10:16 AM EST

Lamar Alexander, R-TN

Mr. ALEXANDER. Madam President, on our Republican time, the Senator from Wyoming, Mr. Barrasso, will lead a colloquy and ask for permission to do that concerning Senator Gregg's amendment, which we will be talking about this afternoon, making clear to the American people this Democratic health care bill is being paid for by treating Medicare as a piggy bank. But before we do that, I want to say, briefly, something in response to the majority leader's comments.

He, the majority leader, said the Republican leader had said the Democratic health care bill is arrogant. It is historic in its arrogance. It is arrogant to think we are wise enough--we 100 Senators are wise enough--in a 2,000-page bill to completely turn upside down and change a comprehensive health care system that affects nearly 300 million Americans and 16 or 17 percent of our economy all at once.

It is arrogant for us to imagine the American people are not wise enough to see through the proposals in this bill, which are to transfer millions more Americans into a Medicaid Program for low-income people that none of us would want our families or members a part of.

It is arrogant for us, then, to send a significant bill for much of that to State governments. We make the decision, we send them the bill, and do that in a way that in my State, at least, will cause devastating cuts in higher education or huge tax increases.

It is arrogant to say to the American people it is an $800 billion bill, which, as the Senator from New Hampshire has pointed out, when it is fully implemented it is a $2.5 trillion bill--half paid for by Medicare cuts.

It is arrogant to say we have balanced our budget when in fact--when in fact--we leave outside the budget what it costs to pay doctors to work in the government-run program we have today.

So this legislation is historic. It is historic in its arrogance, and the American people will see through it and will expect us to, instead, identify a clear goal. That is the Republican proposal, which is, to reduce costs and go step by step in a direction toward those goals--whether we are allowing small businesses to put together their plans so they can serve more people at a lower cost, whether it is creating competition by allowing people to buy insurance across State lines, whether it

is reducing junk lawsuits against doctors. We have made all these proposals.

We are ready not to roll a wheelbarrow of our own in here with a comprehensive proposal. But day after day, we have said, instead of increasing costs, raising taxes, allowing premiums to go up, shifting costs to States, and dumping low-income Americans into Medicaid, let's reduce costs. We have a plan to do that.


I wish to recognize the Senator from Wyoming so we can have a discussion about Senator Gregg's amendment.

10:20 AM EST

John A. Barrasso M.D., R-WY

Mr. BARRASSO. I thank the Presiding Officer.

Mr. President, I have been looking at the bill, which, to me, is going to hurt the health care system of our country. I am a physician. I have taken care of families in Wyoming for 25 years, and I think if we want to get costs under control, if we want to help families all across America who are struggling with their health care needs, we need to focus on an amendment that is before us today, brought forward by the Senator from New Hampshire.

I ask my friend and colleague from New Hampshire, is it not true that the numbers we are looking at are underreported? It is going to be much more expensive and the cuts are going to come from our seniors, those who are vulnerable, those who depend on Medicare for their health care, and we need to make sure and promise the American people we will be protecting those folks who depend on Medicare for their health care?

10:29 AM EST

John Thune, R-SD

Mr. THUNE. Correct. And it seems to me, at least, that the amendment gets at what some on the other side have argued, with their amendments, they are trying to accomplish.

Could the Senator from New Hampshire describe how the effect, the legal effect, of his amendment differs from, say, for example, the votes we have had, where it was a 100-to-0 vote the other day on a Bennet amendment, what the impact the amendment of the Senator from New Hampshire would be relative to some of the previous votes we have had, which it appears to me, at least, were completely meaningless, sort of cover votes, to try and give people on the other side the opportunity to say: We voted

to protect Medicare, when, in fact, they did not?

How is the amendment of the Senator from New Hampshire distinguished from those that have been voted on previously?

10:30 AM EST

Judd Gregg, R-NH

Mr. GREGG. My amendment has force of law behind it. Those amendments have no force of law behind them. They have no effect at all. As the Senator said: a political statement, an editorial comment, a piece of paper written.

This amendment, if passed, will have the force of law behind it. It will very simply be structured in a way that the money cannot be taken out of Medicare if it is going to be used for the purposes of funding the new programs in this bill, whether they are the entitlement programs for people who are not seniors--this expansion of entitlements--or whether they are for the purposes of getting votes to pass the bill.

10:30 AM EST

John Thune, R-SD

Mr. THUNE. So if a Senator on either side of the aisle, a Republican on this side or a Democrat, was serious about protecting Medicare, ensuring that Medicare's solvency is protected and that these funds are not going to be reallocated to create some new entitlement program or spend money on some new, clearly, $2 1/2 trillion expansion of government, which we know is going to require enormous amounts of revenue which seems to me has to come from somewhere--what the Senator's amendment would

do is simply force the other side to put up or shut up with regard to this argument they have, which is that they are, in fact, supporting Medicare; the Senator's amendment would essentially say, very clearly, in a very straightforward way, that funds that come in out of savings from Medicare have to be retained in the Medicare account.

10:31 AM EST

Judd Gregg, R-NH

Mr. GREGG. That is correct. This is the first and only vote Members on this floor are going to have, to make it clear that Medicare dollars will not be used for something other than Medicare.

10:31 AM EST

Saxby Chambliss, R-GA

Mr. CHAMBLISS. Would the Senator yield for an additional question? The language in the Bennet amendment that passed 100 to nothing the other day said, basically, that Medicare savings should benefit the Medicare Program and Medicare beneficiaries. That sounds pretty straightforward, pretty simple. But let me ask the Senator--

10:32 AM EST

Saxby Chambliss, R-GA

Mr. CHAMBLISS. That is exactly the question I am getting to. Is there anything in the Bennet amendment that removes the expenditure of almost $500 billion from Medicare in the base Reid bill that would require the restoration of those cuts to benefit Medicare versus using it as a fund to pay for the underlying Reid bill?

10:32 AM EST

Judd Gregg, R-NH

Mr. GREGG. Well, the Senator has made an excellent point. Essentially, the Bennet amendment has no teeth. It has no substance. It has no substantive effect. It is just a statement of purpose. If the statement of purpose is as recited by the Senator from Georgia, then you would need to vote for this amendment, my amendment, if you voted for the Bennet amendment, because my amendment has the teeth that backs up the language of the Bennet amendment.

10:33 AM EST

Saxby Chambliss, R-GA

Mr. CHAMBLISS. If I understand what the Senator is saying in his amendment, he is requiring the Office of Management and Budget as well as CMS to certify to Congress, basically, that the savings that are referred to in the Bennet amendment as well as in the Senator's amendment are, in fact, being used to fund Medicare benefits versus being used to fund other benefits outside Medicare until such time as Medicare is fully funded.

10:33 AM EST

Judd Gregg, R-NH

Mr. GREGG. That is, essentially, what it says. It says that CMS and OMB must certify that no funds are being used to fund the additional activity in this bill that does not relate to Medicare with Medicare funds. It does not say that Medicare savings--it agrees to the Medicare savings, but those Medicare savings would basically be used for the purposes of reducing the outyear fiscal imbalance of Medicare. So it doesn't contest the Medicare savings as proposed in this bill, although those amendments

have--we have already voted on a number of those. We voted on home health care, and we voted on Medicare Advantage, but to the extent those savings go in, those [Page: S12567]

cuts in Medicare benefits go in, the revenues from those cuts cannot be used and spent to expand the size of government in someplace else which has nothing to do with senior citizens.

10:34 AM EST

John A. Barrasso M.D., R-WY

Mr. BARRASSO. If I could follow up with a question for my colleague from New Hampshire, because as I read the Sunday New York Times, it said the Bennet amendment was completely meaningless--the Bennet amendment was meaningless. It also goes on to say, Senator McCain is trying to keep that $500 billion in Medicare, but the Democrats are trying to take that money out of Medicare and, as the article says, the editorial says: to finance coverage for uninsured Americans but not people on


So it does seem the New York Times, at least in this segment, got it right: that the Bennet amendment that our colleague from Georgia referred to is meaningless, that the cuts are going to come out of people who depend upon Medicare for their health care to pay for a whole new government program and not to focus on Medicare.

Well, don't we owe it to these seniors who have paid into the program and who have been promised the program to save that program first?

10:35 AM EST

Judd Gregg, R-NH

Mr. GREGG. Well, the Senator from Wyoming is absolutely right. I think the New York Times got it right. It is a convergence of two unique forces of nature that the Republican minority in the Senate and the New York Times should be on the exact same page on this issue and both be right.

10:35 AM EST

Lamar Alexander, R-TN

Mr. ALEXANDER. I wonder if the Senator from New Hampshire would characterize this discussion this way: As I am hearing it, in order to protect Medicare, a Senator wouldn't want to say: I voted for the Bennet amendment and then I voted against the Gregg amendment, when it counted.

10:36 AM EST

John A. Barrasso M.D., R-WY

Mr. BARRASSO. I have a question for my Senate colleague from South Dakota who is here. We heard the majority leader, Senator Reid, come to the floor a few minutes ago and talk about how this bill is going to get premiums under control, keep the cost--for people who have insurance, keep their premiums under control. I saw a chart from the Senator from South Dakota yesterday that said for 90 percent of Americans, those who have insurance now, if we did nothing and did not pass this bill,

the premiums would be lower than if we do pass this bill; that passing this bill actually will raise premiums, in spite of the fact the President of the United States promised, while campaigning, that he would lower the cost of premiums for American families by $2,500.

I would ask my colleague from South Dakota, isn't it true that if this bill passes, Americans wanting--feeling they have been promised that premiums would be reduced, are they not doomed to disappointment?

10:37 AM EST

John Thune, R-SD

Mr. THUNE. The Senator from Wyoming is correct. This is where the real rub in this bill comes into play because what we were told and the promises that were made--of course, many promises were made throughout the course of the campaign, many of which will never be realized with this legislation. There was also a promise made that taxes wouldn't go up for people making less than $250,000 a year--not payroll taxes, not income taxes, not any kind of taxes. In fact, we now know that 38 percent of

the people who make under $200,000 a year are going to see their taxes go up under this legislation. So promises made during a campaign season tend not to necessarily be adhered to when it comes time to legislate and actually follow through, and I think that is clearly the case here.

With regard to the question of the Senator from Wyoming, the whole purpose of health care reform, at least as I understand it--and I think, for the most part, as the people of South Dakota whom I represent understand it--is to lower cost. Because everybody complains--the thing you hear the most when you go home--and the Senator from Georgia is here. If you go to Georgia, Wyoming, South Dakota, I think the sentiment you hear most frequently from people in our States is: Do something about the

cost of health care. We have these year-over-year, double-digit increases or increases that are twice the rate of inflation, and we are dealing with this. Small businesses are dealing with it. More and more people--families are struggling with the high cost of health care. Nobody argues that. We all, basically, accept the premise that health care costs have been going up and health care reform ought to be

focused directly on trying to get those costs under control.

The irony in all this is, after cutting $ 1/2 trillion from Medicare in the first 10 years, and if you go into the fully implemented time period it is about $1 trillion, and $ 1/2 trillion in tax increases, what happens with premiums? Well, according to the Congressional Budget Office, 90 percent of Americans would be the same or worse off. In other words, 90 percent of Americans would see no improvement in their health insurance premiums. In fact, if you buy in a small group market, if you

buy in a large group market, your premiums go up by about 6 percent a year, year over year. In fact, a family of four--let's put it in a perspective that an American family can understand. If you are a family of four--this is according to the Congressional Budget Office--that is paying $13,900 for insurance

this year and you are getting your insurance in a large group market because you work for a large employer, in 2016, your insurance cost is going to be over $20,000 a year. In other words, your insurance is going to go up about--a little under $14,000 to over $20,000 a year in that time period.

So what American in their right mind is going to say that is reform? I think most Americans are going to say: What are you doing? You are spending $2.5 trillion, you are raising my taxes, and cutting my parents' or my grandparents' Medicare benefits, for what? So my premiums can stay the same or go up? If you buy your insurance in the individual marketplace, your insurance premiums, according, again, to the Congressional Budget Office, are going to go up anywhere from 10 to 13 percent a year.

So you get Medicare cuts, you get tax increases, and for 90 percent of Americans, you stay the same or are worse off. In other words, your insurance premiums are now going to be impacted, you have achieved the status quo or, worse yet, your insurance premiums are going to go up 10 to 13 percent if you are buying in the individual market. That is according to the Congressional Budget Office.

So I would say to my friend from Wyoming, the point he made is exactly right. In doing all this, the exercise ought to be about reducing costs. Clearly, that is not the case with this legislation.

10:40 AM EST

Saxby Chambliss, R-GA

Mr. CHAMBLISS. Let me address a question to our friend from Wyoming who is a medical doctor, in addition to being an outstanding Senator.

What we are being asked to believe from the folks on the other side and what the American people are struggling with and having a hard time believing is, they are saying that even though they are cutting Medicare by a total of $450 billion-plus over a 10-year period, actually the solvency of Medicare is going to be extended. They expect the American people to believe that somehow.

The fact is, we know from the information we received this spring from the bipartisan Medicare Commission, unless something is done, Medicare is going to become insolvent in the year 2017, pure and simple. What we are doing is not taking the savings they are proposing--and we don't agree with them, but irrespective of that--irrespective of the savings they are saying are going to be achieved, instead of applying that back, we are going to use that to grow the size of government, tie some reimbursement

payments to physicians to the Medicare Program, and now we are looking at about a 23-percent reduction in payments to physicians as reimbursement under Medicare if we don't take some action next year. When you put all this together, the American people are saying: You have to be kidding me. How in the world are you going to extend the life of Medicare by cutting it by almost $500 billion?

10:42 AM EST

John A. Barrasso M.D., R-WY

Mr. BARRASSO. As my colleague from Georgia knows, there is no way you can save Medicare when you cut that kind of money out of it. How, when they cut physicians' payments by 23 percent, are we going to have physicians going to any of our small communities in South Dakota, in Georgia, in Wyoming, where we have many people [Page: S12568]

who depend on Medicare for their health care? I worry about access to care.

Our colleague, Senator Isakson, yesterday talked about home health care and how, for pennies on the dollar, you can help people. It provides a lifeline for people who are homebound. It keeps them out of the hospital, out of the nursing homes. Instead, this Senate, the Democratically led Senate, yesterday voted to cut $42 billion out of home health care, which people in our small communities and in the rural areas of our State depend upon. So there is no way this program can stay solvent.

It is hard for me to fathom and, clearly, hard for the people of Wyoming to fathom, how with all this budget trickery it is going to work for people who need to go to see a doctor or to have a home health care provider in many of our rural communities.

We all have townhall meetings, and when I go to townhall meetings, people say: Don't cut my Medicare, don't raise my taxes, and don't make things worse for me than they are now.

10:43 AM EST

John Thune, R-SD

Mr. THUNE. If the Senator will yield, the Senator, of course, is one of only two physicians in the Senate and has great experience and great depth on this issue and knows what it is like to serve and provide health care services to people in rural areas, such Wyoming and South Dakota and some areas of Georgia.

I think it is interesting too--and the Senator from Georgia was here, as was I; I don't think the Senator from Wyoming was here at the time. But in 2005, we had a debate about Medicare, and the Senator from New Hampshire proposed cutting $10 billion in Medicare, taking $10 billion over a 5-year period or about $2 billion a year, and paid for it by income testing the Part D benefit that people got. In other words, the premiums that are paid, those who are in the higher income categories would

have to pay a higher premium for their Part B drug benefit than would those in lower income categories. You would have thought that the apocalyptic pronouncements and predictions around here about what that was going to do for Medicare: $2 billion a year or $10 billion over 5 and you heard the other side describe it as immoral, it was cruel, it was a disaster of monumental proportions.

That was some of the terminology that was used around here at the time. That was for $10 billion over 5 years, and that basically was to say to people who have higher incomes, the Warren Buffetts of the world ought to pay a little bit more for their prescription drug benefit under Medicare than those in lower income categories, and people on the other side went nuts about that.

Now here we are talking about cutting $465 billion over a 10-year period, $1 trillion over 10 years, when it is fully implemented, and it seems to me, I would say to my colleagues, the other side is going to have a lot of explaining to do to the American people about why $10 billion in reductions was immoral, cruel, and a disaster of monumental proportions, but cutting $ 1/2 trillion out of home health care and nursing homes and hospitals and everything else to pay for an entirely new entitlement

program, a $2.5 trillion expansion, somehow makes sense.

10:46 AM EST

John A. Barrasso M.D., R-WY

Mr. BARRASSO. Mr. President, I appreciate the comments from my colleagues. I think we are hearing around the country that we do need health care reform. We need to get costs under control. We need to have patient-centered reform, not government-centered reform, not insurance-centered reform. We need to not cut Medicare. We need to not raise taxes. We need to not make things worse for the American people.

From what I have seen of this bill--and I worked my way all the way through it--it makes things worse for the American people, not better. This is not the right prescription for health care in America.

With that, I yield the floor.

10:46 AM EST

Max Baucus, D-MT

Mr. BAUCUS. Mr. President, for the benefit of all Senators, I will take a moment to lay out today's program. It has been 2 1/2 weeks since the majority leader moved to proceed to the health care reform legislation. This is the eighth day of debate. The Senate has considered 16 amendments and motions and conducted 12 rollcall votes.

Today, we will debate an amendment by Senator Pryor and, at the same time, an amendment by Senator Gregg to do with spending taking effect. The first 2 hours will be equally divided. The Republicans will control the first 30 minutes and the majority will control the next 30 minutes. There may or may not be a side-by-side amendment to the Gregg amendment. The Senate will conduct votes on or in relation to the Pryor and Gregg amendments this afternoon. We expect at least those

votes to begin sometime between 3:15 and 4 p.m. this afternoon.

I will take a few moments to discuss the amendment Senator Gregg offered yesterday. The Gregg amendment has been billed as protecting Medicare. That seems to be the new fashion on the other side of the aisle--to say that the bill cuts Medicare. Frankly, that is a misleading statement at best, and it is inaccurate, basically. In reality, the Gregg amendment is a killer amendment. It is designed to prevent health care reform from taking effect. That is the purpose of the Gregg amendment.

It is a killer amendment.

The amendment has more details to it, but you can get the flavor of it from a few excerpts. Let me quote from the amendment.

The first subsection of the amendment is entitled ``Ban on New Spending Taking Effect.'' You really don't have to go much further to get an idea of what the amendment is about. Just focus on that statement in the amendment--a ban on new spending taking effect.

Let me quote further from the second subsection:

..... the Secretary of the Treasury and the Secretary of Health and Human Services are prohibited from implementing the provisions of, and amendments made by, sections 1401, 1402, 2001 and 2101. .....

What are those sections? The Gregg amendment will stop this spending from taking effect.

Section 1401 is refundable tax credits providing premium assistance for coverage. Those are the tax credits, the tax reductions that help people buy health insurance. The Gregg amendment says we cannot help people buy health insurance, that they can't have those tax credits.

The second section is 1402. What is that? It is to reduce cost sharing for individuals. That is the part that would make copays and other out-of-pocket expenses affordable. The Gregg amendment says: No, we can't have reduced cost sharing for individuals. We have to keep those copays in effect and out-of-pocket expenses high. It would help people with copays and other out-of-pocket expenses.

The third section the Gregg amendment would stop is section 2001. It is a section that provides Medicaid coverage for the lowest income population. That is the one that provides expanded Medicaid coverage up to 133 percent of poverty. The Gregg amendment says: No, you can't help poor people with health care. The Secretary is prohibited from making those payments to Medicaid if that amendment is adopted.

The fourth section the Gregg amendment would stop is section 2101. Section 2101 is a section that provides additional funding for the Children's Health Insurance Program. Can you believe that? A Senator gets up on the floor of the Senate and wants to stop funding to the Children's Health Insurance Program? That is what that section provides.

So if you don't like tax reductions to help people buy health insurance, if you don't like making health insurance affordable, if you don't like health care for the lowest income Americans, and if you don't like health care for kids, then the Gregg amendment is for you.

The folks on the other side of the aisle have spent a lot of time this year talking about Medicare. That is about all I hear from them. They make it sound as if they want to help Medicare. In effect, they are hurting it. A lot of folks say they want to help Medicare, and I see the big crocodile tears they shed. I will take a few moments to set the record straight about how the trust fund works. That might help them understand, frankly, why the bill before us--the Reid bill--helps Medicare, contrary

to protestations of those on the other side.

