[Congressional Record Volume 154, Number 97 (Thursday, June 12, 2008)]
[Senate]
[Pages S5539-S5564]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE IMPROVEMENT FOR PATIENTS AND PROVIDERS ACT OF 2008--MOTION TO
PROCEED
The ACTING PRESIDENT pro tempore. Under the previous order, the
Senate will resume consideration of the motion to proceed to S. 3101,
which the clerk will report.
The legislative clerk read as follows:
Motion to proceed to S. 3101, a bill to amend titles XVIII
and XIX of the Social Security Act to extend expiring
provisions under the Medicare program, to improve beneficiary
access to preventive and mental health services, to enhance
low-income benefit programs, and to maintain access to care
in rural areas, including pharmacy access, and for other
purposes.
The ACTING PRESIDENT pro tempore. The Senator from New York.
Mr. SCHUMER. Mr. President, I have come to speak on the Medicare
bill, but I must make a few remarks in relation to the debate between
the majority and the minority leaders. The bottom line is very simple,
and that is they haven't said let's fight over what amendments nor have
they offered amendments. They have said that we will not even proceed
to the bill.
So when the majority leader, Senator Reid, says it is Orwellian, of
course it is. In every instance when the minority has come and said
they will do amendments related to the specifics of the issue at hand,
the majority leader has been more than accommodating, rankling even
some on our side. But they don't want to do that.
Senator Reid read the memo. They want to slow the bill down with
extraneous amendments that have nothing to do with energy because they
do not want to allow a vote, even on ANWR.
Now, my friend from Kentucky talks about ANWR as the answer. Even the
most optimistic experts say it will be 7 years before we get a drop of
that oil. So the minority leader and the minority are saying wait 7
years and maybe we will get oil prices down. We don't want to wait that
long. In 7 years, we could have an energy policy that weans us away in
part from fossil fuels in a serious and significant way, like what is
being done in Europe and other places. They do not want to do that
because big oil dominates. They do not want to do that because their
base says drill in ANWR, and the people say no.
This idea that we don't want any production, the minority leader is
just patently incorrect. Democrats, including myself, helped lead the
charge and voted to increase production in the east gulf. That is the
place where there is the most available oil and gas near refineries.
And it wouldn't take 7 years the way starting a whole new venture in
Alaska would. We voted for it under Republican leadership, when the
Republicans led. So we are willing to increase production, but we do
believe we are not going to drill our way out of this problem.
The majority leader is exactly right. The actions of the minority
leader say: Don't even debate it. Then he says they want to debate it.
Well, if you want to debate it, don't block the motion to proceed. And
I am certain--though I haven't talked to the majority leader about
this, but I will, and I know from his past actions--if they have a
series of amendments that are related to energy, they will be
entertained. But if they want to debate George Bush's tax cuts or the
estate tax, well, the majority leader has a perfect right to say, don't
do it.
So, Mr. President, again, this week in the Senate, Republicans are
blocking lower energy costs. They are the party of no--no, no, no. They
are the party of no on global warming, they are the party of no on
lower energy costs, they are the party of no on tax help for solar and
wind, and they are the party of no on preventing the oil companies from
just doing everything they want. And as the majority leader said, the
status quo is not what America wants, but the status quo is exactly
what the minority, the Republicans, are standing for.
I said it yesterday, and I will say it again--I said in the DSCC that
I care more about the substance. I would much rather we move forward.
But as head of the DSCC, the minority is filibustering themselves right
out of their seats. When three-quarters of Americans demand dramatic
change, and the minority says no change, that is not a formula for
political success. You don't have to be a political genius to know it.
So I would say to the rank-and-file members on the other side, I
don't understand the logic, I don't understand the thinking, but you
are sure not helping yourself or helping your country.
Now, Mr. President, I would like to talk about Medicare for a
minute--that is the bill we are on--and I rise to speak in strong
support of the Medicare Improvement for Patients and Providers Act of
2008. I want to congratulate our leader on the Finance Committee,
Chairman Max Baucus, for introducing this much needed legislation.
When Lyndon Johnson signed Medicare into law in 1965, he promised it
would transform the lives of America's senior citizens, and he said
this:
No longer will older Americans be denied the healing
miracle of modern medicine. No longer will illness crush and
destroy the savings that they have so carefully put away over
a lifetime so that they might enjoy dignity in their later
years.
No one could have said it better, and yet 40 years later we are at a
critical moment. Do we make much needed improvements to the program to
allow it to fulfill its promise to America's seniors or do we ignore
this challenge?
We have worked hard in the Finance Committee to put together fair and
reasonable legislation that is supported by all physicians groups and
millions of beneficiaries. We have compromised. I don't believe
Medicare Advantage should come out of medical education. It affects my
State, the majority of it will, and I am still willing to sort of suck
it in and say, OK. But some on the other side are saying no, it has to
be all their way. We know that fee for service in Medicare Advantage is
far more lucrative and far more spread around the country. Yet we don't
have very much of that in here to help pay for the other necessary
increases. But it is a compromise bill. It is a bipartisan bill with
broad support on the Finance Committee, and I urge all Members to vote
for cloture today so we can provide help to millions of America's
seniors and the hard-working health care providers who treat them.
We have to pass this bill to avoid catastrophic cuts to doctors. We
know these physicians face a 10-percent cut. To those who say, well,
they are doctors, they can afford it, the trouble is, if we do this
cut, lots of doctors don't take Medicare, and our poor senior citizens
are left in the lurch. When we cut resources to doctors, patients lose,
in this instance. So we need to put aside politics and do the right
thing for our seniors and pass this bill.
