[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the quorum call be rescinded.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

[[Page S6122]]

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

[[Page S6124]]

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

[[Page S6136]]

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,

[[Page S6137]]

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,

[[Page S6139]]

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

[[Page S6158]]

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

[[Page S6159]]

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,

[[Page S6160]]

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.

[[Page S6161]]

  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.

[[Page S6162]]

  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.

                          ____________________