[Congressional Record Volume 141, Number 172 (Thursday, November 2, 1995)]
[Senate]
[Pages S16591-S16592]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        THE RECONCILIATION BILL

  Mr. KENNEDY. Mr. President, in the reconciliation bill, the 
Republicans have extended an open hand to powerful special interests 
and the back of their hand to the American people. Senior citizens, 
students, children, and working families will suffer so that the 
privileged can profit.
  Republicans are engaged in an unseemly scheme to hide what they are 
doing from the American people. Their proposals are too harsh and too 
extreme. They cannot stand the light of day--and they know it.
  The fundamental injustice of the Republican plan is plain. Mr. 
President, $270 billion in Medicare cuts that hurt senior citizens are 
being used to pay for $245 billion in tax cuts that help the wealthiest 
individuals and corporations in America.
  The Republican bills are also loaded with sweetheart deals for 
special interests, whose money and clout are being used behind closed 
doors to subvert the public interest and obtain special favors. The 
sections of the legislation dealing with health care are packed with 
payola for the powerful.
  The dishonor roll of those who will benefit from the giveaways in 
this Republican plan reads like a ``Who's Who'' of special interests in 
the health care industry.
  The pharmaceutical industry--the most profitable industry in 
America--benefits lavishly from the Republican program. The House bill 
repeals the requirement that the pharmaceutical industry must give 
discounts to Medicaid nursing home patients and to public hospitals and 
other institutions serving the poor. The total cost to the taxpayers 
from these giveaways is $1.2 billion a year--close to $10 billion over 
the life of the legislation.
  The Democrats in the Finance Committee forced the elimination of this 
giveaway in the Senate bill, and the amendment, which I intend to offer 
as instructions to the conference, is designed to ensure that it is not 
included in the conference report.
  The American Medical Association also receives lavish benefits in the 
Republican bill in return for its support of these excessive cuts in 
Medicare. The weakening of the physicians anti-fraud and physicians 
conflict-of-interest rules in the Republican program has been estimated 
by the Congressional Budget Office to cost taxpayers $1.5 billion over 
the next 7 years.
  Even more harmful to the Medicare patients is the elimination of 
restrictions on billing, so that doctors will be able to charge more 
than Medicare will pay, and collect the difference from senior 
citizens.
  Under current law, such billing is prohibited for Medicare patients 
enrolling in private HMOs or competitive medical plans--the only 
private plans currently allowed to contract to provide Medicare 
benefits. The Republican Senate bill eliminates this prohibition for 
HMOs, and for every private plan. When the plan is fully implemented, 
senior citizens could pay as much as $5 billion more for medical care a 
year as a result of the elimination of these protections.
  We had this as an amendment during the time of reconciliation. We 
received some assurance that the billing provisions had been addressed, 
the double-billing provisions would be addressed, then under review of 
the language of the reconciliation we find that no place in those over-
1,000 pages could you find the kinds of protections that exist there 
under the Social Security Act.

  Our amendment directs the conferees to restore the limits on such 
billing and maintain strong protections against fraud and abuse.
  Another extreme provision of the House bill is its elimination of all 
the Federal nursing home standards, a payoff to unscrupulous nursing 
home operators who seek to profit from the misery of senior citizens 
and the disabled.
  The Senate amendment adopted last Friday pretends to restore nursing 
home standards to the Senate bill but, in fact, it leaves a loophole 
wide enough to permit continued abuse of tens of thousands of patients.
  It allows State waivers that could weaken Federal standards and avoid 
Federal oversight and enforcement. Weakening current Federal standards 
is a giveaway to unscrupulous nursing home operators. This amendment 
instructs the conferees to maintain the current strict standards.
  One of the cruel aspects of the Republican proposal is its failure to 
protect nursing home patients and their relatives from financial abuse.
  Mr. REID. Would the Senator yield for a question?
  Mr. KENNEDY. Sure.
  Mr. REID. Would my friend----
  The PRESIDING OFFICER. The time is expired.
  Mr. REID. I ask unanimous consent that I be allowed to speak as in 
morning business for 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. And I extend my time to the Senator from Massachusetts.
  How would it work around the country if we had 50 different sets of 
standards, I say to the Senator from Massachusetts, for how you would 
manage the standards set for rest homes?
  Mr. KENNEDY. The Senator has put his finger on something which is 
basic to the Republican proposal because you would have 50 different 
standards for nursing homes in the 50 different States, as you probably 
would with regard to children and children's coverage, as well as the 
disabled in various States.
  Rather than having a national commitment to our seniors that is 
implicit in the Medicare concept, Medicare is basically an 
understanding that as seniors get older their incomes go down and their 
health needs go up. That happens to seniors all over this country. 
Medicare recognizes that. What we are doing with the nursing home 
standards is carving out an area where the Republicans fail to give 
current protections to those senior citizens, but instead, gives 
protections to the nursing homes--they will be protected.
  For example, in my State of Massachusetts it costs $39,000 for 
nursing home care. If a senior qualifies for Medicaid--which 
effectively means they have no real further assets other than perhaps a 
very marginal protection for the spouse which was addressed under a 
different provision--and that individual is in a nursing home, the 
Medicaid payment is a payment in full.
  Effectively under the Republican program, States may provide only 
about two-thirds of the Medicaid money to nursing homes. The 
Republicans are cutting out $180 billion out of Medicaid. We now spend 
$90 billion a year on Medicaid. They are cutting out $180 billion out 
of the program, which is the equivalent of 2 years of the 7, giving 
that much less money to the States.
  In my State I can understand the State saying we can only pay, 
instead of the $39,000, maybe $25,000. What this legislation will say 
is, all right, the nursing home can try to sue that family for 
additional money--not just the $39,000 but maybe $42,000 or $45,000 --
and at the same time, the Republicans refuse to put in place the 
nursing home standards. The kind of standards which were developed in 
order to address the kinds of abuses that were so evidenced in the 
hearings which our good friend from Arkansas, Senator Pryor, and others 
were involved in, in a bipartisan way, in 1987.

