[Congressional Record Volume 143, Number 90 (Tuesday, June 24, 1997)]
[Senate]
[Pages S6120-S6163]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
BALANCED BUDGET ACT OF 1997
The Senate continued with the consideration of the bill.
Mr. CHAFEE. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. LOTT. 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the quorum call be rescinded.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. LOTT. Mr. President, for the information of all Senators,
approximately 6 hours remain for debate with respect to the Balanced
Budget Act, basically equally divided. There are approximately 30
minutes remaining on the motion to waive the Budget Act with respect to
the Medicare age increase issue. Therefore, a vote will occur on that
motion to waive around 3 o'clock, or maybe shortly before that.
As was mentioned in both luncheons today, the Senate will remain in
session this evening until all time is consumed. If any Senator intends
to offer an amendment after the time has expired, they will be required
to do so this evening. It will then be my intention to stack all votes
on the amendments and the final passage, after the time has expired
this evening, until approximately 9:30 a.m. on Wednesday.
So all debate time and all amendments will be offered tonight, and
then we will begin a series of votes at 9:30. We don't know exactly how
many amendments that could entail. It could be as few as five, I hope.
It could be many more than that. We will begin voting at 9:30 and
continue voting until we complete all the amendment votes and final
passage. Then, of course, we will go to the taxpayers' relief act.
Senators can expect additional votes today and a series of votes
beginning at 9:30 on Wednesday, the last of the series being final
passage of the Balanced Budget Act.
Mr. CHAFEE. Mr. President, I would like to ask the majority leader a
question. As I understand it, suppose somebody has an amendment this
afternoon and is prepared to go to a vote this afternoon; would there
be a vote this afternoon?
Mr. LOTT. Yes, there can certainly be votes this afternoon. In fact,
we expect votes throughout the afternoon, probably until all time has
expired, or around 8:30 this evening. So you could have votes at least
until 7 or 7:30, and then we will put the rest of the votes over until
9:30.
Mr. LOTT. I yield the floor, Mr. President.
The PRESIDING OFFICER. Who yields time?
Mrs. BOXER addressed the Chair.
The PRESIDING OFFICER. Who yields time?
Motion to Waive the Budget Act
Mr. CHAFEE. Mr. President, I would like to address the matter before
us, and I believe the time is running anyway, is it not?
The PRESIDING OFFICER. Time is being charged against the motion to
waive the Budget Act, which is the pending business.
Mr. CHAFEE. I ask that I might have 5 minutes on Senator Roth's time
on this matter.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The Senator from Rhode Island is recognized to speak for up to 5
minutes.
Mr. CHAFEE. Mr. President, there is an organization set up to report
to the Congress every year on the status of Social Security and the
status of Medicare. This group is a very distinguished group. It
consists of the Secretary of the Treasury; the Secretary of Health and
Human Services; the Secretary of Labor, or Acting Secretary of Labor;
and the Commissioner of Social Security, or the Acting Commissioner of
Social Security. These are the people, plus two members of the public.
I might say, of the first four--and there are six in all--four of these
are Democrats. They are not Republicans; they are Democrats. They
submitted a report to us in the Congress in April of this year. What
did they say?
As we have reported for the last several years, one of the
Medicare trust funds, the Hospital Insurance--
The HI, the so called part A.
will be exhausted in 4 years without legislation that
addresses its fiscal imbalance.
This isn't a bunch of right wing Republicans saying there is trouble
[[Page S6121]]
ahead. These are the very prestigious, qualified Cabinet Members of the
President of the United States--every single one of them a Democrat. It
goes on to say:
We are urging the earliest possible enactment of
legislation to further control Hospital Insurance program
costs because of the nearness of the Hospital Insurance Trust
Fund exhaustion date.
Mr. President, these are serious matters. They go on to explain why
this is happening.
On page 6 of its report it says:
Why do costs rise faster than income? The primary reason
for these costs of Social Security and the Hospital Insurance
costs are because of the baby boom generation retirees,
while the number of workers paying payroll taxes grows
more slowly.
Mr. President, we are facing an emergency here. This legislation,
which came from the Finance Committee, proposes to do something about
it. What is the situation? In 1950, which is 47 years ago, there were
16 workers for every retiree--16 workers in the United States paying
into the Hospital Insurance Fund and paying into Social Security.
Mr. DOMENICI. Will the Senator yield for a moment?
Mr. CHAFEE. I will.
Mr. DOMENICI. Mr. President, I want to yield control of the bill to
the chairman of the Finance Committee, even to the extent of his
yielding time off the bill, if he sees fit. He may run out of time, and
Senator Breaux may need time. I am going to leave for about a half
hour, so you can take it off the bill if you need it.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. CHAFEE. As I said, 47 years ago, in 1950, there were 16 workers
for every retiree. Today, there are 3 workers for every retiree--not
16, but 3. Twenty-eight years from now, in the year 2025, the ratio
will fall to two workers for every retiree. So something has to be done
if this Medicare trust fund is going to survive.
What we have proposed is increasing the Medicare eligibility age to
conform with that of Social Security. In 1983, we raised the age of
Social Security eligibility gradually. It comes into full force in the
year 2025. By the year 2025, the retirement age will be 67, not the 65
that it is today.
We have proposed that the Medicare Program step up in similar
fashion. The key thing, Mr. President, is to take these actions now;
don't wait until the baby boomers are all there collecting and we can't
do anything about it. Now, if we act, we can take these very gradual
steps. For example, the first step will be in 2003, 6 years from now,
when the eligibility age for Social Security and Medicare will go from
65 to 65 and 2 months. Then it goes up to 65 and 10 months by the year
2007. Then we take a break for 11 years--excuse me. In 2008, it will be
at age 66, and then gradually it goes up by 2 months and 4 months and 6
months until the year 2025, when the retirement age for Social
Security----
The PRESIDING OFFICER. The Chair advises the Senator that his 5
minutes have elapsed.
Mr. CHAFEE. I ask unanimous consent that I may have 2 more minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. CHAFEE. Social Security is already set. That goes to 67. We did
that in 1983. That goes to age 67 in 2025. What we do in this program
is to have Medicare conform to that.
Mr. President, unless we take these actions, there isn't going to be
any Medicare for the future. A lot of people say, ``Do nothing.'' Well,
I think that is totally reckless. Other people can say, ``Well, just
increase the tax.'' That would mean increasing the tax on Medicare by
250 percent. That is what would be required to increase the payroll
tax. It would have to be increased from the current amount of 1.45
percent of payroll to 3.6 percent, which is nearly a threefold
increase.
So, Mr. President, this is a very wise provision that we did, in a
bipartisan manner, in the Finance Committee, and I certainly hope that
it will withstand any attacks. I thank the Chair and I thank the
distinguished chairman of our committee.
The PRESIDING OFFICER. Who yields time?
Mr. LAUTENBERG. I yield 5 minutes to the Senator from California.
The PRESIDING OFFICER. The Senator from California is recognized for
5 minutes.
Mrs. BOXER. Thank you very much, Mr. President. I support the Senator
from Illinois in his attempt to keep the age of Medicare eligibility at
65.
Mr. President, raising the eligibility age to 67 in the future is
part of the bill that is before us and was an amendment offered by the
Senator from Texas, Senator Gramm.
Now, had the Senator from Texas and his supporters had an alternative
in place for those who would be unable in the future to get Medicare
between the ages of 65 and 67--if there was an alternative in place, if
this bill said that we will, in fact, raise that age, but only after we
have an alternative in place for those people, I would be here
supporting it.
But it is so reckless, Mr. President, to take away Medicare from
people who pay for it their entire working lives--to take it away from
them for 2 years unless there is an alternative in place. I do not know
if any of my colleagues know about our health insurance, but we have a
pretty good plan around here. As a matter of fact, I voted in during
the health care debate to offer that plan to every American. That
didn't fly. ``Oh, we are covered. What do we have to worry about? We
are fine.'' But to take away Medicare from people who have been paying
for it out into the future without any way to replace it, I don't know
what we are doing here.
The Senator from Texas says he is concerned about the solvency of
Medicare. That is what the Senator from Rhode Island said--if we care
about solvency, we will support this. We all know there are many ways
to address solvency.
By the way, the committee does it in some other areas that I support,
but not this one.
My friends, it isn't that tricky to preserve the solvency of
Medicare. If you want to really preserve the solvency, raise the
eligibility age to 90, and for the people who are on Medicare at 90--
there will be enough money to take care of them because everyone else
who would have been eligible previously, will have died.
Medicare solvency is the new mantra of my colleagues on the other
side of the aisle. First they want to vote against Medicare --now they
say they are going to save it. They are going to make it solvent by
telling people that in the future without any alternative means of
health insurance in place, no universal health care, that they have to
wait until they are 67 to be eligible for Medicare.
Medicare remains solvent because they don't talk about what happens
to you when you can't get insurance and you don't get preventive care
and you get sicker. What are people going to do? Either they have to go
out and find it in the marketplace and pay thousands and thousands of
dollars to get coverage, or they will fall down on their hands and
knees and pray to God that they don't get sick.
That is not an option because, unfortunately, if you look at the
tables and you see when Alzheimer's strikes, when Parkinson's strikes,
when stroke strikes, when heart disease strikes, when prostate cancer
strikes, and even when breast cancer strikes, the older you get the
more you are apt to get these conditions. You cannot control it.
The Senator from Rhode Island said we have to save Medicare. What
about saving the people who are served by Medicare?
So this part of the Finance Committee bill puts the cart before the
horse. Don't just say we are going to raise the age at which people can
get Medicare and have nothing in its stead and not even make it
contingent on having universal health care in place because when people
reach the age of 65 they will not have an option.
Mr. President, we ought to look at what we are doing around here. It
sounds great, ``save Medicare.'' I think we need to save the people who
rely on Medicare.
We all know the horror stories of people getting sick. They don't
expect it. And then they try to tie it to the increased age of Social
Security retirement which we phased in, which I support--phasing it in.
But there is one difference. People can still retire at age 62. If they
choose to retire at that age and go on Social Security, there is
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a penalty but it can be done. There is no such provision in here. This
is just a cutoff. The proposal does not say if you need Medicare you
can get half coverage; you can pay 50 percent of your premium. No. This
just takes people off the plan without any alternative--at a time in
their life when they are apt to get seriously sick. If you have ever
been in a hospital and you see some of these charges that come back at
you, thousands of dollars a day, we will put people into ruin. We will
go back to the days when people have to in fact rely on their children
taking care of them at the height of their lives when they need
Medicare and they cannot get it.
So, Mr. President, I urge my colleagues to support the Senator from
Illinois. I want to save Medicare because I believe in it. I do not
want to hurt the people who need Medicare. When you have something in
place for those people to go to, when you have an alternative insurance
plan, I'll am with you all the way. I will support you 100 percent.
We already have 40 million people who are uninsured in this country.
They have no health insurance. You are going to throw 7 million more of
these people onto the uninsured rolls, and you are going to do it in
the name of saving Medicare.
Something is wrong with this picture. It doesn't add up. My friend
from Illinois calls it the ``Texas two-step.'' I think it is the
``backward step.'' It is going back--back to the days when our senior
citizens were very sick with no place to go.
I hope you will support the motion by the Senator from Illinois.
I yield the floor.
Mr. KERREY addressed the Chair.
The PRESIDING OFFICER. Who yields time?
Mr. ROTH. I yield 5 minutes to the Senator.
The PRESIDING OFFICER. The Senator from Delaware will be advised that
the time remaining under his control is 4 minutes and 22 seconds. The
Senator may take time off the bill.
Mr. BREAUX. How much time?
Mr. ROTH. Four minutes.
The PRESIDING OFFICER. The Senator from Louisiana is recognized.
Mr. ROTH. How many minutes?
The PRESIDING OFFICER. There are 4 minutes approximately left. The
Senator may take time off the bill itself.
Mr. ROTH. I yield a total of 5 minutes with 1 minute being off the
bill.
The PRESIDING OFFICER. The Senator from Louisiana.
Mr. BREAUX. Thank you very much, Mr. President. I thank the chairman
for yielding.
Mr. President, this is really an interesting dialog because on the
one hand we have some facts that are uncontested; that is, if we do not
do anything to fix Medicare, it is not going to be around for anybody
by the year 2001 because that is the year when, if we do not do
anything, we are not going to have enough money in the Medicare Program
to pay benefits to nobody.
So it is very clear that Congress now has to do something if it is
going to be around for everybody who is counting on it when they reach
retirement age.
It is really interesting. In the Finance Committee we have had people
come before the committee all of the time saying, ``You all have to fix
Medicare. If is very important. It is the lifeblood or lifeline for
seniors in this country.''
Then we ask them when they tell us to fix it, ``All right. Do you
want to increase premiums?"
``No. We don't want you to do that.''
Then we say, ``Well, would you want to decrease the payments going to
doctors and hospitals?"
They generally say, ``Don't do that either because doctors and
hospitals will soon quit treating Medicare patients because they are
not getting paid enough for those services.''
Then we say, ``Well, would you like us to increase the age limit of
people who are eligible for Medicare?"
They say, ``Oh. No. Don't do that.''
But then, the bottom line: They say when they leave the committee
room, ``Be sure you fix it, by the way. Make sure it doesn't go broke
in the year 2001. Fix it. But don't, don't, don't do anything that is
necessary in order to fix it.''
That is an impossible suggestion for the members of the committee and
the Members of Congress to adopt. If we do nothing it will not be
around for anyone.
In 1965, when Congress in its wisdom passed the Medicare Program, the
life expectancy for people at that time was 66.8 years of age for men;
73 years of age for women. So Congress in its wisdom at that time said,
``Well, let's make an appropriate date for the beginning of Medicare
benefits at 65.''
Guess what has happened since 1965? For every year the life
expectancy of Americans has increased. But the eligibility age for
Medicare has not been increased one time. We did it for Social
Security. What this committee does is to say, ``Let's put the glidepath
for Medicare eligibility the same as Social Security, recognizing that
people in fact live substantially longer and draw Medicare benefits
substantially longer, I might add as well. It almost sounds like we are
getting these calls in our offices from people who are retiring, none
of which are affected by this amendment--not a single one because they
already are on Medicare. In fact, it goes down quite a ways before
anybody is affected whatsoever.
An interesting point is that it sounds like we are talking about
having all of this going into effect immediately, when just the
opposite is true. The amendment that was offered, I guess by Members
from our side, takes 24 years to increase it 24 months. It doesn't
increase it the first year to the age 67. You start off right where you
are today, and it is increased 2 months a year and over 4 years we get
to the age of 67 which is comparable to what we have in Social
Security.
Would it be nice if we didn't have to do that? Sure. Would it be nice
if we didn't have to do anything to fix Medicare? Absolutely. The
problem is we have a system that is in the tank as far as being able to
survive, if we do not do anything. It would be wonderful to say make no
changes and everybody continues to get exactly what you get at the time
you are eligible for it. That is not an option. None of the options are
easy. This one I would argue is far easier than any of the others, and
it helps allow for Medicare to continue for a long period of time.
Mr. HARKIN. Will the Senator yield?
Mr. BREAUX. I would be happy to yield for a question.
Mr. HARKIN. Did the Senator say under his proposal that for each year
that the age increased by 2 months?
Mr. BREAUX. Two months per year.
Mr. HARKIN. In 6 years it would increase by 1 year and, therefore, in
12 years it would increase by 2 years, not 24 years.
Mr. BREAUX. It is increased 2 years over 24--2 months. The whole
thing takes 24 years to get to the age 67; 24 years before 67. It takes
24 years to reach the age of 67, however that calculates out.
Mr. HARKIN. That is 1 month per year.
The PRESIDING OFFICER. Who yields time?
Mr. ROTH. I yield 5 minutes off the regular time to the Senator from
Nebraska.
The PRESIDING OFFICER. The Senator from Nebraska is recognized for 5
minutes.
Mr. KERREY. Mr. President, I rise in strong opposition to the point
of order that has been raised against this provision.
Raising the eligibility age from 65 to 67 is fair. Raising it, too,
from 65 to 67 will change the future course of this program and enable
us to say that we are taking a long-term as well as a short-term view;
and enables us to accomplish the objectives that we were instructed to
accomplish which is to preserve and protect Medicare.
If you want to have universal health insurance as the objective, I am
for that. I would love to change the eligibility under law saying if
you are American, or a legal resident, you are in. But I can't keep
Medicare, Medicaid, VA, and income tax deduction all sitting out there.
This establishes I believe a basis for us to be able to say that for
the long-term Medicare is a solvent program, and it is eminently fair.
As the Senator from Louisiana pointed out, in 1965 the life
expectancy for men was 67; for women it was 76; today it is 73 for men,
and it is 80 for women. It is going to be even greater. We are enabling
people to live longer and
[[Page S6123]]
longer as the consequences have changed in behavior and with changes in
health care technology. And, as a result, the Medicare Program as well
needs to be adjusted.
For those who have come expressing the concern for people not being
able to get health care from 65 to 67, that problem exists today from
62 to 65 and sometimes even earlier. We have in this law a commission
and there is language in the law as well to recommend strongly to this
commission to consider allowing people to buy into Medicare. There is
plenty of time for us to get that done.
For Americans that are listening to this debate, if you are 65--if
you are 64 today, your eligibility age is 65. If you are 63, your
eligibility age is 65. If you are 62, your eligibility age is 65. If
you are 61, it is 65. If you are 60, it is still 65, all the way down
to 59. If you are 59 years of age and you are listening to this debate,
please don't fall into the trap of presuming that all of a sudden your
eligibility age is going to go to 67. It is still 65. If you are 58, it
goes to 65 years and 2 months. The Senator from Iowa and the Senator
from Louisiana engaged in a colloquy earlier. This thing does not fully
phase in until the year 2024 or 2025.
Mr. President, I have had many people come up to me and ask, many
people call and ask, why is this necessary? Well, I have a fact. I have
a very difficult fact I have to deal with. Again, the objective here is
to preserve and protect Medicare. That is the idea. This law has lots
of great provisions to move to market and get more competition, lots of
terrific provisions in it that I think will enable us to seek customers
and consumers who like Medicare more than they do as a result of
choice, great cost controls in here, some courageous efforts on
disproportionate share in this bill.
There are lots of good things in the bill. But the fact out there in
the future that all of us need to accommodate and think about as we
decide how we are going to vote on this amendment is that from the year
2010 to the year 2030--that is 20 years--the baby boomers retire. You
can't change that number. The 76 or 77 million of them that will
retire, they will become eligible for Medicare in that 20-year time
period. We are going to have an increase in the number of Americans who
are in the work force of 5 million people, and the number of retirees
will increase 22 million over that period of time.
That is a fact, Mr. President. I may wish it wasn't so. I may wish it
was a different number, but that is the number. Unless you are prepared
to come down here and argue for a tax increase or some other change,
you have got to move the eligibility age in order to be able to
preserve and protect Medicare out in the future.
It is an imminently fair thing to do given what has happened with
life expectancy. If we were putting Medicare into law today, I don't
believe we would put this program, given the costs of the program, in
place at age 65. This does not affect Americans immediately. It is
phased in. It gives people a chance to plan. Those who argue that it
doesn't have a budget impact and use that as a reason not to support
this provision are wrong. It is precisely because we are phasing it in,
that it produces long-term savings, that they should support it. We are
giving people a chance to plan. We are saying we are going to adjust
the law in order to be able to account for this change out in the
future.
I hope that my colleagues will resist the political temptation to
cast an easy vote and will enable this provision to remain in this law.
It is one of the most significant long-term changes that we make in
Medicare. And whether you are a Republican or whether you are a
Democrat, you ought to be standing on this floor saying I want to be
remembered out there in the future for casting a vote that did
something good. ``No'' on the motion to strike this provision is the
courageous position.
Mr. President, I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. KENNEDY. Mr. President, I would like to----
The PRESIDING OFFICER. Who yields time?
Mr. LAUTENBERG. I yield to the Senator from Massachusetts 4 minutes,
Mr. President.
The PRESIDING OFFICER. The Senator from Massachusetts is recognized
for 4 minutes.
Mr. KENNEDY. Mr. President, as we are moving through this debate, we
have to recognize that in the proposal before us, we have a number of
attacks on Medicare, with all due respect to our colleagues. We
addressed one earlier today. Collecting $5 billion under Medicare. You
are going to permit double billing, which this body has long refused to
do in order to protect our senior citizens. Now we are going to permit
doubling billings.
The Finance Committee failed to make up the $1.5 billion that was
part of the budget agreement. It refused to do that, and now we have a
proposal to change the eligibility age from 65 to 67.
I thought we had a commission that was going to study the long-term
implications of Medicare. The President submitted a program that
provides for the financial stability of Medicare for 10 years. We can
consider a variety of different options. I daresay that I don't happen
to be one who thinks you should just increase the age of eligibility or
otherwise increase the taxes as some have suggested. We know that 90
percent of Medicare recipients cost $1,400 a year, the other 10 percent
more than $36,000. You do something about that 10 percent to reduce
disability, and chronic illness, and you are going to have a dramatic
impact in terms of Medicare spending.
That has not even been considered here, Mr. President. Why should we,
at a time when we are increasing the total number of Americans who are
uninsured, take action in the Senate that is going to add to that
problem. The idea that this can be compared to Social Security makes no
sense, and the Senator from Louisiana understands that. You can retire
now at 62 and get some benefits, but you can't with regard to Medicare.
It is basically a lifeline to our senior citizens. The Finance
Committee failed to give any assurance to those millions of people who
are watching today that they are not going to be sent right off the
cliff.
With all of the signed contracts containing terms to terminate health
insurance in corporate America now at 65, all the workers across this
country whose contracts end health care coverage at 65, and nothing
from the Finance Committee gives them any kind of assurances that there
has been any attention to what is going to happen to them.
Sure, pull up the ladder. We can make this Medicare financially
secure by just continuing increase the age from 65 to 67 to 69. Let us
look at this over the long term, not the short term, and let us stop
this wholesale assault on Medicare that is part of this whole proposal.
It makes no sense.
The PRESIDING OFFICER. Who yields time?
Mr. LAUTENBERG. Mr. President, I yield 4 minutes to the Senator from
Iowa.
The PRESIDING OFFICER. The Senator from Iowa is recognized to speak
for 4 minutes.
Mr. HARKIN. Mr. President, I want to echo what the Senator from
Massachusetts just said. If anything, this provision is the ultimate
anti-blue-collar provision that I have ever seen on the Senate floor.
This strikes right at the heart of the Americans we ought to be here
protecting today. There is a difference. There is a difference between
a corporate executive for Xerox and someone who is out there working
hard every day of their life on a construction job, in a factory, in a
plant. There is a difference between a Senator sitting on this floor or
a Member of the House and that worker who is out there on the line day
after day, the women who suffer from carpel tunnel syndrome, the people
who work in our packing plants. Try that on for size. Do that for 5
years, 10 years, 20, 30, 40 years of your life. There is a difference.
Sure, if you are a corporate executive, you have nothing to worry
about. If you are a Senator, you have nothing to worry about. But I
will tell you, if you are a blue-collar worker out there and you have
worked hard all your life, you have raised your kids, you have sent
them to school, you are now 62, you are worn out, maybe you are not
physically able to continue working. Have you ever thought of that? So
they retire. They get Social Security. God bless them. But they can't
get health care coverage.
What this amendment does, it just sticks it right in their back one
more
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time. You can say, oh, it's just 1 more month a year, 2 more months a
year for 6 years. Then there is this gap and it takes all this time.
But if this provision stays in there, the die will be cast. And we will
have sent a strong message to our seniors: Sorry, when it comes to
health care, you're out of luck; you're on the street some place.
We have a commission, a national bipartisan commission looking at
this. It is supposed to report next year. Why are we jumping the gun on
it?
Now, I would agree with Senators who are supporting this provision
that, yes, we have to do things to ensure the viability of Medicare.
There are a lot of things we can do to preserve the viability of
Medicare. But this is not one of them. This will destroy Medicare
because it destroys the compact we have had all these years. This is an
antiworker provision. That is all it is.
Now, if you want to vote for this provision, sure, fine, keep it in
the bill, but I am telling you, for that working stiff who is out there
who wants to retire, their physical health may not be the best; they
have to retire at age 62, if anything, what we ought to be doing on
this Senate floor is we ought to be closing the gap. We ought to
provide medical care for elderly who have to retire early. But, no, we
won't even do that. Now we are going to make it even a longer period of
time. Well, I think this provision is really unconscionable, should
have no place in this bill, and I hope that we will vote to strke it
overwhelmingly.
Mrs. BOXER. Will the Senator yield for a question?
Mr. HARKIN. I yield to the Senator.
Mrs. BOXER. Is the Senator aware that there are 40 million uninsured
Americans today and about 7 million in this category age 65 to 67? So
the Senator is so right. We are talking about adding millions more to
the uninsured rolls. This committee did nothing, mentioned nothing
about any kind of way to get people through this timeframe. They just
took it out without even writing anything in there that said only if we
have replacement insurance.
Mr. HARKIN. I appreciate the comments of the Senator from California.
It just seems that when I hear this debate about this provision and I
hear proponents of this provision talk, it is as if everybody in
America is like us. Everybody in America is not like us. They do not
have the kind of health care benefits we have. They do not have the
kind of protections we have. They do not have the incomes that we have.
They do not have the lifestyles we have.
The PRESIDING OFFICER. The time of the Senator from Iowa has expired.
Mr. HARKIN. It is time we start fighting for the working people in
America.
The PRESIDING OFFICER. Who yields time?
Mr. ROTH. Mr. President, I yield 3 minutes to the Senator from
Pennsylvania.
The PRESIDING OFFICER. The Senator from Pennsylvania is recognized to
speak for 3 minutes.
Mr. SANTORUM. I thank the Chair.
Mr. President, we have all now just seen and heard why it is so hard
to change anything in Washington. Because anything you try to do is
wrong. You can look at all the facts. And the Senators from Louisiana
and Nebraska and Texas and New Mexico and Delaware laid out chart after
chart. For anyone listening to this debate, the facts stare you smack
in the face. This fund runs out of money in the year 2001 with the baby
boomers retiring in the year 2010. This program is not sustainable in
its current form. Everybody who can read a simple arithmetic chart can
understand that. Yet, you have everybody flying to the floor saying,
oh, yes, it is a problem, but not this.
Well, then, what? We are going to raise taxes? How many are for
raising taxes? There will be a few over there who want to raise taxes.
But that is the option: Raise taxes.
The Senator from Massachusetts talked about rationing care. It is
those people who use all that Medicare who are the problem. And unless
we start rationing that care, we are not going to get to the problem
here. So we can ration care to people who are over 65. That is another
option. Or we can cut reimbursements to providers. The Senator from
Louisiana talked about that. But if we do that, all of us know if you
cut reimbursements to providers, people cannot get care because they
cannot afford to provide the care and rural hospitals close, inner-city
hospitals close. So you cannot take that option.
We can cut benefits. How many here are for cutting back Medicare
benefits? OK. Well, so there we are. What are we going to do? We have a
problem. It is not going to go away. We can sit here and demagog on the
issue and say, well, this is not the right thing.
The only reasonable course is to look at the demographics and see
that I, right here, am the first Member of the Senate who is going to
retire at age 65--right here, age 39, born in 1958. I will retire at
the age of 67. I am ready, willing, and able to take on that
responsibility. I feel I have been adequately warned, giving myself
about 30 years in advance to be able to figure this out. And I think we
are capable of taking it. I am not going to live as my mother and my
father and those before me, whose life expectancies were, as I think
the Senator from Nebraska said, 73 for a female, 68 for a male. At age
65, my life expectancy, the Lord willing, as a group anyway, is going
to be well over 80. I am quite willing and prepared as a generation to
save my generation, the folks who are paying the bills, big-time bills
that previous generations did not pay. We are paying 1.45 percent of
every single dollar we earn. And I would like to say for that dollar
you are going to have a program that is going to be there and provide
adequate benefits when you retire, and, yes, I am willing to take a
little sacrifice. I am willing to pay a little bit more, but I am also
willing to take my share of sacrifice to make sure that it is there for
not just me but for everyone else in my generation and future
generations.
What we are talking about here is being responsible, not standing up
and demagoging to get votes back home. We have got a problem. There are
people in my generation who are tired of this language.
Mr. HARKIN. Will the Senator yield?
Mr. SANTORUM. No.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. SANTORUM. I ask for 1 additional minute.
The PRESIDING OFFICER. The time of the Senator from Pennsylvania
expired. Who yields time?
Mr. SANTORUM. One additional minute? May have 1 additional minute?
Mr. ROTH. Yes.
The PRESIDING OFFICER. The Senator is recognized for 1 additional
minute.
Mr. SANTORUM. I go around and I have talked to hundreds of high
school students, thousands of them. I have been to over 100 high
schools since I have been in office. I ask them, how many believe
Medicare and Social Security will be here when you retire? Not a hand
goes up. I ask them, how many believe in UFOs? And about 20 percent of
the class raise their hand. They believe we are all just joking around,
that any time a serious issue comes up about their long-term future, we
run away. We hide behind our desk and wait for the bombs to explode
around us.
Stand up for the future. Stand up for these young people who pay and
are going to be paying the rest of their lives very dearly for this
program, and stand up and make sure it is healthy for them.
I thank the Chair. I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. LAUTENBERG. I yield myself just a couple of minutes because I
listened with interest. One could not avoid listening.
The fact of the matter is, it is so easy, so easy to stand here at
$135,000 a year with all kinds of benefits and everything and say, ``I
am willing to sacrifice, I am willing to sacrifice. I am willing to do
what I have to. I have 35 years.'' Go down to the factory and talk to
somebody who is hanging on to his job by his fingernails, ask the poor
fellow who has been downgraded as companies shrink their size. I love
these heroics we get in this place, big speeches on lofty pinnacles.
Talk to the people who are doing the work every day, bringing home the
lunch pail, and see what we have.
Sacrifice? I'll tell you how to sacrifice. Cut the benefits here. Cut
them now. Stand up and say we will take less for our health insurance
and our retirement and everything else. If you want to pull a nice
heroic stand--somebody's
[[Page S6125]]
last stand--stand up here and recommend a cut in benefits instead of
talking about, shrieking about, how people have to sacrifice--from this
lofty place.
I will not say anything further. I yield 2 minutes to my friend from
Iowa.
The PRESIDING OFFICER. The Senator from Iowa is recognized.
Mr. HARKIN. Mr. President, I will not even take 2 minutes. I listened
to the impassioned argument of my friend from Pennsylvania. I just had
two observations. No. 1, along the lines of what Senator Lautenberg
said, No. 1, what retirement income will a Senator have when a Senator
retires here? What is that retirement income going to be? A lot of
money. When a Senator retires at age 65, you get a lot of money--big
time money for retirement. It is not a blue collar worker retiring on
Social Security, No. 1.
No. 2, if you retire as a Federal Government employee or as a U.S.
Senator, you can keep your Federal employee's health benefits. There is
no gap for you. You can keep it. It costs you, what, $100-something a
month, $110, $120 a month. So it is easy for a Senator to stand here
and talk about saving his generation. But those in his generation are
not all U.S. Senators. Those in his generation are not all people who
can go on Federal Employee health benefits when they reach age 62. They
need Medicare. That is where most of America is, not sitting in the
U.S. Senate.
I yield the remainder of my time.
The PRESIDING OFFICER (Mr. Kempthorne). The Senator from New Jersey.
Mr. ROTH. Mr. President, I yield 5 minutes off the bill to the
Senator from North Dakota.
The PRESIDING OFFICER. The Senator from North Dakota is recognized
for 5 minutes.
Mr. CONRAD. Mr. President, we have heard a lot of passion on both
sides of this issue. I understand the passion that this issue
generates. But I hope we will think quietly for a moment of where we
are headed in this country.
We have heard pleas to think of the working people. I agree with
that. I came to this Congress wanting to fight for the working people
of my State. The question is, how do we best do that? The hard reality
is, Medicare is headed for a cliff. Social Security has problems and
they have problems because, No. 1, people are living longer. I was
asked moments ago, why do you favor this change in Medicare
eligibility? It is very simple. People are living longer. In 1965, when
we started with Medicare, a male in this country could expect to live
to be 66.8 years of age. A female, 73.8. In 1996, a male could be
expected to live to the age of 72.5, a female to the age of 79.3.
In 2025, when this change is fully phased in, a male is projected to
live to 75.6 years of age, a female to 81.5. These are facts. They are
indisputable. People are living longer, and the hard reality is, this
program that we have put in place only extends the solvency of Medicare
for 10 years. This provision is an attempt to deal with the longer term
problem of Medicare, just as we have done it with Social Security, to
slowly phase in and move up the age of eligibility to treat Medicare
entitlement the same way we treat Social Security. Why? Because we do
care about working people, because we do care about providing for those
who are less fortunate, because we do care about preserving and
protecting Medicare. That is precisely why this Finance Committee
agreed, on a bipartisan basis, to extend the age of retirement for
Medicare eligibility.
We have another problem. The other problem is a demographic time
bomb, and that demographic time bomb is the baby boom generation. As I
look around this Chamber, there are a number of baby boomers here. All
of us in the U.S. Senate understand, if we fail to act, all of these
programs are going to be in deep trouble. The harsh reality is, the
number of people eligible for these programs is going to double in very
short order. Starting in the year 2012, when the baby boomers start to
retire, the number of people eligible for these programs is going to
double. The entitlements commission told us 2 years ago that in the
year 2012, if we fail to act, every penny is going to go for
entitlements and interest on the debt. There is not going to be any
money for parks. There is not going to be any money for highways. There
is not going to be any money for education. There is not going to be
any money for law enforcement. There is not going to be any money for
one thing after another. If that is the course we want to stay on,
agree with this amendment.
Some people say let's wait for a commission. Two years ago we had a
commission. We had the entitlements commission. What did they tell us?
They told us, if you fail to act, you are headed for a cliff. Now we
can choose to continue to fail to act. If we do, we know the results.
There is no question what will happen. We will go right over the cliff.
Unfortunately, it will not be just us going over the cliff, but we will
be taking our fellow Americans right with us.
We do not need another commission. It is time to act. It is time to
protect Medicare for the long term. It is time to reject this
amendment.
Ms. MIKULSKI. Mr. President, I rise today to support the point of
order by Senator Durbin to strike the language increasing the
eligibility age of Medicare from 65 to 67.
I oppose raising the eligibility age because it breaks the promise of
health insurance at age 65 for all Americans. The change was made to
balance the budget. It was not to make a better, more efficient health
care system. The change will hurt people who work hard and play by the
rules.
In 1965, our country realized that it was important to make sure that
all Americans over the age of 65 had health insurance. For those
Americans that did not have the ability to purchase health insurance,
Medicare was there.
It was a promise that America's seniors had somewhere to go. Now, we
are breaking that promise. I can't support that. Promises made must be
promises kept.
We can't turn our backs on people who have planned their lives
depending on our promises.
This change wasn't done to help people. It wasn't done to improve the
system. It wasn't done to make sure that seniors in Maryland and the
country will have a longer and happier life.
It was done to balance the budget. It was done to save a few dollars.
No thought was given to the real life effects on America's seniors.
Raising the eligibility age hurts people when they need insurance
most: in their sixties, at the end of their working lives.
Retirees cannot afford insurance at that age if they can even find
it.
What do we say to the factory workers and construction workers whose
bodies are worn down by age 60?
Now when they need insurance the most, it isn't there. The government
just moved the Medicare age another 2 years away.
Before we start to make big changes in Medicare, we need to talk to
the most important people to consider: The people who use the program.
We need to ask them what works, what could be better, and what we
should change.
We need to have a national bipartisan debate on what Medicare should
look like.
We need Presidential leadership.
I want the people of Maryland to be a part of that debate.
That way, if we need to make big changes, everyone will have had a
chance to speak up and be heard.
Everyone will understand the changes.
Raising the eligibility age penalizes the citizens of Maryland and
the rest of the country who have worked hard, saved, and played by the
rules.
I ask the other Senators to join me and Senators Durbin and Reed to
support this amendment.
Let's strike the increase in the Medicare eligibility age from 65 to
67.
We do not serve in the Senate to tell Americans, ``we needed a few
more dollars for our budget so you'll have to change your plans.''
We should listen to people, debate options, and make the hard choices
openly.
Let's not change the rules during the middle of the game and the
middle of the night.
The PRESIDING OFFICER. Who yields time?
Mr. LAUTENBERG. I yield 4 minutes to the Senator from Massachusetts.
[[Page S6126]]
The PRESIDING OFFICER. That will consume all the time of the Senator
from New Jersey.
