[Congressional Record Volume 143, Number 41 (Wednesday, April 9, 1997)]
[Senate]
[Pages S2866-S2870]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            MEDICARE REFORM

  Mr. WYDEN. Mr. President, I have come to the floor each day this week 
to talk about what I think is the critical need for the Senate to 
develop a bipartisan plan to reform Medicare. Medicare is a lifeline 
for millions and millions of American families, and I think it is 
understood by every Member of this body that this is a program that 
faces financial crisis as we look to the next century.
  Today, as part of the effort to build support for a bipartisan 
Medicare reform effort I will look specifically at the Medicare 
reimbursement formula. I think it is important to take this subject up 
because I believe today's Medicare reimbursement system in many 
instances overcharges taxpayers on costs and shortchanges older people 
who need and deserve good quality care.
  Now, Mr. President, as we all know, there are essentially two major 
types of health care in America. There is traditional health care, what 
is known as fee-for-service. It means just what it sounds like. 
Providers get paid on the basis of the number of services that they 
render. This, unfortunately, can encourage waste. If, for example, an 
older person in traditional health care receives 10 medical tests and 4 
would have been sufficient, under traditional health care the provider 
gets paid for 10. The other type of health care is what is known as 
managed care or health maintenance organizations. This is essentially a 
prepaid kind of arrangement. It creates incentives to hold down costs. 
But as we know, in some instances, tragically, it has also been used as 
a tool to hold back on needed health care that older people depend on.
  The Federal Government, looking to the great demographic changes, the 
demographic earthquake that our country will face in the next century, 
has sought to try to change this system of reimbursement and, in 
particular, try to encourage the availability of good quality--I want 
to emphasize that, good quality--managed care or health maintenance 
organizations.
  They set up a plan for reimbursing these organizations known as the 
average adjusted per capita cost, or AAPCC. Now, I am the first to 
admit that discussion of this topic is pretty much a sleep-inducing, 
eye-glazing issue, but certainly for folks in rural Wyoming, rural 
Oregon and across this country, the low-cost areas, it has great 
implications, but also it has great implications for the system as a 
whole.
  I believe that the Federal Government has botched the job of handling 
this reimbursement system, and it is time to make some fundamental 
changes. Under this reimbursement system, Medicare pays health 
maintenance organizations 95 percent of the estimated cost of treating 
a patient under fee-for-service plans in a particular county. What this 
very often means

[[Page S2867]]

is that in an area where there has not been an effort to inject 
competition, where there has not been an effort to drive out waste, you 
have wasteful, inefficient fee-for-service health care being offered, 
and it is being used, essentially, as a path to guide reimbursement for 
the HMO's, the health maintenance organizations.
  I brought a couple of charts to the floor today. The first is one 
that shows that many, many of our counties across this country that 
have tried to hold down costs are reimbursed for health maintenance 
organizations, or the competitive part of the Medicare system, in a way 
that is below the national average. Certainly, Mr. President, you and 
others like myself who represent rural areas see how critical this 
issue is because our providers have difficulty providing the defined 
benefits under Medicare, let alone some of the extras such as reduced 
drugs, eyeglasses and hearing aids that are available in many of the 
high-cost areas.
  For example, as my next chart illustrates, in 1997, one of the very 
high-cost reimbursement areas was in Florida, in Dade City, FL, with 
$748 a month received there, whereas in Arthur, NE, they receive $221 
per month. So the question, essentially, is to our colleagues, again, 
on a bipartisan basis, our colleagues from Nebraska, Senator Kerrey and 
Senator Hagel: Is it true that a typical 72-year-old Nebraskan is that 
much healthier than a typical New Yorker of the same age? Well, 
Medicare thinks so. That is how the Federal Government does business. 
The Federal Government conducts its affairs that way. I think it is 
wrong. It is that way not just for folks in Nebraska but many other 
parts of the country like ours that, again, we share on a bipartisan 
basis, and as a result our seniors get a much thinner Medicare benefit 
package than they would if they were in an area that was much more 
costly.
  For example, in my home community of Portland, OR, we have the 
highest concentration of HMO's in the country, the highest level of 
penetration of HMO's in the United States, just about 60 percent, and 
we are reimbursed at a level significantly below the national average 
of $467. We get reimbursed at a $387-per-month level. What happens is a 
senior who lives in Dade City, FL, or in southern California or parts 
of New York State calls seniors I represent in Oregon and asks them how 
Medicare is going, and seniors in the high-cost areas say, ``It's going 
great because we can get prescription drugs, eye glasses and hearing 
aids all at essentially little or no cost,'' and seniors in Oregon get 
none of those things, and, in fact, many of their providers in rural 
parts of our State have difficulty providing basic services.