Some Members seem to think that doing more for low-income seniors--
those Americans who are trying to make ends meet and are deciding
between filling their car's tank with $4 gas and paying for a doctor's
visit--is wrong. Opponents of this measure say now is not the time to
improve Medicare. Well, I say now is exactly the time. We need to cut
costs where we can and enhance the program where it is needed.
Our constituents are waiting for action. In my State of New York, the
AARP dropped off 20,000 petitions in three wheelbarrows at my office in
Albany. These 20,000 petitions were from New Yorkers asking Congress to
pass this bill, to pass S. 3101, because it helps seniors on fixed
incomes, establishes an e-prescribing requirement, and helps limit
premium increases.
We are particularly pleased the bill emphasizes preventive health
care and expands coverage for key screenings, which can catch problems
before they become more serious, and many other important measures.
[[Page S5540]]
In addition, the bill stops the cuts to physicians for 18 months and
provides a 1.1-percent update for 2009.
The Medical Society of New York and medical societies throughout
America are in favor. I have spoken to the head of the AMA, who is Dr.
Nancy Nielsen from Buffalo, NY. She is the incoming President of the
AMA. She has been tirelessly working, and I want to give her a shout-
out of thanks here on the floor of the Senate.
I am particularly pleased that this bill provides increased payments
for our ambulance providers. We put in a bill to do this; it got 25
bipartisan cosponsors. GAO found that ambulance providers are
reimbursed on average 6 percent below their costs for providing
services to Medicare patients. This is unacceptable. It means they cut
back on the lifesaving equipment needed in the ambulance. We all know,
for things like stroke and heart attack, having an up-to-date, modern
ambulance with the most lifesaving equipment is often the difference
between life and death, so this increase will actually save lives.
It also, unlike the other alternative, ensures that pharmacists
dispensing prescriptions are receiving payments on time. Two thousand
independent pharmacies in New York--and many more thousands around the
country--are counting on this important change to keep them in the
black. That is in the bill. You cannot ask pharmacies, small
businesspeople, to just give a line of credit to the Federal
Government. That doesn't make much sense.
This is a good bill. I urge we move forward and get the 60 votes. I
hope we will not have another filibuster, No. 76. Let's hope and pray
that doesn't happen so we can help America's seniors and continue to
modernize Medicare and move this bill forward.
I yield the floor and suggest the absence of a quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. SCHUMER. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. SCHUMER. I ask unanimous consent that during the times when we
are in a quorum call, the time be equally divided between the minority
and the majority.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. SCHUMER. Now I again suggest the absence of a quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Ms. COLLINS. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Ms. COLLINS. Mr. President, I ask unanimous consent that following my
remarks, the remaining Republican time be allocated to the following
list for up to 15 minutes each, with Senator Grassley controlling the
remaining time: Senators Enzi, Chambliss, Stevens, Hatch, Cornyn, and
Coleman.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
(The remarks of Ms. Collins pertaining to the introduction of S. 3119
are printed in today's Record under ``Statements on Introduced Bills
and Joint Resolutions.'')
Ms. COLLINS. I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Wyoming.
Fuel Prices
Mr. ENZI. Mr. President, over the past few weeks I have had the
opportunity to come to the Senate floor to speak on a No. 1 issue I am
hearing about as I travel around Wyoming, and that is the high price of
gasoline and diesel fuel. I want to continue to address that issue
today. I listened to the debate on S. 3044, the so-called Consumer-
First Energy Act. It might as well be called the No Energy Act because
the bill does nothing to improve our Nation's energy situation and will
actually do damage to it. One of the targets of S. 3044 is energy
speculators. Their role in the high price of energy has been brought up
time and time again, and my colleagues in the majority have been
especially vigilant in their desire to rein in this group as if they
were the big bad wolf.
If you listen to their arguments, they are persuasive. Unfortunately,
they don't tell the whole truth. An editorial I recently read from the
Wall Street Journal pointed out the flaws in their argument.
The article stated:
The first refuge of a politician panicked by rising prices
is always to blame ``speculators.'' So right on time for this
election season Congress has decided to do something about
rising oil prices by shooting the messenger known as the
energy futures market. Apparently this is easier than
offending the Sierra Club by voting for more domestic energy
supply. Futures markets are not some shadowy, dangerous force
but are essentially a price discovery mechanism. They allow
commodity producers and consumers to lock in the future price
of goods, helping to hedge against future price movements. In
the case of oil prices, they are about supply and demand and
the future rate of inflation. Democrats now argue that these
futures markets are generating the wrong prices for oil and
other commodities.
And who are these ``speculators'' driving up the prices?
The futures market operator Intercontinental Exchange says
that an increasing share of customers are not financial
houses but are commercial firms that need to manage oil-price
risks--[that means] the refiners, the airlines, and other
major energy consumers. Another term for these [energy]
``speculators'' would be ``American business.''
The article continues:
If Democrats won't believe futures traders, maybe they'll
heed their biggest political funder. When . . . hedge fund
billionaire George Soros testified before Congress on this
issue, he noted, ``Regulations may have unintended adverse
consequences. For instance, they may push investors further
into unregulated markets which are less transparent and offer
less protection.''
The article concludes:
Democrats will find that moving jobs to Dubai from New York
and Chicago will not end commodity inflation that they
themselves have helped to create.
I ask unanimous consent that the editorial be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the Wall Street Journal, June 10, 2008]
Dubai's Favorite Senators
The first refuge of a politician panicked by rising prices
is always to blame ``speculators.'' So right on time for this
election season, Congress has decided to do something about
rising oil prices by shooting the messenger known as the
energy futures market. Apparently this is easier than
offending the Sierra Club by voting for more domestic energy
supply.
