Congressional Record, Volume 142 Issue 69 (Thursday, May 16, 1996)

[Congressional Record Volume 142, Number 69 (Thursday, May 16, 1996)]
[Senate]
[Pages S5160-S5168]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

CONCURRENT RESOLUTION ON THE BUDGET

The Senate continued with the consideration of the concurrent
resolution.
Mr. EXON. Mr. President, I suggest the absence of a quorum and ask
that the time be charged equally to both sides.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. EXON. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. EXON. Mr. President, Senator Rockefeller is here. We are trying
to move things along. He is ready to offer an amendment. We had a
discussion here a few moments ago. As I understood it, the arrangement
would be that there would be no more votes before 8 o'clock, and that,
in the meantime, we had agreed to set aside, temporarily, the Exon
amendment, which is before the body, to allow other amendments to be
offered. I am pleased to see my friend from New Mexico here. Senator
Rockefeller is here.
I ask unanimous consent that the Exon amendment be temporarily set
aside for the purpose of other people offering amendments. I simply say
that, under the rules that are still in effect, it would be the
Republican's turn to offer an amendment. If there is no Republican here
and ready to offer an amendment, with the approval of the chairman of
the committee, we could recognize Senator Rockefeller for his
amendment.
Mr. DOMENICI. Reserving the right to object. We have not seen Senator
Rockefeller's amendment. We do not know what it applies to, the
underlying bill, or what.
Mr. President, I have no objection. I will just ask, since we did
this for you last time, you can proceed with the Rockefeller amendment,
and then we will have an amendment. Since we are entitled to go next--
--
Mr. EXON. I guess I was wrong on that, Mr. President. I was ready to
offer an amendment. I would have gone next. Out of deference to the
agreement we made, I am not offering that. So I guess the slot really
would be on our side. I see nothing wrong if the Senator agrees that
Senator Rockefeller will take the place of the Democratic slot I was
prepared to take, and then the next amendment will be on your side.
Eventually, sometime tonight, we will get back to the Exon amendment
that is being temporarily set aside.
Mr. DOMENICI. I have no objection.
Mr. EXON. I yield as much time as is necessary to the Senator from
West Virginia for the purpose of offering and explaining the amendment.
The PRESIDING OFFICER. The Senator from West Virginia is recognized.
Mr. ROCKEFELLER. I thank the Chair and the distinguished Senator from
Nebraska, and also the chairman of the Budget Committee, for their
courtesy.

Amendment No. 3979

(Purpose: To restore $50 billion in excessive Medicare cuts designed to
pay for new tax breaks for the wealthiest Americans, offset by the
extension of expired tax provisions or corporate and business tax
reforms; to protect seniors against unjustified increases in premiums
and other out-of-pocket costs; to prevent the closing of rural
hospitals and other excessive provider cuts that erode access to needed
medical services; to prevent the implementation of policies designed to
force seniors to give up their own doctors to join private health
plans; and to protect Medicare against policies that will cause it to
wither on the vine)

Mr. ROCKEFELLER. Mr. President, I send an amendment to the desk on
behalf of myself, Mr. Dorgan, Mr. Kennedy, Mr. Dodd, Mrs. Boxer, Mr.
Lautenberg, Mr. Daschle, Mr. Wellstone, Mr. Ford, and Mr. Exon.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from West Virginia (Mr. Rockefeller), for
himself, Mr. Dorgan, Mr. Kennedy, Mr. Dodd, Mrs. Boxer, Mr.
Lautenberg, Mr. Daschle, Mr. Wellstone, Mr. Ford, and Mr.
Exon, proposes an amendment numbered 3979.

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

On page 3, line 5, increase the amount by $100,000,000.
On page 3, line 6, increase the amount by $3,400,000,000.
On page 3, line 7, increase the amount by $5,900,000,000.
On page 3, line 8, increase the amount by $9,200,000,000.
On page 3, line 9, increase the amount by $13,200,000,000.
On page 3, line 10, increase the amount by $18,700,000,000.
On page 3, line 14, increase the amount by $100,000,000.
On page 3, line 15, increase the amount by $3,400,000,000.
On page 3, line 16, increase the amount by $5,900,000,000.
On page 3, line 17, increase the amount by $9,200,000,000.
On page 3, line 18, increase the amount by $13,200,000,000.
On page 3, line 19, increase the amount by $18,700,000,000.
On page 4, line 8, increase the amount by $100,000,000.
On page 4, line 9, increase the amount by $3,400,000,000.
On page 4, line 10, increase the amount by $5,900,000,000.
On page 4, line 11, increase the amount by $9,200,000,000.
On page 4, line 12, increase the amount by $13,200,000,000.
On page 4, line 13, increase the amount by $18,700,000,000.
On page 4, line 17, increase the amount by $100,000,000.
On page 4, line 18, increase the amount by $3,400,000,000.
On page 4, line 19, increase the amount by $5,900,000,000.
On page 4, line 20, increase the amount by $9,200,000,000.
On page 4, line 21, increase the amount by $13,200,000,000.
On page 4, line 22, increase the amount by $18,700,000,000.
On page 29, line 10, increase the amount by $100,000,000.
On page 29, line 11, increase the amount by $100,000,000.
On page 29, line 17, increase the amount by $3,400,000,000.
On page 29, line 18, increase the amount by $3,400,000,000.
On page 29, line 24, increase the amount by $5,900,000,000.
On page 29, line 25, increase the amount by $5,900,000,000.
On page 30, line 6, increase the amount by $9,200,000,000.
On page 30, line 7, increase the amount by $9,200,000,000.
On page 30, line 13, increase the amount by
$13,200,000,000.
On page 30, line 14, increase the amount by
$13,200,000,000.
On page 30, line 20, increase the amount by
$18,700,000,000.
On page 30, line 21, increase the amount by
$18,700,000,000.
On page 49, line 17, decrease the amount by $100,000,000.
On page 49, line 18, decrease the amount by
$50,500,000,000.
Mr. ROCKEFELLER. Mr. President, I rise today in order to offer an
amendment to restore $50 billion to the Medicare Program. This
amendment restores $50 billion by closing corporate loopholes and by
extending expired tax provisions already included in the Republican
budget.
Mr. President, we are back again trying to make sure that the
Medicare Program is not gutted to pay for tax cuts for the wealthy.
This is where we were a year ago. This is where we are again now. My
colleagues on the other side of the aisle have tried to dress up their
budget. They are proposing all kinds of fancy maneuvers and 3 separate
budget packages. They are pretending their latest budget is somehow
kinder and gentler. But there is really not much new here compared to
what we had last year. They lost the budget battle last year with the
American

