[Congressional Record Volume 141, Number 179 (Monday, November 13, 1995)]
[Senate]
[Pages S16981-S16991]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         THE 7-YEAR BALANCED BUDGET RECONCILIATION ACT OF 1995

  The Senate continued with the consideration of the bill.
  The PRESIDING OFFICER. Would the Senator suspend while we report the 
motion?
  Mr. KENNEDY. Fine. I would be glad to send it to the desk, if that is 
agreeable.


                    Motion To Instruct--Health Care

  Mr. President, I send a motion to instruct conferees on H.R. 2491 to 
the desk on behalf of myself, Senator Pryor and Senator Wellstone.
  The PRESIDING OFFICER. The clerk will report the instructions.
  The bill clerk read as follows:

       The Senator from Massachusetts [Mr. Kennedy] moves to 
     instruct the conferees on the part of the Senate to insist 
     upon removal of the following provisions included in the 
     House or Senate bills:

  Mr. KENNEDY. I ask further reading of the instructions be dispensed 
with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The motion is as follows:

       The Senator from Massachusetts [Mr. Kennedy] on behalf of 
     himself, Mr. Wellstone, and Mr. Pryor moves to instruct the 
     conferees on the part of the Senate to insist upon removal of 
     the following provisions included in the House or Senate 
     bills:
       (1) Provisions eliminating requirements in the Medicaid law 
     providing drug discounts to State Medicaid programs, public 
     hospitals, other programs or facilities serving low income 
     people, such as community and migrant health centers, health 
     care for the homeless centers, Ryan White AIDS programs, 
     pediatric AIDS demonstrations, family planning clinics, black 
     lung clinics, and public housing clinics;
       (2) Provisions benefitting unscrupulous health care 
     providers at the expense of Medicare and private patients by:
       (a) repealing current prohibitions against additional 
     charges (balance billing) by physicians and other providers 
     rendering services to Medicare beneficiaries enrolled in 
     private insurance plans;
       (b) weakening current statutory provisions to prevent and 
     combat fraud and abuse, including such abusive practices as 
     self-referral and kickbacks, and such proposals to weaken 
     anti-fraud efforts as establishing more lenient standards for 
     imposing civil money penalties;
       (3) Provisions threatening the quality and affordability of 
     care in nursing homes by:
       (a) weakening or eliminating Federal nursing home standards 
     by repealing such standards or allowing state waivers from 
     such standards and Federal enforcement of such standards;
       (b) repealing prohibitions against nursing homes charging 
     Medicaid patients fees for covered services in addition to 
     the payment made by the State;
       (c) repealing current prohibitions against States placing 
     liens on the homes of nursing home patients.
       (4) Provisions providing greater or lesser Medicaid 
     spending in states based upon the votes needed for the 
     passage of legislation rather than the needs of the people in 
     those states.

  Mr. KENNEDY. Mr. President, I yield myself 8 minutes.
  Mr. President, in the reconciliation bill the Republicans have 
extended an open hand to powerful special interests 

[[Page S 16982]]
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, $280 
billion of 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 bill is also loaded with sweetheart deals for special 
interests whose money and clout are being wielded behind closed doors 
to subvert the public interest and obtain undeserved favors. In 
particular, 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. Democrats in the Finance Committee succeeded in eliminating 
this giveaway for the Senate bill. Our motion 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 the AMA support of the excessive Republican cuts in 
Medicare.
  In addition, the bill weakens the anti-fraud and conflict-of-interest 
rules for physicians. The Congressional Budget Office estimates that 
these benefits to physicians will cost the taxpayers $1.5 billion over 
the next 7 years.
  The Republican bill also eliminates the provision in current law that 
prevents doctors from charging more than Medicare permits for those 
enrolled in HMO's and other private plans. The Republican plan will 
permit doctors to collect the difference from senior citizens. As a 
result, senior citizens could pay as much as $5 billion more a year for 
medical care because of the elimination of those protections.
  Our motion directs the conferees to restore the limits on such 
billing and maintain strong protections against fraud and abuse.
  Another unacceptable 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. A Senate amendment purports to restore some 
of the standards, but, in fact, as my friend and colleague, Senator 
Pryor, has pointed out, it leaves a loophole wide enough to permit 
continued abuse of tens of thousands of nursing home patients. It 
allows States to issue waivers that could weaken Federal standards and 
avoid Federal oversight and enforcement. Our motion instructs the 
conferees to maintain the current strict standards and protections for 
our senior citizens in the nursing homes.
  One of the cruelest aspects of the Republican proposal is its failure 
to protect nursing home patients or their relatives from financial 
abuse. The Republicans claim that they have now revised their bill to 
maintain financial protection for the spouses of nursing home 
residents. What they do not tell you is that they still allow nursing 
homes to charge patients more than Medicaid will pay. Spouses can still 
be forced to sell their home, exhaust their savings to give their loved 
ones the care they need. That is not financial protection. It is 
financial abuse.
  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 costs of a parent's nursing home bill. The Republican bill even 
lets States put liens on the homes of nursing home patients if a spouse 
or child are still living there. Obviously, Republican family values 
stop at the nursing home door. Our motion will eliminate these 
indefensible proposals from the bill.
  What a travesty it is for Republicans to call this bill a 
reconciliation bill. The only reconciliation is between the Republican 
majority and special interest lobbyists for whom this bill has become 
one large feeding trough. Who knows what additional giveaways will be 
cooked up behind the closed doors at the conference committee? Adoption 
of this motion is a needed step to expose those sweetheart deals and 
eliminate them from the bill. I urge the Senate to adopt it.
  The conference report on the reconciliation will come to the floor of 
the Senate later this week. But today we face the possibility of a 
Government shutdown because the Republicans are attempting to blackmail 
the President of the United States into signing a Medicare premium 
increase as the price of keeping the Federal Government in operation. 
This is the only proposal in the continuing resolution that would be 
permanent law. It should be rejected by the Senate and vetoed by the 
President. It is clear that there is a new meaning to GOP--Get Old 
People. The Republicans are not insisting that cuts in Medicare 
payments to doctors and hospitals be included in the continuing 
resolution.
  I just want to underline that, Mr. President. In the particular 
provisions that the Republicans have taken as part of the continuing 
resolution, it only applies to what will be paid for by our senior 
citizens. The doctors are not being asked, nor are the hospitals, to 
make a contribution. Only the individual senior citizens, through 
higher part B premiums. That is what this battle is all about. Raising 
the part B premiums is one of the very objectionable provisions of the 
reconciliation bill, and the Republicans have tried to add that 
particular provision to this continuing resolution because they know it 
is an indefensible position. They are trying to force the President to 
sign this so that there can be a continuation of the funding of various 
government programs. It is unacceptable, and the President is 
absolutely right to reject it. They are not insisting that the fraud 
and waste be squeezed out of Medicare, though anti-fraud and abuse 
provisions to protect the Medicare program have been added over the 
last several years, and they are beginning to be effective.
  I can remember hearings that we had in Faneuil Hall when we had 800 
senior citizens. They said, ``Before you begin to raise our premiums, 
Senator, before you continue to raise our deductibles, before you 
continue to raise our copays, let's get fraud and abuse out of the 
whole Medicare system.'' There is not a senior citizen in this country 
who does not understand that.
  Instead of tightening those provisions that would bring billions of 
dollars into the Medicare system, what are our friends, the 
Republicans, doing but weakening those provisions, which are so 
essential and important to the integrity of the system.
  They are not insisting that senior citizens get the preventive and 
outpatient services that will keep them out of the hospital and reduce 
unnecessary Medicare spending. If you want to do something to control 
the cost of the Medicare, you take those senior citizens on Medicare 
who are going into the hospital unnecessarily--anywhere from 25 to 30 
percent--and costing the Medicare system billions of dollars, and give 
them preventive and outpatient care. Or try and provide some help and 
assistance in letting seniors remain home, if that is their choice. 
That can save billions of dollars.
  But those types of provisions are not included. There are no programs 
to increase preventive or outpatient services for our senior citizens 
that will improve the quality of health and also save money. The only 
provision the Republicans are insisting on is a new tax for senior 
citizens in the form of higher Medicare premiums.
  The Republican assault on Medicare is a frontal attack on the 
Nation's elderly. Medicare is part of Social Security. It is a contract 
between the Government and the people that says, ``Pay into the trust 
fund during your working years and we will guarantee good health care 
in your retirement years.'' It is wrong for the Republicans to break 
that contract. It is wrong for Republicans to propose deep cuts in 
Medicare in excess of anything needed 