Mr. LAUTENBERG. I understand.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KERRY. Mr. President, I have listened to a number of my
colleagues come to the floor and say we are heading toward the cliff,
we have to do this because people are living longer and, if we do not
do this, we are not going to be able to save Medicare.
It is true that people are living longer. But it is not true that
this is the only way to save Medicare. The notion that we have to be
forced to have a choice on the floor of the Senate, with the idea that,
in order to make up for a fixed amount of money that we are supposed to
find to make up for cutting, that we have to take it out of that gap
between the age of 65 and 67, is absolutely specious. What they have
decided to do is find a fixed amount of money so we can give an $85
billion tax cut. I mean, the tax bill is not on the floor today, but
this is related to the tax bill. The fact is, we are going to find our
capacity to give back $85 billion, the lion's share of which will go to
the wealthiest people in America under the current construction. And,
in order to do that, we are forced to come here and tell people who are
65 years old, in the future--even if it begins for somebody who is 60
or 65 today, if you are 61 and you are looking at the time when you are
67 then you will be eligible for Medicare, you are forced to go out and
find it somewhere in the marketplace. For a whole lot of people in
America that age they cannot find it in the marketplace. They cannot
afford it. There is no provision in this measure that provides some
kind of stopgap capacity for those people to be able to afford the
premiums they will be charged in the marketplace.
So the choice of the U.S. Senate is, so we can give an $85 billion
tax bonanza to a lot of people in America, people between the age of 65
and 67 in the future are going to have to do whatever they can to get
health care. Do whatever you can; we are cutting you off. We are moving
exactly in the opposite direction from what everybody in the health
care industry in this country says--that we ought to be covering more
people, not less. What is the rationale for that? What is the
philosophical connection between saying we want more people covered in
their health care in America, particularly in the later years of their
life, but we are going to come along here now and facilitate this great
tax give-back by making sure that we fix Medicare. What is the
connection between the tax and the Medicare?
Everybody says we have to fix it. Well, it is money that is
available. This is a zero sum game. There is money here. There is money
there. You have the ability to find it if you want to. You do not have
to necessarily do that, but, instead, we are making a choice to do it.
I recognize obviously people are living longer. I know what the
demographics say about Medicare in the long run. Maybe in the long run
the commission would come back and say it makes sense to lift the age
but it also makes sense to guarantee that nobody falls through the
cracks. The way you are going to guarantee that nobody falls through
the cracks is raise the premiums on the richest people in America, for
whom the average person is paying for their ability to be able to ride
the Medicare train, and ask them to contribute more so the people who
will fall through the cracks won't in fact fall through the cracks.
This is not that hard a choice.
But rather than even try to do that, we are being presented at the
11th hour with something that the White House didn't cut in in the
deal. This wasn't in the budget agreement. This is right out of the
sky. We are going to reach out and do this because in a certain respect
it seems to make sense on paper. I do not think it makes sense in the
lives of a lot of people who will not be able to buy health care, who
will be squeezed out of the system, even if you can say it is not going
to cut in until the year 2002 and people are going to have plenty of
time for it. Somebody who is downsized and out of work at that age and
does not have the ability to provide additional income does not have
the capability of paying $6,000 or $7,000--and it will be more by then,
incidentally, for the annual health care premiums.
So what you are really deciding to do is cut off and not include
people, poor people, in coverage. You are going to exclude people from
coverage, and that is the exact opposite direction than we ought to be
moving in.
I yield back whatever time I have.
The PRESIDING OFFICER. All time has expired on the motion to waive.
Who yields time?
Mr. NICKLES. Will the Senator give me 5 minutes off the bill?
Mr. ROTH. I yield 5 minutes to the Senator from Oklahoma.
The PRESIDING OFFICER. The Senator from Oklahoma is recognized for 5
minutes.
Mr. NICKLES. Mr. President, first, I wish to compliment several
speakers, Senator Kerrey of Nebraska and Senator Conrad of North
Dakota, for excellent statements, and Senator Gramm and others who
spoke out on the need for policy change.
Some of my colleagues on the other side say it was not in the budget
agreement. That's right. The reason they can make a point of order is
it has no financial impact over the next 5 years. The reason is, as
proponents of this amendment, we wanted to give people plenty of time
to make this change, to get rid of the eligibility time to be
concurrent with Social Security. I urge my colleagues on the other side
who are opposing this amendment to take a look at the estimate of 1997
Hospital Insurance Trustee Report regarding what the health of Medicare
part A trust fund will be. It is going broke and it is going broke
rapidly.
Some of my colleagues say this bill keeps the trust fund solvent for
10 years. You will not hear this Senator say it because I do not think
it is the case. We are making some changes. We are going to save $115
billion in Medicare. In addition, we are going to transfer home health,
over a period of years phase it into part B, three-quarters of which is
paid for by general revenues, by taxpayers. I do not think it keeps the
trust fund solvent for 10 years.
I am looking at the trust fund report. It says that by the year 2005
Medicare part A is going to have a $97.3 billion revenue shortfall,
deficit; in Medicare alone, almost $100 billion by the year 2005, only
7.5 years from now. I fail to see how we are going to keep it solvent
for 10 years.
To address some long-term reforms, the Finance Committee passed some
good policy changes that will make eligibility for Medicare concurrent
with Social Security, and, yes, that means somebody my age is going to
have to wait another year before he or she is eligible for Medicare.
Well, guess what? Life expectancy has increased since 1965. Males age
65 are now expected to live 15.5 years and females age 65 will live 19
years. In 1965, a male age 65 would live on average only 13 years and a
female 16 years. People are living longer. And the percentage of people
who are paying into the system is decreasing. In 1965, we had 5.5
workers for every beneficiary. In 2030, there will only be 2.3 workers
for every beneficiary.
Some people seem to think the solution is raising taxes. If we want
to keep the trust fund solvent for the next 25 years, the trustees say
we should increase payroll taxes by 66 percent, and if you want to keep
it solvent for 75 years, they say we should raise the current 2.9
percent tax--that is 1.45 percent for employee and employer--we should
raise that to 7.22 percent immediately. I don't want to do that. I
don't want to have that big a payroll tax increase.
So what can we do to make the system more solvent? What can we do to
make sure the money will be there when people need it? One of the
things we can do, and one of the things that will come out of any
report--any report--will say that we should have eligibility age be
concurrent with Social Security. It is the right thing to do.
I compliment my colleagues on the Finance Committee who have spoken
on behalf of this amendment, as well as the chairman of the Finance
Committee for putting it in. We didn't get any scoring for it. If
anybody says we are doing it so you can pay for tax cuts for wealthy
citizens, that is absolutely, totally, completely false. We got zero
scoring for this, but it happens to be the right thing to do, and it
happens to be in the long term, that this will help
[[Page S6127]]
keep Medicare more solvent, it will help ensure there will be a
Medicare program when I reach retirement age. It still won't solve the
problems. I will tell my colleagues, even in spite of the fact we do--
and we have to do it and the earlier we do it the better off so people
have more time to know the changes are coming--in spite of this, we are
still going to have to make further changes.
I ask unanimous consent to have printed in the Record a report of the
part A trust fund by the hospital trustee report.
There being no objection, the material was ordered to be printed in
the Record, as follows:
PAYROLL TAX DATA FOR EMPLOYEE AND EMPLOYERS
----------------------------------------------------------------------------------------------------------------
Wage base Tax rates (in percent)
Year -------------------------------------------------------
OASDI HI Total OASI DI HI
----------------------------------------------------------------------------------------------------------------
1950.................................................... 3,000 n/a 1.500 1.500 n/a n/a
1951.................................................... 3,600 n/a 1.500 1.500 n/a n/a
1952.................................................... 3,600 n/a 1.500 1.500 n/a n/a
1953.................................................... 3,600 n/a 1.500 1.500 n/a n/a
1954.................................................... 3,600 n/a 2.000 2.000 n/a n/a
1955.................................................... 4,200 n/a 2.000 2.000 n/a n/a
1956.................................................... 4,200 n/a 2.000 2.000 n/a n/a
1957.................................................... 4,200 n/a 2.250 2.000 0.250 n/a
1958.................................................... 4,200 n/a 2.250 2.000 0.250 n/a
1959.................................................... 4,800 n/a 2.500 2.250 0.250 n/a
1960.................................................... 4,800 n/a 3.000 2.750 0.250 n/a
1961.................................................... 4,800 n/a 3.000 2.750 0.250 n/a
1962.................................................... 4,800 n/a 3.125 2.875 0.250 n/a
1963.................................................... 4,800 n/a 3.625 3.375 0.250 n/a
1964.................................................... 4,800 n/a 3.625 3.375 0.250 n/a
1965.................................................... 4,800 n/a 3.625 3.375 0.250 n/a
1966.................................................... 6,600 6,600 4.200 3.500 0.350 0.350
1967.................................................... 6,600 6,600 4.400 3.550 0.350 0.500
1968.................................................... 7,800 7,800 4.400 3.325 0.475 0.600
1969.................................................... 7,800 7,800 4,800 3.725 0.475 0.600
1970.................................................... 7,800 7,800 4.800 3.650 0.550 0.600
1971.................................................... 7,800 7,800 5.200 4.050 0.550 0.600
1972.................................................... 9,000 9,000 5.200 4.050 0.550 0.600
1973.................................................... 10,800 10,800 5.850 4.300 0.550 1.000
1974.................................................... 13,200 13,200 5.850 4.375 0.575 0.900
1975.................................................... 14,100 14,100 5.850 4.375 0.575 0.900
1976.................................................... 15,300 15,300 5.850 4.375 0.575 0.900
1977.................................................... 16,500 16,500 5.850 4.375 0.575 0.900
1978.................................................... 17,700 17,700 6.050 4.275 0.775 1.000
1979.................................................... 22,900 22,900 6.130 4.330 0.750 1.050
1980.................................................... 25,900 25,900 6.130 4.520 0.560 1.050
1981.................................................... 29,700 29,700 6.650 4.700 0.650 1.300
1982.................................................... 32,400 32,400 6.700 4.575 0.825 1.300
1983.................................................... 35,700 35,700 6.700 4.775 0.625 1.300
1984.................................................... 37,800 37,800 7.000 5.200 0.500 1.300
1985.................................................... 39,600 39,600 7.050 5.200 0.500 1.350
1986.................................................... 42,000 42,000 7.150 5.200 0.500 1.450
1987.................................................... 43,800 43,800 7.150 5.200 0.500 1.450
1988.................................................... 45,000 45,000 7.510 5.530 0.530 1.450
1989.................................................... 48,000 48,000 7.510 5.530 0.530 1.450
1990.................................................... 51,300 51,300 7.650 5.600 0.600 1.450
1991.................................................... 53,400 125,000 7.650 5.600 0.600 1.450
1992.................................................... 55,500 130,200 7.650 5.600 0.600 1.450
1993.................................................... 57,600 135,000 7.650 5.600 0.600 1.450
1994.................................................... 60,600 no limit 7.650 5.260 0.940 1.450
1995.................................................... 61,200 no limit 7.650 5.260 0.940 1.450
1996.................................................... 62,700 no limit 7.650 5.260 0.940 1.450
1997.................................................... 65,400 no limit 7.650 5.350 0.850 1.450
1998.................................................... 68,700 no limit 7.650 5.350 0.850 1.450
1999.................................................... 71,400 no limit 7.650 5.350 0.850 1.450
2000.................................................... 74,100 no limit 7.650 5.300 0.900 1.450
2001.................................................... 76,800 no limit 7.650 5.300 0.900 1.450
2002.................................................... 79,800 no limit 7.650 5.300 0.900 1.450
----------------------------------------------------------------------------------------------------------------
Source: 1996 Trustees Reports and President's Budget.
PAYROLL TAX DATA FOR EMPLOYEES AND EMPLOYERS
------------------------------------------------------------------------
Maximum annual contribution
Year ---------------------------------------
Total OASI DI HI
------------------------------------------------------------------------
1950............................ 45 45 n/a n/a
1951............................ 54 54 n/a n/a
1952............................ 54 54 n/a n/a
1953............................ 54 54 n/a n/a
1954............................ 72 72 n/a n/a
1955............................ 84 84 n/a n/a
1956............................ 84 84 n/a n/a
1957............................ 95 84 11 n/a
1958............................ 95 84 11 n/a
1959............................ 120 108 12 n/a
1960............................ 144 132 12 n/a
1961............................ 144 132 12 n/a
1962............................ 150 138 12 n/a
1963............................ 174 162 12 n/a
1964............................ 174 162 12 n/a
1965............................ 174 162 12 n/a
1966............................ 277 231 23 23
1967............................ 290 234 23 33
1968............................ 343 259 37 47
1969............................ 374 291 37 47
1970............................ 374 285 43 47
1971............................ 406 316 43 47
1972............................ 468 365 50 54
1973............................ 632 464 59 108
1974............................ 772 578 76 119
1975............................ 825 617 81 127
1976............................ 895 669 88 138
1977............................ 965 722 95 149
1978............................ 1,071 757 137 177
1979............................ 1,404 992 172 240
1980............................ 1,588 1,171 145 272
1981............................ 1,975 1,396 193 386
1982............................ 2,171 1,482 267 421
1983............................ 2,392 1,705 223 464
1984............................ 2,646 1,966 189 491
1985............................ 2,792 2,059 198 535
1986............................ 3,003 2,184 210 609
1987............................ 3,132 2,278 219 635
1988............................ 3,380 2,489 239 653
1989............................ 3,605 2,654 254 696
1990............................ 3,924 2,873 308 744
1991............................ 4,085 2,990 320 774
1992............................ 4,246 3,108 333 805
1993............................ 4,406 3,226 346 835
* 1994.......................... 4,636 3,188 570 879
* 1995.......................... 4,682 3,219 575 887
* 1996.......................... 4,797 3,298 589 909
* 1997.......................... 5,003 3,499 556 948
* 1998.......................... 5,256 3,675 584 996
* 1999.......................... 5,462 3,820 607 1,035
* 2000.......................... 5,669 3,927 667 1,074
* 2001.......................... 5,875 4,070 691 1,114
* 2002.......................... 6,105 4,229 718 1,157
------------------------------------------------------------------------
* = The table computes the maximum HI tax contribution based upon the
OASDI wage base, even though the HI wage base was higher than the
OASDI wage base in 1991, 1992, and 1993 and eliminated thereafter.
Source: 1996 Trustees Reports & President's Budget.
Mr. NICKLES. Mr. President, I ask unanimous consent to have printed
in the Record a chart showing the Medicare eligibility age as to what
it is today and what it will be should this amendment be adopted.
There being no objection, the material was ordered to be printed in
the Record, as follows:
MEDICARE ELIGIBILITY AGE
----------------------------------------------------------------------------------------------------------------
Current
Age today-- Born in-- law Proposed Change
(years)
----------------------------------------------------------------------------------------------------------------
Over 65......................... Before 1931........ 65 65 y............... None
Over 65......................... Before 1932........ 65 65 y............... None
Over 64......................... Before 1933........ 65 65 y............... None
Over 63......................... Before 1934........ 65 65 y............... None
Over 62......................... Before 1935........ 65 65 y............... None
Over 61......................... Before 1936........ 65 65 y............... None
Over 60......................... Before 1937........ 65 65 y............... None
Over 59......................... Before 1938........ 65 65 y............... None
Over 58......................... Before 1939........ 65 65 y 2 m........... +2 months
Over 57......................... Before 1940........ 65 65 y 4 m........... +4 months
Over 56......................... Before 1941........ 65 65 y 6 m........... +6 months
Over 55......................... Before 1942........ 65 65 y 8 m........... +8 months
Over 54......................... Before 1943........ 65 65 y 10 m.......... +10 months
Over 53......................... Before 1944........ 65 66 y 0 m........... +1 year
Over 52......................... Before 1945........ 65 66 y 0 m........... +1 year
Over 51......................... Before 1946........ 65 66 y 0 m........... +1 year
Over 50......................... Before 1947........ 65 66 y 0 m........... +1 year
Over 49......................... Before 1948........ 65 66 y 0 m........... +1 year
Over 48......................... Before 1949........ 65 66 y 0 m........... +1 year
Over 47......................... Before 1950........ 65 66 y 0 m........... +1 year
Over 46......................... Before 1951........ 65 66 y 0 m........... +1 year
Over 45......................... Before 1952........ 65 66 y 0 m........... +1 year
Over 44......................... Before 1953........ 65 66 y 0 m........... +1 year
Over 43......................... Before 1954........ 65 66 y 0 m........... +1 year
Over 42......................... Before 1955........ 65 66 y 0 m........... +1 year
Over 41......................... Before 1956........ 65 66 y 2 m........... +1 yr 2 months
Over 40......................... Before 1957........ 65 66 y 4 m........... +1 yr 4 months
Over 39......................... Before 1958........ 65 66 y 6 m........... +1 yr 6 months
Over 38......................... Before 1959........ 65 66 y 8 m........... +1 yr 8 months
Over 37......................... Before 1960........ 65 66 y 10 m.......... +1 yr 10 months
36 and under.................... Before 1997........ 65 67 y 0 m........... +2 years
----------------------------------------------------------------------------------------------------------------
Mr. NICKLES. Mr. President, I urge my colleagues, let's have a
bipartisan vote for responsibilities not to score some points, but
really try to make sure Medicare funds will be there when promised. I
yield the floor.
The PRESIDING OFFICER. All time has expired on the motion to waive.
Mr. LAUTENBERG. Mr. President, I yield 4 minutes off the bill to the
Senator from Minnesota.
The PRESIDING OFFICER. The Senator from Minnesota is recognized.
Mr. WELLSTONE. I am pleased to follow the Senator from California, if
that would be all right.
Mrs. BOXER. Just 1 minute.
Mr. LAUTENBERG. Fine. The Senator from California can have 1 minute.
Mrs. BOXER. Just 1 minute.
The PRESIDING OFFICER. The Senator from California is recognized for
1 minute.
Mrs. BOXER. Mr. President, I thank my colleague for yielding. People
are living longer, so what are we doing about that? We are punishing
them in the committee bill, saying, ``You're living longer, therefore,
you have to
[[Page S6128]]
wait until you are 67 to get onto Medicare.''
I say to my colleagues, why do you think people are living longer?
Because we have Medicare. In the old days, we didn't have it and people
got very, very sick. Take a look at Russia. The average man there lives
to 58 because they have no access to health care. People are living
longer because they go to a doctor early, they don't wait for a crisis.
They get preventive care, and what this bill does is say, ``American
people, you're living too long, we're going to have to send this
back.'' Do we want to go back to when people died at 58 and 60? Then
you will really have a strong Medicare Program because no one will be
able to use it. Thank you, I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. WELLSTONE addressed the Chair.
Mr. LAUTENBERG. I yield 4 minutes to the Senator from Minnesota.
The PRESIDING OFFICER. The Senator from Minnesota is recognized for 4
minutes.
Mr. WELLSTONE. I thank the Chair, and I thank the Senator from New
Jersey.
Mr. President, just two points in 4 minutes, the first one being, I
was listening to my colleague from Oklahoma, and I know he had to leave
the floor, but I heard him say this has not been scored and it has
nothing to do with the tax cuts. But, I think only here in the Senate
do we sort of decontextualize what we are doing. I don't think most
people in the country do. Most people in the country see a clear
connection between the reconciliation bill on tax cuts, the lion's
share of benefits going to the very top of the population and, at the
same time, what is, indeed, the functional equivalent of a cut in
Medicare benefits.
I am troubled by the discussion because, Mr. President, I think that
what some of my colleagues are talking about in the name of saving or
preserving Medicare will have just the opposite effect. Maybe that is
the problem. We do it on a reconciliation bill, there is not a lot of
time, and we don't really know what the consequences are of what we are
doing. But, I will suggest to you that if we are serious about
cost containment and we are serious about what we need to do to deal
with the estimates of how many people will be living to be over 65 and
85 when we get to the year 2030 and, at the same time, how many people
are working, and all of what has been presented here by way of
demography, then what we will do is not just focus on Medicare, we will
go back to looking at this overall health care system, and we will
figure out ways in which we contain costs so that, indeed, we can
provide decent health care coverage, not just to the elderly but to
other citizens as well.
What we are doing now, philosophically, is we are moving in exactly
the opposite direction. Whatever happened here? Just a couple of years
ago, we were talking about Medicare for all. We were saying that we
ought to make sure that other people have the same opportunities as
elderly people. Now what we seem to be doing is saying, My gosh, there
are some people in the country who don't have good coverage; what we
now need to do is downsize Medicare instead of improving Medicare and
improving health care for people in this country. It makes no sense
whatsoever.
Mr. President, this is a huge mistake--a huge mistake. We ought to be
talking about providing good health care coverage for elderly people.
We ought to be talking about keeping this as a universal coverage
program. We ought to be talking about health care reform systemwide.
And we ought to be talking about not downsizing Medicare but, as a
matter of fact, taking this very good program and making sure that all
of our citizens have the opportunity for decent health care coverage.
This proposal coming out of the Finance Committee takes us exactly in
the wrong direction. It is profoundly mistaken, and I thank Senator
Durbin for his leadership and am proud to support his effort. I yield
the floor.
Mr. COATS addressed the Chair.
The PRESIDING OFFICER. Who yields time?
Mr. COATS. I wonder if the Senator from Delaware will yield me a
couple of minutes off his time?
Mr. ROTH. I yield 2 minutes off the bill.
The PRESIDING OFFICER. The Senator from Indiana is recognized for 2
minutes.
Mr. COATS. Mr. President, I was sitting in the Chair and listening to
the debate and listening just now. I came to the Congress in 1980, and
one of the first issues we tried to do was the pending Social Security
problem.
Over an 18-year period of time, we have been debating Medicare and
Social Security and what changes need to be made to guarantee solvency
for the future. I don't think there is any Member on this floor who
doesn't understand the facts. The trustees have reported over and over,
we have had commissions, we have had demographers, we have had
politicians--everybody has been talking about the problem that we all
know is coming very, very soon: The problem that if we don't make
structural changes within the programs, we are going to face imminent
collapse of the system. It just can't sustain. The numbers are clear to
everybody.
There are a number of ways to fix it. As the Senator from
Pennsylvania said, we can raise taxes, cut spending, impose penalties
on providers. I find it somewhat stunning that a proposed phase in of a
fix--which doesn't fix the problem, it defers the problem for another
10 years so the Congress in 2008 can deal with it as we are dealing
with it here and every Congress before that--something that phases in
over a period of 24 years that basically doesn't affect anybody in the
current system, raises such a level of passion as if we are destroying
the program.
We are going to probably lose this vote. We will have postponed for
the umpteenth time any solution proposed by anybody. No matter what is
suggested, it is rejected. I have seen dozens of proposals out here.
Every one rejected. The language always turns to--well, I don't want to
use the word demagoguery--it always turns to pitting one class against
another class, and those who are trying to get a fix proposed basically
are labeled as people who want to destroy the system. Actually, they
want to save the system.
I don't think we have the political will to do it. Probably when the
system collapses or is near collapse, the people will rise up and
demand their representatives do something. I hope they look back at the
record of all those who tried to do something over 18 years and,
basically, were shouted down in the process time after time after time.
We will undoubtedly lose this one, too. We will move on. Hopefully, we
will get to the brink of collapse sooner rather than later, so it will
not cost as much to fix it.
The PRESIDING OFFICER. Who yields time?
Mr. LAUTENBERG. Mr. President, I yield 5 minutes off the bill to the
Senator from Illinois.
The PRESIDING OFFICER. The Senator from Illinois is recognized.
Mr. DURBIN. Mr. President, I thank my colleague from New Jersey.
So it is understood what we are debating, there is a provision in
this bill which would raise the eligibility age for Medicare from 65 to
67. There are those of us who think that is unwarranted and are
opposing it and there are those, of course, who are defending it.
It is interesting to me to consider what we are debating here. Five
years ago, we debated on Capitol Hill the premise that not enough
Americans had health insurance. Forty million Americans uninsured,
millions underinsured, what would we do as a nation? Would we rise to
the challenge? Would we come to the rescue of these families and
individuals? We debated it long and hard, and we failed.
When it was all said and done, nothing was done. A lot of ridicule
and scorn was heaped on the White House and the First Lady and nothing
happened.
So 5 years later, we return to the debate of health insurance
coverage, but this time with a different premise. Instead of helping
more people receive insurance coverage, we now have in this bill a
proposal to take more people off insurance coverage.
Have we come full circle? Five years later, there is a proposal to
increase the eligibility age for Medicare from 65 to 67, and the
younger Members of the Senate stand over there and say, ``People can
prepare for it, people can get used to it, people can save for it.''
[[Page S6129]]
Think of the real-life challenges. Someone I know personally at age
60 retired from management in a company in California with health care
benefits and a gold watch. Along came some changes in management, a
little downsizing, and guess what? They sent him a letter saying,
``Sorry, no more health insurance for you as a retiree from the
management of our company.'' As he received the letter, he started
having heart problems, two different heart surgeries, and this
individual who had derided big Government programs overtaking your
lives started counting the days until he would be eligible for
Medicare, realizing that uninsured and uninsurable, he had no
protection.
What is the proposal in the Finance Committee? Let him hang out for
another 24 months, let him count another 24 months and days wondering
if he can live long enough to be covered by Medicare. It is shameful.
It is shameful that we have not preceded this debate with a discussion
about how we will provide more coverage for people across America.
They want to create a commission in this bill to study the problem,
and we should. One of the provisions the commission is supposed to
study is whether or not to extend Medicare to those age 62 and beyond.
But before the commission comes back and reports, the Finance Committee
would say to us, before we know what the fix is for Medicare, let's
start with the premise that we are going to raise the retirement age,
let's start with the premise that people will pay more out of pocket,
and then let's talk about reform of Medicare.
Excuse me; excuse me. This program was designed to help people in
their retirement. It has worked. It is successful. Some of my friends
on the other side resent it because it is a Government program that
people respect and admire. For them to now have a shot at raising this
retirement age to age 67 is unfortunately going to put more people in
the lurch. People who have made their plans and want to make them
cannot anticipate whether they will be wealthy enough to pay for
hospitalization insurance, whether they will be healthy enough to take
care of themselves. Instead, we should be providing protection. What we
are doing is putting more and more people into jeopardy. I think that
is shameless.
Look at this, too. This comes to us as part of a debate about a tax
cut. This was supposed to be a tax cut that families across America
would cheer. Which family will cheer the prospect of 2 more years of
uninsurability under health insurance? You and I know we value this as
much as anything.
When my young daughter, fresh out of college, got a new job, the
first thing her dad asked was, ``What about health insurance,
Jennifer?''
``Oh, dad, I have a little bit of this and a little bit of that.''
And I worry about it every step of the way. She is a healthy young
woman, but think about a situation where you are 60 or 62 and you are
not healthy, you don't have insurance, and it costs $10,000 a year out
of your pocket. The folks in the Finance Committee say this is part of
reform, this is responsible, this is compassion, this is courageous.
I'm sorry, this is just plain wrong.
Let us have a national debate to make sure that Medicare is there for
decades to come for everyone who needs it. Let us say to the high
school classes that are skeptical, yes, you have to sign up to help
your parents and grandparents, as your children will sign up to help
you. It is part of America. It is part of our responsibility as a
family in America. Instead, we have these potshots at Medicare to raise
the retirement age to 67 without so much as a suggestion of what it
will mean to the American family. This is wrong. We should defeat it.
I urge my colleagues to join me in opposing the motion to waive the
budget agreement.
The PRESIDING OFFICER. The Senate Democratic leader.
Mr. DASCHLE. I will use my leader time to address the amendment.
I rise to associate myself with the remarks so eloquently made by the
distinguished Senator from Illinois. He speaks for many of us and has
done so on several occasions.
This issue really does define us. It is an issue that, in many
respects, reflects our party's approach to the larger issue of access
to health care in this country. Year after year and time after time in
Congress after Congress many of us have come to the floor expressing a
desire to expand ways to protect people from the serious problems they
face when they have inadequate health coverage.
Many of us have had personal family experiences in recent times that
personalize this issue for us. Those of us who have parents who have
suffered as a result of illnesses can thank our predecessors for the
foresight they demonstrated in bringing Medicare to people that
otherwise would not have had any health coverage. Indeed, other
provisions of this legislation recognize the importance of expanding
health coverage by encouraging States to find new ways to insure
children. So how ironic, at the very time we are expanding health care
for one segment of our population we are taking it away from another.
How ironic.
Mr. President, this is too important an issue to be left to a brief
debate on an amendment in a reconciliation bill. This ought to be the
subject of a weeklong debate. We ought to be debating this in depth,
debating all of the ramifications of this amendment, because this issue
is as important as they get.
This legislation essentially tells millions of Americans that their
coverage is no longer available to them, at the very time when they
need it the most.
As many of my colleagues have noted, we have hundreds if not
thousands of companies that have mandatory retirement at age 65, and
along with that retirement comes a termination of health benefits. What
is going to happen to these people? What is our message to them?
Now, if we had done the right thing a few years ago and ensured that
everybody, regardless of age, had access to health care, I probably
would not be standing here at this moment. But we did not do that.
Instead, we said we will address this problem step by step, that we
will find ways to expand coverage incrementally. Never once did I hear
anybody come to the floor and say we should be taking insurance away
from people.
Mr. President, I cannot support an effort that will increase the
number of uninsured Americans. I cannot be a part of it. I hope that my
colleagues on this Senate floor, before they vote, will think about
what it means for millions of people who are watching right now, hoping
that we have the good sense not to take away the only option they will
have for good health care in the future. This is a critical vote. I
hope all of my colleagues will weigh very carefully all of the
consequences of this legislation prior to the time they cast their
vote.
I yield the floor.
Mr. LAUTENBERG. I yield myself 3 minutes. Mr. President, a
significant part of the discussion has been why it is that we do not,
to use the expression, bite the bullet, get it going, set the program
into place so that over the years this will work its way into the
system and we will have done better by Medicare.
Well, Mr. President, I was the senior Democratic negotiator in
developing the budget resolution, and we shook hands and we came to the
consensus, and this bill before the Senate, part of the reconciliation
package, now is supposed to put into place, as I understand it, the
things that we agreed to in the extensive meetings that we had,
including participants from the White House and the House of
Representatives, as well.
Having gotten that into place, suddenly now we are approached with
something that I describe and Senator Kerry from Massachusetts before
described as coming in from nowhere, coming in from outer space. I say
coming in from left field. Suddenly, we had a new proposition to
consider whether or not we will say to those who are anticipating that
their coverage would fall into place at age 65, well, no, we have a new
kind of novel idea. We are going to extend it to age 67 and we want to
get it into place now.
Mr. President, in the development of this bill, this big booklet I am
holding, there is a chapter on commissions, and we say that the
commission shall meet and within 12 months after their appointment--it
is a 15-person commission, bipartisan in character, with 3 appointees
by the President--we say in 1 year we will have a report, we will have
recommendations. It is not going to be
[[Page S6130]]
done in a half hour or half day on the floor of the Senate. We are
going to take good time and thoroughly review it. We will debate it, as
our leader said just now, debate it, have hearings, review it, make
sure we are all certain about what we want to do. But, no, suddenly
that is too slow. We want, in reality, to take 20 or 30 years to
develop it, but it has to be done today to kick it off. I think that is
part of the absurdity of this, Mr. President.
I look at this legislation, and I am wondering what happened between
the Finance Committee's final deliberation and this moment here.
We talk about the purpose of this. The purpose of this is purportedly
to present more solvency to the Medicare Program. There is only one
problem: The program will perhaps be more solvent, but more individuals
will be insolvent. That will be the outcome. There is nothing more
worrisome today--and I see it in conversations, social, business and
otherwise--than any other time that I ever remember, people saying, ``I
hope I don't lose my health insurance if my company closes down.''
I understand that even now in separation agreements in marital
disputes that a part of the responsibility that is being asked of the
income earner is, ``I want to be provided,'' says the person being
left, ``with health insurance. I need to protect myself. I can't be
there with the children and be exposed to a sickness or an accident.''
People worry about that all the time. People who have saved all their
lives so they would have a little nest egg for retirement are saying,
``Wow, you see what it costs to be in the hospital these days, see what
it costs to have an operation. It costs so much I would be bankrupt if
I had to go through one of those things.''
We are dealing with a very sensitive issue, a very complicated issue.
I hope, Mr. President, that all of our friends on the floor of the
Senate will give this a chance for the commission to get to work to
review it and not introduce this new--I will call it--extraneous
subject, and I am not defining it in terms of the budget process but in
terms of the place that it holds.
I hope we will work, Mr. President, not to permit the waiver of the
budget agreement.
Mr. ROTH. Mr. President, I yield 5 minutes off the bill to the
distinguished Senator from New York.
The PRESIDING OFFICER. The Senator from New York is recognized for 5
minutes.
Mr. MOYNIHAN. Mr. President, today the Senate is considering two
important changes approved by the Finance Committee for the Medicare
Program: increasing the eligibility age from 65 to 67, and increasing
premiums for higher income beneficiaries. Raising the eligibility age
will simply bring Medicare into line with the retirement age under
Social Security. And means-testing the part B premium is in fact
overdue.
I was a member of the administration of President Johnson when
Medicare legislation was developed and enacted, and I remind Senators
that at that time the part B provision for physician's bills was meant
to be paid one-half by the individual and one-half out of general
revenues--50-50.
In 1972, we limited the increase in the part B premium to the rate of
increase in Social Security benefits, which are tied to the Consumer
Price Index. Inasmuch as medical costs grew at a much faster rate than
that, generally, of prices, that 50-50 share gradually dropped to what
is now a quarter, 25 percent. In no way do we change that 25-75
arrangement that has emerged, but we do ask that high-income retired
persons pay a higher premium. About 6 percent to 7 percent of retirees
will be affected.
Retired couples with incomes under $75,000, will not in any way be
affected; individuals with incomes under $50,000 will not in any way be
affected. We are really only returning somewhat to the original
intention and the original provisions of Medicare part B.
If my distinguished chairman would permit me, I yield the balance of
my 5 minutes to the distinguished Senator from Louisiana.
Mr. ROTH. That is fine.
Mr. BREAUX. I thank the distinguished chairman and the distinguished
ranking member. There is no easy answer to this problem. Everybody
wants us to fix Medicare, but nobody wants us to do anything in order
to fix it.
When you say, ``Do you want to increase premiums,'' everybody says
no. When you say, ``Do you want to reduce benefits,'' everybody says
no. When you say, ``Do you want to reduce payments of doctors and
hospitals,'' they say no because they may not serve us any more. When
we say, let's gradually, by the year 2027, forewarn people that that
will be the eligible age of Medicare, we are now saying do not do that,
either.
The fact is that in the year 2001 Medicare becomes insolvent. What
are we going to tell the people then? Are we going to say we did not
have the political courage to do anything, so there is no more Medicare
available for anybody, regardless of age? That is what is facing us
now. This is probably one of the easiest steps toward ensuring that
Medicare will be solvent. There are no easy answers, and I suggest that
this is one of the easier ones. If we do not have the political courage
to do this, how are we going to handle the question about what happens
when there is no more Medicare available for anyone?
I think this ought to be adopted.
Mr. ROTH. I yield back to the distinguished chairman of the Budget
Committee.
Mr. DOMENICI. Mr. President, first, I apologize to the distinguished
chairman for not being on the floor, but I understand that everybody
did a great job. I wish I could have been here to listen to it all.
I had a chart printed in the Record. I do not think the numbers and
years can be disputed off of this chart. I want to make sure everybody
knows what this fight is about.
First of all, for anybody age 59, nothing changes. When you get to be
58, it will have changed by 2 months. If you are today 58, this has
been changed by 2 months. If you are 57 today, it is changed by 4
months. If you are 56, it is changed by 6 months. If you are 55, it is
8 months, and if you are 54, it is 10 months.
Now, there is after that period of time if you are 53, 52, 51, 50,
49, 48, 47, 46, 45, 44, 43, 42, it is 1 year--1 year for all of those,
1 year. If you are 41 today, it is changed by 1 year and 2 months. If
you are 40, it is 1 year and 4 months. I will skip to 37, where it is 1
year and 10 months, and if you are 36 or under, it is 2 years.
Those are the facts regarding the changes that are going to cause the
insurmountable damage that has been alluded to here on the floor.
Let me repeat, these are the actuarial numbers and the numbers in
this statute. They are not dreamed up; they are written. Essentially,
it says what I have just said. Now, let me ask--somebody 59, there is
no change, OK. So anybody talking about that, there is none. If you are
58, it is changed by 2 months. And then let us go all the way down to
42 years of age; it is changed by 1 year. So if you are 42 today,
planning on getting Medicare when you come of age, instead of 65, it
will be 66 for that person; is that right, Senator Gramm?
Mr. GRAMM. That's right.