The Medicare trust fund provides hospital insurance for seniors and Americans who are disabled. Working Americans pay into that trust fund when they pay their payroll taxes. [Page: S12569]

When a senior has to go to the hospital or a nursing home--there are lots of areas where seniors get help--the spending to help pay for that hospitalization comes out of the trust fund. The actual sum comes out of Medicaid, but some payments come out of the Medicare trust fund,

such as for home health care, et cetera.

When payroll tax revenues are greater than the payments for hospitalizations, the assets in the Medicare trust fund grow. That is good. On the other hand, when spending for hospital care is greater than payroll tax revenues and interest payments on the trust fund assets, then assets in the Medicare trust fund diminish. That is not good.

The Actuary for Medicare--the person charged with determining the health of the Medicare trust fund over at HHS--tells us that if we don't do anything--if this legislation is not passed--then by about 2017 the Medicare trust fund assets will be exhausted. That is clear. That is definite. That is a fact, and I emphasize the word ``fact.'' I am just being honest, Mr. President. I have to be objective and honest about this stuff. When I hear Senators talk about Medicare, they are not looking at

facts. It is one thing to say something and engage in all this rhetoric, but if it is not backed by facts, it is a bit irresponsible.

The fact is, the life of the Medicare trust fund will be extended for 5 years under this legislation. I talked to a Senator on that side privately. He said that the Medicare trust fund will not be extended--the solvency--for 5 years. I asked him privately: How can that be true? Did you read the Actuary's report? By the way, it was not this Senator right here; it was another Senator, and that Senator said: I don't believe it. It is a fact. The Actuary says that will be the result of the legislation

before us; namely, that the solvency of the trust fund will last 5 more years. That is a fact. That is what the Actuary's report said.

So we can either raise more payroll taxes to continue the solvency of the trust fund so that seniors get their benefits or we can reduce spending out of the trust fund. We can either increase the money or decrease the money coming out.

I will say it again. The Medicare Actuary tells us that health care reform will extend the life of the Medicare trust fund by 5 years or, to put it another way, if we do not enact health care reform, we will hurt Medicare's long-term solvency.

Let me cite some examples on how that works.

Health care reform would discourage hospital readmissions, for example. That is waste. See, here is what the other side doesn't quite understand. You don't hear them talking about it. The goal here is to extend the life of the trust fund, basically by cutting out waste--not hurting seniors but cutting out waste and cutting back on overpayments in some areas where some providers are overpaid, and where seniors are helped, not hurt.

Again, here is an example: hospital readmissions. If you can discourage hospital readmissions, that is fewer dollars wasted out of the trust fund, and it is better health care for seniors. The incentive is for hospitals to have more readmissions because that is how they make money. Some hospitals, frankly, don't go out of their way to prevent readmissions because they can make more money that way, although it is not good care for seniors.

When a senior is discharged from a hospital, you want to make sure there is a flow, a seamless effort of keeping health care for that patient, whether it is extended care or home health care in a nursing home or whatnot, and there is a physician involved and nurses involved and so forth, making sure the patient is taking his or her medication, and it is just to make sure patients are getting better all the time.

We all know--I know because I have experienced it, and I have watched it firsthand, and I have heard many people talk about this--that too often, when a patient is discharged, the care for that patient is not as great, as the hospital is in longer involved, and sometimes the regular doctor is not involved because that doctor is not very much involved with the patient at the hospital. My own view is that it needs improvement. It is not working too well.

Again, we are saving dollars in the Medicare trust fund by preventing excessive readmissions. That is wasteful and doesn't help the patient. So that is a way we are saving and extending the solvency of the trust fund. That is one way. There are others. I will cite a second.

Health care reform discourages hospital-acquired infections. I think in America, unfortunately--and I don't know the facts, but I have read this somewhere, but I haven't confirmed it--the rate of infections in American hospitals is greater than it is for other industrialized countries. That is clearly a problem. People die from infections in hospitals, and it seems to me that the more we can encourage fewer infections--one way is through health care reform. Maybe we can lower payments to hospitals

that have too many infections. I know it is hard to do. It is a judgment call. You have to do the best you can. That, too, will help the solvency of the trust fund and help care for patients. That is another way we are extending solvency of the trust fund.

I see my good friend from Wyoming on the floor, Senator Barrasso, who talks about home health care. I am sure he wants to eliminate fraud in home health care. I am sure he does. We all want to. So we cut back on areas where there is fraud. Where is there fraud? In outliers. Too many hospitals bill too much for outlier payments, additional payments, because they say they have a special patient who is an outlier. One county in Florida billed for 60 percent of the outlier payments in America

even though they had 1 percent of seniors in America. There are other examples like that. The GAO came to us and said we have to do something about this. There is fraud in the home health care program. I am a big fan of home health care--a big, big fan. They do very good work. But we want to take out the fraud--excessive payments that are fraudulent. Isn't that a good thing? Doesn't that extend the solvency of the trust fund? Isn't that helping patients instead of hurting them?

There are examples. The home health folks came to us and said: Make some of these changes because it is more efficient and we can give better care. As a result, fewer dollars are going to home health care. We also had a provision for rural health care. We add an extra bonus for rural health care.

My point is simply that when Senators stand up on the floor and say we are cutting Medicare--sometimes they use the words ``cutting benefits'' or ``hurting beneficiaries''--that is patently false. It is not true. It is true that in some cases we are taking some of the fraud out. It is also true that in some cases we are taking excessive payments--not by our judgment but by the judgment of MedPAC and other organizations and experts who study this. One Senator from Florida stood up and told me

he agreed that payments to Medicare Advantage are excessive. Doesn't it make sense to take out the excess, the waste, and the fraud in order to extend the solvency of the trust fund? That is what this bill does.

It doesn't hurt seniors by ``cutting'' Medicare, leaving the implication that we are cutting Medicare benefits. It is an old saying in life: If you say something loud enough, maybe people will start to believe it. That is what the other side is engaging in.

If you look at the actual facts, the actuary says it does extend the life and solvency of the trust fund. The actual fact is we are cutting out waste. The actual fact is the industry has come to us and said: Help us with this, help us with that so we can be more efficient, much of what is going on here.

I have countless examples. Let me give a third one. This legislation would encourage hospitals and doctors to work together by bundling payments. If doctors and hospitals work together, guess what happens. They are less likely to order duplicate tests. They are working together. Payments based on fee for service, payments based today on volume, on quantity are, in some cases, wasteful. It is wasteful.

All of us who go to a hospital, a doctor's office, we kind of wonder: My gosh, some things seem wasteful here. We have to get new tests, new this; the doctor doesn't know what happened when I was here previously; we have to start all over again; new x rays, new imaging, so forth. They are waste. We [Page: S12570]

are trying to cut out a lot of this waste, and bundling payments is definitely going to help.

We have other techniques--accountable care organizations, medical home concepts. These could take 1 year, 2, 3, or 4 to kick in. But if they do work, it is the model of integrated care systems we all talked about which cut out waste and improve quality at the same time, and that is going to help Medicare. These integrated systems are going to also help extend the solvency of the trust fund and improve quality of care--not reduce it but improve it.

The main point I am making is these reforms will extend the life of the trust fund. And guess what. They improve the quality of care, not decrease the quality of care but improve it.

We also add some additional benefits for seniors that they will not receive if this legislation does not go into effect.

I note we only have a half hour on our side. I probably used more time than I should. The chairman of the HELP Committee is on the floor. Mr. President, how much time remains on the majority side?

11:18 AM EST

Robert F. Bennett, R-UT

Mr. BENNETT. Mr. President, in this morning's Washington Post, we have, once again, an outstanding article by Robert Samuelson, this one entitled: ``Health-care Nation: Medical spending threatens everything else.'' Mr. Samuelson has been critical of Republicans--and he is in this article--and he has been critical of Democrats--and he is in this article--but he makes some points I think are worth bringing to our attention, the primary one being that we are not focusing on the right issue, which

is making some kind of attempt to turn the cost curve down--using the budgetary doublespeak--with respect to health care.

Let me quote a few comments from Mr. Samuelson's presentation. He says, first:

The most obvious characteristic of health spending is that government can't control it.

As demonstrated by our past history, that is a very true statement, which I will show in a moment. He goes on to say:

[The] consequence is a slow, steady, and largely invisible degradation of other public and private goals. Historian Niall Ferguson, writing recently in Newsweek, argued that the huge Federal debt threatens America's global power by an ``inexorable reduction in the resources'' for the military. Ferguson got it half right. The real threat is not the debt but burgeoning health spending that, even if the budget were balanced, would press on everything else. ``Everything else'' includes universities,

roads, research, parks, courts, border protection, and--because similar pressures operate on States through Medicaid--schools, police, trash collection and libraries. Higher health spending similarly weakens families' ability to raise children, because it reduces households' discretionary income either through steeper taxes or lower take-home pay, as higher employee-paid premiums squeeze salaries.

He concludes:

..... Obama talks hypocritically about restraining deficits and controlling health costs while his program would increase spending and worsen the budget outlook. Democrats congratulate themselves on caring for the uninsured--who already receive much care--while avoiding any major overhaul of the delivery system. The resulting society discriminates against the young and increasingly assigns economic resources and political choice to an unrestrained medical-industrial complex.

Mr. President, I ask unanimous consent to have printed in the Record the entire article at the conclusion of my remarks.

11:21 AM EST

Robert F. Bennett, R-UT

Mr. BENNETT. To demonstrate the accuracy of what Mr. Samuelson has to say, I have some charts. This one shows the breakdown of Federal spending in 1966. Why do I pick 1966? Because that was the year for the beginning of Medicare. At that time, 26 percent of the Federal budget went for mandatory spending--overwhelmingly Social Security--7 percent went to pay interest on the national debt, and 44 percent went for defense, with 23 percent for nondefense.

Where are we now? In 2008, mandatory spending had more than doubled and had gone to 54 percent, interest costs remained about the same--8 percent--defense had shrunk to 21 percent, cut in half, and the nondefense discretionary, 17. The difference? Medicare and Medicaid taking over the mandatory side.

What do we see as we look out to 2019. We can't break down the difference between defense and nondefense because that would require an analysis that is not available to us in that future year. But mandatory by that time will have grown to 61 percent. The size of the debt increasing costs now, interest costs have grown to 10 percent and defense and nondefense discretionary have shrunk to 29--a complete reversal. That is roughly what mandatory was when Medicare was started.

I am not saying we should not have Medicare, and I am not saying we should not have Medicaid, but I am saying we should be focusing on how we make people healthier, how we reward people for not using the system, how we do something to control the costs, instead of increasing the status quo with respect to health care spending.

This chart was drawn up before we had the bill before us. I think it is very likely, if the bill before us passes, this mandatory will grow even further and we find ourselves in this situation with respect to 2010. I watched the budget as it came down and it said, in 2010, Federal revenues were going to be $2.2 trillion and mandatory spending was going to be $2.2 trillion, which means every dime of everything else had to be borrowed.

I worked with Senator Wyden and a number of others on both sides of the aisle to craft a health care plan that would turn the cost curve for health care down. We didn't even get a vote in the Finance Committee. We didn't even get anybody to consider what we had to say because everyone was focused entirely on the issue of let's cover the uninsured. The position is: Let's cover the uninsured by taking what we are doing now and spreading it even wider.

As Mr. Samuelson says, very clearly, in his column today: That squeezes out the money for everything else. That is an uncontrolled expenditure. We are not focusing on changing the system in a way that can cause cost curves to come down, we are focusing on taking the present system and spreading it wider.

The cost curve can come down. I have quoted this before. The Dartmouth study talks about where the best health care is available in America, and it is in three cities, according to Dartmouth: Seattle, WA, Rochester, MN, and Salt Lake City, UT. Then they go on to say, if every American got his or her health care in Salt Lake City, UT, it would be the best in the country and one-third cheaper than the national average. It is one-third cheaper than the national average because the focus in that

plan, as it is in Rochester, MN, at the Mayo Clinic, and other places, is trying to make health care better and, therefore, cheaper, instead of focusing on taking the present system and perpetuating it.

If we don't get into that mentality, if we just take the present system, which this bill does, and spread it over a wider number of people, which this bill does, we will see the spending go up and we will see everything else suffer as a result of it and the health care will not get any better for the people who are involved.

Exhibit 1

11:26 AM EST

Tom Harkin, D-IA

Mr. HARKIN. Mr. President, I would say that a lot of what Senator Bennett says I agree with. That is why, in this bill--and I keep reminding people because it is not talked about much--there are more provisions in this bill to promote wellness and prevention than any health bill we have ever passed--ever--in the United States. There are huge investments in this bill on prevention and wellness.

I happen to think that perhaps one of the reasons Salt Lake City is so good is because people don't smoke and don't drink and that goes a long way toward providing for a healthier form of living. So I say to my friend from Utah, people talk about bending the cost curve only in terms of the spending. I think--and I sincerely believe this--the only way we are going to bend that cost curve is by pushing more of this upstream, by keeping people healthy in the first place, starting with kids and adults,

community-based, clinical-based, workplace-based wellness programs.

So I ask my friend from Utah to look at that part of the bill.

11:27 AM EST

Robert F. Bennett, R-UT

Mr. BENNETT. Mr. President, if I can reclaim my 2 minutes to respond to the Senator from Iowa, I can give you data that indicates it is not just the fact there are a lot of people who don't smoke and don't drink in Utah that makes them healthier. I agree there are many things in this bill that are for wellness, and I approve of that. But the fact is, the bill does not go anywhere near far enough in this direction to change the paradigm that has created the situation we find ourselves in.

Every expert I have talked to, in the 3 1/2 years I have immersed myself in this issue, has repeated that. They have said the only way you are going to deal with this is to do something dramatically different, which is what Senator Wyden and I tried to do and we got the cold shoulder. All right, I understand, if you don't have the votes, you can't get anywhere. But the fact remains, we are not going to be able to afford all the things we want to do in this country, militarily and otherwise,

in this cost projection that we are on with respect to health care right now.

11:28 AM EST

Robert F. Bennett, R-UT

Mr. BENNETT. That is right; my time has gone. I will be happy to respond to the Senator from Montana, if he wants to take the time to let me.

11:30 AM EST

Robert F. Bennett, R-UT

Mr. BENNETT. Responding to the question of the Senator from Montana, I am delighted there is as much of that in the bill as there is, but I still believe the basic structure of the bill is fatally flawed because it perpetuates the present system in ways that will guarantee the cost curve will continue to go up.

I disagree with him about the Samuelson article. I do not think he is being overly pessimistic. I think he is being very realistic.

11:31 AM EST

Max Baucus, D-MT

Mr. BAUCUS. One more moment, if I might, Mr. President.

I understand the bill that the Senator and Senator Wyden cosponsored is basically to move us away from the employer-based system. Currently, our tax law encourages employers providing tax free health insurance and so forth. I understand the theoretical and actual problems with the current system. In fact, I earlier advocated moving in that direction, all the way to your legislation. But as you know, this town, this city, this country, this White House was not moving there, and major

business was not moving in that direction. Therefore, we had to find something else. My main point is, if we can't go in that direction--you might say keep trying, but read the tea leaves. If we can't do that, at least now, isn't it better to start moving toward the integrated delivery system reforms in this bill?

11:32 AM EST

Bernie Sanders, I-VT

Mr. SANDERS. Mr. President, there are at least two major goals we have to achieve in health care reform and that is we have to expand access to everyone in America, and we have to control costs. We focus a lot on expanding insurance but expanding insurance is not expanding access. There are people today in America who have insurance but they do not have access. The fact is, we have 60 million people who do not have access to a physician on a regular basis and many of those people--according to

recent studies, 45,000--may die because they do not get to a doctor in a timely manner. By the time they walk into the doctor's office their situation is terminal.

We need substantially improved access to health care. When we improve access, we save money because people do not go to the emergency room, they do not end up in the hospital, sicker than they otherwise would have been. We need a revolution in primary health care in America. Unless we do something and do it now, our primary health care system infrastructure is close to collapse.

We have an aging primary care workforce which is not being replaced. At a Senate hearing I chaired earlier this year, it was noted that only 2 percent of internal medicine residents were choosing primary care as their specialty. Happily, there are two Federal programs that can both assure access and control costs, and I refer to the Community Health Center Program and the National Health Service Corps. Both are well-established programs that have garnered broad bipartisan support because of their

proven cost effectiveness.

What a federally qualified community health center is about--and I believe they exist in all States in this country. They have widespread support from Members of the Senate and the House of both political parties. What they are about is saying that anyone in an underserved area can walk into that facility and get health care, either [Page: S12574]

Medicaid, Medicare, private insurance, or a sliding scale--if you don't have enough money, you pay on a sliding scale

basis--and low-cost prescription drugs.

This is a very successful program that now provides health care to over 20 million Americans and it is a 40-year-old program, again supported widely in the House and the Senate.

I am pleased that in the Senate bill, it recognizes the importance of both federally qualified community health centers and the National Health Service Corps. The National Health Service Corps is a long-established Federal program which says to people in medical school: We are prepared to provide debt forgiveness to you--on average, I know in Vermont, people are coming out $150,000 in debt--if you are prepared to work in primary health care in an underserved area.

In the Senate bill we recognize the importance of the federally qualified community health centers and the National Health Service Corps. In fact, our bill calls for authorization levels that, if appropriated, would enable the Community Health Centers Program to expand to every underserved area within 5 years, and would result in supporting at least 40,000 more primary care professionals in the next 10 years--doctors, nurses, dentists.

But we can and must improve the Senate bill. I favor very strongly the language in the House bill which calls for a dedicated trust fund with mandatory annual spending for community health centers and the National Health Service Corps. In other words, in the Senate we have authorized funding. The House has established a trust fund to actually pay for it. The Senate bill contains authorization levels that would be sufficient to fund a community health center in every underserved area in America

and thus provide primary health care to 60 million more people by the year 2015. These are people who do not have to go into the emergency room, they don't have to go into the hospital because they are sicker than they should have been. They are going to get timely, cost-effective health care at a community health center.

Therefore, let me be very clear: I favor the language in the House bill which includes community health centers in its Public Health Investment Fund and guarantees mandatory funding for health centers totaling $12 billion over the next 5 years. This is in addition to the $2.2 billion current annual appropriation for community health centers which, it is anticipated, would also continue to be appropriated in each of the next 5 years. While this House funding level will not achieve a community

health center in every underserved area, it will take us very far toward that goal, bringing primary care health services to some 40 million citizens living in underserved areas. Also in the House bill there is appropriated money to greatly expand the National Health Service Corps.

In the middle of all this discussion on health care, health insurance, let us not forget a few basic points. Sixty million Americans do not have access to a doctor. We need a revolution in primary medical care. We need to make sure we have the physicians, nurses, and dentists who are going to get out in underserved areas. The Senate bill provides authorization. The House bill provides a trust fund for community health centers and for disease prevention in general. My strong hope--and I am going

to do everything I can to make sure it happens--is that the Senate adopts the House provisions.

If we are serious about providing health care to all Americans, we have to expand community health centers, we have to make sure there are primary health care doctors, dentists, nurses out there.

In addition, we need to focus on disease prevention. I know my colleague from Iowa has worked very hard on that. So we have to support the trust fund in that area.

I yield to my friend from Iowa.

11:39 AM EST

Tom Harkin, D-IA

Mr. HARKIN. First, I thank my friend from Vermont. There is no one who has been leading the charge longer and stronger and more fervently than the Senator from Vermont, Mr. Sanders. I thank him for that. Obviously, we all have community health centers in our States. In Iowa they have been a godsend for so many people in rural areas who did not have access to these kinds of facilities.

I remember one time I was in Fort Dodge several years ago. They had a small free clinic there. It was in a church basement one night a week, so people could come in who didn't have insurance and couldn't get access to a doctor. They had one old dental chair there. I think every couple of weeks a dentist would come in for people. A woman had come in who had an abscessed tooth. It was hurting her so much she took a hammer and screwdriver and tried to knock her tooth out. Of course she damaged her

gums. That is how desperate people get.

Because of that, I got the Fort Dodge community looking at a community health center. They now have a wonderful community health center. They have doctors there, they have nurses there, and people have access to that kind of dental care and health care.

11:40 AM EST

Bernie Sanders, I-VT

Mr. SANDERS. Let me mention to my friend, in the State of Vermont, the poorest region of our State borders on Canada. It is called the Northeast Kingdom, in the northeast part of the State. For 30 years we have had a number of community health centers in that region. Do you know what? Amidst all of the poverty, all of the unemployment, all of the economic problems, we do not have a problem in terms of primary health care in the poorest area of the State of Vermont precisely because of these community

health centers, which you indicate address dental care, which we often forget about, mental health counseling, we forget about, low-cost prescription drugs.