  So the question then becomes, what are some of the fundamental ways 
in which to change this system which so often rewards waste, penalizes 
the frugal and, in effect, creates an incentive for various parts of 
the country to do business as usual, even though the General Accounting 
Office and other bodies are saying that business as usual will be bad 
news for both seniors and for taxpayers. Several practical suggestions 
are at hand, Mr. President, and suggestions that I believe ought to be 
adopted on a bipartisan basis. I think for the long term, it is time to 
separate out, to literally cut off the link between HMO's, the managed 
care, and fee-for-service, because I think what we are having today is 
a situation that literally creates incentives for wasteful health care.
  Second, it seems to me there ought to be a new minimum payment floor 
that brings up all the counties that have been low cost, and especially 
those in rural areas, and certainly the President of the Senate, just 
as I see in rural Oregon, understands the importance of that.
  Third, it seems to me that the Senate, on a bipartisan basis, ought 
to begin a gradual effort to move to a national reimbursement level, a 
blended kind of level, and do it gradually so that areas that have been 
more inefficient are not going to face all of the changes 
overnight, but are going to understand very clearly that with an effort 
to move to a blended or national reimbursement rate, Congress is not 
going to tolerate what we have today, which is a system that rewards 
waste.

  Finally, Mr. President, it seems to me that the Federal Government 
should be trying to promote competition, serious competition, as the 
private sector does, in areas of high-cost managed care or significant 
penetration of health maintenance organizations. There is no question 
in my mind that some HMO's are overpaid. We do need to produce 
competition in those areas. I believe that that can be carefully 
targeted. That, in my view, is the guts of reimbursement reform, Mr. 
President.
  I would like to conclude my remarks today by saying that going to the 
next level of Medicare reform after we take care of the reimbursement 
issue is a logical step because it flows from what needs to be done 
with the reimbursement formula. By getting good data and more logical 
data about the various counties, the Health Care Financing 
Administration will be in a position to make information available to 
older people and their families across this country about how to make 
better choices with respect to their health care. Today, what we have 
is a situation where many older people get no choices at all. We see 
that in many rural parts of our country because of the reimbursement 
formula. The reimbursement formula is so low that many plans won't come 
in, so seniors in those areas get few choices. In the high-cost areas, 
the Federal Government has put out a mishmash of information which 
makes it impossible to choose between the various services that are 
available to them, and that is absolutely key because in those high-
cost areas we have exactly the places where it is most important to get 
competition.
  Yesterday, I brought to the floor--I am going to blow it up in the 
days ahead so that it's possible for the Senate to see it in more 
detail--an example of what it is like for an older person in Los 
Angeles to try to navigate through the various health choices available 
to her. In fact, it takes one full wall, in a picture that the General 
Accounting Office took, just to put the various pieces of information 
that that senior would have to wade through. So I want to see us now 
have the Federal Government look to what the private sector is doing to 
empower seniors and their families to get understandable, clear 
information about Medicare so that they can make appropriate choices. 
This involves details on the way different Medicare choices and plans 
work, data on the experience of seniors with similar health and income 
backgrounds, the methods and the decision steps used by plans to pay 
participating practitioners and health care facilities and providers. 
And, Mr. President, certainly, Members of this body should understand 
that this is doable because this is largely the kind of information 
that is available to Members of the Senate and other Federal employees 
who participate in the Federal employee health plan.
  So in ensuring that seniors can receive a full list of plans 
available to them, enrollment fairs are an approach that has been 
looked at in the past, and there may be other ways to do that, such as 
publishing appropriate performance data on plans. These kinds of steps 
are approaches that the Federal Government has pursued and have related 
to Senators and members of the Federal service. It seems to me that 
there is no reason to further delay making this kind of information 
available to those who depend on Medicare. Older people ought to be in 
a position to enroll and disenroll from a plan at any time.
  Certainly, this kind of approach will encourage competition. Perhaps 
at some point there ought to be incentives to try to keep people in 
plans that are cost effective, and I think that the Federal Government 
can look to this kind of approach. But, certainly, significant rights 
of older people to enroll and disenroll in plans is critical.
  So these kinds of rights, like appeal rights when you have been 
denied benefits, a good grievance procedure--in effect, a patients' 
bill of rights--is what is fundamental to making sure that older people 
are in a position to get the kind of information they need in order to 
make choices about their health care and, at the same time, inject 
competition into this system.
  We have made many of these decisions already as it relates to Federal 
employees and Senators. We have made them as it relates to the private 
sector and, in fact, we have even made them in areas that have 
parallels to this program--for example, in the Medigap