Futures markets aren't some shadowy dangerous force, but
are essentially a price discovery mechanism. They allow
commodity producers and consumers to lock in the future price
of goods, helping to hedge against future price movements. In
the case of oil prices, they are a bet about supply and
demand and the future rate of inflation. Democrats
nonetheless now argue that these futures markets are
generating the wrong prices for oil and other commodities.
And who are these ``speculators'' driving up prices? The
futures market operator Intercontinental Exchange says that
an increasing share of its customers are not financial houses
but commercial firms that need to manage oil-price risks--
refiners, airlines, and other major energy consumers. Another
term for these ``speculators'' would be ``American
business.''
Not ironically, the leaders of Capitol Hill's shoot-the-
messenger caucus are among those most culpable for the lack
of domestic oil supplies. Senator Maria Cantwell (D., Wash.)
has been threatening to hold up appointments to the Commodity
Futures Trading Commission until the CFTC increases
regulation of oil trading. In the best tradition of
bureaucratic self-protection, the CFTC's acting chief Walter
Lukken has agreed to investigate.
Ms. Cantwell's recent press release on ``outrageous energy
prices'' didn't mention her own contributions to the problem.
According to the Almanac of American Politics, she
``successfully worked the phones'' in 2005 to round up enough
colleagues to block drilling in the Alaskan wilderness. Ms.
Cantwell has also backed a slew of mandates and subsidies
that have helped to raise food prices by diverting corn and
other crops to a fuel. She even claims to have helped create
the biofuels industry in her state.
Her counterpart in the House is Michigan's Bart Stupak, who
claims special credit for a permanent ban on drilling in the
Great Lakes and has also cast votes against exploration in
Alaska and off the California coast. With $4 gasoline, this
is a man in need of political cover as Michiganders head into
the summer driving season. A spokesman says Mr. Stupak is
hoping to roll out a new bill by the end of this week to
require ``additional reporting and oversight' in the oil
futures markets.
Then there's New York Senator Chuck Schumer, another
staunch opponent of new domestic oil supplies. Mr. Schumer
has
[[Page S5541]]
egged on the Federal Reserve's rate-cutting binge that has
contributed so much to the oil price spike. But, with
impeccable political timing, he now suspects ``price
manipulation by speculators'' is the real cause of rising gas
prices.
Mr. Schumer's answer is the ``Consumer-First Energy Act,''
due for a cloture vote in the Senate today. Bundled with a
windfall profits tax on oil companies, the plan also includes
an increase in margin requirements for those who wish to
trade oil futures. This would of course make it more
expensive to trade in U.S. futures markets, which in a world
of computerized, instantaneous trading means that those
trades would merely move to markets overseas. As luck would
have it, the Dubai Mercantile Exchange celebrated its first
birthday last week with the launch of two new oil futures
contracts that compete with those offered by American
exchanges.
Leave aside the question of whether Mr. Schumer believes
that the Dubai exchange, which is majority-owned by Middle
Eastern governments, will offer more consumer protection than
America's shareholder-owned exchanges. This is the same Chuck
Schumer who warned in 2007 that heavy regulation threatens
New York's preeminence in global finance. Along with Mayor
Michael Bloomberg and former Governor Eliot Spitzer, Mr.
Schumer introduced a long report on the threats facing New
York with a short note that specifically mentioned Dubai as
an increasingly formidable competitor. That of course was not
an election year.
If Democrats won't believe futures traders, maybe they'll
heed their biggest political funder. When Senator Cantwell
invited hedge-fund billionaire George Soros to testify last
week, she probably didn't expect the backer of left-wing
causes to deviate from her market-manipulation narrative. But
among other things, Mr. Soros noted that ``Regulations may
have unintended, adverse consequences. For instance, they may
push investors further into unregulated markets which are
less transparent and offer less protection.''
Democrats will find that moving jobs to Dubai from New York
and Chicago will not end the commodity inflation that they
themselves have helped to create.
Mr. ENZI. Do we need an open and transparent market? Yes. Is there
more that could be done? Probably. Which is why the Commodity Futures
Trading Commission announced, on June 10, that it was forming an
interagency task force to evaluate developments in the commodity
markets. Rather than sitting here in the Senate Chamber spending our
time criticizing commodities traders, we should be working together to
pass legislation that we can agree on to improve our Nation's energy
situation. The problem we face is a problem of supply and demand, less
American-made energy and more demand for that energy. That is the
problem that Congress should be addressing. That is what those in
control of both Houses of Congress don't seem to understand at this
stage, even though 2 years ago they complained about the price of
gasoline and promised they would bring the price down.
The continued rise of gas prices is going to put an end to this dog-
and-pony show eventually. Unfortunately, we are not at that point yet
where the majority will seriously deal with this issue. The bills we
are debating will do nothing to improve our Nation's energy situation.
The substitute to the Lieberman-Warner Climate Security Act would have
cost us money, at a time when we are paying record energy prices. The
so-called Consumer-First Energy Act would lead to less investment in
energy; therefore, less supply and, therefore, higher prices for
consumers. As bad as these bills are, the process by which they get
here is even worse. They don't go through committee. They won't be
signed by President Bush, and yet we still waste the time of the Senate
talking about them, as if they will be made law and they will improve
the Nation's energy situation. That is not the case. It is also not how
we do things around here.
I have heard complaints that Republicans are stopping progress on
important legislation. I have heard complaints that the majority is
unable to legislate. ``Unwilling'' would be a better term. We are
paying record prices at the pump. Those record prices are connected to
specific actions or inactions by those in control of Congress in the
recent past and years ago.