[[Page S5161]]

public when the public realized that the drastic cuts in the Medicare
and Medicaid programs were going to be used to pay for tax breaks for
the wealthy.
Instead of going back, as I would have thought they would have done,
to the drawing board and come up with some new ideas and better health
policies, they have merely changed the rhetoric. Instead of proposing
ways to strengthen the Medicare Program, they have come up with some
complicated three-tiered reconciliation process so that they can send
three different bills to the President in a desperate attempt to score
some political points. Instead of working with Democrats and with
President Clinton to actually enact a bipartisan balanced budget, the
Republicans continue to work behind closed doors.
The budget resolution before us has been preconferenced. I want my
colleagues to understand this. It has already been preconferenced
between the House and Senate Budget Committees. I have only been here
11\1/2\ years. I have never heard of that--a preconferenced bill
involving something so massive as Medicare, for example. The deals have
already been worked out and they have shut the door on any serious
attempt to reach an agreement on a balanced budget. It is either their
way, with massive Medicare cuts to finance tax cuts for the wealthy, or
it is no way at all.
Mr. President, last year the Finance Committee did not hold a single
hearing on the so-called ``chairman's mark'' to cut Medicare by $270
billion; totally different approach than the one that Senator Kennedy
and Senator Kassebaum in their respective minority-majority positions
took in their committee. The Labor and Human Resources Committee has
done their legislation in a bipartisan, open-to-all, way. We did not do
that in Finance. We held hearings on the problems of the Medicare
Program earlier in the year. But not a single hearing was held on the
Republican's actual plan to cut $270 billion out of the Medicare
Program. Not a single hearing was held to figure out what the impact of
these really very radical cuts would be on the average Medicare
beneficiary who already spends, let my colleagues understand this, 21
percent of their budget on health care.
I wrote Dr. O'Neill, head of the Congressional Budget Office, last
year asking for estimates of what she thought this $270 billion might
have in the way of an impact on the average senior's pocketbook.
Needless to say, I never got a response.
It is no different this year, Mr. President. This year the Finance
Committee has failed to hold a single hearing on any aspect whatsoever
of the Medicare Program--not one hearing. This budget resolution
assumes enactment of the same type of radical policy changes without
even preserving current law financial protection for seniors.
Mr. President, this debate is not about whether we should balance the
budget but how we should balance the budget. This Republican budget
still seeks the unprecedented cuts in the Medicare Program, just as it
did last year. Just as that was rejected by the American people, here
we are back again.
The President's budget achieves balance with $50 billion, or 44
percent, less in Medicare cuts.
If they both achieve balance, then it seems to me quite reasonable to
take the President's approach and simply restore $50 billion knowing
that the budget would then be in balance.
Mr. President, even the Congressional Quarterly wrote, ``This year's
Republican Medicare budget proposal looks a lot like last year's
proposal.'' The same thing--a huge public outcry last year, and with a
new year out it comes once again.
On the surface, the Medicare cuts appear somewhat reduced. But a lot
of the reduction can be attributed to CBO's revised Medicare baseline
estimates and because this year's budget only includes 6 years worth of
cuts rather than 7 years.
For hospitals, though, this year's budget resolution is much, much
worse than last year's. The American Hospital Association estimates
that the projected hospital cuts in the budget are 20 percent greater
than the cuts in last year's proposed hospital budget cuts.
I have here a letter which I ask unanimous consent to have printed in
the Record.
There being no objection, the letter was ordered to be printed in the
Record, as follows:

May 16, 1996.
Dear Senator: On behalf of the undersigned organizations
representing hospitals and health systems, we strongly urge
your support of any amendment to S. Con. Res. 57 (the FY 1997
Budget Resolution) which lowers reductions to Medicare. We
cite in particular an amendment to be offered by Sen. Jay
Rockefeller (D-WV) to restore $50 billion to the Medicare
program.
While it appears that the overall Medicare budget
reductions of $165 billion included in S. Con. Res. 57 are
roughly the same as those in the last Republican offer in
January, the budget drastically changes how the reductions
would be allocated within the program. The FY 1997 budget
proposal achieves the total reduction by saving $124 billion
from Part A Medicare (the Hospital Insurance Trust Fund) and
$44 billion from Part B.
The net result is that in S. Con. Res. 57, the reductions
in Part A have increased by approximately $25 billion. Not
only are these unprecedented reductions, but they would have
a disproportionate adverse impact on hospitals. To achieve
reductions of this magnitude, Congress may need to adopt
policies that would freeze or actually reduce payment rates
per beneficiary.
Hospitals and health systems support a reasonable deficit
reduction package, and believe that changes in Medicare are
sorely needed to keep the Part A trust fund solvent. Many of
us have supported various proposals that achieve a balanced
budget with reductions in Medicare. However, we are gravely
concerned about the level of Medicare Part A reductions
proposed in S. Con. Res. 57.
Again, we ask you to support any amendments that temper the
level of reductions to Medicare Part A, including Sen.
Rockefeller's amendment to restore $50 billion to the
Medicare program, and seek a more balanced approach to
achieving savings.
Sincerely,
American Hospital Association, American Association of
Eye and Ear Hospitals, Association of American Medical
Colleges, Catholic Health Association, Federation of
American Health Systems, InterHealth, National
Association of Public Hospitals and Health Systems,
Premier, Inc., VHA Inc.

Mr. ROCKEFELLER. Mr. President, this letter is signed by the American
Hospital Association, the Catholic Health Association, the Federation
of American Health Systems, and seven or eight others, in which they
say the budget drastically changes how the reductions would be
allocated within the programs.
They refer to: ``Not only are these unprecedented reductions, but
they would have a disproportionate adverse impact on hospitals,'' and
so on. It is a much more drastic cut for hospitals. That is something
that we all need to worry about.
The Prospective Payment Review Commission, ProPAC, a highly
respected, nonpartisan commission that advises Congress on hospital
payment issues, has warned us in their March report that severe
reductions in hospital payments could have a severe impact on
hospitals. They go on to say, ``The required restraint on cost growth
may not be feasible, or desirable. Low updates over an extended period
could affect a hospital's financial health and compromise access and
compromise quality of care. They could also impede the diffusion of
quality-enhancing technological advances.''
Mr. President, this is not a partisan conclusion reached by this
Senator or the Clinton administration about the hospital cuts proposed
in the Republican budget. This is a conclusion that has been reached by
a group of health care experts who have been advising Congress on the
financial health of hospitals since 1983.
This budget truly ignores the heavy reliance of rural hospitals on
the Medicare Program. Small rural hospitals may have to shut their
doors. We have heard that before. But with this 20 percent greater
impact, it is far more dangerous.
Mr. President, in West Virginia one-half of all seniors live in rural
areas. Well over half of our hospitals are rural and are, therefore,
clearly and logically disproportionately dependent on the Medicare
Program for their payments.
Mr. President, my colleagues on the other side of the aisle will yet
again claim that they are proposing these massive reductions in
Medicare to save the trust fund from insolvency.
Once again, I say this is nonsense. While the most recent Medicare
trustees' report showed the trust fund in somewhat worse shape than
last year,

