SO WELL.
AND JUST TO REEMPHASIZE, THAT
JUDGE, MR. EBBERLY, WHO PAID IN
ARE FOR 40 YEARS INTO MEDICARE,
UNTIL HE GOT 65, HE GOT NOT A
DIME OF MEDICARE BENEFIT, DID HE?
MR. GRASSLEY: NO.
THE ONLY WAY HE WOULD HAVE GOT
BENEFITS IS IF HE HAD BECOME
DISABLED BEFORE AGE 6567895.
THESE YEARS AND JUST NOW GETS TO
DRAW IT AND START TAKING IT OUT.
WELL, I WANT TO THANK YOU,
SENATOR GRASSLEY, FOR YOUR
LEADERSHIP ON THIS ISSUE.
AND I THINK YOU AND I KIND OF
COME OUT OF THE SOIL OF OUR
STATES, OUT OF THE REAL WORLD,
AND MY IMPRESSION IS THAT NOTHING COMES FROM NOTHING.
WOULD
SOMEBODY'S GOT TO PAYMENT
MR. GRASSLEY: SAY IT THIS WAY.
WE'RE IN A TOWN WHERE WE'RE
DEALING WAY LOT OF WASHINGTON
NONSENSE AND I HE FROM THE
RURAL AREAS OF ALABAMA, LIKE THE
STATE OF IOWA, YOU BRING A LOT
OF COMMONSENSE TO THIS TOWN
WHERE THERE ISN'T A LOT OF IT.
MR. SESSIONS: THANK YOU, VERY
MUCH.
MR.
THAT THE MATTER IS A VERY
SERIOUS ONE THAT WE'RE DEALING
WITH.
I TODAY HAD THE OPPORTUNITY TO
TALK ABOUT A -- TALK TO A VERY
EXPERIENCED PERSON INVOLVED IN
HEALTH CARE ISSUES FOR MANY
YEARS, AND
BAFFLEMENT ABOUT SE OF THE
DISAGREEMENTS WE HAVE ABOUT HUGE
ISSUES.
AND ONE OF MY STAFFERS WROTE IT
DOWN WHAT HE SAID.
HE SAID, IN ALL MY YEARS,
I'VE -- QUOTE -- "NEVER SEEN
SUCH TRANSPARENT DISHONESTY IN
THE CONGRESS."
HE SAID, IT'S THE BIGGEST FRAUD THAT'S BEEN PERPETRATED IN THE
HISTORY OF OUR COUNTRY, IN HIS
OPINION.
I MEAN, SO HERE WE HAVE A
SITUATION -- I JUST WANT TO SAY
I'M GOING TO PURSUE THIS A
LITTLE MORE, IN MORE GREAT
DETAIL, AND I'M NOT GOING TO GO
INTO IT HERE TONIGHT, BUT WE HAD
AN AMENDMENT -- SENATOR BENNETT
HAD AN AMENDMENT YESTERDAY THAT
SAID WE WOULDN'T CUT GUARANTEED
BENEFITS.
AND, WELL, THE WAY THIS -- FOR MEDICARE.
BUT THE WAY THIS DEAL IS BEING
DONE IS THEY'RE CUTTING PAYMENTS
TO PROVIDERS OF MEDICARE, AND WE
ARE ALREADY REACHING, AS SENATOR
GRASSLEY SAID, A NATIONAL
CRIS, BECAUSE BY 2017, WE
WON'T BE ABLE TO HAVE A SURPLUS
IN MEDICARE.
WE'RE GOING INTO DEFAULT IN
MEDICARE AND WHERE ARE WE GOING
TO GET THE MONEY.
WELL, COULD WE HAVE
EFFICIENCIES, COULD WE SAVE SOME
MONEY IN MEDICARE, COULD WE DO
SOME THINGS TO KEEP THE PROGRAM
AFLOAT?
PERHAPS.
BUT IF WE DO SO, SHOULD WE NOT
USE IT, SHOULDN'T WE NOT USE ANY
EFFICIENCIES AND SAVINGS THAT WE
COULD SCRAPE TOGETHER WITHOUT
DAMAGING THE COMMITMENT WE HAVE
TO OUR SENIORS?
SHOULDN'T WE USE THOSE SAVINGS
TO SAVE MEDICARE, THAT'S GOING
INTO DETAUGHT?
I SUGGEST --
THAT'S GOING INTO DEFAULT?
