[Congressional Record Volume 148, Number 108 (Thursday, August 1, 2002)]
[Senate]
[Pages S7852-S7856]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
LEGISLATIVE ACTION
Mr. NICKLES. Mr. President, as we wrap up this summer session prior
to the August break, I want to make a few comments. Several of my
colleagues have discussed different issues.
First, let me state that I am very pleased that this Congress was
successful in passing trade promotion authority and the Andean Trade
Preferences Act. Both of those are vitally important and long overdue.
The Andean Trade Preferences Act should have been passed by the end of
last year. Unfortunately, the majority said it had to be packaged with
trade promotion authority and with trade adjustment assistance. I have
no objection to passing trade adjustment assistance; I think we should.
We have always done it. I happen to agree with it.
Unfortunately, the majority--in this case the Democrats--said, in
addition to trade adjustment assistance, we want to put in new
entitlements and expand trade adjustment assistance not only for
individuals who might directly lose their job to imports, they also
said indirectly. That is an expansion. They also said we want to
include agricultural workers. You might have every agricultural worker
in America who says they lost a job, that it was due to imports because
we are in an international market and prices go down. Now they want
Federal assistance.
Then we also made a mistake because there was a new benefit added
that said, in addition to trade adjustment assistance, in other words,
being trained to pick up a new job, now the Federal Government is going
to pick up 65 percent of the health care cost, an advanceable,
refundable tax credit. We don't do that for somebody employed. We don't
do that for a lot of people. But we will do it for somebody who says, I
was unemployed because of trade. And they will be eligible to receive
that for 2 years.
Then in conference, inexplicably, it was suddenly altered to qualify
those now receiving benefits under the Pension Benefit Guarantee
Corporation, if they are between ages 55 and 65, to receive the tax
credit. That little amendment which didn't pass the Senate is going to
cost over $2 billion.
So the entitlement portion of the trade adjustment assistance has
more than doubled, and I am constantly amazed at the number of people
who always say: Wait a minute. Spending is going up, we should not be
spending here, but it is fine if we do it in entitlements. They insist
we do it in entitlements. That is real money. And a lot of times
entitlements are hard to roll back.
I wanted to express my displeasure with the almost frivolous way we
have greatly expanded the Trade Adjustment Assistance Program and then
held trade promotion authority hostage to get this kind of expansion.
That being said, the good of trade promotion authority and the Andean
Trade Preferences Act outweighed the negative of the expansion of the
entitlement. So I voted for it. I am pleased we were able to pass it.
It is a very significant accomplishment.
Chairman Greenspan said we could do two things to advance the economy
in this country, one of which was to show fiscal discipline--we have
not done that--two, he said, to expand trade. By passing trade
promotion authority, we have made it possible for this country to
regain its leadership which we had lost. We lost it during the Clinton
administration. Every previous President, going all the way back to
Jerry Ford in 1974, had trade promotion authority. Bill Clinton had it
in his first 2 years of office. He did not get it extended in 1996.
He was running for office. It expired in 1994. He didn't ask for an
extension until after his reelection in 1996. At that time he couldn't
get it through the House. The House was controlled by the Democrats. It
was controlled by the Democrats when he was in power the first 2 years.
He didn't get it extended then, and he couldn't get it extended later.
In the Senate we had the votes to extend it. He wasn't able to get it.
Now this President, President Bush, is going to get it. I am glad. I
think that will help expand trade and again regain our leadership role
as it has been, as it should be, as really the promoter, the leader,
the cheerleader, frankly, for international free trade. Ronald Reagan
helped expand it in the
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early 1980s, and that has certainly been a benefit to our economy and
the economy of the free world.
A couple of other issues have been brought up. I want to touch on
them.
I heard some of my colleagues say we need to pass a Patients' Bill of
Rights, and maybe there will be an attempt to appoint conferees to
conference on the Patients' Bill of Rights. I will probably be a
conferee.