Mr. DOMENICI. A person 42, a 1-year change. If you are all the way
down to 36 years of age, in order to have a Medicare that is solvent,
it will be changed 2 years for you.
I ask unanimous consent that this chart be printed in the Record.
There being no objection, the chart was ordered to be printed in the
Record, as follows:
MEDICARE ELIGIBILITY AGE
----------------------------------------------------------------------------------------------------------------
Current
Age today-- Born in-- law Proposed Change
(years)
----------------------------------------------------------------------------------------------------------------
Over 65......................... Before 1931........ 65 65 y............... None.
Over 65......................... Before 1932........ 65 65 y............... None.
Over 64......................... Before 1933........ 65 65 y............... None.
[[Page S6131]]
Over 63......................... Before 1934........ 65 65 y............... None.
Over 62......................... Before 1935........ 65 65 y............... None.
Over 61......................... Before 1936........ 65 65 y............... None.
Over 60......................... Before 1937........ 65 65 y............... None.
Over 59......................... Before 1938........ 65 65 y............... None.
Over 58......................... Before 1939........ 65 65 y 2 m........... +2 months.
Over 57......................... Before 1940........ 65 65 y 4 m........... +4 months.
Over 56......................... Before 1941........ 65 65 y 6 m........... +6 months.
Over 55......................... Before 1942........ 65 65 y 8 m........... +8 months.
Over 54......................... Before 1943........ 65 65 y 10 m.......... +10 months.
Over 53......................... Before 1944........ 65 66 y 0 m........... +1 year.
Over 52......................... Before 1945........ 65 66 y 0 m........... +1 year.
Over 51......................... Before 1946........ 65 66 y 0 m........... +1 year.
Over 50......................... Before 1947........ 65 66 y 0 m........... +1 year.
Over 49......................... Before 1948........ 65 66 y 0 m........... +1 year.
Over 48......................... Before 1949........ 65 66 y 0 m........... +1 year.
Over 47......................... Before 1950........ 65 66 y 0 m........... +1 year.
Over 46......................... Before 1951........ 65 66 y 0 m........... +1 year.
Over 45......................... Before 1952........ 65 66 y 0 m........... +1 year.
Over 44......................... Before 1953........ 65 66 y 0 m........... +1 year.
Over 43......................... Before 1954........ 65 66 y 0 m........... +1 year.
Over 42......................... Before 1955........ 65 66 y 0 m........... +1 year.
Over 41......................... Before 1956........ 65 66 y 2 m........... +1 yr 2 months.
Over 40......................... Before 1957........ 65 66 y 4 m........... +1 yr 4 months.
Over 39......................... Before 1958........ 65 66 y 6 m........... +1 yr 6 months.
Over 38......................... Before 1959........ 65 66 y 8 m........... +1 yr 8 months.
Over 37......................... Before 1960........ 65 66 y 10 m.......... +1 yr 10 months.
36 and under.................... Before 1977........ 65 67 y 0 m........... +2 years.
----------------------------------------------------------------------------------------------------------------
Mr. DURBIN. Will the Senator yield?
Mr. DOMENICI. Yes.
Mr. DURBIN. I would like to ask the Senator a question. At age 65,
how long would you be willing to go without insurance if you had a
medical problem and you realize that your medical bills could bankrupt
your family and squander your family savings?
Mr. DOMENICI. I will answer that for the Senator. If you are 36 years
of age and you start planning for this and then you are 65 years of age
and you still don't have coverage between 65 and 67, then something is
wrong with you. You have 31 years to get ready for it. If you are 65
today, you don't even get any impact.
Mr. DURBIN. Will the Senator yield further?
Mr. DOMENICI. Yes.
Mr. DURBIN. Is the Senator suggesting that we pass a law to guarantee
that insurance be available to every one at age 65?
Mr. DOMENICI. I might say we didn't pass any that required 65; it
just happened because it is reasonable. People are working longer. They
are going to be working longer than 65. They are going to have coverage
everyplace. You are suggesting they are going to be denied coverage
because we say you have to wait a year 25 years from now?
Mr. DURBIN. If the Senator will yield further, 70 percent of the
people of age 65 today have no health insurance. The Senator suggests
it is just going to vanish. This is reality, what families face.
Mr. DOMENICI. If there are people 65 who don't have any health
coverage, then I assume they don't have Medicare. If they don't have
Medicare, that is going to be the same situation later on. There is no
difference.
Mr. DURBIN. Will the Senator yield?
Mr. DOMENICI. Of course.
Mr. DURBIN. The point I am trying to make is that of the people
between ages 60 and 65, 30 percent of them have health insurance
through employment and 70 percent do not. These are people who are
retiring without health insurance. The Senator is suggesting this is
going to get better automatically. I don't think so.
Mr. DOMENICI. Well, Mr. President, I am suggesting that for those
people who are covered by Medicare today and those who are going to be
covered by it in the future, it has been discussed on the floor of the
Senate today that people are going to be shocked and they are going to
have no insurance. I submit, if you are 36 years of age now, when you
get to be 65, you will have 2 years added. So for people 36 years of
age, it will be 67. How do any of the arguments made about not having
coverage apply to that? Are they not going to have coverage? Of course,
they are. If they have Medicare today, they are going to be working 16,
18 years from now, too--unless we assume everybody is no longer going
to work, so you won't even qualify. Frankly, maybe we will not do this
before the time this finishes conference. I don't know. The House
didn't do it.
But all I am trying to say is, if this is a major issue between the
two parties--and luckily it isn't because some Democrats have the
courage to face up to the truth--so no matter how much the leader on
that side says this is distinguishing between the parties, there are
some Democrats who agree with us. If it is being said that this is
going to just annihilate senior citizens, I thought we ought to put a
chart in and let Americans look at it. Let's ask a 36-year-old, would
you rather have a chance of having Medicare solvent so it will be there
for you? Or would you rather insist that when you get to be 65, you get
it, even if we were to tell you we greatly enhanced the chance of it
being there if you wait until 67? If it is a chasm between our parties,
let me suggest that it is a little, tiny chasm. It has nothing to do
with great philosophical differences about who is for seniors and who
is against them. That is just rubbish.
I yield the floor.
Mr. KERRY. Will the Senator yield for a minute?
Mr. LAUTENBERG. I yield time to the Senator from Massachusetts for 1
minute because this debate is just about over.
The PRESIDING OFFICER. The Senator from Massachusetts is recognized
for 1 minute.
Mr. KERRY. I wanted to ask the Senator a question. I think there are
two truths here. I don't think the gap is that great. All of us accept
the fact that the demographics are changing. We accept the fact that we
are going to have to do something. We accept the fact that people are
living longer. You are going to have an increasing number retiring that
we don't have a sufficient capacity to cover. We understand that.
But the other truth is the truth that the Senator from Illinois spoke
of--the fact that you have this very large proportion of people today
who aren't covered and who haven't reached the age of eligibility. The
question that is avoided by the Senator from New Mexico, which would
bridge the gap, is: How do you guarantee, as you raise the age, that
you are not going to lose more people in that gap? That is the only
issue that separates us. As I have talked to colleagues on the other
side of the aisle, they have agreed that the commission will probably
recommend that solution. We could have provided some kind of capacity
for a stopgap and we would all walk out of here having done the right
thing, but also having guaranteed that we are not going to lose more
people without coverage.
The PRESIDING OFFICER. The time of the Senator has expired.
All time having expired, the question now occurs on the Roth motion
to waive the Budget Act in response to the point of order of the
Senator from Illinois. The yeas and nays have been ordered.
The clerk will call the roll.
The assistant legislative clerk called the roll.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
[[Page S6132]]
The yeas and nays resulted--yeas 62, nays 38, as follows:
[Rollcall Vote No. 112 Leg.]
YEAS--62
Abraham
Allard
Ashcroft
Baucus
Bennett
Bond
Breaux
Brownback
Bryan
Burns
Campbell
Chafee
Coats
Cochran
Conrad
Craig
DeWine
Domenici
Enzi
Faircloth
Feinstein
Frist
Glenn
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hutchinson
Hutchison
Inhofe
Jeffords
Kempthorne
Kerrey
Kohl
Kyl
Lieberman
Lott
Lugar
Mack
McCain
McConnell
Moynihan
Murkowski
Nickles
Robb
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Stevens
Thomas
Thompson
Thurmond
Warner
NAYS--38
Akaka
Biden
Bingaman
Boxer
Bumpers
Byrd
Cleland
Collins
Coverdell
D'Amato
Daschle
Dodd
Dorgan
Durbin
Feingold
Ford
Harkin
Hollings
Inouye
Johnson
Kennedy
Kerry
Landrieu
Lautenberg
Leahy
Levin
Mikulski
Moseley-Braun
Murray
Reed
Reid
Rockefeller
Sarbanes
Snowe
Specter
Torricelli
Wellstone
Wyden
The PRESIDING OFFICER. On this vote the yeas are 62, the nays are 38.
Three-fifths of the Senators duly chosen and sworn having voted in the
affirmative, the motion is agreed to.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
Mr. GRAMM. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The question occurs on the Harkin amendment,
amendment No. 428. The Senator from New Mexico is recognized. May we
have order, please?
Mr. DOMENICI. Mr. President, I ask unanimous consent that the pending
amendment be set aside so that we may proceed with a committee
amendment with reference to means testing. I believe this process has
been cleared with the manager on the Democratic side.
The PRESIDING OFFICER. Is there objection? Hearing none, it is so
ordered.
Mr. DOMENICI. I yield time on the amendment which will be sent to the
floor by Chairman Roth, I yield time to manage it under the Budget Act
to the chairman.
The PRESIDING OFFICER. The Senator from Delaware.
Amendment No. 434
[Purpose: To provide for an income-related reduction in the subsidy
provided to individuals under part B of title XVIII of the Social
Security Act, and to provide for a demonstration project on an income-
related part B deductible]
Mr. ROTH. Mr. President, I send an amendment to the desk on behalf of
Senator Moynihan and myself.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:
The Senator from Delaware [Mr. Roth], for himself and Mr.
Moynihan, proposes an amendment numbered 434.
Mr. ROTH. Mr. President, I ask unanimous consent that reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')
Mr. ROTH. Mr. President, this amendment does two important things.
First, it would raise part B premiums for seniors who could afford to
pay more. Second, the amendment would provide new part B premium
assistance for low-income beneficiaries. Regarding the income-related
premium, the amendment would reduce the Federal subsidy of part B
premiums--
The PRESIDING OFFICER. Will the Senator withhold for a moment,
please? The Senate will please come to order so we can hear the
substance of the amendment.
The Senator may proceed.
Mr. ROTH. Mr. President, as I was saying, regarding the income-
related premium, the amendment would reduce the Federal subsidy of part
B premiums for some seniors. Today, the Federal Government pays 75
percent of the cost of the part B program and Medicare beneficiaries
pay just 25 percent. The Federal Government funds part B, which is a
voluntary program, and pays for such things as doctors' bills out of
general tax revenues which are raised from all taxpayers, rich, poor,
and middle income. This amendment would require those single seniors
with incomes of $50,000, to pay a bit more for part B; single seniors
with incomes over $100,000 paying all of their share of part B costs.
The corresponding income range for couples would be $75,000 to
$125,000. But, even under this proposed increase, the cost of
participation in part B will remain relatively modest. Next year, it
would cost a senior with an income of $100,000, paying his or her
entire share of part B costs, an additional $1,620. The savings from
this amendment would go into part A trust fund, helping to ensure its
continuing solvency. In addition, the amendment would provide premium
assistance for more low-income seniors. Today, for poorest seniors,
those individuals with incomes below 120 percent of poverty, part B
premiums are paid by Medicaid. The amendment would give States
additional funds to help seniors with incomes between 120 and 150
percent of poverty. This amendment meets the terms of the budget
agreement which provided for $1.5 billion in additional premium
assistance for low-income beneficiaries over the next 5 years. In
short, this amendment helps protect the most vulnerable seniors and
keeps our word with the President.
Mr. President, I ask this amendment be adopted and considered
original text for purposes of amendments.
The PRESIDING OFFICER. Could we have a little more order around the
outside periphery here, please, so we can hear the proceedings? Will
staff please take their conversations in the cloakroom.
The Senator from New Jersey.
Mr. LAUTENBERG. Mr. President, the Senator from Delaware, the
chairman of the Finance Committee, just gave us an assurance that the
text here will be considered original text for the purpose of further
amendment. It is acceptable on our side. This amendment, as we have
heard, just to repeat for a moment, has three major elements. It
includes $1.5 billion to protect low-income individuals with incomes
that are up to 120 percent of poverty from having to pay additional
premiums in the future. This provision is designed to bring the bill
into compliance with the bipartisan budget agreement. The amendment
also would change the means-tested deductible into a means-tested
premium. This is in response to the broad criticism of the Finance
Committee's original bill as unworkable and inequitable. However, I
want to make it clear that I intend to support a motion that we are
going to hear about shortly to strike the means-tested premium.
Finally, the amendment includes a modest initiative to explore the
concept of a means-tested deductible. This is a very limited test that
would not force any seniors to pay a means-tested deductible but would
allow a very small number of them to do so, rather than paying a higher
premium.
So we are again willing to accept this amendment.
Mr. ROTH. Mr. President, I urge its adoption.
The PRESIDING OFFICER. If there be no further debate, the question is
on agreeing to the amendment.
The amendment (No. 434) was agreed to.
Mr. LAUTENBERG. Mr. President, I move we reconsider and then lay that
motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senator from Massachusetts.
Amendment No. 440
(Purpose: (1) To strike income-relating of the Medicare part B premiums
and deductibles; (2) to delay the effective date of income-relating of
the Medicare part B premiums and deductibles; and (3) to means-test
Senatorial health benefits in the same way as the bill means-tests
Medicare part B premiums and deductibles)
Mr. KENNEDY. Mr. President, I send an amendment to the desk on behalf
of myself and the Senator from Maryland, Senator Mikulski----
The PRESIDING OFFICER. The Harkin amendment is pending.
Mr. KENNEDY. I ask that be laid aside.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The bill clerk read as follows:
[[Page S6133]]
The Senator from Massachusetts [Mr. Kennedy], for himself
and Ms. Mikulski, proposes an amendment numbered 440.
Mr. KENNEDY. Mr. President, I ask unanimous consent that further
reading of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
Strike section 5542.
In section 5542(d)(1), strike ``1998'' and insert ``2000''.
On page 1047, between lines 5 and 6, insert the following:
SEC. 6004. MEDICARE MEANS TESTING STANDARD APPLICABLE TO
SENATORS' HEALTH COVERAGE UNDER THE FEHBP.
(a) Purpose.--The purpose of this section is to apply the
Medicare means testing requirements for part B premiums to
individuals with adjusted gross incomes in excess of $100,000
as enacted under section 5542 of this Act, to United States
Senators with respect to their employee contributions and
Government contributions under the Federal Employees Health
Benefits Program.
(b) In General.--Section 8906 of title 5, United States
Code, is amended by adding at the end the following:
``(j) Notwithstanding any other provision of this section,
each employee who is a Senator and is paid at an annual rate
of pay exceeding $100,000 shall pay the employee contribution
and the full amount of the Government contribution which
applies under this section. The Secretary of the Senate shall
deduct and withhold the contributions required under this
section and deposit such contributions in the Employees
Health Benefits Fund.''.
(c) Effective Date.--This section shall take effect on the
first day of the first pay period beginning on or after the
date of enactment of this Act.
Mr. KENNEDY. Mr. President, I demand a division of the amendment as
follows: Division I being line 1, division II being line 2, and
division III being the balance of the amendment.
Mr. President, I will be glad to withhold that request as long as I
do not lose the right to do so.
The PRESIDING OFFICER. The Senator has a right to divide his
amendment.
Mr. KENNEDY. I thank the Chair. Let me just explain.
Mr. ROTH addressed the Chair.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. ROTH. Mr. President, I make a point of order a quorum is not
present.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. DOMENICI. 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. DOMENICI. Now, Mr. President, might I ask a parliamentary
inquiry. I understand--and is my understanding correct--that the second
amendment is subject to a point of order?
The PRESIDING OFFICER. Yes, it is.
Mr. DOMENICI. Then I propose that we do the following, and I think it
is going to be acceptable, that we not have a vote on the third
amendment but, rather, accept it, and then that we proceed thereafter
with debate on the first amendment. And I would ask on the first
amendment could we have a half-hour on each side?
Mr. KENNEDY. A half-hour on each side.
Mr. DOMENICI. On the first one. And on the second one, when the point
of order is made on the motion, you would move to waive it, I assume?
Mr. KENNEDY. Yes.
Mr. DOMENICI. How much time does the Senator want on that?
Mr. KENNEDY. Half an hour on a side.
Mr. DOMENICI. Could we do 15 minutes on a side?
Mr. KENNEDY. Half an hour on that.
Mr. DOMENICI. Let us say not more than. And you could maybe do it in
less.
Mr. KENNEDY. That is fine.
Mr. DOMENICI. I put that unanimous-consent request to the Chair.
The PRESIDING OFFICER. Is there objection? The Chair hears none, and
it is so ordered.
Mr. DOMENICI. I reinstate my previous allocation on the time and
management to the chairman of the Finance Committee.
Vote on Amendment No. 440--Division III
The PRESIDING OFFICER. The question then is on agreeing to division
III of amendment No. 440.
The amendment (No. 440), Division III was agreed to.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
Mr. GRAMM. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Amendment No. 440--Division I
The PRESIDING OFFICER. The question now is on agreeing to division I.
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. As I understand now there is a half-hour on each side?
The PRESIDING OFFICER. That is correct.
Mr. KENNEDY. I yield myself 6 minutes, Mr. President.
This is what I consider another real assault on the Medicare-health
care concept that has served the American people so well. I think the
two great experiments we have seen that have taken place since the
1930's have been Social Security and also Medicare. We understand now
that the Medicare trust fund needs attention. The President has made
the recommendation that we have a period where we would have the
opportunity to have a thorough discussion and debate about what steps
must be taken in order to remedy the long-term financial needs of
Medicare.
That was what was recommended to go to conference and come back with
recommendations to work that process through. What we have here in this
particular Medicare proposal is not really dissimilar in many respects
to some of the other proposals, and that is it has a very fundamental
change in the whole Medicare system. It has this important change.
For years, under the Medicare system, it was a universal system in
the sense that people would pay in all across this Nation, needy
people, poor people paid in and wealthy people paid in and people
received the benefits under the Medicare system. Now that concept is
being challenged and I believe undermined in a very important way for
this reason. We are using under the recommendation of the Finance
Committee effectively a means test for those of certain incomes--above
the $50,000 as individuals or $75,000 up to $100,000 and up to
$125,000. That means that there will be an increase in the various
premiums and the ability to pay.
Now, that will go into effect in another year. First of all, what is
the message that this sends to hundreds and thousands, millions of
Americans who are earning $50,000 a year and just about to go on
Medicare? We are saying to them that their premiums are going to rise
from $64 a month--it will rise in the current proposal by $2,000. It
can rise under this proposal from $259.60 a month up to $3,100 a year
for those at $100,000. We are saying to senior citizens this is going
to be put upon you. They had little time to prepare for it, little time
to plan for it.
Mr. President, $50,000 is a lot of money but for many Americans it is
right there in the heart of working families with two members of the
family working. So we are saying--and this is the fundamental point--
the first means test that we are going to provide on health care is
going to be Medicare. We are not providing means tests for the
deductibility of health insurance for the self-employed, the doctors
and professional personnel, as well as some others in our society. We
are not saying we are going to means test your particular health
benefits. We are not saying to the wealthiest individuals who are going
to be able to use the tax system to provide a deduction for their
health benefits, we are not saying we are going to means test you. No.
The only people we are going to means test are those under Medicare.
That is the only group. We do not do it to those individuals who are
self-employed. We do not do it to individuals who are deducting under
much more costly health care programs. We are saying it's all right for
you to go ahead and deduct and let the taxpayers pick up your
deduction. We are saying, with regard to the self-insured, the same
thing, but not with regard to Medicare--not with regard to Medicare.
Now, what is going to be the result of this? Mr. President, what you
are going to find out is that the wealthy individuals who participate
in the Medicare system--listen to this. Those with the highest incomes,
the top 25 percent
[[Page S6134]]
under Medicare will pay about $159,000 more than they will collect in
benefits. Do we understand that? The top 25 percent--that is what you
are looking at in this particular amendment--they pay in $159,000 more
than they collect in benefits. In contrast, those in the lowest income
category, the bottom 25 percent collect $72,000 more in benefits than
they will pay in taxes.
That is the current system. So it would seem to me that we ought to
give some consideration to those individuals from $50,000 to $100,000
who have been paying into Medicare, because they have been paying in
more than they are paying out.
What are the financial implications of that loss? What we are going
to see, when any individual is going to be paying $3,100 a year in
terms of premiums, they are going to leave the system. They are going
to leave the system. We don't have any studies on that. We have no
guidance, no professional advice as to the extent they are going to
leave the system, how fast they are going to leave the system, but they
are going to leave the system.
The PRESIDING OFFICER. The Senator's 6 minutes have expired.
Mr. KENNEDY. I yield myself 2 more minutes.
So we are taking a high-risk kind of approach on something which is
very basic and fundamental, and that is the integrity of the Medicare
system.
By means testing this premium, we are endangering the total Medicare
system, because those who are contributing the most and adding to the
Medicare system which needs those funds are going to leave the health
care system. We have not had 5 minutes of hearings on the implication
of this program to the Medicare trust fund.
Beyond that, what we are saying is, of all the people in this country
who are going to be means tested, it is going to be those individuals,
working families, men and women who played by the rules, contributed to
Medicare over the course of their lives, depending on the Medicare
system, they are going to find that they are the first beneficiaries to
whom the means test is applied.
It is wrong in terms of the Medicare system. It is wrong in terms of
a health care policy. I don't know what it is about the Senate Finance
Committee. They are trying to drive more and more people out of
Medicare health care coverage. They are doing it by raising the age of
eligibility, and they are doing it with regard to this particular
program. I can understand why some would want to do it, because they
want to ship people out of Medicare and into the private insurance
market so they can make profits in Medicare. We are endangering
Medicare and taking a high risk. It is the wrong economic policy. It is
the wrong health policy. I hope the amendment will be accepted.
I yield 8 minutes to the Senator from Maryland.
The PRESIDING OFFICER. The Senator from Maryland.
Ms. MIKULSKI. Mr. President, I thank the Senator from Massachusetts.
I rise to support the Kennedy-Mikulski amendment, and I am proud to be
an original cosponsor of this amendment. This amendment strikes the
Medicare means-testing provision in this bill. I am adamantly opposed
to Medicare means testing. I have two very grave concerns about the
legislation pending. First, it breaks the bonds of faith between the
people and their Government. Second, it overturns 30 years of Medicare
in 3 days, without any hearings and no real debate.
This bill breaks faith with seniors. It breaks faith with workers
currently paying into Medicare. This bill says if you paid into
Medicare under one set of rules, you are going to receive your benefits
under a completely different set of rules. The bill penalizes those who
work hard, save and try to play by the rules.
This bill puts a previous condition on getting Medicare benefits: the
money you saved. It tells the American people that their savings
account counts against them when they are ready for Medicare.
I believe that promises made must be promises kept. This bill breaks
that promise.
If I were a financial planner, I would advise the senior citizens in
Maryland, ``Go to Ocean City for a vacation, buy a big car, live it up.
Don't save your money for retirement, because the Government will take
it away from you and increase Medicare deductibles, increase Medicare
premiums and place a penalty on you for your savings. If you don't have
any money, at least then you might qualify for Medicare.''
But I am not a financial planner. I am a U.S. Senator, and it is my
job to stand sentry to protect Medicare.
Medicare was meant to be portable, affordable and undeniable. The
purpose of Medicare was to provide health insurance to senior citizens
because the private sector wouldn't do it in a way that was affordable,
portable and universal for people over the age of 65.
Medicare premiums will now go beyond what some private insurance
policies now cost. This provision ends Medicare, as we know it, and
turns it into a welfare program. This is unacceptable.
We must ask ourselves, who are we making Medicare affordable for? Is
Medicare meant to be affordable for senior citizens, or was it meant to
be affordable for Government? I want to make sure that Medicare is
affordable to the senior citizens who need it.
Let's be realistic, we do have a problem with Medicare. Yes, the
clock is ticking on solvency. Yes, we do need to address this problem
with a sense of urgency.
As we are concerned about the future solvency of Medicare, we need to
be concerned about the solvency of senior citizens. They need Medicare
now. This bill attacks them when they are sick, when they are most
vulnerable, and it does nothing or little to make Medicare solvent.
For those young people working who are now in their twenties,
thirties, forties and fifties--the baby boomers--they should be
concerned. We have 78 million baby boomers in this country. They are
going to be doubly squeezed. They will be taking care of their aging
parents and paying the high cost of educating their children, and now
we would have them pay Medicare taxes for 47 years and then pay again
when they are elderly.
If we want to talk about Medicare costs, we can begin cracking down
on the $23 billion of fraud in Medicare. We don't do anything by
sticking it to the middle class in the middle of the night, and that is
what this bill does.
This legislation is a direct attack on the middle class and the
beginning of a slippery slope for more attacks on work and savings.
This is not the time, this is not the place or the way to change
Medicare. It should be the starting point for a national debate on how
we protect Medicare and reward work and saving.
It is too important not to have a debate, but there has been little
or no debate. We should not have spent the time this year debating
contentious issues that are going nowhere. We should have spent the
time debating Medicare, its solvency and a variety of alternatives to
be able to educate the American people.
Instead, we are changing the rules in the middle of the game and the
middle of the night. We need Presidential leadership. We need
bipartisan cooperation. We don't need a middle-of-the-night attack on
the middle class that raises costs, does nothing to improve health care
for our citizens and threatens the very health care for the middle
class.
I will stand sentry to protect Medicare. I will stand sentry to make
sure the promises made are promises kept. And I will stand sentry for
America's senior citizens. The means testing in this legislation before
us breaks faith with those seniors.
Retired seniors, as well as those nearing retirement age, have
planned for that retirement with the understanding that they would have
to pay about $100 in deductibles. Now they will be advised that they
will have to contribute anywhere from $550 to $2,000 a year for a
premium on a Government insurance program and at the same time have to
pay Medigap insurance.
When you are retired, every dollar counts, and even those with
average incomes need to be able to count on every dollar. We must
preserve the covenant that we established with our seniors to provide
affordable accessible health insurance at old age. Out-of-sight
additional fees and new income reporting requirements break those
promises. What we are telling people is, if they play by the rules,
they are now going to lose.
[[Page S6135]]
Those who planned and saved the most are penalized for their efforts.
The provision tells seniors that after a lifetime of hard work and
savings, the Government is going to add to your burden when you are
sick.
So these provisions send a horrible message to seniors with higher
incomes, but they also send a frightening message to every senior who
depends on Medicare. If we make this change now, what does it say to
seniors who fall just below the income threshold of the provision in
the bill? What assurance do they have we won't be asking them to pay
higher out-of-pocket expenses in the years ahead?
I believe it is wrong to scare seniors this way, and it is
unconscionable to undermine our commitment to people who depend on
Medicare.
Honoring your father and your mother is a great commandment. I think
it is a great public policy. The Medicare Program must embody the
values of ``honor your mother and your father.''
Mr. President, that is why I support the Kennedy-Mikulski amendment.
I believe we should strike this means testing, wait for another day
after we have had a national debate, a report of a national commission,
and then look at the variety of tools best able to ensure the solvency
of Medicare, and yet at the same time reward hard work and savings.
I yield back such time as I might have.
The PRESIDING OFFICER. Who seeks time?
Mr. ROTH. Mr. President, I yield 5 minutes to Senator Gramm.
The PRESIDING OFFICER. The Senator from Texas is recognized for 5
minutes.
Mr. GRAMM. Mr. President, I want to begin by reading from the report
of the trustees of Social Security and Medicare programs. In their
annual report dated April 1997 they state:
As we reported for the last several years, the Medicare
trust fund would be exhausted in 4 years without legislation
that addresses its financial imbalance. Further delay in
implementing changes makes the problem harder to solve. We
urge the earliest possible enactment of legislation extending
the life of the HI trust fund.
The HI trust fund is the Medicare part A trust fund. That is not me
talking. This is the trustees of Medicare, three of whom are Cabinet
officials of the Clinton administration.
No one disputes the facts. This chart represents the cumulative
deficit of Medicare as we look toward the future, and we know with
relative certainty that over the next 10 years, Medicare is going to be
a cumulative drain of $1.6 trillion on the Federal budget.
We now know about some of the things that the Senator from
Massachusetts is against. We know he doesn't want to conform the
eligibility age for Medicare with the retirement age under Social
Security. We know that he doesn't want to ask high-income retirees to
pay more of their share of the cost.
However, we don't know what he is for. We don't know if he is
willing, as will be required in the year 2025, to triple the payroll
tax? It is very easy to say what you are against. It is easy to say,
let's not do this today, let's not do it this year, let's not do it
this decade, let's never do it. But the problem is, 4 years from now,
Medicare will be in the red, and the system is going to be bankrupt if
we don't act.
What have we done? First of all, all this rhetoric about playing by
the rules of the game and paying into Medicare over our working lives
is good rhetoric, but it has nothing to do with the bill before us.
Nobody pays for any part of part B of Medicare, which is basically
physician services, during their working lives.
Let me repeat that. During our working lives, we pay 2.9 percent of
our wages into the part A trust fund which funds hospital care, but
only after we retire do we pay anything for our part B benefits. We now
pay 25 percent of the cost as a premium.
The bill before us means tests that premium. It says that for those
individuals who in retirement have incomes of $50,000 to $100,000, or
couples $75,000 to $125,000, that we are going to phase up the part B
premium from 25 to 100 percent so that individuals who have $100,000 of
earnings in retirement and couples who have $125,000 of income in
retirement will be asked to pay another $1,577 a year in their part B
premiums.
Let me remind people that part B of Medicare is voluntary; it is not
a mandatory program. Nobody makes anybody participate in this program.
If asking people who have incomes of $125,000 a year to pay $1,577 more
a year for this coverage is too much, they don't have to do it.
Mr. GREGG. Will the Senator yield for a question?
Mr. GRAMM. I will be happy to yield.
Mr. GREGG. I think you have raised a very significant point. It goes
to the argument of the Senator from Massachusetts. What you are saying
is today a person who participates in the Medicare system pays 25
percent of the costs of the part B premium.
Mr. GRAMM. That's right, and pays none of the cost during their
working lives.
Mr. GREGG. That means 75 percent of the cost is being paid by the
wage earner.
Mr. GRAMM. That's right.
Mr. GREGG. By John and Mary Jones who happen to be working on a line
in a factory in New Hampshire or working in Texas trying to raise a
family, they are paying 75 percent of the cost of the premium of the
person who today is receiving part B Medicare benefits, is that not
correct?
Mr. GRAMM. That is correct.
Mr. GREGG. So if you follow the logic of the Senator from
Massachusetts, you are saying John and Mary Jones, the wage earner of
America, should be subsidizing the person who is earning $100,000, that
would be the practical effect of adopting Senator Kennedy's amendment.
Mr. GRAMM. Not only would it have that effect, if we adopt Senator
Kennedy's amendment, we are going to be asking moderate-income-working
families to subsidize people in retirement who are making up to
$125,000 per year. The program is voluntary. If they don't think it is
a good deal, they don't have to do it.
Can I have 1 additional minute, Mr. President?
The PRESIDING OFFICER. Does the Senator from Delaware yield
additional time?
Mr. ROTH. I yield 1 additional minute.
Mr. GRAMM. Mr. President, in order to keep Medicare solvent, we are
going to ask very high-income retirees to begin to pay more of the cost
of a benefit which they receive. It is a voluntary benefit which no one
pays for during their working life and for which they are currently
paying 25 percent of the cost. We are going to phase that up to 100
percent of the cost for individuals with incomes of $100,000 a year and
couples with incomes of $125,000 a year in order to keep the system
solvent.
The alternative is to ask moderate-income-working families to pay the
cost. We don't believe that is fair. This is a voluntary program.
Nobody is required to participate in part B of Medicare. It is a
voluntary program. So if very high-income people do not want to pay the
$1,577 they do not have to pay it. They can drop out of the program.
They are not going to drop out because it is still a good deal.
The PRESIDING OFFICER (Mr. Gregg). Who yields time?
Mr. KENNEDY. Mr. President, I yield myself 3 minutes.
The material that the Senator from Texas was quoting was not focused
on this particular amendment. It was talking generally about the
problems of the Medicare.
The Senator has not responded to one of the principal criticisms of
this amendment and that is that the top 25 percent of the Medicare
recipients are paying into the Medicare system some $132,000 more than
they are taking out over a lifetime. You are raising their part B
premiums to $3,100 and you are talking about it being voluntary.
How many of those individuals in the top 25 percent will leave
Medicare? And what will the economic implications on the trust fund be
then? You have not had any hearings or any testimony. The answer that I
hear is, ``Well, the very wealthy get 75 percent of their part B paid
by general revenues.'' Yes, they do, and I can give you the studies
that show that the top 25 percent pay more into part B than they get
back in terms of whatever services or assistance they get under part B.
So you are going to take steps here on means testing premiums for the
first time, on a program that is working, and has no financial problems
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under the proposal of President Clinton --$115 billion of savings. We
will make sure we have 10 years to set up that commission and to
consider a variety of different alternatives in terms of the Medicare
trust fund. But no, no, we have the answers to these problems today in
the Finance Committee. They were marking up these measures with 5-
minute time limitations on discussion for each of the various
amendments.
Mr. President, this is not the way to treat senior citizens. I know
the Senator is against the Medicare system. I have listened to him
oppose it. I know he was part of a program in the last Congress to cut
it by $256 million and use the money to pay for billions of dollars in
tax breaks for wealthy individuals.
The Senator asked me what I am for. I am for preserving the Medicare
system and not destroying it. And I am for giving careful consideration
and study to the different alternatives, in the light of day. I am not
for having a seat-of-the-pants recommendation which can threaten the
Medicare system. We are fast-tracking these proposals. We are debating
these issues on Medicare with a time limit of 1 hour.
I was here when the Senate debated Medicare for days and weeks, and
now it reverses itself over a period of 3 years. We are now asked here
to make judgments and decisions in just a few moments. It is a
disservice to senior citizens. It is a disservice to all the men and
women in this country who believe in a retirement that they can plan,
knowing what they could expect in terms of the Medicare premium.
Finally, HCFA, which is the principle organization that is going to
be working through the process of administering this, keeps no income
records. What is going to happen to an individual that makes $49,500
and somebody that makes $50,500? What happens when they make a certain
amount 1 year but not the second year? What if they make it in the
third quarter and not the fourth quarter? How do you administer this?
Who will make those decisions? You are going to set up a massive
bureaucracy. The Senator has not commented on that.
We were here debating just the other day a children's health bill,
talking about doing a cigarette tax and we already collect a cigarette
tax. We were talking about distributing that money to the States
through the agreement that Senator Hatch and I proposed, and we heard
``Wow, a totally new administration will have to be set up.''
What the Senators in the Finance Committee are proposing will require
the grandaddy of all bureaucracies to be set up. A set up in a way that
I think will seriously threaten the long-term security of the Medicare
system.
Mr. ROTH. Mr. President, I yield 5 minutes to the distinguished
Senator from Louisiana.
Mr. BREAUX. I thank the chairman for yielding.
These arguments on the floor sometimes become very confusing.
Everybody wants to fix Medicare. But what I hear from so many of our
colleagues when we can all agree on fixing it, no one can agree how to
fix it.
We ask the question, when are we going to fix it? And some say, well,
not now. And we ask the question, well, who is going to fix it? And we
say, not us. And then they ask the question, well, how are we going to
fix it? And the response is, well, not this way, but fix it.
I think that the politics of the issue at hand before the Senate is
really very confusing to me. I cannot imagine going to my State of
Louisiana and talking to a truck driver who is making, say, $25,000 a
year, and supporting a wife and two children, and explain to him how it
is correct and good policy to say that he and his two children and his
wife are going to subsidize a retired couple that is making over
$75,000 a year in retirement income.
As a Democrat, how do I handle that? I suggest as a Republican, how
do I explain that? It is not explainable. It is not good politics. Even
more important, it is not good Government.
Medicare is going to be insolvent in the year 2001. We have an
obligation to try and fix it. I think it is good policy to say to that
person who works every day and maybe makes $25,000 that we no longer
are going to ask you to subsidize somebody's doctor's insurance that
may be sitting home, in retirement, collecting over $100,000 a year,
clipping coupons.