I look forward to working with the chairman of the HELP Committee and others to make sure we fund the kind of revolution we need in disease prevention, in primary health care, which at the end of the day improves people's health, keeps them out of the emergency room, keeps them out of the hospital, saves us money.

Study after study: Saves us money.

11:42 AM EST

Tom Harkin, D-IA

Mr. HARKIN. Come to community health centers. Why? Because they get the kind of hands-on care, they get many kinds of supportive services. A lot of times there are language barriers that are a problem. They get preventive care, they get all the things that make people feel better about their own quality of health care. So more and more we are finding people who actually have health insurance going to community health centers.

I ask if that has been the experience in Vermont?

11:43 AM EST

Bernie Sanders, I-VT

Mr. SANDERS. Let me concur. In the State of Vermont we have gone from 2 to 8 with 40 satellites. Over 100,000 people in Vermont are now accessing community health centers for their primary health care.

The other point we don't often make about community health centers is they are democratically run, they are run by the communities themselves. My experience is exactly that of the Senator from Iowa. They are community health centers.

In rural areas it is not rich or poor. By and large, most of the people, regardless of income, go there. The doctors are there for a long time. The dentists are there. It is, in fact, in the best sense of the word, a community health center open and accessed by all people. People take responsibility for it because it is democratically run. It is a program--one of the bright shining stars of public health in America. I hope to work with the chairman of the HELP Committee to make sure these

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programs are funded adequately in this bill and that we adopt the language in the House, which goes a long way.

I yield the floor.

11:44 AM EST

Tom Harkin, D-IA

Mr. HARKIN. I can assure my friend from Vermont that this Senator will be in the forefront of fighting for the maximum possible support, money, and input for community health centers that we can possibly get out of this bill. I can assure him that.

11:50 AM EST

Max Baucus, D-MT

Mr. BAUCUS. Does the Senator further agree that would extend the life of the trust fund because that program--in this case, home health--would be spending fewer dollars even though the quality of health care is not diminished? Doesn't that have the effect of extending the quality of health care, and isn't that reduction for Medicare, for seniors, not to take it away but to give it to seniors because it extends the life of the trust fund?

11:51 AM EST

Mike Enzi, R-WY

Mr. ENZI. That is where the Senator runs into a dead end. If you take the money that would be from home health care and you put it into an entitlement that has nothing to do with home health care, nothing to do with Medicare, then you did not extend the life of Medicare.

11:51 AM EST

Max Baucus, D-MT

Mr. BAUCUS. No, no, no. There is less spending; therefore, by definition, the solvency of the trust fund is extended, so there are more dollars for seniors in future years. That is the basic point here. That is not a dead end. That is a big wide avenue to help extend the solvency of the Medicare trust fund.

11:52 AM EST

Mike Enzi, R-WY

Mr. ENZI. Reclaiming my time, I am the accountant in the Senate. If you take money from a program and you give it to something else, you have less money in that program. We admit that Medicare does have problems in the long term. Seven or eight years out there, it is going broke, and maybe we can extend it a year or two. If we took that money, that fraud and abuse--and I will say some more things about fraud and abuse here in just a minute--if we took that money and put it into the Medicare Program

to extend the life of the program, we could give some assurance to seniors that we are doing something for them. That is where a lot of the concern comes from.

On fraud and abuse, if there is all this fraud and abuse out there, how

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come we haven't been getting at that in the past and putting it to some kind of good use? All of a sudden, we are saying there is all this fraud and abuse and we are going to take this extra fraud and abuse and we are going to put it in there. I notice we have increased the amount of fraud and abuse we are capturing, but we did that by changing the definition. We just

claimed more fraud and abuse. We didn't capture more money. That is one of the problems with having a government bureaucracy do things they really have no value in doing. If the government agency finds the money, it doesn't come back to their program, so they are not very excited about doing it. We keep passing fraud and abuse things around here, and the fraud and abuse never gets found to any extent. And the money can't be used if it can't be found.

As an accountant, what I have always suggested is, we have a separate fund set up, and when we find this fraud and abuse, we put it in that fund. We would only be able to use the money from that fund in these areas where we say we are going to fund it with fraud and abuse money. Because we

have no incentive in government to go out and collect the money. It is a huge problem around here.

Some Democrats have argued that we are not creating a new entitlement program. They are simply wrong with that too. Just like Social Security, Medicare, and Medicaid, this bill will commit the Federal Treasury to paying for these new subsidies for the uninsured forever.

When we start a program around here, we don't put an end date on it. As soon as we have passed it, the people say: Wow, thanks, that is really great. Now what are you going to do for us? We look around and we say: Maybe we can do like Medicare Part D. Then we pass that and they say: Yes, you gave us Medicare Part D, but you still have the doughnut hole. So we take care of that. Anytime we do an entitlement, we keep adding to the entitlement regardless of where the money is coming from. And that

is how Medicare has gotten in trouble. Once subsidies are given, they are never taken back. They are only expanded. There is no appreciation for what has been done. Medicare Part D; now they want the doughnut hole closed.

We are going to do kind of a phony thing to close that doughnut hole. PhRMA said they would give $50 billion that can be used as a subsidy as people go through the doughnut hole, but they said: You can only use the subsidy if we can pay it directly to the customer. That way, they keep in contact with the customer. And you can only use it if they stay with our brand name. OK, so they get through the doughnut hole. Then the taxpayer picks up the money, and they are stuck with the brand name. That

is why the pharmaceutical companies can make so much money. If they can get them to not switch to that generic and make good economic decisions as they go through the doughnut hole, they can make a lot more money, once it is on the taxpayer outside of the doughnut hole. I am really upset with the pharmaceutical industry for doing that. That is the reason they are putting all the money into promoting this.

That means that as Federal spending continues to grow, new programs continue to grow. It will crowd out other Federal spending priorities such as education or national defense. States will tell you it is already crowding out education. When we put these new Medicaid requirements in there and they have to pay for them, they have a limited budget too. What they have done is take money away from colleges, so colleges have had to increase tuition dramatically in order to cover the money they had

to give to Medicaid. So when we do some of these things, we are affecting a whole lot of things, other spending priorities such as education and national defense.

Any future attempts to modify or restrain this growth will be met by cries of indignation, arguing that cuts would devastate access to health care. If anyone has any doubt, they should look at the transcripts from our debate on the Deficit Reduction Act.

In 2005, Congress tried to reduce Medicare spending by about $20 billion and enact modest reforms to the Medicare Program. These reforms would have strengthened the long-term solvency of these programs which we are talking about now and helped reduce the Federal deficit. In response, Senator Reid called that bill an ``immoral document,'' and the junior Senator from California said she strongly opposed the cuts in the bill because they would ``cut Medicare and Medicaid by $27 billion.''

There are thousands of media quotes. The media quotes the majority more often, and here in DC the volume of quotes is equated with being right. Yet today these same Members and the rest of my Democratic colleagues want to create a new entitlement program that will spend hundreds of billions of dollars, and they would pay for it by cutting $464 billion from the Medicare Program. That is enough money to run the State of Wyoming for 320 years.

We don't understand how much money we are talking about here. You can't take that kind of money from a program, give it to other programs, and expect the program to work. We recognize that. That is why we put this Medicare Commission in there that annually is supposed to suggest extra cuts.

Let's see. We made a deal with the hospitals that we weren't going to cut them. We made a deal with the pharmaceuticals that we wouldn't cut them any more. We made a deal with doctors that we wouldn't cut them any more, although we never followed through on the doctor stuff because their deal--and these were all hidden deals--was supposed to be that they would either get a 1-year fix on the doc fix and medical malpractice or they would get a 10-year fix on the doc fix. That isn't in either of

the bills. I don't know if they are going to stick with the hidden deal they made. I don't know what other hidden deals there were in this.

I believe these facts highlight why we need to adopt the Gregg amendment.

We should be very careful creating a new entitlement program which will permanently obligate our children and grandchildren to pay its costs. In fact, with the way we have maxed out our credit cards, we are now talking about the seniors actually having to pay for these other new entitlements. So grandpa and grandma will be paying for that, too, not just our grandkids and children. If my colleagues insist on doing it, however, at a minimum we need to guarantee that any new program has a stable

and reliable source of funding. The Medicare cuts in this bill are neither stable nor reliable.

My Democratic colleagues have spoken at length about how the Medicare provisions in this bill will bend the growth of health care spending. That, unfortunately, is far from accurate. If you don't believe me, listen to what the other nationally recognized experts have to say.

According to the New York Times, the CEO of the world-renowned Mayo Clinic, which we use around here all the time, dismissed the reforms in the bill. Dennis Cortese said the Reid bill only took baby steps toward revamping the current fee-for-service system. The dean of the Harvard Medical School, Jeffrey Flier, said the bills being considered in Congress would accelerate national health care spending.

I wish there were more actual reforms in this bill. I applaud some of the efforts Senator Baucus included that will create incentives for coordinated care and rewarding providers who provide higher quality.

I believe those are exactly the types of things we should do to improve the Medicare Program. Unfortunately, the savings from these actual reforms are a few pennies compared to the dollars of the arbitrary payment cuts included in the bill.

According to the Congressional Budget Office, all of the savings from the various policies to link Medicare payments to quality and encourage better coordination of care in the Reid bill provide less than $20 billion in total savings.

In contrast, the Reid bill includes over $220 billion in arbitrary payment cuts to health care providers, including hospitals, nursing homes, home health agencies, and hospice providers. We have made a point of how much those are and what the effect is going to be, and it is going to take away service that people have come to expect.

The Reid bill also includes an additional $120 billion in cuts to Medicare Advantage plans. Medicare Advantage is--we talked about wanting to provide catastrophic care for everybody. That [Page: S12577]

was one of the goals. Well, Medicare people do not have catastrophic care. They can buy catastrophic care through Medicare Advantage. But we are talking about making some substantial cuts to that which are either going to decrease benefits or, in some cases, make the

whole service go away.

Those are not reforms. Instead, they represent the best efforts of folks in Washington to guess how much it actually costs real doctors and nurses to provide health care services to Medicare beneficiaries. We are not experts in the health care field, but we are going to guess at how much extra revenue they are getting. I want to emphasize that word ``revenue'' because, again, as an accountant, there is a difference between profit and revenue. We are going to cut substantially into the revenues,

which is going to eliminate profits, which is the point at which people say: Why am I doing this?

So doctors and nurses are going to--people who are looking at being doctors and nurses are going to say: Why would I want to do that? Well, there is going to be a huge demand because the baby boomers are coming up, and they are going to need services.

So cuts like the ones to doctors and nurses and home health, and all of those, are an excellent example of how government price controls do not work.

Medicare does not negotiate payment rates with providers like private insurers do. Medicare uses price controls to set payment rates.

When I first went into the shoe business, President Nixon suggested we should have price controls; that the cost of goods was going out of sight. At that time, one could buy a pair of men's dress shoes for $10. They put in price controls--like this--but they could not put the price controls in immediately because it takes a while to pass a bill. So what did everybody who was manufacturing shoes do? They raised their prices, which forced us at the retail end to have to raise our prices too. By

the time that went into effect, that $10 pair of shoes was $20. So price controls do not work. I have experienced it. It was dramatic, and it was terrible for the customer. We are talking about customers again.

Medicare uses price controls to set payment rates. Experts in Washington then look at various reported costs, revenues, and profits of health care providers, and then decide how much we should pay health care providers.

I have often said everyone thinks they know everything about a business until they actually have to run it. Unfortunately, we have been taking over a lot of businesses, and our expertise is showing. I am kind of fascinated by the Cash for Clunkers. That was a little business we decided we would set up on behalf of the government, and we said it would last for 4 months. It went broke in 4 days.

So as to any of the numbers anybody around here is considering, you ought to take a look at it because as a former small business owner, I want to assure them, it is actually a lot harder to run a business than it looks. For the simplest business you can think of out there, if you scratch the surface just a little bit you will find out those people are making dramatic decisions on a daily basis just to keep in business, which means, hopefully, paying themselves, but definitely paying their employees

because that is not an option. If it was as easy as we think around here to do a business, everybody would be going into business.

The Medicare cuts in this bill are based on the efforts of folks in Washington to decide how much it costs to run a nursing home in Cheyenne or a home health agency in Gillette or any of these businesses in much smaller communities than that. Based on the past track record of Washington, I do not have much confidence in their abilities, and I do not think America does. I think that is showing up in the polls. I think that is showing up in the town meetings.

In 1997, Congress passed the Balanced Budget Act. It contained Medicare payment cuts. Lots of smart folks in Washington made arguments similar to those we are hearing today about how those cuts would not harm the providers or beneficiaries. That was historic.

Well, let me show you the historic arrogance of that time. What happened after these cuts went into effect? Within 2 years, these cuts had driven four of the largest nursing home chains in the Nation into bankruptcy. Vencor, Sun Healthcare, Integrated Health Services, and Mariner Post-Acute Network all filed for bankruptcy. Between them, they operated 1,400 nursing homes that provided care for hundreds of thousands of Medicare beneficiaries.

Similarly, the bill also included cuts in payments to Medicare+Choice plans. After these cuts went into effect, one out of every four plans pulled out of the Medicare program. Millions of beneficiaries lost the extra benefits these plans had provided.

Given this track record, I have grave concerns about what the Medicare cuts in the Reid bill would do to Medicare beneficiaries and the doctors, hospitals, and other providers who treat them. I have even greater concerns about using any estimated savings from these cuts to fund this new entitlement program for the uninsured.

That is why we should pass the Gregg amendment. Rather than relying on cuts that could devastate the Medicare Program, let's find a stable and reliable funding source that we could use to pay for health care reform. The Gregg amendment says that savings from any Medicare cuts should be reserved for the Medicare Program. That way, if the Washington experts again got it wrong, we will not have already spent all the savings on another program.

12:35 PM EST

Judd Gregg, R-NH

Mr. GREGG. I heard the Senator from Montana and the Senator from North Dakota say the amendment I have pending would make it impossible for them, under this bill, to create their entitlement programs because the Medicare money that will be taken from Medicare would not be available. My amendment says they cannot do that. It says Medicare cannot be used to create new entitlements, but it doesn't say those entitlement programs cannot be created if they want to pay for them some other way. So really

what they are saying is they don't have the idea, the courage, or the will to pay for them in a way other than by stealing from Medicare. Isn't that what they are saying?

12:36 PM EST

Mike Enzi, R-WY

Mr. ENZI. The Senator from New Hampshire is absolutely correct. I am glad he came here to make that point on the amendment we are going to vote on this afternoon. It is critical. If you want to save Medicare, this amendment will save Medicare. It doesn't prohibit their programs from happening. They can still do the entitlements, but they have to be sure they are paid for. That is one of the problems. To say they are going to take the $464 billion from Medicare and put it into these other entitlements,

that is not fair.

12:47 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Madam President, before we continue, I ask unanimous consent that the time be extended for debate only until 2 p.m., with the limitations of the previous order remaining in effect.

12:47 PM EST

Mike Enzi, R-WY

Mr. ENZI. Madam President, I usually don't say much at these debates, but today I am going to make that an exception. I allocate the rest of our time to me. There have been a lot of comments here and they need to be clarified.

I do want to pass a bill that decreases health insurance premiums. I have traveled thousands of miles across the State of Wyoming, and every time I talk with somebody about health care, they ask me to do something to lower their health care costs--to lower their health care costs. That is what most people in America want.

American families cannot afford to pay ever increasing health insurance premiums. Small businesses cannot afford premiums that increase twice as fast as inflation.

Earlier this week, CBO issued--actually, it was last week--its long awaited report on the impact the Reid bill would have on insurance premiums. CBO said the premiums for individuals and families purchasing their health insurance will increase by 10 to 13 percent.

That means if the Reid bill is enacted, these folks will pay 10 to 13 percent more--more--for their health insurance. The legislation that its sponsors say is intended to lower health care costs will actually increase insurance premiums.

We should not be surprised by this finding. Several well-known actuarial business consulting firms have already issued reports that said the exact same thing: The bill increases health insurance premiums.

What is surprising is that some of my Democratic colleagues have argued that this CBO report provides support for enacting health reform. The New York Times even described this as ``Good News on Premiums.''

These statements defy logic and common sense. The bill attempts to completely restructure the nonemployer insurance market and impose massive new government mandates. Is anybody surprised that as a result the costs will go up?

Yet some of my Democratic colleagues have attempted to cherry-pick data and use selective quotes to try to mask what CBO said. For instance, some of them have pointed out how CBO said the Reid bill would lower premiums by 7 to 10 percent because of changes in the rules governing the insurance market.

As the Senate's only accountant, I take offense to these kinds of misrepresentations. Giving my Democratic colleagues the benefit of the doubt, I will assume they do not understand the differences between gross and net numbers.

I am not going to try to do a lot of numbers here. I did that once in committee and my staff watching back at the office--I got to ask the accountants at the SEC important questions at the time Enron was failing. You could see this little wedge of people seated behind the people testifying, and they were all asleep. I want to use this chart instead.

CBO did say the premiums would go down 7 to 10 percent due to insurance market changes. They also said premiums would go down another 7 to 10 percent because healthier people would sign up for insurance. What my colleagues forgot to mention or do not want to mention is that CBO also said that premiums would go up by 27 to 30 percent because the bill has so many mandates and requires most Americans to purchase more expensive coverage.

Yes, the Federal Government is going to tell you what you need for insurance, and then they are going to fine you if you do not get it. Maybe this chart helps to explain it.

We can see the net impact. Here is the 27 percent in increases because of [Page: S12582]

the mandates and the requirement to purchase more expensive coverage. This is the decrease that I mentioned. But you cannot just talk about this decrease and you cannot just talk about this decrease. You can talk about the net, and the net is a 13-percent increase in premiums.

I urge anyone who questions what I am saying to read the CBO letter. It is on the CBO Web site. Page 4 of the letter clearly states premiums will increase by 10 to 13 percent. That amounts to $2,100 for families purchasing coverage on their own. That does not meet the requirement that people in Wyoming think they are going to get. And the younger they are, the more surprised they are going to be because we get rid of the ratings, and young people will be paying considerably more. They are already

paying into Medicare for seniors without getting any promise that will last until the time they become seniors, unless we pass something like the Judd Gregg amendment.

We have to protect that Medicare money to make sure it goes to Medicare and only Medicare if we are going to make sure Medicare stays solvent. We have to make that as a promise to the kids paying into the system now. They and their employers, and the amount the employers pay in, is the amount they could have in their own pocket if the employer did not have to pay it. But they are paying that so seniors can have the Medicare benefits, and we want them to have those benefits. We should not at this

point take money from Medicare and build new entitlements and expect those same young people to pay an increased amount on while they pay an increase in their insurance premiums. Their insurance increase is going to be a lot more than 27 percent. In Wyoming, it was estimated to be around 300 percent. I think they will notice. I think they will be upset. If this bill passes, there will be a revolution in this country when people realize what has been thrust on them in this bill.

I yield the floor and keep the remainder of my time.

12:53 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Madam President, I think everybody who is interested in the subject ought to read the CBO letter. Different people make different claims about the CBO letter, but I think it is only fair to read the entire letter, refer to the entire letter, not bits and pieces and parts of the CBO letter.

For example, it has been stated that CBO claims the average premiums--we are talking about the nongroup market. That is the individual market now. In fact, that is page 6 of their letter which said average premiums would be 27 percent to 30 percent higher because of greater coverage. That is the statement we just heard.

The CBO letter does say that. But I think it is also important to say that those people would be getting much higher quality insurance because of all the insurance market reforms we provide for in this legislation.

Even more important, CBO goes on to say on that same page in that same letter:

The majority of these enrollees, about 57 percent, would receive subsidies via the new insurance exchanges, and those subsidies on average would cover two-thirds of the total premium.

It is true that some in the so-called nongroup market in the year 2016 would find their premiums go up without subsidies. I think that figure nets out to about 7 percent. But they are getting better insurance, much better insurance than they currently have because the insurance they buy in the exchange--we are talking about 2016--

will be much better insurance than they now have.

According to everybody else, a fair reading of the CBO letter leads one to conclude that premiums will basically go down by a little bit--not a lot, a little bit--or be about the same. For example, I have heard on this floor the assertion, but no reference, no authority for this assertion--I heard this morning the assertion that for employees who work for larger companies, their premiums would go up. The fact is the CBO letter said just the opposite.

One can make the assertion premiums go up, but I think it is unfair to the American people to make rhetorical claims that are not backed up with authority. The CBO letter is probably the best authority we have for us to work with, and that letter says flatly that premiums for those persons--that is about five-sixths of Americans--would go down, not up, as has been asserted without the authority on the floor.