[[Page S 16983]]
to protect the trust fund. And it is doubly wrong for the Republicans 
to propose those deep cuts in Medicare in order to pay for tax breaks.
  The cuts in Medicare are too harsh and too extreme: $280 billion over 
the next 7 years. Premiums will double, deductibles will double, senior 
citizens will be squeezed hard to give up their own doctors and HMOs.
  The fundamental unfairness of this proposal is plain. Senior citizen 
median income is only $17,750 a year; 40 percent of the elderly 
Americans have incomes of less than $10,000. Because of gaps in 
Medicare, they already pay too much for health care that they need. 
Yet, the out-of-pocket costs they must pay for premiums and deductibles 
will rise $71 billion over the next 7 years, an average of almost 
$4,000 for elderly couples.
  The Republican premium is especially objectionable, because it breaks 
the national contract with senior citizens over Social Security. Every 
American should know about it. Every senior citizen should object to 
it. Medicare is part of Social Security. The Medicare premium is 
deducted directly from a senior citizen's Social Security check. Every 
increase in the Medicare premium is a reduction in Social Security 
benefits, and the Republican plan proposes an increase in the part B 
premium and a reduction in Social Security which is unprecedented in 
size.
  The Republican plan proposes an increase in the part B premium and a 
reduction in Social Security which is unprecedented in size. Premiums 
are already scheduled to go up under current law, from $553 a year 
today to $730 by 2002. Under the Republican plan, according to the 
Congressional Budget Office, the premium will go up much higher--to 
$1,068 a year.
  As a result, over the life of the Republican plan, all senior 
citizens will have a minimum of $1,240 more deducted from their Social 
Security checks. Every elderly couple will pay $2,480 more.
  The impact of this program is devastating for moderate- and low-
income senior citizens. It is instructive to compare the premium 
increase next year to the Social Security cost-of-living increase that 
maintains the purchasing power of the Social Security check. One-
quarter of all senior citizens have Social Security benefits of $5,364 
a year or less. The cost-of-living increase for a senior citizen at 
this benefit level will be $139 next year.
  The average senior citizen has a Social Security benefit of $7,874. 
The cost-of-living increase for someone at this benefit level is $205.
  But under the Republican plan, the premium next year will be $126 
higher than under current law. Average income senior citizens will be 
robbed of almost two-thirds of their cost-of-living increase. Low-
income senior citizens will be robbed of a massive 90 percent of their 
increase.
  Senior citizens have earned their Social Security and Medicare 
benefits through a lifetime of hard work. They have built this country 
and made it great. Because of their achievements, America has survived 
war and depression. It is wrong to take away these benefits--and it is 
especially wrong to take their Social Security cost-of-living increase 
to pay for an undeserved tax break for the wealthiest individuals and 
corporations in America.
  The Republicans' attack on Medicare will make life harder, sicker, 
and shorter for millions of elderly Americans. They deserve better from 
Congress. This cruel and unjust Republican plan to turn the Medicare 
Trust Fund into a slush fund for tax breaks for the wealthy deserves to 
be defeated. And this attempt to sneak a Medicare premium increase into 
law as part of the continuing resolution needed to keep the Government 
running deserves the Presidential veto it will quickly receive.
  It is irresponsible for the Republicans to threaten to shut down the 
Government if they do not get the unfair increase they want in the 
Medicare premium. I say, shame, shame, shame on the Republican party. 
Nothing more clearly demonstrates the harsh and extreme nature of their 
right-wing agenda for Americans that this attack on senior citizens and 
the willingness of Republicans in Congress to shut down the Government 
itself if they don't get their way.
  Mr. DOMENICI. Mr. President, what is the time situation?
  The PRESIDING OFFICER. The proponents have 20 minutes 10 seconds, and 
the Senator from New Mexico has 20 minutes.
  Mr. DOMENICI. Mr. President, I yield myself 5 minutes.
  First of all, I see Senator Pryor on the floor. He offered a set of 
instructions to the conferees. I might tell him, I hope he wins 100 to 
nothing, because I am going to urge everybody to vote for him.
  As a matter of fact, I think most of what the Senator from Arkansas 
is talking about will find its way into the reconciliation bill. I 
think we had this battle once before. Senator Pryor won and we won 
also. It is kind of a dual win. He won on his proposal, and we turned 
around and in our reconciliation bill we won, with Senator Cohen being 
a cosponsor of Senator Pryor's and arguing in favor of ours.
  I do not see why we ought to have any further argument. We are 
willing to accept the Senator's motion. He would like to have a vote, 
but I can assure him, there will be 100 in favor--well, if they are 
here. We are going to tell every Republican to vote for it. Senator 
Pryor is making some headway, at least he thinks he is.
  There has been an argument on the floor about taxation and Medicare, 
sort of tying the two together, implying that we are reforming Medicare 
to save money so we can cut taxes.
  Mr. President, and fellow Americans, let me say once and for all that 
the reconciliation bill, which they seek to instruct us about, does not 
need instruction on that issue, because what we have done in 
conference, that will come to us in the reconciliation bill, is nothing 
but a simple proposition that says none of the savings that come in 
part A or part B--so none of the savings in Medicare that come from 
anywhere in Medicare--can be used for anything other than Medicare. In 
other words, we have created a lockbox, a trust, if you would like, and 
not only did we leave in that trust fund what we saved in part A 
hospitals which belongs there, but the savings that will accrue because 
of part B--that is the everything but hospital insurance coverage for 
seniors--whatever we save there will all go into the trust fund.
  Somebody might stand up and say, ``Well, that can't be, Senator 
Domenici, because we have never done that before.'' And that is right. 
We have never taken the taxpayer part of Medicare and put it into the 
trust fund. It has only been the entrusted money that went there.
  But what we are saying now is that all of their savings go into the 
trust fund to preserve, protect part A hospital coverage. What can we 
say when we have done that? When we have done that, there is not any 
need to instruct us. So if there is an instruction telling us not to 
use any of Medicare savings for tax cuts, we will accept the 
instruction, because we are not going to do that.
  We have decided that we want to make the trust fund solvent for more 
than just a few years. So we are going to make it solvent until 
somewhere around 2010 and to 2015.
  So, seniors, as you hear all of these things about the Republican 
plan, what we are doing is taking every single penny, dime, nickel, 
dollar, hundreds of thousands or billions, we are taking every bit of 
that savings and putting it into Medicare hospitalization so it will 
not go bankrupt.
  I cannot do it any better than that. When the bill comes to the 
floor, we will read you the language so that you will understand 
unequivocally, those who want to attack this plan can still run around 
and say, ``You are using Medicare savings to cut taxes,'' but if you 
read the law, it says you cannot do that because it says every bit of 
savings in Medicare stays in Medicare.
  We cannot be any more certain of what our intentions are, any more 
certain of what we want to do on Medicare than to go the exceptional 
mile where never before have we put in that hospital trust fund dollars 
from the general taxpayer. But we are doing it here to the extent that 
we are savings taxpayers' dollars. We are putting the savings in that 
trust fund.
  I am not sure what all these instructions are. My good friend, the 
occupant of the chair, has been here during the day, but to the extent 
that there is an instruction telling us to make sure we are not 
cutting, reforming, changing 