I have been involved in that issue for several years now. I look
forward to working with our colleagues on both the House and the Senate
sides to pass a good Patients' Bill of Rights package. But I do find it
kind of curious that we passed the bill over a year ago. Let me repeat
that. We passed Patients' Bill of Rights over a year ago. The House
passed it a year ago tomorrow, on August 2 of last year. We are just
now appointing conferees. This was the most important item on the
agenda for the Democrats who regained control of the Senate last
summer--the first major legislative item we passed. However the House
passed it a year ago.
We could have appointed conferees a year ago. We are just now getting
around to doing that. I find that kind of curious. I still want to pass
a bill. I might be able to refresh my memory enough to see if we can't
negotiate a positive package. Let me restate that I don't want to pass
a package that will greatly increase health care costs for patients.
Unfortunately, that is what passed the Senate 13 months ago--a bill
that would increase health care costs, estimated by the CBO, by 4 or 5
percent. I think at one time they scored it at 4.7 percent. And this is
an increase over and above the increases already coming in on health
care inflation and insurance costs, and health care insurance costs are
exploding.
The California health care plan, CalPERS, may be one of the largest
plans in America. I remember reading the headline that their health
care insurance costs are going up 25 percent. Small business insurance
costs are going up 15 to 20 percent. Nationally, almost everybody's is
going up 12 to 14 percent. This is going to add another 4, 5 percent on
top of it.
I don't want to do that. I will work energetically to see that we
don't pass a bill that would greatly increase health care costs. Also,
I don't want to pass a bill that will increase the number of uninsured.
If I remember the Senate bill accurately, the bill also had new causes
of action where people could sue not only the big, bad HMO, but
employers as well. Some of us wanted to protect employers. We know if
you make them liable for health care costs, employers don't have to
provide them, and a lot of employers won't provide health care costs.
The net result will be more people joining the ranks of the uninsured.
We should do no harm. We should not pass any bill that will increase
costs dramatically or increase the number of uninsured. I am afraid
that will happen if we pass the Senate bill. I am happy to work with my
colleagues on both sides of the aisle. If you are looking at what the
major changes are--when I was chairman of the task force--and I was
chairman of the conference committee for over a year, which dealt with
this issue--we had internal appeals in the bill we passed in the Senate
at one time; we had external appeals. So if somebody is denied
coverage, they can get an immediate response and get it overturned if
it was unfairly denied by a big, bad HMO bureaucrat. That decision can
be final. We can make a penalty if somebody doesn't abide by the
external appeal. We can make that binding, where it would be
ridiculous, or expensive, for somebody not to comply with the appeal so
they can get health care when they need it.
Some people don't want to have that be the final solution. They think
the real solution should be in court. Oh, yes, they want unlimited
damages, or damages that, frankly, are so high it would scare a lot of
employers away. I don't want to do that--pass a bill that will increase
the number of uninsured, or the cost of health care beyond the reach of
countless businesses and individuals across the country.
I am happy to work with our colleagues. I don't know why it has taken
us a year to appoint conferees. I find it almost ironic. I look forward
to working with my friends on both sides of the aisle to do it.
Mr. President, next I want to touch on the issue of prescription
drugs. Some of our colleagues who were proposing an amendment yesterday
came to the floor tonight and were implying that colleagues who opposed
that proposal were not truthful. I was reading the remarks and thought,
wait a minute, is he talking about me? I opposed the proposal. And I
think I was right. I remember hearing a colleague saying that you are
entitled to your own opinion, but you are not entitled to your own
facts. I use that, also. I thought, he is using that against me or my
colleagues.
That bothers me. I would do anything before I would mislead my
colleagues. If I ever mislead colleagues, I will be more than happy to
come and apologize, correct the record, you name it. I want to win
badly, but I never want to win so badly that I would distort the
truth--ever. I think that was implied. I hope it wasn't. If it was, I
believe it is in violation of rule XIX of the Senate. That should not
happen.
Certainly, nobody should be misled. The issue at hand was on Medicaid
costs. I am happy to talk about the facts of that. I did see a chart
that was shown on the floor of the Senate. I saw a chart that showed
that a lot of States would pay a lot more money in Medicaid costs.