I SUGGEST THAT'S A MOR AND
LEGAL COMMITMENT.
AS THIS MR. EBBERLY HAS WRITTEN
TO ME, HE'S PAID FOR 40 YEARS.
HE'S
ANYTHING OUT OF IT, FOR 40 YEARS
AS HE'S PAID INTO IT.
AND NOW HE GETS READY TO DRAW,
WE'RE TELLING HIM WE'RE GOING TO
CUT MEDICARE PAYMENTS.
AND THIS IS MATTER.
AND WE SEEM TO HAVE,
WE SEEM TO HAVE THIS DISPUTE.
AND ONE GROUP FROM THE OTHER
SIDE SAYS THAT, DON'T WORRY,
WE'RE NOT TAKING $465 BILLION
FROM MEDICARE, AND WE WOULDN'T
CUT MEDICARE, AND WE DON'T
BELIEVE IN CUTTING MEDICARE, AND
WE DON'T WANT TO HURT MEDICARE
IN ANY WAY.
AND OUR SIDE'S OVER HERE SAYING,
BUT YOU ARE.
NOW, ACCORDING TO THE NUMBERS
THAT WE'VE -- THAT ARE PRETTY
PLAIN IN THIS LEGISLATION,
HOSPITALS WILL HAVE $134 BILLION
REDUCTION.
HOSPICES, AS THE SENATOR --
HOSPICES, $7 BILLI,
LIFE-ENDING CARE THAT HAS BEEN
SO HELPFUL TO SO MANY PEOPLE.
NURSING
HOME HEALTH AGENCIES THAT
SENATOR GRASSLEY TALKED ABOUT,
$42 BILLION REDUCTIONS.
ARE WE IMAGINING THIS?
IS THIS SOMEHOW WE'VE JUST
FORMULATED THIS UP?
IT ALL TOTALS UP TO ABOUT
$465 BILLION.
SO THIS MATTER I SUGGEST IS NOT
GOING AWAY.
EITHER WE HAVE REALITY HER OR NOT.
I BELIEVE THAT THE
SHOW THAT WE ARE RAIDING
MEDICARE, WE ARE WEAKENING THAT
PROGRAM WHEN IT IS ALREADY KNOWN
TO ALL OF US IN THIS BODY THAT
MEDICARE IS NOT ACTUARIALLY SOUND.
I REMEMBER WHEN PRESIDENT BUSH
DETERMINED IN A FAILED EFFORT TO
TRY TO ALTER SOCIAL SECURITY IN
A WAY THAT HE FELT WOULD PUT IT
ON A SOUNDER FOOTING, GOT NO
HELP AT ALL.
WE HAD MANY OF OUR SENATORS ON
BOTH SIDES OF THE AISLE SAYING,
WELL, IF YOU REALLY WANT TO DO
SOMETHING
IS, MEDICARE IS IN MUCH WORSE FINANCIAL FIX.
WHY AREN'T YOU FIXING IT?
I REMBER A NUMBER OF YEARS
AGO, TEN OR MORE, WHEN SENATOR
JUDGE GREGG, THEN CHAIRMAN OF
THE BUDGET COMMITTEE, TRIED TO
COME UP WITH SOME LEGISLATION TO
CONTAIN A LITTLE BIT OF THE
GROWTH IN MEDICARE, AND OVER $5
YEARS HE HAD A PLAN THAT WOULD
CONTAIN THE GROWTH BY $10 BILLION.
NOT A SINGLE DEMOCRAT VOTED FOR
THE GREGG PROPOSAL.
EVERY BIT OF IT.
AND THEY HAD ACCUSED THE
REPUBLICANS OF TRYING TO DAMAGE
MEDICARE WHEN, IN FACT, EVERY
PENNY OF THE $10 B
VED WAS GOING TO BE UTILIZED
TO STRENGTHEN MEDICARE AND TRY
TO KEEP IT FROM GOING IN
DEFAULT.
SO NOW WE'RE TALKING ABOUT
TAKING $465 BIION OUT OF
MEDICARE AND STARTING A NEW
ENTITLEMENT PROGRAM, A NEW
ENTITLEMENT PROGRAM AT THE TIME
THAT THIS NATION HAS JUST
PASSED -- OR JUST
LARGEST SINGLE DEFICIT IN
HISTORY OF THE
REPUBLIC, $1.4 TRILLION.