Now, you would think that good policy for both parties would be to
say we want to help the guy who is struggling to raise his two
children, support his wife, who makes $25,000 a year, by asking someone
who is retired that makes over $75,000 a year in retirement to pay a
little bit more of what he is getting from the Government.
We asked the Congressional Research Service--and certainly they are
bipartisan, nonpartisan--how many people are affected by this change?
They said that approximately 1.6 million people in the Nation age 65 or
older, one-half of 1 percent of the noninstitutionalized people, not in
hospitals or homes, have adjusted gross income at or above the
threshold that this bill provides for--$50,000 for a single person or
$75,000 for a couple filing their return.
Ms. MIKULSKI. Will the Senator yield?
Mr. BREAUX. That means only 1.6 percent of the people filing returns
would be affected by this. How many millions of people do we have back
in our States that are making $25,000 and continuing to subsidize those
who are in retirement income? The average income in my State for
working people is about $22,000 or $23,000. We have very few people
that are retired that make over $75,000 a couple--almost none.
I am happy to yield.
Ms. MIKULSKI. The Senator just stated, according to CRS, it affects
only 1 million people. If the numbers are so modest then could the
Senator explain in his remarks, and I will be glad to ask for
additional time, if the numbers are so modest in terms of population,
then how are the financial savings so great?
Mr. BREAUX. It is not necessarily just the financial situation we are
looking at. We are looking at something that is called fairness. When
we, as Democrats, look at trying to tax people that are making $25,000
and a blue-collar job, driving a truck in my State of Louisiana, and
telling that couple that they should be subsidizing someone who makes
$100,000 a year who is retired, that is not good policy.
So this is a policy change as much as it is anything else. It is a
question of fairness. We have a system that is going broke and we are
going to make changes. The changes should be fair. I suggest this is a
fair and equitable change to ask for those who can most afford it to
pay a little bit more so those who can least afford it will not have to
continue to subsidize those who are very well-off in retirement. That
is a fair test. It is a good proposal. I suggest that we support it.
Ms. MIKULSKI. I ask 2 minutes additional time for the Senator to
answer a question.
Mr. KENNEDY. I yield 4 minutes.
Ms. MIKULSKI. How much, then, is this going to save, or is it, as we
believe, just a ruse to create the principle of means testing to get
what I call the slippery slope done--that really will not save very
much money in Medicare, and it really does not deal with solvency of
Medicare, it just lays the groundwork for additional means testing.
Mr. BREAUX. I respond to the Senator from Maryland who has been
active in this issue, in addition to the overriding fairness, it saves
$3.9 billion over 5 years. I suggest that when you add the fairness
test plus $3.9 billion to a system that is nearly broke and insolvent,
that is a good deal.
Mr. KENNEDY. I yield 3 minutes to the Senator from West Virginia.
Mr. ROCKEFELLER. Mr. President, one thing that occurs to me listening
to this debate is that some very, very important principles followed by
amendments are being put before the Senate in a context that the
American people do not fully understand nor have they any reason to
because it has not really been discussed with them.
In speaking quite honestly, this sort of grew up within the Finance
Committee, of which I am a member, and it became a kind of a fluent
subject within the Finance Committee. It got a credence--had people for
it, had people against it--it got its own momentum, and the Finance
Committee was acting apart from the rest of the Senate, and apart from
the rest of America.
I am not by definition innately opposed to means testing but I am
oppose to doing things before they receive what I call a larger
consideration,
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which I think falls into the commission on Medicare which is what I
introduced as a bill 2 years ago. It seems to me when you are dealing
with something in a State, for example, like West Virginia, where the
average senior citizen income is $10,700 a year, you really do not make
decisions like this--or like a number of other issues that have been
before us --without a larger discussion with the American people, a
larger context being placed before the American people. We have
traditionally done that with major pieces of legislation.
This discussion has come out of a kind of sanctuary of privileged
discussion. I am not saying it is not without merit at some point, but
I do not think it is at this point, because of the absence of the
larger discussion of the American people. When you are dealing with
people that have $10,700 a year to live on, every deductible, every
single decision about a means test, all of it counts, and it really
does in human terms. I am not being evasive. I am simply reflecting
what a whole lot of people in this country are very afraid of.
So my plea would be that we would not let up on this but that we
would continue this, but in the larger context of the commission on the
future of Medicare, which I think is the only place to really do that.
That reflects not just my feeling about this amendment but other
amendments that I have voted on during the course of the day in a way
which I might not vote on after a commission had discussed it and a
national discussion had been held. That has not taken place to this
point. It is kind of a privileged conversation, and it is not one I am
entirely comfortable with on behalf of the people I represent.
Mr. LAUTENBERG. Mr. President, I rise in opposition to the proposal
to means test Medicare part B premiums.
Mr. President, I am not opposed in principle to asking wealthier
Americans to pay more for certain Government services. At the same
time, I think we have to be very, very cautious before making
fundamental changes in a program as important as Medicare. And it's not
something that should be done on a fast-track reconciliation bill, with
little opportunity for public input or debate.
Mr. President, Medicare is a universal program that can benefit each
and every citizen. The universal nature of Medicare provides a broad
base of beneficiaries that helps maintain the program's economic
viability. By covering all eligible individuals, no matter their health
risks, Medicare spreads those risks broadly, as an insurance program
must do.
Yet increasing the costs of Medicare to better-off individuals
threatens to drive wealthier and healthier individuals away from the
voluntary part B program. And, at some point, that could undermine the
broad base of beneficiaries that is necessary. I am not prepared to say
that the particular proposal in this bill would do so. I don't know.
But it's a serious issue that deserves careful consideration before we
move forward.
Mr. President, beyond the need to ensure Medicare's economic
viability, there's also a need to ensure that the program maintains
broad support among the public and in the Congress. That's why so many
Medicare supporters are concerned about turning the program into
anything that resembles a welfare program.
Now, Mr. President, at some point, these concerns may have to give
way to the stark economic realities of upcoming demographic changes.
But if we are to move toward some type of means testing, we need to do
it very carefully, to ensure that the public understands, and supports
the change. The stakes are too high to rush into this without preparing
the way, and making sure we're doing it right.
Mr. President, beyond the broad economic and political concerns
involved with introducing means testing into Medicare, there are
practical issues to resolve, as well. If premiums are to vary based on
income, who is to evaluate a person's income, and how? Will the IRS
take on the responsibility? Or will we create a whole new bureaucracy
to do the job--some might call it, Son of IRS.
This proposal seems to adopt the latter approach. But many believe
this is duplicative and inefficient. It also raises questions about
whether this new bureaucracy will adequately protect the
confidentiality of senior citizens' private financial information.
A related question is how we can monitor the changing incomes of
beneficiaries. Take an individual who last year received a sizable
salary, but who was laid off at the end of the year, and now has no
income. How are we supposed to know that this person now cannot afford
a higher premium? I wonder whether this type of issue has really been
thought through.
Mr. President, all of these issues need to be considered carefully
before we rush into a proposal of this magnitude. Yet the proposal to
means test premiums comes to us now at the last minute. It has not been
subject to hearings. Nor has the public been involved in the debate.
Mr. President, there is a more appropriate avenue for considering
this kind of proposal. The bill before us calls for a commission that
would study long term changes needed to sustain the Medicare system. So
my suggestion would be to wait, and have the commission study the
proposal and options for implementation. The commission is required to
report back within a year. So this issue will not get deferred
indefinitely. But we need to do this right.
Mr. President, I would remind my colleagues that we do not need to
means test Medicare premiums to balance the budget. Nor is it necessary
to make Medicare solvent for an 10 additional years. We've accomplished
those goals in the bipartisan budget agreement, and without resorting
to means testing.
So, Mr. President, I would suggest to my colleagues that we should
act with caution when it comes to a program as important as Medicare.
Means testing has potentially huge implications for the economic and
political viability for the Medicare Program. And, in my view, it's not
something we should be doing on a fast-track bill with little
opportunity for serious review and public input.
The PRESIDING OFFICER. Who yields time?
Mr. ROTH. I yield 5 minutes to the distinguished Senator from Rhode
Island.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. CHAFEE. Mr. President, I would like to briefly review the bidding
here, if I might. Part B is a program that provides for payments to
physicians; it is an insurance program. Nobody who is in Medicare has
to take out this insurance program. Those that do pay a $45-per-month
premium currently, over 99 percent of all Social Security
beneficiaries, take the part B insurance. That is what it is--
insurance. What is this premium that they pay the $45? That is
calculated to cover 25 percent of the costs of the program, of the
entire part B cost. Twenty-five percent is what an individual pays. So
where is the other 75 percent coming from? The other 75 percent comes
from the General Treasury. So you get this anomalous situation of a
very low-income individual that might be the person that cleans the
streets, if you will, or cleans up our offices early in the morning;
that individual's income taxes go into the General Treasury, and then
part of them come out to pay some millionaire retiree's doctor bills--
75 percent of them. Now, something is wrong here. Why should those
people be paying 75 percent of Warren Buffet's doctor bills?
So what we have proposed here is that there be what we call a means
test. The wealthier individuals will pay more for that premium instead
of having it come out of the General Treasury. So did we start with
low-income people? Hardly. Before anybody has to start paying more than
the 25 percent premium, that individual, if he is an individual, as
opposed to a married couple, that individual has to have an income of
over $50,000 a year as a retiree. And it gradually comes in a greater
portion, until finally that individual, if he is making $100,000 per
year, is paying 100 percent of the premium. He doesn't have to take it
if he doesn't want it. If he can go out and find a better deal
somewhere, so be it. But I suspect he will find that this is a very,
very good insurance program and he is delighted to pay the 100 percent,
and he surely can afford it. It will only be $135 a month more, if he
is paying the total premium, than if he were just paying the 25
percent.
What about the married couple? There is talk here about how onerous
[[Page S6138]]
this is. It doesn't even start with a married couple to pay more than
the 25 percent until that couple is filing an income tax return showing
that a $75,000 income. They don't pay the entire amount of the premium
until their income is $125,000 a year. Where I come from that is a
pretty good income.
So, Mr. President, what we are trying to do is overcome this, I
think, shocking situation where a very wealthy person is only paying 25
percent of the cost of a program with the taxpayers of the Nation. That
cleaning woman, her taxes are going into that general fund to come out
and pay some wealthy person's doctor bill--75 percent of them. That,
Mr. President, just plain isn't fair.
The question is whether we should debate it longer. I don't know how
long it takes to understand the particular program we are proposing
here this evening. Now, there are going to be savings. As the
distinguished Senator from Louisiana pointed out, the savings are
nearly $4 billion over 5 years. You can say, oh, that's not much. Boy,
that is getting pretty inured to Washington spending if you say $4
billion isn't much. All that savings goes into the Medicare Program,
the part A program, the hospital insurance, which is about to go under.
Is it me that says that? No.
We previously, this evening, quoted from the report of the trustees
of the Medicare fund. Those trustees have used the most alarming words.
I have here the little booklet that they put out in which they use
terms of the part A trust fund, namely the Hospital Insurance. They use
terms like--these are the trustees, and four of the six trustees are
Cabinet officers, all Democrats. This is what they say:
Further delay in implementing changes makes the
problem harder to solve. We urge the earliest possible
enactment of legislation to extend the HI trust fund. The
Medicare trust fund, the HI, will be exhausted in 4 years
without legislation to address it.
It seems to me, Mr. President, that this is a very worthwhile
undertaking. It is the right thing to do. It is not hurting anybody. If
people at a $125,000-a-year income can't pay their entire insurance
bill, then they are not doing their budgeting very well.
So, Mr. President, I strongly support this measure, which was
reported from the Finance Committee.
Mr. MOYNIHAN. Unanimously.
The PRESIDING OFFICER. Who seeks time?
Mr. KENNEDY. Mr. President, how much time do I have?
The PRESIDING OFFICER. The Senator has 5 minutes remaining.
Mr. KENNEDY. I yield 2 minutes. I listened to my friend and colleague
from Rhode Island talking about how Part B of the Medicare system is
subsidized by 75 percent from the general funds. Well, of course, the
health insurance of every Member of the U.S. Senate is also subsidized
by roughly the same amount. When he talks about how bad it is for
upper-income seniors to pay only 25 percent of their Part B costs, it
should be clear that Senators--whose incomes are all above the maximum
threshold they have set for senior citizens--also pay only 25 percent
of the health insurance premium.
This is the point, Mr. President. Under family coverage for Blue
Cross, we only $108.40 per month, while the taxpayers spend $292 a
month on our coverage. So that is what happens right here in the U.S.
Senate. If we are going to begin to means-test taxpayer-subsidized
health insurance benefits, why are we starting with Medicare?
The third part of our amendment changes this by requiring Senators
whose annual income is over $100,000 to pay for 100 percent of their
health insurance premiums. As we have seen under the Lewin-VHI study
commissioned by the National Committee to Preserve Social Security and
Medicare, the top 25 percent of wage earners of this country pay
$159,000 more into the Medicare system than they take out. By contrast,
those in the lowest income category--the bottom 25 percent--will
collect about $72,000 more in benefits than they pay in taxes.
You cannot assure us that higher income group is going to choose to
stay enrolled in Medicare under these new conditions. Studies have
demonstrated that those in the top 25 percent pay more into part B than
they receive back. All we are asking for is a hearing on this issue.
Those are the figures. I have the studies right here to demonstrate
that. Now, if that is true, we don't want to lose this group because
they are providing help and assistance for other needy workers. I must
remind my colleagues that health status generally rises with income,
which means wealthier senior citizens are generally healthier. If they
choose to leave Medicare, they take their premium dollars with them.
So I believe that it is true, and we have the testimony to provide
it. We ought to at least explore this proposals impact on Medicare
enrollment before blindly voting for it.
The PRESIDING OFFICER. The time of the Senator is up.
Mr. KENNEDY. I yield myself another minute. The fact is, if that is
true--and I believe it is--we have to make a calculation of how many
people are we going to drive out of the part B, because we are raising
their annual premiums to well over $3,000. You can't tell us different
here this afternoon. So, Mr. President, I think that this measure ought
to be given more consideration.
A final point. Ten years ago, Medicare recipients spent on average 18
percent of their income on out-of-pocket health care expenses. It is
now up to 21 percent.
The PRESIDING OFFICER. The Senator's time is up.
Mr. KENNEDY. I yield myself 1 additional minute. The elderly already
spend a disproportionate share of their income on health care. While
those under age 65 spend only about 8 percent of their income on health
care, Medicare beneficiaries spend an average of 21 percent. This
amendment will only increase that disparity. It poses, I believe, a
serious threat to the Medicare system and it should be given much more
thought and consideration than it has here today. Medicare's success is
based in part on the fact that all groups are treated equally -- poor,
rich, younger, older, sick, healthy. This provision undermines the
fundamental promise of Medicare that says you will all contribute an
equal amount and you shall all be guaranteed equal benefits.
I withhold the remainder of my time.
Mr. ROTH. Mr. President, I yield 5 minutes to the Senator from
Nebraska.
Mr. KERREY. Mr. President, I oppose the effort to strike this
important provision in the Finance Committee's bill. Since Medicare was
enacted in 1965, there have been many legislative efforts to make it
more fair, to make it more progressive. Most colleagues, I suspect,
support the Qualified Medical Beneficiary Program, the QMB Program and
the SLMB Program, the dual-eligibility program. All of these programs
are efforts not in 1965, but much later, to make the program fair, to
help lower-income beneficiaries, to make it more progressive. That is
what these programs do.
Dual eligibility in Medicaid is a terrific program. It enables that
low-income individual to be held harmless against all costs, premium,
deductibles, copayment, as well as additional Medicaid coverage. QMB
does premium deductible and copayment for all Medicare beneficiaries
under 100 percent of poverty. And it made the program fair, more
progressive. SLMB is up to 120 percent. The chairman has added a
provision that would allow it to go from 120 to 150 percent because of
the changes recommended by the President, shifting home health from
part A to part B.
Those who argue against this change say that we are on the slippery
slope somehow. We have done this before. There have been constant
efforts to try to evaluate Medicare and to try to make it fair. This
proposal makes Medicare more fair on its face. Individuals earning up
to $50,000 a year will continue to enjoy a 75 percent subsidy in part
B. That doesn't change. That is for individuals at $50,000 and couples
at $75,000. We begin to phase out the subsidy of that part B premium.
It will go from about $560 to about $2,100. That $1,500 or $1,600
subsidy that we currently have in place will be phased out. For
seniors, with adjusted gross incomes of $100,000 for individuals and
$125,000 for couples, they will pay an unsubsidized part B. They will
still receive part A with no change, but for part B, physician
services, they will pay an unsubsidized premium.
It makes the program more progressive, Mr. President. It has been
noted,
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and quite correctly, that for many seniors there is a significant
percentage of income that goes for health care. But what we need to
look at is that inside that senior population, there are significant
differentials. For lower income beneficiaries, they will pay for health
care a higher out-of-pocket amount than higher income beneficiaries--30
percent versus 3 percent for higher income beneficiaries. This is a
problem that we are trying to solve. We are trying to make this program
more progressive.
As to the suggestion that we need to study this, this is not a
proposal that just came out of the blue. This is a proposal that has
been around a long time. It has been discussed; it has been opposed;
all kinds of arguments have been thrown up against it. There have been
all kinds of good suggestions that perhaps we can improve it somehow.
So this is not a brandnew proposal. We don't need to study this, Mr.
President.
I have great respect for the senior Senator from Massachusetts and
the Senator from Maryland, as well. They come to the floor because they
care deeply about Medicare beneficiaries, wanting to preserve and
protect Medicare, which is the goal of this piece of legislation. By
making Medicare more progressive, I believe we have a much better
chance of securing the intergenerational commitment that Medicare
represents.
Medicare is an intergenerational commitment on the part of younger
people to allow themselves to be taxed so that we can provide benefits
to the beneficiaries of Medicare. It is a strong commitment. It is a
good commitment. It has made our Nation better as a consequence of
having it in law. This change, by making it more progressive and fair,
will strengthen the commitment that we have for this good program.
Mr. KENNEDY. Can I ask the Senator a question on my time? Will the
Senator yield for a question?
Mr. KERREY. I am kind of busy.
Mr. KENNEDY. I heard the Senator say this has been around a long
time. I think it has been on the floor here for about an hour. This
wasn't the proposal that came out of the Finance Committee, was it?
Mr. KERREY. No, it was not the proposal that came out of the Finance
Committee.
Mr. KENNEDY. Had that been around a long time, too.
Mr. KERREY. Is this a jury deal, where I get a yes-or-no answer? You
have lots of time here.
Mr. KENNEDY. I don't have much time.
Mr. KERREY. Mr. President, we did get a proposal that came out of the
committee to use deductible instead of premium and, as a consequence of
that being untested, we changed it back to premium. The premium is not
an untested proposal. I have been asked about whether or not----
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. KENNEDY. I yield another 30 seconds.
Mr. KERREY. Another 30 seconds? I can't say hello in 30 seconds.
This proposal has been around--adjusting by income the part B premium
has been around a long time. I know I was asked about it when I
campaigned in 1988. This is not a new proposal. It has been argued. It
has been vented. It has been discussed. It is reasonable. It is fair.
And I hope my colleagues will oppose the Kennedy effort to strike.
Mr. KENNEDY. Mr. President, how much time remains?
The PRESIDING OFFICER. The Senator from Massachusetts has 37 seconds.
Mr. KENNEDY. I yield whatever time remains to Senator Mikulski.
Can we get 2 minutes to wind up for Senator Mikulski to make a final
comment?
The PRESIDING OFFICER. Is there objection to the request for 2
additional minutes?
Mr. DOMENICI. Reserving the right to object--I shall not--how you
much time remains on our side?
The PRESIDING OFFICER. The Senator from New Mexico has 8 minutes. The
Senator from Massachusetts has 37 seconds.
Mr. DOMENICI. I would like to take it off the bill, if we can.
Mr. LAUTENBERG. We will give the Senator from Maryland 2 minutes off
the bill.
The PRESIDING OFFICER. The Senator from Maryland.
Ms. MIKULSKI. Mr. President, 32 years ago this summer I graduated
from the University of Maryland School of Social Work. And my very
first job was to go out to the Baltimore neighborhoods to tell people
what this new bill called Medicare was; to tell them what medical
services they would be entitled to. As I went door to door to door in
the streets and neighborhoods, onto the white-marbled steps of
Baltimore, people's eyes opened wide. They could not believe that the
United States of America had passed legislation that would provide them
universal affordable health care in their old age and that it would be
the next step to the Social Security commitment; that they would have
in perpetuity a safety net that did not have a previous condition on
it; that the premium would be affordable; that it would be undeniable.
Thirty-two years later we are changing the rules of the game. The
very people that were 30 years old then are now in their sixties. They
didn't know it was going to be means tested. I respect the Finance
Committee. But I will tell you that there has been no national
discussion on what it means to the solvency of Medicare.
All we are asking is strike the means testing now. Let's have an
American national debate, not a time-limited rule which we agree to
temporarily. But let's have a national debate.
The Finance Committee might have studied it. It might not be a new
idea to them. But I will tell you something. It is a new idea to the
American people. And the middle class knows that the minute you start
this class-warfare language of means testing people over $100,000 and
say it is fair, button down your hatches, blue-collar workers. They are
coming after you next.
The PRESIDING OFFICER [Mr. Coats]. Who yields time?
Mr. ROTH. I yield 3 minutes to the Senator from New Hampshire.
The PRESIDING OFFICER. The Senator from New Hampshire is recognized.
Mr. GREGG. Thank you, Mr. Chairman.
Mr. President, listening to this argument here, it seems to me that
it is extraordinarily disjointed coming from the other side.
Let's remember what we are talking about. We are talking about people
who are making $75,000 or $100,000 a year being supported in their
health care under part B by people who are making $25,000 a year,
$30,000 a year, or $40,000 a year. People who are working on a line job
in New Hampshire, at a restaurant in Texas, and at a garage in New
Mexico are supporting people who are retired who are making $75,000 to
$100,000. And what is the complaint from the other side? The complaint
from the other side is that somebody who makes $100,000 might have to
pay 2 percent of their income in their retirement years to buy part B
insurance--2 percent. You tell me where you can go out and spend as a
senior citizen in the private sector 2 percent of your income and buy a
health care plan that is going to cover you for physician costs. You
can't do it.
The statement was made from the other side that somehow these
extremely wealthy people have been paying into the system more; and,
they paid in more and, therefore, they should get some sort of
extraordinary benefit as a result of that where they are subsidized by
people earning $25,000 to $30,000 a year. That is simply not true. They
may have paid more into part A, yes. But they have not paid more into
part B. Part B is on a cash basis system. It is a pay-as-you-go system.
You buy that insurance on an annual basis. The people who pay more for
part B happen to be the poor men and women who are working in America
who are paying payroll taxes, and who are paying into the general fund
and then have to subsidize to the extent of 75 percent the person who
is making $100,000. That is the person who is paying more--the wage
earner. The concept that high-income individuals should not have to pay
the full cost of the health care benefit which they are receiving, the
insurance benefit they are receiving, makes no sense at all. It makes
no sense that someone who is making $100,000 shouldn't have to bear the
full cost of the part B premium.
We heard earlier today that the other side was surprised that people
are living longer, and that is why they don't
[[Page S6140]]
want to move too quickly into the issue of whether or not we should
raise the retirement age. We heard earlier today from the other side
that people were, I guess, surprised that the part A trust fund is
going broke. That is why they don't want to move too quickly into the
issue of whether or not people should have their age of retirement
raised.
I can't believe, recognizing the speakers from the other side who
have been carrying the water on this issue, that they are surprised
that there are rich people in America, and that is what this is about.
There are rich people in America, and they are not paying their fair
share.
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. ROTH. I yield 3 minutes to the distinguished Senator from New
York.
The PRESIDING OFFICER. The Senator from New York.
Mr. MOYNIHAN. Mr. President, some may have thought that there has
been a leakage of reality about the social insurance programs of the
American Nation; that only crisis brings us forward to some sensible
responses. But I think today we proved just the opposite. The vote
earlier on extending the eligibility age for Medicare over the next
generation to 67 years parallels exactly the measure we took at a time
of crisis in 1983 with respect to Social Security. This was recommended
by a commission of which I was a member. Senator Dole, our beloved
former majority leader, was a member.
Sir, I don't know about other Members of this body but I have not
heard a word about that. It has been accepted. It is something that is
going to take place over a generation. It makes sense.
The same on this matter of contributions of high-income persons--what
is basically an intergenerational subsidy on retirement benefits and
health-care benefits.
In 1983, we began to tax Social Security benefits for high-income
persons up to 50 percent of their benefit. In 1993, in legislation I
brought to the floor from the Finance Committee, we took it to 85
percent. That is the actuarial income that is not paid by the
contributor himself or herself.
Sir, there has been no response or reaction to that, save acceptance
that it is fair, and it makes sense. This is fair, and it is necessary.
I would say once again I was a member of the administration of
President Johnson when the planning for Medicare and Medicaid took
place. On part B we specified that half the premium would be paid by
the person choosing to take the option of buying this form of health
insurance. In 1972, we limited increases in the premium to the rate of
increase in Social Security benefits, which are tied to the Consumer
Price Index. But because of the higher rise in medical costs in the
years that followed, above the rate of price increase, we dropped it to
25 percent. It is 25 percent today--not what we planned when we began
this program, when the costs were much lower and unsustainable in the
years ahead. The annual part B subsidy right now per person is $1,600
of general revenue--not trust fund. And if we have to provide that a
$500,000 earner pays 2.9 percent, why can we not do so? I think, Mr.
President, we are going to.
I thank the Chair.
The PRESIDING OFFICER. Who yields time?
Mr. ROTH. I yield the remainder of my time to the distinguished
chairman of the Budget Committee.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Do you have some additional time you would like, if I
can take 5 minutes off the bill?
Mr. ROTH. All right.
Mr. DOMENICI. You keep your 5. I will speak.
The PRESIDING OFFICER. The Senator from New Mexico is recognized for
5 minutes, with the time to come off the bill.
Mr. DOMENICI. Mr. President, I yield 2 minutes off the bill to just
talk a little bit to the Senate about where we are.
First, let me inquire.
How much time remains for both sides?
The PRESIDING OFFICER. The Senator from New Mexico has 1 hour and 15
minutes remaining, and the Senator from New Jersey has 1 hour and 21
minutes.
Mr. DOMENICI. I wonder if I might propound a unanimous consent
request to get us moving on two votes?
I understand, immediately after we are finished debating this
amendment, that the next thing that would come up would be the second
Kennedy amendment which is subject to a point of order; I would make a
point of order, and the Senator would move to waive. And he has
indicated that he would be satisfied with 2 minutes of debate on each
side on the motion to waive.
I put that unanimous-consent request to the Senate.
The PRESIDING OFFICER. Is there objection to the unanimous-consent
request?
Without objection, it is so ordered.
Mr. DOMENICI. I thank the Chair.
I apologize for interrupting.
Second, I would ask that we proceed as follows: That as soon as we
finish the debate on the current amendment, that we vote on it, or in
relation thereto, and then we proceed immediately, before we proceed to
vote, we take care of the 2 minutes on each side on the Kennedy motion
to waive, and then we proceed on two votes back-to-back with the first
one being 15 minutes and the second one being 10.
The PRESIDING OFFICER. Is there objection?
Mr. KENNEDY. Mr. President, I apologize to the chairman of the
committee. So you want to yield back the time and we would then ask
consent that it would be in order to make the point of order?
Mr. DOMENICI. We just got that.
Mr. KENNEDY. I was glad to accommodate the leader, and always try to.
But I would like to at least say that we eliminate the 2 minutes. I
would like to at least have the opportunity to perhaps address the
Senate for that period of time before we vote. It will not save an
awful lot of time just to go back to back, as the Senator knows. I
would like to make just a very, very brief comment about what that
commitment is. We have very different amendments.
I would appreciate that.
Mr. DOMENICI. The Senator objects. Why don't we just do it in two
parts? We will dispose of the first amendment in the manner we
described, and thereafter there will be 4 minutes after that vote is
completed, 2 minutes to a side, and that will be the subject matter
of--that vote will be a waiver of a point of order that the Senator
from New Mexico will make on the Kennedy amendment.
The PRESIDING OFFICER. Is there objection?
Mr. BUMPERS. Reserving the right to object--I shall not--will the
Senator indicate approximately what time this back-to-back vote will
occur?
Mr. DOMENICI. How much time do you want to use Senator--2 or 3
minutes?
I would say 6 minutes.
Do you want some time? Ten minutes maximum.
Mr. KENNEDY. Is this additional time to be yielded off the bill, or
just because we are going to have additional time? I think we are over.
The PRESIDING OFFICER. A total of 2 minutes for the Senator from New
Mexico.
Mr. KENNEDY. I was willing in accommodation to go back and limit our
side. Now we have been limited. And now the other side is getting
additional time for the amendment. Then I would ask for equal time to
be able to respond. I would be glad to move ahead as agreed on earlier.
Mr. DOMENICI. We are going to do that. We will yield our 2 minutes
remaining to Senator Nickles, and I believe 5 minutes off the bill for
me to accommodate some time taken off the bill on your side. That makes
it about even.
Mr. KENNEDY. Whatever. That is fine.
Mr. LAUTENBERG. As long as your arithmetic is right. I would ask the
Parliamentarian. How does that time projection stack up?
The PRESIDING OFFICER. Only 2 minutes has been yielded off the bill.
It was yielded to the Senator from Maryland.
Mr. LAUTENBERG. So what is being requested over here now?
Mr. DOMENICI. The remaining 2 minutes on our side goes to Senator
Nickles, and I asked for 5 minutes off the bill.
Mr. LAUTENBERG. The Senator from Massachusetts----
[[Page S6141]]
Mr. KENNEDY. I ask for equal time, and I probably will not use it.
Mr. DOMENICI. OK. I will cut my time down to 2 minutes. Might I ask
right now, please?
I ask unanimous consent that it be in order that I make the point of
order against the second Kennedy amendment.
The PRESIDING OFFICER. Is there objection?
Mr. KENNEDY. As I understand it, I have time at the conclusion or you
want me to make it now?
Mr. DOMENICI. I think now we ought to ask unanimous consent it be in
order the Senator make his motion to waive at this point.
The PRESIDING OFFICER. Is there objection?
Mr. KENNEDY. That I can be in order to waive.
Mr. WELLSTONE. Mr. President, I say to the Senator from New Mexico, I
am not trying to hold things up. Just a question on the way we are
going. I have been waiting for quite a while to introduce an amendment.
Is there a way that we could have some understanding about introducing
amendments after we get through with this as far as unanimous consent
is concerned?
Mr. LAUTENBERG. I would, if I may on this side, Mr. President----
Mr. DOMENICI. Surely.
Mr. LAUTENBERG. I had promised the Senator from Rhode Island early
this morning that he would have an opportunity. He has deferred and
waited to introduce an amendment that he wanted to have done. As we
heard from the Presiding Officer, we have about 2\1/2\ hours, as I
calculate it, left in total. So certainly if we can divide these up
into proper sized pieces, why if we could just lay it out----
Mr. DOMENICI. Mr. President, let me just suggest that if we are going
to go back and forth, we will have disposed of two Kennedy amendments
in a row. And then I assume we should get at least one, if not two, and
then return to that side. And I would like to do that. Senator Gramm
has a simple amendment that should not take very long. We would like to
do that next, but I am not asking that we have time agreed to. And then
is there another one on our side?
We then move to your side. You have one for Senator Reed.
Mr. LAUTENBERG. Senator Reed would be willing to take 20 minutes
equally divided.
Mr. WELLSTONE addressed the Chair.
Mr. DOMENICI. What is the Reed amendment?
Mr. REED. It would substitute.
Mr. DOMENICI. Substitute for the whole bill?
Mr. REED. Yes, it is, eliminating some of the provisions we have
already debated with respect to the age limitation, MSA's, et cetera.
Mr. DOMENICI. I do not want to agree to that other than to say you
are entitled to an amendment. But it may be subject to a point of order
in raising the same subject matter that has already been debated today
with a motion to reconsider, table and reconsider having already been
voted on. But if the Senator will let us look at it--
Mr. REED. I would be happy to let the distinguished chairman do that.
Mr. DOMENICI. Does anybody need time to discuss a complete
substitute?
Mr. GRAMM. It might be a substitute.
Mr. DOMENICI. It might be. Let's not agree on your time yet. You
might take more time than your 10 minutes.
Mr. REED. Fine.
Mr. DOMENICI. There is a half-hour on each by statute.
Mr. WELLSTONE. Mr. President, again since I initiated this
discussion, I wonder whether I could not be a part of this. I have two
amendments--one Senator Mikulski wants to do with me --and I wonder
whether they could be part of it.
Mr. DOMENICI. Will you tell me which one Senator Mikulski is with
you?
Ms. MIKULSKI. The amendment Senator Wellstone and I wish to do is a
version of the restoration of the Boren amendment on nursing home
reimbursement to ensure safety standards and adequacy.
Mr. LAUTENBERG. In how much time do you think you could deal with
that?
Mr. DOMENICI. We are going too far ahead. I do not even have the
amendments listed on anything that was given to me by that side. I do
not have the Boren amendment's reinstatement on this list. I have your
mental----
Mr. WELLSTONE. That is the one that I would like to get in right now
on this unanimous consent, on the mental health. That one I have been
waiting several days.
Mr. DOMENICI. Senators, let me just suggest that we get the votes out
of the way and in the meantime any Senator who has any amendments, we
would like to have--we now have 18 amendments, and that is without any
process amendments and there may not be any process votes on this bill.
It may be that they will be saved for another time. But if you can get
us any amendments, and as soon as this vote is over, I will try to
arrange yours in sequence, I say to Senator Wellstone.
Mr. WELLSTONE. I thank the Senator.
Mr. DOMENICI. Can we proceed then?
The PRESIDING OFFICER. If the Senator from New Mexico will restate
the unanimous-consent request, the Presiding Officer is somewhat
confused as to what the correct state of affairs is.
Will the Senator restate the unanimous-consent request we will order.
Mr. DOMENICI. My last one is that it be in order for Senator Kennedy
right now----
Mr. KENNEDY. I do not need the time. Four minutes to the Senator will
be fine.
Mr. DOMENICI. I need the Senator to do something else. I ask it be in
order that he waive the Domenici point of order and he do his now even
though it is reserved for later.
Mr. KENNEDY. I do so now.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
Mr. DOMENICI. It seems we have time on our side. Senator Nickles has
2 minutes under the half-hour allowance.
The PRESIDING OFFICER. Is the Senator going to make a point of order?
Mr. DOMENICI. I make the point of order that the Kennedy amendment
violates the Budget Act.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, pursuant to section 904 of the Budget
Act, I move to waive the point of order and ask for the yeas and nays
on the motion to waive.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second. The yeas and nays are
ordered.
Mr. LAUTENBERG. I would ask, if the Senator from Oklahoma will excuse
me just a moment, so that we have a little longer sequence planned,
that is, after the Senator from Oklahoma, after the vote on the budget
waiver, I assume that the chairman intends to go to the Senator from
Texas?
Mr. DOMENICI. Yes.
Mr. LAUTENBERG. And thereafter we put in line the Reed amendment to
be reexamined, and we will take a look at the timeframe. If we could
plan the next two, that would probably consume the remainder of the
time. What would the Senator from New Mexico expect would come up after
that?
Mr. DOMENICI. Look, I would like to leave it at that. We have three
or four Republican amendments that I have to discuss with them. So
let's just leave it there and try to finish the vote, and we will try
to sequence the Wellstone amendment in.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
Mr. NICKLES. Mr. President, I urge my colleagues to vote against
Senator Kennedy's amendment which would eliminate--some people call it
income testing, means testing, but I would rephrase it. It would
eliminate subsidies for upper income individuals on part B premiums.
Right now the Federal policy is the taxpayers pay $3 for every $1 for
all persons on Medicare part B. It does not make any difference if the
person has $1 million of income. We are asking taxpayers with incomes
of $20,000 to be paying general taxes to subsidize their premium.
I do not think that is good policy. I might mention the Finance
Committee, when we corrected this, we did it with bipartisan support.
We have all known this issue. Some people say, well, let us substitute
it. Let us do it in
[[Page S6142]]
the commission. We know this should be done. We know this is good
policy.
I might also mention this was not done so we would have more money to
spend someplace else. This was not done in order that we could have
more tax cuts. The Finance Committee took 100 percent of the savings,
of this amount of reducing subsidies for higher income individuals, 100
percent of that money and put it into part A solvency.