Where did that chart come from? Somebody said it is some anonymous
chart, and I guess it didn't have any identification on it. It wasn't
handed had out to every Senator. It was handed out to a lot. It was
available in the Chamber. It came from the administration, from the
Department of Health and Human Services, to try to get kind of an
estimate on what the impact of the last Graham proposal offered because
we are trying to figure it out. Senator Graham read a comment that was
made. I thought it was made by me, but it turned out to be made by
Senator Grassley. He implied that it was incorrect. I looked at that. I
happen to know Chuck Grassley, and he would never misstate anything
intentionally, and I don't think he misstated one word.
I am bothered that somebody would quote somebody in the Record--when
he is not here to defend himself--and imply that he didn't tell the
truth in order to win the debate. That bothers me. I love the Senate
and I hate to see this kind of almost accusation.
Let's look at the facts. Senator Graham's amendment was introduced
yesterday. We never saw a copy of it until it was introduced. It was
held overnight. I think it was brought to the floor at 2, 3 o'clock in
the afternoon on Tuesday. We voted on it Wednesday morning. Granted,
overnight, the Department of Health and Human Services looked at it and
gave us some estimates.
I know in my State it would cost a lot. The Medicaid Director, Mike
Fogerty, said Oklahoma would not be able to do it without cutting the
program's financing. If there is any cost, the only way you can find
the money is other places in the program.
We did find some serious problems with the Graham amendment. It said
we are not going to just expand Medicare, we are going to have a low-
income benefit, and do it through Medicaid. Medicaid happens to be,
factually, a Federal-State program. The Federal Government pays a
portion and the State pays a portion. In some States it is 50/50. In
some States, it is 70/30. The Graham amendment said we are going to
provide a brand new drug benefit with very small copays from the
beneficiary--$2 and $5--and we are going to provide this benefit for
anybody who makes less than 200 percent of poverty. Well, State
Medicaid drug benefits for most States--31 States, maybe 30--I counted
them yesterday, and I think I counted 31, but it may be plus or minus.
This had to be done very quickly. It may not be 100 percent accurate
because it was done quickly. Every State has to provide a prescription
drug benefit for Medicaid up to 74 percent of poverty. They do that on
the State match.
So, again, for this drug benefit, whatever benefit the State has--in
my State, you get three prescriptions per month and the State pays its
share--in my case, 30 percent--and the Federal Government pays 70
percent. That is up to 74 percent of poverty. The Graham amendment says
let's make that 120 percent of poverty. In other words, we
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greatly expanded the pool of eligible people because our State, right
now, is only 74 percent. So we greatly expanded it to 120, and the
State is still liable for its share.
Well, that is a big new unfunded mandate for which the State has to
pay. That will cost millions and millions of dollars because there is
no limit on the number of drugs. The State will have to make its match,
depending on what the State match is. Between 120 and 150 percent, a
State still has to pay.
There is an enhanced match. The State would get S-CHIP. S-CHIP
usually has a reimbursement rate of 78 percent, I believe, on average.
The State would still have to put in 22 percent. So you are expanding
the eligible pool of people who are going to receive the benefit, and
you are also expanding what the State has to pay. Those are facts.
Those are in the Senator's bill.
Between 150 percent and 200 percent of poverty, the Federal
Government would pay 100 percent. The Federal Government pays that, so
I guess that is not an unfunded mandate. It is just a cost to the
Federal Government.
Below 150 percent of poverty, between, frankly, 74 percent and 150
percent of poverty, there is a big new mandate on the Federal
Government and on the State government. The State would have to pay its
share, and that would cost----
Mr. GRAHAM. Mr. President, will the Senator yield for a series of
questions?
(Mr. NELSON of Florida assumed the Chair.)
Mr. NICKLES. I will be happy to yield in just a moment. That is a
great big cost. That has to be accounted for somehow. Someone might
say: There might be savings because we have catastrophic on the other
end. Right now, maybe the State is paying that--that may be--but that
may not get there.
Mr. President, 80-some percent of the people do not have drug costs
that exceed $2,000. Catastrophic did not kick in until $3,300. No doubt
some people would benefit, but maybe the majority of the people would
not. It looked to me as though it was a real loser for the States. I
think OMB happens to agree. They estimate it would cost my State
something like $62 million. I would not be a bit surprised if it cost
more than that. Our State cannot afford that. We have a Medicaid
Program that is already going bankrupt.