[[Page S 16984]]
Medicare to cut taxes, whatever that instruction is, we are going to 
accept that, too.
  If we can sort it out here, we are going to give whoever proposed it 
a resounding 100 votes, because we have already done it. We have made 
sure that we cannot use Medicare savings to cut taxes.
  Now, in a while, I will wrap up the other ones and see how I can 
inform our Senators as to how to vote. For now, I yield the floor.
  Mr. KENNEDY. Mr. President, I yield myself 2 minutes, or until the 
Senator from Arkansas returns.
  Mr. President, the fact of the matter remains that if they found the 
savings and premiums did not go up, in this particular instruction, 
some $52 billion--if they did not go up, the tax breaks would not be 
there, would they, I ask the Senator?
  Mr. DOMENICI. They might be.
  Mr. KENNEDY. It is not a question of might or might not. My 
understanding is that in order to condition the tax breaks, the other 
provisions of the Republican budget had to be achieved and accomplished 
before the instructions went to the Finance Committee.
  Mr. DOMENICI. That is correct.
  Mr. KENNEDY. The point is made. If they do not have this money, you 
do not get the large tax breaks. So, senior citizens, understand that 
they are taking your money right out here, as the chairman of the 
Budget Committee just said, putting it in some kind of box on the way 
into the pockets of the wealthiest individuals and corporations.
  The Senator from New Mexico has just reconfirmed what we have been 
saying this whole time. If they did not have this increase in the 
premium, you would not have the tax breaks for the very wealthy. You 
can describe that in whatever way.
  Mr. DOMENICI. I did not agree with that. It was another statement you 
made. I will explain the tax cuts in just a moment.
  Mr. KENNEDY. Mr. President, I yield whatever time the Senator from 
Arkansas wants.
  The PRESIDING OFFICER. The Senator from Arkansas is recognized.
  Mr. PRYOR. Mr. President, I thank my friend from Massachusetts for 
yielding to me. I also thank my friend, the Senator from New Mexico, 
for his statement about the nursing home standards. I hope that we will 
have a 100 to 0 vote on that in a few minutes, after the Senate resumes 
its voting process. I am very grateful for all of the support that we 
have had throughout the country to retain the present standards.
  Mr. President, I want to talk about one other aspect of the Kennedy 
proposal that I strongly support. In fact, I support each of his very 
splendid proposals within this motion to instruct the conferees. But 
there is one specifically that I think deserves attention and emphasis 
at this point.
  Before 1991, State Medicaid programs faced an intolerable situation. 
Since 1951, they were forced to pay the very highest prices for 
prescription drugs in the country. The irony was that these States and 
their Governors were buying medicines from the pharmaceutical companies 
for the very lowest-income families in the country. Alone, they could 
not afford these life-saving medications. Medicaid provided a lifeline 
for their well-being and their quality of life. But because the drug 
companies refused to negotiate with State Medicaid programs on price 
discounts, these programs were paying the highest prices in the 
country.
  Something important changed in 1991, something very like the nursing 
home standards enacted in 1987. A coalition of individual Senators and 
Congressmen got together from both sides of the aisle and enacted 
something called the Medicaid prescription drug best-price rebate 
formula. Instead of being forced to pay the highest prices in the 
country, we told the States that they could purchase their prescription 
drugs at the best prevailing price in the country. We guaranteed that--
if the companies would not negotiate in good faith--the States would be 
assured of rebates justified by the large volumes of drugs they 
purchased and the acutely vulnerable populations they served.
  Let me emphasize, Mr. President, how important a change this was for 
the States. The Congress said that it would be the policy of our 
country to assure that States receive the best possible prices on 
medicines for the poorest of the poor. We struck a deal, and that deal 
has worked remarkably. It has been a remarkable work of efficiency and 
of fairness. I know of no State that does not appreciate and value this 
program. It has allowed the States, for the first time, to negotiate 
with real leverage with the pharmaceutical companies.
  Since 1991 alone, the States--including Wyoming, Arkansas, Michigan, 
and Massachusetts--have benefited to the extent of $5 billion in 
rebates from the pharmaceutical companies. These funds have gone 
directly to the States to help them support the poorest of the poor 
within our population.
  That is not the end of the good aspects of this program, Mr. 
President. The Congressional Budget Office estimates that, over the 
next 7 years, the States are going to gain another $12 billion in 
rebates. This is a tremendous boon to the States and their Medicaid 
programs.
  Mr. President, this is an amazing breakthrough. It is a program that 
has worked, and it has worked well. The Governors have lauded this 
program. They have come to Washington to testify on behalf of keeping 
this program. The Medicaid directors--those who work daily with a 
diminishing number of dollars--say that Medicaid rebates are one of the 
best things that ever happened to them.
  Let me repeat: Prior to 1991, we were paying the highest drug prices 
for the poor. The Medicaid rebate program was the first break that the 
States had in this intolerable situation. Today, billions of dollars a 
year are paid to the pharmaceutical companies by the Medicaid program. 
This is the one opportunity for the pharmaceutical companies to do 
their share--their fair share, I might say--of contributing to helping 
the poor and to assisting those who cannot afford their medicines. This 
is their one chance at justifying some of the very lavish tax breaks 
that we are about to give to some, in my opinion, who should not be 
getting tax breaks under the Republican proposal.
  But let me tell you what has happened in the past few weeks. The drug 
industry has lobbied intensely to water the rebate program down. There 
are changes proposed by the other side of the aisle which could 
jeopardize the progress we made in 1991, as well as the progress we 
have subsequently made on behalf of the Department of Veterans Affairs, 
Indian Health Service, Public Health Service, and other Government 
programs.
  The Senate language would strip flexibility and choices from the 
States, prohibiting them from negotiating the deepest possible 
discounts. The House language allows drug companies to ignore the needs 
of the Department of Veterans Affairs, the Public Health Service and 
Indian Health Service. The House would also exempt nursing home drugs 
from rebates outright--gutting the Medicaid program and forcing States 
to pay far more for 70 percent of their drug purchases.
  Tens of billions of dollars are being expended every year, and we are 
on the verge of taking away the leverage in spending those tens of 
billions of dollars. We are proposing to take leverage away from the 
States, the Veterans Administration, the Public Health Service--they 
are going to be cut adrift. They will be forced to say to the public, 
we are sorry, we don't have the leverage anymore to negotiate. The 
playing field has been tilted against the poor and in favor of the most 
profitable industry in the world.
  This would be a terrible thing, Mr. President, if we were to weaken a 
highly successful program which was born in a bipartisan spirit, has 
saved billions in taxpayer's money and which has been kept together by 
people who truly share the belief and the commitment to raising the 
quality of life of those who urgently need medicines but lack the 
resources to obtain them.
  What will we be left with, Mr. President? A hollowed-out Medicaid 
rebate program that serves the drug industry more than the poor. 
Draconian restrictions on the number of drugs we can dispense to 
children and families under Medicaid. A free license to companies to 
ignore veterans, AIDS patients, and those served in America's public 
hospitals and community health centers. 

[[Page S 16985]]