I am making the opposite assertion they will go down by about 3 percent. Not a lot but 3 percent. But my authority is the Congressional Budget Office. That is what they say.

Basically, 93 percent of premiums will either go down or be about the same. I mentioned a 3-percent reduction for the employees. Five-sixths of persons work for big companies and in the so-called small group market, CBO says--this is all the year 2016--premiums will be up 1 percent or down by 2 percentage points. It depends on who gets the credit. Some will, some will not.

Let's not forget small business gets credit under this legislation, too. I am not sure whether CBO calculated that in. A fair reading is the small group market, that is about 13 percent of Americans, it is, say, a net minus 1 because some go up 1 percent and some down by 2 percent.

Basically, if we compare apples to apples, that is what insurance will be in 2016--premiums will go down for those in the nongroup market, down by 14 or 20 percent. Because those with better benefits will find their premiums might go up by 10 to 13 percent and add in the tax credits which one has to do because that is the legislation, on a net basis, for two-thirds of those folks, their premiums will be lower by a large amount. By ``large,'' I mean by about 56 to 59 percent.

Who knows what is going to happen in 2016. CBO is giving their best shot based on this legislation. That is what their letter says. I have the letter right in front of me.

I might also say that CBO says--I don't know if it is in this letter or another letter--the bill is deficit neutral, and basically over 10 years--I think a 20-year period--the net effect is not much more government or less government, it is about the same as today. There are wild assertions: Oh, it is bigger government. CBO said government's involvement in people's lives will be basically no more or less than today, and that is partly because of a lot more choice people will have. They will have

a lot more choice in the exchanges, a lot of choice under the exchanges. It is that choice which will encourage greater competition, and greater competition will encourage lower prices. At least that is the theory. Most of us tend to think competition lowers prices, and that is what the legislation does.

Unless the Senator from Wyoming wishes to speak, Senator Kerry, on our side, wishes to speak for at least 15 minutes.

1:16 PM EST

John F. Kerry, D-MA

Mr. KERRY. I thank the distinguished leader and the Chair.

So the opponents of health care reform are simply not telling you that the program is about to be insolvent because private insurance companies and some of the providers are, in fact, using the money basically to get rich off the Medicare dollar.

We ought to be clear about the impact of these policies. Even with the Medicare changes we have made--I hope Medicare beneficiaries hear this--even with the Medicare changes in the bill, overall provider payments are still going to go up. They are not cut. They are going up. We are simply slowing the rate of growth, and that is something everybody on the other side has said they want to do.

Wall Street analysts also have suggested that many providers, including hospitals, are going to be ``net winners.'' That is a quote, ``net winners.'' Under our bill, they estimate hospital profitability will increase with reform because more and more hospital patients will have private insurance that they do not have today and the hospitals today are out of pocket because they take care of these people but they do not have the insurance. Just as in Massachusetts, where the premiums went down

and where the expenses for free care went down, that is precisely what the impact will be here.

We have a choice. We can do nothing, which is basically what our colleagues have proposed. The status quo means Medicare is going to be broke in approximately 7 years. It means seniors are going to pay higher and higher premiums and cost sharing due to wasteful overpayments to providers. It means that each year billions of Medicare dollars are going to continue to be wasted, lining the pockets of the private insurance companies that kick people off indiscriminately or tell them they don't have

the coverage when they finally get sick and need the coverage. The status quo means seniors are going to continue to pay for their prescription drugs.

The fact is, this is the time for responsible action. This bill strengthens the Medicare Program, it reduces premium costs for seniors, it restores Medicare's financial integrity, and it fortifies Medicare and protects Medicare benefits for America's seniors.

Let me point to another thing they keep saying. They keep saying this bill cuts billions of dollars from the Medicare Advantage Program, hurting the 11 million seniors who are enrolled in those programs today. I know that is exactly what they have said--this bill cuts Medicare Advantage and hurts those millions of seniors. Wrong, not true, scare tactic, same old procedure, trying to distort and provide fear. Nothing could be further from the truth. This bill cuts down on overpayments, not benefits.

What taxpayer in America should knowingly be paying an additional amount for a service, more than the service is worth and more than we pay in the regular program?

1:19 PM EST

John F. Kerry, D-MA

Mr. KERRY. I want to finish the thought. If we can yield on your time at the end, I will be happy to do that, but I want to make the points.

It is the overpayments to insurers that actually threaten Medicare's future. That is what increases the costs for seniors.

In 2009, MedPAC, the independent commission that advises us on issues affecting Medicare, estimates that Medicare is going to pay approximately $12 billion more for beneficiaries enrolled in private Medicare Advantage plans than if they were in the traditional Medicare. These are overpayments, according to MedPAC and according to folks in the medical profession. They exist because private insurers, under Medicare Advantage, are overpaid by about 14 percent, on average.

I might add, coincidentally, in 2008, when the Senator from Arizona was the nominee for President, one of his top aides, Mr. Douglas Holtz-Eakin, said--I think it was in an article in USA TODAY--that Medicare Advantage plans should ``compete on a level playing field'' with traditional Medicare. The changes in this bill will help to reduce these overpayments, and they bring us closer to that level playing field that was suggested last year.

My friends on the other side of the aisle also say that reducing the government subsidies to private medical plans is going to increase the costs for seniors. Again, this statement is fiction. The overpayments private insurance companies receive under the current law to deliver Medicare benefits have increased the costs for seniors today. They, in fact, result in a $90 increase in premiums to every married couple enrolled in Medicare.

As we go forward, I hope it is the truth and facts that will prevail here, not the fiction we keep hearing to scare seniors.

Americans ought to take note that the Minority do not come to the floor of the Senate and show us how we could fix Medicare's problems more effectively. The minority does not support changes that serve seniors better. Instead, they just embrace the status quo. Everyone in America knows the status quo is unacceptable. We cannot afford it. Medicare will go bankrupt within the next 10 years. I ask my colleagues, then where are we going to be?

This is the time for responsible action, and every step we have offered offers that kind of responsible action without reducing care. Opponents of health reform won't rest. They are using myths and misinformation to distort the truth and wrongly suggest that Medicare will be harmed. After a lifetime of hard work, don't seniors deserve better?

The Patient Protection and Affordable Care Act clearly strengthens the Medicare program. The bill reduces premium costs for seniors, improves [Page: S12585]

Medicare's financial integrity and delivers immediate benefits for seniors like lower prescription drug costs and free preventive services. In short, health care reform will fortify Medicare and protect Medicare benefits for America's seniors.I would like to take the next few minutes to separate the facts from

the fiction.

My friends on the other side of the aisle say that health reform will cut Medicare benefits for seniors. And once again, this statement is false. Health reform will increase the number of Medicare benefits that seniors are entitled to under law. Nothing in this bill will take away or reduce guaranteed Medicare benefits. In fact, the legislation increases coverage of preventive services at no additional costs to seniors. That means, when seniors visit a doctor for a colonoscopy, mammography, or

other preventive screen, they won't pay the co-pay required under current law. Encouraging more preventive care is one of the best ways we can save lives and lower health care costs. That's why, under this bill, seniors will receive even better preventive benefits than they receive today.

My friends on the other side of the aisle say that under health reform, government bureaucrats will dictate personal health care decisions. This statement is completely false. Health care decisions about providers and treatments are some of the most personal decisions many people make. Under current law, doctors and patients decide which treatments Medicare patients need. The same is true under this bill. Health reform will keep these decisions between health care providers and patients. And

with improved payment policies, this bill also ensures Medicare providers get the resources they need to continue providing quality care to their patients.

My colleagues on the other side of the aisle say that reducing fraud, waste and abuse in Medicare will not save a significant amount of money. To the contrary, waste, fraud and abuse cost the health care system billions of dollars every year. Improving Medicare's financial integrity is one of the first steps we can take to save the program. According to independent analysis from the Congressional Budget Office, under this bill, enhanced oversight, like requiring background checks and screening

for providers, will save Medicare dollars. Targeting waste, fraud and abuse in Medicare will protect American taxpayers and help extend the life of the program.

My friends on the other side of the aisle claim that health care reform will not lower costs for seniors but drive costs higher. The truth is that seniors will see immediate savings in prescription drug costs under health care reform. This legislation will save seniors money in the Medicare prescription drug coverage program by providing more coverage and lowering the costs of brand-name prescription drugs. In 2010, seniors will receive an additional $500 of coverage before they have to begin

paying out of their own pocket in the coverage gap or ``doughnut hole'' in the Medicare Prescription Drug Benefit. Also beginning in 2010, the price of brand-name drugs and biologics will be cut in half for the seniors who have to pay for prescriptions out of their own pocket when they hit the ``doughnut hole'' between initial and catastrophic coverage.

Those on the other side of the aisle say that we are not doing enough to protect home health care. The fact is that this bill includes provisions I introduced to make home and community-based services more widely available in Medicaid. Despite advancements in home and community-based services, seniors have few affordable and accessible options in choosing a health care setting today. Seniors deserve more options, rather than just nursing homes. For seniors eligible for both Medicare and Medicaid

and who prefer home or community-based services, this bill provides valuable support.

We have heard repeatedly from my friends on the other side of the aisle that leading advocacy groups do not support the Senate health care bill. Nothing could be further from the truth. The country's leading advocacy groups for seniors rights are helping stop the scare tactics and clear up the facts. Voices like AARP and the American Medical Association support the responsible Medicare reform in this bill.

On November 18th, AARP said:

The new Senate bill makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits, and--most notably for AARP--members reducing drug costs for seniors who fall into the dreaded Medicare doughnut hole, a costly gap in prescription drug coverage.

On November 20th, the American Medical Association said:

[We are] working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform.

On November 16th, the Federation of American Hospitals said

Hospitals always will stand by senior citizens.

And on November 16th, the Catholic Health Association of the United States said:

The possibility that hospitals might pull out of Medicare [is] very, very unfounded. Catholic hospitals would never give up on Medicare patients.

The minority today is arguing the exact opposite of what they have said previously. In the late 1990s, Republicans and Democrats joined together to fight for America's seniors, advocating Congress take the advice of experts who said the solvency of Medicare was in trouble. Today, some are using scare tactics, falsely claiming that the Patient Protection and Affordable Care Act will impose ``cuts to Medicare'' that hurt seniors. In truth, this bill protects the guaranteed Medicare benefits our

seniors deserve. I urge my colleagues to stop spreading the misinformation and false claims about this bill that are intended only to scare seniors. Instead, I urge you to work with us on this legislation which delivers health care to an additional 31 million Americans and strengthens and preserves Medicare for the 45 million beneficiaries who rely on the program.

1:22 PM EST

Tom Coburn, R-OK

Mr. COBURN. Mr. President, the question I was going to ask the distinguished Senator from Massachusetts is, how many Medicare Advantage patients has he ever cared for? How many Medicare Advantage--how many Medicare patients has he ever cared for? How many times has he been in the trough, experiencing the heavy hand of government as we try to care for people on Medicare? The answer to that question is zero because he is not a physician. He relies on the American Medical Association--the American

Medical Association that today represents less than 10 percent of the active practicing doctors in this country. He relies on AARP, which has 40 million in membership but is the fifth largest revenue receiver from supplemental policies. That is whom he relies on. The fact is, he does not have the experience of being in the trough, caring for patients.

Let me tell you what is going to happen to Medicare Advantage patients.

1:27 PM EST

John F. Kerry, D-MA

Mr. KERRY. I reserve the right to object. I want to find out if we can have a moment to have a discussion, I ask my colleague.

1:27 PM EST

Tom Coburn, R-OK

Mr. COBURN. In this bill, what we are debating are three terrible things for care but great things for cost: the U.S. Preventive Task Force on Prevention Services, the Medicare Advisory Commission, and the references to the Cost Comparative Effectiveness Panel.

When the U.S. Preventive Services Task Force came out with their recommendation, as far as costs--I am talking about breast cancer screening for 40- to 49-year-olds--as far as costs, they were absolutely right, as far as cost-effectiveness. But as far as clinical effectiveness, they were absolutely wrong. What did we do? We accepted a Vitter amendment to hold off, so that recommendation, that mandate from that panel will not apply to women in this country under these programs--except the women

in California on Medi-Cal because, you see, this week California embraced the U.S. Preventive Services Task Force. So if you are a Medicaid patient--which we are going to put 15 million more people into--you cannot have a mammogram in California if you are under 50. You cannot have it because, from a cost standpoint, they are right. From a clinical standpoint, they are wrong.

What we have done is, every time one of these three organizations creates a ruling, that the American people rise up and say: That is wrong, we are going to come in here and correct it? But throughout this bill, strung throughout are multiple references to what these three panels are going to ration--I did not miss that word--ration the care to American people in this country.

If you are a senior, you have two real reasons to be worried. One is, we are cutting Medicare. And if we are not, then vote for the Gregg amendment and you will make sure we don't. It is an insurance policy. But more important, within that, we are going to see the care to seniors rationed based not on what is in their own best interests or their health's best interests but what is in the cost's best interests. There is no question about it. We are going to do that.

It would be different if we created a comparative effectiveness panel, a clinical comparative panel. But they are already out there. We knew that.

When I study to take my recertification exams, I have to know what the clinical comparative effectiveness guidelines are or I will not pass as a practicing physician. But we didn't do that. We said: Cost is most important. So how are we going to cut? We are going to say where something is cost-effective though not clinically effective, we are going to cut that care.

So if you are a senior, especially if you are on Medicare Advantage, you don't have to just worry about the fact that we are going to decrease the revenue stream that will supply those benefits that cause you not to have to buy a supplemental policy, and we are going to decrease some of the things that are available to you as a Medicare Advantage patient, but you also have to worry about the next ruling that is going to come from the U.S. Preventative Health Services Task Force. You have to worry

about what is going to come from the Medicare Payment Advisory Commission because it is going to be looking at costs too.

Then you have to worry about what is going to come from the cost comparative effectiveness panel. I could spend up to 8 hours talking about tragedies from England and Canada on care denied based on things Americans have today that that very panel is going to deny to Americans in the future because they are not cost-effective. That is one of the reasons our result in terms of cancer treatments is one-third better than anywhere else in the world. It is because we don't have mother nanny bureaucracy

saying what you can and cannot have.

It would be totally different if we created incentives for lowering the cost, but we don't. We create mandates. We drive down the cost of health care in specific areas through these three separate panels.

There is one thing that is even worse than the two things I just talked about for Medicare patients. Here is what it is. When you have these three panels, you have just taken away the loyalty of your physician to you. You have just decided, with these three panels, that the physicians have to keep their eyes on the government. They have to do what the government says is in your best health interest rather than what that provider knows is in your best interest. Remember, the Medicare Payment Advisory

Commission, the cost comparative effectiveness panel, and the Preventative Services Task Force doesn't know your family history, doesn't know your clinical history, has never done an exam on you, do not know the idiosyncrasies of your health care. But we are going to apply that all to you; we are going to depersonalize health care.

I readily admit, for 80 percent of the people, it is going to be just fine. They will not see any untoward result. But I will predict, as a practicing physician for over 25 years, for that remaining 20 percent it is going to be a disaster as far as their personal health is concerned. It will destroy the patient-doctor relationship. It will give us worse outcomes, and it will not save us any money because the consequences of those decisions will create a complication which will require more dollars


When we think the government can practice medicine--and that is what this bill does; this bill sets up the government to practice medicine--we might as well hang it up and just be ready because 20 percent are going to get substandard care compared to what a Medicare patient receives today. We are going to get sicker. The life expectancy of people under this health care bill will decline. The quality of care will decline. The innovation of new advancements in health care will decline because we

have chosen the government to decide what everybody will get. It is a disaster as far as the individual patient is concerned. [Page: S12588]

That is not the motivation of my colleagues on the other side. I know that. I am not accusing them of that. But what they don't see, sitting in Washington, is what I see in a clinic office practice in medicine. Medicine is intensely personal. It ought to be about your choice, about what is best for you and your family and your children, not what the government says makes the best economic sense to the budget picture in Washington any particular year. When we lose that quality in American medicine,

we are going to lose the best of what we have in the name of fixing what is wrong.

I agree with my colleagues the insurance industry has a lot of stink to it. But there are a lot of ways to fix it other than the way we have done. I agree with my colleagues that my profession is not pure at every turn of the corner. I agree with my colleagues we can do better. But when we write a bill that is absent any absolute clinical judgment left to the practice of medicine by those who know the patients best, who have 100 percent of that patient's best interests at heart, we are going

to hurt the quality of care. We are going to hurt it significantly. Your motivations are good. The answers are wrong on a clinical basis.

Now to the Gregg amendment. The Gregg amendment does what you all say you want to do. I remind my colleagues the Medicare trustees are highly suspicious of the Medicare cuts in this bill. What they say is, they highly doubt it will ever happen because it has never happened before because there is not the political will to decrease the dollars in Medicare. More importantly, the dollars are going to come out of care instead of out of fraud. There is only $2 billion, say, out of at least $100 billion

a year, in fraud. Only 2 percent of it per year is coming out. That is the problem. We could have had a Medicare bill and we could have cut $60 or $70 billion of fraud together out of this bill. We can come together on that. We could have cut $720 billion out of Medicare just based on fraud alone without ever touching Medicare Advantage, without ever giving sweetheart deals to the people in Florida because their Senator wanted it, without ever touching FMAP adjustments in other States.

We could have done that, but we chose not to. We chose what we know up here rather than what we know in the hinterland, those of us who are practicing medicine. What do we know? We know there are some rip-offs in home health care. We know there are significant rip-offs in durable medical equipment. We know there are some rip-offs in hospice. We know there are drug company rip-offs. We could agree to some of those. We actually even know in large hospitals that there are some problems there as

well. But there are very few problems in our rural hospitals because they are struggling just to keep the doors open. We could have done that, but we chose not to. So we have this divide, and we are going to fix it one way. The biggest pot of honey in Medicare is fraud. Everybody knows that. But we are not going to fix it.

If, in fact, what my colleagues claim is true, that these are Medicare cuts that nobody will ever feel any consequence from, in spite of my own years of practice and knowing the difference, that that isn't true, but let's give you that, why would we not put it all back in Medicare so we don't steal from our children and our grandchildren? Why would we not do that? We have chosen not to do that. We have chosen to mix it. And it is honorable to try to create a system to get more people insured.

Yet we will still have 24 million people not insured. Out of this bill, we will still have 24 million people not insured, when it is all said and done, if everything goes as planned.

Yesterday I introduced into the Record the analysis by the State insurance commission in the State of Oklahoma. Kim Holland is of your party, the majority party. But she sees what is getting ready to happen with this bill. What does she say? What she says is, insurance premiums are going to significantly rise in Oklahoma. More people will be uninsured than there are today. The State Medicaid fund is going to be tremendously stressed with at least $67 million a year having to go into

that, again, based on the mandates in this bill that we don't have money to do; that, in fact, it is not the way to solve what Oklahoma is facing in terms of health care.

I didn't call her and say: Give me something bad to say about this bill. She volunteered this information out of her legitimate concern for the consequences, of what is going to happen with this bill. Why would she do that? Because she knows one heck-of-a-lot more about insurance than I do and anybody else in this body. She knows it in our State. And the other insurance commissioners around here, some through their association, have endorsed this bill. Most, when they look at their State, especially

the poorer States, especially West Virginia, it is going to hurt.

How are we going to cover that? We are going to shift 15 million people to Medicaid. What do we know about Medicaid? I have delivered thousands of babies and over half of them have been Medicaid. I have cared for thousands of Medicaid children, thousands of Medicaid adults and thousands of Medicaid patients. What do we know? Medicaid is a substandard program. Compared to everybody else, it is substandard, except when compared to the Indian Health Service, and that is a disaster. So our answer

is to put a mandate on the States that they cannot afford and shove another 15 million people into a system that has poorer outcomes, higher complication rates, higher infant mortality rates, later presentation, and a system that has 11 million people eligible for it today who are not signed up.

We have the system out there, but they are not signed up. So they are not getting any preventative care. They are not interacting with a primary care physician.

And that is our answer? Move 15 million more Americans into Medicaid. By the way, keep a discriminatory stamp on their forehead, rather than give them an insurance program; put a stamp on their forehead that says 40 percent of the doctors can't see you, 65 percent of the specialists will not see you because your reimbursement rate is so low they can't afford to have you walk into their office and cover the cost of seeing you. That is what we are going to do.