My point being--and I mention this with my friend from Florida here.
I have respect for my colleagues, but always I think it is important we
not impugn the integrity of Senators.
Mr. GRAHAM. Mr. President, I ask the Senator to yield.
Mr. NICKLES. I will be happy to yield for a question.
Mr. GRAHAM. I think my integrity was impugned when it was suggested
yesterday that we had slipped into this amendment, hoping it would go
undiscovered, a provision that would end up costing the States some $70
billion over the next 10 years. That is close to a verbatim statement.
That was made on the basis of this sheet which was printed and
distributed on the Senate floor without a source and without anyone
accepting personal responsibility. This is what I call Enron
accounting. You only accounted for the additional cost to the States
without any reference to the savings the States would get as a result
of the Federal Government picking up substantial costs the States are
currently incurring which the Congressional Budget Office has stated to
be approximately equal to what the States would have to expend in terms
of these new obligations. No reference was made----
Mr. NICKLES. Mr. President----
Mr. GRAHAM. No reference was made on this chart to the fact there
were very substantial savings to the States in addition to the costs.
The PRESIDING OFFICER. The Senator from Oklahoma has the floor.
Mr. NICKLES. Mr. President, I regain the floor. I looked at the
chart. The chart does not have all States. Maybe some States were not
impacted as much. Maybe they highlighted the States that have the most
additional cost.
I mentioned my State. I know my State would be out of a lot of money.
We offered a drug benefit that goes up to 74 percent of poverty, and we
are going to put a new mandate between 74 and 150 percent of poverty.
The State has to make that match. I know it is going to cost my State
millions. HHS said it cost $68 million. They said the cost for the
first year is over $5 billion. Maybe some States are pluses, maybe some
are winners. Maybe they did not include all this.
I will say a couple words about the legislative process. I happen to
be a believer in the legislative process, and I think my colleague from
Florida knows that. We did not abide by the legislative process.
We did find his amendment greatly increases Medicaid costs for a lot
of States. Yes, we exposed that. That happens to be factual. This was
not just a Medicare expansion. It was a Medicaid expansion, and the
States have to match Medicaid.
Did we find it? Yes. Did we find in the original Graham proposal that
the proposal limited the prescription drugs to one, up to two, drugs
for therapeutic class? We did. I think it probably is one of the
reasons that proposal did not pass--because it is such a limitation.
Did we find it? Yes, it was in the language. Did we have a whole lot
of time? No, we told people about it. I do not back off that a bit. I
think we have a right to point out the weaknesses of arguments. As
always, my colleague can point out this was not a complete chart. We
did not have time to get a complete chart. I did not. Maybe there is a
complete chart around, but the amendment was offered in the afternoon
and we were voting on it in the morning.
One of the things that is really wrong is to try to legislate in a
manner such as this. I believe in the legislative process. I believe in
hearings. I would love to have a hearing on the proposals we voted on
this week. I would love to have experts testify on the pluses, the
strengths, the weaknesses, the gaps, the minuses on the various
proposals. We have had some good proposals. We have had some that are
not so good. I heard my colleague from Florida say that CBO by e-mail
said this is a net wash for the States. HHS shows me that some States,
or these States that are listed, would have a net loss of $5 billion in
1 year. This is a 10-year program.
Mr. GRAHAM. Will the Senator yield for a question?
Mr. NICKLES. The point I am making: It would be nice to go through
the process, have a bipartisan markup, have hearings, have experts, and
not be relying on e-mails that came from somebody in CBO.
Incidentally, I noticed in CBO's scoring of the proposal, it was
scored and was estimated to be $394 billion, but there is an asterisk:
Scoring done by estimates, not by the language of the bill. In other
words, they did not have the language of the bill on which to do the
scoring. This is the most important expensive expansion of an
entitlement that we have dealt with in decades. It is the most
expensive important expansion of any entitlement, and we are doing it
with CBO not even having legislative language to look at.