Recently, on May 13, the Democratic majority defeated the American
Energy Production Act by a vote of 56 to 42. The measure would have
expanded domestic oil production as well as opening the potential of
oil shale and coal-to-fuel technology. In 1996, President Clinton
vetoed a bill that would have enabled us to get 1 million barrels of
American oil a day. That is what we are demanding that Saudi Arabia
give us. I remember in 1973, when we made some demands on Saudi Arabia,
and they cut us off entirely. Some of us are old enough to remember the
gas lines and the shortages we had then. But he vetoed a bill that
would have enabled us to get a million barrels of American oil a day
from the Arctic National Wildlife Refuge, an area about a sixth the
size of Dulles Airport. The entire refuge is considerably bigger, but
we are talking about drilling on a very small portion of it.
On May 22, House Democrats voted down a measure sponsored by
Congressman Mike Conaway that would have expanded the use of coal to
fuel, oil shale, and tar sands, as well as expediting the permitting
process for new refineries on three closed military bases. In December,
Democratic members of the Senate Environment and Public Works Committee
debated a proposal to ensure development of nuclear energy to meet
emission goals. That is this year.
The list goes on and on, as does the majority's theatrics of
inaction. When they got the majority a year and a half ago, the Speaker
promised lower gasoline prices. How have they delivered? Their answer
for our need to produce more American energy is to always say no, and
their solution is always, let's tax the oil industry, a plan we know
won't work because, under President Carter, we tried that, and we drove
a lot of business overseas, which is where we have to ship our money
unless we can get oil production in the United States. A lot of people
don't realize--maybe they do--that Saudi Arabia is the biggest producer
and that the Soviet Union is the second largest producer. What they
don't realize is that the United States is the third largest producer,
and we could solve a lot of our own problems if we were to do some of
the things suggested here.
Like most of my colleagues, I support developing more alternative
energy. I support the use of wind energy and the development of better
solar energy technologies. Wyoming is the perfect place for a lot of
that development to happen. We have, most days, the sunshine, and we do
get some wind. While we need to develop those technologies for the long
term, we need all the energy we can get today. We need more American
oil from American soil, we need more domestic natural gas, we need more
nuclear energy, and we definitely need more clean coal. More taxes and
lawsuits are not going to get us there.
I emphasize again that I have a lot of faith in American ingenuity.
For the long term, there is some research that could be done that would
work with coal to make it cleaner, greener, and meet the needs, because
that is the biggest resource we have. We have more Btus in coal than
Saudi Arabia has in oil, and we have that in one county in Wyoming. But
for the shorter term, yes, we do need to conserve, and, yes, we need
alternative energy sources. We cannot abandon the sources of energy we
have right now.
I am going to end with a story. A while ago, I had to go out to
California for a meeting. I was supposed to speak in the evening, and
my plane got into California at rush hour. I thought: I am probably not
going to be able to make this speech. I rented a car. My wife was with
me. I found out they have these high-occupancy vehicle lanes. Well,
there was one lane for high-occupancy vehicles. I have never seen so
many lanes. I am pretty sure there were six more lanes besides the one
lane for high-occupancy vehicles. I made that speech on time. I zinged
right through that high-occupancy-vehicle lane because it only required
two people in the car--only two. Out here, there are a lot that require
three, but in California it was only two. Now, what about the other six
lanes of traffic? Stalled out. Six lanes--cars stopped dead, idling
their motors, putting carbon in the air, one person to a car. Now, that
is a State with 34 million people and huge concentrations of people. So
I would like to encourage California to carpool a little bit.
Now, I would encourage the people in Wyoming to carpool too, but I
spend a lot of time trying to teach the East and the far West about the
Midwest, and most of the people we have are driving because they have
to and because they are going to a single site where they are the only
worker. And
[[Page S5542]]
we only have half a million people, to begin with. But a lot of trucks
come through our State that are delivering produce and other things to
the rest of the Nation, and that is important to have happen.
But when people talk about gasoline and trying to reduce its use,
they have to remember that a lot of that is to provide services and
products that we in the United States have grown very accustomed to. We
do not rely on everything coming from our own county; we rely on it
coming from not only the rest of the United States but the rest of the
word.
The only way we are going to get out of this dilemma is to work on
the short term, which is to get people to conserve; work on the medium
term, which is to do some things with alternative energy but to put
some research into the future so we can handle the kinds of things we
need to provide for the energy we need for this country. Increasing the
supply is the only thing that is going to bring down the price.
Mr. President, I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. Brown). The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. CHAMBLISS. 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. CHAMBLISS. Mr. President, I rise today to talk about how Congress
can take action to provide relief to American families who are really
feeling the pain at the pump due to high gas prices.
Obviously, this is a very complex issue and requires a multipronged
strategy to respond. But the base price of gasoline reflects the
principles of supply and demand. Asian economies continue to boom,
creating soaring demand for oil. At the same time, many oil-producing
regions are curbing output. These factors can create a perfect storm
that leads to historic high prices for the price of crude oil and the
resulting prices at the pump we see today.
I believe we must find both short-term and long-term solutions to
provide energy security for our Nation and give relief to the
unprecedented gas prices we are experiencing today.
Republicans and Democrats recently came together and passed a piece
of legislation, with my vote, to suspend the filling of the Strategic
Petroleum Reserve until the end of the year. This was an attempt to
provide a short-term solution to high gas prices at the pump by dealing
with the supply side of the issue. It is a bill that passed with strong
bipartisan support.
The Strategic Petroleum Reserve has the capacity of 727 million
barrels of oil and currently holds just over 700 million barrels. The
United States had been filling this Reserve to the tune of about 70,000
barrels per day.
This was the right thing to do for several reasons: first, because we
should not be buying the most expensive oil ever and simply putting it
in the ground; secondly, because it will leave a little more oil on the
market, which will hopefully alleviate prices somewhat; and third,
because it shows that Congress recognizes that increasing the supply of
oil in the market can have an impact on the price of oil. Finally, it
sends a message to energy markets that Congress can take action and
thereby reduce speculation, which certainly has been a participant in
the rising price of oil.