That is not reform to health care. That is banishing people to a substandard system as compared to what the rest of the system is and then feeling good about it. That is not reform. That is discrimination because here is what really happens to a Medicaid mom and her children.

If she has a sick kid, she can't get in. She has this 6-year-old with a fever, not eating, dehydrated, and she can't get in to see a primary care physician, which could keep that child out of the hospital. So what happens? She keeps trying to get in. What does she do? She accesses the emergency room, the most expensive place. She accesses it late--not early, late.

So we have a sicker child, with higher costs, because we have a system that will not reimburse its costs. And you all have actually talked about the cost shift on that, from Medicare and Medicaid, to the private sector. We would be much better off paying the same rates in Medicaid so we do not get that cost shift, so we do not discriminate against people on Medicaid for access to care. But we have chosen not to do that because it fits with the numbers. It fits with the Washington, government-centered

management of health care.

I will tell you as a physician, we would be better off--single-payer rationing and all--than what you are doing to so many of these patients in this bill. We would be better off with the government just running it all, rationing it, and saying: Tough, you get to 75 years of age, you can't get your hip fixed; you get cancer, we are not going to give you the latest drugs. We would be better off because now we are going to get the worst of both worlds. We are going to get the rationing through these

three panels I talked about. They are going to tell doctors what they can and cannot do. They are going to practice medicine--the very people who have never touched, never had an encounter, never visited with that patient and do not know anything about them--they are going to make a decision.

Mr. President, I would inquire, I think I have 5 minutes.

1:47 PM EST

Tom Coburn, R-OK

Mr. COBURN. Every person in this country should be able to have access. I agree. Nobody should lose their home. Nobody should have to file for bankruptcy because of health care. I agree. That premise we agree on. How we get there is in two totally different ways.

The No. 1 impediment to access is cost. Costs are not going to go down. We know that by all the studies. The health care costs are not going to go down. They are not going to go down per individual and they are not going to go down in total. So we will not have fixed the big problem with health care, which is cost.

We will have worked on access through a government program, but we will not have fixed the real problems. What are the real problems? Fraud is at least 6 percent of the cost of health care. Tort extortion by the trial bar is at least 6 percent of the cost of health care when you count defensive medicine. There is 12 percent where you could lower it tomorrow--12 percent where you could lower the cost of health care tomorrow if, in fact, we would fix the real problems.

No. 3, transparency with insurance companies and transparency with doctors so you know what the cost is, you know what the outcomes are, you know what their track record is, so you can truly make a decision about your care. There is no incentive for that, the incentivization for prevention and management of chronic disease.

I have said this on the floor before, but it bears repeating: The reason we have a primary care doctor shortage in this country today is because of Medicare. The Centers for Medicare & Medicaid Services sets the rates of reimbursement for primary care encounters in Medicare, and everybody else follows it. So you have a disruption, a differential of 300 percent from a family practice doctor and an obstetrician like me to a super-subspecialist. And what do you think the doctors in medical schools

are doing? Last year, only 1 in 50 went into primary care. Only 1 in 50 went into primary care.

So let's say we get everybody covered. Who are they going to see? Oh, I know what the answer is. We are going to use physician extenders. So not only are we going to say you are covered, now we are not going to give you an experienced, gray-haired, reasoned, long-term educated physician with 25 or 30 years of experience; we are going to hand you off to somebody who is a nurse or a PA who is good at limited things but does not practice the art of medicine.

So I will wind up with this. I so want to fix health care. I am so sick of the way it is. But I am not near as sick of the way it is as the way it is getting ready to be under this bill. I know my patients are going to get hurt under this bill. My Medicaid patients are going to get hurt under this bill. My Medicare patients are going to get hurt under this bill. And those who are in between--whether it is with insurance with their employer or insurance they are buying on their own or they are

paying cash--are going to pay more for their health care because of this bill. That is what I believe is going to be the outcome of this bill. And all you have to do is go look at the history. Talk to Alice Rivlin, the first CBO Director, about the accuracy of CBO in estimating anything when it comes to health care. They have missed it every

way. They have only gotten one ``wrong,'' by saying it was going to cost more. For every other one, they said it was going to cost less than it did. So every patient--every patient--in some way or another is going to suffer under this bill. That is what we should be worried about. We should not worry about whether the President wins or we win.

1:52 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Mr. President, I would like to yield 3 minutes to the Senator from Massachusetts. I have spoken with Senator Sessions. He is very kindly and very graciously agreeing that Senator Shaheen from New Hampshire will be able to speak next after Senator Kerry. So Senator Kerry for 3 minutes, and then the remaining 5 1/2 minutes will be for Senator Shaheen.

I also unanimous consent that we be able to proceed until 3 o'clock under the usual form; that is, under the conditions of the last agreement.

1:52 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Mr. President, I yield 3 minutes to the Senator from Massachusetts. It is also my understanding that the Republican leader may come down at some point after Senator Shaheen speaks and use leader time. That is my understanding--or after Senator Kerry speaks. Whenever he comes, he comes. Thank you.

2:02 PM EST

Jeff Sessions, R-AL

Mr. SESSIONS. Mr. President, I appreciate the comments that have been made about preexisting illnesses, and I do think we can do something with this legislation to fix that. We just have to be careful. If you have two people both making the same salary, they have both worked for 20 years, one individual saved and paid his health care insurance for those 20 years and got sick and is covered by it, and another one chose not to, it is not insurance if a person then walks in and wants somebody else

to pay for it. But we can do that. I think we can work through those difficulties, and I would definitely support moving in that direction.

My colleagues earlier mentioned about Medicare Advantage, that this is a program some are critical of, and they think we can deliver health care better without the Medicare Advantage part of the Medicare Program. I would say Medicare Advantage can and probably should be reformed, but we shouldn't address the problems in Medicare Advantage by directly cutting its seniors' benefits.

With regard to the physicians, in my hometown of Mobile, the medical association ran a poll of their members and 94 percent of them opposed a government option which is in this bill, a part of this legislation. They opposed the bill in general in large numbers. A similar poll in Montgomery, AL, showed the same thing.

What I wish to talk about today is the Gregg amendment. The purpose of his amendment is to prevent Medicare from being raided for new entitlements and to use those Medicare savings, any that we can achieve, to save Medicare. I note for the record Senator Gregg, the former chairman of our Budget Committee and the ranking member on the Budget Committee today, is probably the most knowledgeable person in the Senate--not probably, I am pretty certain he is the most knowledgeable person in

the Senate on the financial instability of Medicare. He has worked hard over the years to try to identify some way to fix it. A number of years ago he proposed an amendment, an idea that would have saved, over 5 years, $10 billion through cost effectiveness and smart actions within Medicare, and that $10 billion would have enabled the Medicare Program to extend its life. Because all the actuaries tell us--and there is no dispute about this--that by 2017 Medicare will be in default.

Less money will be coming in than going out. So Senator Gregg saw that coming and he attempted to fix it. He was attacked by my colleagues on the other side for this $10 billion efficiency idea that would have strengthened Medicare, not spent it on something else, but he would spend it to strengthen Medicare. I do not think a single Member of the Democratic Party voted for it and several Republicans didn't. It was a tie vote. The Vice President had to break the vote.

The idea now that we are going to find $465 billion in Medicare savings without damaging the care and take that money not to strengthen Medicare and put it on a self-sustaining basis, as we should be trying to do, but to take it and create an entirely new entitlement program, is something I cannot support. Actually, I understand my colleagues in their speeches say they don't support it. They say they don't. They voted for the Bennet amendment which sort of seemed to say that. But we knew, those

of us who read it carefully, that the amendment of the Senator from Colorado wouldn't do anything. Even the New York Times which supports this bill said it was a meaningless amendment.

So let's talk about where we are. The Gregg amendment, unlike the Bennet amendment, means what it says. This is a serious vote. It simply says if you [Page: S12591]

take money from Medicare, it ought to be used to strengthen Medicare, not to create a new program with it. It is pretty clear about it. It has teeth. It means what it says. It is not a joke. It is not a flimflam. It is a serious amendment. So we will now be, I think, ascertaining how people in this body

actually believe with reference to Medicare and whether we ought to be taking money from it.

The amendment says if non-Medicare savings--which are very few, if you want to know the truth--if the non-Medicare savings in this proposal do not offset the new cost of this new bill, the Secretary of the Treasury and the Secretary of HHS are prohibited from implementing new spending or revenue reduction provisions in the bill. The reality is there are not going to be any--or very few say non-Medicare savings. That is where the savings are, frankly.

The amendment prevents Medicare cuts from being used to create new and expanded entitlement programs and to fuel massive government growth on the backs of Medicare beneficiaries. I recall for my colleagues that people who pay into Medicare have paid into it all their lives and they are now at a point in their life where they are drawing from it. The social contract we had with them was that they would pay into this program, and when they got to be 65, they would get the benefits from it. They

didn't get the benefits of it when they were 30. They didn't get the benefits when they were 40. They didn't get the benefits when they were 50, yet they were paying in all these years, and now when the time comes to benefit from it, we have a massive plan to raid that program that clearly is the most unstable, actuarially unsound program we have in our country. It is heading

into default. When it goes into default, it is not going to gradually go beyond the break-even line; it is going to drop below it dramatically. It accelerates. One study from the Heritage Foundation, I believe, said as much as $80 trillion over the lifetime of instability in this program. So I don't think anybody disputes the numbers and the problems that Medicare faces.

The bill says we are going to have a budget-neutral piece of legislation here, and don't worry, it is not going to add to the debt. In fact, we are told by the President that not one dime will be added to the debt. We have Members of this body who say the bill on the floor will create a $130 billion surplus over 10 years. Well, that would be good if it were true. How do you do that? Well, there are a number of things, but one of them is you have a $494 billion tax increase, and an $848 billion

fund achieved largely from Medicare. That is where the $465 billion comes from: Medicare. But the truth is that is not an accurate

number, because the tax increases start immediately and the benefits don't start until 2014, 5 years down the road, the fifth year. When you add that up and you take the first 10 years of the real implementation of the legislation that is on the floor, it is going to cost $2.5 trillion. That is a big amount of money.

Also, it does not fix the doctors payments that everybody assumed and thought and we were told would be part of health care reform. That is not done. Why is it not done? Because the bill wouldn't balance. You wouldn't be able to tell the American people that it brings in revenue when it doesn't. That is $250 billion to fix an essential payment to our doctors that we cannot cut. We need to put that on a sound financial basis. It should be a part of this reform. But since they couldn't--they figured

they had raised enough taxes and they couldn't claim to cut anymore from Medicare, they put it out here on the side somewhere and we will do as has been done in the past, unfortunately: Pay the doctors their payments by increasing the debt. Every penny of the money that goes to make up the shortfall in doctor payments increases the debt and it is going to continue and it should end.

The bill is not balanced in any fair analysis. It is a shell game. It moves the $250 billion shortfall for doctors out of the bill. They say we don't have a problem, our bill balances. But there is a $250 billion hole sitting over here; we just moved it across the room here. That is not good and sound policy.

The Gregg amendment prohibits the using of the $465 billion in Medicare cuts to pay for the new government spending in this legislation. It would keep the Medicare expansions--Medicaid expansions from going into effect without--by having or saving cuts in Medicare or Social Security. Unlike the Bennet amendment, which had no meaning whatsoever, it has some teeth to it. So we will know something significant about how people feel about Medicare and the financial responsibility when this vote comes


Senator Bennet has said:

With my amendment, the bill strengthens Medicare and preserves seniors' benefits.

Well, I think that is not an accurate statement. Once and for all, with this amendment, we will be able to show American seniors who have paid into their health care--Medicare--all their lives, that we mean it when we say we don't want to weaken their program.

One asks, how can you have such a disagreement, Senator Sessions? Look, you might ask me, they say the money is there; you say you are cutting Medicare; they say it is not cutting Medicare, $465 billion. Somebody ought to be able to get it straight here. How can you possibly have this kind of disagreement? I say to you the general fund budget for the State of Alabama--we are about one-fiftieth of the Nation's population, 4 million people, it is about $2 billion. So how can we lose $465

billion? Well, this is what they are saying. If you listen to much of the comments carefully, they are saying: We are not cutting guaranteed benefits to seniors. They are not saying they are cutting Medicare, if you listen to most of the people who are careful about what they say. They say, We are not cutting guaranteed benefits.

I see. What are we doing?

We are cutting home health care agencies; we are cutting hospice programs; we are cutting hospitals; we are cutting the disproportionate share hospitals for poor people; we are cutting program after program after program. So they are cutting the providers and telling everybody we are not cutting Medicare. But if we are going to cut providers, why haven't we already done it and put Medicare on a sound footing? You can't cut providers this much. You cannot do so. They will collapse. Doctors already

are refusing to take Medicare patients and they are worried about that.

I think in the future, if we go through with this legislation, we will see far more will quit seeing those patients.

Well, the Gregg amendment makes sure Medicare savings go to making the program more solvent and not to offset the creation of an entirely new entitlement program. There are many things we can do in this legislation to improve health care in America. I know many on our side have offered many things, some of which are in the bill, many of which are not, but we can do a lot of things together that we could agree on that would strengthen and make health care better in this country.

This legislation is unsound. We will be raiding Medicare. We will have a massive, new tax increase. If we were going to raise taxes, let me ask, might that money be best spent to make Medicare solvent instead of creating a new program, when we know Medicare is going to be insolvent in just a few years? We will be raising taxes and creating bogus, phantom cuts in Medicare, and they claim that will make this bill balance. They are adjusting the numbers in the bill so the benefits don't start for

5 years, to make the first 10 years look like it is a sound program--looks like it is going to cost $848 billion for the first full 10 years of implementation, and it costs $2.5 trillion.

There is not nearly enough money to pay for that. We are just going to be increasing the debt. That is why the American people have noticed. They have been out there at tea parties and meetings and rallies, pleading with us to be responsible, to quit throwing away money, quit acting like there can be something for nothing. There can't be something for nothing. Somebody has to provide care if we say care will be provided. If they provide it, it has to be paid for. That is simple.

We are creating a mindset that has resulted in a budget from the President that will double the entire national debt in 5 years and triple the national debt in 10 years. The national debt--$5.7 trillion last year--will go to $11 trillion-plus in 5 years and $17 trillion in 10 years. That is unacceptable. It is irresponsible. We need to listen to our constituents and respond to their commonsense pleas that we act with more [Page: S12592]

responsibility in the Senate.

I thank the Chair.

2:41 PM EST

Dick Durbin, D-IL

Mr. DURBIN. Mr. President, I thank the Senator from Tennessee. Although we disagree on this issue, I respect him very much. I am hoping--maybe it is a false hope--before the end of the day, [Page: S12594]

he will join us and make this a truly bipartisan effort. We have tried, we have reached out to the other side of the aisle for almost one calendar year with lengthy hearings in the HELP Committee, in the Finance Committee, inviting Republican Senators to come join


There were times when there was kind of a tease that was going on where they would come in and offer amendments and the amendments would be adopted in the HELP Committee. I think over 100 Republican amendments were adopted. We felt they were coming our way, that we were going to have a bipartisan bill. Then the roll was called and not a single Republican Senator would vote for it.

As I stand here today, after 1 year of effort, despite three committees in the House going through markup, two committees in the Senate, despite the vote on the Senate floor, the official tally is this: Only two Republicans have voted for health care reform. One Congressman from New Orleans, LA, a Republican Congressman, voted for the House bill. One Republican Senator, Senator Snowe of Maine, voted for the Finance Committee bill to be brought from the committee. We have made a good-faith

effort. We will continue to.

I salute the Senator from Wyoming who is on the floor who is the ranking member of the HELP Committee. I know he spent long, arduous allocations of time meeting and trying to find a bipartisan solution without success. But thank you for trying.

I say to the Senator from Tennessee, we would like to have your support. We would like to have your help in passing this bill and truly making it bipartisan. That is our goal, and I hope it happens.

The Senator from Tennessee questioned the fundamental building blocks of this bill. I cannot resist the opportunity to say I think this is a good bill, and I believe the effort that went into it by Senator Dodd, who has now joined us, and the HELP Committee and Senator Baucus and the Finance Committee gives us a bill that has many positive things.

This is our bill, 2,074 pages. It is the Democratic reform bill. You will see the desks on the other side of the aisle are empty because they do not have a bill. The Republicans have not produced a health care reform bill. In 1 year of speeches and press releases and charts and appearances on television talking about health care reform, they have not produced a comprehensive health care reform bill. I know why. It is hard. It is very difficult to tackle one-sixth of our economy. We did it, and

it took a lot of effort, as I mentioned earlier.

Second, there are some in the Senate--not on this side of the aisle--some in the Senate who do not believe we need to change. Some accept the current system. I think if they accept it, then they have to answer a few fundamental questions about the building blocks of this amendment. If the Republican Senators who oppose our bill accept the current system, what do they have to say about the affordability of health care premiums?

We know what has happened. Health care premiums have risen dramatically. Ten years ago, a health insurance plan for a family of four was $6,000 on average. Today it is $12,000. We project in 8 years it will be $24,000. If we do not stop this, fewer and fewer Americans will have health insurance, and what they have may not be any good.

We have in this bill efforts to reduce the increase in costs in health insurance premiums. Don't take my word for it. The Congressional Budget Office, which is the official umpire, has said, yes, the vast majority of Americans will see their health insurance premiums either go down in cost or not go up as they would have.

So we address, No. 1, the affordability of health care for businesses and families across America. There is no Republican bill that does this.

Secondly, the provisions in this bill will extend protection of health insurance so that 94 percent of Americans will have the peace of mind of knowing they have health insurance. Thirty million more Americans uninsured today will have health insurance. Of the lowest income categories, some will qualify for Medicaid, the government program for the poor and disabled, and in other instances some will qualify for the health insurance program, but they will have protection--30 million more Americans.

There is no Republican bill or amendment that extends coverage of health insurance to 30 million more Americans. There is none.

There is a third issue, too. We have built into the front end of this bill what we call the health care bill of rights. It is about time somebody stood up for families and individuals across America who have been treated very poorly by health insurance companies. These extremely profitable companies make a lot of money by saying no--saying no to your doctor's recommendation for surgery, saying no to your doctor's recommendation for the appropriate medication. They have people who just say no.

But here is what our bill does. Our bill says that in America you will have the right to buy insurance if you have a preexisting condition.

What that basically means is the No. 1 reason that health insurance companies deny coverage today is going to come to an end. We are creating new risk pools where preexisting conditions cannot exclude you. I know everyone is concerned about that critical moment in time when there is a frightening diagnosis or a terrible accident that they will turn to their health insurance they have paid into for a lifetime and the company will say: No. We checked your application and you failed to disclose

something about your past medical history--such as acne. Incidentally, that was one of the reasons used to refuse coverage. So the first thing we do is make sure that Americans have the right to buy insurance and won't be excluded for preexisting conditions.

We also make sure you will be able to keep your insurance if you become sick or injured. Too many times when you get sick, your insurance fails you. Two out of three people filing for bankruptcy in America today file because of medical bills they can't pay--two out of three. And 74 percent of them had health insurance. They thought they had protection--they paid the premiums--but when they needed it, it wasn't there. So the No. 2 element in our health care bill of rights in this bill is that

you can keep your insurance if you become sick or injured, that your insurance won't face lifetime limits on coverage, and that you will have affordable insurance if you lose or change your job. That is a large portion of the uninsured people in America.

Here is one that parents will appreciate. Remember when you first learned when your family policy wouldn't cover your son or daughter, right as they were coming out of college? And you thought: Uh-oh, they are loaded with student debt, they are looking for a job, and now they don't have health insurance. I can't tell you how many times I called my daughter and said: Jennifer, have you got health insurance yet? Oh, yeah, dad, I will get to that soon. I didn't like to hear that. Parents don't like

to hear that. Well, we extend them from age 24, and we say they can stay on their parents' insurance policy until they are 27. That is an addition of several years of protection--peace of mind--while a young person goes about finding a job, starting a career, and starting a family.

We also provide preventive care without extra cost, and we also begin to eliminate the discrimination in health insurance premiums. Health insurance companies--insurance companies in general and health insurance companies--are the only business, save American baseball, that is exempt from antitrust laws, which means they can literally come together--the executives of the insurance companies--and decide how much to charge in premiums for women, the elderly, people who are members of a minority

group, and they can make those distinctions and do it legally. We put an end to that. We say you have a right to fair insurance premiums without discrimination based on gender, health history, family history, or occupation.