  In conclusion, Mr. President, I ask my colleagues to consider this 
one fact. Rebates have allowed us to expand the reach of Medicaid and 
the Veterans Health Administration and the Public Health Service. They 
have served the neediest in our country--and have done so efficiently. 
What we are doing today is turning our backs on that progress. Instead, 
we want to give an additional windfall to the pharmaceutical companies 
and allow them the opportunity to escape paying rebates back to the 
States.
  Once again, Mr. President, I do not know why we are doing this. It is 
a program that has worked. It is a program that the Governors support. 
It is a program that the Medicaid directors support. It is a program 
that we should keep as it was passed in 1991. We should not change it.
  I am very hopeful that the Senate will adopt Senator Kennedy's motion 
to instruct the conferees to keep the concept of buying Medicaid drugs 
at the best possible price, to preserve the States' leverage in serving 
taxpayers, and to allow the pharmaceutical companies of America to 
participate in contributing to this tremendous cause.
  I understand there is a possibility that Senator Dorgan of North 
Dakota may want a few moments. At this time, Mr. President, I yield 
back my time to my distinguished colleague from Massachusetts.
  Mr. KENNEDY. I will yield myself a few minutes until the Senator from 
North Dakota arrives.
  I want to again express the appreciation of all the Members to 
Senator Pryor from Arkansas. He was the Senator that really worked out 
a bipartisan, cooperative agreement with the pharmaceutical companies 
so that those whose lives depend on many of these prescription drugs, 
among the poorest of the poor in our country, were not going to be 
denied being able to receive those prescription drugs, and to work that 
discount out.
  We have been able to extend the rebate program. It applies to the 
black lung clinics. It applies to the neighborhood health centers that 
serve 6 million of the poorest Americans. We worked that out 2 years 
ago, and we had bipartisan support and also had the support of the 
pharmaceutical industry.
  Now all of that is effectively being wiped out--over $200 million a 
year will be lost in terms of the public health clinics. I hope that we 
would say--this should be done, as I understand, with hearings or 
justification.
  We have yet to hear why there is suddenly this very important need to 
wipe this kind of protection out--whether the poor are getting 
wealthier, whether there are less uninsured, we are moving beyond the 
needs of the poorest.
  Quite frankly, every indication is to the contrary. The total number 
of uninsured are going up, the number of poor children and generally 
needy people in our society is going up.
  I am just interested, since the Senator from Arkansas is a member of 
the Finance Committee, if he would just review with me and correct me 
if he believes I am wrong on this point, that the Medicare part B 
premium is really very much a part of Social Security.
  I remember when we heard long speeches in this body about how we were 
not going to take away or touch Social Security. It is my understanding 
that next year the Social Security COLA would be $139 for those Social 
Security recipients that are receiving $5,300 a year. That is $139 for 
a COLA to offset the increases in the cost of living, which the seniors 
have no ability to control.
  The increase in the part B premium for next year is expected to be 
$136, so if you take the $136 which the seniors will have to pay in 
this new kind of tax, and put that under their $139 in new dollars, 
they will have for a COLA, they end up with $3.
  In a very real way, this is diminishing or adding an additional tax 
on Social Security. The neediest recipients of Social Security would 
have received $139; but at the end of the day they only have $3, and 
effectively the increase in premiums is taking 98 percent of the COLA.
  An average Social Security recipient receiving $7,800, will receive a 
COLA of $205. You subtract $136 for their premium increase and end up 
with $69, which means 66 percent of their premium will be taken.
  Even those that get $10,000 in Social Security benefits--which is 
about the highest level--get a COLA of $261; take $139 from there and 
that leaves $125. So their COLA is effectively cut in half.
  Does the Senator agree with me that these are real dollars for Social 
Security recipients, and that with the increase in the premiums that 
are being suggested by the Republicans, this, in effect, is an 
additional tax? You can call it a fee or premium or whatever, but you 
are taking the money out of the paychecks of Social Security 
recipients.
  Mr. PRYOR. Mr. President, if I may respond to my friend from 
Massachusetts, I think he is precisely on point. He is exactly right.
  In addition, I might like to add just one more factor. I believe that 
something like 60 percent of all of the Social Security recipients are 
on a fixed income. They cannot go out and sell some more shoes or sell 
some more cars or do this or do that to increase their resources 
because they are locked in to an income.
  If we take this money from their Social Security by essentially 
adding a tax to their part B premium, and add it to the dilemma of 
trying to survive today, paying the costs of getting by, and paying the 
costs of food and the tremendous escalating costs of their medicines, 
we are going to impoverish many of our seniors today on Medicare.
  I want to salute the Senator from Massachusetts for bringing this to 
our attention. I wanted to elaborate to some extent on the number who 
were on fixed incomes.
  Mr. KENNEDY. Mr. President, I yield myself 1 final minute and 
hopefully the Senator from North Dakota will be here.
  Mr. President, it is irresponsible, then, for the Republicans to 
threaten to shut down the Government if they do not get the unfair 
increases they want in the Medicare premium.
  I say, ``shame, shame'' on the Republican Party. Nothing more clearly 
demonstrates the harsh and extreme nature of their right-wing agenda 
for Americans than this attack on senior citizens and the willingness 
of Republicans in Congress to shut down the Government itself if they 
do not get their way.
  I yield the floor.
  Mr. DOMENICI. I yield 5 minutes to the Senator from Wyoming.
  Mr. THOMAS. Mr. President, I express some concern about the 
continuing opposition to change that I hear here on the floor. Some 
concern about how in the world we are going to get a consensus in 
public policy when we have as much, I believe, misinformation as we 
have here on the floor.
  I think we really need to address ourselves, do our jobs here as 
trustees for the American people in trying to find a way to do some 
things, to make this fundamental change.
  You have to go back, it seems to me, each time we do this, to 
examining where we are. The Senator from Massachusetts who just left 
talked about having more poor people than we have had, more different 
than we have had. You cannot expect things to be different unless we 
make some change. If you want different results, you have to make some 
changes.
  We have set about in this last few months coming to a culmination, 
coming to the end, this week, the opportunity to make fundamental 
change, the opportunity to balance the budget--which I suggest my 
friends who have been here for 20 years, 30 years, have not done it for 
30 years--some fundamental change in welfare, welfare reform, the 
welfare plan than that which has been in place for 25 years. We have, 
as the Senator suggests, more poor people than we did before. We have 
to make some changes.

  Medicare? There is no question but that we have to make a change in 
Medicare. The trustees say we have to make a change in Medicare. 
Medicare has been growing at three times the rate of inflation. You 
cannot continue to do that. Obviously, we have to make some change.
  Someone on the floor a while ago used a parallel of having a home 
with no insulation and holes in the walls and cold was coming in. You 
have two choices. You can either buy more fuel and start a fire and let 
most of it go out through the hole in the wall, or you can find some 
insulation and try to fix the wall. That is what we are seeking to do. 

[[Page S 16986]]

  There is a limit to how much money you can put into health care. But 
what we need to do is fundamentally reduce some of the costs, and that 
is what we are seeking to do here in Medicare. We are seeking to give 
some choices to the elderly, choices that you and I have as Government 
employees, so they can choose appropriately; an opportunity to go into 
managed care which will be less expensive and provide excellent 
services.
  The idea that there is a tax increase, I do not quite understand. In 
1990, a Democrat-controlled Senate voted to increase part B premiums 
from 25 percent to 31\1/2\. That is where it is. But I hear from 
everyone, as if by rote, that ``you are raising taxes.'' We are not 
raising taxes at all. It is continuing at 31 percent of the premium. 
That is where we are.
  What are the words--``raising taxes so you can pay for tax breaks for 
the rich,'' 90 percent of which goes to families earning below 
$100,000. These are the kinds of things that make it difficult, it 
seems to me, to have some kind of a public policy debate when those are 
the kinds of things we talk about. They are not accurate.
  There is a reason why this matter of the part B premium is on this 
continuing resolution. The reason has to do with the ability of Social 
Security to put it in the computer and not go back to 25, to go back to 
31 in May. That is the reason it is there. It is a legitimate, 
logistical reason it is there. It is not a political reason, not a 
political reason to talk about.
  So I guess I am really enthusiastic about the fact that we are going 
to have a chance to make some fundamental change, that we are going to 
have a chance to change the programs that we see have not produced the 
kinds of things we want to have happen, to get the results that we 
want. And that is what it is all about.
  Mr. President, I urge my associates to vote in favor of our 
reconciliation and to go forward with the balanced budget proposal that 
the Senator from New Mexico has given such great leadership in bringing 
to us.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. DOMENICI. Mr. President, how much time do I have?
  The PRESIDING OFFICER. The Senator from New Mexico has 9 minutes and 
36 seconds.
  Mr. DOMENICI. How much time do the Democrats have?
  The PRESIDING OFFICER. They have 2 minutes and 19 seconds.
  Mr. DOMENICI. Senator Dorgan, if I were to yield you 2 minutes, that 
would give you 4. Would that help you out?
  Mr. PRYOR. Mr. President, I wonder if it is possible to put the 
Senate in a quorum call, not to have the time going against either 
side, for the time being? It will be very short.
  Mr. DOMENICI. What is the purpose of it? We want to start voting. 
That is the only reason I am reluctant, because I am going to start 
speaking.
  Mr. PRYOR. Senator Kennedy has been yielded this time.
  Mr. KENNEDY. How much time remains?
  The PRESIDING OFFICER. The Senator from Massachusetts has 2 minutes 
and 19 seconds.
  Who yields time?
  Mr. KENNEDY. Mr. President, I yield the remaining time to the Senator 
from North Dakota.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DOMENICI. Will the Senator like 2 additional? I will yield 2 of 
mine, just to leave me 7.
  Mr. President, so Senators and staffers will know, we are getting 
close to the time for the first vote. My colleague will speak for 4 
minutes, I will speak 7, if that is satisfactory to Senator Pryor?
  Mr. PRYOR. The leader is Senator Kennedy from Massachusetts.
  Mr. KENNEDY. We are fine. That is perfectly agreeable to me because 
there is no other alternative.
  Mr. DOMENICI. I yield 2 minutes to Senator Dorgan.
  The PRESIDING OFFICER. The Senator from North Dakota has 
approximately 4 minutes.
  Mr. DORGAN. Mr. President, we have had a healthy discussion on the 
floor of the Senate today about four sense-of-the-Senate resolutions 
which we have been trying for some weeks actually to offer. We do this 
because we are concerned about the priorities. I know some have been on 
the floor of the Senate saying one side wants a balanced budget and the 
other side does not care. Of course, that is not the case. The question 
is not whether we ought to balance the Federal budget. Of course we 
ought to do that. The issue is priorities. What kind of choices do we 
make? How do we balance the Federal budget?
  Somebody says, ``Here is our destination.'' We say, ``Fine. We agree 
with the destination.'' But there are a lot of different roads to get 
to the destination. Among the discussions we have had this afternoon 
are issues of Medicare, the use of Social Security funds, and the 
Senator from New Mexico and I have talked previously about the use of 
Social Security funds. We will probably not agree on that issue. But I 
do not think those of us who raise these questions have ever been 
wrong. I just want to go back for a couple of minutes on this issue of 
Social Security.
  It was 1983 that we passed a Social Security reform package. I happen 
to know that because I was on the Ways and Means Committee in the House 
at the time, and I happen to remember the day we did it because in the 
House, when we marked it up, I offered the amendment, the amendment in 
the Ways and Means Committee that was defeated.
  That said, if you are going to raise extra money each year for Social 
Security and call it Social Security revenue and put it in a trust 
fund, take it out of workers' paychecks and say, ``We promise you we 
will keep it for the Social Security system,'' I said let us make sure 
it is not misused later.
  That was 12 years ago, and every year since, as we began to accrue 
these surpluses, every year since it has been used as an offset against 
operating revenue in the Federal budget. That is just a fact. That is 
not something we ought to debate. That is a fact.
  The argument I hear on the other side is it has been done over all 
these years so let us keep doing it. That is an argument for business 
as usual. This ought not be business as usual, and we ought not 
continue to take money out of the Social Security trust funds to use to 
balance the Federal budget.
  I showed a chart on the floor here 1 day. I should have brought it 
back today. It has a little arrow on it. It says you cannot use money 
for two different things. Double-entry bookkeeping does not mean you 
can use the same money twice. Either the money is going to be in the 
Social Security trust funds or it is not. It is going to be used over 
here, in the operating revenues for the Federal budget, or the Social 
Security trust funds. They are going to be used one place or the other, 
not both. Regrettably, what we have in the coming year is the use of 
the Federal trust fund money over here in the operating revenues. And I 
have thought it was wrong since 1983. I have addressed it 
legislatively. I have offered amendments on it. It is wrong now. It is 
going to be even more wrong in the future because each year this amount 
of money grows.