AND NEXT YEAR WE'LL BE OVER
$1 TRILLION, ACCORDING TO THE
CONGRESSIONAL BUDGET OFFICE.
NOT ME.
SO IS THIS SMART TO HAVE A
PROGRAM THAT PEOPLE HAVE
DEPENDED ON, THAT WE HAVE A
MORAL COMPACT TO SUPPORT OUR
SENIORS WHO PAID INTO THIS PLAN
FOR 40 YEARS
OUT OF THAT TO CREATE A NEW PROGRAM?
IT IS, IN FACT, IN QUITE A
NUMBER OF AREAS GOING TO COST
FAR MORE THAN IS BEING SUGGESTED
BY THE PEOPLE WHO ARE PROMOTING
THE LEGISLATION.
WE'RE GOING
TO DIG INTO THIS AND TRY ANALYZE
IT WITH MORE CLARITY.
BUT THE TRU
JUST DON'T ADD UP.
THEY WON'T WORK.
WE -- WE JUST OUGHT N TO BE
ESTABLISHING A NEW ENTITLEMENT
PROGRAM OF MASSIVE PROPORTIONS
IN A WAY THAT WE REALLY HAVE
LITTLE CONCEPT OF HOW IT'S GOING
TO PLAY OUT AT A TIME OF THE
LARGEST DEFICITS THIS NATION HAS
EF HER.
-- EVER HAD.
DEFICITS THAT ACCORDING TO OUR
OWN CONGRESSIONAL BUDGET OFFICE
WILL DOUBLE THE NATIONAL DEBT IN
FIVE YEARS AN TRIPLE IT TO DZ --
AND TRIPLE IT TO $17 TRILLION IN
10 YEARS.
IT IS AN UNSUSTAINABLE COURSE.
AND ONE OF THE FIRST THINGS YOU SPEND YOUR MONEY.
I TALKED TO AN INDIVIDUAL TODAY.
HE SAID IT'S LIKE YOUR HOUSE IS
IN SERIOUS NEED OF REPAIR.
YOU REALLY DON'T HAVE THE MONEY
TO FIX IT.
YOU FINALLY DECIDE YOU'VE GOT TO
BORROW MONEY TO FIX THE HOUSE
AND INSTEAD YOU BORROW MONEY AND
ADD A WING ON TO THE HOUSE.
WE NEED TO FIX THE HOUSE WE'VE GOT.
WE NEED TO MAKE
HONOR OUR COMMITMENT TO MEDICARE RECIPIENTS.
YOU SEE, THEY'VE ALREADY PAID.
THAT'S THE IMPORTANT POINT TO REMEMBER.
THEY ALREADY PD THEIR WORKING
LIFE UNDER A COMPACT AND
COMMITMENT THAT THAT MONEY WOULD
BE IN THE FUND
THEM AND WE OUGHT NOT TO TAKE IT
AWAY.
I URGE MY COLLEAGUES TO THINK ABOUT THIS.
AND THIS IS JUST PERHAPS THE
MOST SIGNIFICANT FATAL FLAW IN
THE LEGISLATION.
IT JUST DOESN'T ADD UP.
THERE ARE A LOT OF OTHERS.
BUT THIS ONE, TO ME, IS THE
DRAMATIC, THE MOST
THE ONE THAT IS MOST UNWISE.
AND WE SIMPLY NEED TO SLOW DOWN,
ASK OURSELVES HOW WE CAN MAKE
OUR HEALTH CARE SYSTEM BETTER.
HO
BREAKING THE BANK.
AREN'T THERE SOME THINGS THAT WE
CAN DO TO IMPROVE HEALTH CARE IN
AMERICA WITHOUT A HUGE COST?
YES, THERE ARE.
AND LET'S START WITH EVERY
SINGLE ONE OF THOSE THAT WE CAN
AGREE ON AND IF WE DO THAT, I
THINK THAT WE CAN MAKE A
PROGRESS.
AND WHO KNOWS, IF THIS ECONOMY
TURNS AROUND, AND WE ALL HOPE IT
WILL, WE'LL BE IN A BETTER
FOOTING TO CONSIDER SOMETHING --
CONSIDER A NEW B
FUTURE.
I WOULD THANK THE CHAIR AND
YIEL
THE PRESIDING OFFICER: THE
SENATOR FROM MONTANA.