[[Page S5162]]

the variation falls within the typical margin of error. There is over
$120 billion in that trust fund, and there is no imminent danger that
claims cannot or will not be paid.
During my almost 10 years' tenure on the Finance Committee, Mr.
President, we have been faced with many of these situations, to be
quite honest, with many scenarios of impending trust fund short-term
insolvency crises. You have not heard very much about them. The reason
you have not heard very much about them is that each time, except for
the last time, Finance Committee members worked together to enact
Medicare payment reforms to extend short-term solvency to that one and
same trust fund. We have done it time and time again, maybe seven or
eight times over a period of 15 years.
We enacted major reforms in hospital payments in 1983 and followed up
with physician payment reform, something that Senator Durenberger and I
were closely involved in in 1989, as well, of course, as Senator
Kennedy. We made countless payment and policy adjustments to rein in
Medicare spending and extend trust fund solvency, but we did it
together. It was bipartisan. You heard very little, if anything, about
it.
In fact, until very recently, the Medicare Program outperformed the
private sector in containing its health care costs. The private sector
is doing slightly better right now, but realize that the private sector
is ensuring fewer and fewer people while Medicare's enrollment is
increasing. Medicare pays for home care services and skilled nursing
home care, types of services that are not normally covered by private
insurance policies, and Medicare pays for an older and sicker
population.
So in spite of this, except for this year, they have held their costs
below the rate of increase of the private sector. They have done very
well. As everybody knows, or hopefully knows by now, their
administrative costs are about 2 percent, which is virtually impossible
to imagine but true.
At the beginning of the Clinton administration, the trust fund was
projected to be exhausted by 1999--not 2002 but 1999. The Democrats on
the Finance Committee were forced to work single-handedly in 1993 to
extend the solvency of the trust fund by 3 more years, and I am aware
of that because I negotiated the Medicare part of that.
I can tell you, Mr. President, that we did not have a single
Republican vote. We did it, nevertheless. I did not hear one single
concern expressed by the current congressional majority about the
solvency of the trust fund back in 1993, which was not very long ago.
The Congressional Budget Office has certified that the balanced
budget proposed by the President would extend the solvency of the trust
fund for 10 more years. That is about the same level of solvency
achieved by the Republican budget. But the President's budget does so
without damaging programmatic changes and drastic cuts that would
eventually cause the Medicare Program to, as one noted public servant
said, ``wither on the vine.'' We can address the short-term solvency
needs of the trust fund without slashing and burning the Medicare
Program. We can extend short-term solvency without shifting huge new
costs to senior citizens. The President's budget proves that it can be
done.
The tougher issue, of course, is the long-term solvency of the trust
fund, and about that we are all concerned. When the baby boomers begin
to age into the Medicare Program, there will be a huge strain on the
trust fund. None of the balanced budget proposals deal with the issue
of long-term solvency. The Democratic proposal does not. The
President's proposal does not. The Republican proposal does not do
that.
Last year, I introduced legislation--which I believe is strongly
supported by Senator Dole; he said he strongly supports it--that would
establish a bipartisan Medicare commission. When people hear the word
``commission,'' they say, ``Oh, yeah, one of those.'' Well, yes, one of
those was what solved the Social Security problem for a great many
years under President Reagan and Alan Greenspan back in 1981. The House
and the Senate and the President, Republicans and Democrats, all went
along with that. Tough decisions were made. Bullets were bitten. The
bill was passed, and Social Security is not the concern that it was at
that time.

None of the balanced budget proposals, as I indicated, deal with
this, and I think a Medicare commission to make recommendations to
Congress on ways to deal with the long-term solvency of the Medicare
Program is the intelligent, rational way to go. If we adopted the
President's proposal on Medicare, we would have plenty of time, plenty
of time, to adopt a bipartisan solution that addresses this long-term
solvency.
It has always been a matter of some amusement to me; if it is solvent
until the year 2002--the Medicare HI trust fund--and this is 1996, that
is called 6 years.
The President could call this commission into being next year, if he
is reelected, or, if Senator Dole is elected, then he could do it. He
says he is for it. It would meet for a period of 6 months or a year or
whatever it would be, and the problem, therefore, would be resolved and
we could vote on it in 1998, 4 years before the crisis even hit us. Six
years is ample time. Medicare is not in danger. Congress will not walk
away from our responsibilities on Medicare. We simply will not do it.
So from my point of view, in concluding, the Republican budget is
designed to raid, not save, the Medicare Program. Medicare's money is
going to be used to finance tax cuts for the wealthy. It is that
simple. It has nothing to do with assuring long-term solvency of the
Medicare trust fund. I find that abhorrent. It has nothing to do with
making sure that Medicare programs continue to provide high-quality
health care for our senior citizens and the disabled. It has everything
to do with the Republican promises to balance the budget in 7 years and
hand out tax cuts to the rich.
Mr. President, I hope my colleagues will adopt my amendment.
Mr. President, I send a modification of my amendment to the desk in
that there was a small error.
The PRESIDING OFFICER. The Senator has the right to modify his
amendment.
The amendment, as modified, is as follows:

[[Page S5163]]

On page 30, line 14, increase the amount by
$13,200,000,000.
On page 30, line 20, increase the amount by
$18,700,000,000.
On page 30, line 21, increase the amount by
$18,700,000,000.

Mr. ROCKEFELLER. I thank the Presiding Officer, and I yield the
floor.
The PRESIDING OFFICER. The Senator from Michigan.
Mr. ABRAHAM. I thank you, Mr. President. I yield myself 10 minutes to
speak to the amendment.
Mr. President, the Senator from West Virginia and I from time to time
agree on things in the Chamber, and on this occasion we disagree on the
approaches being taken to Medicare. Let me just begin by trying to put
in context the magnitude of the problem which we confront. While it may
be true in the past there have been projections that Medicare, the part
A trust fund was headed toward insolvency at some point in the future,
we have never come this close before in the following sense. We have
never before faced a situation where we actually were paying more
dollars out of the trust fund than taxpayers were paying into the trust
fund, but that, indeed, is where we are today.
Last April, the Clinton administration estimated that the trust fund
balance would increase by $4.7 billion in fiscal year 1995 and 1997
would be the first fiscal year in which it would run a deficit.
However, Department of Treasury figures indicate now that the Medicare
Program ran a deficit of $37 billion in fiscal year 1995, 2 years
earlier than expected. CBO has projected that based on this change in
circumstance, Medicare is now likely to become insolvent as early as
the year 2000. I ask unanimous consent to enter into the Record at this
point a letter from the head of the CBO, June O'Neill, which indicates
their projected timetable.
Mr. President, the concerns I think all of us have about the solvency
of the part A trust fund are ones that need to be addressed. They need
to be addressed decisively. I agree with the Senator from West Virginia
that we must confront the long-term population projections, the aging
of the baby boom generation and the impact that will have on Medicare,
but I do not think we should postpone dealing with that problem until
down the road in some commission. I think we have to begin laying the
foundation for dealing with that problem now. That is what we are
trying to do with the Republican budget before the Senate here tonight.
New estimates, as I said, by the Congressional Budget Office post the
year 2001 as the likely point at which the trust fund part A will be
insolvent.
Matters seem to be getting worse. Last year, Republicans offered a
systemic change, an effort to try to create a competitive choice system
for Medicare recipients. We were able to get that through the Congress,
but, unfortunately, it was vetoed ultimately. But the direction we are
moving in is one that will try to address this problem both short term
and long term. Contrary to some of the comments that have been made,
the Finance Committee has had, it is my understanding, 13 hearings
already on Medicare in this Congress.