Congress also acted in a bipartisan manner to address a component of
the long-term solution to energy security by enacting the Energy
Independence and Security Act in December of last year. This
legislation, again with my support, was an attempt to provide a long-
term solution to high gas prices by dealing with the demand side of the
issue.
This legislation contains an aggressive new renewable fuels standard
that requires fuel producers to include a certain amount of alternative
fuel in their product. I am excited about the significant opportunity
this provides for Georgia, which has not been a large producer of
biofuels in the past, to participate in the development of renewable
fuel sources. The renewable fuel standard requires 36 billion gallons
of renewable fuels in American motor fuels by 2022. I think it was the
right thing to do to require 21 billion of the 36 billion gallons of
renewable fuels to come from advanced biofuels. This means instead of
corn-based ethanol, we will be making fuels from cellulose such as wood
chips, peanut hulls, and switchgrass.
This emphasis on biofuels is consistent with legislation I introduced
last year to increase the amount of advanced biofuels and gasoline.
This is also very consistent with the farm bill that passed this body.
In the energy title in that farm bill, of which I was particularly
excited about and remain excited, what we did was to induce the
manufacture of additional amounts of ethanol in this country. But the
production of ethanol from corn has had unintended consequences--we
have seen the price of food products increase. It hasn't just been
corn-based food products as a result of the high demand for corn. We
have seen more corn planted, which means the demand for wheat,
soybeans, peanuts, as well as other commodities, has increased and
driven up the price because farmers are simply planting more corn due
to the high price. It looks as if the demand is going to be there for a
long time to come.
So in this farm bill, what we did was to incentivize the production
of ethanol not from corn but from cellulosic-based products, whether it
is peanut hulls, switchgrass, pine trees, or who knows. In my part of
the world, we have a vine culled kudzu that grows rampant across
Georgia, and there is not much use for it. One of these days we may
even see a biodegradable product, such as kudzu, become available for
the manufacture of ethanol. It is a serious problem, and in the farm
bill we sought to address the additional production of ethanol through
cellulosic-based products.
I wish to read a couple pieces of correspondence I have received from
constituents of mine which further emphasizes the intensity of this
problem, the seriousness of this problem, and the fact that all of a
sudden families are simply not able to incorporate into their budget
this huge increase in gasoline prices in such a short period of time.
Deanna Payne of Winder, GA, writes as follows:
Senator Chambliss: Due to the high cost of gas, I am having
to cut down on groceries and visit local food banks. My
husband makes the same amount of money he did in 2007, but we
just can't make ends meet. Gas prices have doubled the cost
of some of the grocery items I used to purchase. I just can't
do it. Please give us some relief! This is ridiculous!
Americans are going hungry and losing everything!
Another constituent from Augusta writes:
I am very concerned about rising gas prices and what if
anything Congress plans to do to help Americans. I cannot
afford to fill up my vehicle at these rates which today are
approaching $4. My husband is a platoon sergeant training
troops at Fort Gordon. I work at the Medical College of
Georgia. We have a combined income of over $70,000. It is
becoming harder and harder to put any money aside. Not only
is the cost of gas rising, but the cost to heat and cool our
home and the cost of groceries are all making it difficult to
make ends meet. My husband re-enlisted in September 2007. We
as a family came to the decision that even during this time
of war, the Army was the only guarantee of a paycheck and
health care coverage for the next few years. I hope that
Congress is putting aside its partisan issues and working
together to help all Americans, as I feel our Nation will
soon fall apart at the rate it is going now.
A constituent from Montrose, GA, writes:
Please work to help us with the prices of gas and its
effects on every household's budget. We should be drilling
anywhere and everywhere to alleviate this current situation.
The brightest in this country need to be assembled and given
the resources to come up with alternative energy sources. We
need to have the Nation go to a 4-day work week starting with
government agencies leading the way by example. These
problems have been gradually getting worse all along with
nothing getting done. Steps better be taken soon before this
country gets into a position that it can't recover from.
Thank you.
From Douglasville, GA:
I am a single mother of 3. I had to take $20 out of my
grocery money to pay for gas just to get to work. That is the
only place I drive. The kids and I walk to our local stores
if needed. This is not the American Dream, or the way we are
supposed to live in the great United States! I can't afford a
new car that is better on gas. I already drive a 4 cylinder.
SOMETHING'S GOT TO GIVE!
I am sure the Presiding Officer has dozens and dozens of these same
types of letters in his office, and it is a further indication of the
fact that Americans truly are hurting at the gas pump.
[[Page S5543]]
It is imperative we provide the leadership in Washington that reacts
from a short-term standpoint but, more importantly, looks to the long-
term solution to this problem. It is going to be very difficult to
reduce gas prices in this short term, but I think, without question, if
we implement today long-term policies, we will see an immediate
reaction by oil-producing countries and we will see an immediate effect
on gas prices and I think, without question, we will see a lowering of
those gas prices, to a certain extent.
But the important matter is we have to address the issue. As I look
around this body and see the rhetoric going back and forth on both
sides of the aisle, I don't see solutions coming out. I see blame being
placed. I see political statements being made. I think it is time we
put those political statements aside, we put partisan politics aside,
and we, sure enough, try to reach an accord for some commonsense
solutions to a problem that is having a direct effect on constituents
of Republicans and constituents of Democrats alike. It is time we make
sure we address this problem for the long term, incorporate the
multifaceted issues that are involved, and that we come together and
make sure we are doing the work the people sent us to do. I don't see
that happening today, and that is what I am hearing from my
constituents back home.