[[Page S2868]]

Program. I and others were involved in this to try to make sure that 
seniors who purchased supplemental coverage would be in a position to 
make sure they could get full value and have a place to turn to for 
their questions. We can take a lesson from the Medigap Program, and the 
Federal Government ought to make available troubleshooters to answer 
questions from older people as we move to competition.
  So, Mr. President, let me conclude by saying that I think every 
Member of this body understands that business as usual with respect to 
Medicare is unacceptable. I will tell you, if you don't like the 
program, if you really dislike Medicare, keep it the way it is, because 
the way it is is going to be a path that will cause, in my view, great 
calamity for families and seniors. If you believe Medicare is a program 
that has made an enormous difference in the lives of older people, I 
think that is the best argument for a bipartisan Medicare reform 
effort, a bipartisan Medicare reform effort that would ensure that 
seniors got guaranteed, secure benefits, not some check or some sort of 
voucher that just said, well, maybe this will be enough for your care 
and maybe it won't.

  Seniors deserve guaranteed, secure benefits. Many of my colleagues on 
the other side of the aisle have been absolutely right in saying that 
much of Medicare across this country is an outdated tin lizzy kind of 
program, a program that the private sector consigned to the attic years 
ago. So let us try to bring the parties together around the proposition 
that there ought to be defined, secure, guaranteed benefits, around the 
proposition that it is time to bring the revolution in the private 
sector to Medicare, and do it in a way that protects patients' rights--
no gag clauses or limitations on what older people can know about 
plans, grievance procedures, appeal rights. Those are the kinds of 
issues I think that both parties can agree on.
  I intend to come to the floor day after day to bring the issues of 
Medicare reform to the attention of the Senate and to the attention of 
the public, because I believe this is going to be the issue that is 
going to dominate the debate about our priorities, particularly our 
domestic priorities, for the next 15 to 20 years.
  I believe that every Member of this body in the next century is going 
to be asked: What did you do in 1997 to get Medicare on track?
  I believe there are opportunities now, as we move to the budget, as 
we move to efforts to have a bipartisan balanced budget, to start the 
changes that will put Medicare on track for older people and taxpayers.
  Senator WYDEN. Mr. President, to reiterate, the heart of the Medicare 
Program is the 38 million beneficiaries now dependent on this health 
care system as an essential social lifeline.
  Any changes we make to Medicare must, first and foremost, consider 
the likely effects those reforms will have on these beneficiaries, many 
of whom are frail, infirm, and low-income.
  As I've said every day on the floor of the Senate this week, I'm 
going to be talking today about the choices and access those 
beneficiaries ought to have, but who in too many parts of the country 
have no choices and poor access to health care.
  I'm also going to be talking about the window of opportunity we have 
in this Congress to enact significant changes in the program to cure 
the half-trillion-dollar shortfall we can expect in this program by the 
end of the coming decade, and to bring new choices, new access and new 
efficiencies necessary to save Medicare for not just the next 5 years, 
but into 2010, 2020, and 2030.
  As I said yesterday, Medicare is a 1965-model tin-Lizzy health care 
program showing little resemblance to the rest of American health care. 
Various out-dated, out-moded and bureaucratic features of Medicare 
practically encourage practitioners in the greater part of the Medicare 
system to drive up unnecessary care and resulting over-billing--actions 
which over-charge the Government on costs, but short-change 
beneficiaries on good health care.
  Beginning in the last decade, the Government's partial solution to 
this was to institute coordinated care in Medicare. We encouraged 
health insurers to begin offering plans that managed service Medicare 
beneficiaries received, and we offered encouragement to beneficiaries 
to participate in the form of lower out-of-pocket costs and, we 
anticipated, a broader package of goods and services.
  And we would determine how each plan, in each city, would be paid for 
each beneficiary in the plan according to an arcane formula called the 
average adjusted per capita cost--or the AAPCC.
  Now, before your eyes glaze over, let me give you a very simplistic 
idea of how the local AAPCC payment rate is determined, and how this 
formulation really penalizes beneficiaries living in places where 
medical costs are relatively low.
  The AAPCC is any given county is formulated on the cost of providing 
medicine, per beneficiary, in the most costly portion of Medicare--the 
traditional sector known as fee-for-service. This is the portion of the 
program where beneficiary can elect to see just about any doctor they 
want, whenever they want, and the individual care providers in those 
situations can be reimbursed for just about any services they deem 
necessary for that beneficiary.