But the fact remains that there are two basic choices for us to make
here in the U.S. Senate. The President has offered a proposal which
essentially maintains the solvency of the part A trust fund by
shifting, from the part A trust fund, vital programs, home health care,
to the tune of approximately $50 billion, maybe a little bit more than
$50 billion, and through that mechanism produces a greater solvency for
the trust fund.
We, on our side of the aisle, do not think that is the appropriate
way to address the problem. Countless Americans depend on the part A
trust fund to provide those home health care services. Moving them out
of the trust fund, moving them into the general account, making them,
instead, subject to congressional deliberation and imposing their costs
on the taxpayers, or to force those programs to be competitive with
others, is not the way to go.
If that is the solution we are going to take every time the trust
fund approaches insolvency, if we say the answer is to move parts of
the programs under the trust fund out of the trust fund, I do not think
that is providing seniors with much security at all. In fact, I think
for any senior who is listening to this debate, I would warn them if we
set the precedent saying the way we are going to address the pending
insolvency of the Medicare part A trust fund is by taking away services
and putting them up for negotiation and debate in part B, or in some
other way to be dealt with by the Congress, we are undermining the
confidence that seniors will have in Medicare, and it will continue in
my judgment.
So, instead of approaching it that way, what we have attempted to do
on the majority side is to provide what we think is a comprehensive
approach to guaranteeing the solvency for 10 years of the part A trust
fund. In addition, what we have done is to take the President's own
number, which is $44 billion of savings in the part B Medicare portion
of the budget. So what that means is that we are taking action that
will guarantee the solvency of part A for 10 years, through the year
2006. That is, I think, a goal worthy of us and one that we should, I
think, accomplish for purposes of protecting the American people who
are dependent on Medicare. And we are using the President's own
projected savings in part B of $44 billion to arrive at our Medicare
objective.
Now that may not be the approach that others support. They seem to
feel we need to try to increase the funding. But if we increase the
funding in Medicare we are only creating, I think, a more serious
insolvency problem. If we do not begin now to reform the programs to
create the options and the choices for Americans so we can begin to
reduce the rate of growth of the Medicare Program, we are inviting even
greater problems at a sooner point, in my judgment.
We strongly oppose the amendment that is being offered. We think that
the President's approach is not the proper way to go. We think that the
approach of just spending more money without trying to reform the
system is not the approach to take. Certainly we do not think the way
to go is to have the usual solution around here of more taxes to fund
programs. We need to reform the programs themselves.
So, for those reasons, I strongly urge my colleagues to oppose the
amendment. I yield the floor at this time.
The PRESIDING OFFICER. The Senator from West Virginia.
(Mr. ABRAHAM assumed the chair.)
Mr. ROCKEFELLER. Mr. President, I would like to respond to the
distinguished Senator from Michigan in his reference to treatment of
home health care financing. I am addressing, in fact, the distinguished
Senator from Michigan as the Presiding Officer.
It is complicated, but it is very important. I would like to take
just a couple of minutes, if that is all right, outlining why this
change in home care financing does, in fact, make sense. And then also
why, therefore, it is a legitimate way to improve the solvency of the
part A trust fund.
A little history: Before 1980, financing of the home health care
benefit was divided between part A and part B, pre-1980. At that time
only the first 100 days of home visits after a 3-day hospital stay were
financed from the part A fund. All other visits were financed by part
B. The policy behind this was that Medicare part A was designed to pay
for short-term recuperative home care services. In 1980, Congress
enacted legislation that improved Medicare's overall home health care
benefit by removing the 100-day visit limit and the prior
hospitalization requirement, the so-called 3-day requirement. As a
result, financing of all home care services was shifted at that point
to part A, even though part A was never intended to pay for long-term
home health care services. That is the rationale, and it makes sense.
The President's proposal restores financing of the home health care
benefit back to the original intent of Medicare, and that is what
happens in his proposal. It brings Medicare financing in line with use
patterns that show home health care has evolved into two distinct
benefits: Care to persons recovering from an acute care hospitalization
and care where there is no hospitalization but long-term care services
are required. This proposal extends the solvency of the part A trust
fund by capping part A financing of Medicare's home health benefit and
saves the trust fund almost $60 billion over 7 years.

[[Page S5164]]