  So what you have here is a legislative sleight of hand of those who 
say we are going to balance the Federal budget, in effect, in the year 
2002. Even under the most optimistic assumptions, you will still have a 
$110 billion budget deficit.
  The Senator from New Mexico knows that on page 3 of the budget report 
that came to the Congress, it has a section called deficits. You go to 
2002, on page 3, and evaluate what is this deficit? It is $110 billion. 
That is what they say, not me. Why? Because, in order for them to say 
zero, they had to take that money from the Social Security trust fund 
and use it--or misuse it. That is the issue. They are funny about their 
issues--the issue of education, which I think is important. The issue 
of part B premiums is what is holding us up at the moment.
  As you know, among other things, the circumstances in which the 
majority party says we insist on this legislation, this stopgap 
legislation, insist on increasing the part B premiums, makes no sense. 
They ought to pass a clean stopgap bill, send it to the President, and 
let us stop this. This makes no sense.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico is recognized. 

[[Page S 16987]]

  Mr. DOMENICI. Mr. President, let me first talk about the issue of 
whether we have a balanced budget or not. The distinguished Senator has 
just addressed the issue of whether we do or do not because of the 
trust fund.
  Let me remind everyone who is listening and wondering about this 
contentious issue that the trust fund must not be ignored. What is in 
that trust fund should not be used to balance the budget. The President 
of the United States sent us a budget when he first went into office. 
He used the trust fund as part of the unfunded budget. He sent us a 
budget this year. He did it 3 months later, claiming it was in balance. 
He used the trust fund. Mr. President, every President since I have 
been a Senator used it in the exact same way. The Republicans used it 
in the exact same way.
  Lo and behold, 19 Democratic Senators on the floor of the Senate, 
courageous Democrats, produced a balanced budget. One of them happened 
to have as a cosponsor along with the distinguished Senator, Senator 
Simon, his fellow Senator from his State as a cosponsor. And what kind 
of budget was that in terms of a balance? That was the exact same kind 
the Republicans produced and all the Presidents produced. There was no 
difference. It treated everything just like it has been treated before, 
excepting now the distinguished Senator, Senator Dorgan, insists that 
we are not in balance.

  Frankly, I do not think the American people understand the argument, 
nor do they care about it. We are making such a gigantic step in the 
direction of a balanced budget that I do not think anybody is going to 
ask us to do more. That is essentially the argument--that we ought to 
do more. We have not done enough.
  Why are we on the floor now? The U.S. Senate passed a reconciliation 
bill, a big law change, to change the laws so we can get to a balance. 
That already passed. We voted on 58 amendments. There might have been 
two or three of them who were Republican. They had every opportunity to 
vote. They lost. They might have won one or two.
  When we are all finished, they want another day on the floor of the 
Senate. So now they say, let us instruct the conferees, the ones who 
are going to go off and meet with the House who have already been 
meeting--who have already finished the budget--but for another meeting. 
They want a chance to tell them what to do by virtue of motions to 
instruct. This is nonbinding.
  It is also a desperate act of, let us get one more opportunity on the 
floor of the Senate to make some charges and allegations.
  So we say, fine. Have at it.
  I am pleased to tell those who offered all of these instructions, 
including my good friend, the Senator from Florida, Senator Graham, 
that I am going to urge that every Republican Senator vote for his 
instruction. So if he is worried about it, he should know that he is 
going to win tonight. He is going to win because, in our opinion--and 
we are going to tell the Republicans--nothing in our budget bill 
violated the Budget Enforcement Act.
  Second, we do not include anything in the conference report that 
violates that section that he refers to. And, lo and behold, we did not 
use $12 billion in Social Security cuts to balance the budget. So we 
are going to vote for it, and the Senator's instruction, albeit after 
the fact, is going to be noted and well taken. So I thank him for that.
  I offered Senator Kennedy a proposal that we take all of his, except 
one. So if anybody wonders how this big argument--he has about 10 
provisions. We said we did all of them in our reconciliation except one 
with reference to balanced billing. So if we have to vote no on Senator 
Kennedy's long list, it is because we do not agree on balanced billing. 
But on all of the rest, we agree. If he would agree to strip that, we 
will even vote for his instruction tonight. I will leave that for him 
to decide here in the next few minutes.
  That leaves Senator Pryor. I have said we are going to vote for that. 
And I say to the Senator, I was thinking of what I said. I am not 
saying we did every single thing that he is recommending in his 
instruction. I am saying we went as far as we could go, and we will 
accept the instruction since it is not binding. We will say we told the 
conferees to do their very best on his instructions, and I think for 
the most part it is going to be found to be rather close to what he 
wants. But I did not want him to think we adopted his exactly.
  That means that we are not going to go with Senator Rockefeller, who 
has something in his saying we should only raise $89 billion to make 
part B solvent. So he would like to make it solvent for only a few 
years.
  Mr. PRYOR. Mr. President, will the Senator yield?
  Mr. DOMENICI. Let me finish my last reasoning since I did not have 
any time, and I will get back to the Senator. I do not want to run out 
of time.
  So essentially the one we cannot agree to is we cannot agree to 
Senator Rockefeller's for one reason. He said we should only make the 
part A coverage solvent to the extent of $89 billion put back into it. 
We are putting a lot more back into it because we want it to be solvent 
until the year 2010, maybe even 2015.
  So we could not agree to that. The last part of his we would agree 
to. He says, do not use any of these to raise taxes. We did not. We put 
all of the Medicare savings back into Medicare. So, but for that, we 
could even vote for his but we will have to vote no on that.
  If Senator Kennedy will modify his, the Democratic Senators will have 
their great victory this afternoon. We will vote for them--all three.
  Mr. KENNEDY. Mr. President, if the Senator will yield for 30 seconds, 
no one is more accommodating than the Senator from New Mexico in 
attempting to try to find common ground. But the issue on the double 
billing is one of extreme importance.
  Now, of course, beneficiaries are not permitted to be charged above 
the reimbursement for Medicare. And it is my understanding from 
reviewing the language that under the proposal that is being discussed 
in conference there can be additional charges to senior citizens. But 
we want to retain current law.
  All my legislation does is effectively retain current law. But, as I 
understand it, that is not the position of the Senator, the chairman of 
the Budget Committee.
  Mr. DOMENICI. We will have a vote on the Senator's instruction. I 
thank the Senator.
  Let me close by saying that this argument that we are having on the 
floor has nothing to do with these instructions. It has to do with 
whether or not we are going to get a balanced budget in 7 years using 
valid economics and using valid assumptions on what Government will 
cost. We have done that. We have used the Congressional Budget Office, 
and we will actually have a balance. And we are able to give the 
American taxpayers $245 billion back in taxes.
  Let me say that while I cannot reveal the details of the conference, 
lo and behold, 90 percent of the tax cut is going back to middle-income 
Americans. So if there was any fear that we were going all the way to 
the House side, we did not. As a matter of fact, $75,000 is the 
earnings for a single head of household for the child care credit. And 
the rest of it, 90 percent, will be for middle-income Americans.
  We will have capital gains in. For those who do not like that because 
some of it goes to rich people, that is just going to be the issue. But 
essentially we are passing a budget not for today, not for seniors, not 
for cowboys, not for ranchers, not for schoolteachers, but for everyone 
in America, in particular our children. Whatever they do in their 
lives, we are hoping they will have a better life than we. And we do 
not think that is the case with $200 billion deficits as far as the eye 
can see. That is the real issue.