  No questions asked. No oversight.
  This may sound like a pretty good deal for the beneficiaries. But it 
doesn't always mean they get the care they need or require. For 
example, there's nothing to stop an individual provider in fee-for-
service for ordering up 10 or 12 tests for a beneficiary, when only 3 
or 4 really are required.
  This is one of the reasons why fee-for-service Medicare is growing at 
a much more rapid rate than the rest of the program--and it's one of 
the reasons we find ourselves in such a deep financial hole.
  It is also clear that the rapid growth of fee-for-service Medicare 
seems endemic to certain large metropolitan regions of the county.
  As my colleagues may be able to see, the areas in blue and white 
represent portions of the country where the AAPCC rate is below the 
national average.
  The areas in red and orange represents areas where the payments are 
above the average.
  And just for the record, the variation is huge. The 1997 high-
reimbursement county is Richmond County, up in New York, at $767 per 
month, per beneficiary, while the lowest paid county was over here in 
Arthur County, Nebraska, at $221 per month.
  Now, I'd ask my colleagues Bob Kerrey and Chuck Hagel whether they 
think a typical 72-year-old Nebraskan is that much healthier than a 
typical New Yorker of the same age?
  Medicare seems to think so, and I think they're wrong.
  And unfortunately for folks in Nebraska and other low pay States--my 
home State of Oregon is certainly one of them--the difference is that 
they get a much thinner Medicare benefit package in coordinated care 
plans, if they have access to such plans at all because their monthly 
reimbursement rate is so abysmally low.
  Let's talk about some examples of how this hurts beneficiaries in 
cost-efficient counties where the reimbursement rate is particularly 
screwy.
  In Mankato, MN, where the average payment is $300 per month, 
beneficiaries in coordinated plans get their basic managed care 
coverage under Medicare rules--but nothing else. No discounts on 
prescription drug purchases, no additional preventative care, no 
hearing aid discounts, no coverage for eyeglasses.
  In Portland, OR, my home town, the rate is a little better at $387 
per month, but that's still well below the $467 national average. That 
means the best additional benefit received by these folks, who have the 
highest managed care penetration rate in the country at about 60 
percent, is a 30 percent discount on prescriptions up to a $50 maximum.
  Now, let's go up to the high end of this wacky AAPCC payment system. 
In Miami, FL, where the payment rate is all the way up to $748 per 
month, seniors in these programs get unlimited prescription drug 
reimbursements, a $700 credit for hearing aids, and dental coverage--
all add-ons that are virtually unheard of in most of the rest of the 
country.
  Mr. President, I wish I could say that this is the kind of cost-
accounting that's going to add stability and integrity to the Medicare 
Program into the

[[Page S2869]]