MR. BAUCUS: I ASK CONSENT THAT
THE SENATE PROCEED TO A PERIOD
OF MORNING BUSINESS WITH
SENATORS PERMITTED TO SPEAK UP
TO 10 MINUTES EACH.
THE PRESIDING OFFICER: WITHOUT OBJECTION.
MR. BAUCUS: I ASK THAT THE
COMMITTEE ON HOMELAND GOVERNMENT
AFFAIRS -- THE BILL
THE THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BAUCUS: MR. PRESIDENT, I ASK CONSENT THAT THE SENATE PROCEED
TO THE IMMEDIATE CONSIDERATION
OF CALENDAR NUM
341. THE PRESIDING OFFICER: THE CLE
WILL REPORT.
THE CLERK: CALENDAR 212,
341, SUPPORTING PEACE, SECURITY
AND INNOCENT CIVILIANS AFFECTED
BY CONFLICT IN YEMEN.
THE PRESIDING
PROCEED TO THE MEASURE.
MR. BAUCUS: MR. PRESIDENT, I ASK UNANIMOUS CONSENT THAT THE
RESOLUTION BE AGREED TO, THE
PREAMBLE B MOTION TO RECONSIDER BE LAID ON
THE TABLE WITH NO INTERVENING
ACTION OR DEBATE AND ANY
STATEMENTS RELATED TO THE
RESOLUTION BE PLACED IN THE
RECORD AT THE APPROPRIATE PLACE
AS IF READ.
THE PRESIDING OFFICER: WITHO
OBJECTION.
MR. BAUCUS: MR. PRESIDENT, I ASK
UNANIMOUS CONSENT THAT THE
SENATE NOW PROCEED
CONSIDERATION OF S. RES. 370,
WHICH WAS SUBMITTED EARLIER
TODAY.
THE PRESIDING OFFI WILL REPORT.
THE CLERK: S. RES. 370, RELATIVE
TO THE DEATH OF PAULA F.
HAWKINS, FORMER UNITED STATES
SENATOR FOR THE STATE OF
FLORIDA.
TH
OBJECT
PROCEED TO THE MEASURE.
MR. BAUCUS: MR. PRESIDENT, I ASK
UNANIMOUS CONSENT THAT THE
RESOLUTION BE AGREED TO, THE
PREAMBLE BE AGREED MOTION TO RECONSIDER BE LAID ON
THE TABLE. THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BAUCUS: MR. PRESIDENT, I ASK
UNANIMOUS CONSENT THAT WHEN THE
SENATE COMPLETES ITS BUSINESS
TODAY,
10:00 A.M. ON SATURDAY, SEPTEMBER 5.
THAT FOLLOWING THE PRAYER AND
PLEDGE, THE JOURNAL OF
PROCEEDINGS BE APPROVED TO DATE,
THE MORNING HOUR BE DEEMED
EXPIRED, THE TIME FOR THE TWO
LEADERS BE RESERVED FOR THEIR
USE LATER IN THE DAY AND SENATE
RESUME CONSIDERATION OF H.R.
3590, THE HEALTH CARE REFORM
LEGISLATION.
THAT THE FIRST THREE HOURS
FOLLOWING ANY LEADER REMARKS
EQUALLY DIVIDED BETWEEN THE TWO
LEADERS OR THEIR DESIGNEES AND
CONTROLLED IN 45 MINUTE
ALTERNATING BLOCKS OF TIME.
WITH THE MAJORITY CONTROLLING
THE FIRST BLOCK AND NO OTHER
MOTIONS OR AMENDMENTS IN ORDER DURING THE CONTROLLED TIME.
THE PRESIDING OFFICER: WITHOUT
OBJECTION.
MR. BAUCUS: MR. PRESIDENT,
SENATORS SHOULD EXPECT ROLL CALL
VOTES TOMORROW AFTERNOON.
THERE WILL BE NO ROLL CALL VOTES
REQUIRE PRIOR TO 1:00 P.M.
I ASK THAT THE SENATE ADJOURN
UNDER THE PROVISION OF S. YES 3
-- S. RES. 370 FOR PAULA
HAWKINS, THE PREVIOUS SENATOR
FOR STATE OF FLORIDA.
THE PRESIDING OFFICER: THE
SENATE WILL ADJOURN UNTIL
10:00 AND S. RES. 370, DOES SO
AS A MARK OF RESPECT FOR PAULA
HAWKINS, FORMER SENATOR FROM THE
STATE OF FLORIDA.