I just wanted to make that point. The Senator from Michigan, the
Presiding Officer, had raised this point and I think it does bear
explanation on a policy basis.
I thank the Presiding Officer and yield the floor.
Mr. BENNETT addressed the Chair.
The PRESIDING OFFICER. The Senator from Utah.
Mr. BENNETT. Mr. President, I was listening to the presentation of
the Senator from West Virginia and felt I had to respond in some
particulars. I appreciate the Presiding Officer giving me relief from
the chair so that I might do this.
I hear the Senator from West Virginia use the statement that we have
heard many times on the floor, that the purpose of the Republican
number for Medicare is to pay for tax cuts for the wealthy. I say once
again, if these tax cuts are going to benefit the wealthy, the wealthy
have to have awfully big families because the tax cut is limited to
$500 per child and I do not know anybody who is really wealthy who is
going to make any money off of this at $500 per child. The people who
need this are the people who have low incomes and big families. Those
are the people in my State who are getting a little tired of the
rhetoric that this is a tax cut for the wealthy. I have heard the
statement made on the floor that this is going to mean $10,000 in tax
cuts to some people. They have to have an awful lot of kids to get
$10,000 at $500 per child.
Second, ``slash and burn'' is a phrase that was used, on the amount
of money to be spent on Medicare; the incredible cuts. I was a Member
of this body when the Senator from West Virginia cosponsored the
Clinton health care plan. In the Clinton health care plan, as explained
in hearings before the Congress by Mrs. Clinton, the growth of Medicare
spending was to be slowed. Mrs. Clinton made the very specific point,
and some of us have seen that on videotape as it has been replayed,
that we are not cutting Medicare, she said, we are simply slowing its
growth so that we can pay for all the things we need to do in health
care.
The bill that is before us slows the growth of Medicare less than the
amount proposed by Mrs. Clinton in the bill that she proposed, and
which the Senator from West Virginia cosponsored.
I do not consider that it was slashing and burning Medicare when Mrs.
Clinton proposed it, and I do not think it is slashing and burning
Medicare now. I hope we will stay with the numbers as they really are.
We are proposing increasing spending on Medicare, and the Republicans
are proposing increasing spending on Medicare at a higher rate than
Mrs. Clinton proposed, and that was in the bill that the Senator from
West Virginia cosponsored.
Mr. President, the Senator from West Virginia has talked about the
repeated actions of the Finance Committee in dealing with short-term
solvency problems. An analogy sprang to my mind. We have watched the
Government of the District of Columbia give us repeated short-term
solutions to their short-term solvency problems, and the long-term
solvency problem has gotten continually worse until finally the
District of Columbia is facing the crisis that it is.
I am not proud--I did not participate, so I was not involved--but I
am not proud of the actions of the Finance Committee over the years in
the way they have solved the short-term solvency problem. I am not
proud of administrations that I would call my administration--that is
the Bush administration--in the way it has addressed the short-term
solvency problem, because all they have done repeatedly is postpone the
day of reckoning, and to say, ``Well, we've been able to do it on a
bipartisan basis.''
All right, shame on both parties. But what happens again and again
when you are faced with the short-term solvency problem in Medicare is,
say we are going to reduce the amount we will reimburse to the doctors
and we will make those greedy doctors and hospitals pay by putting a
lid on the amount they can charge. There is another word for that, Mr.
President. It is called wage and price controls. We have been trying to
solve our inflation problems in this country with wage and price
controls perhaps from the beginning of time. They have never worked in
any other arena, and they have not worked in Medicare. Every time the
Finance Committee or the administration puts wage and price controls on
Medicare payments, the people who are faced with those wage and price
controls find ways around them. Then the costs start going up again, so
we have to have another short-term fix with wage and price controls.
The only solution is to forget the pattern of the past and make
systemic changes in Medicare, and my party has had the courage to
attempt that. The party of the Senator from West Virginia has said,
``No, we will not attempt systemic changes in Medicare. Let's have a
commission.''
I would be happy to serve on such a commission and endorse such a
commission if the charge of that commission was to say that we are not
going to do what we have historically done because it is what we have
historically done that has brought us to the point we are today. We
have to face the fact that Medicare is a wonderful 1960's program
frozen in time by virtue of its having been made a Government monopoly.
We have to break the monopoly, open this thing up to free market
forces, recognize that wage and price controls do not work, and start
with a clean sheet of paper. If we had that kind of circumstance, I
would be happy to do whatever is necessary to cooperate with the
Senator from West Virginia in a bipartisan fashion. But more of the
same, a repeat of what we have done in the years that have gotten us to
this, is not the kind of call we need to deal with Medicare.
Mr. President, I recognize that I have opened a can of worms or a
hornet's nest here, and I should return to the chair, but if the
President will grant me the indulgence, I recognize that the Senator
from West Virginia is now on his feet and wants to defend himself, and
I congratulate him for that. If I may be allowed to stay here and
defend myself and we have this debate, I think it will be a worthwhile
circumstance.
With that, Mr. President, I yield the floor, in anticipation of
hearing a rebuttal from my friend from West Virginia.
Mr. ROCKEFELLER. General reminders, perhaps, would be more
appropriate in terms of the phrasing. I certainly listened to what my
distinguished friend said, and respect him. In fact, in all that he
says, because he has a particularly articulate, modified way of saying
things which I have long respected, which the Senator knows from our
previous conversations.

The Senator has brought up a number of points, such as wage and price
controls, and this is something which is not necessarily totally
accurate, but which I ask the Senator to contemplate. He talked about
the evils of wage and price controls. Let us leave wages out for the
moment--no, let us not leave wages out for the moment.
I submit to the Senator what we are now seeing increasingly in
private sector managed care--you made reference to the Clinton health
care program which is long gone. It seems to me like the debate on
health care reform was 10 years ago. Since it failed, there was this
convulsion in the marketplace, an extraordinary explosion of activity,
and managed care took off. We have health maintenance organizations,
HMO's, which are wonderful in their concept of paying a doctor so much
to keep a patient healthy. Therefore, the incentive was to keep the
patient healthy, and the incentive was always on the relationship
between the doctor and the patient. Then we see the introduction of
for-profit HMO's, which are now sweeping the Nation. That introduces
quite another concept, and that is the interest of the shareholder of
the company as opposed to, perhaps, in contrast to, in contradiction
with, perhaps, the relationship between the doctor and the patient.
I just wonder out loud if what we have seen, therefore, and the
resulting kind of caps and limits, and ``this will be allowed and that
will not be allowed,'' is, in fact, a form of wage and price controls,
but under the guise of the private sector, therefore, we do not think
of calling it as such. I just raise that as something for the Senator
to think about.
Second, on the short-term basis aspect, the Senator expressed great
concern about having to do this all the time. I am in total agreement.
I am in total agreement, and I think the reason that we have had all of
these short-

[[Page S5165]]