I find that to be a pretty crummy way to legislate. I am offended by
this process. I am offended by being a member of the Finance Committee
and not even being able to offer an amendment in the markup of the
bill. I am offended by the fact--I looked at the history of the Finance
Committee, which is one of the great committees of the Senate. I waited
16 years to get on that committee. It took a long time. It is a great
committee. I thought it would be worth the wait because we would be
marking up very substantive legislation, such as Social Security,
Medicare, Medicaid, welfare reform, and taxes. Yet the committee is
bypassed, so we have 20 members of the committee who did not get a
chance to offer an amendment.
We have an amendment that was created somewhere and scored overnight
not by legislative language. No one gave us a chart and said here is
the impact of your State. I would love to see the impact to my State.
My State Medicaid director says this is going to be a real problem; we
cannot do it.
We exposed that a lot of States would have a problem doing that.
There is no reason to apologize for doing that. I just want to make
sure that Senate debate never improperly impugns the integrity--I
believe my colleague who was quoted was Senator Grassley--I do not ever
want anybody's integrity
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to be impugned on either side of the aisle. That is below the Senate,
and there happen to be Senate rules against it. I wanted to make that
point.
I will just assume and take for granted no one meant to do that. But
we have to be very careful not to do that. We have to be careful that
we are factual. Sometimes maybe in the heat of the debate things get
going.
I want to move on to one other subject.
Mr. GRAHAM. Mr. President, before the Senator does that, will he
yield since we are on this subject?
Mr. NICKLES. I yield just for a question.
Mr. GRAHAM. Does this chart in any of the columns contain the offset
savings which the States would have secured as a result of the passage
of the underlying Graham-Smith amendment?
Mr. NICKLES. The chart does not show any offsetting. It shows a total
cost increase of the new Medicaid mandate. I think the Senator is
trying to imply there may be some savings for some areas if a State had
a lot of catastrophic and the Federal Government were going to pick up
100 percent of that cost, I guess. That may be correct, but it does not
have a column that shows that. Maybe if we would have had a little more
time--the answer is no.
I ask my colleague, though, since CBO did some work for the Senator,
did they do a State-by-State analysis on what the impact of the State
of Oklahoma would be?
Mr. GRAHAM. They did not do a State-by-State analysis. I do not know
who did the analysis of the State-by-State costs presented by my
Republican colleagues so I cannot have any means of even determining
who to go to talk to about where these numbers came from. But the
answer to the question, which is relevant, is there are very
substantial savings to the States. In fact, according to the
Congressional Budget Office, the savings to the States as a result of
the passage of this prescription drug amendment would be equal to----
Mr. NICKLES. I have the floor.
Mr. GRAHAM. These additional costs.
Mr. NICKLES. The Senator can answer the question. I have the floor
and I will state again, some States lose under the Senator's proposal
big time. I am not sure all States do; some States lose big time.
The Senator stated that he did not have a State-by-State analysis, so
every fact that is on this chart may well be accurate. The Senator also
stated that CBO did not do a State-by-State analysis, and I will say if
we are going to be changing Medicaid formulas, or if we are going to be
changing Medicaid programs and States have to make a certain percentage
match, it is only prudent that we would do an analysis of what the
impact would be on a State-by-State basis.
Unfortunately, CBO did not do that. Fortunately, the Department of
HHS did. The States that are included on this list are the States that
get hit the hardest, and we expose that.
Now, there may be some offsets, but I tell my colleague from Florida,
I can almost assure him, since 80 percent of seniors have prescription
drug costs that are $2,000 or less, that catastrophic program savings
would not come near to offset the increased costs of utilization. And
the fact that they have to make matches up to 50 percent, almost to 100
percent, for the program, minus a small deductible for people under 200
percent of poverty, it would not come too close to make it. It would
not come close in the State of Nebraska or the State of Oklahoma. I
know that. There are not near that many people who would have the
savings through the State.
In our State program, the individual who gets three prescriptions per
month is not going to come close to $3,000. That program is not that
generous in my State so the savings on the catastrophic side would not
come close to making the savings or the increased costs that is on the
low-income side.