So I hope, as we move forward over the next several days before we
adjourn for the Fourth of July week break, when we are all going to be
back home and we are going to continue to hear these issues raised, we
can say: Here is what we are prepared to do in a bipartisan way to
solve this problem and to make sure we don't continue to be dependent
on foreign petroleum imports, to the tune of 62 percent of our needs;
that we are taking action to address that imbalance, and we are taking
action to implement measures to ensure that alternative fuels are
developed, that the research is put in place to provide those
alternative fuels at the gas pump, which will help drive the price
down, and that we are prepared to implement conservation measures and
implore the American people to also think about that from the
standpoint of the implementation of conservation measures. If we don't
do it ourselves, it is difficult for us to ask the American people to
do it.
So I do hope the leadership in this body, on both sides of the aisle,
is listening to the American people and is cognizant of the fact that
people across America simply don't think we are doing anything and that
partisan politics is not allowing us to do anything; that we address
that issue; that we find long-term solutions which will help in the
short term as well as the long term; and that we seek positive
legislation coming forward from both sides of the aisle to address this
problem immediately.
With that, I yield the floor, and 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. STEVENS. 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. STEVENS. Mr. President, what is the situation regarding time?
The PRESIDING OFFICER. The Senator from Alaska has 15 minutes.
Development in ANWR
Mr. STEVENS. Mr. President, Americans are forced to pay more for gas
every day, every week. The price is going up and up. There have been
many ideas presented on the floor of the Senate, but I do think some of
the comments made by the Senator from New York, Mr. Schumer, need a
response. He has made some comments about the developing of the Arctic
Plain, known as ANWR. Actually, it is not part of the Arctic Wildlife
Refuge. It is 1\1/2\ million acres that were set aside in 1980 for oil
and gas exploration and development. That land has been waiting for
approval of Congress and the President. The 1980 act required that
there be an environmental impact statement finding that there would be
no irreparable harm to the flora and fauna of the Arctic, and that
finding would have to be approved by the President and Congress;
namely, it would have to be approved by an act of Congress, signed by
the President.
Since 1981, we have tried to proceed as was planned at that time. At
the time that President Carter had withdrawn over 100 million acres of
Alaska land, the one success we had in that bill--the 1980 bill--was
the provision that permitted the exploration and development of the oil
and gas resources of this area of the Arctic Plain.
Now, the Senator from New York said opening ANWR's 1 million barrels
a day of production would reduce the price of gas at the pump by only a
penny. We found that rather strange because he later said he wanted the
President to ask the Saudi Arabian people to increase their production
of oil from 700,000 to 800,000 barrels a day, and if they did, it would
reduce the price of gas at the pump--at first, he said by 35 to 50
cents, and then he said it would reduce it by 62 cents a gallon. I find
it strange that 1 million barrels of oil from Alaska would reduce the
price at the pump by only one penny but 800,000 barrels a day from
Saudi Arabia would reduce the price at the pump by 62 cents. Somehow or
other, that kind of calculation is not the way we add up things in
Alaska.
Let me repeat that. He said: One million barrels a day from Alaska
would reduce the price at the pump by one penny, but 800,000 barrels a
day from Saudi Arabia would reduce the price up to 62 cents. It is not
really understandable when a Senator presents arguments that contradict
each other. I think it is time now for the Senator from New York to
come back to the Senate floor and restate his position on ANWR. Is it
an economic position or is it just a philosophical position, where he
is agreeing with those people who are against exploration and
development of the Arctic Slope? If it is, I understand it.
At first, the Senator from New York said he favored drilling in the
eastern Gulf of Mexico because the oil could come to market more
quickly than Alaskan oil. That, too, is too much to pass up. Congress
authorized the eastern gulf development a year and a half ago, in
December 2006. The lease sale occurred this past March, and it will be
7 to 10 years before that oil comes to shore. As a matter of fact, it
is probably going to take longer to develop the gulf oil than it would
take to develop the Alaskan oil on the Arctic Slope because the 3-D
seismic has been done in our State. We know where the oil is located.
We just have to finish exploration and develop that field. And it would
take less time because there is a pipeline already in place.
Perhaps the Senator from New York has forgotten that we have a
pipeline. At the time of the Persian Gulf war, that line carried 2.1
million barrels a day to American markets. Now it is carrying about
700,000. It is about two-thirds empty, Mr. President. That is a very
difficult thing for Alaskans to understand, when we know there is oil
in the Arctic Plain waiting to be developed. As a matter of fact, if
President Clinton had not vetoed the ANWR bill in 1995, we would have
up to 1\1/2\ million barrels a day being delivered today through that
pipeline. That argument has been the same every year since 1980.
I have been here every year trying to get approval of the finding
that there would be no irreparable harm to the Arctic if developed. It
is supported by the people of Alaska and other people of the United
States and there is an overwhelming approval now to proceed with
development of the Arctic Slope. It has to be done.
We have had development of our Arctic at Prudhoe Bay. At the time we
argued on the floor of the Senate for approval of the amendment to
permit the oil pipeline to be built back in the 1970s, there were cries
on the Senate floor, in the press, and throughout the country that it
would harm the caribou, that the caribou would be put into jeopardy.
Mr. President, there are three to four times as many caribou in that
area now than before the pipeline was built. As the pipeline was built,
in the area where it was restored, we planted grasses there that were
even better than the natural grasses. If you want to see caribou in
Alaska now, the place to go is by the pipeline. We have not had any
spill on shore of any nature. There was some last winter--in terms of a
gathering pipeline, that leaked a little. But it was during the
wintertime, and it was totally cleaned up and there has been no
irreparable harm.