term fixes is because we have not had to consider Medicare in a longer
term context.
The Senator made some correct observations. But that is why I think
that a commission, never before entered into, on Medicare, which has
grown enormously because Congress has added enormous new burdens on it,
services to be paid for, as well as the cost of health care and
everything else, that it is, in fact, a long-term commission approach
which is the answer to solidifying patterns, making adjustments, and
biting the bullet on some very difficult issues.
I think that the deal, so to speak, would be that the commission
would be so well balanced as to who was on it--experts, seniors,
consumers, et cetera, it would be fairly done and expertly done--that
it would be voted through by the House, voted through by the Senate and
signed by the President almost without debate, like the Social Security
Commission's recommendations were. It was an enormously controversial
problem. Senator Dole and Senator Moynihan were on that commission.
With respect to when the Senator talked about the old bromide, or
whatever it was, of Democrats talking about tax cuts for the rich, I
have to go by what people in the majority say, because we in the
minority have to respond to that.
The Senate budget resolution would, and I quote, ``accommodate
further tax reform or tax reductions, to be offset by the extension of
expired tax provisions or corporate and business tax reforms. Such tax
reductions could include proposals such as economic growth, a capital
gains tax reduction package, State tax reform, economic growth, fuel
excise taxes * * *.''
And on to the end of the quote.
So I have to believe that tax cuts for the wealthy are still very
much in the mind of the Republicans. I cannot prove it, but I can point
to the Republican budget resolution before us.
What am I to think as I see this?
Mr. BENNETT. Would the Senator yield on that point?
Mr. ROCKEFELLER. Of course.
Mr. BENNETT. I do not have the figures in front of me, but I would be
happy to supply them to the Senator. If you take the total amount set
aside for tax cuts, you would find that the vast bulk, I think in the
neighborhood of something like 80 percent of the value of the tax cut,
goes for the $500 tax credit for children. The taxes that the Senator
is pointing out, in terms of the total impact, are relatively small and
can honestly be described as minor in their financial impact.
By far, the greatest bulk of the tax money is going for the $500
rebate for children. That is the expensive item in the tax cut bill. I
am sure the Budget Committee would be happy to give the Senator those
details.
Mr. ROCKEFELLER. We will see on all of this, because there is a very
strong predilection on the part of the majority party to make--when you
are talking about inheritance taxes, you know, that is pretty heavy
stuff. That would raise questions. The Senator who is speaking knows
something about that.
The other thing I guess I want to say, if the Senator would further
yield----
Mr. BENNETT. I am happy to yield.
Mr. ROCKEFELLER. This amendment is about restoring $50 billion that
was cut by the Republicans from Medicare. That is what my amendment is
about. That is kind of what I would like our discussion to be about.
Mr. BENNETT. Mr. President, I thank the Senator for his reasoned
response. I remain unconvinced by it, but I appreciate the manner and
the tenor in which it is offered. May I make several comments, and then
I will return to the chair, and perhaps this will pass on for those who
want to read about it in the Record.
The reference to wage and price controls and HMO's. Wage and price
controls, by definition, are imposed by Government. Market conditions
may set prices elsewhere. One of the main things wrong with our whole
health care system--and the Senator and I can have this discussion at
length at some other time--is the very fact that market forces do not
operate here and cannot because of the Government's attempt to enforce
wage and price controls.
We have a circumstance, I say to the Senator, where the user of the
service is not the purchaser of the service, and market conditions
therefore cannot operate.
If I, for example, am enrolled in an HMO I do not like, there is
nothing I can do about it because the person who chooses that HMO is my
employer. It is the employer who purchases the service, pays for it and
makes the deal. It is I, the employee, who uses the service.
Mr. ROCKEFELLER. Would the Senator yield?
Mr. BENNETT. I will yield in a moment.
I have been the chief executive officer of a company and, therefore,
in a position to choose what kind of health care the employees will
get. It will come as no surprise to say that I chose a program that I
liked.
During the debate over the Clinton health care plan, people would say
to me, ``Why don't you give us as good a health care plan as you have
as a Member of Congress?'' My response was, ``I wish I had as good a
health care plan as I had before I came to Congress,'' because the only
health care plan I have now, as a Member of Congress, is that which the
Government has decided to make available to Government employees. If
you want the same kind of health care plan I have, go get yourself a
Government job. But if you want a different kind of health care plan,
go petition your employer.
That does not make sense. In any other circumstance, you make the
choices if you buy the service. But we have created a circumstance here
in our country--frankly, we can debate the historical roots of it--
where the employer makes the decision but the employee receives the
service. So whom does the HMO have to please? It has to please the
health and human resources person at the employer's desk. If the
employee does not get what he wants, too bad. The employer has made the
choice.
Mr. ROCKEFELLER. If the Senator will yield?
Mr. BENNETT. I am happy to.
Mr. ROCKEFELLER. The Senator--and I apologize to my colleagues
because we are no longer debating this amendment, which is about
restoring $50 billion in Republican cuts to Medicare. That is what will
be, hopefully, voted up later.
But when the Senator said, ``I ran a company, and I decided what my
employees were going to get. I made the decision''----
Mr. BENNETT. That is correct.
Mr. ROCKEFELLER. That is a very powerful statement. What that
basically says is that the employees were denied any choice as to
whether or not, for example, their doctor happened to be included in
that program or not.
Mr. BENNETT. That is correct.
Mr. ROCKEFELLER. Whether certain services were offered in that
program or not.
Mr. BENNETT. That is correct. The Senator is exactly right. He is
describing the way health care works in this country.
Mr. ROCKEFELLER. If I might then just go back for a moment to the
thoroughly savaged Clinton health care plan on the floor this evening,
which, as I indicated is now a part of history. One of the things that
the Senator is now able to do, if he in fact takes the trouble to do
this, under the so-called Government health insurance program, which I
would submit is hardly Government, because, for example, I have a Blue
Cross-Blue Shield card, and the last I heard Blue Cross-Blue Shield was
a private insurance company----
Mr. BENNETT. I say to the Senator, the Government----
Mr. ROCKEFELLER. If I could continue my point, I say to the Senator.
Mr. BENNETT. By all means.
Mr. ROCKEFELLER. That the Senator and this Senator and all those who
work for the Federal Government have, in fact, between 25 and 29
different plans that they can choose from every single year. I have
watched my daughter go through this process of spreading out the
different programs, sitting on the floor cross-legged, and just looking
at all of these 29 different programs spread out before her, 29
different options of health care which she gets to choose from. With
Blue Cross-Blue Shield, through that arrangement, she pays them, she
can pick her doctor, she can pick her service. She can reject one thing
from one year to another. But the choice is hers.

[[Page S5166]]

The point I would like to loudly insert in this debate is that the
Senator in mandating for his employees what they will have. And,
indeed, it occurs to me that that is a mandate. That is an entirely
different situation from Federal employees, or those in the alliances
that were contemplated in the Clinton health care plan. Through their
joint purchasing power, they could have in fact a great variety of
programs that would be spread before them. In fact, the Federal
intervention that came in was from something called a Federal Quality
Board which was made up of medical experts who would certify that any
health plans that were being offered to the public through alliances or
otherwise would have to be certified as being qualified and of high
quality.