So all the savings that come from the increased premiums on more
affluent people by reducing subsidies, all the savings that come from
that will go toward extending solvency in part A. And as I mentioned in
an earlier speech, part A, the hospital insurance trust fund, has
serious problems. It is going to have a shortfall in the year 2005,
without these changes, of about $100 billion per year, and it grows
from there. So we need to do more to save part A, to make sure the
hospital bills will be able to be paid.
The Finance Committee took this step. They took it for, I think, all
the right reasons, for good policy, to eliminate subsidies for upper-
income people. I urge my colleagues to support this bipartisan
recommendation that came out of the Finance Committee and to vote no on
the Kennedy amendment.
Mr. DOMENICI addressed the Chair.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. I believe I have 2 or 3 minutes.
The PRESIDING OFFICER. Under the unanimous-consent agreement, the
Senator from New Mexico has 3 minutes.
Mr. DOMENICI. Mr. President, I thought I would just suggest to the
Senate and those listening how many senior citizens are covered by this
means testing. And here is what I think it is. First of all, let me put
it in dollars. The premiums collected over the next 5 years amount to
$125 billion. The income-conditioned premiums, the means-tested
premiums, amount to $4 billion. That is 3.1 percent of the premiums
will be means tested.
What does that amount to in numbers? The best we can figure, out of
38 million Americans, it is 5 percent--5 percent will be financially
affected by this amendment.
So if you are going into some neighborhood and talking to seniors
about this, chances are pretty good that you are not talking to a
senior that is affected by this because only 1 out of 20 will be
affected by this and 19 will not be affected at all.
I think that is a pretty realistic approach to trying to change this
basic part B law to be more realistic to those people who are working
hard, paying taxes, are not even earning as much money as the retirees,
perhaps raising two or three children, and unless their employer is
paying insurance for them many do not have insurance. So I believe this
is a good approach, and I am prepared to yield back the remainder of my
time.
How much time do I have?
The PRESIDING OFFICER. The Senator from New Mexico has 1 minute 21
seconds.
Mr. DOMENICI. I yield my remaining minute to the Senator from Texas.
The PRESIDING OFFICER. The Senator from Texas.
Mr. GRAMM. Mr. President, above the Speaker's stand in the House of
Representatives is a quote from Daniel Webster which talks about doing
something worthy of being remembered. I believe that if we defeat the
Kennedy amendment, given what we have already done by changing the age
of eligibility for Medicare, that we will have adopted two changes
which will dramatically change in Medicare. They will be the first
things we have ever done that will permanently strengthen the Medicare
trust fund, and I believe that we will have done something truly worthy
of being remembered.
We do not do that very often around here. It is not very often that
you see courageous votes cast. And I think we will have seen two major
ones today.
I thought some note should have been made of that fact. I do not want
to congratulate us in advance of casting this vote. But I think we are
doing something very important here, something that 10 or 20 years from
now every Member who votes against this amendment and votes for these
two important reforms will be able to say to their children and
grandchildren they did something worthy of being remembered.
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. DOMENICI. Parliamentary inquiry.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. On this vote, for the Senator to prevail, must he get
60 votes?
The PRESIDING OFFICER. That is correct.
Mr. DOMENICI. I thank the Chair.
Mr. KENNEDY. Yeas and nays.
The PRESIDING OFFICER. The yeas and nays have been ordered. The
Senator from Massachusetts has 37 seconds.
Mr. KENNEDY. I yield back the remainder of the time.
The PRESIDING OFFICER. Time has been yielded back. The yeas and nays
have been ordered.
Mr. DOMENICI addressed the Chair.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. I asked a parliamentary inquiry and I believe I got the
wrong answer. How many votes are required for Senator Kennedy to
prevail on this? A simple majority on the first one; is that correct?
The PRESIDING OFFICER. The first vote is on the amendment. A simple
majority is sufficient to pass this amendment.
Mr. ROTH addressed the Chair.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. ROTH. I make a motion to table. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. The question is on agreeing to the motion to
table. The yeas and nays have been ordered. The clerk will call the
roll.
The assistant legislative clerk called the roll.
The result was announced--yeas 70, nays 30, as follows:
[Rollcall Vote No. 113 Leg.]
YEAS--70
Allard
Ashcroft
Baucus
Bennett
Bingaman
Bond
Breaux
Brownback
Bryan
Bumpers
Burns
Campbell
Chafee
Coats
Cochran
Collins
Conrad
Craig
DeWine
Dodd
Domenici
Enzi
Faircloth
Feingold
Feinstein
Frist
Glenn
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Harkin
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Jeffords
Kempthorne
Kerrey
Kerry
Kohl
Kyl
Landrieu
Levin
Lieberman
Lott
Lugar
Mack
McConnell
Moynihan
Murkowski
Nickles
Robb
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Stevens
Thomas
Thompson
Thurmond
Warner
NAYS--30
Abraham
Akaka
Biden
Boxer
Byrd
Cleland
Coverdell
D'Amato
Daschle
Dorgan
Durbin
Ford
Inouye
Johnson
Kennedy
Lautenberg
Leahy
McCain
Mikulski
Moseley-Braun
Murray
Reed
Reid
Rockefeller
Sarbanes
Snowe
Specter
Torricelli
Wellstone
Wyden
The motion to lay on the table the amendment (No. 441), Division I,
was agreed to.
Mr. DOMENICI. Mr. President, I move to reconsider the vote by which
the motion was agreed to.
Mr. ROTH. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Motion to Waive the Budget Act--Amendment No. 440, Division II
The PRESIDING OFFICER (Mr. Brownback). The question is now on the
Kennedy motion to waive section 310(d) of the Budget Act. There are 4
minutes for debate equally divided between the two sides.
Mr. KENNEDY. Mr. President, may we please have order?
The PRESIDING OFFICER. The Senate will come to order.
Mr. LOTT addressed the Chair.
The PRESIDING OFFICER. The majority leader is recognized.
Order of Procedure
Mr. LOTT. Mr. President, I think it will be helpful to all Members if
we can engage in a colloquy now, and I hope the Democratic leader can
join us so we can discuss how we will proceed from here.
Mr. FORD. Mr. President, we do need order, I say with all respect.
[[Page S6143]]
The PRESIDING OFFICER. With due respect to all Members, may we please
have order in the body? Those having conversations, please take them
off the floor.
The majority leader.
Mr. LOTT. Mr. President, my intent, of course, is to go now to the
second vote on the Kennedy amendment, and then that would probably move
us close to 7 o'clock. We would proceed to use the remainder of the
time on other debate or amendments that will be offered. I presume that
time will expire about 8 to 8:30. And then other amendments will be in
order and will be debated tonight.
All amendments that are going to be offered need to be offered
tonight, and then we will stack all the votes on all the amendments and
final passage beginning at 9:30 in the morning.
We have discussed this with the Democratic leader. I do have a
unanimous-consent request to implement that, but we will go ahead and
have the vote now, and then we will make the UC request after that
vote.
I wanted the Members to know my intent. If that is agreed to, then
this next vote will be the final recorded vote tonight. We will begin
to vote on all the amendments and final passage in the morning at 9:30.
I yield to the distinguished chairman of the committee, Senator
Domenici. Mr. President, I ask the chairman, is that his understanding
and does he have some feel as to what we are talking about here?
Mr. DOMENICI. I think the time runs out about 8:30.
Mr. LAUTENBERG. About 9, because the time for the vote does not come
off, it just adds to it.
Mr. DOMENICI. So what we will do is Senator Lautenberg and I will
stay here until that hour, let's use the example of 9 o'clock. There
will only be one vote; it will be on the Kennedy point of order. We
will spend the rest of the evening with Senators offering their
amendments. It looks like there are about 20 of them. With a little
debate tonight on each one, they then will be taken up seriatim
tomorrow with 2 minutes to a side, but I think they have to be offered
tonight. That is what the proposal will be.
Mr. LAUTENBERG. As a point of clarification for everybody, by what
time do the amendments have to be sent to the desk?
Mr. DOMENICI. By the time we close up here tonight at 9 o'clock.
Mr. LAUTENBERG. When the time expires on the bill.
Mr. DOMENICI. Yes. That request will be made momentarily.
Mr. CHAFEE. Mr. President, can I ask, do we have a list of order of
priority----
The PRESIDING OFFICER. Let's have order in the body.
Mr. LOTT. I will be glad to yield for a question from the Senator
from Rhode Island.
Mr. CHAFEE. I ask the majority leader or manager of the bill, we have
a list of priority. I am in line, and I don't want mine too far down
the line.
Mr. DOMENICI. The Senator is pretty high up the line. He is about
fourth or fifth.
Mr. LOTT. Maybe even higher, depending on who is here to offer their
amendments at the time. Does the Democratic leader wish to add anything
to what we have advised Senators?
Mr. DASCHLE. Mr. President, the arrangement just described by the
majority leader is one that he and I have discussed, and I have
subscribed to, as well. This would allow us to complete our work on
this bill and provide the opportunity to those Senators who wish to
have a debate on their amendments--the time to do so is tonight. We
would then begin voting as early as 9:30 in the morning and have votes
on all remaining amendments sometime tomorrow morning.
I think it is the appropriate way with which to resolve the remaining
issues on this particular bill, and I encourage Senators to offer their
amendments and complete our work on it by the end of the evening.
Mr. LOTT. Therefore, Mr. President, I ask unanimous consent that all
remaining amendments in order to S. 947 must be offered prior to the
close of business today, and any votes that will occur with respect to
the amendments occur beginning at 9:30 a.m. on Wednesday in a stacked
sequence.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BUMPERS. Reserving the right to object, and I shall not, will
there be a time for each amendment, for the proponents and opponents?
Mr. LOTT. Mr. President, I ask unanimous consent to amend that
request to provide for a minute to explain the amendment on both sides,
2 minutes equally divided.
Mr. BUMPERS. Two minutes equally divided. Will that same time be
accorded to people who offer second-degree amendments?
Mr. LOTT. It would be, but they would have to be offered tonight, I
remind the Senator.
Mr. BUMPERS. A second-degree amendment cannot be offered until the
first-degree is brought up.
Mr. President, parliamentary inquiry. A second-degree amendment in
this scenario cannot be offered until the first-degree amendment is
offered, can it?
Mr. LOTT. That is correct, but once the first-degree amendment is
offered, then the second-degree----
Mr. BUMPERS. The second-degree could be in order, and it is not
necessary that the second-degree amendment be filed or any notice given
prior to that time.
Mr. LOTT. It has to be filed tonight once the first-degree amendment
is offered, but you would not have to give notice until the first-
degree amendment is offered, if it is offered, or you would still have
the option, of course, to offer it as a first-degree amendment if you
want to.
Mr. BUMPERS. Parliamentary inquiry, Mr. President. Is that a correct
statement, that the second-degree amendment would have to be offered
tonight and you would not know precisely what amendment you would offer
it to until tomorrow?
The PRESIDING OFFICER. The majority leader is correct. The first-
degree and the second-degree would both have to be offered this
evening.
Mr. BUMPERS. Is the Parliamentarian saying that if I have a second-
degree amendment to any amendment that is going to be offered here
tonight before we adjourn for the evening, that I will not be allowed
to offer second-degree amendments tomorrow to any one of those
amendments unless that second-degree amendment is filed also this
evening?
The PRESIDING OFFICER. The second-degree amendment must be offered
tonight and only tonight.
Mr. BUMPERS. Offered or filed?
The PRESIDING OFFICER. Offered.
Mr. BUMPERS. Has to be offered this evening?
The PRESIDING OFFICER. That is correct.
Mr. BUMPERS. I am not sure about the language here. How can you offer
a second-degree amendment before a first-degree amendment is offered?
Mr. LOTT. If the Chair will allow me, the first-degree amendments
would be offered tonight if Senators wish to offer them, and then the
second-degree amendment would be in order to be offered tonight once
the first-degree amendment is offered.
I do not understand why that is a problem. You have to stay here to
offer your second-degree amendment or have some leadership person in
your behalf offer that second-degree amendment, but there would be
ample opportunity on both sides tonight to offer second-degree
amendments if a Senator so desires.
Under the rules, all time will expire between 8:30 and 9 o'clock, and
the only time remaining then will be to offer amendments and to have
the votes in order on those amendments.
Mr. BUMPERS. I have to stay here then until 10 o'clock tonight to see
whether a first-degree amendment to which I can offer a second-degree
amendment would be filed this evening, is that correct?
Mr. LOTT. That is correct.
Mr. BUMPERS. Could I get a parliamentary ruling on that.
The PRESIDING OFFICER. If the Senator wants to offer a second-degree
amendment, the Senator would have to stay this evening to offer a
second-degree amendment.
Mr. DOMENICI. Will the Senator yield?
Mr. BUMPERS. I yield.
Mr. DOMENICI. What the leadership has proposed is that between now
and 9 o'clock any amendment that is going to be offered to this bill be
offered, and
[[Page S6144]]
then it says anybody that has a second-degree amendment to any
amendment that is offered tonight must also offer the second-degree
tonight, leaving the work tomorrow to be just votes on the amendments
that were offered tonight, and any second-degree amendments, if any,
will also be voted tomorrow under the 2 minutes equally divided rule.
Mr. LOTT. I might say, Mr. President, we have a list----
Mr. BUMPERS. I object to the unanimous-consent agreement.
The PRESIDING OFFICER. The objection is heard.
Mr. LOTT. Mr. President, since there is an objection, then we would
go ahead with the amendment, and we will have an opportunity to discuss
further with the Senator his concerns, and we will renew our request
after this vote.
Mr. CHAFEE. I would like to ask the majority leader a question, if I
might. I have a question.
I have an amendment which I will be presenting this evening, but it
may well be tomorrow that there might be modifications that the
leadership might want to make to it which would be acceptable to me,
but that cannot take place unless that is all filed tonight?
Mr. DOMENICI. It can be done by unanimous-consent request tomorrow.
Mr. CHAFEE. It can be done by unanimous consent tomorrow, I see.
Division II--Amendment No. 440
The PRESIDING OFFICER. The question is on the Kennedy motion to waive
section 310(d) of the Budget Act. There are 4 minutes equally divided
between the sides on this motion.
Mr. KENNEDY. Mr. President, under the current bill approximately 2
million Medicare recipients will, starting in January of next year, pay
more for their Medicare premiums. They did not know that yesterday.
They did not know that this morning. They did not know that at noon
today, and they did not know it until just a few moments ago when the
Senate made its decision to retain this provision.
This particular amendment asks the Senate to postpone the effective
date of this amendment for 2 years to permit the commission to review
the effect of the means-testing proposal and to allow the retirees
affected by this increase to make changes in their family budgets to
accommodate the significantly higher premiums that will otherwise go
into effect in just 6 months. Unless Congress takes other action during
this time, the provision would take effect in January 2000.
This time would give us an opportunity to fully discuss and debate
this landmark decision.
That is the practical effect of waiving the point of order. This is a
matter of great importance to the Medicare system and the 2 million
beneficiaries who will be affected by the proposal, and we ought to be
able grant a reasonable period of time for its assessment and for
seniors to prepare to pay more.
Mr. ROTH. Mr. President, I think that the last vote overwhelmingly
decided this issue. Income-related premiums are fair.
I just point out that by delaying it 2 years, we would lose something
like $1.3 billion in a program that is already in difficulty. These
funds are necessary and they are needed.
Mr. President, if a means test is fair in 2 years, then it is fair
today. I see no reason for the delay. Let me remind my colleagues that
the premium increase is very modest, given the part B benefits.
I urge my colleagues not to waive the point of order.
Mr. DODD. Mr. President, briefly, I supported the amendment which
would means test this program, but I think a 24-month delay on this,
while there is some loss of revenue here, is a wise move to make. We
are moving very rapidly here on some major changes. I believe the means
testing is the right way to go.
Mr. ROTH. Point of order. Is time limited?
Mr. DODD. I ask unanimous consent to speak for 1 minute, if I may, 1
minute on means testing Medicare.
The PRESIDING OFFICER. The Senator from Massachusetts has 30 seconds
remaining on his time.
Mr. KENNEDY. I am happy to yield.
Mr. DODD. Briefly, it seems to me, a 24-month delay on this--I
supported means testing, but I think we ought to know the full
implication of what we are doing, and while there is a loss of revenue
here by not implementing, it is for 2 years. It seems to me that
proceeding with a degree of caution to make sure all the people that we
want to benefit will be benefited and those to be excluded will be
excluded properly, is not a lot to ask.
I urge the proposal of the Senator from Massachusetts be adopted. It
seems to me we ought not to be fighting over 24 months. We have agreed
to means test. We waited a long time to get to this. Now we should do
it intelligently.
The PRESIDING OFFICER. The Senator from New Mexico has 1 minute
remaining.
Mr. DOMENICI. Mr. President, I want to use my 1 minute to inform the
Senators that I did not tell the Senate, when our distinguished
majority leader was seeking unanimous-consent requests, I do not intend
to offer any process amendments here tonight or tomorrow. They are just
as much relevant to the finance tax bill as they are to this one, and I
choose not to put them on here.
People may have had second-degree amendments to my process. There
will not be any process amendments on this, at least from this Senator.
Others might want to do them, but they are not second-degreeing mine.
I yield back the balance of my time.
The PRESIDING OFFICER. The question is on the Kennedy motion to waive
section 310(d) of the Budget Act, for the consideration of division II
of amendment No. 440.
The yeas and nays have been ordered.
This is a 10-minute vote.
The clerk will call the roll.
The assistant legislative clerk called the roll.
The result was announced--yeas 37, nays 63, as follows:
[Rollcall Vote No. 114 Leg.]
YEAS--37
Abraham
Akaka
Biden
Bingaman
Boxer
Bumpers
Byrd
Cleland
Collins
Coverdell
D'Amato
Daschle
Dodd
Dorgan
Durbin
Ford
Harkin
Inouye
Johnson
Kennedy
Kerry
Lautenberg
Leahy
Levin
McCain
Mikulski
Moseley-Braun
Murray
Reed
Reid
Rockefeller
Sarbanes
Snowe
Specter
Torricelli
Wellstone
Wyden
NAYS--63
Allard
Ashcroft
Baucus
Bennett
Bond
Breaux
Brownback
Bryan
Burns
Campbell
Chafee
Coats
Cochran
Conrad
Craig
DeWine
Domenici
Enzi
Faircloth
Feingold
Feinstein
Frist
Glenn
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Jeffords
Kempthorne
Kerrey
Kohl
Kyl
Landrieu
Lieberman
Lott
Lugar
Mack
McConnell
Moynihan
Murkowski
Nickles
Robb
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Stevens
Thomas
Thompson
Thurmond
Warner
The PRESIDING OFFICER. Three-fifths of the Senators duly chosen and
sworn not having voted in the affirmative, the motion is rejected.
The point of order is sustained and the amendment falls.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
Mr. LOTT. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Unanimous-Consent Agreement
Mr. LOTT. Mr. President, we have again conferred with the Democratic
leadership, and I believe we have this unanimous-consent agreement
approved.
I ask unanimous consent that all remaining amendments in order to S.
947 must be offered prior to the close of business today and any votes
ordered with respect to those amendments occur beginning at 9:30 a.m.
on Wednesday, in a stacked sequence, with 2 minutes equally divided
between each vote.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. LOTT. I ask unanimous consent that when the Senate reads S. 947
for the third time, the Senate proceed to vote on passage of the
balanced budget reconciliation bill, all without intervening action or
debate, and when the Senate receives the House companion bill, the
Senate proceed to its immediate consideration and all after the
enacting clause be stricken and the
[[Page S6145]]
text of S. 947, as amended, be inserted, the bill be immediately
considered as having been read for a third time and passed and the
motion to reconsider be laid upon the table, all without further action
or debate.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. LOTT. Mr. President, we can announce that that would be the last
recorded vote tonight. We will begin our stacked votes in the morning
at 9:30. We are ready to go with the remaining debate and amendments
that will be offered.
I yield the floor.
Mr. GRAMM. I yield to the Senator from Illinois for a unanimous-
consent request, without losing my right to the floor.
Ms. MOSELEY-BRAUN. I thank my friend, the Senator from Texas.
Change of Vote
Ms. MOSELEY-BRAUN. Mr. President, on rollcall vote No. 111, I voted
aye. It was my intention to vote no. Therefore, I ask unanimous consent
that I be permitted to change that vote. It in no way changes the
outcome of the vote.
The PRESIDING OFFICER. Without objection, it is so ordered.
Amendment No. 444
(Purpose: To provide waiver authority for penalties relating to failure
to satisfy minimum participation rate)
Mr. GRAMM. Mr. President, I send an amendment to the desk and ask for
its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:
The Senator from Texas [Mr. Gramm] proposes an amendment
numbered 444.
Mr. GRAMM. 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 947, between lines 2 and 3, insert the following:
(n) Failure to Satisfy Minimum Participation Rates.--
Section 409(a)(3) (42 U.S.C. 609(a)(3)) is amended--
(1) in subparagraph (A), by striking ``not more than''; and
(2) in subparagraph (C), by inserting before the period the
following: ``or if the noncompliance is due to extraordinary
circumstances such as a natural disaster or regional
recession. The Secretary shall provide a written report to
Congress to justify any waiver or penalty reduction due to
such extraordinary circumstances''.
Mr. GRAMM. Mr. President, the amendment that I sent to the desk is
really a technical correction. When we were drafting the welfare bill
in the Senate, we had a 5-percent penalty for failure to meet the work
requirement. It went up from 5 percent the first year to 10 percent the
second and 15 the third, up to 100 percent. In conference, we decided
to reduce the penalty for noncompliance in consecutive years from an
additional 5 percent to an additional 2 percent. So the penalty would
be 7 percent in the second year and 9 percent in the third, with a cap
of 21 percent. Inadvertently--and everyone agrees it was a technical
mistake--the staff added three words, ``not more than,'' which gave the
Secretary discretion over the size of the penalties.
Senator Graham of Florida raised the question in committee as to
whether or not we should give the Secretary the power to waive or
reduce the size of the penalty where there was a natural disaster or
where there was a regional economic crisis.
So my amendment goes back and puts the actual language that we had
agreed to in conference on the welfare bill. But it also addresses the
concerns that Senator Graham of Florida raised. It gives the Secretary
the power to waive the penalties for not meeting the work requirement
in two additional cases which were not included in the original bill.
One is a natural disaster, and the other is in the case of where you
have a regional economic problem.
I think this deals with the concern that was raised.
I ask my colleagues to support the amendment.
I yield the floor.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Mr. President, I understand that Senator Gramm has
completed the introduction of his, and the vote will occur tomorrow
with 1 minute on each side.
I think we agreed that Senator Reed could go next. He has 10 minutes
on a full substitute.
The PRESIDING OFFICER. The Senator from Rhode Island.
amendment no. 445
(Purpose: To provide for a complete substitute of division 1 of title
V)
Mr. REED. Thank you, Mr. President. I have an amendment at the desk.
The PRESIDING OFFICER. Will the Senator withhold for a moment?
If there is no objection, the pending amendment will be set aside,
and the Senator from Rhode Island is recognized.
Mr. REED. I thank you, Mr. President,
Mr. President, my amendment this evening gives my colleagues of the
Senate a clear choice to stabilize the solvency of the Medicare trust
fund without including some of the provisions which we already talked
about this afternoon, and others which undermine the concept of a
universal Medicare system. Medicare provides excellent health care for
all of our seniors--it is a system that has operated for 30 years, a
system that works, a system that is supported by the vast majority of
Americans.
Specifically, what my amendment will do is provide for the revenue
savings and the cost savings that are incorporated in the underlying
bill, but remove from that bill those provisions that harm the
structural integrity of the Medicare program.
My amendment would retain the Medicare eligibility age of 65. It
would strike the home health copay. It would add the current law that
protects Medicare recipients with respect to balanced-billing
protection for those recipients and beneficiaries who may choose to opt
for private fee-for-service Medicare health coverage. It would also
eliminate the means-tested provisions for Medicare. And, finally, it
would eliminate the medical savings account as a Medicare option.
All of these provisions which I have mentioned are not necessary to
preserve the solvency of the Medicare fund. We can achieve solvency by
agreeing to the savings and reimbursement changes which are in the
underlying bill. And we can provide for a solvent Medicare system in
the future without endangering the Medicare program itself.
I would like to comment on the specifics in my substitute.
First, as I mentioned before, my amendment would strike the rollback
of the Medicare eligibility age to 67. I realize that this has been
debated today. But this is such a critical point that it bears
restating.
Reducing the Medicare eligibility age is exactly the wrong way to
proceed with respect to health care reform--not just Medicare reform,
but health care reform in this country. Our goal should be to encourage
more participation in health care, to extend health care benefits to
more Americans and not to reduce health care coverage.
Indeed, it is a cruel irony tonight that one of the beneficial
aspects of the underlying legislation is the extension of health care
to more children and, yet, we are contracting the health care coverage
of seniors.
I believe also that this provision will send shockwaves throughout
our entire health care system as companies are forced to realize the
additional liability under current accounting rules. Many employers
provide health care to their employees until Medicare eligibility age.
If that age is rolled back, employers incur more costs. If they incur
more costs and have to show it on the balance sheet, they are going to
have to make very difficult choices not only about the coverage for
retirees, but also if they are going to continue to provide coverage
for their current workers.
This is something that should not be done lightly and, indeed,
represents, a retreat from our commitment to provide more and more
Americans with access to good quality health care.
Let me also suggest with respect to the home health copay that this
is a provision which does not support those people who particularly
need this type of support. Forty-three percent of the individuals who
would have to pay this copay have incomes under $10,000 a year. Two-
thirds of persons using these benefits are women, one-third of whom
live alone.
Just yesterday we heard from a woman--an 82-year-old woman --who
desperately relies upon home health
[[Page S6146]]
care services. She--and many others like her--would be in no condition
to pay the increased costs. This provision should also be stricken.
With respect to medical savings accounts, this is the provision which
I think will go toward the unraveling of the Medicare system as we know
it. Under the MSA concept, a senior would be required to use Medicare
money to buy a catastrophic health policy, and any savings left over
from Medicare's payment could be put in the medical savings account.
This provision will attract wealthy seniors who, frankly, can pay for
some of these costs. It would also attract those people who are
healthy. Essentially, they would be making a judgment whether they are
healthy enough to run the risk of avoiding significant illness, and, if
so, this is a good option. If they are not so healthy, then their best
rational choice would be to go for fee-for-service, traditional
Medicare. The consequence would be that we would see wealthy, healthy
seniors leave the Medicare system and, with them, the proportion of
money that is contributed in their behalf. The remaining seniors would
be sicker, older, and more likely to use services. This would put
increased pressure on the Medicare program.
Those who see this as a way of making the system more solvent and
more secure are missing the point. MSAs would lead to a situation in
which the system is harmed, more costs are piled upon Medicare,
Medicare becomes more difficult to fund and, indeed, to support.
Also, my substitute would eliminate the means testing provision.
Philosophically, I think Medicare works because it is seen as a health
care program and not a welfare program. To the extent that we make this
part B premium differential between wealthy individuals and nonwealthy
individuals, this program will take on quickly the shades of a welfare
program. It will undercut the tremendous support in all ranges of
American life for the Medicare system.
This part B premium adjustment is done in the context of a voluntary
system, a system in which seniors might perceive--particularly wealthy
seniors--that it is no longer a good deal to be part of part B. These
seniors could voluntarily leave or buy other types of insurance--in
fact the industry, I think, right now is probably planning to sell.
Once again, we will see the unraveling of the Medicare system as more
people leave and as their contributions are taken with them from the
Medicare system.
All of these together will lead to a situation in which we hear the
first crack in the system. And as time goes on, those cracks will widen
to deep fissures, and the solid support that we have today will
ultimately erode.
A final point is with respect to a provision in the underlying bill,
the lack of balanced billing protections in the private fee-for-service
option. Current Medicare law balance billing limits protect seniors now
and would be undercut because of the options in the underlying bill
that allow beneficiaries to choose medical policies in which physicians
could charge beyond the Medicare limits. This balanced billing
protection exists for fee-for-service, traditional Medicare recipients.
It should be in place for all beneficiaries of Medicare regardless of
the program they choose. My amendment would add balance billing limits
to the Medicare Choice provisions of the bill currently without them.
In a sense, what this amendment does in the nature of a substitute is
say that we can provide solvency for Medicare. We can go ahead and
provide the opportunities to make careful, comprehensive review of the
system. We can make changes. But we don't have to do it today. We don't
have to have to do it hastily. We don't have to do it in an ad hoc
fashion which misses the systematic impact of all of these changes we
have talked about today. Rather, we can--as I think the agreement
reached with respect to the budget agreement several months ago
indicates--we can stabilize the system, reduce the increasing costs
associated with Medicare by roughly $115 billion and not defer, but
study carefully and comprehensively and thoroughly the impact of some
of these proposed changes.
This amendment stabilizes the system. It eliminates precipitous
changes in Medicare that will undermine the program--changes in this
bill that may leave us in a situation where Medicare is no longer a
universal program in which all of our seniors can participate. Medicare
should continue to be a program in which all of our seniors can and
will participate, and a program in which all of our seniors will be
guaranteed high quality health care that they can afford.
Mr. LAUTENBERG. Mr. President, I want to commend the Senator from
Rhode Island for bringing this up. He stood against overwhelming odds
as he introduced this substitute, because it did go over some ground
that we had already covered. But, to Senator Reed's credit, he is
determined to make certain that the system is as fair and as effective
as it can be.
I compliment him for sticking to this. I know the prospects may be
grim. But hope springs eternal. And that is the attitude that I think
Senator Reed always has. I hope that the best will come as everybody
reflects overnight on what is in his amendment.
Mr. REED. I thank the Senator.
Mr. DOMENICI. Parliamentary inquiry, Mr. President. Does Senator Reed
have any time remaining?
The PRESIDING OFFICER. The Senator from Rhode Island has 15 minutes
remaining.
Mr. DOMENICI. I thought he agreed to 10 minutes.
Mr. REED. Indeed, I did.
Mr. DOMENICI. The Senator agreed to 10 minutes, and we agreed to 10
minutes in opposition, which we will not use.
The PRESIDING OFFICER. That was not the understanding of the
Parliamentarian. Let me check that.
Mr. DOMENICI. It was informal. I did not state it.
The PRESIDING OFFICER. We don't have a consent agreement to that
effect. But if there was a formal agreement, the Parliamentarian and
the Presiding Officer is certainly willing to accept it.
Mr. REED. Mr. President, I did not hear the amount of time remaining
based on 10 minutes.
The PRESIDING OFFICER. The Senator has spoken for 10 minutes.
Mr. REED. I thank the President.
The PRESIDING OFFICER. And he yields back.
Mr. DOMENICI. Mr. President, this is the amendment, 600 pages long.
We do not know what is in it. We do not know if it meets the budget
reconciliation instruction. We do not know what the Congressional
Budget Office says it does to reduce deficits. It is obviously subject
to a point of order, which I will make in a moment.
But I just want to remind Senators so we will know tomorrow that this
bill also forces us to vote again on at least three amendments that
passed by rather large votes here today.
It retains the medical care eligibility at 65. We have already passed
an amendment that over the next 30 years implements an age increase to
67.
It strikes the home health copay, which passed by rather substantial
margin.
It eliminates the means testing of Medicare, which we just finished
debating about 35 to 40 minutes ago and which passed with a rather
significant vote.
It eliminates medical savings accounts as a Medicare option. Now, we
have not voted on that yet.
But those are some of the things that I know are in it.
I yield back any remaining time that I have.
I make a point of order that the amendment violates the Budget Act,
310(b).
Mr. REED addressed the Chair.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. REED. Mr. President, pursuant to Section 904, I move to waive any
point of order against my amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
Mr. DOMENICI. Mr. President, I think everything from this point on is
rather informal, so maybe we can work together on it. If we go to our
side, we will have Senator Chafee, and then we will return to Senator
Wellstone, if that is satisfactory to him. He has been
[[Page S6147]]
waiting a long, long time. How much time would you like, Senator
Chafee?
Mr. CHAFEE. Let me try 10 minutes.
Mr. DOMENICI. Ten minutes. OK. And, Senator Wellstone, you need how
much? And I need some of your time.
Mr. WELLSTONE. Ten minutes will be fine.
Mr. DOMENICI. And I can use part of that time.
Mr. WELLSTONE. Ten minutes equally divided.
Mr. CHAFEE. How much time does he have--equally divided?
Mr. DOMENICI. Yes. That's all right, you go now, and we will go next.
Senator Lautenberg, can we go ahead and set up times so all Senators
will know what to expect?
Mr. LAUTENBERG. I think that is a good idea.
Mr. DOMENICI. Whatever I am stating here, I am asking these will be
the times.
The PRESIDING OFFICER. Without objection, the Senator from Rhode
Island will be recognized for 10 minutes, followed by the Senator from
Minnesota, to be recognized for 10 minutes, with 5 minutes of that time
to be given to the Senator from New Mexico.
Mr. DOMEINICI. Is there somebody who wants to oppose Senator Chafee's
amendment?
Mr. CHAFEE. No.
Mr. LAUTENBERG. Senator Chafee shook his head no.
Mr. DOMENICI. Senator D'Amato?
Mr. D'AMATO. Ten minutes.
Mr. DOMENICI. Between the two of you.
Mr. HARKIN. Ten minutes each.
Mr. D'AMATO. I will take 5 minutes and the Senator 10 minutes.
Mr. HARKIN. Ten minutes. I need about 10 minutes.
Mr. DOMENICI. Ten minutes between you?
Mr. HARKIN. I would like to have 10 minutes.
Mr. DOMENICI. Senator D'Amato.
Mr. D'AMATO. Just 5.
Mr. DOMENICI. I don't know whether we are going to oppose it, but I
would like to keep 5 minutes. I think I am opposed to it.
Senator Hutchison.
Mrs. HUTCHISON. I would like 5 minutes on an amendment.
Mr. DOMENICI. Might I suggest that Senator Hutchison's amendment is
going to be acceptable. Perhaps we can give you the 5 right now. We ask
unanimous consent she have 5 minutes, but we may just let her go out of
order to get hers taken, if that would not be objectionable.
Mr. LAUTENBERG. Senator Durbin wants 10 minutes.
Mr. DOMENICI. Ten minutes.
Mr. DURBIN. I will try to make it short.
Mr. DOMENICI. Is that it? Senator Burns.
Mr. BURNS. Mr. President, I have an amendment to offer, but I am not
going to require any time. I can do mine in the morning, and after you
look at it, it may be acceptable.
Mr. DOMENICI. You do it in the morning, but we will offer it for you.
Mr. BURNS. I want to do it tonight.
Mr. DOMENICI. We will offer it for you, and you will be able to
debate it in the morning.
Mr. BURNS. That is exactly right.
Mr. DOMENICI. Any other Senators want any other time?
The PRESIDING OFFICER. If there is no objection, we will add to the
previous request 15 minutes for the amendment of the Senator from Iowa,
to be divided 10 minutes to the Senator from Iowa and 5 minutes to the
Senator from New York; 5 minutes to the Senator from Texas for her
amendment; and 10 minutes to the Senator from Illinois on his
amendment.
Is there objection? Without objection, it is so ordered.
Mr. DOMENICI. Now, Mr. President, I wonder if Senator Chafee would be
so good as to let Senator Hutchison, whose amendment is going to be
accepted--is your amendment acceptable also?
Mr. CHAFEE. I would be delighted if my amendment would be acceptable.
Mr. DOMENICI. OK. We are going to let you go right now, and to the
extent that violates the agreement, we ask unanimous consent.
The PRESIDING OFFICER. Without objection, the Senator from Texas is
recognized.
Mrs. HUTCHISON. I thank the Chair, and I thank the distinguished
chairman.
Amendment No. 446
(Purpose: To require States to verify that prisoners are not receiving
food stamp benefits)
Mrs. HUTCHISON. Mr. President, I send an amendment to the desk and
ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report the amendment.
The bill clerk read as follows:
The Senator from Texas [Mrs. Hutchison], for herself and
Mr. Santorum, proposes an amendment numbered 446.
Mrs. HUTCHISON. 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:
At the end of title I, add the following:
SEC. 10____. DENIAL OF FOOD STAMPS FOR PRISONERS.
(a) State Plans.--
(1) In general.--Section 11(e) of the Food Stamp Act of
1977 (7 U.S.C. 2020(e)) is amended by striking paragraph (20)
and inserting the following:
``(20) that the State agency shall establish a system and
take action on a periodic basis--
``(A) to verify and otherwise ensure that an individual
does not receive coupons in more than 1 jurisdiction within
the State; and
``(B) to verify and otherwise ensure that an individual who
is placed under detention in a Federal, State, or local
penal, correctional, or other detention facility for more
than 30 days shall not be eligible to participate in the food
stamp program as a member of any household, except that--
``(i) the Secretary may determine that extraordinary
circumstances make it impracticable for the State agency to
obtain information necessary to discontinue inclusion of the
individual; and
``(ii) a State agency that obtains information collected
under section 1611(e)(1)(I)(i)(I) of the Social Security Act
(42 U.S.C. 1382(e)(1)(I)(i)(I)) through an agreement under
section 1611(e)(1)(I)(ii)(II) of that Act (42 U.S.C.