  We are delighted to have another debate on it. In a few days we will 
bring the bill here on the floor, and we will have another 5 hours of 
debate. We hope we can send to the President a real balanced budget.
  Mr. PRYOR. Mr. President, parliamentary inquiry: Have we appointed 
conferees from this body to a conference on reconciliation? Has the 
Senate appointed conferees?
  The PRESIDING OFFICER. The Senate has not.
  Mr. PRYOR. So if we do not have any conferees, Mr. President, we do 
not have a conference. Is that correct?
  The PRESIDING OFFICER. The Senator is correct. 

[[Page S 16988]]

  Mr. PRYOR. The Senator from New Mexico keeps talking about ``we'' 
have decided, that ``we'' have decided that. But yet, there is no 
conference because there are no conferees.
  Mr. DOMENICI. The Senator is correct.
  Mr. PRYOR. Who does the Senator speak of when he is talking about 
``we'' have decided this?
  The PRESIDING OFFICER. That is not an appropriate parliamentary 
inquiry.
  Mr. DORGAN. Mr. President, may I ask the Senator from New Mexico for 
his comment----
  Mr. DOMENICI. We are out of time. I will be pleased to correct the 
record.
  Mr. PRYOR. Mr. President, I ask unanimous consent that the Senator 
from New Mexico be allowed to answer my question in 1 minute.
  Mr. DOMENICI. Could I ask for 1 minute for Senator Cohen to put a 
statement in the Record?
  Mr. PRYOR. I would be glad to.
  Mr. DOMENICI. Does the Senator from Maine wish to include a statement 
in the Record?
  Mr. COHEN. I will withhold.
  Mr. DOMENICI. Mr. President, fellow Senators, just as the Democrats 
did last year when they put together the President's package with the 
largest tax increase in history, only Democrats really put the package 
together. I happened to have been a Member. I was not invited to that 
meeting. When it was finished, they called a meeting and said it is 
finished.
  So what we have been doing is meeting informally because we know we 
are going to have to write this package. We worked very hard day and 
night, all weekend, and when we finally got together tonight we could 
not appoint conferees because these motions were in the way. They 
wanted to have this debate today first.
  So as soon as it is finished, we will appoint the conferees, and in 
due course during this week the conferees will meet and they will put 
together, ratify, and approve a conference report.
  Mr. DORGAN. Mr. President, if I might ask a question, as soon as the 
conference is finished, they will appoint conferees?
  The PRESIDING OFFICER. The 1 minute has expired. Any debate at this 
point would require a unanimous consent.
  All time has expired.
  The Senator from Maine has 1 minute.
  Mr. COHEN. Mr. President, during the Senate debate on the budget 
reconciliation bill I offered an amendment with my colleague from 
Arkansas, Mr. Pryor, to retain strong Federal standards for nursing 
homes and I am pleased that the Senate-passed budget reconciliation 
bill maintains the tough Federal standards that are currently in place 
to protect elderly and disabled individuals living in nursing homes. 
The continuation of OBRA '87 nursing home standards in the Senate bill 
is a major victory for today's 2 million nursing home residents, and 
tomorrow's growing elderly and disabled population.
  A few weeks ago I chaired a hearing of the Senate Special Committee 
on Aging to examine the need for strong Federal quality of care 
standards in nursing homes. The testimony from family members and 
expert witnesses convinced me more than ever that the Federal 
Government must continue to play a central role in monitoring and 
enforcing nursing home standards.
  The law provides a framework through which facilities can help each 
resident reach his or her highest practicable physical, mental, and 
general well-being. It also provides critical oversight and enforcement 
of nursing home standards, following years of evidence that the States 
simply did not make enforcement of nursing home standards a high 
priority.
  While the bill originally reported by the Finance Committee required 
that States include certain quality of care provisions in their 
Medigrant State plans, I had strong concerns that many of the important 
OBRA '87 provisions were eliminated and that the bill lacked adequate 
Federal oversight and enforcement of nursing home standards.
  Therefore, I worked with the Republican leadership and many of my 
colleagues on both sides of the aisle to ensure that this bill keeps 
intact the standards, enforcement, and Federal oversight now contained 
in current law.
  During the debate on the reconciliation bill and since its passage, 
the nursing home standards provisions contained in the Senate bill have 
been attacked as inadequate and a return to the days when nursing home 
residents were tethered and overdrugged. It is unfortunate that my 
colleagues on the other side of the aisle have chosen to play on the 
strong emotions and fears of families of nursing home residents. They 
argue that the waiver provision included in the Senate-passed bill is a 
veiled attempt to gut nursing home enforcement. I want to assure my 
colleagues that, while I would prefer that a waiver not exist, this is 
simply not true.
  An article appeared today, entitled, ``GOP Health Reforms Leaving 
Nursing Homes Behind. Both the House and Senate Budget Plans Propose a 
Wholesale Repeal of Important Nursing Home Standards First Passed in 
1987,'' paints a distorted picture of the facts. The headline leaves 
the clear impression that both the Senate and House plans are callous 
and have turned their backs on nursing home residents. The article then 
goes on to attack the waiver process in the Senate bill as a plan to 
eliminate the Federal nursing home standards which we have all fought 
so hard to achieve.
  Let me set the facts straight for the record.
  First, the Senate bill continues Federal standards and enforcement. 
To lump the Senate provisions as being as bad as the House bill is 
simply unfair. The Senate recognized the need to maintain Federal law 
and did so in its reconciliation bill.
  Second, the Senate-passed bill does provide for States to receive 
waivers from the Federal nursing home reform law, but these are 
provided in only very limited circumstances. Specifically, a State may 
apply for a waiver of standards only if its standards are equal to or 
more stringent than the Federal requirements. The amendment clearly 
indicates that no such waiver is allowed unless the Secretary approves 
the waiver, and only if the standards are equal to or more stringent 
than the Federal standard. Further, the provision specifies that 
waivers allowed under this section in no way waive or limit the Federal 
Government's enforcement of tough nursing home standards, patient 
protections, and other provisions of OBRA '87 against the States or the 
nursing homes.
  Under the Senate-passed bill, even if a State obtains a waiver, the 
Federal Government retains the authority to go into specific facilities 
and impose penalties. Specifically, the Federal Government can still: 
perform look back inspections, through which the Federal Government 
reinspects a percentage of nursing homes already inspected by the 
States to determine if the States are adequately enforcing OBRA '87; 
enter any nursing home facility to ensure compliance with OBRA; 
terminate a facility's certification for Medicaid if conditions in the 
facility causes an immediate harm to residents; fine a facility if the 
nursing home is not complying with Federal law; terminate or suspend a 
waiver of any State that is not enforcing the Federal nursing home 
standards or has standards weaker than the Federal law.
  Colleagues on the other side of the aisle argue that the Secretary 
does not retain these rights and that the Federal Government is unable 
to enforce Federal standards against individual facilities. I maintain 
that this is simply not correct under the language of the Senate-passed 
provision and have been urging the leadership to clarify this in 
conference so there will be no doubt of the intent. Rather than working 
constructively to support and clarify this language, however, those on 
the other side of the aisle have decided that they can score more 
political points if they provide strained readings of the provisions, 
energize opposition among the nursing home patients' groups, and paint 
a picture of all Republicans trying to roll back standards and 
enforcement.
  The fact is that States are now allowed to apply more stringent 
standards than the Federal Government under current law. So the waiver 
really gives nothing to a State--other than the option of requiring 
nursing home standards that are tougher, with the Federal Government 
looking over the shoulder of the State and facility every 