[[Page S 16592]]

  Mr. REID. I ask one additional question of my friend.
  Is the Senator aware that in 1980, just a few years ago, 40 percent 
of the people who were in convalescent homes were restrained--that is, 
strapped down with some type of narcotic, or they could not move; is 
the Senator aware of that?
  Mr. KENNEDY. I am aware that it was a practice that was used far more 
often than was necessary. Both the physical restraints and also the 
sedation, as well as the failure of adequate personal hygiene care for 
seniors.
  Mr. REID. Is the Senator aware since the national standards were 
established, that figure has dropped dramatically?
  Mr. KENNEDY. That is my understanding.
  The indications are that since the enactment of the 1987 standards, 
the overall health evaluation of seniors--basically we are talking 
about parents and grandparents--in nursing homes has substantially--
substantially--improved.
  That has been referenced during the course of this debate. It has 
never really been challenged.
  I think not only have the improvements been affirmed by various 
studies, but one thing that you cannot evaluate in terms of dollars and 
cents is relieving the families of the anxiety and the concern that 
they have for their parents. When they visit and see how, in many 
instances, the parents were treated prior to the 1987 provisions it 
gave them anxieties. At the same time they had those anxieties they 
were out working, trying to provide for their children all the time 
while also worried about their parents.
  They had some relief from that type of anxiety as a result of those 
standards, and under the Republican bill those standards have been 
altered or changed.
  Mr. REID. Mr. President, I ask unanimous consent because of my 
interruption that the Senator from Massachusetts be allowed to finish 
his statement.
  The PRESIDING OFFICER. The time of the Senator from Nevada has 
expired.
  Mr. KENNEDY. I ask unanimous consent for 4 additional minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KENNEDY. Mr. President, the Republican bill also wipes out the 
protections that have been in Medicaid since 1965 that prevent States 
from forcing adult children to pay the cost of their parents' nursing 
home bill.
  The Republican bill even lets States put liens on the houses of 
nursing home patients, even if the spouse or children are still living 
there. Obviously, Republican family values stop at the nursing home 
door.
  The amendment instruction which I will offer with others will 
eliminate these indefensible proposals from the bill.
  What a travesty it is for the Republicans to call this a 
reconciliation bill. The only reconciliation involved is between the 
Republican majority and their special interest lobbyist friends for 
whom this bill has become one large feeding trough.
  Who knows what additional giveaways will be cooked up behind the 
closed doors of the conference committee? Adoption of the sense of the 
Senate which I will propose at the appropriate time is a needed step to 
expose those sweetheart deals and eliminate them from the bill. I will 
urge the Senate to adopt it. I wish we had the opportunity to debate 
this over the course of the week, but we have effectively been denied 
that opportunity.
  Mr. President, finally, last week, when I raised the issue of balance 
billing on the Senate floor, the chairman of the Budget Committee 
contended that the Senate finance bill preserved this protection in 
Medicare.
  Let me cite the facts. Section 1876 of the Social Security Act 
clearly prohibits physicians who are part of HMOs or competitive 
medical plan networks from making any additional charge to enrollees of 
that organization. This is in the first part of an instruction I will 
offer.
  It further prohibits charges beyond what Medicare would normally 
allow even for services provided by physicians not part of the network.
  What does the Republican bill do? First, it establishes a whole new 
category of private plans that can contract with Medicare, the Medicare 
Choice plans. The limitations in section 1876 do not apply to these new 
plans. Then it repeals section 1876 effective January 1, 1997, so the 
existing limitations do not apply to HMOs currently contracting with 
Medicare.
  You can read all 65 pages of the subtitle of the bill establishing 
Medicare Choice. In fact, you can read all 2,000 pages of the Senate 
bill, and you will not find the applications that are there in section 
1876(j).
  You will not find them because they are not there. In fact, just to 
make the intentions of the authors of this program crystal clear, 
section 189fC(d)(2)(B) of the new Medicare Choice program requires that 
enrollees be notified of their ``liability for payment amounts billed 
in excess of the plan's fee schedule.''
  The Republicans trumpeted their achievement when they passed this 
bill, but they seem reluctant to go to conference. Do they want to 
divert public attention from the contents of the bill? What do they 
want to hide? I can understand their concern. There is much to be 
ashamed of in it and nothing to be proud of. It is a cruel and unfair 
bill, it hurts families, senior citizens, and helps only the wealthy 
and the powerful.
  I hope we will have an opportunity to debate this sense of the Senate 
at an appropriate time so the Senate itself can make a judgment as to 
whether to endorse and support this sense of the Senate.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.

                          ____________________