1382(e)(1)(I)(ii)(II)), or under another program determined
by the Secretary to be comparable to the program carried out
under that section, shall be considered in compliance with
this subparagraph.''.
(2) Limits on disclosure and use of information.--Section
11(e)(8)(E) of the Food Stamp Act of 1977 (7 U.S.C.
2020(e)(8)(E)) is amended by striking ``paragraph (16)'' and
inserting ``paragraph (16) or (20)(B)''.
(3) Effective date.--
(A) In general.--Except as provided in subparagraph (B),
the amendments made by this subsection shall take effect on
the date that is 1 year after the date of enactment of this
Act.
(B) Extension.--The Secretary of Agriculture may grant a
State an extension of time to comply with the amendments made
by this subsection, not to exceed beyond the date that is 2
years after the date of enactment of this Act, if the chief
executive officer of the State submits a request for the
extension to the Secretary--
(i) stating the reasons why the State is not able to comply
with the amendments made by this subsection by the date that
is 1 year after the date of enactment of this Act;
(ii) providing evidence that the State is making a good
faith effort to comply with the amendments made by this
subsection as soon as practicable; and
(iii) detailing a plan to bring the State into compliance
with the amendments made by this subsection as soon as
practicable and not later than the date of the requested
extension.
(b) Information Sharing.--Section 11 of the Food Stamp Act
of 1977 (7 U.S.C. 2020) is amended by adding at the end the
following:
``(q) Denial of Food Stamps for Prisoners.--The Secretary
shall assist States, to the maximum extent practicable, in
implementing a system to conduct computer matches or other
systems to prevent prisoners described in section
11(e)(20)(B) from receiving food stamp benefits.''.
SEC. 10____. NUTRITION EDUCATION.
Section 11(f) of the Food Stamp Act of 1977 (7 U.S.C.
2020(f)) is amended--
(1) by striking ``(f) To encourage'' and inserting the
following:
``(f) Nutrition Education.--
``(1) In general.--To encourage''; and
(2) by adding at the end the following:
``(2) Grants.--
``(A) In general.--The Secretary shall make available not
more than $600,000 for each of fiscal years 1998 through 2001
to pay the Federal share of grants made to eligible private
nonprofit organizations and State agencies to carry out
subparagraph (B).
``(B) Eligibility.--A private nonprofit organization or
State agency shall be eligible to receive a grant under
subparagraph (A) if the organization or agency agrees--
``(i) to use the funds to direct a collaborative effort to
coordinate and integrate nutrition education into health,
nutrition, social service, and food distribution programs for
food stamp participants and other low-income households; and
``(ii) to design the collaborative effort to reach large
numbers of food stamp participants and other low-income
households
[[Page S6148]]
through a network of organizations, including schools, child
care centers, farmers' markets, health clinics, and
outpatient education services.
``(C) Preference.--In deciding between 2 or more private
nonprofit organizations or State agencies that are eligible
to receive a grant under subparagraph (B), the Secretary
shall give a preference to an organization or agency that
conducted a collaborative effort described in subparagraph
(B) and received funding for the collaborative effort from
the Secretary before the date of enactment of this paragraph.
``(D) Federal share.--
``(i) In general.--Subject to subparagraph (E), the Federal
share of a grant under this paragraph shall be 50 percent.
``(ii) No in-kind contributions.--The non-Federal share of
a grant under this paragraph shall be in cash.
``(iii) Private funds.--The non-Federal share of a grant
under this paragraph may include amounts from private
nongovernmental sources.
``(E) Limit on individual grant.--A grant under
subparagraph (A) may not exceed $200,000 for a fiscal
year.''.
The PRESIDING OFFICER. The Senator from Texas.
Mrs. HUTCHISON. Mr. President, I understand this has been cleared by
both sides. This is an amendment that I offer. It is an amendment that
passed on a record vote of 409 to zero in the House. It basically
closes a loophole in the Food Stamp Program.
The GAO did a study and determined that the Federal Government is
losing nearly $4 million a year to provide food stamps for prisoners
who obviously do not need food stamps. Prisoners do not qualify for
food stamps because, of course, they are being fed in prison. But
nevertheless, there is food stamp abuse going on where someone in a
household claims a prisoner to add to the food stamp benefits.
Mr. President, I am very pleased that this amendment is going to be
accepted because I think it is very important that the States do a
basic check of their prison rolls with their food stamp rolls to make
sure that the food stamps are being used for the purpose for which they
were intended.
Food stamps are an entitlement, as they should be. They are given to
anyone who is in need. But I think it is not fair to double dip, and we
can save $4 million. In fact, that $4 million will go into some of the
other very important programs that will be covered by this
reconciliation bill.
So I am very pleased that we are closing this loophole, and I am very
pleased that we are also adding another part that provides nutrition
education for the low-income households through a network of social
service organizations. This is something that Senator Rick Santorum has
been a leader in doing, and he is a cosponsor of this amendment. I
think we can do a lot of good.
So I thank the managers of the bill for accepting this amendment. I
urge adoption of the amendment and ask that we have a voice vote.
The PRESIDING OFFICER. Is there further debate?
Mr. HARKIN addressed the Chair.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. I just wonder if I could ask--I was just informed of this
amendment as ranking member on authorization. I just want to make sure
I understand it fully. I would ask the Senator from Texas to yield for
a question.
Mrs. HUTCHISON. Yes, I would be happy to yield for a question.
Mr. HARKIN. As I understand, what the Senator is saying is that right
now under the food stamp rolls, if there is a person in the household
who is incarcerated, that you just want to ensure that the changes are
made to reflect that there is one less person in that household for
purposes of food stamp eligibility and food stamp allotment?
Mrs. HUTCHISON. I think what the Senator is asking is, is this going
to affect the rest of the family? The answer is no. It is just that the
prisoner would be taken out of the equation.
Mr. HARKIN. That is a good amendment.
Mr. DOMENICI. That had been accepted. We had failed to tell you we
had already agreed.
Mr. HARKIN. I appreciate that. It is a good amendment.
Mrs. HUTCHISON. I thank the Senator from Iowa for accepting the
amendment. I ask unanimous consent that it be adopted.
The PRESIDING OFFICER. Without objection, the amendment is agreed to.
The amendment (No. 446) was agreed to.
Mrs. HUTCHISON. Mr. President, I will send another amendment to the
desk and ask for its immediate consideration. Then I want it to be set
aside for future consideration.
The PRESIDING OFFICER. The clerk will report.
Mr. DOMENICI. Is this being submitted pursuant to the unanimous
consent that it would be taken care of tomorrow?
Mrs. HUTCHISON. This is an amendment that we are placing--it is on
the ``DSH'' issue, and we are going to do a place-holder amendment, but
it was suggested I go ahead and put it in.
Mr. DOMENICI. It was on the list. Could you send it to the desk?
Mrs. HUTCHISON. I just want to formally submit the amendment.
Amendment No. 447
(Purpose: To modify the reductions for disproportionate share hospital
payments)
Mrs. HUTCHISON. Mr. President, I send an amendment to the desk and
ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:
The Senator from Texas [Mrs. Hutchison] proposes an
amendment numbered 447.
Mrs. HUTCHISON. 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:
Beginning on page 770, strike line 18 and all that follows
through page 774, line 15, and insert the following:
``(2) Determination of state dsh allotments for fiscal
years 1998 through 2002.--
``(A) Non high dsh states.--
``(i) In general.--Except as provided in subparagraph (B)
and paragraph (4), the DSH allotment for a State for each of
fiscal years 1999 through 2002 is equal to the applicable
percentage of the State 1995 DSH spending amount.
``(ii) Applicable percentage.--For purposes of clause (i),
the applicable percentage with respect to a State described
in that clause is--
``(A) for fiscal year 1998, 98 percent;
``(A) for fiscal year 1999, 95 percent;
``(B) for fiscal year 2000, 93 percent;
``(C) for fiscal year 2001, 90 percent; and
``(D) for fiscal year 2002, 85 percent.
``(B) High dsh states.--
``(i) In general.--In the case of any State that is a high
DSH State, the DSH allotment for that State for each of
fiscal years 1999 through 2002 is equal to the applicable
reduction percentage of the high DSH State modified 1995
spending amount for that fiscal year.
``(ii) High dsh state modified 1995 spending amount.--
``(I) In general.--For purposes of clause (i), the high DSH
State modified 1995 spending amount means, with respect to a
State and a fiscal year, the sum of--
``(aa) the Federal share of payment adjustments made to
hospitals in the State under subsection (c) that are
attributable to the 1995 DSH allotment for inpatient hospital
services provided (based on reporting data specified by the
State on HCFA Form 64 as inpatient DSH); and
``(bb) the applicable mental health percentage for such
fiscal year of the Federal share of payment adjustments made
to hospitals in the State under subsection (c) that are
attributable to the 1995 DSH allotment for services provided
by institutions for mental diseases and other mental health
facilities (based on reporting data specified by the State on
HCFA Form 64 as mental health DSH).
``(II) Applicable mental health percentage.--For purposes
of subclause (I)(bb), the applicable mental health percentage
for such fiscal year is--
``(aa) for fiscal year 1999, 50 percent;
``(bb) for fiscal year 2000, 20 percent; and
``(cc) for fiscal years 2001 and 2002, 0 percent.
``(iii) Applicable reduction percentage.--For purposes of
clause (i), the applicable reduction percentage described in
that clause is--
``(A) for fiscal year 1998, 98 percent;
``(A) for fiscal year 1999, 93 percent;
``(A) for fiscal year 2000, 90 percent;
``(A) for fiscal year 2001, 85 percent; and
``(B) for fiscal year 2002, 80 percent.
Mrs. HUTCHISON. Mr. President, I ask unanimous consent the amendment
be set aside.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mrs. HUTCHISON. I thank the Chair.
The PRESIDING OFFICER. Under the previous order, the Senator from
Rhode Island is recognized.
Amendment No. 448
(Purpose: To clarify the standard benefits package and the cost-sharing
requirements for the children's health initiative)
Mr. CHAFEE. Mr. President, on behalf of Senator Rockefeller, Senator
Jeffords, and myself, I send an amendment to the desk and ask for its
immediate consideration.
The PRESIDING OFFICER. The clerk will report.
[[Page S6149]]
The bill clerk read as follows:
The Senator from Rhode Island [Mr. Chafee], for himself,
Mr. Rockefeller and Mr. Jeffords, proposes an amendment
numbered 448.
Mr. CHAFEE. Mr. President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')
Mr. CHAFEE. Mr. President, I am offering an amendment with Senator
Rockefeller and Senator Jeffords to ensure that the children's health
insurance block grant, which is what we provided for from the Finance
Committee, provides adequate health coverage for children and that it
is affordable for most low-income families.
Let me say I am very pleased in this package we have $24 billion, $24
billion set aside to provide health insurance coverage for some of the
10 million children in our Nation who are currently uninsured. I thank
the chairman of the committee for helping us in many respects in
connection with how this health care money is dispensed.
There are two areas which remain of concern to me, namely what
benefits are we going to provide to these children and how much are we
going to require their parents to pay toward health insurance; in other
words, deductibles and copayments. Under the Finance Committee bill, it
provides that the benefits should be actuarially equivalent to the
benefits provided under the Federal Employees Health Benefits Plan.
This, of course, is not a single plan. It is a menu of plans that
Federal employees may choose from. These plans are designed to meet the
needs of adult Federal workers and retirees, not children. Stating that
the benefits must be actuarial equivalent, which means the same dollar
value, does not spell out what benefits the children will get. Children
could be denied critical benefits, such as vision and hearing care.
Some may say the States will offer the benefits that children need,
but that is not what the record shows. A survey by the National
Governors' Association of the 28 non-Medicaid--in other words programs
that are not pursuant to Medicaid-- State health programs for children
found that they did not cover vision care in 16 of these plans; 16 out
of 28 did not cover glasses for these poor children, and 10 didn't
cover hearing defects.
The amendment I am offering today would require that the benefits be
at least the same as those under the standard Blue Cross/Blue Shield
benefit package, including hearing and vision services.
We are talking about very low-income children here. These are
children who live in families of three where the gross income is under
$18,000. We are talking about children at 133 percent of the Federal
poverty level. They do not have extra money to provide for eyeglasses
or hearing aids. What we do is provide that the package be the same as
the Blue Cross/Blue Shield package as far as benefits go. This is a
standard package and it includes eyeglasses and hearing aids.
In addition, we provide deductibles and copayments be eliminated for
those who are--not eliminated, but be nominal for those from these very
low-income families. So, that is the essence of it. It is a very good
amendment. I wish it would be accepted. And I yield now--how much time
do I have left?
The PRESIDING OFFICER. The Senator has 6 minutes and 40 seconds
remaining.
Mr. CHAFEE. I yield 4 minutes to my colleague from West Virginia.
Mr. ROCKEFELLER. Mr. President, I thank my distinguished colleague
from the State of Rhode Island. My comments on the amendment, this
Senator's comments, would echo those of the Senator from Rhode Island.
In the present bill before us, there is a requirement that benefits
provided be actuarially equivalent to the benefits provided under the
Federal Employees Health Benefits Program or FEHBP, it sounds good.
But, in fact, since there are so many plans out there, you do not know
what kind of benefits that is going to get you. Actuarial equivalence
simply guarantees a dollar amount that the insurance for each child has
to add up to. It does not specify an actual level or set of benefits,
which is the true meaning of decent and necessary health insurance. In
fact, the child could very well not get inpatient services or not get
outpatient services or not receive prescription drugs. Our amendment
ties benefits that would need to be provided to a child to a specific
health plan that is available under FEHBP. Sixty percent of Federal
workers select the BC/BS standard PPO option. Our amendment says that
benefits provided to children must be at least up to that level, plus
vision and hearing. We want our children to get hospital care, we want
them to get primary care, we want them to get preventive care. Basic
protections that a majority of Federal workers choose for their own
families.
The cost sharing requirements in our amendment would also set a
standard that would allow nominal cost sharing for families with
incomes under 133 percent of poverty. For children in families with
incomes above 133 percent of poverty, the Secretary must certify that
the cost sharing requirements are reasonable.
Mr. President, GAO did a study that found that several States fell
short in terms of providing adequate benefits. Alabama only provides
outpatient care. Pennsylvania, which has been a national model,
provided only limited inpatient care. According to a NGA survey of 30
statewide voluntary programs, only 8 States provide dental care, only
11 States provide hospital care, only 14 provide vision care, and less
than half cover physical therapy services.
With the fresh infusion of Federal dollars that the Senate Finance
Committee is choosing to commit and spend on health insurance for
children, there needs to be an assurance that the benefits provided are
adequate and geared to meet the health needs of children. Under the
proposal before us, the Federal Government will be picking up more than
half of the costs of children's health insurance.
A GAO report found that Alabama and Pennsylvania and Florida and
Minnesota still have a long way to go in addressing the needs of
uninsured children in their States. For example, in the case of Alabama
they have covered less than 6,000 kids and they have 182,000 uninsured,
in New York they have covered 104,000 but there is almost 600,000 they
have not covered. Yes, they are trying, but they need the resources we
bring to them. The amendment I am offering with Senator Chafee will
ensure that children get the benefits they need to grow up healthy.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. CHAFEE. Mr. President, there are some saying, ``Oh, you are
giving them a Cadillac package.'' It is just not so. I ask unanimous
consent to have printed in the Record a comparison between what
Medicaid provides, which some could say is a Cadillac package, and what
we have in here, which we provide, which is just what the Blue Cross
provides. You can see as you look down the list that Blue Cross does
not cover shoes and corrective devices, transportation to medical
services, family counseling, hearing care or vision care. So we go with
the Blue Cross package with the exception of adding vision care and
hearing assistance.
There being no objection, the list was ordered to be printed in the
Record, as follows:
COMPARISON OF BENEFITS OFFERED UNDER MEDICAID AND BLUE CROSS
------------------------------------------------------------------------
Benefit Blue Cross Medicaid
------------------------------------------------------------------------
Inpatient hospital care............ Yes............. Yes.
Surgical benefits.................. Yes............. Yes.
Mental health...................... Limited......... Unlimited.
Substance abuse.................... Limited......... Unlimited.
Home care.......................... No.............. Yes.
Speech therapy..................... Limited......... Unlimited.
Transplants........................ Limited......... Unlimited.
Shoes and corrective devices....... No.............. Yes.
Transportation to medical services. No.............. Yes.
Family counseling.................. No.............. Yes.
Nursing home care.................. No.............. Yes.
Non-prescription drugs............. No.............. Yes.
Inpatient private nursing duty..... No.............. Yes
Dental............................. Limited......... Unlimited.
Hearing care....................... No.............. Yes.
Vision care/eyeglasses............. No.............. Yes.
Well-baby care..................... Yes............. No.
------------------------------------------------------------------------
Mr. CHAFEE. We are talking about children at 133 percent of poverty
or less. So I do not think this is going overboard. I very much hope
this could be accepted.
Mr. President, it is a good amendment and all it does is provide that
we know what the benefits are going to be for these children and we
include with the standard package known throughout the country through
the FHEPA
[[Page S6150]]
that we provide for the vision care and hearing assistance.
Mr. President, I am delighted to support this package and would be
delighted to have any other assistance, cosponsors.
Mr. ROCKEFELLER. Will the Senator yield?
Mr. CHAFEE. Yes.
Mr. ROCKEFELLER. Could I just point out one thing? I want to
compliment the chairman of the Senate Finance Committee and his staff
because they were, in fact, as I understand it seriously considering
accepting a version of our amendment. It was not ultimately accepted
apparently because some of my colleagues on the other side of the aisle
did not want to have hearing and vision services included in the
benefits package. I deeply regret that. This really is a good
amendment, does deserve support, and reflects thinking on both sides.
Mr. DOMENICI. That's not true.
Mr. CHAFEE. Mr. President, I cannot vouch for what my distinguished
colleague from West Virginia was saying in that last statement, about
who was willing to accept it. I am not sure of all that.
All I know is I worked with the distinguished chairman of the
committee and his staff. We were making some progress but I can't
account for what resulted in it not being finally accepted. That is
beyond my knowledge.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. ROTH. I would say we did seek to work with the distinguished
Senator from Rhode Island. No agreement was reached. Undoubtedly there
is opposition to this proposal so we will have to deal with that in the
morning.
Mr. CHAFEE. I appreciate that. Again, I join with the comments the
distinguished Senator from West Virginia said about the chairman of the
committee. He worked hard with us on how this originally started, and
we are grateful to him coming as far as he did. We would be even more
grateful if he came a little further.
I thank the Chair.
The PRESIDING OFFICER. Who yields time?
Mr. LAUTENBERG. Mr. President, we have taken a quick look. I would
say from our standpoint we think this is a pretty good amendment. I say
to the Senator from Rhode Island and the Senator from West Virginia, we
think it is a pretty good amendment. Apparently there is some question
yet to be resolved.
Mr. DOMENICI. Mr. President, that means this amendment goes on the
list for tomorrow with 1 minute on a side, is that correct?
The PRESIDING OFFICER. That is correct.
Mr. DOMENICI. If it is subject to a point of order, that point of
order is reserved for tomorrow?
The PRESIDING OFFICER. The Senator is correct.
Mr. CHAFEE. Mr. President, the Senator from New York, Senator
D'Amato, asked to be added as a cosponsor.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Minnesota.
Mr. WELLSTONE. Mr. President, are we ready for another amendment?
Amendment No. 449
(Purpose: To provide for full mental health parity with respect to
health plans purchased through the use of amounts provided under a
block grant to States)
Mr. WELLSTONE. Mr. President, I send an amendment to the desk and ask
for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:
The Senator from Minnesota [Mr. Wellstone], for himself and
Mr. Domenici, Mr. Reid, and Mr. Conrad, proposes amendment
numbered 449.
Mr. WELLSTONE. 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 862, between lines 14 and 15, insert the following:
``SEC. 2107A.--MENTAL HEALTH PARITY.
``(a) Prohibition.--in the case of a health plan that
enrolls children through the use of assistance provided under
a grant program conducted under this title, such plan, if the
plan provides both medical and surgical benefits and mental
health benefits, shall not impose treatment limitations or
financial requirements on the coverage of mental health
benefits if similar limitations or requirements are not
imposed on medial and surgical benefits.
``(b) Rule of Construction.--Nothing in this section shall
be construed--
``(1) as prohibiting a health plan from requiring
preadmission screening prior to the authorization of services
covered under the plan or from applying other limitations
that restrict coverage for mental health services to those
services that are medically necessary; and
``(2) as requiring a health plan to provide any mental
health benefits.
``(c) Separate Application to Each Option Offered.--In the
case of a health plan that offers a child described in
subsection (a)(2) or more benefit package options under the
plan, the requirements of this section shall be applied
separately with respect to each such option.
``(d) Definitions.--In this section:
``(1) Medical or surgical benefits.--The term `medical or
surgical benefits, means benefits with respect to medical or
surgical services, ad defined under the terms of the plan,
but does not include mental health benefits.
``(2) Mental health benefits.--The term `mental health
benefits' meant benefits with respect to mental services, as
defined under the terms of the plan, but does not include
benefits with respect to the treatment of substance abuse and
chemical dependency.
Mr. WELLSTONE. Mr. President, this past fall for me as a Senator, one
of the proudest moments was when the Senate passed the Domenici--and I
was pleased to join him--Wellstone Mental Health Parity Act. This
became part of the VA-HUD appropriations bill and became, really,
eventually the law of the land. This was a first and important step in
ending the discrimination when it comes to health care coverage for
people struggling with mental illness, to say we take another step
toward punching through some of the prejudice and some of the ignorance
about mental illness.
Mr. President, I thank, and I say to my colleague from New Mexico
this is really what it is all about--we have in the gallery, family
gallery, people representing the National Alliance for the Mentally
Ill, the American Psychiatric Association, and the National Mental
Health Association. They have been here all day. This has been several
days we worked on this. I believe, thanks to the strong support of
Senator Domenici, that we have now an amendment that will be approved.
I thank him for his fine work.
I thank the people who have been here today, thank you for your help,
and I would like to thank also Margaret Halperin who works with me in
the mental health area.
This amendment just says that now what we have done is we have
focused on children's health care, we have some $16 billion of
additional money. I thank the distinguished Senator from Delaware for
all of his fine work on this. What this amendment says is--it does not
mandate anything. What it says is when it comes to providing health
care coverage, now that it goes to States, as there is additional
funding to provide health care coverage for children if there is going
to be mental health coverage in any package that we do not have any
discriminatory treatment toward those children that are struggling with
mental illness.
This is terribly important. What we are doing again is we are just
kind of breaking through more prejudice. It is another step toward
ending discrimination and it is so important, I say to colleagues. This
is passed now at night. Tomorrow I hope we will focus on it, if not on
the floor of the Senate I know there will be many people in the country
who will want to focus on it, groups and organizations here that will
want to focus on this.
What this means for families and for children, I cannot even begin to
explain. But let me simply say all too often it has been devastating.
There has been no coverage. All too often it is children who could be
doing well in school but are not able to, it is children who could live
full lives but are not able to. What we do with this amendment is we
take another step toward breaking through the prejudice, toward
breaking through the discrimination and, we say, now that we have funds
going to States and now we are going to be focusing on the health care
of children, please, colleagues, please remember that when we talk
about the health of children we are also talking about the mental
health of children.
That is what this amendment says. That is what this amendment is all
about. I am so pleased that this amendment is going to be accepted. We
will work very hard to keep this in conference committee and this,
again, is
[[Page S6151]]
an amendment with, I think, strong bipartisan support. And more than
anybody here in the Senate I thank Senator Domenici for all of his
help.
I yield the floor to my colleague from New Mexico.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Mr. President, I obviously would be remiss if I did not
thank Senator Wellstone for his diligence in this regard. I think the
time is now upon us, with the overwhelming passage of an amendment last
year which I sponsored along with my friend Senator Wellstone, which
essentially said for the private sector, if you are going to cover
people that have mental illness, you have to create some parity for the
mentally ill; that is, you cannot say they have less coverage per year
or less coverage for the life of the policy. That set a very big wave
of movement in the country to try to establish nondiscrimination in
these kinds of efforts. I think business is beginning to work its way
through it.
Today, we offer an amendment very similar. It says the coverage that
is going to be afforded to children under this bill, if mental illness
is covered, it shall be covered with the same kind of coverage that you
provide for the physical illnesses.
There is a escape clause of a sort that has to do with making sure we
are not impeding the formation of HMOs and managed care.
Nonetheless, I believe the time is right to try this one on in the
country. We are moving step by step, leading to a point where mental
and physical ailments will be treated the same in terms of coverage. We
need not make long speeches tonight. We made those to the Senate
heretofore and we received very warm response.
On this one we do not have that much time. I yield whatever remaining
time I have. I understand the chairman and ranking member of Finance
have no objection to the amendment.
THE PRESIDING OFFICER. If there be no further debate, the question is
on agreeing to the amendment.
The amendment (No. 449) was agreed to.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
Mr. LAUTENBERG. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. Under the previous order, the Senator from
Illinois is recognized for up to 10 minutes.
Mr. DURBIN. Mr. President, I have an amendment----
Privilege Of The Floor
Mr. ROTH. Mr. President, I ask the distinguished Senator to withhold.
Mr. President, I ask unanimous consent that Rick Werner, a detailee to
the Finance Committee from the Department of Health and Human Services
be granted the privilege of the floor for the duration of the debate on
S. 947, the Balanced Budget Act of 1997.
The PRESIDING OFFICER. Without objection, it is so ordered.
Amendment No. 450
(Purpose: To provide food stamp benefits to child immigrants)
Mr. DURBIN. Mr. President, I send an amendment to the desk and ask
for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:
The Senator from Illinois [Mr. Durbin] for himself, Mr.
Wellstone, and Mrs. Boxer proposes an amendment numbered 450.
Mr. DURBIN. 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:
At the end of title I, add the following:
SEC. 10 . FOOD STAMP BENEFITS FOR CHILD IMMIGRANTS.
(a) In General.--Section 402(a)(2) of the Personal
Responsibility and Work Opportunity Reconciliation Act of
1996 (8 U.S.C. 1612(a)(2)) is amended by adding at the end
the following:
``(E) Child immigrants.--In the case of the program
specified in paragraph (3)(B), paragraph (1) shall not apply
to a qualified alien who is under 18 years of age.''.
(b) Allocation of Administrative Costs.--Section 408(a) of
the Social Security Act (42 U.S.C. 608(a)) is amended by
adding at the end the following:
``(12) Designation of grants under this part as primary
program in allocating administrative costs.--
``(A) In general.--Notwithstanding any other provision of
law, a State shall designate the program funded under this
part as the primary program for the purpose of allocating
costs incurred in serving families eligible or applying for
benefits under the State program funded under this part and
any other Federal means-tested benefits.
``(B) Allocation of costs.--
``(i) In general.--The Secretary shall require that costs
described in subparagraph (A) be allocated in the same manner
as the costs were allocated by State agencies that designated
part A of title IV as the primary program for the purpose of
allocating administrative costs before August 22, 1996.
``(ii) Flexible allocation.--The Secretary may allocate
costs under clause (i) differently, if a State can show good
cause for or evidence of increased costs, to the extent that
the administrative costs allocated to the primary program are
not reduced by more than 33 percent.
``(13) Failure to allocate administrative costs to grants
provided under this part.--If the Secretary determines that,
with respect to a preceding fiscal year, a State has not
allocated administrative costs in accordance with paragraph
(12), the Secretary shall reduce the grant payable to the
State under section 403(a)(1) for the succeeding fiscal year
by an amount equal to--
``(A) the amount the Secretary determines should have been
allocated to the program funded under this part in such
preceding fiscal year; minus
``(B) the amount that the State allocated to the program
funded under this part in such preceding fiscal year.''.
The PRESIDING OFFICER. The Senator from Illinois.
Mr. DURBIN. Mr. President, I know the hour is late but the subject is
very important and in a few moments I would like my colleagues to
consider what this amendment would do. During the course of passing the
welfare reform bill, we made many changes in many programs in an effort
to move people from welfare to work. There were several aspects of that
bill--even though I supported the bill in its entirety--there were
several aspects of that bill which were troubling, not the least of
which was the reduction in nutritional assistance for children in the
United States. The purpose of this amendment is to correct what I
consider to be a very serious error and a serious problem in this
legislation, because with this amendment we will restore food stamps
for the children of legal immigrants.
Keep in mind that I have said legal immigrants. These are children
legally in the United States who are in poverty and have been denied
the protection and sustenance of the Food Stamp Program. It is a
significant problem nationwide. Over 4,000 immigrant children in
Illinois have lost their food stamps because of this welfare reform
bill; over 283,000 nationwide. According to the Food Research Action
Council survey of families living below 185 percent of poverty, hungry
children suffer from two to four times as many individual health
problems such as frequent colds and headaches, fatigue, unwanted weight
loss, inability to concentrate and so on.
These children--hungry children--are often absent from school. They
can have a variety of medical problems arising from nutritional
deficiencies, not the least of which is anemia. Hungry children are
less likely to interact with other people, explore and learn from their
surroundings, and it has a negative impact on the ability of children
to learn. We should be focusing on healthy children in America, not
hungry children in America.
This amendment seeks to correct that problem by giving to these
children the basic protection of food stamps.
Just a month or so ago, I visited the Cook County Juvenile Detention
Center, a facility which, unfortunately, is doing quite a large
business in juvenile crime. I spoke to the psychologist at that center
and asked him what traits these kids who committed crime had in common.
I would like to focus on one which he said was very common, a learning
disability, a neurological deficit.
I said, ``Where does that come from?''
He said it can come from improper prenatal nutrition, improper infant
nutrition. These kids get a bad start, and with that bad start, they
don't learn as well, they become frustrated, they fall behind, they
become truant, they drop out, they become statistics, crime and welfare
statistics which haunt us in this Chamber as we consider all of the
ramifications of a child's failed life.
[[Page S6152]]
Many times we overlook the basics. I am happy that my colleagues
tonight have addressed children's health. I think that is something
that should be a given in America, that we provide basic health care
protection to all children. But can we then argue that children should
go hungry at the same time? The children that would be protected by
this bill would now be qualifying for food stamps. In my State of
Illinois, many of the soup kitchens and other food providers have
experienced a dramatic increase in demand for services by children
since enactment of the welfare reform bill.
The Reverend Gerald Wise of the First Presbyterian Church in Chicago
recently came to tell me that the pantry at the First Presbyterian in
the extremely distressed Woodlawn neighborhood and the Pine Avenue
United Presbyterian Church in the Austin neighborhood are stretched
beyond capacity.
Fifty-two percent of the cities participating in the U.S. Conference
of Mayors' 1995 survey reported emergency food assistance facilities
were unable to provide necessary resources, and that is before the
welfare reform bill.
This amendment, which I have been joined in offering by Senator
Wellstone and Senator Boxer, restores food stamp benefits to legal
immigrant families with children 18 years and under. According to the
CBO, it would cost the Treasury $750 million over 5 years.
We have established an offset in this bill from the administrative
moneys being given to the Governors so that they can administer the new
welfare reform bill, food stamps and other programs. Our amendment
tries to ensure that Federal dollars are being used efficiently to make
sure that direct benefits are given to needy children.
I am going to stop at this point, as I know some of my colleagues are
waiting to offer an amendment and others have been here a long time. I
hope tomorrow when this amendment comes to the floor that my colleagues
on both sides of the aisle will join in a bipartisan spirit to help the
children of legal immigrants. These children are likely to become
naturalized citizens in America. We want them to be healthy, productive
citizens, good students making this a better nation in which to live.
If we are pennywise and pound foolish and cut these children short when
it comes to one of the basic necessities of life, food itself, we may
end up paying the price for decades and generations to come.
Let us do the right thing, the compassionate thing, yes, the American
thing. Let us make sure that hungry children are provided for.
Mr. President, I yield the floor.
The PRESIDING OFFICER. Is there further debate on the amendment?
Mr. DOMENICI. Mr. President, I have nothing other than we will take
our minute tomorrow. Again, if this amendment is subject to a point of
order, we have not waived the point of order tonight.
The PRESIDING OFFICER. The Senator is correct.
Mr. D'AMATO addressed the Chair.
The PRESIDING OFFICER. The Senator from New York.
Amendment No. 451
(Purpose: To improve health care quality and reduce health care costs
by establishing a national fund for health research that would
significantly expand the Nation's investment in medical research)
Mr. D'AMATO. Mr. President, on behalf of Senator Harkin, Senator
Specter, Senator Mack, Senator Rockefeller, Senator Daschle, Senator
Boxer, Senator Kerry, Senator Durbin, and myself, I offer this
amendment and ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report the amendment.
The bill clerk read as follows:
The Senator from New York [Mr. D'Amato], for himself, Mr.
Harkin, Mr. Specter, Mr. Mack, Mr. Rockefeller, Mr. Daschle,
Mrs. Boxer, Mr. Kerry, and Mr. Durbin, proposes an amendment
numbered 451.
Mr. D'AMATO. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
On page 1027, between lines 7 and 8, insert the following:
Subtitle N--National Fund for Health Research
SEC. 5995. SHORT TITLE.
This subtitle may be cited as the ``National Fund for
Health Research Act''.
SEC. 5996. FINDINGS.
Congress makes the following findings:
(1) Nearly 4 of 5 peer reviewed research projects deemed
worthy of funding by the National Institutes of Health are
not funded.
(2) Less than 3 percent of the nearly one trillion dollars
our Nation spends on health care is devoted to health
research, while the defense industry spends 15 percent of its
budget on research and development.
(3) Public opinion surveys have shown that Americans want
more Federal resources put into health research and are
willing to pay for it.
(4) Ample evidence exists to demonstrate that health
research has improved the quality of health care in the
United States. Advances such as the development of vaccines,
the cure of many childhood cancers, drugs that effectively
treat a host of diseases and disorders, a process to protect
our Nation's blood supply from the HIV virus, progress
against cardiovascular disease including heart attack and
stroke, and new strategies for the early detection and
treatment of diseases such as colon, breast, and prostate
cancer clearly demonstrates the benefits of health research.
(5) Health research which holds the promise of prevention
of intentional and unintentional injury and cure and
prevention of disease and disability, is critical to holding
down health care costs in the long term.
(6) Expanded medical research is also critical to holding
down the long-term costs of the medicare program under title
XVIII of the Social Security Act. For example, recent
research has demonstrated that delaying the onset of
debilitating and costly conditions like Alzheimer's disease
could reduce general health care and medicare costs by
billions of dollars annually.
(7) The state of our Nation's research facilities at the
National Institutes of Health and at universities is
deteriorating significantly. Renovation and repair of these
facilities are badly needed to maintain and improve the
quality of research.
(8) Because discretionary spending is likely to decline in
real terms over the next 5 years, the Nation's investment in
health research through the National Institutes of Health is
likely to decline in real terms unless corrective legislative
action is taken.
(9) A health research fund is needed to maintain our
Nation's commitment to health research and to increase the
percentage of approved projects which receive funding at the
National Institutes of Health.
SEC. 5997. ESTABLISHMENT OF FUND.
(a) Establishment.--There is established in the Treasury of
the United States a fund, to be known as the ``National Fund
for Health Research'' (hereafter in this section referred to
as the ``Fund''), consisting of such amounts as are
transferred to the Fund under subsection (b) other amounts
subsequently enacted into law and any interest earned on
investment of amounts in the Fund.
(b) Transfers to Fund.--
(1) In general.--The Secretary of Health and Human Services
shall transfer to the Fund amounts equivalent to amounts
described in paragraph (2).
(2) Amounts.--
(A) In general.--Amounts described in this paragraph for
each of the fiscal years 1998 through 2002 shall be equal to
the amount of Federal savings derived for each such fiscal
year under the medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) and the medicaid
program under title XIX of such Act (42 U.S.C. 1396 et seq.)
that exceeds the amount of Federal savings estimated by the
Congressional Budget Office as of the date of enactment, to
be achieved in each such program for each such fiscal year
for purposes of the Balanced Budget Act of 1997.
(B) Determination by secretary.--Not later than 6 months
after the end of each of the fiscal years described in
subparagraph (A), the Secretary of Health and Human Services
shall--
(i) make a determination as to the amount to be transferred
to the Fund for the fiscal year involved under this
subsection; and
(ii) subject to subparagraphs (E) and subsection (d),
transfer such amount to the Fund.