One of the great complaints one hears across the land today in
America from physicians, hospitals and persons conversant in health
care public policy is that the word ``quality'' is rapidly disappearing
from the discussion, if not the practice of medicine.
Mr. BENNETT. Mr. President, we perhaps should end this. I hope it is
instructive. I am sure the Senator from West Virginia and I will
continue this at another venue.
We clearly are not communicating here. He has outlined what I
consider to be a prime example of what I was talking about. The
Government has decided that his daughter's choices will be limited to
Blue Cross-Blue Shield. The Government has decided that the plan I was
under before coming to the Senate will not be available to me now that
I am in the Senate. The Government has picked, yes, 29 different plans,
and that is a lot, but that is not all that is available. I cannot take
my money that is being spent for health care, deducted from my pay, go
out in the open market and buy something else with it. I can only use
it within the framework that this commission that he has described has
made available to me.
Now, I will concede to him, absolutely, the commission he described
did a good job and most employees will find that in the choices the
Government offers they will find something that covers their needs. The
point is that 29 choices is not the universe. If I want to make choice
number 30, my employer--in this case the Government--has decreed that I
cannot make choice number 30 with the money they are spending on my
behalf for health care.
That is another debate for another time. We can have it. But I wanted
to introduce it into this circumstance because I think it addresses the
basic issue and goes back to the amendment that the Senator has
offered.
Mr. ROCKEFELLER. Will the Senator yield for a closing thought?
Mr. BENNETT. Yes.
Mr. ROCKEFELLER. There were many more insurance plans than Blue
Cross-Blue Shield involved at that time.
I just ask the Senator to contemplate the difference between the 25
to 29--and yes, there might be 30 on the one hand--as compared to the
one that the Senator as president and chairman of the corporation which
he ran picked out on behalf of his employees.
Mr. BENNETT. This is not the place to get into these details. I say
the plan I chose had a number of choices within it so that the
employees could make, frankly, almost as many choices as Government
employees could make. Ultimately I had to make the decision as to what
the framework would be for our employees. I made a decision to a plan
that, in my opinion, was better than the one that is currently
available to me.
My employees, I think, were better served with that decision that I
was making than the Government employers and the decision you are
talking about. Those are not appropriate questions here. We can have
this discussion elsewhere. I think they go to the core of what has to
be addressed when we talk about fixing the health care system in this
country.
To summarize, and then I will return to my duties in the chair, I
have always congratulated President Clinton on his leadership in
addressing America's health care problems. I am one Republican who has
been critical of my party's inability to exercise the proper leadership
here. President Clinton did a courageous thing in taking this issue on.
I had congratulated him at the time. I congratulated him all the way
through, even while disagreeing with him on the details of his plan. I
have congratulated him for his courage in being willing to face the
fact that our health care system in this country is broken and badly
needs fixing. I just do not think his solution fixed it. In my opinion,
his solution made it worse.
I feel the same way about Medicare, that my party has had the courage
to recognize that Medicare, to be handled as business as usual, is
headed for disaster, and it is headed for disaster quickly. We have
taken the political heat. We have taken the political rhetoric. We have
been accused of slashing and burning. However, we have stood up to
facing the problem.
As the Washington Post has said in its editorials, the Republicans
deserve credit for telling the truth about Medicare and the Democrats
have slipped into the posture of ``Mediscare.'' That, in fact, does not
add and contribute to the debate.
I thank my friend from West Virginia for the opportunity to have this
exchange. I thank the Senator from Michigan for allowing me to escape
the enforced silence of the chair long enough to vent my feelings on
this issue, which I am sure will continue to provide opportunity for
lots of dialog for lots of months and perhaps years to come.
I yield the floor.
Ms. MIKULSKI. Mr. President, I rise to express my strong support for
the Rockefeller amendment on Medicare. The amendment restores $50
billion to the Medicare Program. It keeps Medicare solvent. It honors
our national commitment to seniors.
Haven't we been this way before? It's the same old story--big cuts in
Medicare to pay for tax cuts for the wealthy. Yes, we must balance the
budget and keep Medicare solvent. But we can do that with the
President's budget.
I will fight to protect health care for all seniors. Medicare pays
for medical care for almost 38 million seniors. Over 500,000 of these
seniors live in my State of Maryland. In my travels to senior centers
throughout the State, I hear the same thing over and over. Seniors tell
me they're afraid of losing their Medicare coverage. They fear they
won't be able to keep their own doctors. They are worried they will be
forced into managed care plans.
Our seniors count on Medicare for their health care. I want to keep
the CARE in Medicare. This amendment will do that. It protects seniors
from excessive premium increases and out-of-pocket costs. It lets
seniors keep their own doctors. It attacks fraud and abuse. Doctors and
hospitals won't be able to charge patients above the cost of Medicare.
And seniors will have access to care because it prevents the closing of
rural and urban hospitals.
There has been a lot in the news lately about Medicare going
bankrupt. I am concerned about the solvency of the Medicare trust fund.
We owe it to what I like to call the GI Joe generation and future
generations to keep Medicare solvent. The GI Joe generation is the
generation that fought for freedom and democracy for the world during
World War II. They didn't hesitate to serve. When the war was over,
they came home, raised their families, and contributed to the greatest
prosperity this Nation has ever known. We would not be a nation much
less a world power today if it weren't for the GI Joe generation. They
have worked hard all their lives and played by the rules. Now they need
Medicare to be there for them. Promises made must be promises kept.
We can balance the budget with far fewer Medicare cuts. At the same
time, we can keep Medicare solvent and protect seniors from new costs.
The President's budget accomplishes these goals. Under his plan, the
solvency of the trust fund is extended for 10 years.
Medicare is one of the best health care systems in the world. Before
Medicare was enacted 30 years ago, less than 50 percent of seniors had
health insurance. Now 99 percent do. Let's not dismantle this
successful program.
I oppose increasing seniors' out-of-pocket costs. That's why I oppose
balance billing. This lets doctors and hospitals charge patients above
the cost of Medicare. It increases seniors out-of-pocket costs. Ninety-
seven percent of Medicare funds are spent on recipients with incomes
less than $50,000. Seniors

[[Page S5167]]

already spend 21 percent of their income on health care. They can't
afford to spend more. Let's not hurt middle-income Americans. We need
to renew our commitment to help those who help themselves.
The budget cuts Medicare part A by $98 billion. This part pays for
hospitals and providers. We can't overlook the effect these drastic
cuts will have on hospitals. What will happen to institutions like
Johns Hopkins School of Medicine and the University of Maryland Medical
School under these cuts? Cuts this large will put some hospitals out of
business. It will cut down on the training of new doctors. And in the
end, our seniors will be the ones hurt the most.
I say to my fellow Senators, do the right thing today. Don't balance
the budget on the backs of our seniors. Preserve the Medicare Program.
Let's keep our commitment to senior citizens.
Mr. KERRY. Mr. President, I rise today in support of Senator
Rockefeller's amendment to reduce the size of the Medicare cuts to the
level of the President's budget and to preserve the basic health care
protections this nation now provides for senior citizens.
Without Medicare, many and perhaps most of the 38 million Americans
who are Medicare beneficiaries would have inadequate health care and
treatment--or no treatment at all. This year's Republican budget would
cut Medicare by $167 billion over 6 years, $50 billion more than the
President's budget. This cut would reduce Medicare spending growth far
below projected private sector growth rates, resulting in reduced
quality and access to health care for millions of Americans.
This year's Republican Medicare cuts are all too similar to last
year's Medicare cuts. In their fiscal year 1996 budget, the Republicans
would have cut Medicare by $270 billion over a 7 year period to finance
a $245 billion tax cut primarily for America's wealthiest people. These
cuts would have resulted in a $9.5 billion loss to Massachusetts alone
over the next 7 years. These cuts, if allocated evenly among all
beneficiaries, would have cost each of the 900,000 seniors and disabled
people who depend on Medicare an additional $1,240 a year.
But this year's Republican cuts in Medicare are still too large and
will risk turning Medicare into a second-class system for seniors who
cannot afford to opt out of the traditional Medicare Program through
Medical Savings accounts. It is also amazing that Republicans still
have not disavowed their intention to increase premiums to pay for a
tax cut. Our Nation's senior citizens, with an average annual income of
$17,000, spend more than 20 percent of their incomes on health care.
Additional health care expenses would put an even greater burden on
this population.
I believe that Medicare can be reformed without totally dismantling
the fundamental security that the system provides. The President's
budget shows that premium increases, deep cuts, and damaging structural
changes are not necessary to balance the budget and guarantee the
solvency of the Medicare trust fund. By failing to identify and
eliminate corporate subsidies, and adamantly insisting on tax cuts for
the rich, the Republicans are forced to cut programs for middle-class
Americans far deeper than the President's plan, and the Medicare
Program is bearing the brunt of this attack.
Medicare is a part of Social Security, a contract between the
Government and the people. People pay into the trust fund during their
working years and then receive good health care in their retirement
years. The Republicans would break this fundamental contract with the
American people.
I urge my colleagues to support the amendment offered by Senator
Rockefeller which I am proud to cosponsor. We must stop the Republicans
from using the Medicare trust fund as a slush fund to pay for tax cuts.
We must carefully and responsibly reform Medicare for the sake of
preserving and strengthening Medicare and those who depend on it. The
Republican budget really fails this test once again. In colloquial
terms, Mr. President, ``They just don't get it.''
The PRESIDING OFFICER (Mr. Bennett). The Senator from West Virginia.
Mr. ROCKEFELLER. Mr. President, might I ask a question of the
distinguished Senator from Michigan? If this amendment which is about
trying to restore $50 billion to Medicare, is it the intention of the
majority that we will discuss but not vote or that we will vote
tonight?
Mr. ABRAHAM. It is my understanding, I say to Senator from West
Virginia, we at least will not vote on anything before 8 o'clock. There
is an agreement to not have any votes prior to that. At whatever point
debate on the amendment of the Senator from West Virginia ends, if
there is no further debate, I plan to speak briefly about it.
I am prepared to offer another amendment which, I think, would be in
order, which will address Medicare and probably open up further
discussion about the topic we have been discussing for the last half
hour or so. Whatever point we decide there is no further debate on
this, I am prepared to bring another amendment for discussion. I do not
believe there is an agreement on specifically when we would vote. My
understanding is we would not vote on anything prior to 8 o'clock.
Mr. ROCKEFELLER. I say to my friend that is approximately 22 minutes
from now. Medicare is a pretty important subject. There may be people
who want to speak. On the other hand, part of the deal around here is
that if you want to say something you have to be here.
Can I assume that maybe by 8:30 or 9 o'clock we could vote?
Mr. ABRAHAM. I say to the Senator, I do not know of any other people
right now on our side who are prepared to speak. I have been told
several Members were coming to the floor earlier, but I have not seen
them. I am not certain we will not have speakers. I have a few brief
comments to make on the amendment before us, and I am prepared to bring
up another amendment discussing the topic of Medicare that I presume we
will debate for some period of time. I have received no further word
from anyone on our side with an interest in speaking. I do not know
whether on your side there are others who plan to come down.
It is my understanding there are approximately 30 minutes left on
each side.
The PRESIDING OFFICER. The Senator is correct.
Mr. ABRAHAM. And I can offer my amendment when we either exhaust the
time or it has been yielded back.
Mr. President, I will speak to the amendment for such time as I may
need at this point. I want to make a couple of points, following up on
my earlier statement. As you know, Mr. President, I expressed the
concern that we have on our side over the way the President has
attempted to address the Medicare issue. Specifically, the provisions
in his budgets which would transfer the home health care expenditures
from the part A to the part B fund.
The Senator from West Virginia has indicated that the rationale from
a policy standpoint for doing this is the fact that some 16 years ago,
or just prior to the year 1980, there was a limit on the duration of
part A's coverage for home health care and a prerequisite of a previous
hospitalization was necessary to trigger that part A coverage.
I only say this. If we are going to use as a standard for changes in
Medicare the fact that at one time we did it differently, there would
certainly be plenty of other Medicare-related issues then that would
fall under that policy justification. For example, last year, there was
a pretty significant debate here before the Senate over the question of
the percentage of part B premium that would be paid by the recipients,
by the people in the Medicare Program, a debate on whether or not the
percentage would be dropped from 31 to 25 percent. It was argued at
that time that we should not maintain a 31 percent, we should reduce
it. That is a debate that has passed, but the fact is, there was a time
in the program where the percentage of co-pay of the part B recipients
was much higher than 31 percent.
So I do not think it is at least a reasonable justification to say
that, because 17 years ago, the Medicare Program was structured a
certain way, that that alone, or in any sense, is a justification to
return to that approach. The same, presumably, is true for a variety of
other ratios, formulas, reimbursements, and so on, whether it is for
direct medical, education, or