next century. Unfortunately, all this payment formula accomplishes is: 
First, huge overpayments in some counties, with resulting extravagant 
profits to insurance companies, and second, payments to other counties 
which are obviously too low, and which result in either no coordinated 
care offerings to beneficiaries in those communities or bare-bones 
plans that for millions of beneficiaries to incur higher out-of-pocket 
costs purely as a matter of geographic accident.
  I believe we can transform Medicare from an aging dinosaur insurance 
program into a comprehensive seniors health care system while 
maintaining our historic commitment to a basic package of benefits for 
every beneficiary, no matter their health or income status.
  But that transformation necessarily will involve providing seniors 
with many more choices with regard to their health plan selection.
  The current formula used for paying Medicare in rural counties and in 
other places where communities have worked hard to reduce general 
health care costs is precisely antagonistic to that purpose.
  This system denies folks choice because it necessarily results in 
poor quality health plans, high out-of-pockets expenses, or no managed 
care choices--or a combination of all three--for vast numbers of 
beneficiaries.
  And again, an accident of geography seems to be the deciding factor 
in the current state of affairs.
  I believe Medicare reform has to include remedies for these problems.
  This is not just a matter of increasing the benefit package for folks 
in low pay counties. More fundamentally, this is an issue of providing 
more choices, to encouraging the entry of more plans, into large areas 
of this country where the current AAPCC formula creates reimbursement 
rates which are so low--which are so nonsensical--as to completely 
discourage anything but fee-for-service Medicare in those communities.
  I believe reimbursement reform include several important features:
  A new minimum payment floor that brings all counties up to 80 percent 
of the national average, immediately.
  A new annualized reimbursement increase formula that shifts 
adjustments away from localized fee-for-service medicine costs, and 
toward actual cost increases in coordinated care.
  A systematic imposition of financial controls reimbursement growth in 
high-reimbursement counties in order to squeeze out what have to be 
monumental over-payments to plans in those communities, and huge losses 
to the Medicare Program.
  Mr. President, reforming Medicare isn't just about reforming payment 
systems, however.
  It's also about helping beneficiaries to become smarter shoppers in a 
new Medicare environment that we hope will offer many of them many more 
choices and options for care.
  Therefore, it is critical that we change the program in way that will 
empower seniors to make the appropriate choices.
  At the bottom, this means developing and executing a much better 
system of informing beneficiaries about their rights in managed care, 
and about the most important provisions of the health plans available 
to them. This information must be given to seniors as ``news they can 
use''--data that is in clear and accurate layman's language, and which 
conforms to standardized reporting practices so that consumers can 
compare one plan against another in a traditional kitchen-table-
assessment.
  Indeed, these tools if we had them would be useful, today, with 
80,000 beneficiaries per month choosing to leave fee-for-service 
Medicare for Medicare managed care organizations.
  According to Stanley Jones, chairman of the National Institute of 
Medicine's committee on choice and managed care:

       Many elderly are making these new choices without enough 
     information to judge which option is best for them, what the 
     plan they choose will actually cover, or how the plan will 
     operate.

  Jones said that many seniors misunderstand the basic structure of HMO 
payment and care practices. He criticized Medicare managers for 
providing information to beneficiaries about differences in available 
health plans that ``appears primitive'' compared with what's available 
from private purchasers.

  Mr. President, last year I asked the General Accounting Office to 
look into this problem, and the GAO auditors came to similar 
conclusions:

       Though Medicare is the nation's largest purchaser of 
     managed care services, it lags other large purchasers in 
     helping beneficiaries choose among plans. The Health Care 
     Financing Administration (HCFA) has responsibility for 
     protecting beneficiaries' rights and obtaining and 
     disseminating information from Medicare HMOs to 
     beneficiaries. HCFA has not yet, however, provided 
     information to beneficiaries on individual HMOs. It has 
     announced several efforts to develop HMO health care quality 
     indicators. HCFA has, however, the capability to provide 
     Medicare beneficiaries useful, comparative information now, 
     using the administrative data it already collects.