There has not been a single Republican bill offered that offers this patients bill of rights to make sure we have this kind of protection when it comes to health insurance. It is one of the fundamental building blocks when it comes to health care reform in America. [Page: S12595]

The Senator from Tennessee and others have raised the question about deficits and have said: Well, isn't this bill, for all that it seeks to do, going to add more expense to our deficit? That was a legitimate question, asked by President Obama when he told us: If you want to do health care reform, don't do it at the expense of adding to our debt as a nation.

When we passed the prescription drug bill under Medicare--when there was a different party in charge in the Senate and in the White House--they added $400 billion to the deficit and didn't blink--$400 billion in debt added to America with impunity. It meant more subsidies for pharmaceutical companies--which do quite well--and more subsidies for health insurance companies--which are very profitable--at the expense of our deficit.

Now when it comes to this bill, that same party has returned to its role as the deficit hawk. Well, they should look very carefully at this bill, because the Congressional Budget Office tells us this legislation will reduce the deficit of the United States by $130 billion over the next 10 years, and in the following 10 years there will be $650 billion in reduced deficit. That is almost $1 trillion in deficit savings over 20 years.

There is no bill that has ever been introduced that makes this kind of deficit savings, according to the Congressional Budget Office. And unfortunately for their argument, there is not a single bill before us on the Republican side of the aisle which would even come close to reducing the deficit in that regard. In fact, all the major amendments that have been offered so far on the Republican side of the aisle add to our deficit. They want to continue the subsidy for private health insurance companies

under a program called Medicare Advantage.

The Senator from Connecticut has said repeatedly--and I hope he will say again soon--that Medicare Advantage is neither Medicare nor an advantage. It is a subsidy from taxpayers to profitable health insurance companies, which the Republican side of the aisle has labored day after day to protect--a private subsidy to health insurance companies. The health insurance companies can't stand this bill because it upsets their apple cart and maybe their profit and loss statement, and they can't stand

the thought of having Medicare Advantage policies held to accountability or losing the subsidy they currently have. But we believe that if we are honest with Medicare and its future, we have to do that.

I want to address one issue that comes up every time my colleagues on the other side of the aisle stand to speak, and it is the issue of the future of Medicare. They fail to recall that Senator Corker, from Tennessee, Senator Dodd, myself, and the Presiding Officer all voted in favor of the amendment offered by Senator MICHAEL BENNET of Colorado. The amendment that he offered--which is the most bipartisan amendment we have had on this otherwise partisan bill--said nothing

we do here in this bill will in any way reduce or endanger guaranteed benefits under Medicare, No. 1. And, No. 2, any savings that we get from this bill under the Medicare Program have to go back into putting Medicare on solid financial footing, to extend the benefits available to seniors, and to reduce the cost to seniors.

We all voted for that. It is now a part of the law we want to pass. So to come to the floor and argue the opposite is to ignore their own votes on the issue. Senator Bennet of Colorado has passed a watershed amendment that every senior and the families of seniors should respect as important to their future. So although you may disagree with the fundamental building blocks of this

amendment, I think they are sound, I think they are responsible from a fiscal viewpoint, and they are responsible when it comes to the future of Medicare.

2:54 PM EST

Chris Dodd, D-CT

Mr. DODD. Be careful about that. The last thing you want to have is a debate here. We used to have them. It doesn't happen often enough these days.

A couple of points you made can't be reinforced enough. One of the great worries, obviously, is the cost issue. I think everyone agrees this is the great nightmare we have, the growing problem of cost--the premium costs. Again, we either love or hate CBO depending on what numbers they come back to us with. I have been on both sides of those emotions when dealing with CBO, but we have come to recognize and accept the fact--I think collectively here--that we rely on them. This is not Mount Olympus,

not to say they are 100 percent right on every occasion. But I was going over the numbers, and I wondered if my colleague from Illinois--I know he is aware of these, but I may be wrong on some of this.

If you take the individual market in the country, there are 32 million people under CBO's analysis that are in the individual market. They would pay, according to CBO, 14 to 20 percent less in premiums of an equivalent plan than under the status quo. In the small group market, there are 25 million people, according to CBO, who fall into the small business market--the small group market, and the ones who are eligible for tax credits would pay 8 to 11 percent less in premiums than for an equivalent

plan under the status quo. If you work for small business and don't qualify for the tax credit, your premiums would be about 2 or 3 percent lower. So you go from 8 to 11 percent to 2 or 3. And, lastly, where most people are--where five out of every six people work, in the large group market--people who work for large employers--roughly 134 million people, according to CBO--would see lower premiums up to 3 percent than what they pay under the status quo.

That, to me, goes to the heart of this. Obviously, getting down and reducing our budget deficit by $130 billion, $150 billion the second decade, is terribly important. But if I am sitting out there as a consumer and I want to know one thing more than anything else--how is this going to affect me; am I going to be paying more or less--as the Senator points out, we are now looking at the year 2000 in Connecticut where a family of four paid between $6,000 and $7,000 for health care and they are

now paying $12,000, the same family, and in the next 7 years they will go to 24,000, and some predict within 10 years going to 35,000. Those are staggering increases.

Compare that, if you will, with what we are being told, even if these numbers are off a little bit, and they may well be one way or the other. But assume for the sake of debate they are not off quite that much; they may almost be flat, the cost; not actually a reduction in premiums. I can't understand why people wouldn't embrace this in a wholehearted fashion and say this is a great achievement. No one has been able to improve these numbers.

Am I wrong about some of these numbers, or are those your calculations as well?

2:57 PM EST

Dick Durbin, D-IL

Mr. DURBIN. As a matter of fact, the Senator from Connecticut, I would say through the Chair, is quoting a study from the Congressional Budget Office requested by Senator Bayh of Indiana, who asked the straight-up question of the Congressional Budget Office: If this is passed and becomes law, what will happen to premiums to people across America? As the Senator from Connecticut correctly reports, the premiums are either going to stay the same or go down for the vast majority of people;

otherwise, they are going up dramatically.

There is one other element, which I know the Senator is aware of. If you happen to be one of those callous, styptic-hearted individuals who could care less about people who are uninsured, believing the poor will always be with us, you ought to stop and reflect upon the fact that many of the poor people with no health insurance receive medical care through charity, compassionate care from hospitals and doctors, and their costs are passed along. We estimate that current premiums reflect about $1,000

to $1,200 a year that each of us pays--in addition to what we need to cover our families--to cover those uninsured who receive the benefits and the treatment they seek at hospitals.

So in addition to reducing the premiums, as the Senator from Connecticut said, as more and more people [Page: S12596]

come into coverage with their own health insurance, there is less of a pull on our benefit packages to subsidize the uninsured.

2:59 PM EST

Chris Dodd, D-CT

Mr. DODD. One other statistic that again jumps off the page at you, and I went back to my staff and said: Are you sure these numbers are right? I am told they are correct. For people who receive tax credits--and many do under our proposal here--the premium savings, on average, are 56 to 59 percent lower relative to the current individual market premiums--56 to 59 percent lower.

That is an incredible achievement in a piece of legislation designed to deal with cost--how do you get costs down? And of course the added elements of this--which again CBO doesn't calculate in showing reductions in premiums--include catastrophic options available to young adults, reinsurance provisions, which would reduce premiums even further. None of those calculations were actually calibrated by CBO in arriving at their conclusion. So, actually, I think these numbers turn out to be far better

than the ones we have just talked about.

3:00 PM EST

Dick Durbin, D-IL

Mr. DURBIN. I say to the Senator from Connecticut, this affordability element is the No. 1 reason why we need health care reform, and I think the one reason why our critics on the other side of the aisle come to this debate emptyhanded. They don't have anything to offer to reduce the costs. We are looking for a comprehensive bill from the Republican side.

This is ours, and it has been on the Internet for over 2 weeks. Every word can be read by every person in America. That kind of transparency and disclosure is what we need in the course of this debate. I am sorry the other side doesn't offer an alternative but does offer, unfortunately, amendments which don't enhance this bill's goals.

3:00 PM EST

Chris Dodd, D-CT

Mr. DODD. If I could get a last minute on the floor, Mr. President, I commend Senator MARK PRYOR, our colleague from Arkansas, whose amendment we will vote on shortly. I commend him for his work. This is a very worthwhile amendment he is offering, and gives individuals and small businesses better and more consistent information about insurance plans that would be sold in the exchange. All of us in this Chamber, and every Federal employee, gets one of these.

This is a little booklet. What it says is: ``Guide to Federal Benefits.'' I think I get some 15 or 20 options this year. I get options--take a look. I can open this book to various pages, and there is a comparative analysis of consumer reactions to the various plans over the last year or so, what they thought of them, how well they worked. There is nothing similar to this. We put language in our bill out of the HELP Committee to try to put this in common language people can understand, getting

away from the small print, telling people what exactly will be the benefits under their plan, or the disadvantages, to some degree. The Pryor amendment includes this kind of provision in the bill and strengthens it tremendously. I commend Senator Pryor of Arkansas for including a provision in this bill that will provide greater clarity and greater understanding, the same kind of clarity we get

under the Federal Employees Health Benefits package that allows us to make that very simple. You don't have to have a Ph.D. in economics to understand this. You can go right through and they list it quickly, if it is only yourself, yourself and your family, what it is like in Delaware, the District of Columbia, Florida, Georgia, every State. It is a very simple, very clear understanding of how this works.

One of the complaints all of us get all the time, this is complicated. No matter how sophisticated you may think you are, trying to sort out what is the best plan for you--and I say this candidly, the insurance industry isn't always as forthcoming in letting you know what the disadvantages are as they are marketing their various plans to people. So the Pryor amendment, I think, will go a long way toward providing that kind of clarity and understanding that all Americans want. I urge my colleagues

to support the Pryor amendment when that issue comes up for a vote.

I see the time is 3. I inquire and see I have gone over a little bit past 3 o'clock. I apologize to my colleague.

3:03 PM EST

Dick Durbin, D-IL

Mr. DURBIN. I will be happy to yield and ask our time be evenly divided, but I wish to give the Senator from Washington a chance to speak for a few moments too.

3:04 PM EST

Bob Corker, R-TN

Mr. CORKER. I listened to the Senator from Illinois talking about Medicare, and I assume, based on his comments, there is a chance we may get a 100-to-zip vote on the Gregg amendment, which truly ensures that all Medicare savings are used to make sure Medicare is more solvent.

The Bennet amendment, as I think the Senator knows, was parodied in the New York Times over the weekend, talking about it as toothless. It was a cover vote to give people the opportunity to be able to say they voted for something that saved Medicare, but actually the Gregg amendment does that. It puts the money away in such a fashion that all savings that are derived from Medicare are used to make Medicare more solvent. I am assuming that, since the Senator from Illinois is so supportive of ensuring

that occurs, that he will be supporting this amendment.

3:05 PM EST

Dick Durbin, D-IL

Mr. DURBIN. If the Senator from Tennessee is propounding a question, I will be opposing the Gregg amendment. I think the Bennet amendment achieves what we wanted to achieve. I think my friend from New Hampshire in his amendment goes too far and, basically, we understand what he wants to do. He doesn't want to see us create tax credits to help families pay for health insurance premiums. He believes it is an entitlement. I think your side referred to it as such. I think it is important to help

businesses and individuals who are struggling to pay health insurance premiums receive some assistance in doing so.

3:30 PM EST

Tom Harkin, D-IA

Mr. HARKIN. Mr. President, I listened to my colleague from Iowa earlier talking about the ``meaningless amendments'' and that amendments that do not have any teeth are just meaningless, stuff like that. I listened to that.

I want to make it very clear that the Gregg amendment is not a meaningless amendment. It has a lot of meaning because what it does is it kills health reform. Oh, yes, this is a meaningful amendment, make no mistake about it. It goes right to heart of what the health reform is all about: making sure people at the low-income end of the scale have a little bit better coverage; that is, people on Medicaid--that is section 2001--the tax credits and the copays that are in there, again, to help moderate-income

people and families be able to afford better coverage for themselves and their families--he guts that too--and, of course, the expansion of SCHIP.

So really, yes, I say to my friend from Iowa, this is a meaningful amendment--if you want to kill the bill, if you want to kill it. I suppose since most of my friends on that side of the aisle would like to kill the bill, they will probably vote for the Gregg amendment. But it completely guts it--completely guts it. Why? To help protect the wasteful subsidies to the insurance companies at the expense of families who are struggling to afford insurance and seniors who rely on Medicare.

This bill lowers premiums for American families, businesses, and the country as a whole. The Congressional Budget Office just said that this week. It strengthens Medicare, it improves benefits, and it adds years of life to the Medicare trust fund.

Let's be clear. Not one dime of the Medicare trust fund is used to pay for this reform, and no guaranteed Medicare benefits will be cut. If anyone can prove otherwise, please come forward. We have had a lot of rhetoric about it, but prove that this statement is not true: Not one dime of the Medicare trust fund is used to pay for reform and no guaranteed Medicare benefits will be cut.

3:33 PM EST

Tom Harkin, D-IA

Mr. HARKIN. Mr. President, I ask unanimous consent that the Senate now proceed to vote in relation to the Pryor amendment No. 2939; and that upon disposition of that amendment, there be 2 minutes of debate prior to a vote in relation to the Gregg amendment No. 2942; that no amendments be in order to either amendment, and that the second vote in this sequence be 10 minutes in duration; that each of the above-referenced amendments be subject to an affirmative 60-vote threshold, and if the amendment

achieves that threshold, then it be agreed to and the motion to reconsider be laid upon the table; that if the amendment does not achieve that threshold, then it be withdrawn; that upon disposition of the above amendments, Senator Nelson of Nebraska be recognized to call up his amendment No. 2962; that once the amendment has been reported by number, it be set aside, and the Republican leader's designee be recognized to call up his motion to commit with instructions.

3:34 PM EST

Judd Gregg, R-NH

Mr. GREGG. Mr. President, reserving the right to object, I believe I still have 15 seconds left on my time. But independent of that, I would ask that this unanimous consent request be amended and that we agree to the Pryor amendment by unanimous consent.

3:34 PM EST

Tom Harkin, D-IA

Mr. HARKIN. Mr. President, I will have to object to that. I have no instructions from Senator Pryor. I believe he wants a vote on his amendment. So I would have to object to that.

3:35 PM EST

Judd Gregg, R-NH

Mr. GREGG. Mr. President, I reserved the 15 seconds because it is easy to respond to the Senator from Iowa and it only takes 15 seconds.

Taking money out of the Medicare fund to fund other parts of this bill is a mistake and it is not appropriate.

3:36 PM EST

Mark Pryor, D-AR

Mr. PRYOR. Mr. President, I would ask my colleagues to look at this amendment very closely. It is a good consumer-oriented amendment that will allow people to make smart decisions on their health insurance. We need more of this type of information to allow the premium payers to make good decisions for themselves, for their families, and for their businesses. So I would ask my colleagues on both sides of the aisle to consider voting for this amendment.

Mr. President, I ask for the yeas and nays.

4:05 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Madam President, the Gregg amendment is a killer amendment. It would kill the tax cuts in the bill, kill assistance for copays, kill the Medicaid expansion for the lowest income Americans, kill additional funding for the Children's Health Insurance Program.

Proponents advertise this amendment as protecting Medicare. That is false advertising. The Gregg amendment would kill health care reform. Health care reform would extend the life of the Medicare trust fund by 4 to 5 years. Health care reform would result in commonsense changes, such as decreasing hospital readmissions, decreasing hospital-acquired infections, and paying doctors and hospitals to work together. Health care reform will not reduce guaranteed Medicare benefits. Health care reform

would extend the life of the Medicare trust fund.

The choice is clear. If you want to vote against tax cuts, Medicaid, and the Children's Health Insurance Program, vote for the Gregg amendment. If you want to extend the life of Medicare, vote against it.

4:06 PM EST

Judd Gregg, R-NH

Mr. GREGG. Madam President, I appreciate--although it was with a bit of hyperbole--that the Senator from Montana has made my case.

The Medicare trust fund and its recipients will be cut by almost $ 1/2 billion in the first 10 years. That money will be taken to fund initiatives that have nothing to do with senior citizens, and it will not benefit them.

In the end, it is going to mean the Medicare trust fund is less solvent and less capable of sustaining the benefits seniors deserve. This is the only amendment we will get to vote on that absolutely guarantees the Medicare funds will not be used to fund a new entitlement or the purchase of votes for the purpose of passing this bill or to fund anything else in this bill that isn't tied to the senior citizens' benefits.

You can either vote with seniors and protect the Medicare funds for them or you can vote to raid the Medicare fund and spend it on something else.

Madam President, I ask for the yeas and nays.

4:31 PM EST

Barbara Boxer, D-CA

Mrs. BOXER. Madam President, we are trying to get the times locked in so that Senators who have come over here get their time. So I ask unanimous consent that Senator Nelson speak for 10 minutes, Boxer for 5, Mikulski for 10, Grassley for 10, Cornyn for 10, Gillibrand for 10, and then Senator McCain wishes to comment.

4:32 PM EST

Ben Nelson, D-NE

Mr. NELSON of Nebraska. Madam President, my lead cosponsor, Senator Hatch, will appear sometime later and speak in favor of amendment 2962. He is unable to be here at the moment.

Before the Thanksgiving break, I voted with a number--and the majority, actually--of my colleagues in favor of beginning this debate. Debate is essential in our democracy. It keeps our country resilient and strong through changing times.

Before that vote, some argued here on the Senate floor that we shouldn't hold this open and full debate. They seemed to suggest that obstruction was better than action. Some also argued here on the floor that the November 21 vote was about abortion. They were wrong. That vote was whether to begin a debate on an issue that has consumed the American public. Now is the time to start debating the issue of abortion, as we are addressing many other issues in health care reform.

I wish to discuss the amendment that I propose, along with a bipartisan group of colleagues, which includes Senators Hatch, Casey, Brownback, Thune, Coburn, Johanns, Vitter, and Barrasso. The amendment we offer today mirrors the Stupak language added to the House health care bill.

For more than three decades, taxpayer money has not been used for elective abortions, and it shouldn't under any new health reform legislation either. Some suggest that the Stupak language imposes new restrictions on abortion. I disagree. We are seeking to justify the same standards on abortion to the Senate health care bill that already exist for Federal health programs. They include those covering veterans, all Federal employees, Native Americans, active-duty servicemembers, and others.

I note that the Senate health care bill, if enacted, would indeed chart new ground--it covers abortion. The language in the bill goes around the Federal standard disallowing public funding of abortion. A clear majority of Americans, including my constituents in Nebraska, support this prohibition against using public money to cover abortion. Our amendment formally extends that standard to this health reform bill.

The U.S. Supreme Court has held that government may regulate abortion and may disallow public funds being used for elective abortions. Beginning in 1976, with the Hyde amendment, Congress has prohibited public funding for elective abortion in all significant health-related bills. Exceptions have been preserved for when the life of the mother is in danger or in cases of rape or incest. And except for those exceptions, public funds may not be used for any health care benefits package that covers


Some have now cited the Federal Employees Health Benefits Program--FEHBP--as a possible model for health care reform. The FEHBP helps pay premiums for many different private health insurance plans. That way, Federal employees may choose the insurance plan that best suits their budget and personal needs. It is important to note that none of the benefits packages offered to Federal employees provide health insurance coverage for abortion. I repeat: None of the benefits packages offered to Federal

employees provide coverage for abortion, nor do benefits packages that are offered to individuals in other Federal programs, such as the Children's Health Insurance Program, Medicare, Medicaid, Indian Health Services, veterans health, and military health care programs.

Some have argued that the Stupak language imposes tougher restrictions than in current law. That is not the case. Our amendment merely aims to extend the current standard to this new legislation.

On another point, under Federal law, States are allowed to set their own policies concerning abortion. Many States oppose the use of public funds for abortion. Many States also have passed laws that regulate abortion by requiring informed consent and waiting periods, requiring parental involvement in cases where minors seek abortions and protecting the rights of health care providers who refuse, as a [Page: S12601]

matter of conscience, to assist in abortions. And

perhaps most importantly, there is no Federal law, nor is there any State law, that requires a private health plan include abortion coverage.

I believe the current health care reform we are debating should not be used to open a new avenue for public funding of abortion. We should preserve the current policies prohibiting the use of taxpayer money for abortion that have existed for more than three decades.

A number of polls this year have again shown that most Americans do not support using taxpayer money for abortion. The Senate bill, as proposed, goes against that majority public opinion. The bill says the Secretary of Health and Human Services may allow elective abortion coverage in the Community Health Insurance Option--the public option--if the Secretary believes there is sufficient segregation of funds to ensure Federal tax credits are not used to purchase that portion of the coverage.