[[Page S5544]]
We have literally billions of barrels of oil available to us. At the
time we proceeded with the oil pipeline, the estimate was made that
Prudhoe Bay would develop 1 billion barrels. Well, we have sent over 14
billion barrels of oil to the south 48, by virtue of the Mondale
amendment to the Oil Pipeline Act, that all the oil transmitted in the
Alaska pipeline must go to American markets. I voted for that
amendment. I think this is American oil, and it should fill American
needs. As a matter of fact, we are tired of seeing the increase in the
importation of oil from foreign sources.
At the time of the 1970s embargo on oil by the Arab nations, we were
importing about 33 percent of our oil. Today we are importing over 60
percent of our oil. In about 5 years we will be importing about 40
percent of our natural gas, LNG. Think about that. This Nation, which
has been a leader in the world in industrial development and in
technology, is going to be at the place where almost two-thirds of our
need for oil or gas is going to be dependent upon foreign sources, when
we have known areas in this country that can boost out oil and gas.
It is primarily a situation where this is an opposition that has
arisen on a political basis. After President Clinton vetoed the ANWR
bill in 1995, many of my friends on the other side of the aisle decided
they would not support ANWR anymore, and they have voted that way.
I think it is unfortunate because we should have access to develop
American sources of oil to meet American needs. This area of our North
Slope meets those conditions fairly well. I do think the concept of the
Senator from New York, in demanding that the President go to Saudi
Arabia to increase their production when he opposes doing so in this
country, is unacceptable.
It is the duty of Congress to keep American dollars in America when
we can. By developing a very small portion--less than 2,000 acres of
that million and a half acres, which is all we need to develop for the
oil and gas resources of the Arctic Plain--we could offset the entire
oil imports we bring in from Venezuela or Saudi Arabia. I was surprised
at my friend from New York, when he said the idea of developing the
ANWR oil is a poorly executed ``magic trick.'' I don't know what is
magic about it. It is just a matter of simple engineering. We can and
have developed oil and gas in the Arctic, and we have not seen the harm
that other people have indicated would come to either our area or to
the wildlife of our area.
We need to have Americans realize it is the very fact of starting to
develop this oil that will bring down the prices from foreign sources.
Once the foreign sources see we are getting ready to increase our own
supply, they will start reducing their price in order to take away the
incentive we have, based on the current prices, to open these areas in
the United States. So if you want an immediate reaction from anything,
in terms of this current gas price problem, then have the Congress act
and have the President sign a bill to start the development of the
Arctic Plain, known as ANWR. If we do that, that signal to the foreign
producers of oil will say America is just getting ready to restore its
own supply. If it restores its own supply, prices will come down in
foreign oil. They don't want our competition; they want our markets. So
far they are convinced that we will not provide our own oil, and since
we will not, there is no limit to what they will charge us for oil.
We have seen such a dramatic change that I cannot believe it. At the
time the oil pipeline was approved, oil was $7 and $8 a barrel. It is
now approaching $150 a barrel. Why? Because of the law of supply and
demand. We have refused to increase our domestic supply of oil, and
having done so the price is set at a world price.
I remember there used to be a posted price in San Diego or Los
Angeles or Philadelphia or Seattle or even in Alaska--a posted price by
the refineries on how much they paid for oil. That is no longer the
case. The case is now that we look to the foreign suppliers to see what
they are going to charge. We have to pay whatever they charge. With an
increasing demand all over the world from the developing countries,
such as China, there is no reason for us not to understand what is
happening.
Just a week ago, on the front page of the Wall Street Journal, there
was a chart that showed the future situation with oil and gas. It
showed the supply almost steady at the same level for coming years. It
showed the demand on an ever-increasing curve going up, up, and up.
When the price of oil started going up, I predicted on the floor of the
Senate, when we debated the ANWR situation in 2006, that the price of
oil could reach $100 a barrel. Actually, there was laughter from the
other side of the aisle. Some of my Democratic colleagues laughed and
said it was another exaggeration by the Senator from Alaska.
Mr. President, it reached not only $100 a barrel, it is over that. It
is going to stay over $100 a barrel, until we wake up and start
developing our own supply of oil. Once we start developing that supply,
the foreigners will know we are going to be able to bring that price
down by our supply, and they will start bringing it down so we will not
increase it to the point where we present a dangerous challenge to
their domination of the world market, as far as oil is concerned.
I think the concept of these imports has just been totally missed. My
friends talk about exporting jobs. Nothing has exported more jobs than
purchasing our oil abroad. Every 1 million barrels of oil a day coming
in has eliminated 20,000 jobs in the United States. That is 20,000 jobs
for every million, and we are importing over 12 million barrels of oil
a day. Mr. President, 12 million barrels of oil is the same as 240,000
jobs.
When we look at this, I think it is time for the Senate to settle
down. I do hope my friend from New York will settle down a little bit
because there is no trickery in ANWR, there is no trickery in exploring
and developing American sources of oil. The trickery is in terms of the
prices we are paying, the exaggerated prices caused by those who are
buying futures and speculating futures on our oil. We are no longer
buying oil from foreign sources, we are buying them from some of our
own people who invested in futures, and they are speculating on that
price and driving up the price.
It is time for us to get down to the fact that we must find a way to
authorize exploration and development of the Arctic Plain, known as
ANWR.
I yield the floor.
The PRESIDING OFFICER. The Senator from Kansas is recognized.
Mr. BROWNBACK. Mr. President, I ask unanimous consent to speak on
Senator Cornyn's time for up to 5 minutes, and I further ask unanimous
consent that after I speak, the Senator from Illinois be recognized.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BROWNBACK. Mr. President, I appreciate my colleague from Alaska
raising some of these points. I was thinking particularly about the
point that the markets react to what actions are taken, and that is a
key point on driving prices down.