Mr. GRAHAM. Could I ask the Senator another question?
Mr. NICKLES. Yes.
Mr. GRAHAM. What leads the Senator to believe that the only way in
which the States would secure savings under the Graham-Smith amendment
would have been through the catastrophic savings?
Mr. NICKLES. Well, I will tell my colleague, all we had from CBO on
the Senator's amendment was one page that said, one, it never went
State by State and, two, it said $394 billion and it said it was not
based on legislative language. We had nothing to score off of from what
was provided for by CBO or by the Senator, except for the Senator's
word that he had an e-mail that said the States net out about even.
I did have work that was done by HHS, and it may not have included
every extrapolation, but they did compute the cost of the low-income
benefit and how much that would cost the States to make the match, and
it is in the billions of dollars, to the tune of $5 billion for some
States. Maybe some States would come out better. I am not sure. But
that is my point. This is not the way to legislate.
This is legislating as if we are going to legislate on the back of an
envelope. It is almost as if Senator Daschle said, do not go to
committee, do not have a markup, here is $400 billion, $500 billion,
$600 billion, or $800 billion and can we not cobble together 60 votes?
That is a crummy way to legislate. We could have passed a
prescription drug bill if we had done two things. If we would have
passed a budget, this Senate--the House passed a budget. Incidentally,
the House passed a budget with a prescription drug amount of $350
billion. The Senate passed a budget a year ago, I might mention when
Republicans were in control of the Senate, and it was a $300 billion
total Medicare change. It could be prescription drugs or it could be
for something else.
That is what we are relying on in the Senate today. Why? That is a
year old. Because the Senate Democrats, or the leadership of the
Senate, did not pull up a budget. We do not have a budget. We did not
pass a budget, first time since 1974, and because we did not, a budget
point of order lay against anything that was over $300 billion.
If we had passed a budget, gone to conference with the House and
resolved whatever amount that would be--and let's presume the House
would prevail--then the committees would have been instructed to pass a
bill, if the House prevailed, up to $350 billion. It could be passed if
it went through the Finance Committee. Any bill could be reported out
that would be up to $350 billion, and it could pass with a majority
vote. No budget point of order would lay against it. We could have
passed a prescription drug benefit this week. Unfortunately, that did
not happen.
So the committee did not mark up any proposal that came out that was
over $300 billion. Last year's level had a budget point of order, had
to have 60 votes, had to have a supermajority. The real fault of that
came because we did not pass a budget earlier.
Again, I love the Finance Committee but I hate the way the Finance
Committee has been trampled on. I hate the fact that the Finance
Committee is being ignored, the fact they did not mark up the bill, the
fact I did not have a chance to offer one amendment, the fact I did not
get to have the chance to ask the Medicaid director: How does this
impact you? Is this a good proposal? Do you mind if we put on this new
requirement, oh, yes, below 150 percent of poverty? Here is this brand
new benefit. It is going to cost you a ton of money. How much does it
cost? Can you afford it? Could you pay for it? I am afraid the answer
would be, no, no, no, no.
We did not have a chance. Instead, we had to try to write the bill on
the floor, and in this case we had to take up this amendment and we had
less than 24 hours to deal with it.
Again, my purpose in expanding this is not to redebate the amendment.
My purpose is to defend my colleague, Senator Grassley, whose integrity
I value more than anything. I would not--and I know he would not--
misstate a fact to win a debate for anything.
I came to the Senate with Senator Grassley in 1980. That was 22 years
ago. We have cast thousands of votes together. I know him very well. I
agree with him most of the time--not all the time--but I would defend
his integrity every day of the year.
I am going to start making points of order, rule XIX, if people imply
or impugn the integrity of another Member. I am going to do it, and
those words will be stricken from the Record and
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the Senator will not be allowed to get access to the floor for the rest
of the day; and maybe other penalties. We have not done that, but maybe
we need to do it. So that is my purpose for coming to the floor.
I want to make a couple of other comments.
Mr. GRAHAM. Will the Senator yield for another question?
Mr. NICKLES. I am not going to yield. I am going to make one other
comment on a different subject.
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