(C) Separate estimates.--In making a determination under
subparagraph (B)(i), the Secretary of Health and Human
Services shall maintain a separate estimate for each of the
programs described in subparagraph (A).
(D) Limitation.--Any savings to which subparagraph (A)
applies shall not be counted for purposes of making a
transfer under this paragraph if such savings, under current
procedures implemented by the Health Care Financing
Administration, are specifically dedicated to reducing the
incidence of waste, fraud, and abuse in the programs
described in subparagraph (A).
(E) Cap on transfer.--Amounts transferred to the Fund under
this subsection for any year in the 5-fiscal year period
beginning on October 1, 1997, shall not in combination with
the appropriated sum exceed an amount equal to the amount
appropriated for the National Institutes of Health for fiscal
year 1997 multiplied by 2.
(c) Obligations From Fund.--
(1) In general.--Subject to the provisions of paragraph
(4), with respect to the amounts
[[Page S6153]]
made available in the Fund in a fiscal year, the Secretary of
Health and Human Services shall distribute--
(A) 2 percent of such amounts during any fiscal year to the
Office of the Director of the National Institutes of Health
to be allocated at the Director's discretion for the
following activities:
(i) for carrying out the responsibilities of the Office of
the Director, including the Office of Research on Women's
Health and the Office of Research on Minority Health, the
Office of Alternative Medicine, the Office of Rare Disease
Research, the Office of Behavioral and Social Sciences
Research (for use for efforts to reduce tobacco use), the
Office of Dietary Supplements, and the Office for Disease
Prevention; and
(ii) for construction and acquisition of equipment for or
facilities of or used by the National Institutes of Health;
(B) 2 percent of such amounts for transfer to the National
Center for Research Resources to carry out section 1502 of
the National Institutes of Health Revitalization Act of 1993
concerning Biomedical and Behavioral Research Facilities;
(C) 1 percent of such amounts during any fiscal year for
carrying out section 301 and part D of title IV of the Public
Health Service Act with respect to health information
communications; and
(D) the remainder of such amounts during any fiscal year to
member institutes and centers, including the Office of AIDS
Research, of the National Institutes of Health in the same
proportion to the total amount received under this section,
as the amount of annual appropriations under appropriations
Acts for each member institute and Centers for the fiscal
year bears to the total amount of appropriations under
appropriations Acts for all member institutes and Centers of
the National Institutes of Health for the fiscal year.
(2) Plans of allocation.--The amounts transferred under
paragraph (1)(D) shall be allocated by the Director of the
National Institutes of Health or the various directors of the
institutes and centers, as the case may be, pursuant to
allocation plans developed by the various advisory councils
to such directors, after consultation with such directors.
(3) Grants and contracts fully funded in first year.--With
respect to any grant or contract funded by amounts
distributed under paragraph (1), the full amount of the total
obligation of such grant or contract shall be funded in the
first year of such grant or contract, and shall remain
available until expended.
(4) Trigger and release of monies.--
(A) Trigger and release.--No expenditure shall be made
under paragraph (1) during any fiscal year in which the
annual amount appropriated for the National Institutes of
Health is less than the amount so appropriated for the prior
fiscal year.
(d) Required Appropriation.--No transfer may be made for a
fiscal year under subsection (b) unless an appropriations Act
providing for such a transfer has been enacted with respect
to such fiscal year.
(e) Budget Treatment of Amounts in Fund.--The amounts in
the Fund shall be excluded from, and shall not be taken into
account, for purposes of any budget enforcement procedure
under the Congressional Budget Act of 1974 or the Balanced
Budget and Emergency Deficit Control Act of 1985.
Mr. D'AMATO. Mr. President, I guess it was about 5, 6 years ago, my
friend and colleague from Iowa, Senator Harkin, came to me and said,
``You know, we haven't been able to get sufficient funding for breast
cancer research because there are those who object to our attempt to
take it from defense and transfer it over to NIH.'' I think we had just
been rebuffed 50 some odd to 42 or 43.
Then he said, ``How about us keeping that money in the defense
budget. After all, a significant portion of the military will be women.
This is a matter of national health in our defense of our families.''
And we came forth with that proposal, and we were able to get a huge
vote.
Since that point in time, forget about votes, we have produced, in
addition to what was being funded by NIH, something in excess of $600
million for breast cancer research, and it has made a difference.
My colleague, once again, has come forth and said this time,
``Alfonse, why don't we look to meet the needs that this body itself
has acknowledged in their overwhelming vote on January 21, 1997,'' when
Senator Mack and my friend from Iowa, Senator Harkin, myself and
others, who offered an amendment which was designed to say, let us
double, we call it the biomedical commitment research resolution, and
it is so easy for us to vote for it because we voted to say yes, we
want to double the amount of money going into NIH for biomedical
research because the demands are incredible, absolutely incredible. So
we voted 100 to 0.
Now comes the problem. How do we fund it? Notwithstanding that the
chairman of the subcommittee, Senator Specter, is making every effort
to find the funds, where does he get them? Where does he get them? What
program does he cut? Does he cut food stamps further? We just heard an
eloquent presentation as it relates to the needs of children. What
senior citizen program does he cut it from? We have already seen the
battles when we look for funds. Do we give more money to breast cancer
research at the expense of diabetes? What about emerging infectious
diseases? Incredible, frightening if you read what is going on.
Let me tell you, the investment of moneys into biomedical research
will pay great dividends, it will save lives, it will result in savings
many, many, many times more than what we invest, and it is so
necessary. I think about 80 to 90 percent of the worthy applications by
some of the great medical research centers of this country are being
turned down, not because they are deficient, but because we simply
don't have the money.
I have to tell you something, there is nothing better that we can be
investing money in than in terms of medical research for the prevention
of illnesses, for finding out the cures, for doing the genetic
research, for doing all of that work that so many of us talk about. We
go home and say, ``Yes, I am going to vote to increase it.'' Here is
what we do.
Let us take the cumulated savings annually from Medicare and Medicaid
that this bill provides. Let me tell you, the chairman of the Finance
Committee, Senator Roth, deserves the appreciation and accolades of
everyone, Democrat and Republicans, because he has crafted a bill that
is designed to control costs and to produce savings. Let CBO, the
Congressional Budget Office, look at the end of each fiscal year how
much in the way of savings have been accumulated and provide these
moneys be set aside to be used exactly for that which we voted 100 to
0, biomedical research in NIH.
Let us not fight to take money from one program that is so
desperately needed, whether it be for senior citizens, whether it be
for food stamps, and then say we are going to make winners of some at
the expense of others and not nearly meet the needs.
If we looked at the last 4 years, we will see we increased the total
appropriations in these accounts by about $400 million a year. That is
not going to meet our commitment when we are talking about increasing
it by $2.5 billion annually.
Mr. President, again, this does not impact, it does not need a
revenue offset. If the revenues are not generated, the savings, no
expenditure. If they are, I suggest we couldn't find a better and finer
place to put those moneys. If someone wants to then come in and make an
amendment to take part of those moneys and put them someplace else,
they can come to the floor and we can argue it out. But I believe the
establishment of that trust fund keeps the promise we made, that we
attempt to look for ways to find the moneys that we all came out here
on the floor and voted for.
I commend my colleague. It has been a great privilege and pleasure
for me to work with him in this endeavor.
Mr. HARKIN addressed the Chair.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. Mr. President, I thank my friend from New York for his
kind words, but also, more important, let me thank him for his
stalwart, unwavering support through the years for medical research.
I have been involved in this battle for a long time, and I have never
found anyone who has fought harder to make sure we had adequate funding
for all of the biomedical research we need done in this country than
Senator D'Amato from New York. I thank him for that unwavering support
down through the years and for his support on this amendment also.
Mr. President, this amendment does have strong bipartisan support.
Senator Specter and Senator Mack are cosponsors, as well as a number on
our side--Senator Rockefeller, Senator Daschle, Senator Boxer, Senator
Durbin, Senator Kerry. So it has strong bipartisan support.
I want to pick up on what the Senator from New York said. We voted
not long ago, the entire Senate, every one of us voted to double
funding for NIH by 2002. We are all in favor of that. But
[[Page S6154]]
it is very hard finding the money. I worked very hard with Senator
Specter when I was chairman and he was ranking member. Now he is
chairman and I am ranking member. We have worked very hard to get
adequate funding for NIH every year. It is getting more and more
difficult, and with this balanced budget which I am supporting
strongly, which I have continued to support in the past and will
continue to support, it is going to be even harder.
If we wanted to double NIH funding by 2002 out of our discretionary
account, if we zeroed out all the other accounts we have--maternal-
child health care, the Centers for Disease Control, mental health block
grants and a host of others--if we zeroed all those out and shifted it
just to NIH, we would still be $2 billion short of doubling it. We are
not going to zero out mental health block grants and the Centers for
Disease Control and everything else. So we have to look for someplace
else to find this money.
Without our action, the investment in NIH research is only going to
decline in real terms. The only way that we can get it is by going
outside of the regular discretionary spending process. I guess what
this amendment is, more than anything, is there was a book of
``Thinking Outside the Box.'' We get put in these boxes and sometimes
we have to think outside of the box.
What this amendment does, again, to repeat, to reemphasize what
Senator D'Amato said, this research trust fund would work in the
following way. Every year, CBO and the Secretary of Health and Human
Services would look back to determine whether the annual Medicare and
Medicaid savings actually achieved as a result of the changes made by
the Balanced Budget Act exceeded the savings called for in the budget
resolution. In other words, are there more savings than what was called
for to balance the budget? If that is so, if there are excess savings,
then that excess savings would be deposited each year into a health
research fund to be distributed to NIH for the purposes of medical
research. It is a very simple, a very elegant amendment, so offset is
needed.
As we consider long-term changes to the Medicare Program--and we will
be--the creation of a medical research trust fund is only common sense.
I know a point of order will be made against the amendment that it is
not germane. I accept the fact that this amendment is not germane to
the bill before us. But I submit to you, it is every bit germane to the
issue of saving Medicare and how we are going to deal with Medicare.
A number of recent studies have shown that investments in medical
research can lower Medicare costs through the development of more cost-
effective treatments and by delaying the onset of illnesses. Duke
University recently did a study that said the financial crisis in
Medicare can be resolved without raising taxes or cutting benefits by
improving the health of older Americans through biomedical research. It
is the key investment, it is the key to reducing health costs in the
long run. If we can find cures for things like breast cancer, lung
cancer, Alzheimer's, the savings would be enormous.
Unfortunately, while health care spending devours nearly a trillion
dollars annually, our medical research budget is dying of starvation.
The United States devotes less than 2 percent of its total health care
budget to health research.
Look at it this way, the Defense Department spends 15 percent of its
budget on research, and yet, in health care, we spend less than 2
percent. So we have smart bombs and smart missiles and everything that
defends our country, and we are all happy about that, but look what
they have done with research.
If we want a smart bomb and a smart missile to knock out lung cancer
or breast cancer or Alzheimer's, or to help us with mental illness,
this is where we have to put the money.
Take Alzheimer's alone: Funding for Alzheimer's research is about
$300 million a year. Yet, it is estimated that the 4 million people in
America who suffer from Alzheimer's is costing us about $100 billion a
year. That is about $25,000 per person who has Alzheimer's on average.
If we could just delay the onset of Alzheimer's for 5 years, that would
go a long way toward solving our Medicare problems.
Gene therapy, treatments for cystic fibrosis, Parkinson's--this is a
time of great promise. Almost every day new stories are coming out
about one advance or another. We are not suffering from a shortfall of
ideas. We are suffering from a shortfall of revenues.
Also, in the last several years the number of young people going into
research is declining. The number of people under the age of 36 even
applying for NIH grants dropped by 54 percent in the last 10 years.
Why? Because when they submit their proposal, it gets peer reviewed.
They say it is a good grant, and there is no money. And so young people
who would want to pursue research look for other careers.
Well, again, health research saves money. It saves lives. And the
time is right. This fund will allow us to pursue the innovative cures,
treatments and therapies that will help us solve the Medicare Program.
Again, I want to thank my colleague from New York, Senator D'Amato,
and Senator Mack, Senator Specter, with whom I work on the
Appropriations Committee, and all the others who have worked so hard.
This is a very simple and elegant amendment. I hope that Senators
will take that step, sort of outside the box, to think newly, to think
anew, to think about how we start getting more money into NIH, through
a process that will still help us balance the budget as we all voted to
do.
So, Mr. President, again, I urge my colleagues to support this
amendment and urge its adoption.
The PRESIDING OFFICER. Is there further debate on the amendment?
Mr. DOMENICI. Is there anything further on your side?
Mr. HARKIN. I have two amendments I would like to just lay down.
Mr. DOMENICI. Well, let me just make a couple comments, because we
will not be able to say much tomorrow.
It is with regret that I oppose this amendment, and actually I will
raise a point of order because I believe it is subject to a point of
order. I will do that tomorrow.
But, you know, it is kind of interesting. I do not know what money we
are going to be using. You see, what the amendment says is, you take
the estimates of what we are supposed to save in this reconciliation
bill from Medicare and Medicaid, and then you, whatever those estimates
were, you take a look and see if the new estimates say we save more.
Well, this is an estimate of an estimate. And I do not really know
where the money comes from. I mean, do you wait until the end of 5
years and then get the reality check, or do you do this based on
estimates?
Now, that is just purely technical and budgetese. But, frankly, as
much as I would like to put more into NIH, I believe it is not right to
take savings that accrue on the entitlement side of the ledger that are
estimates and attribute that in advance to any function in Government,
which is what we are doing here. If we are clairvoyant enough and wise
enough in the future, and understand the future well enough to say if
we are saving money in Medicare and Medicaid, all that savings ought to
go to just this one program, how do we know there are not some health
programs that need some of that money? How do we know they should not
be used for tax cuts? That is what they are permitted to be used for
now.
And last but not least, I just do not think we need another trust
fund. We have plenty of trust funds. We ought not create another one,
to use the sense-of-the-Senate vote by which every Senator expressed an
opinion and said, as I read it, we sure hope that within 5 years we
could double NIH. If you asked 100 people that voted for that, if they
thought we were going to be able to achieve that, I believe 100 percent
of them would have said probably not. So to turn around and use that to
take a slice of savings that might be applied either to the deficit, to
tax cuts, to other entitlement programs, and say we just think now we
ought to cut that off and we ought to put them in the NIH, I do not
believe is good budgeting. I do not believe it is a very good way to
advance fund anything.
So I will use my minute tomorrow. I will not have as much time as
tonight to indicate what great respect I have
[[Page S6155]]
for these two Senators. Everybody knows that. Senator D'Amato from New
York is one of my best friends in the world. But I do not believe this
is the right approach, and I have to resist it.
Mr. President, I make a point of order that the amendment violates
the Budget Act.
Mr. D'AMATO. Mr. President, I move to waive.
The PRESIDING OFFICER (Mr. Enzi). What point of order does the
Senator make?
Mr. D'AMATO. I move to waive the point of order on the budget.
Mr. DOMENICI. I thought the Parliamentarian knew so well what part of
the Budget Act this violates that I would not have to pick it out for
him. But if you give me a minute here, we will.
It is not germane.
The PRESIDING OFFICER. The motion to waive has been made.
Mr. D'AMATO. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
Mr. D'AMATO addressed the Chair.
The PRESIDING OFFICER. The Senator from New York.
Mr. D'AMATO. First of all, let me say there is no one that I have
greater respect for and no one who I admire more than my colleague and
friend from New Mexico, Senator Domenici. And I would ask, if the
Senator might be willing, between now and the time the amendment comes
up, to look at the question of the trust fund. As far as I am
concerned, and I think I speak for my colleague, if that were one of
the important issues, I think we could put that aside and have those
moneys allocated directly into NIH.
I would also indicate that I think in the draftsmanship of this we
provided that it would be only the year after on the look-back that the
Congressional Budget Office would ascertain whether or not the mark we
have set, which would be set in law, by the way--this will no longer be
an estimate, be set in law--that if it has been achieved and there has
been an excess in the way of savings, that those dollars then would go
into this account at NIH for biomedical research.
Understand, it is exactly my friend's point that no one really knows
where to get the money and that here is an opportunity to say that if
we do achieve these savings, yes, that we are making a judgment now;
that if we do, we are making a judgment to see that these dollars will
be allocated for these areas, whether it is Alzheimer's research,
diabetes, cancer, research on the brain.
I mean, the fact is, we desperately, desperately need these moneys.
And here is an opportunity to identify with specificity and, yes, to
come forward and say, yes, if we have an extra $500 million or $1
billion, that it will go into that account. And we will be making that
commitment that we talked about a reality.
So I ask my colleague and friend to just look at it in terms of if
there needs to be some additional language to tighten this up and to
deal with some of the parliamentary objections. And if there is a real
question whether or not you want to set up a trust fund for this, that
possibly we could deal with that in the manner that would facilitate
the spirit of that resolution that was passed saying we must do more.
Because I believe that the spirit was there and the recognition that we
have to do more in biomedical research.
I yield the floor.
Mr. HARKIN addressed the Chair.
The PRESIDING OFFICER. The Chair recognizes the Senator from Iowa.
Mr. HARKIN. I just want to again thank my colleague from New York.
And I want to say to the Senator from New Mexico, again, I know his
strong feelings on medical research. We fought side by side in the past
when I was privileged to chair the Appropriations Subcommittee in
working with the Senator to increase funds for medical research. I know
his strong feelings, and I appreciate that.
Again, I just hope we can sort of think outside the box, as I said
earlier, of looking at this and get this money into research. We have
to do it, get more money into medical research. I mean, they are
starving out there. And the young people who want to go into research--
right now, less than 25 percent of the peer-reviewed grants at NIH are
being funded.
I always talk about medical research as sort of like you have doors
that are closed. You want to look behind the closed doors. Well, if you
only are looking behind one out of every four doors, the odds are four
to one that you are not going to find the answer. If you look at two
out of four, or three out of four, your odds are a lot better that you
are going to find the answer. That is what we are attempting to do with
this amendment.
So, again, I hope that we can have a resolution of this and get on
with getting the increased funding for NIH.
Mr. President, I want to ask the Senator from New Mexico, before I
leave, I have two amendments that I would just like to lay down. Should
I do those now, send those up?
Mr. DOMENICI. If you have not given them to the ranking member and
want to do them separately, he can. He is submitting all of your
Democratic Senators' amendments en bloc. He will do those for you, too.
Mr. HARKIN. I will give them to Senator Lautenberg. I thank you.
I yield the floor.
Mr. DOMENICI. Mr. President, I do not want to leave with any the
impression that I am stubborn or unwilling to consider things when I am
asked to. I will. But every time I consider, I think of more reasons
why we should not do it.
Mr. HARKIN. Don't think about it.
Mr. DOMENICI. So I better not be thinking for a while. The $3.9
billion that we transferred into the trust fund for Medicare from part
B savings, what if we are over by $3.9 billion? Do we take the $3.9
billion out of the trust fund and make it less weak and put that money
in here?
Second, I was just thinking, where have we done this before? You
might all look at this. We did this because Senator Byrd at one time
wanted to set up a trust fund so we could use a lot of appropriated
money on crimefighting, because we had found kind of a bird's nest of
money when some Senator decided that we were going to cut payroll for
the Government.
And so Senator Byrd said, well, if we are going to do that, let us
put that trust fund in crime prevention. But, you know, over time all
it has done has been--it is a business, it is an accounting thing. You
give that committee, to start with, that entrusted money, but that does
not mean that the appropriations give as much money to the committee
they would have if you did not put that in, and you end up getting no
more money for crimefighting. You cannot solve that riddle with
additions from an entitlement program.
So I will think about it. I will be glad to do that.
medicare payment review commission
Mr. FRIST. Mr. President, I rise to engage in a colloquy with my
colleague from Delaware, Senator Roth. As chairman of the Finance
Committee, I commend him for guiding this budget process through the
committee with overwhelming bipartisan support and bringing these
issues before the full Senate in a timely manner.
The legislation before us, establishes a new Medicare Payment Review
Commission to replace the Physician Payment Review Commission [PPRC]
and the Prospective Payment Assessment Commission [ProPAC]. The
Medicare Payment Review Commission is required to submit an annual
report to Congress containing an examination of issues affecting the
Medicare Program. The commission will review, and make recommendations
to Congress concerning payment policies under both the Medicare Choice
program and Medicare fee-for-service.
I have heard criticism that the Health Care Financing Administration
[HCFA] does not keep up with the latest medical supply products, even
if they prove to be cost-effective. HCFA has stated its intent to
become a more prudent purchaser. Indeed, that goal requires analysis of
both the cost and quality of various products and requires constant
review of medical developments.
I understand that the new Medicare Payment Review Commission will
have broad authority and should include the ability to review and make
recommendations on procurement reimbursement and reform issues,
including
[[Page S6156]]
the effect, impact and cost implications of competitive bidding,
flexible purchasing and inherent reasonableness on the provision of a
full range of effective medical products and services to Medicare
beneficiaries.
Mr. President, I simply ask my colleague if that is correct?
Mr. ROTH. In response to Senator Frist's question, it is the
committee's intent that the Medicare Payment Review Commission shall
have broad authority to study and make recommendations to Congress on a
variety of issues relating to the Medicare Choice program and the
Medicare fee-for-service program. The committee recognizes that the
previous two advisory committees did not have explicit authority to
study issues relating to reimbursement of durable medical equipment and
medical supplies. However, it is the committee's intent that the
Medicare Payment Review Commission will have broad authority in these
and other areas regarding the review of all Medicare reimbursement
issues.
dsh payments
Mr. FRIST. I would like to take a moment to clarify the intended
meaning of the changes in State allotments for disproportionate share
hospital [DSH] payments as they impact States that have received
waivers to adopt managed care programs statewide, using DSH funds to
help finance expanded care to the uninsured. Two such States are
Tennessee, which initiated the TennCare program in January 1994, and
Hawaii, which has operated the QUEST program since mid-1994.
In these cases, the States combine their DSH allotment and their
regular Medicaid dollars to fund capitation payments to managed care
providers who are responsible for service not only to existing
Medicaid-eligible recipients but to a substantial portion if not most
of the children and adults who would not otherwise qualify for Medicaid
but who do not have coverage under other insurance programs. Direct DSH
payments to hospitals have been essentially eliminated, because the
hospitals and other providers receive payments to cover care to the
uninsured through the waiver program, either from managed care
providers or, in the case of some hospitals, from the State under
supplementary pools.
The committee's legislation provides that DSH payments relating to
services to persons eligible under the State's Medicaid plan must be
made directly to hospitals after October 1, 1997, even where the
individuals entitled to the service are enrolled in managed care plans,
and cannot be used to determine prepaid capitation payments under the
State plan that relate to those services. That provision does not by
its terms apply to States operating under waivers where the DSH funds
are used to fund a broader range of services to the uninsured. I would
like your confirmation of this understanding, for it would be
inconsistent with the TennCare and QUEST programs to apply the new
provision to them.
I also seek your concurrence that the adjustments to State DSH
allocations are not intended to impact on the funds available to these
waiver States to operate their programs. Both Tennessee and Hawaii no
longer use their DSH allotments for DSH payments. As a result, CBO's
estimates showed no impact on those States of the committee's provision
adjusting DSH allotments and payments. That is entirely appropriate,
for these States are subject to limitations on their Medicaid funding
by reason of the budget terms of their waiver. Moreover, they no longer
make DSH payments as we have come to know them, but instead have
developed more efficient means of delivering health services and have
extended them to a broader segment of the population.
Can the chairman confirm my understanding of these two DSH-related
points?
Mr. ROTH. I am happy to confirm the Senator's understanding on both
points. There is no intention to alter the manner of distribution of
funds under demonstration waiver programs as long as those programs are
in effect. Further, we do not intend any change in the budget and
finance provisions of these demonstration waivers, where the DSH funds
are used to expand coverage to the uninsured.
Amendments Nos. 452, 453, and 454, En Bloc
Mr. DOMENICI. I have three amendments that are going to be accepted.
One is for Senators Lieberman, Chafee, Jeffords, Kerrey, Breaux, Wyden
and Kennedy, to require Medicaid managed care plans to provide certain
comparative information to enrollees. One is for Senator Feinstein to
require managed care organizations to provide annual data to enrollees
regarding nonhealth expenditures. And a third is a Craig-Bingaman
amendment to study medical nutrition therapies by using the National
Academy of Sciences to do that.
I send the three amendments to the desk and ask that they be agreed
to en bloc.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report the amendments.
The legislative clerk read as follows:
The Senator from New Mexico [Mr. Domenici] proposes
amendments numbered 452, 453, and 454, en bloc.
The amendments (Nos. 452, 453, and 454) en bloc are as follows:
amendment no. 452
(Purpose: To require medicaid managed care plans to provide certain
comparative information to enrollees)
At the end of proposed section 1941(d) of the Social
Security Act (as added by section 5701), add the following:
``(3) Provision of comparative information.--
``(A) By state.--A State that requires individuals to
enroll with managed care entities under this part shall
annually provide to all enrollees and potential enrollees a
list identifying the managed care entities that are (or will
be) available and information described in subparagraph (C)
concerning such entities. Such information shall be presented
in a comparative, chart-like form.
``(B) By entity.--Upon the enrollment, or renewal of
enrollment, of an individual with a managed care entity under
this part, the entity shall provide such individual with the
information described in subparagraph (C) concerning such
entity and other entities available in the area, presented in
a comparative, chart-like form.
``(C) Required information.--Information under this
subparagraph, with respect to a managed care entity for a
year, shall include the following:
``(i) Benefits.--The benefits covered by the entity,
including--
``(I) covered items and services beyond those provided
under a traditional fee-for-service program;
``(II) any beneficiary cost sharing; and
``(III) any maximum limitations on out-of-pocket expenses.
``(ii) Premiums.--The net monthly premium, if any, under
the entity.
``(iii) Service area.--The service area of the entity.
``(iv) Quality and performance.--To the extent available,
quality and performance indicators for the benefits under the
entity (and how they compare to such indicators under the
traditional fee-for-service programs in the area involved),
including--
``(I) disenrollment rates for enrollees electing to receive
benefits through the entity for the previous 2 years
(excluding disenrollment due to death or moving outside the
service area of the entity);
``(II) information on enrollee satisfaction;
``(III) information on health process and outcomes;
``(IV) grievance procedures;
``(V) the extent to which an enrollee may select the health
care provider of their choice, including health care
providers within the network of the entity and out-of-network
health care providers (if the entity covers out-of-network
items and services); and
``(VI) an indication of enrollee exposure to balance
billing and the restrictions on coverage of items and
services provided to such enrollee by an out-of-network
health care provider.
``(v) Supplemental benefits options.--Whether the entity
offers optional supplemental benefits and the terms and
conditions (including premiums) for such coverage.
``(vi) Physician compensation.--An overall summary
description as to the method of compensation of participating
physicians.
____
amendment no. 453
(Purpose: To require managed care organizations to provide annual data
to enrollees regarding non-health expenditures)
At the end of proposed section 1852(e) of the Social
Security Act (as added by section 5001) add the following:
``(6) Annual report on non-health expenditures.--Each
Medicare Choice organization shall at the request of the
enrollee annually provide to enrollees a statement disclosing
the proportion of the premiums and other revenues received by
the organization that are expended for non-health care items
and services.
At the end of proposed section 1945 of the Social Security
Act (as added by section 5701) add the following:
``(h) Annual Report on Non-Health Expenditures.--Each
medicaid managed care organization shall annually provide to
enrollees a statement disclosing the proportion
[[Page S6157]]
of the premiums and other revenues received by the
organization that are expended for non-health care items and
services.
____
amendment no. 454
(Purpose: To provide for a study and report analyzing the short term
and long term benefits and costs to the medicare system of coverage of
medical nutrition therapy services by registered dietitians under Part
B of title XVIII of the Social Security Act)
On page 412, between lines 3 and 4, insert the following:
SEC. 5105. STUDY ON MEDICAL NUTRITION THERAPY SERVICES.
(a) Study.--The Secretary of Health and Human Services
shall request the National Academy of Sciences, in
conjunction with the United States Preventive Services Task
Force, to analyze the expansion or modification of the
preventive benefits provided to medicare beneficiaries under
title XVIII of the Social Security Act to include medical
nutrition therapy services by a registered dietitian.
(b) Report.--
(1) Initial report.--Not later than 2 years after the date
of the enactment of this Act, the Secretary shall submit a
report on the findings of the analysis conducted under
subsection (a) to the Committee on Ways and Means and the
Committee on Commerce of the House of Representatives and the
Committee on Finance of the Senate.
(2) Contents.--Such report shall include specific findings
with respect to the expansion or modification of coverage of
medical nutrition therapy services by a registered dietitian
for medicare beneficiaries regarding--
(A) cost to the medicare system;
(B) savings to the medicare system;
(C) clinical outcomes; and
(D) short and long term benefits to the medicare system.
(3) Funding.--From funds appropriated to the Department of
Health and Human Services for fiscal years 1998 and 1999, the
Secretary shall provide for such funding as may be necessary
for the conduct of the analysis by the National Academy of
Sciences under this section.
Mr. CRAIG. The amendment directs the Secretary of Health and Human
Services to request a study, through the National Academy of Sciences,
on the short-term and long-term costs and benefits to the Medicare
system of coverage of medical nutrition therapy services provided by
registered dietitians. The Secretary is directed to provide funding for
this study from the HHS appropriations for fiscal year 1998 and 1999.
The report shall be submitted to the Finance and Ways and Means
Committees no later than 2 years after the date of enactment.
Essentially the same language was included in the House version of
the budget reconciliation bill. The House version included broader
coverage, that is, covering dental care and bone mass measurement.
The PRESIDING OFFICER. Is there further debate on the amendments?
Without objection, the amendments are agreed to.
The amendments (Nos. 452, 453, and 454) en bloc were agreed to.
Mr. DOMENICI. I move to reconsider the vote.
Mr. LAUTENBERG. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Amendment No. 455
(Purpose: To conform the Energy Title to the Bipartisan Budget
Agreement)
Mr. DOMENICI. Mr. President, I send this amendment on behalf of
Senator Murkowski to the desk in compliance with the unanimous consent
request for consideration tomorrow.
The PRESIDING OFFICER. The clerk will report the amendment.
The legislative clerk read as follows:
The Senator from New Mexico [Mr. Domenici], for Mr.
Murkowski, proposes an amendment numbered 455.
On page 130, line 3, strike ``2002'' and insert ``2007''.
medicare provisions
Mr. HATCH. Mr. President, late last week the Senate Finance Committee
completed work on one of the most significant and important pieces of
legislation considered in the U.S. Congress in recent memory. By a vote
of 18 to 2, the Committee approved its portion of the Budget
Reconciliation Act of 1997, S. 947, the bill we are debating today.
As a member of the Finance Committee, I can vouch for the hard work
that went into the development of this historic legislation. It has not
been an easy task by any stretch of the imagination.
The bill is not perfect. But it is a good start. And I hope it will
get even better as it moves forward in the legislative process.
And, I want to take this opportunity to commend the chairman of the
Finance Committee, Senator Roth, and the ranking minority member,
Senator Moynihan, for their outstanding leadership in forging a
consensus on what has been one of the most contentious issues presented
to the committee since I have been a member.
The committee was presented with budget reconciliation instructions
earlier approved by both the House and Senate and tasked to provide for
significant changes in federal spending and program authorizations
principally in the Medicare and Medicaid programs.
As my colleagues well know, these two entitlement programs are
currently growing at unsustainable levels. Even the President's own
handpicked members on the Medicare Board of Trustees reported as early
as April 1995 that the ``Medicare program is clearly unsustainable in
its present form'' and that Medicare Part A will be bankrupt in the
year 2001 unless structural changes are implemented soon.
The legislation currently before the Senate attempts to address the
numerous and oftentimes conflicting issues associated with reducing the
rate of growth in Medicare expenditures while preserving the level of
services available to current and future beneficiaries.
The one message that we must convey to our constituents is that we
have preserved the needs of Medicare beneficiaries while addressing the
fiscal imperative of bringing some discipline in Medicare spending.
Both objectives are not mutually inconsistent.
Not only have we restrained Medicare growth over the next five years
to a point that preserves fiscal integrity for now and the future, but
we have provided beneficiaries with greater choices of health care
plans. ``Medicare Choice'' will now make it possible for beneficiaries
to have greater options in how they want their health care provided.
In fact, not only will this legislation provide more options for
beneficiaries, it will offer them more information about those options.
Better Information about Coverage Options: One provision of the bill
requires that beneficiaries be provided with information about the
extent to which they may select the provider of their choice, a concern
of many elderly. The need for this provision was pointed out to me by
the Utah Psychological Association. The measure was included in the
1995 Balanced Budget Act, and I am pleased that it was carried over to
the bill we are considering today.
Another information provision was suggested to me by Utah Governor
Mike Leavitt, who correctly pointed out that states are making
information on managed care available to beneficiaries of state-funded
programs. Governor Leavitt suggested that the Federal government be
required to coordinate the information it provides with state efforts;
that amendment is included in the bill today at my request.
The traditional fee for service systems, which all beneficiaries have
come to know, will still be there for those who wish to choose that
system of health care delivery. But we are also going to provide more
managed care options such as Health Maintenance Organizations and
Preferred Provider Organizations as well as Medical Savings Accounts to
beneficiaries who desire to participate in those plans.
No longer will America's seniors be limited to one or two choices in
health care. They will now have greater choices which will lead to more
competition, a greater diversity of services especially in rural areas,
and increased savings to the federal government which is fundamental to
the overall well-being of the Medicare program.
Home Health and Skilled Nursing Facilities: I am particularly pleased
with the provisions pertaining to home health care and skilled nursing
facilities or SNFs. In fact, the legislation reported by the Finance
Committee incorporates many of the important provisions contained in
legislation I introduced, S. 913, the Home Health Care Prospective
Payment Act, and S. 914, the Skilled Nursing Facility Prospective
Payment Act.
I have long supported efforts to enhance the quality and delivery of
care provided by home health care agencies
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and skilled nursing facilities. These organizations perform extremely
valuable services to our nation's elderly and disabled citizens. And,
as our population increases in age, the role of these services in our
society will become an even more critical component in the provision of
health care.
It was also apparent from our hearings that the costs associated with
home health care and SNFs have been rising at a disproportionately
higher level compared to other components of the Medicare program.
Indeed, part of this increase can be attributable to the fact that most
people prefer to be treated in the familiar surroundings of their home.
Accordingly to the General Accounting Office, ``After relatively
modest growth during the 1980's, Medicare's expenditures for SNFs and
home health care have grown rapidly in the 1990's. SNF payments
increased from $2.8 billion in 1989 to $11.3 billion in 1996, while
home health care costs grew from $2.4 billion to $17.7 billion over the
same period.'' Over that period, annual growth averaged 22 percent for
SNFs and 33 percent for home health care, the fastest growing
components in the Medicare program.
Unquestionably, the rate of growth in home health care led to
considerable discussion over the need for a new, minimal copayment for
home health visits as a measure to reduce over utilization. The
committee approved a capped $5.00 copayment per visit which will be
billable on a monthly basis and limited at an amount equal to the
annual hospital deductible under Part A.
I am mindful that we do not want to impose additional costs
particularly on the poor. But there was near universal agreement that
some method was needed to curtail the seemingly unchecked utilization
of these services.
This is an issue we will have to monitor closely as the program is
implemented recognizing the administrative difficulties in collecting
these co-payments as well as the impact on beneficiaries.
Home Health and Skilled Nursing Facilities Prospective Payment
System: Perhaps the most significant reform that is included in both
pieces of my legislation and which is now included in the Finance bill
are the provisions for a prospective payment system for both home
health and skilled nursing facilities. This provision will help create
the proper and needed financial incentives for providers to behave in a
more cost effective manner while protecting the quality and continuity
of care for beneficiaries.
We have learned a great deal about Medicare reimbursement since we
passed the Prospective Payment System for hospitals in 1983. We know
the value of a proper transition so providers can manage their agencies
toward a permanent system. We also know that we can model a payment
system that encourages providers to manage costs and utilization
better. We also realize that moving to a new reimbursement system is a
massive undertaking.
I believe the Finance bill moves in the right direction to ensure
cost-effective care for millions of beneficiaries today, and well into
the next century.
Rural Health Care: The issue of health care in our rural communities
was also an item which received considerable attention. As we begin to
provide Medicare beneficiaries with greater choice in the delivery of
their health care, it is apparent the financial incentives to providers
to development of these systems in rural communities simply do not
exist.
Accordingly, it was necessary to change the manner and level of
reimbursement for managed care organizations that wish to provide
services in nonurban areas.