[[Page S 16989]]
step of the way. While I strongly share the concern of my colleague 
from Arkansas that States have not had a good history of enforcing 
standards in nursing homes, the law should not automatically assume 
that tough enforcement by States--with full monitoring and full 
enforcement by the Federal Government of standards--is absolutely 
impossible.
  Some critics also question whether a State could receive a waiver if 
its standards as a whole--rather than each and every standard--for 
nursing homes were equal to or more stringent than the Federal 
standards. I believe that the language in the Senate-passed bill means 
that each standard must be equal to or more equivalent to the Federal 
standards in order to qualify a State for a waiver. Again, I would 
support language to even further clarify that this is the intent--but 
we should do this in an effort to clarify and strengthen the bill, 
rather than suggesting that there is a veiled effort to create 
loopholes for nursing homes.
  In addition, under the Senate-passed bill the Secretary is given 120 
days to approve or disapprove a waiver application from a State. 
Opponents challenge this provision as perhaps allowing a State waiver 
to go into effect by default if the Secretary does not act within this 
time frame. This interpretation is a far stretch, since as my 
colleagues well know, under current law similar waivers are not granted 
by default if the Secretary does not expressly approve the waiver.
  As I stated on the floor during debate on the reconciliation bill, I 
am pleased that the amendment that I cosponsored to preserve the 
current Federal law on nursing home standards was adopted and I 
supported the Roth amendment to the bill only because I believe that 
the waiver provisions contained in it do not undermine strong Federal 
enforcement and standards. I assure my colleagues that I will continue 
to press for strong Federal standards and enforcement, and will not 
support a conference report on the budget reconciliation bill that I 
believe will dilute either Federal standards or Federal enforcement 
against States or individual facilities.
  Mr. President, I intend to support the motion of the Senator from 
Arkansas, but I also want to indicate I believe that there has been a 
distortion of what the Senate did last week. The indication is that 
somehow the Republicans have been less than concerned about nursing 
home residents and their rights and the standard that will be applied 
to make sure that at the very highest levels we maintain Federal 
enforcement obligation.
  I wish to assure my colleague from Arkansas that the measure which 
passed--both measures--and I supported, and the Republican substitute, 
will insist upon standards that States can measure up to are higher 
than Federal standards. We still retain Federal enforcement rights. I 
believe you are insisting there be no waivers, but I wish to assure you 
that Republicans, by no means, are going to tolerate any diminution of 
either standards or enforcement by the Federal Government.
  Mr. PRYOR. If the Senator will yield, does the proposal that the 
Senator has accepted contain waivers by States?
  Mr. COHEN. The proposal that was voted last week in the Senate 
allowed for States that either had equal to or greater standards to 
apply for a waiver that could be granted but only if the Federal 
Government retained enforcement standards, enforcement rights. That is 
the measure we debated.
  Mr. PRYOR. That is a change of which I wish to warn my colleagues.
  The PRESIDING OFFICER. All time having been consumed, the question is 
on agreeing to the motion of the Senator from Massachusetts.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. I have a unanimous consent request. I ask unanimous 
consent that the votes occur in the order in which they were deferred 
and that there be 2 minutes equally divided between each motion to 
instruct.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  Mr. DOMENICI. I thank the Chair.


                   Motion to Instruct--Nursing Homes

  The PRESIDING OFFICER. There is now 2 minutes to be equally divided 
on the Senator's motion.
  Mr. PRYOR. I thank the Chair.
  Mr. President, what we are faced with right now is whether we are 
going to retain the Federal standards as adopted in OBRA 1987. These 
are high standards. They are accepted standards. They are understood 
standards. They are standards that apply across this great country, 
across this wide land of ours in each of our 50 States.
  In my opinion, to relax these standards is going to be a statement 
that we are making to 2 million nursing home residents that we do not 
care enough about their safety to retain these high standards.
  I have just seconds ago been informed that even though I had been 
told earlier my motion would be accepted as is, there is going to be 
the possibility of relaxation of some enforcement provisions made by 
the Republicans in their so-called conference, and the conference does 
not even exist with the Democrats. So this is our last opportunity. I 
hope we will support the motion that is before the Senate at this time.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. I waive my 1 minute.
  The PRESIDING OFFICER. The question is on agreeing to the motion. The 
yeas and nays are already ordered on this motion.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
who desire to vote?
  Mr. LOTT. I announce that the Senator from Texas [Mr. Gramm], the 
Senator from Vermont [Mr. Jeffords], and the Senator from Indiana [Mr. 
Lugar] are necessarily absent.
  The result was announced--yeas 95, nays 1, as follows:

                      [Rollcall Vote No. 570 Leg.]

                                YEAS--95

     Abraham
     Akaka
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Dole
     Domenici
     Dorgan
     Exon
     Faircloth
     Feingold
     Feinstein
     Ford
     Frist
     Glenn
     Gorton
     Graham
     Grams
     Grassley
     Gregg
     Harkin
     Hatch
     Hatfield
     Heflin
     Helms
     Hollings
     Hutchison
     Inhofe
     Inouye
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Kyl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lott
     Mack
     McCain
     McConnell
     Mikulski
     Moseley-Braun
     Moynihan
     Murkowski
     Murray
     Nickles
     Nunn
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Simon
     Simpson
     Smith
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner
     Wellstone

                                NAYS--1

       
     Ashcroft
       

                             NOT VOTING--3

     Gramm
     Jeffords
     Lugar
  So the Pryor motion to instruct conferees was agreed to.


                      Motion to Instruct--Medicare

  The PRESIDING OFFICER. The question now occurs on the motion to 
instruct conferees offered by the Senator from West Virginia [Mr. 
Rockefeller]. The yeas and nays have not been ordered.
  By a previous unanimous consent, there is 2 minutes to be equally 
divided to explain the amendment.
  Mr. ROCKEFELLER addressed the Chair.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. I thank the Presiding Officer.
  Mr. President, this particular motion to instruct is to say to 
conferees that Medicare should not be cut by more than $89 billion, 
which is sufficient to keep it solvent to the year 2006, and that any 
money necessary to ensure budget neutrality would come from the tax 
break. That is it.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, shortly I am going to move to table the 
Rockefeller motion. Let me say to all Senators on the Republican side, 
I would have urged that you support this but for the $89 billion 
limitation, because we think we can do better and we 

[[Page S 16990]]
deserve to make the fund solvent for more than just a few years.
  So we are going to make it solvent to about 2010, maybe 2014. But as 
far as that portion of this that says we should not use Medicare to cut 
taxes, I can assure you that we are not doing that. We have put all the 
Medicare savings back into the Medicare trust fund, even those that 
come from the general taxpayer for part B, so we are not using any 
Medicare savings for tax cuts.
  Mr. President, I move to table the Rockefeller motion and ask for the 
yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. The question is on agreeing to the motion to 
lay on the table the motion of the Senator from West Virginia to 
instruct conferees. The yeas and nays have been ordered. The clerk will 
call the roll.
  The legislative clerk called the roll.
  Mr. LOTT. I announce that the Senator from Texas [Mr. Gramm] and the 
Senator from Indiana [Mr. Lugar] are necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 51, nays 46, as follows:

                      [Rollcall Vote No. 571 Leg.]

                                YEAS--51

     Abraham
     Ashcroft
     Bennett
     Bond
     Brown
     Burns
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Coverdell
     Craig
     D'Amato
     DeWine
     Dole
     Domenici
     Faircloth
     Frist
     Gorton
     Grams
     Grassley
     Gregg
     Hatch
     Hatfield
     Helms
     Hutchison
     Inhofe
     Jeffords
     Kassebaum
     Kempthorne
     Kyl
     Lott
     Mack
     McCain
     McConnell
     Murkowski
     Nickles
     Nunn
     Pressler
     Roth
     Santorum
     Shelby
     Simpson
     Smith
     Snowe
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner

                                NAYS--46

     Akaka
     Baucus
     Biden
     Bingaman
     Boxer
     Bradley
     Breaux
     Bryan
     Bumpers
     Byrd
     Conrad
     Daschle
     Dodd
     Dorgan
     Exon
     Feingold
     Feinstein
     Ford
     Glenn
     Graham
     Harkin
     Heflin
     Hollings
     Inouye
     Johnston
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Mikulski
     Moseley-Braun
     Moynihan
     Murray
     Pell
     Pryor
     Reid
     Robb
     Rockefeller
     Sarbanes
     Simon
     Specter
     Wellstone

                             NOT VOTING--2

     Gramm
     Lugar
       
  So the motion to lay on the table the Rockefeller motion to instruct 
conferees was agreed to.


                  Motion To Instruct--Social Security

  The PRESIDING OFFICER. The question next occurs on the motion to 
instruct conferees offered by the Senator from Florida, Senator Graham. 
Under previous agreement, each Senator has 1 minute to explain the 
position on the motion.
  The Senate will please come to order.
  The Senator from Florida is recognized.
  Mr. GRAHAM. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  Mr. GRAHAM. Mr. President, this motion relates to a provision that 
was included in the last hour of our consideration of the 
reconciliation bill. That provision purported to fund $13 billion of 
new spending by utilizing funds out of the Social Security trust fund.
  This motion states that it is not our intention to dishonor the 
commitment that this Congress made in 1990 not to utilize the Social 
Security trust fund for financing the general purposes of Government 
and, therefore, instructs our conferees to desist from any actions that 
would have that effect.
  I believe this amendment is acceptable to the chairman of the Budget 
Committee. I urge its adoption.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, the first portion of his instruction we 
have never violated, so we can be instructed on it.
  The second section, we have never violated it, so we can be 
instructed not to.
  The third one, on $12 billion worth of Social Security, we did not 
think we violated it on the Senate floor. However, in the final 
product, we did not have to use that to get to a balanced budget, so I 
am recommending we vote aye on this instruction.
  The PRESIDING OFFICER. All time has expired. The question occurs on 
the motion to instruct conferees offered by the Senator from Florida, 
Senator Graham.
  The yeas and nays have been ordered.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. LOTT. I announce that the Senator from Texas. [Mr. Gramm] and the 
Senator from Indiana [Mr. Lugar] are necessarily absent.
  The result was announced--yeas 97, nays 0, as follows:

                      [Rollcall Vote No. 572 Leg.]