  The kind of data HCFA collects, now, of use to beneficiaries includes 
performance indicators such as: First, annual disenrollment rates, 
second, cancellation rates, third, so-called rapid disenrollment 
rates--the percentage of enrollees who disenroll within 12 months of 
signing up, fourth, rate of return to fee-for-service Medicare from the 
plan, and fifth, disenrollments tied specifically to sales agent abuses 
involving, among other things, marketers who mislead enrollees about 
what a plan may cover.
  I think we can go beyond these quality indicators. The Federal 
Employees Health Benefits Program [FEHBP], for example, includes a 
graded system of reports on the quality of key services in federal 
employee health plans. There is no reason why Medicare beneficiaries, 
who must make these decisions on their own without benefit of employers 
or corporate benefit managers, shouldn't have at least the kind of 
qualitative analysis available to members of Congress who are covered 
by FEHBP plans.
  Mr. President, I am heartened by the announcement earlier this year 
by HCFA Administrator Bruce Vladeck that the program would begin 
offering beneficiaries some qualitative information on managed care 
plans through the Internet. I think that's great for seniors that use 
the Internet in their homes or have access to that technology somewhere 
else.
  I think it's clear, however, that we need to step up efforts going 
beyond the limited information that eventually would be made available 
at a HCFA website.
  Here's the bare minimum of information that seniors need in a 
revamped Medicare program which empowers them to make appropriate 
choices:
  Details on the way different Medicare choices and plans work.
  Data on the experience of seniors of similar health and income 
background in those plans.
  The methods and the decision steps used by plans to pay participating 
practitioners and health care facilities and service providers.
  And here are the steps we need to take to insure seniors receive that 
information and the other tools they need to prevail in an increasingly 
more complex and choice-intensive Medicare marketplace:
  First, Medicare managers must ensure that every senior, in every 
county, receive a full list of plans available to him, with a detailed 
description of what each plan offers. These submissions must be written 
in a way that allows a consumer to make easy comparisons between plans.
  HCFA should require annual ``enrollment fairs,'' giving seniors a 
chance to review all plan materials at least once a year in order to 
determine if alternative Medicare offerings might be more suitable to 
the individual enrollee.
  Second, Medicare must collect, evaluate and publish appropriate 
performance data on every plan. Using independent quality review 
organizations like the National Council of Quality Assessment, Medicare 
must devise and publish qualitative analysis--consumer report cards--on 
each Medicare plan, further enabling seniors to make appropriate 
choices among offerings.
  Third, consumers must be allowed to enroll and disenroll from plans 
at any time during their first 12 months in a plan. After the first 
year of enrollment, disenrollment with guaranteed enrollment in a new 
plan would be limited to a first opportunity after six months in the 
second year.

[[Page S2870]]

  We would make it somewhat tougher to disenroll after the first year 
because we would expect plans to make investments of preventative 
health services for new enrollees in the initial few months of their 
enrollment.
  Fourth, health plan enrollees need a patient bill of rights that by 
Federal statute protects certain baseline issues fundamental to their 
good health. At the top of this list would be a Federal statute 
absolutely protecting the free and unfettered communication between 
patient and doctor on that enrollee's health condition and any 
appropriate services and procedures necessary to treat the patient.
  Fifth, give Medicare beneficiaries a certain and sure grievance and 
appeals process, and the information they need to use it. Medicare must 
streamline the current process, allowing beneficiaries to by-pass 
certain bureaucratic roadblocks in the present system--most especially 
those that force time-delaying procedural exercises when the outcomes 
already are known. On an initial enrollment, and at any time a 
beneficiary changes plans, an explanation of new or amended appeals 
procedures must be part of the enrollment exercise.
  And as with Medigap insurance, HCFA should hire and train ombudsmen 
and trouble-shooters tell help beneficiaries both understand provisions 
in plans, generally, and appeals and grievance procedures specifically.
  Sixth, every Medicare risk provider should offer at least one plan in 
his portfolio that includes a point-of-service provision, so that those 
seniors who would try plans if they could keep going to a particular 
practitioner would be allowed to do so.
  Mr. President, I have spent quite a number of years talking with 
seniors about their health care. Before I was elected to the House of 
Representatives in 1980, I was cochairman of the Oregon Gray Panthers. 
I know that seniors are deeply suspicious of any changes to Medicare, 
in particular, and many of them view the current debate over the shape 
and direction of the program with a good deal of alarm.
  But many more who I've talked to recognize the need for changes and, 
indeed, want to see this debate begin.
  And on the basis of those conversations I am convinced that seniors 
will feel a lot better about anything we do if we give them more 
decision-making power to fashion the health care they receive through 
the program.
  Fundamental to that is making sure they have the information and 
tools to make the right decision, at the front end, and to protect 
themselves in the case of disputed decisions while they are enrolled in 
plans. These changes would go a long way toward providing seniors with 
that kind of empowerment, and in the long run strengthening and 
improving Medicare as a critical government program.
  Mr. President, I yield the floor.
  Mr. FAIRCLOTH addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina [Mr. 
Faircloth], is recognized.
  Mr. FAIRCLOTH. Mr. President, I ask unanimous consent to be 
recognized for 10 minutes in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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