The bill would also require that at least one insurance plan cover abortion and one that does not cover abortion be offered on every State insurance exchange. Federal legislation establishing a public option that provides abortion coverage and Federal legislation allowing States to opt out of the public option that provides abortion coverage eases the restrictions established by the Hyde amendment.

Our amendment would prohibit Federal funds from being used for elective abortion services in the public option and also prohibit individuals who receive tax credits from purchasing a plan that provides elective abortions.

I have always been pro-life and I have a strong record opposing abortion. As Governor of Nebraska in the 1990s, I signed into law the parental notification law and the ban against partial birth abortion. In the Senate, I cosponsored and voted for legislation that prohibits taking minors across State lines to avoid parental notification laws and voted for legislation creating a separate offense for harming or killing an unborn child in utero during the commission of specified violent crimes.

Aside from my personal views, however, I think most Americans would prefer that the health care reform we are working on remain neutral on abortion. Public polls suggest so. So does the fact that over the last 30-plus years Congress has passed new Federal laws that have not provided public funding for abortions.

So the question has been settled: Most Americans, even some who support abortion, do not want taxpayer money to be used for abortions. We should not break with precedent on this bill.

And, finally, as President Obama has said, this is a health care reform bill. It is not an abortion bill. It is time to simply extend the standard disallowing public funding of abortion, which has stood the test of time, to new proposed Federal legislation.

I look forward to debating this and other issues in the health reform bill as we work to address solutions to our troubled health care system. Today it costs too much and delivers too little to the people of my State and to most Americans.

Madam President, I yield the floor.

5:04 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. Madam President, as is the agreed-upon procedure by the two leaders, I send a motion to commit to the desk with instructions, as part of the side-by-side procedure that has been agreed to by the majority leader and the minority leader, and ask for its consideration.

5:05 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. Madam President, the motion I am offering would simply commit the bill back to the Finance Committee for a short period to apply the same grandfathering provision in this legislation to all Medicare Advantage beneficiaries, the provision in the bill as it is specifically drafted, to prevent the drastic Medicare Advantage cuts from impacting some seniors in Florida, which compare to the cuts facing Medicare Advantage enrollees in the rest of Florida and the rest of America,

including the 330,000 Medicare Advantage enrollees in my State.

Basically, this motion says that the same benefits that have been granted in the legislation to citizens in Florida would also apply to citizens who are enrollees in the Medicare Advantage Program all over America. It is pretty simple.

Specifically, starting in 2012, this motion would accomplish a fix that allows all Medicare Advantage enrollees to maintain the current levels of benefits on the date of enactment. That would be in keeping with the sense-of-the-Senate resolution that was agreed to by the Senator from Colorado, Mr. Bennet, that called for all Americans to be able to keep the same level of benefits as they presently have today under Medicare and Medicaid.

During the Finance Committee markup, the senior Senator from Florida advocated in favor of treating certain Medicare Advantage enrollees in Florida better than the rest of America's seniors under Medicare Advantage.

Let me read from two articles written at the time of the Senate Finance Committee's deliberation. From the New York Times, ``Senator Tries to Allay Fears on Health Overhaul,'' September 24, 2009:

But Mr. Nelson, a Democrat, has a big problem. The bill taken up this week by the committee would cut Medicare payments to insurance companies that care for more than 10 million older Americans, including nearly one million in Florida. The program, known as Medicare Advantage, is popular because it offers extra benefits, including vision and dental care and even, in some cases, membership in health clubs or fitness centers.

``It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare,'' said Mr. Nelson, who has been deluged with calls and complaints from constituents. ``I am offering an amendment to shield seniors from those benefit cuts.''

Pretty simple. The Senator from Florida believes there would be cuts to the Medicare Advantage Program, and he was able to get into this bill an exemption for some 950,000 enrollees in Medicare Advantage in Florida. Admirably, the Senator from Florida was able to insert in this bill protection for 800-some or 900-some thousand constituents of his who are Medicare enrollees. There are 330,000 of them in my State who are seniors, who have paid into Medicare, who have the Medicare Advantage Program

which, under the legislation, with the exception of the carve-out for the citizens in Florida by Mr. Nelson, would also then lose their benefits.

Similar concerns exploded into public view on Wednesday as members of the Finance Committee slogged through a mammoth health care overhaul bill for a second day.

Senator Nelson said Republicans were waging a ``scare campaign,'' but he shares some of their concerns. His predicament highlights the political risks for Democrats eager to reassure older Americans who vote in large numbers.

There are risks for President Obama as well. He cannot afford to lose Mr. Nelson's vote. White House officials have offered to work with him to address his concerns. Mr. Obama has said repeatedly that ``if you like your health care plan, you will be able to keep it.''

That is one of the remarkable statements that is obviously contradicted by anybody who reads this bill. Any one of 11 million Americans, with the exception of Senator Nelson's constituents, who are under Medicare Advantage will see cuts in Medicare Advantage. That is a fact. If those 11 million Americans like their health care plan, they will not be able to keep it.

The cost of Mr. Nelson's proposed fix--to preserve benefits for many people enrolled in the private Medicare plans--could total $40 billion over 10 years, and that could also be a problem for the White House. Mr. Obama has promised not to sign a health bill that increases the deficit, and so far Mr. Nelson has not said precisely how he would pay for his amendment.

Approval of the amendment could invite other Democrats to ask for similar deals that might make the bill more palatable to their constituents, but more costly as well.

Well, since that September article, obviously other Senators have asked for the same shielding of their constituents who are enrolled in Medicare Advantage.

An October 20, 2009, Bloomberg story, ``Reid Leads Democrats into Carving Out Favors for States on Health.''

Democrats such as Senator Bill Nelson of Florida and Ron Wyden of Oregon secured provisions setting aside $5 billion to shore up benefits for constituents who participate in Medicare Advantage. That program allows private insurers to contract with the government to provide Medicare benefits. Nelson said the aid isn't directed solely at Florida. ``It affects several States, including New York,'' he said. ``We're trying to grandfather in seniors so they don't lose the benefits they have.''

Well, I am trying to carry out Senator Nelson's ambition. Senator Nelson said that, in effect, several States, including New York, are trying to grandfather in seniors so they don't lose the benefits they have. That is exactly what this motion is all about.

I assume I can expect Senator Nelson's affirmative vote, along with all others listed in the motion of the 11 million people who are under Medicare Advantage in their States.

And the deal-making continues. We have now learned about the special provisions in the 2,000-page legislation designed for certain Senators--I might add, at the expense of Medicare Advantage members in other States and the American taxpayer. We have had to read about such deals because they have been cut in secret closed meetings without the benefit of the C-SPAN cameras, as promised. Just the other day, it came to light that this legislation has special provisions for Oregon, New York, and a

special one in Florida. I have had a conversation with Senator Wyden of Oregon, and he says that is not the case. I will certainly take Senator Wyden's word for it.

I want the same protections extended to all seniors. That is all this motion is about--the same protection for all seniors, no special deals for any constituents related to the State in which they reside or the influence of their elected representatives. That is not the way we should treat seniors who have paid into Medicare Advantage.

The special carve-out for some Florida seniors is quite interesting. Despite beneficiaries in Florida hearing the President's promises about being able to keep what you have, it appears the 950,000 Medicare Advantage enrollees in Florida aren't satisfied with the Democrats' promises to protect so-called guaranteed benefits. Medicare Advantage beneficiaries in Florida thought [Page: S12605]

they would be able to keep the Medicare Advantage benefits that provide protection

from high cost sharing in traditional Medicare, wellness programs, and vision, hearing, and dental benefits upon which they have come to rely.

However, when Florida beneficiaries learned they were not going to be able to keep what they have--in fact, they were going to see a 64-percent cut in benefits--a deal benefiting some at the expense of other Medicare Advantage beneficiaries and taxpayers was added in exchange for support to move forward on the cuts.

Let me point out, despite attempting to protect hundreds of thousands of Florida seniors from benefit cuts, Senator Nelson's deal still leaves approximately 150,000 Florida seniors and seniors across the country unprotected. So even in the proposed deal that was cut, Senator Nelson was willing to leave 150,000 beneficiaries subject to Medicare Advantage cuts.

The Medicare Advantage Program is a program that had bipartisan support and the support of 11 million seniors who are enrolled in the program.

Just a few short years ago, when Congress enacted the Medicare Modernization Act, new funding was intentionally provided to stabilize the Medicare health plan program. This was one of the few issues on which there was strong bipartisan agreement during the 2003 Medicare debate. It was done to ensure seniors all across America had access to an option in the Medicare Program, an option for additional, better benefits than are available under the traditional Medicare Program.

In June 2003, several of our colleagues, including Senator Schumer and Senator Kerry, offered a bipartisan amendment on the Senate floor to provide additional funding for benefits under the Medicare Advantage Program. So I find it a little interesting that Members on the other side want to cut benefits to seniors now. Even though they supported the funding before, they now want to cut them.

Later in 2003, as the Medicare conference committee was completing its deliberations, a bipartisan group of 18 Senators signed a letter urging the conferees to provide a meaningful increase in Medicare Advantage funding. This letter was signed by a diverse group of our colleagues, including Democratic Senators such as DIANNE FEINSTEIN, CHRISTOPHER DODD, RON WYDEN, FRANK LAUTENBERG, PATTY MURRAY, ARLEN SPECTER, MARY LANDRIEU, and MARIA CANTWELL.

Here is a letter dated September 30, 2003. It says ``United States Senate,'' and it is signed by a number of Senators, including my colleague, Senator Kerry. It says:

Dear Medicare conferee:

We are writing to ask you, as a member of the Medicare conference committee, to ensure that the final Medicare bill includes a meaningful increase in Medicare+Choice funding in fiscal years 2004 and 2005.

So I guess my friend and colleague, Senator Kerry, was against cuts in funding before he was for them. He was against them before he was for them. So anyway it goes on to say:

We strongly support additional Medicare+Choice funding for two very important reasons: (1) to protect the health care choices and benefits of the nearly 5 million Medicare beneficiaries who are currently enrolled in private sector health plans; and (2) to strengthen the foundation for future health plan choices.

We believe that the Medicare+Choice funding provisions ..... are critically important to preserving choice and quality for America's seniors. We urge you to include these provisions in the final bill reported out of the Medicare conference committee.

Since then the Medicare Advantage Program has been popular enough so that 11 million of our senior citizens have joined the program. I think that is a pretty impressive number of people who have decided to join the program. So I urge my colleagues to vote for this motion, just to give equal access to a very popular program to all citizens rather than just give it to several hundred thousand who happen to live in a certain part of the country.

5:23 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. Madam President, I have found that the debate on the floor has been invigorating. I have found it to be educational not only to the Members of this body, and this Senator in particular, but I think to all Americans. Believe it or not, a lot of the deliberations and the debate and discussion we have had on the Senate floor have been vigorous. They have been sometimes passionate because this is such an important issue--issues such as the one I just discussed--and they have

been sometimes tough.

But I must say, I have always tried to be respectful of the views of my colleagues, even though we have had some--especially the Senator from Illinois, the distinguished whip of the Democratic Party, whom I have engaged vigorously--but they have always been respectful debates. I intend to maintain that respect, as I have throughout my career. But I do not mean that means I will not be passionate.

So I was astonished--I was astonished--and taken aback to see a foxnews.com article that just crossed my desk titled: ``Reid Compares Opponents of Health Care Reform to Supporters of Slavery.''

Senate Majority Leader Harry Reid took his GOP-blasting rhetoric--

I am quoting from the article--

to a new level Monday, comparing Republicans who oppose health care reform to lawmakers who clung to the institution of slavery more than a century ago.

Senate Majority Leader Harry Reid took his GOP-blasting rhetoric to a new level Monday, comparing Republicans who oppose health care reform to lawmakers who clung to the institution of slavery more than a century ago.

The Nevada Democrat, in a sweeping set of accusations on the Senate floor, also compared health care foes to those who opposed women's suffrage and the civil rights movement--even though it was Sen. Strom Thurmond, then a Democrat, who unsuccessfully tried to filibuster the Civil Rights Act of 1957 and it was Republicans who led the charge against slavery.

So not only was Senator Reid wrong in his accusations, Senator Reid was also incorrect in who opposed slavery and who supported the Civil Rights Act. But that is not the important point. The important point, as the article goes on to say:

But Reid argued that Republicans are using the same stalling tactics employed in the pre-Civil War era.

And I quote from the article that is quoting Senator Reid:

``Instead of joining us on the right side of history, all the Republicans can come up with is, `slow down, stop everything, let's start over.' If you think you've heard these same excuses before, you're right,'' Reid said Monday. ``When this country belatedly recognized the wrongs of slavery, there were those who dug in their heels and said `slow down, it's too early, things aren't bad enough.' ''

He continued: ``When women spoke up for the right to speak up, they wanted to vote, some insisted they simply, slow down, there will be a better day to do that, today isn't quite right.''

``When this body was on the verge of guaranteeing equal civil rights to everyone regardless of the color of their skin, some senators resorted to the same filibuster threats that we hear today.''

That seemed to be a reference to Thurmond's famous 1957 filibuster--the late Senator switched parties several years later.

Sen. Orrin Hatch, R-Utah, said Reid's remarks were over the top.

``That is extremely offensive,'' he told Fox News. ``It's language that should never be used, never be used. ..... Those days are not here now.''

Sen. Saxby Chambliss, R-Ga., suggested Reid was starting to ``crack'' under the pressure of the health care reform debate.

``I think it's beneath the dignity of the majority leader,'' Sen. Tom Coburn, R-Okl., said. ``I personally am insulted.''

So this is a debate which has been spirited. This has been a debate which has been passionate. This has been a debate that I think has been very helpful to the American people. Some of the back and forth that I have seen I think has been excellent. It has been excellent debate and discussion. I enjoyed it when the Senator from Montana and I had a discussion about various endorsements. I appreciated the fact that Senator Durbin brought my record to light and questioned it. But, most importantly,

most of the conversation has been about the components of this bill and its impact on the future of America.

So to somehow compare--as this article says--we who believe firmly in the principles that are being violated by this 2,000-page legislation to people who supported slavery, I would very much appreciate it if Senator Reid would come to the floor and, if not apologize certainly clarify his remarks that he was not referring to those of us who believe we are carrying out and performing our constitutional duties; that is, acting in the best interests of our constituents on an issue that will

impact the future of the United States of America for years and years and years.

Madam President, I ask unanimous consent that the foxnews.com article be printed in the Record.

There being no objection, the material was ordered to be printed in the RECORD, as follows:

Reid Compares Opponents of Health Care Reform to Supporters of Slavery

Senate Majority Leader Harry Reid took his GOP-blasting rhetoric to a new level Monday, comparing Republicans who oppose health care reform to lawmakers who clung to the institution of slavery more than a century ago.

The Nevada Democrat, in a sweeping set of accusations on the Senate floor, also compared health care foes to those who opposed women's suffrage and the civil rights movement--even though it was Sen. Strom Thurmond, then a Democrat, who unsuccessfully tried to filibuster the Civil Rights Act of 1957 and it was Republicans who led the charge against slavery.

Senate Republicans on Monday called Reid's comments ``offensive'' and ``unbelievable.''

But Reid argued that Republicans are using the same stalling tactics employed in the pre-Civil War era.

``Instead of joining us on the right side of history, all the Republicans can come up with is, `slow down, stop everything, let's start over.' If you think you've heard these same excuses before, you're right,'' Reid said [Page: S12607]

Monday. ``When this country belatedly recognized the wrongs of slavery, there were those who dug in their heels and said `slow down, it's too early, things aren't bad enough.' ''

He continued: ``When women spoke up for the right to speak up, they wanted to vote, some insisted they simply, slow down, there will be a better day to do that, today isn't quite right.

``When this body was on the verge of guaranteeing equal civil rights to everyone regardless of the color of their skin, some senators resorted to the same filibuster threats that we hear today.''

That seemed to be a reference to Thurmond's famous 1957 filibuster--the late senator switched parties several years later.

Sen. Orrin Hatch, R-Utah, said Reid's remarks were over the top.

``That is extremely offensive,'' he told Fox News. ``It's language that should never be used, never be used. ..... Those days are not here now.''

Sen. Saxby Chambliss, R-Ga., suggested Reid was starting to ``crack'' under the pressure of the health care reform debate.

``I think it's beneath the dignity of the majority leader,'' Sen. Tom Coburn, R-Okla., said. ``I personally am insulted.''

5:31 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. So if I could return to my amendment. My amendment would make sure every beneficiary is protected and receives equal treatment. I would expect strong bipartisan support, since I think we would all like to see the same protections guaranteed for our own constituents. I know the Senator from Pennsylvania will appreciate this amendment, since he filed his own amendment to spend $2.5 billion in taxpayers' dollars to protect Medicare Advantage beneficiaries in Pennsylvania. I

guess the 864,000 Medicare Advantage beneficiaries in Pennsylvania weren't satisfied with the promise to protect so-called guaranteed benefits either.

This motion to commit is straightforward and will help the President keep his promise that if you like your health insurance you have today, the policy you have today, you can keep it, and will protect 10.6 million Medicare Advantage beneficiaries from at least a 64-percent cut in benefits.

May I say, again, I think it has been an important debate we have engaged in. I do not and will not impugn the motives or the integrity of those who are sponsors of this legislation. Yes, I will argue we didn't keep the President's promise and commitment over a year ago during the Presidential campaign when he said he would have the C-SPAN cameras in, that there would be bipartisan negotiations with the C-SPAN cameras in, with Republicans and Democrats sitting down together so, in his words,

the American people could see who is on the side of the health insurance companies and the special interests and who is on the side of the American people. I think that is a legitimate statement and a legitimate questioning as to the process that is taking place today, where there have been no negotiations with the Members on this side and there has been no C-SPAN camera included where these negotiations are taking place. So I hope there will be. I hope this legislation is defeated. I hope we can go back and sit down together, Republicans and Democrats, and agree on medical malpractice reform, on crossing State lines to be able to get the best

insurance policy for every citizen and their family, to emphasize wellness and fitness and reward it, and to enact outcome-based treatment for our patients. I hope we can produce a lot of measures and take a lot of significant steps that would truly reduce the cost of health care in America, not enact a $2.5 trillion new

entitlement program that is a scam. It is a scam because of the way the budgetary process has been set up. Right now, today, I can go out and buy an automobile, and I don't have to make a payment for a year. Under this proposal, you start making the payments and 4 years later you get the benefits. That is Enron accounting.

I hope my colleagues will allow us to continue this spirited debate and discussion. I say, with the greatest respect, these are tough issues and there are strong differences of opinion. But I think, overall, this debate and discussion is good for the American people and, hopefully, the outcome will be one where we will be better informed and can better address the issue of the skyrocketing costs of health care in America and our ability to provide them with affordable and available health care.

I yield the floor.

5:47 PM EST

Chuck Grassley, R-IA

Mr. GRASSLEY. Madam President, for the benefit of my colleagues waiting to speak, I don't think I will speak much more than 10 minutes. Before I speak on my purpose for coming to the floor to support Senator McCain's amendment, I want to take a couple of minutes to go over a source of information that is no longer credible, which has been used in debate on the floor several times, used throughout the year--information that has been in letters to the editor of Iowa newspapers.

The most recent hearing of this was when the Senator from California rose to talk about the quality of our health care and the reference to the fact that the United States is 37th out of all of the nations of the world in quality of health care.

I don't deny we have to do a lot to improve the quality of health care in America. I even admit that in this legislation, though I oppose the bulk of this 2,074-page bill, there is a lot in the bill that has to do with the enhancing of the quality of care.

We keep hearing about the United States being 37th in quality. That comes from a World Health Organization analysis that was made back in the year 2000, ranking the United States among all the other nations. It is a 10-year-old report that was flawed in its analysis at the very outset. Yet it is repeated as if gospel truth by almost anybody who wants to denigrate America's health care system and build a case for this monstrosity of a bill we have before us. When I call it a monstrosity, I will

say it has some very good provisions in it that would enhance the quality of care. The World Health Organization no longer produces such a ranking table because of the complexities of the task. The rankings were flawed because they judged health care systems for problems--cultural, behavioral,

and economic--that are not controlled by health care. There is no differentiation between the quality of medical systems and other factors, such as diet, exercise, and violent crime rates, which ought to be taken into consideration when considering a nation's delivering quality of health care.