                                YEAS--97

     Abraham
     Akaka
     Ashcroft
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Dole
     Domenici
     Dorgan
     Exon
     Faircloth
     Feingold
     Feinstein
     Ford
     Frist
     Glenn
     Gorton
     Graham
     Grams
     Grassley
     Gregg
     Harkin
     Hatch
     Hatfield
     Heflin
     Helms
     Hollings
     Hutchison
     Inhofe
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Kyl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lott
     Mack
     McCain
     McConnell
     Mikulski
     Moseley-Braun
     Moynihan
     Murkowski
     Murray
     Nickles
     Nunn
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Simon
     Simpson
     Smith
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner
     Wellstone

                             NOT VOTING--2

     Gramm
     Lugar
       
  So, the Graham motion to instruct conferees was agreed to.


                    Motion to instruct - Health Care

  The PRESIDING OFFICER (Mr. Santorum). The question is on agreeing to 
the motion to instruct conferees offered by the Senator from 
Massachusetts [Mr. Kennedy]. Each side has 1 minute of debate.
  Mr. KENNEDY. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. There is 1 minute of debate time on each side 
on this motion before the vote.
  The Senator from Massachusetts.
  Mr. KENNEDY. I thank the Chair.
  Mr. President, this motion retains existing law in four important 
areas: In the discounts which are currently available for prescription 
drugs for our senior citizens; second, in the prohibition against 
double billing that is in existing law, so that the senior citizens 
will not be charged a cost above that designated, for example, in 
Medicare; third, in anti-fraud and abuse, to make sure that the 
existing provisions to prevent fraud and abuse to deal with those 
exigencies are preserved, which they are not preserved in the 
reconciliation bill at the current time; and fourth, in protections 
against additional costs in Medicaid, to make sure that there will not 
be additional costs for nursing home residents on Medicaid, spouses and 
their families.
  We preserve existing law in all four areas. This will save seniors 
and seniors' families billions of dollars and save billions of dollars 
for the taxpayer, and I urge its acceptance.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. I thank the Chair.
  Mr. President and fellow Senators, frankly, it is very difficult to 
ascertain from this long litany of instructions to the conferees which 
of these we really can do and which ones we cannot, and because I 
cannot discern that with certainty--and a couple of them I know we 
cannot get done in the conference in the next 24 hours--I am going to 
recommend we table the motion.
  Frankly, I believe we are going to get a lot of these good provisions 
done. I do not think we need to be instructed at this point.
  So, Mr. President, I move to table, and I ask for the yeas and nays. 

[[Page S 16991]]

  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  Mr. DOLE addressed the Chair.
  The PRESIDING OFFICER. The majority leader.
  Mr. DOLE. Let me advise Members, this is the last of the four votes 
on the instructions. I would recommend you take a beeper with you 
because if we do work out something on the CR, the vote could come any 
time between now and tomorrow morning.
  The PRESIDING OFFICER. The question is on agreeing to the motion to 
table the motion to instruct conferees. The yeas and nays have been 
ordered. The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. LOTT. I announce that the Senator from Texas [Mr. Gramm] and the 
Senator from Indiana [Mr. Lugar] are necessarily absent.
  The result was announced--yeas 48, nays 49, as follows:

                      [Rollcall Vote No. 573 Leg.]

                                YEAS--48

     Abraham
     Ashcroft
     Bennett
     Bond
     Brown
     Burns
     Campbell
     Chafee
     Coats
     Cochran
     Coverdell
     Craig
     D'Amato
     DeWine
     Dole
     Domenici
     Faircloth
     Frist
     Gorton
     Grams
     Grassley
     Gregg
     Hatch
     Hatfield
     Helms
     Hutchison
     Inhofe
     Jeffords
     Kassebaum
     Kempthorne
     Kyl
     Lott
     Mack
     McCain
     McConnell
     Murkowski
     Nickles
     Pressler
     Roth
     Santorum
     Shelby
     Simpson
     Smith
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner

                                NAYS--49

     Akaka
     Baucus
     Biden
     Bingaman
     Boxer
     Bradley
     Breaux
     Bryan
     Bumpers
     Byrd
     Cohen
     Conrad
     Daschle
     Dodd
     Dorgan
     Exon
     Feingold
     Feinstein
     Ford
     Glenn
     Graham
     Harkin
     Heflin
     Hollings
     Inouye
     Johnston
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Mikulski
     Moseley-Braun
     Moynihan
     Murray
     Nunn
     Pell
     Pryor
     Reid
     Robb
     Rockefeller
     Sarbanes
     Simon
     Snowe
     Specter
     Wellstone

                             NOT VOTING--2

     Gramm
     Lugar
       
  So the motion to lay on the table the Kennedy motion to instruct 
conferees was rejected.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I ask unanimous consent that the Rollcall 
vote be vitiated on this motion.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The question occurs on agreeing to the motion to instruct offered by 
the Senator from Massachusetts.
  So, the motion was agreed to.
  Mr. KENNEDY. Mr. President, I move to reconsider the vote by which 
the motion was agreed to.
  Mr. DOMENICI. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. DOMENICI. Mr. President, I just want to comment in the presence 
of Senator Kennedy, one of the reasons we let this happen and did not 
fight any harder is because we are so appreciative on the Republican 
side for all the help he has been in getting the reconciliation bill 
passed.
  Mr. KENNEDY. I thank the Senator. I want to be of similar help and 
assistance on----
  Mr. DOMENICI. That kind of help we do not need. In spite of what it 
was, he prevailed.
  The PRESIDING OFFICER. Under the previous order, the Chair appoints 
the following conferees.
  Thereupon, the Presiding Officer (Mr. Santorum) appointed:
  From the Committee on the Budget for consideration of all titles: Mr. 
Domenici, Mr. Grassley, and Mr. Exon;
  From the Committee on Agriculture, Nutrition, and Forestry for 
consideration of title I: Mr. Lugar, Mr. Dole, Mr. Helms (for 
consideration of section 1113 and subtitle D of title I), Mr. Cochran 
(for consideration of title I, except sections 1106, 1108, 1113, and 
subtitle D), Mr. Craig (for consideration of sections 1106 and 1108 of 
title I), Mr. Leahy; and Mr. Pryor;
  From the Committee on Armed Services for consideration of title II: 
Mr. Thurmond, Mr. McCain, and Mr. Bingaman;
  From the Committee on Banking, Housing and Urban Affairs for 
consideration of title III: Mr. D'Amato, Mr. Gramm, and Mr. Sarbanes;
  From the Committee on Commerce, Science, and Transportation for 
consideration of title IV: Mr. Pressler, Mr. Stevens, Mr. McCain, Mr. 
Hollings, and Mr. Inouye;
  From the Committee on Energy and Natural Resources for consideration 
of title V: Mr. Murkowski, Mr. Hatfield, Mr. Nickles, Mr. Craig, Mr. 
Johnston, Mr. Bumpers, and Mr. Ford;
  From the Committee on Environment and Public Works for consideration 
of title VI: Mr. Chafee, Mr. Warner, Mr. Smith, Mr. Baucus, and Mr. 
Reid;
  From the Committee on Finance for consideration of title VII and 
title XII: Mr. Roth, Mr. Dole, and Mr. Moynihan;
  From the Committee on Governmental Affairs for consideration of title 
VIII (and for consideration of the title of the House bill relating 
solely to abolishing the Department of Commerce): Mr. Stevens, Mr. 
Cohen, Mr. Thompson, Mr. Glenn, and Mr. Pryor;
  From the Committee on the Judiciary for consideration of title IX: 
Mr. Hatch, Mr. Grassley, and Mr. Biden;
  From the Committee on Labor and Human Resources for consideration of 
title X: Mrs. Kassebaum, Mr. Jeffords, Mr. Coats, Mr. Frist, Mr. 
Kennedy, Mr. Pell, and Mr. Simon (for ERISA and other matters);
  From the Committee on Veterans' Affairs for consideration of title 
XI: Mr. Simpson, Mr. Murkowski, and Mr. Rockefeller.
  Mrs. BOXER addressed the Chair.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, I ask unanimous consent to speak as in 
morning business not to exceed 15 minutes.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.

                          ____________________