[[Page S5168]]

other components. Clearly, they have changed over the years. It just
seems to me that to say we can move home health care out of part A
because at one time it was structured differently does not reach the
most important element here, which is, by doing this, we are changing
dramatically the expectations of part A Medicare recipients.
Those people believe that home health care is, in fact, part of that
trust program. It is, in fact, not subject to the availability of funds
or the need to either increase taxes or find other spending cuts to
justify payments for it. And that is why we feel the President's budget
does not really meet the challenge for us.

I would like to say a couple of other things with respect to the
specifics of the amendment before us. According to the Congressional
Budget Office, the President's Medicare proposal would not maintain
solvency of the part A Medicare trust fund for the full 10 years that
we want. In fact, the projection is that it would be insolvent by the
year 2005. Now, I would like to bring to the attention of the Senate
the fact that, in the President's budget, the reductions in the
growth--I will give the President the benefit of the doubt and not call
it a cut. By reducing the growth by $116 billion, the President's
budget maintains solvency not for 10 years but for 9 years. If, in
fact, the $50 billion that is proposed in this amendment were used to
increase the rate of growth of the Medicare Program, as proposed in our
budget, then the actual total net change under our budget would only be
$108 billion over the period of time our budget covers, through 2002.
In other words, it would be less savings than in the President's
budget. So, in other words, if this amendment were to pass, Mr.
President, then we would be, in fact, not ensuring the solvency of part
A of the trust fund as long as the President even does, and we believe
on this side that the President's proposal to maintain solvency through
2005 is not adequate.
So I think it is important for our colleagues to understand that, in
supporting this, they are in fact supporting an amendment that would
bring about the insolvency even earlier than that which would be the
case under the President's budget, and certainly which would be the
case under our budget.
I also wanted to clear up one other point, Mr. President. In the tax
cut provisions in the budget we are offering, the total amount of $122
billion, I believe, is targeted--it does not, in fact, even cover fully
the $500-per-child tax credit. So there, in fact, would not be enough
money to fund the other tax cuts beyond the $500 tax credit in the
budget which we have.
To summarize, we have several facts that I think need to be
revisited. First, the Medicare trust fund is going broke. At the
current rate of growth in spending, at the current rate of projection
from the Congressional Budget Office, it will go broke in 2001. We
cannot let that happen, Mr. President.
Second, I think we want to make sure that its solvency is not
maintained for a short duration of time--3, 4, 5, 6 years--but we want
it to be solvent for 10 years. The President's budget would not
accomplish that. If this amendment passes, our budget would not
accomplish that either.
Finally, we on the majority side do not want to eliminate the home
health care protections under the part A trust fund. The President's
budget would do that and, obviously, there is a sharp difference there.
So, in short, Mr. President, we are prepared and desire to fix and
repair the trust fund and maintain solvency for a decade. We think that
is the least we can do to address this problem at this time. In our
judgment, at least, anything short of that does not meet the mark, does
not provide our seniors with the protections they need, does not
provide the trust fund with the protection it needs.
We want to give families a chance to keep more of what they earn.
That is why we have the money in this budget for a tax cut. But it is
not connected to the Medicare issue at all. Once again, to portray it
that way is simply inaccurate. We have the Medicare part A trust fund
headed toward bankruptcy. For the first time, in 1995, it was actually
spending more than it was taking in. The time has come to repair it for
a sufficient period of time, and to allow us to focus on a broader and
even longer term fix, which is clearly needed.
I yield the floor.
Mr. EXON addressed the Chair.
The PRESIDING OFFICER (Mr. Bennett). The Senator from Nebraska is
recognized.
Mr. EXON. Mr. President, in keeping with what we have done several
times today, I ask unanimous consent at this time that the Senator from
Georgia be recognized for appropriate remarks on the tragedy that faced
all of us today, especially the U.S. Navy.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Georgia [Mr. Nunn], is recognized.

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