The editor in chief of this 2000 report of the World Health Organization, Philip Musgrove, called the figures `` ..... many made-up numbers,'' and the result a ``nonsense ranking.'' Dr. Musgrove, an economist who is now deputy editor of the journal Health Affairs, said he was hired to edit the report's text but didn't fully understand the methodology until after the report was released. Once he left the World Health Organization, he wrote an article in 2003 for the medical journal Lancet criticizing

the rankings as ``meaningless.''

The U.S. health system spends more than any other country per capita and was ranked 37th out of 191 due to that spending alone. Prior to considering how much we spend, the United States was ranked 15th, not 37th.

The Dominican Republic, Costa Rica, and Morocco ranked 42nd, 45th, and 94th before adjusting for spending levels. After the adjustment for spending levels, can you believe it? They ranked above the United States--35th, 36th, and 29th, respectively.

The United States ranked first in responsiveness. That means respect for persons and prompt attention. Americans understand and appreciate this quality care. This will be lost in this massive health care reform bill when the government takes more control.

Experts in the field of health, such as Mark Pearson, head of health for the [Page: S12609]

Organization of Economic Cooperation and Development, OECD, was quoted as saying:

It's a very notorious ranking. Health analysts don't like to talk about it in polite company. It's one of those things that we wish would go away.

I hope my colleagues will take that into consideration when they bring up the rationale for this bill, that it is because of that World Health Organization study, which I think what I said and a lot of other things you can say about it ought to put it into proper perspective.

For my support of the McCain motion to bring equalization among the 50 States for the Medicare Advantage portions of this bill, I have spent the past 28 years in Congress working to make sure that rural Iowans have access to the same quality of health care as people living in more urban areas.

Medicare, since 1965, has been a national program. Well, it is a national program with traditional Medicare. But before we brought equity to Medicare Advantage, it wasn't a national program. It was a program for California, Arizona, Texas, New York, Florida, Chicago, or near the Midwest, maybe Omaha. Since Medicare Advantage was not a national program, and since Medicare since 1965 has been a national program, I set out in the Medicare Modernization Act to bring equity to rural America just as

we have in urban America. I fought to make sure that seniors living in rural areas would have the same choices as seniors living in Miami, New York City, or Los Angeles.

That is simply saying that wherever you live in the United States, you have Medicare--traditional Medicare. Before then, wherever you lived in the United States, in most rural areas you didn't have Medicare Advantage. Since Medicare is a national program, people living in rural America ought to have the same choice as those in urban America.

Today that is the case. Seniors in every county in Iowa have a choice between traditional Medicare and Medicare Advantage. That is a big improvement, since prior to the Medicare Modernization Act not all Iowans had that choice. I can narrow it down to 1 out of 99 counties--Pottawattamie County, across from Omaha, had Medicare Advantage. The other 98 counties didn't have it. I want to tell you, there are still inequities, because Iowa providers offer high-quality care that leads to less utilization.

Iowans get approximately $1,500 less per year in Medicare Advantage benefits than seniors living in Florida. Under this bill, Iowans will see even less in Medicare Advantage benefits. It looks like that won't be the case for some lucky Floridians.

In another one of those backroom deals--a backroom deal that seemed to be needed to get 60 votes, backroom deals that are still being attempted to get 60 votes--the Senator from Florida, in one of these backroom deals, was able to secure a provision in the Finance Committee bill that would make sure that seniors in certain Florida counties are able to maintain their current benefits. I am not talking about the so-called guaranteed benefits that Democrats say they are protecting. The provision

secured by the Senator from Florida will also protect additional and extra benefits for Floridians. In pushing for this amendment, the senior Senator from Florida said:

It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare.

I guess Floridians weren't satisfied with the promise that has been made throughout the last 2 weeks of debate on this bill to protect the so-called guaranteed benefits. Seniors in Florida still wanted the lower cost sharing, wellness programs and vision, hearing and dental benefits they have come to rely on. Now we have the Senator from Pennsylvania filing an amendment to help Medicare beneficiaries in Pennsylvania protect their extra benefits, to get these extra benefits that people on Medicare

Advantage have.

I am guessing that seniors in Pennsylvania must have also picked up on the Democrats' hollow promises to protect guaranteed benefits but not worry about other benefits. In fact, the presence of these special deals is proof that this bill is cutting Medicare benefits.

It is even proof that some Senators are worried about going back to their constituents and trying to explain the difference between cutting guaranteed and additional benefits, and explaining why they voted to cut Medicare Advantage benefits by 64 percent. Why else would these special deals be necessary?

I am here to ask my colleagues, why should seniors in Florida or Pennsylvania get to keep their extra benefits, while more than 9 million seniors in other parts of the country see an average cut of 64 percent? To quote the Senator from Florida, isn't this also intolerable?

My colleagues on the other side talk about efficiency and fairness, but they are supporting a bill that maintains the highest Medicare Advantage payments in the country, while slashing benefits in higher quality rural areas. One of those higher quality rural areas is the State of Iowa, where we are fifth in quality but near the bottom of 50 States in reimbursement on Medicare, whereas other States are fiftieth in quality and No. 1 in reimbursement on health care.

All of this doesn't sound very efficient or fair to me. Senator McCain's motion is pretty straightforward. It goes State by State. I am not going to read all 50 States, but it says here that 1 million--it is going to benefit the 70,000 Medicare Advantage enrollees in Arkansas. It is going to benefit the 198,000 Medicare Advantage enrollees in Colorado. In Iowa, it is probably something in the neighborhood of 63,902. It will make sure that seniors in every other State in the country--red

States and blue States--get the same deal Senator Nelson got for Florida.

A vote for the McCain amendment is simply a vote for equity. But a vote against the amendment is a vote to favor backroom deals that put the interest of a handful of Floridians above 10 million seniors across the country.

I urge my colleagues to support all seniors and vote for the McCain motion.

I yield the floor.

6:01 PM EST

Kirsten E. Gillibrand, D-NY

Mrs. GILLIBRAND. Mr. President, I rise today in strong opposition to an amendment that has been offered by my distinguished colleague from Nebraska.

There has been a lot of misinformation about what the health care bill we are debating would mean for women and for reproductive rights. So let me please set the record straight.

The underlying legislation before us maintains a historic compromise we have had in this country by barring the use of Federal funds for the full range of reproductive services, except in cases of rape, incest, and to save a woman's life. That is the current law of the land, and the Senate bill goes to great lengths to maintain current Federal law.

The legislation would segregate private funds from public funds, so only a person's private money will contribute to their reproductive coverage. This is not an accounting gimmick, as some critics have falsely charged. In fact, this kind of arrangement is often used when public funds are given to parochial schools or other religious institutions to maintain a separation of church and state.

The Senate version would also require that at least one plan within the health insurance exchange offer a plan that covers reproductive services and one that does not. It would authorize the Secretary of Health and Human Services to audit any and all plans to make absolutely certain abortion is not being paid for with Federal dollars. This arrangement is squarely in line with the historic compromise we have had in this country for 30 years that keeps Federal funds from being used to pay for abortions.

As we debate the solution to the deepening health care crisis that has affected every citizen, business, and community in the country, this is not the time nor the place to instigate a new battle over reproductive rights and reproductive freedoms. Families and businesses that are getting buried under the weight of the current cost of health care deserve much better.

Proponents of the Stupak-Pitts amendment claim this is a continuation of current Federal law, but that is simply false. This proposal goes far beyond Federal law and will, in fact, bring about significant change and dramatic new limitations on reproductive access in this country. It establishes [Page: S12610]

for the very first time restrictions on people who pay for their own private health insurance. This is not partisan spin; this is fact. A new study by George

Washington University School of Public Health and Health Services concluded:

The treatment exclusions required under the Stupak/Pitts amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange.

This is government invading the personal lives of Americans, and it puts the health of women and young girls at grave risk.

In fact, this amendment would represent the only place in the entire health care bill where opponents are actually correct. This would truly limit access to medical care by giving the government the power to make medical decisions, not the patient or the doctor.

We all agree it is important to reduce abortions in this country, and I will continue to work in many ways to reduce unintended pregnancies and to promote adoption. However, the Stupak amendment prohibits the public plan as well as the private plans offered through the exchange, if they accept any subsidized customers, from covering any abortion services. This effectively bans full reproductive coverage in all health insurance plans in the new system, whether they are public or private.

Creating a system in which women are forced to purchase a separate abortion rider is not only discriminatory, it is ridiculous. It would require women to essentially plan for an event that occurs in the most unplanned of circumstances and often in critical emergency situations.

There are currently five States that require a separate rider for abortion coverage. In these five States, it is nearly impossible to find such a private insurance policy that covers full reproductive care. In one State, one insurance company holds 91 percent of the State's health insurance market and refuses to even offer such a rider.

There is no doubt that a lack of access to full reproductive health care puts the lives of women and girls at grave risk. The Stupak measure poses greater restriction on low-income women and those who are more likely to receive some kind of subsidy and less likely to be able to afford a supplemental insurance policy.

Denying low-income women reproductive coverage in this way is not only discriminatory, it is dangerous. Without proper coverage, women will be forced to postpone care while attempting to find the money to pay for it. Such a delay can lead to increased costs and graver health risks, particularly for these younger girls or these women will be forced to return to dangerous back-alley providers. Women and girls in America deserve better.

I am optimistic we can defeat this radical change to Federal law, pass a health care bill in the Senate that respects current law, and strip the dangerous Stupak measure during the conference process. As I said before, I think there has been a lot of misinformation about what the Stupak measure does and the level of danger this kind of sweeping change could pose to women and girls.

This health care package must move us forward toward quality, affordable health care for every single American.

I ask my colleagues to oppose the Nelson amendment and any similar measure. I ask that we work together to preserve current law and respect the private choices made between a woman and her doctor.

Madam President, I yield the floor.

6:16 PM EST

Al Franken, D-MN

Mr. FRANKEN. Madam President, I rise to speak in opposition to the Nelson-Hatch amendment, which replaces the compromise language in the current bill with unprecedented restrictions on women's access to safe and legal abortion services.

I think we can all agree that women's health is fundamental to our Nation's health. We all know that when women are healthier, families, communities, and countries are healthier. But I also know the issue of abortion is difficult, no matter where you stand on it, and I truly respect the fact that we have a range of opinions among us. Women have abortions for different reasons. Some of these reasons may not seem right to some of us. But even if we disagree, it is better that each woman be able

to make her own decision with her doctor.

In a perfect world, no woman should have to face the decisions we are discussing today. But the reason we have insurance coverage is to help us deal with the unexpected. No woman expects to have an unplanned pregnancy. No woman expects to end a wanted pregnancy because of fetal anomalies or risks to her own health. If we limit options in private health insurance coverage, we take away a woman's right to make a decision that may be best for her and for her family in their circumstances.

But unplanned pregnancies do occur, and we have a responsibility to provide women with the full range of choices regarding their health. The Supreme Court has repeatedly ruled on this issue and made it clear that women have a constitutional right to access abortion. It is our responsibility to make sure abortions are safe, legal, and rare.

Supporting a woman's right to make decisions about her health means more than keeping abortion services legal; it means supporting a woman's decision to terminate a pregnancy safely and with dignity. It also means teaching honest, realistic sex education. It means the right to choose contraception. It means standing with women who choose to continue their pregnancies--with the hope and expectation that a compassionate society will support them in their responsibilities raising a child. It is

about respecting women's personal decisions and the challenges they face, especially at times when they are the most vulnerable.

I strongly oppose the Nelson-Hatch amendment because it undermines the status quo and breaks new ground by restricting women's fundamental rights. The amendment stipulates that health plans cannot cover abortion services if they accept even one subsidized customer, even if the abortion coverage would be paid with the private premiums health plans receive directly from individuals. If adopted, this would mark the first time in Federal law that we would restrict how individuals can use their own

dollars in the private health insurance marketplace.

I also oppose the amendment because we have a workable solution. The existing compromise in our bill represents genuine concessions by both pro-choice and pro-life Members of Congress. The current bill prohibits Federal funding of abortion but also allows women to pay for abortion coverage with their own private funds. It makes clear abortion can't be mandated or prohibited and stipulates that Federal funds cannot be used for abortion.

Let me be clear. The compromise within the current bill is as far as we can go. We have negotiated to get to this point. We cannot negotiate further without literally undermining the compromise we have made on behalf of women's health in this country.

We are on the verge of passing a historic health reform law that will do more to improve the health of women and families than any legislation in recent history. We will end discrimination based on health history, on gender, or history of domestic violence. We will provide access to preventive health services so women can get annual exams and mammograms at no cost. It is our responsibility to guarantee women are not worse off--under the health reform we are going to pass--than they are today.

As my friend Paul Wellstone used to say: ``If we don't fight hard enough for the things that we stand for, at some point we have to recognize that we don't really stand for them.'' I urge my colleagues to stand with me today to oppose this amendment.

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

6:25 PM EST

Sherrod Brown, D-OH

Mr. BROWN. Madam President, I am troubled by what I have seen in the Chamber of the Senate in the last week. Actually, I am troubled by what I have seen in the Senate Chamber for the last several weeks, as I have watched this slow walk that so many of my colleagues who oppose health care reform are doing--anything to stall, anything to slow things down, anything to distract the public.

It began last summer, when some negotiations were going on. It was pretty clear there was no interest in any kind of real compromise, in any kind of constructive input into these negotiations. I can say that because I remember what happened in the Health, Education, Labor, and Pensions Committee in July. In June and July, we wrote the original--the first health care bill that passed a Senate committee, the HELP Committee.

We processed hundreds of amendments. The markup--which is the discussion inside the committee--took 11 days, the longest markup in anybody's memory. Everybody got a chance, everybody--all 23 Members of the committee, 13 Democrats, 10 Republicans--to offer amendments. Most of those amendments were voted on or agreed to. Nobody filibustered.

There was certainly lots of discussion. Sometimes we are a little long-winded around here, more so than we should be, but 160 Republican amendments were passed--either agreed to or actually voted on and passed in the committee. I voted for most of those amendments--I would say probably all but 10 of them--something like that. But the point is, there was a lot of bipartisanship in this legislation.

On the bigger questions, the differences are more ideological, more fundamental. For instance, Democrats support a strong Medicare. Republicans, who originally opposed Medicare in the 1960s--and not for partisan reasons but for ideological reasons--do not think government should run Medicare. That was pretty clear.

In the 1990s, when I was a Member of the House, Speaker Gingrich and the Republicans--they had a majority in the House and Senate--tried to privatize Medicare. President Clinton mostly blocked it, although he went along with some of it. When the Republicans, for the first time, had the House, the Senate, and the White House, in 2003, they dramatically privatized Medicare, shoveling all kinds of moneys into the insurance companies and giving huge subsidies to the drug companies. Look what we got.

We got more difficult problems with Medicare, more budget problems. We went from a budget surplus to a budget deficit, partly because of that bill and because of the war. [Page: S12612]

My point is, this bill was bipartisan in many ways, but on the big fundamental questions--should government be involved in things such as Medicare; what should we do on worker safety issues; what to do on consumer protections--the Democrats want to see strong consumer protections, with no more cutting people off their coverage because of preexisting conditions, no more discrimination against women.

As the Presiding Officer knows, through her work in New Hampshire, she has seen too many of her female constituents paying higher prices than male constituents. What is fair about that? So the Republicans have generally sided with the insurance companies and the Democrats generally side with consumers. On those fundamental questions, they aren't really partisan as much as they are ideological.

Saturday night, a couple weeks ago, when we actually began the debate--where no Republican voted to allow the bill to even be debated--that was the ultimate stall tactic, to keep it off the floor. The Democrats voted to put it on the floor. But what bothers me about this stalling is not just that they are stopping us from doing what we need to do in this country, it is that in my State alone, there are 400 people every single day--from Toledo to Athens, from Bryan to St. Clairsville, from Conneaut

to Middletown--400 Ohioans every day lose their insurance, 400 Ohioans every day. Across the country, 45,000 people die every year, according to studies, and 1,000 people a week die because they don't have insurance.

As the Presiding Officer knows, because of her work on women's health care, a woman with breast cancer, without insurance, is 40 percent more likely to die than a woman who has breast cancer with insurance.

Think about that. If you have breast cancer, as anxious as you are, as fearful as you are, as sick as you are, if you have insurance you at least do not have to worry about that; you can go get decent medical care and many times your life is saved, particularly if you caught it early enough. But if you don't have insurance, you can't go to the emergency room. They are not going to take care of you every day. They might take care of you at the end of your life, right at the end; if you are dying

you might get emergency care. But people like that are just left out of the system. That is why a woman with breast cancer without insurance is 40 percent more likely to die. That is why these delays from my friends over there, they write memos on the best way to delay the bills.

They try every motion they can think of. For 3 days we couldn't even get a vote when we wanted to vote on one of their amendments, Senator McCain's amendment on Medicare. We literally could not get a vote because the Republicans blocked the vote. We finally did.

It is just these delay tactics. Again, 400 people in Findlay and Mansfield and Zanesville and Springfield and Xenia and Columbus--400 people every day lose their insurance in my State alone. Forty-five thousand people die a year because they do not have insurance.

Let me read a couple of letters. I come to the floor most days and read letters from people from my State. Many of these letters--not every one, but many of them--come from people who, if you asked them a year ago, would have said they had pretty good insurance. Then they have a child born with a preexisting condition, and they lose their insurance or then maybe they got sick and their hospital bills were so high the insurance company cut them off. Maybe they lost their job and they lost their


So many of those letters, as I said, were from people who thought they had good insurance and found out when they really needed the insurance, it was not such good insurance.

Let me just read from a couple of letters. This comes from Amy from Franklin County. Franklin County is in the middle of the State, the State capital located in Franklin County.

I recently had two minor surgeries. But in the last six months alone, I've had to spend about $4,000 to cover 15 percent of my income. Thank you for taking a strong stance on health reform.

What Amy writes about, when you are spending one-sixth of your gross income on health care--then this is somebody who is working, she is playing by the rules, she is doing everything she can, and she got really sick--there was not the safety net for her that there should be.

Our bill will take care of that. Our bill says if you have health insurance and you like it, you can keep it, but in addition you are going to get good consumer protections, no more preexisting condition, no denial of care that way.

A second thing: If you are a small business you are going to get assistance--some tax incentives, some tax incentives, some tax credits--to insure your employees. Most small business people I know in Bucyrus, OH, in Galion, in Crestline, in Shelby, and all over my part of the State, like that. Most of them want to cover their employees, but if you have 20 employees and one of them gets sick, your insurance rates will go so high you can no longer afford it sometimes or you will get cancelled.

The third thing our bill does is it helps people, those who do not have insurance, by giving them assistance so they can afford insurance, so people like Amy can get a better insurance policy rather than spending that much money out of pocket.

The other letter I would like to share is from Amber from Morrow County, an area of the State sort of north-central, north of Columbus, Mount Gilead, that part of the State, Cardington. She says, at age 19--this is more a story about her than an actual letter--at age 19 Amber was discontinued on her stepfather's insurance plan because of a preexisting condition. Needing constant medication and treatment for her diabetes, she tried to obtain her own health insurance plan. She was unable to afford

any of her treatments or medications because she couldn't get insurance. As a result of an inability to treat her condition, she suffered two heart attacks and lost most of her vision.

She is 22 years old now. Now legally blind, she has lost feeling in her hand and feet, missing many of her teeth, and has kidney and intestinal problems. She feels lucky now to qualify for government disability benefits.

I don't know Amber. I know what her family members sent to us about her. But because she could not get insurance, because she was taken off her stepfather's insurance because of a preexisting condition, she was not able to do the kind of care diabetics are able to do.

It is a horrible disease. My best friend had diabetes. We have friends and neighbors and family members and colleagues and associates who have diabetes. Most of them, if they have a good health insurance plan, are able to live normal lives and don't have these kinds of things happen that happened to Amber.

What has happened, lost feeling in her hands and feet, kidney and intestinal problems, all the awful things that come out of diabetes are because it is a chronic disease. They are manageable. You know what will happen. Amber ends up in the hospital. Because she doesn't have insurance, it costs others in Morrow County who have insurance. They all pay more because they have to take care of Amber in a very expensive situation instead of providing insurance for Amber so she can manage her diabetes

at much less cost and much more humanely.

It simply doesn't make sense to continue to stall. I have been around a good while in government. I have never been more upset than I have watching these stall tactics. These are not games people should be playing when you think about the human life, you think about Amber, you think about Amy, you think about how we all have people in our States who have suffered because they do not have insurance. We know how to fix it. We need to move forward and get this done as quickly as we can.

Four hundred Ohioans losing their insurance every day; 45,000 Americans dying every year because they don't have insurance. Those things simply are not acceptable.

I yield the floor.