In 1983, Medicare began making payments to qualified ``risk-
contract'' HMOs or similar entities that enrolled Medicare
beneficiaries. The intent was to give Medicare beneficiaries the
opportunity to enroll in HMOs as a more cost effective alternative to
fee for service health care.
In effect, Medicare makes a single monthly capitated payment for each
of the organization's Medicare enrollees. This payment equals 95
percent of the estimated ``Adjusted Average Per Capita Cost [AAPCC] of
providing Medicare services to a given beneficiary under a fee for
service system.
The committee legislation proposes to raise the Medicare payment for
each year through 2002 which will have the effect of providing the
necessary financial incentives for managed care organizations to
develop and sell products to beneficiaries in rural communities. This
will be particularly beneficial to residents of my state which has a
strong managed care presence in our urban areas but, as yet, little
penetration in rural locations.
Debate on the AAPCC was extremely lively in Committee; it is a hard
task for set payment levels at an amount that will provide incentives
for managed care, but which will also encourage cost-efficiency with no
diminution of services for the elderly and disabled.
I want to comment on two issues associated with the AAPCC that will
be before the conference committee. The first is the transition from a
locally based payment rate to a rate that is decoupled from fee-for-
service reimbursement. The Medicare Equity and Choice Enhancement Act
authored by Senator Grassley establishes a five-year phase-in of a 50/
50 blend of the input price-adjusted national average rate with an
area-specific rate. I think this is a fair transition and one which I
hope will be preserved in conference.
The second issue associated with the AAPCC is removing from the
calculation payments for graduate medical education and
disproportionate share hospitals. That change, reflected in the Finance
bill, will allow a more equitable calculation of the AAPCC, one which
will help ensure that teaching hospitals receive the reimbursement they
need.
On the issue of reimbursement for managed care, I continue to remain
disturbed about the bill's provision which, in essence, discounts by
five percent payments for new beneficiaries. I fully appreciate the
need to find a ``risk adjuster'' which will provide us with a better
measure of the cost per beneficiary, but to me the 5 percent discount
is arbitrary. It will penalize organizations that are doing exactly
what we are urging them to do: enroll new beneficiaries in managed
care. This is something at which I hope the conferees will take a
closer look.
Qualified Medicare Beneficiaries: Another payment issue, that of
qualified Medicare beneficiaries (or ``QMBs'') is of great concern to
me.
Current law requires Medicaid to pay Medicare cost-sharing charges
for individuals who are eligible for both Medicare and Medicaid
assistance. These individuals are ``dual eligibles'' and QMBs who have
incomes less than 100% of the federal poverty level (FPL) and meet
other requirements.
Medicaid frequently has lower payment rates for services than would
be paid under Medicare. Medicaid program guidelines permit states the
flexibility to pay either (a) the full Medicare deductible and
coinsurance or (b) cost sharing only to the extent that the Medicare
provider has not received the full Medicaid rate.
Several federal courts, including the 2nd, 3rd, 4th and 11th Circuit
Courts of Appeals, have interpreted current law as allowing providers
to claim Medicare cost sharing for QMBs and dual eligibles in excess of
Medicaid payment rates. Therefore, some state Medicaid programs are now
reimbursing Medicare providers to the full allowable rates.
With the exception of one trial court decision in California, the
courts have overruled the HCFA policy that does not require the full
Medicare payment.
I strongly prefer the outcome of the appellate courts and oppose the
particular provision of the Finance Committee version of the
Reconciliation bill that acts to reverse the four Federal Courts of
Appeals decisions and will allow lower reimbursement for QMBs and dual
eligibles.
My position is consistent with the first of the principles adopted by
the Chairman in the Medicaid mark: ``Enhance the ability of the Federal
and State government to meet the health care needs of vulnerable
populations.''
QMBs and dual eligibles are poor, and mostly elderly, individuals
that are dependent on both Medicare and Medicaid in order to receive
quality health care.
Dual eligibles and QMBs are the very elderly (greater than 85 years
old) and the very sick. For example, about 40 percent of QMBs have a
cognitive or mental impairment (including many with out difficult
chronic conditions such as stroke and Alzheimer's).
Minority group Medicare beneficiaries are more likely to be dual
eligibles. Compared with the general Medicare population, dual
eligibles are more likely to be women, living alone.
The QMB/Dual Eligible population is financially dependent on Medicaid
to provide the needed supplemental insurance coverage to Medicare.
The bill, as reported by the Finance Committee, allows states to act
in a fashion that would deny providers the full Medicare level of
benefits for these particularly needy QMB and dual eligible
beneficiaries, and will unintentionally fray the safety net precisely
where it needs to be strengthened.
For example, a recent study by the
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Physician Payment Review Commission reported that 43 state Medicaid
programs identified serious problems in maintaining adequate levels of
physician participation chiefly due to already low payment rates.
In fact, the study found that, over a 15 year period, sate spending
on physician services per Medicaid recipient failed to keep pace with
Medicare by more than a threefold factor.
The better policy is to adhere to the precedent of the great majority
of courts that have considered this issue and continue to compel these
payments for these beneficiaries.
Frankly, it is difficult to see how the provision in the Finance bill
to lower reimbursement for QMBs and dual eligibles will result in
anything other than in undermining the willingness of providers to
treat QMBs and dual eligibles.
The Second Circuit, one of the several courts that have ruled in
favor of the framework I find preferable, reviewed the relevant laws
and legislative history in concluding: ``* * * Congress sought to avoid
a wealth-based, two tiered system of health care for the elderly and
certain disabled and indeed wanted to integrate all of those who were
Medicare-eligible into the existing health care system.''
As the 11th circuit said in the Smith Case, 36 F.3d 1074: ``we reject
* * * attempts to wring ambiguity from a statute where there is none.''
The bill as reported by the Finance Committee is ambiguous, but is
unambiguously a poor policy and will certainly affect the care received
by those many physically frail QMBs and dual eligibles negatively.
I strongly prefer the House position on this particular issue because
by not adopting the Senate Finance Committee policy it protects
individuals whose health and income status place them in a precarious
medical situation.
As the Washington Post editorialized, on June 16, 1997, on the
problem of the dual eligibles: ``* * * suddenly Medicare, which was set
up to be a uniform, universal system for all the elderly and disabled,
becomes a two-tier system, with different levels of payment
and therefore, in the long run, quite different levels of care for the
better and the less well-off.''
We should not act to decrease access to quality health care for poor,
sick and predominantly old individuals. We should retain and enlarge,
not reverse, a policy on QMB and dual eligible reimbursement that many,
including four Federal appellate courts, have concluded is consistent
with the letter and spirit of both Medicaid and Medicare.
Chiropractic Care: Turning to another issue of great interest to me,
that of chiropractic care for Medicare beneficiaries, I am hopeful that
the conferees will be able to approve Representative Crane's provision,
which I had hoped to offer in Committee.
Chiropractic services are currently provided in the Medicare program;
however, the coverage is extremely limited to treatment by means of
manual manipulation of the spine. Moreover, current law requires
chiropractors to obtain an x-ray before payment will be made even
though Medicare will not pay chiropractors to take the x-ray.
I had initially planned to offer an amendment identical to the
language in the House Ways and Means Committee that would remove the
requirement for x-rays as a condition of coverage and payment of
chiropractic services. I would note that this provision also had the
support of the Administration and was included in their budget proposal
as well.
Unfortunately, the Congressional Budget Office scored the provision
as costing $600 million over a five-year period. And, although it was
included in the Ways and Means bill as I previously mentioned, the
Finance Committee spending parameters did not allow for its inclusion
principally due to the cost estimate.
Accordingly, I offered an amendment proposing a two-year
demonstration project to study the cost effectiveness of removing the
x-ray requirement as well as allowing doctors of chiropractic to order
and perform x-rays in both a fee for service and managed care setting.
I am grateful that Chairman Roth indicated he would conditionally
accept my demonstration amendment on the basis that a final CBO would
be de minimis. With that understanding, the committee unanimously
approved my amendment.
I was astonished to learn yesterday that, in fact, the CBO scored my
amendment at $900 million--a third more than the entire provision in
the House! I have asked for a complete justification of this figure,
but pending that review, the Committee had no choice but to drop my
amendment.
I firmly believe that affording greater access to chiropractic
services by beneficiaries will not only result in reduced Medicare
expenditures but will also reduce the performance of needless surgery
to correct back problems.
I hope that as this issue is addressed in the conference committee,
that the Ways and Means language will prevail, and will, therefore,
bring a more pragmatic approach to the delivery of health care to our
seniors.
Durable Medical Equipment: On reimbursement for durable medical
equipment (DME), I am happy to report that the committee agreed to
include an amendment I proposed which would allow beneficiaries to buy
more expensive equipment than that allowable under Medicare and pay the
extra amount out-of-pocket. This is an amendment originally proposed by
our former colleague, Senator Bob Dole, and I think it makes a good
deal of sense. Since this provision was contained in the Balanced
Budget Act of 1995, I am extremely optimistic it will become law this
year.
Orthotics and Prosthetics: On the topic of reimbursement for
orthotics and prosthetics (O&P), I am grateful that the bill includes
an annual update of at least one percent over the coming five years.
O&P providers design, fit, and fabricate braces and limbs for persons
with physical disabilities. As such, this small industry is distinct
from DME. O&P suppliers have much less control over the costs of their
program than DME suppliers, given that it is hard to imagine ``induced
demand'' for O&P equipment. Consequently, I hope that any provisions
undertaken to restrict the growth of DME, which I recognize is a
concern, will not be attributed to O&P as well.
Home Oxygen Services: One of the most contentious, and for me, most
troubling, issues associated with this bill was how to set the
appropriate reimbursement level for home oxygen services.
None of us want to see quality diminished for this vital service.
That is clear.
But the Committee was presented with very compelling evidence that
payment levels are too high.
For example, the General Accounting Office report comparing oxygen
services in the Veterans Administration to those under Medicare
concluded that the Health Care Financing Administration is paying
almost 40 percent too much for home oxygen.
I will be the first to admit that I do not know what the exact number
should be. Nor is there any statistical measure that can be reliably
employed.
I will say that there was virtual unanimity that the current payment
levels are too high. However, given the need to ensure continuing high-
quality services for beneficiaries, I am much more comfortable with the
House provision. Serious questions have been raised about the severity
of the Finance recommendation and the effect that it could have on
small, rural providers such as many who operate in my home state of
Utah. If we are to err, I would rather err on the side of quality.
Fraud and abuse: I would also like to comment briefly regarding the
new fraud and abuse provisions in the bill. The bill, as amended by
Senator Graham, contains new, significant and, in some respects,
untested anti-fraud and abuse penalties including additional Medicare
exclusions and civil monetary penalty authority.
I believe that we need effective fraud and abuse enforcement tools. I
just want to be sure that these provisions do not have any unintended
consequences or implications that would penalize innocent parties who
are following the letter of the law.
Many of these provisions found in the Finance bill as amended are
actually based on provisions contained in the Administration's fraud
and abuse legislation introduced earlier this year, and on which no
hearings were held in the Senate.
As a general rule, we in the Congress should not act without the full
and open benefit of hearings so that all parties have an opportunity to
comment,
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and so that legislation can be modified as appropriate.
While I am not going to oppose these provisions, I do have
reservations about some of them. And, I am encouraged to learn that the
House intends to address some of these in conference.
The expanded authority with respect to the imposition of civil
monetary penalties was particularly troublesome.
The two provisions at issue included (1) the addition of a new civil
monetary penalty for cases in which a person contracts with an excluded
provider for the provision of health care items or services, where that
person knows or should know that the provider has been excluded from
participation in a federal health care program; and, (2) the addition
of a new civil monetary penalty for cases in which a person provides a
service ordered or prescribed by an excluded provider, where that
person knows or should know that the provider has been excluded from
participation in a federal health care program.
While, certainly, no provider should contract with or furnish
services ordered or prescribed by another provider whom they know to be
excluded, the provisions also would subject providers to civil monetary
penalties where they ``should know'' that another provider is excluded.
This ``should know'' standard has the potential to create anxiety
among providers. What would rise to the level that a provider ``should
know?'' In my view, these provisions target the wrong providers--they
punish the provider who is serving the patient based on a legitimate
and legal prescription, rather than the excluded provider who is at
fault.
For example, retail pharmacies fill thousands of prescriptions per
month based upon prescriptions from numerous prescribers. It is not
hard to imagine a situation in which a pharmacy would be unwilling to
fill an emergency prescription for a sick child late at night in a
rural community. The pharmacist might not have enough information about
the prescribing doctor to risk a $10,000 fine.
I think it is extremely important to clarify our expectations on this
issue and others within the CMP section. Accordingly, I am pleased that
Chairman Roth agreed to the inclusion of report language that, in
effect, clarifies that the committee ``does not intend these two new
civil monetary penalties--for arranging or contracting with an excluded
provider, or for providing items or services ordered or prescribed by
an excluded provider--to impose an affirmative burden on providers to
find out if another provider has been excluded from a federal health
care program. Rather, only in instances where a provider acts in
deliberate or reckless disregard of another provider's excluded status
may the government seek to impose civil monetary penalties under these
provisions.''
Community Health Centers: Before turning to the final issue I wish to
discuss, I just wanted to take a moment to mention my appreciation that
Chairman Roth agreed to continue the current reimbursement system for
Federally-Qualified Health Centers.
FQHCs are the best way I know to deliver high-quality, low-cost care
to underserved areas. They are increasingly being squeezed in today's
managed care environment, in large part because they are providers of
last resort and have no insurers on which to shift costs if they are
underpaid. Studies have indicated that Community Health Centers, for
example, are only receiving about half of their costs from managed care
entities. Faced with that situations, CHCs have little recourse, and
can only hope that their appropriated funds make up the difference.
This is a situation that I intend to follow closely. No one likes to
argue for cost-based reimbursement; that is not a particularly
effective payment mechanism. But, to require CHCs and Rural Health
Clinics (RHCs) to provide services at less than cost is also
inefficient, and stifles the development of a cheaper alternative form
of health care delivery which is proven to be high quality. There is no
easy answer here, but let us not undercut these great little providers
while we seek a solution.
Children's Health Initiative: Finally, I want to close by commenting
on what may be the most important provision of this bill: the
children's health insurance initiatives.
Let me just say that a lot of progress has been made on the issue of
children's health in the 105th Congress.
I believe that, when the history of this Congress is written, two of
the most important chapters will address the balanced budget agreement
and the children's health initiative. It seems only fitting that this
budget reconciliation bill that brings the budget into balance includes
the key funding and program provisions on children's health insurance.
Our kids will have a healthier future in both of these important
respects.
Let us be clear why we take these major actions to include $24
billion in new spending over the next 5 years to pay for children's
health insurance.
An estimated 10 million American children are without health
insurance.
This amounts to about 25 percent of the nation's uninsured
individuals.
In my state of Utah, about 10 percent of our children lack health
insurance. This amounts to about 55,0000 uninsured children in my
state.
Because the Medicaid program is targeted to provide health care to
poorest of the poor, it is important to understand that many of the
uninsured children in our nation come from working families with
incomes just above the poverty level.
In fact, about 88 percent of these uninsured children come from
families where at least one parent works.
What I have been trying to do over the last few months is to help
these children from America's working families.
That's why I teamed up with Senator Ted Kennedy to introduce the
Children's Health Insurance and Lower Deficit Act (CHILD). In essence,
this twin legislation, S. 525 and S. 526, calls for an increase in the
federal tax on tobacco products in order to finance a voluntary program
of state block grants for children's health insurance and to provide
for deficit reduction.
Because of our well-recognized divergent philosophies, Senator
Kennedy and I had hoped that, by drafting compromise legislation, we
would be able to attract support for our legislation across the
political spectrum.
By and large, we have been successful with working with advocacy
groups like the Children's Defense Fund and the Child Welfare League to
raise awareness of this issue. And, I believe we should give credit to
these organizations--as well as to health care providers such as
children's hospitals and American Academy of Pediatrics--for their
tireless and long-standing efforts to highlight the health care needs
of children in our country.
And, although I do not see eye to eye with Senator Kennedy on all, or
even most, matters, I must commend my friend from Massachusetts for all
of his work and vision on this important issue. There is no more
tenacious advocate in the United States Senate for a cause he feels
strongly about than Senator Kennedy.
The Senator from Massachusetts and I worked hard to arrive at a
compromise that would be attractive for many. As an ardent anti-tax,
anti-big government conservative, the critical tasks were to devise a
program that did not centralize decisionmaking in Washington and that
did not have the potential of growing out of control. It was also
essential that it be paid for.
While I am generally loathe to increase taxes, the adverse health
effects of tobacco and their concomitant costs to society, not to
mention the costs to public programs, made raising the tobacco tax a
``two-fer.''
Tobacco is a killer. I don't know of any other product that, when
used as directed, will kill you.
Tobacco accounts for an estimated 419,000 American deaths annually.
In 1993, cigarettes killed more of our fellow citizens than AIDS,
alcohol, car accidents, fire, cocaine, heroin, murders, and suicides
combined.
About 50 million Americans smoke.
About 1 in 5 deaths are smoking related.
4 of 5 smokers begin by age 18. About half by age 14.
Each day 3000 young Americans begin to smoke.
Experts believe that tobacco costs society $100 billion annually,
including $50 billion in direct health care costs.
Of this $50 billion, there are $10 billion in annual costs to
Medicare; $5 billion in Medicaid; $4.75 billion to other federal
programs; and, $17 billion in increased insurance premiums.
Not only does tobacco kill, it also results in a tremendous amount of
unnecessary health care costs.
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When all is said and done, use of tobacco products comprises the
number one preventable public health threat.
A strong argument can be made that it is this unique public health
threat posed by tobacco that forms the basis of the justification for
raising the tobacco tax.
The American public overwhelmingly approves of the idea of financing
children's health programs through an increased tobacco tax.
An April 26, Wall Street Journal/NBC poll asked the public its
opinion of financing state block grants for children's health care
through an increase in the tobacco tax.
72 percent of Americans agreed with this proposal.
And this support cuts across almost every demographic category. For
example, more than 50 percent of smokers agree with the idea of
increasing tobacco taxes to pay for children's health insurance.
So the case against tobacco and for a tobacco users tax increase is
strong.
Overall, I am pleased with the children's health provisions of the
reconciliation bill as reported by the Finance Committee.
Those involved in the efforts over the last few months to increase
materially the funding for children's health insurance should take
credit for the addition of $24 billion in new funding over the next
five years.
Few could have thought that we could have come so far so fast in this
effort.
I know that there are some that think we have, in fact, gone too far,
too fast.
But I think that these critics who deny that we can utilize this
average $4.8 billion in funding wisely and prudently are just wrong.
If all of the states, for example, exercised the Medicaid option of
the block grant we know, applying the $860 per person average federal
contribution for a Medicaid covered child, about 5.58 million children
could be covered. This is barely half of our nation's uninsured
children.
There are a number of ways to look at such a statistic. But in this
case, I think the glass is clearly half full. If we take care of more
than half of the uninsured children in our nation we will have achieved
a major accomplishment.
It is also possible that if states chose to exercise the block grant
option, we will be able to take care of more kids than possible under
Medicaid.
At this point, no one can know with certainty how many states will
use Medicaid and how many will use the block grants.
We do not know what eligibility criteria and financial requirements
that states implementing the block grants will chose to adopt. All of
these factors will affect how many children will be covered.
But before we get too caught up in focusing on the number of children
covered, we must not lose sight that it is also important to see what
benefits that covered children are going to receive.
The Finance Committee heard expert opinion from the Administrator of
the Health Care Financing Administration, Dr. Bruce Vladeck, that it
costs about $1000 per child for a quality children's health insurance
plan.
So even with the increased flexibility of the block grants, do not be
misled to believe that $4.8 billion per year is somehow too much money.
Even when we add in the required state matching rate and co-insurance
and co-payment requirements, it is hard to project that even two-thirds
of the nation's uninsured children will be taken care of by this $4.8
billion a year.
Also, inflation in the health care sector will eat into the
purchasing power of the average $4.8 billion per year allocation.
As I argued last week in the Finance Committee, I would have
preferred to get the entire $20 bill in children's health insurance
funding over the $16 billion already set aside in the budget
resolution. I pointed out that, taken together, these funds could have
taken care of the projected 7 million of the nation's uninsured that
live in families with incomes under 240 percent of the federal poverty
level. This would represent about 70 percent of the uninsured children
in this country.
While I was not able to persuade the full Finance Committee to
allocate the full Hatch-Kennedy legislation on top of the initial $16
billion set aside, I am pleased that the Committee did agree to the
essence of the Hatch-Kennedy CHILD legislation by imposing an increased
tobacco tax to finance children's health block grants to states.
Frankly, I think that one of the great watershed events of the return
of Republican majorities in both chambers of the Congress is that the
days of tax and spend are over in favor of a more fiscally responsible
climate in which new taxes are seldom proposed and, if proposed,
scrutinized with the highest degree of skepticism.
This is tough medicine but it is what we have to do to set our fiscal
house back in order. We need to let working Americans keep more of
their hard-earned money by looking for ways to tax and spend less of
their income.
So, would I have preferred more money for children's health in the
Finance Committee bill? Yes.
But, I would much more rather be in the position of having my
colleagues on the Committee nearly unanimously support a tobacco tax
that will generate, in part, an additional $8 billion over five years
for children's health that I would like to be in an uphill, all but
hopeless, battle to win a major floor amendment on a fast moving
reconciliation bill.
To me, the $8 billion in hand was more certain than the $20 billion
in the bush--so to speak. Moreover, I believe that the positive,
bipartisan support for the Finance Committee provisions bodes well for
both the success for the provisions and the program itself. The last
thing I want is to make children the subject of an acrimonious debate
over concepts and details.
This, of course, assumes that the Senate funding level and tobacco
tax structure prevails in conference.
I have told my colleagues on the Finance Committee, some of whom--it
is a matter of public record--are very much opposed to this source of
tax revenue and this funding level, that if the Senate tobacco tax and
children's health funding levels are changed in conference then I will
pursue, in every way that I know how, more funding. My goal is to get
this done, not just put out a press release about it.
Let me also say that it will be my firm position that any funds
allocated toward children's health from the so-called ``global tobacco
settlement'' should be considered as distinct from, and additive to,
the funds earmarked for children's health in the Senate reconciliation
bill.
One of the major reasons that I decided to compromise on the amount
of funds that I would seek from the Finance Committee in the
reconciliation process is because I was aware of the possibility that
additional funding may be available from the global settlement.
But let's not kid ourselves here. The global settlement faces a tough
road as it wends its way through the Administration, Congress, the
Courts, and--perhaps most importantly--the court of American public
opinion.
Suffice it to say that I will strenuously resist any effort to reduce
in conference or subsequently any of the children's health funding
already secured. But, I also believe that my colleagues in both the
House and Senate will see the merit in the provisions adopted by the
Finance Committee. The need is compelling; the compromise program is
reasonable; and it is paid for by taxing a commodity that not a single
person can defend as worthwhile.
While I did not get everything that I wanted in this legislation, it
is seldom the case that any one legislator gets all that he or she
wants. Since this is not a monarchy but a democracy, compromise and
consensus building is what distinguishes our form of government.
Given the original philosophical lines of scrimmage, I think the
children's health provisions represent a good compromise. The bottom
line is that we can all take pride in this provision.
The advocates for children and public health should take credit for
successfully raising the concern about the problem of uninsured
American children to the level of concern that a major funding
commitment--$24 billion over 5 years--was included in an otherwise very
frugal budget balancing bill. That's a big achievement that will
benefit literally millions of American children into the next century.
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The governors should take credit for the fact that the final package
approved by the Finance Committee gives the states a great deal of
flexibility in devising programs and eligibility criteria that will
work best in their respective states. I am confident that the governors
will use their creativity to establish programs that deliver high
quality health care to the children of working families.
Let me hasten to add that I recognize there are some provisions in
the bill of which the children's advocates and the governors do not
approve. I understand those concerns. We all want to provide the best
possible health care to our kids. But we also want the money to go as
far as possible. It is a balance, and we have endeavored to set the
scales right.
But politics is the art of the possible. Only because of the debate
that we have engaged in over these last few months--a debate comprised
of many perspectives and many heated moments--it will now be possible
to help millions of American children to reach adulthood in good
health.
I see this as both good public health and evidence that Congress is
capable of working constructively to address the nation's business.
conclusion
In closing, Mr. President, I count myself among those who have worked
hard for a balanced budget. As much as each of us wished otherwise,
balancing the budget is not some idle task. Indeed, it is the most
difficult of endeavors. We are faced with hard choices, choices that
have serious consequences for citizens everyday.
Again, if I were the only senator writing this bill, I would have
written some provisions differently. I would have more tax relief, for
example. I would have spread spending reductions more evenly over the
five-year period.
And, if I can't have everything I want, President Clinton cannot have
everything he wants.
But, on balance, I think that this bill lives up to its goals.
Senators on both sides of the aisle, but especially the Senator from
New Mexico, deserve to be commended for developing this legislation.
When we pass this bill, Congress will have passed another balanced
budget bill. We will have preserved Medicare for the foreseeable
future, and we have made a considerable downpayment on our children's
health. And that is the most important legacy we can leave to our
country's future.
I urge President Clinton to give this bill his unequivocal support.
medicare coverage of oral anti-cancer drugs
Mr. SANTORUM. Mr. President, the budget reconciliation bill before us
presents a historic opportunity to balance the budget, provide long
overdue tax relief for families and ensure that important programs such
as Medicare will be here for the next generation of Americans. I intend
to support this legislation, but first, I would like to make a few
comments about the Medicare provisions.
We all know that Medicare is in serious trouble. For 2\1/2\ years, we
have been hearing that Medicare is going bankrupt. Today, we have an
opportunity to do something to put Medicare back on the path to
solvency. This bill calls for reasonable structural reforms of the
Medicare program. It extends Medicare's solvency and promotes more
choices for seniors--much like Members of Congress enjoy under the
Federal Employee Health Benefits plan. If we truly care about
Medicare--if we really mean it when we say that Medicare must be here
for our children and grandchildren, then it's not enough to just talk
about saving the program. We need to take action. And yes, we need to
ask the baby boomers and today's young people--who I might add are
already paying for a program which will not benefit them if we continue
the status quo--to accept some structural changes that are absolutely
necessary to protect and preserve this program. I commend those who
have had the courage to come to the floor and explain these reforms in
spite of what the special interest groups say. On behalf of the next
generation, I thank my colleagues who are constructively working to
solve Medicare's problems before it is too late.
Mr. President, reforming Medicare is not just about saving money. It
is also about improving seniors' choices in health plans and treatment
options. One way to achieve these goals is by allowing Medicare
reimbursements for orally administered anti-cancer drugs which cannot
be produced in intravenous form (I.V.). Unfortunately, this change was
not included in the bill before us. After considering that orally
administered anti-cancer drugs would simultaneously enhance the quality
of life for cancer patients and save a significant amount of money, I
hope the conferees will include this proposal in the final
reconciliation bill.
Medicare's current policy with respect to coverage of anti-cancer
drugs is outdated. Medicare pays for injectable and intravenous anti-
cancer drugs. Several years ago, Medicare law was amended to also allow
coverage for oral anti-cancer drugs, but only if they are available in
intravenous form. This policy recognized that if a drug comes in both
an oral and an I.V. form, it makes sense to provide coverage for the
cheaper oral version instead of requiring patients to take the much
more expensive and often more toxic I.V. version. Since then,
researchers have developed oral anti-cancer drugs that are just as
effective, easier to administer, and have fewer side effects, but are
not--and cannot be--produced in I.V. form. Because they have no
intravenous formulation, Medicare does not cover them.
Efficacy, safety, and quality of life should be the primary factors
when a patient and physician select the appropriate cancer treatment.
Unfortunately, current Medicare policy forces many patients to make
reimbursement the overriding factor. As a result, the patient is
subjected to procedures which are more invasive, more expensive, and
often less appropriate simply because Medicare will pay for it. At the
same time, Medicare absorbs tens of thousands more in extra costs. For
example, the cost of intravenous treatment for recurrent ovarian cancer
ranges from $20,000 to $42,000 per patient per treatment course. At the
same time, the oral therapeutic alternative--which does not come in
I.V. form--costs just $3,300. If Medicare covered the oral alternative,
the program could save between $17,000 and $39,000 per ovarian cancer
patient, and the patient could enjoy a potentially better outcome and
quality of life. Wealthy seniors can pay for the oral drug out-of-
pocket if that is their preference, but most seniors do not have that
luxury.
Once again, I want to emphasize that when we talk about Medicare
reform, we are not just talking about saving money. We also want to
create incentives for individuals to seek the most appropriate care.
Changing Medicare law to allow coverage of oral anti-cancer drugs meets
both tests. I urge my colleagues to incorporate this change in
conference. The Health Care Financing Administration supports it.
Cancer patients deserve it. Medicare would save money because of it.
There is no reason not to do it.
Thank you, Mr. President.
Mr. GRAHAM. Mr. President, although none of us received all of what
we wanted in this budget deal, I rise today not to point out its
deficiencies. Rather, I want to highlight the key strength of this
agreement--It makes Medicare and Medicaid smarter.
It is smart to root out fraud and abuse; it is smart to permit
competition; and it is smart to promote preventive health care.
Cracking down on those who abuse the system is smart. Paying less for
more goods and services is smart. And preventing diseases is smart.
My colleagues and I are here today not to eliminate Medicare and
Medicaid. Nor are we here to preserve the status quo. We are here to
make these programs smarter--More efficient, more equitable, and more
solvent.
We were faced with the politically unenviable task for paring
Medicare by $115 billion and Medicaid by $23 billion to accomplish the
overarching goal of this legislation--a balanced budget by the year
2002.
Both health care providers and senior citizens will share in the
burden of meeting this goal.
Mr. President, before we ask providers and senior citizens to
sacrifice, we should feel confident that this budget makes inroads into
cutting fraud and abuse out of the program.
Just yesterday, my esteemed colleague, Senator Harkin, discussed
[[Page S6163]]
some of our mutual concerns in this area. Senator Harkin and I have
long been champions of anti-fraud measures and pro-competitive
measures, sometimes to the consternation of health care suppliers and
providers.
Senator Harkin was right yesterday when he spoke strongly about
Medicare's need to begin negotiating for the best deal on supplies and
equipment, like other Federal agencies have done. It makes no sense
that Medicare--the largest single purchaser of health care services in
the country--has to follow a price list set out in seven pages of
statute rather than relying on competition.
Our efforts in this area have been bipartisan. Just last week in the
Senate Finance Committee, I, along with Senator Nickles, sponsored an
amendment to give the Health Care Financing Administration the
authority to institute competitive bidding for part B services. My
colleagues on the Committee stood with me as we unanimously adopted
this proposal. It is my sincere hope that my House colleagues will
follow suit.
Implementation of competitive bidding is one way in which Congress
can show that we have finally gotten serious about preserving the
integrity of Medicare.
Another way is to begin a serious crackdown on fraud in not only
Medicare, but Medicaid. Congress simply cannot be taken seriously when
it asks for sacrifice if we are not willing to push as hard as we can
to prevent people from ripping off the system.
Let me give you some brief examples of the rampant problems we face
in this area:
In 1993, in my home town of Miami Lakes, FL, the Office of the
Inspector General reviewed 100 claims for Medicare reimbursement by a
home health agency. About out-fourth of these claims did not meet
Medicare guidelines in that they either were unnecessary, not
reasonable, or not provided at all. The home health agency made $8.5
million in claims, $1.2 million did not meet the reimbursement
guidelines.
Two years ago, I spend a day working in the U.S. Attorney's Office in
South Florida. There I learned that it is easier to get a provider
number under Medicare than it is to get a Visa card. It is easier to
get a blank check signed by Uncle Sam than it is to get a household
credit card.
Mr. President, we cannot repair the Medicare Program without first
cracking down on fraud and abuse. Those who play by the rules should
not have to suffer at the hands of cheats and swindlers, and this
Congress should put an end to the conditions in which cheats and
swindlers thrive.
I would like to thank Chairman Roth for including many of the
Medicare anti-fraud proposals contained in bipartisan legislation I
introduced with Senator Mack and Senator Baucus last month, including
mandating that providers post a $50,000 surety bond to participate in
the Medicare program.
While a $50,000 bond is relatively inexpensive to post for scrupulous
contractors, at a cost of about $500, the requirement has achieved
tremendous results in my State. Since implementation of the
requirement, the ``fly-by-night'' providers have scattered like so many
roaches when the lights are turned on.
Durable Medical Equipment Suppliers have dropped by 62 percent, from
4,146 to 1,565; home health agencies have decreased by 41 percent, from
738 to 441; providers of transportation services have disenrolled from
the State's Medicaid program in droves--from 1,759 to 742, a drop of 58
percent. Fewer providers bilking the State's Medicaid Program is
projected to save over $192 million over the next 2 years in Florida.
Mr. President, we have expanded the surety bond requirement not only
to Medicare in this bill--but the Finance Committee also adopted my
amendment to expand this requirement to Medicaid.
This is just one of the many anti-fraud provisions included in this
budget. I want to reiterate my thanks to Chairman Roth for his
willingness to take a tough stance to ensure that Medicare and the
State Medicaid Programs are run efficiently, without the graft we have
seen overrun the programs in recent years.
Finally, Mr. President, we must do as much as we possibly can to
ensure that our seniors receive preventive care--``health care'' not
``sick care.''
In the long run, we stand to save billions of dollars by providing
early, regular, and preventive medical care, as opposed to acute,
reactive, emergency care. It is both fiscally and physically prudent to
prevent sickness before the fact and not after.
We can start by covering colon cancer screenings under Medicare. We
can save millions of dollars--and millions of lives--by detecting and
treating this cancer in its early stages. Colon cancer is the second
most frequent cancer killer in America, causing 55,000 deaths each
year. But while it is estimated that screening and early detection and
intervention could eliminate up to 90 percent of these deaths, Medicare
does not currently pay for these preventive measures.
Colon cancer screenings cost only $125-$300 apiece, and patients
diagnosed through early detection have a 90 percent chance of survival.
But if a patient isn't diagnosed until symptoms develop, the chance of
survival drops to a mere 8 percent. Care for treatment in such cases
can cost up to $100,000. The cost of not covering colon cancer
screenings--in lives and in dollars--is unacceptable.
It is also imperative that we eliminate co-payments for mammography.
According to a 1995 study in the New England Journal of Medicine, women
in the Medicare Program who have to pay some of the cost of mammography
are far less likely to actually undergo the procedure. Only 14 percent
of those women who had to make some kind of cash payment actually had a
mammogram. In contrast, among women who had some kind of insurance to
supplement their Medicare benefits, 43 percent had mammograms. Lack of
supplemental coverage should not be a barrier to necessary and
ultimately cost-saving medical treatment. Mammography should not be a
luxury. It is a necessity.
Mr. President, another necessary preventive measure is Bone Mass
Measurement, the procedure which detects Osteoporosis.
Osteoporosis is a debilitating bone disease which afflicts 28 million
Americans and causes 50,000 deaths each year. Eighty percent of its
victims are women.
Osteoporosis fracture patients cost Medicare $13.8 billion a year.
This cost is projected to reach $60 billion by the year 2020 and $240
billion by the year 2040 if medical research has not discovered an
effective treatment. We can curb these skyrocketing costs by providing
Medicare coverage of bone mass measurement.
Because we now have access to drugs which can slow the rate of bone
loss, early detection is our best weapon in the fight against
Osteoporosis. It is only through early detection that we can thwart the
progress of the disease and initiate preventive efforts to stop further
loss of bone mass.
In order to ensure that we detect bone loss early, we need to ensure
that older women have coverage for bone mass tests. Unfortunately,
coverage of bone mass measurement is inconsistent from state to state.
Qualifications for testing, and the frequency of testing, differ from
carrier to carrier and region to region. The current system is
confusing and inequitable. Medicare Bone Mass Measurement Coverage
should be covered uniformly in all states.
Diabetes, with its tremendous financial and human toll, also deserves
greater protection under Medicare. By providing for Medicare coverage
of blood glucose monitoring strips and outpatient self-management
training services, we can expect to see significant reductions in
complications and expensive treatments.
Coverage of test strips and self-management training services will
allow people with diabetes to care for their own individual needs. In
so doing, they can better prevent complications such as blindness,
kidney failure and heart disease.
Mr. President, this budget agreement is smart. It cracks down on
fraud and abuse. It makes medical goods and services cheaper. And it
promotes preventive health, saving millions of lives and billions of
dollars.
These are necessary and long overdue measures, and I thank my
colleagues who have supported them.
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