I used to report on commodity markets a number of years ago when I
was a broadcaster. The idea of buy on the rumor and sell on the fact is
something to which markets react. So we could help on a near-term basis
driving these prices down if we would act. Plus, I like the idea of
pegging a price of a gallon of gasoline. When the average prices across
the country hit $4.50 a gallon, let's give Governors the option of
opening some of these closed-off lands. These are ideas we ought to be
talking about on getting energy prices down.
Tornado Damage In Kansas
Mr. President, the reason I have come to the floor is not to talk
about energy prices but to talk about what happened in my State last
night. We had devastating tornadoes. A series of tornadoes struck parts
of our State and caused at least two deaths and a huge amount of damage
in a swath 150 miles long. The counties of Ellsworth, Saline,
Dickinson, Riley, Clay, Geary, Pottawatomie, and Jackson all suffered
severe damage last night.
The town of Chapman in Dickinson County, with a population of 1,400,
appears to be the hardest hit. Initial estimates are 85 percent of the
homes and businesses have received some damage, and up to 70 percent of
the town may be destroyed.
[[Page S5545]]
One person is reported dead in Chapman. Also one person is reported
dead in Soldier, KS. That is in Jackson County. Certainly, my prayers
and the prayers of many go to the victims and their families who are
struggling and suffering.
Damage was also reported in Salina, KS, and Manhattan, KS. The
northern part of Kansas State University apparently received extensive
damage.
I am hopeful my colleague Pat Roberts and I will be able to travel
with others this afternoon to look at some of that damage.
Evidently, the tornado touched down near the old field house on
Kansas State University campus, the Ahearn Field House, and traveled
across campus. There was damage sustained on Cardwell Hall, Ward Hall,
Burt Hall, and the engineering complex. Ward Hall houses a nuclear
reactor, a teaching facility nuclear reactor, and the building received
some damage. The reactor is safe.
The Wind Erosion Laboratory, a federal laboratory on the K State
campus, apparently was destroyed.
Damage was also reported in several of the parking lots with cars
being tossed around. The Sigma Alpha Epsilon house received extensive
damage. Thankfully all the residents there are safe.
While it is early, the damage will be well into the millions of
dollars. My office and the office of my colleague Pat Roberts contacted
FEMA and State officials this morning, and we continue to work closely
with both State and Federal officials to help the citizens of Kansas
rebuild.
This has been a very difficult, extraordinary tornado season. I was
in north central Kansas on Monday of this week looking at damage to
another of our towns, Jewell, KS, and the extensive damage there by a
tornado within the past 2 weeks. We have had these on a periodic basis.
We are getting a lot of hail damage and a lot of wind and rain damage
throughout the State. It seems as if every other night there is some
system developing and passing through the region.
Certainly, as well, everybody's thoughts and prayers are with the
scout troop in Iowa that suffered four deaths, apparently perhaps more,
due to the tornado that was in much of that same line of thunderstorms
and tornadoes that swept throughout much of the Midwest last night.
I say that to this body as a way of recognizing and stating to people
what is taking place as far as damage, and also the support and help we
are going to need throughout the Midwest for some of the tornado damage
that has occurred. It is extensive.
We are in a very difficult tornado season. It does not appear to be
abating. We are getting a lot of flood damage, hail damage, and tornado
damage. We will be reporting back to the body on some of the work that
is going to need to be done to rebuild, whether it is Kansas State
University, Chapman, or other places that have been damaged. We can
only hope we can last the rest of the season with no more loss of life
and hope there is no more damage to communities. But it has been a very
difficult season.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The assistant majority leader is recognized.
Price of Gasoline
Mr. DURBIN. Mr. President, in my brief period of time, I wish to
address two issues. One relates to a topic that is important across
America. Another relates to the pending legislation.
The first topic is the issue of the price of gasoline. I don't need
to show this chart to people to remind them what is happening.
Beginning with the Bush administration when the President was sworn
into office, the average price for a gallon of gasoline was $1.47. As
of June 9, the average price across America was $4.04, the most
dramatic increase in the price of gasoline in our history. It is a
situation which has called for analysis and attention because no matter
where we go--in Illinois, Ohio, in any State--people say: Senator, what
are you going to do about these gas prices? They are killing us.
They go to the gasoline stations, the service stations, pull out
their credit cards and cash, and cannot believe how much it costs. It
is not just an inconvenience for many people, it is a hardship. For
some, they have had to make family budget decisions because they cannot
afford to keep the tank full, and many do not have an option. If they
are from my part of the world in downstate Illinois, there are not that
many buses outside the cities. There is no mass transit. What are you
going to do? You moved out into the country to get a home you can
afford. You commute to a job spending an hour each way to work. And now
filling that gas tank takes so much of your paycheck, so you have to
cut back in other areas or borrow more deeply, finding your credit card
balance growing and your ability to reckon with it diminishing. That is
the reality of where we are today.
Obviously, people across America say: Well, Senators, what are you
going to do about it? You were elected, weren't you, to do something
about the issues and challenges facing our country?
So this week we came to the floor and said: Let's debate it. Let's
put our best efforts to work. Let's debate a bill that may help and
amend it and try to come up with some way to deal with the energy
crisis facing America.
On Tuesday, we took this vote. We needed 60 out of 100 Senators to
vote to start the debate--60 out of 100. When the final count was in,
all the Democrats voted for it, six or seven Republicans joined us, and
we were still about nine votes short of what we needed. The motion to
proceed failed.
At that point, we couldn't even debate the most serious issue facing
families and businesses across America. That is unfortunate. All we
needed were nine more Republicans to join us to start the debate. That
is all we wanted to do--start the debate. Maybe we would have agreed on
something. Wouldn't that be newsworthy.
But as it stands, we had two votes on Tuesday, we tried to proceed to
bills, and in both instances, the Republican minority said: No, we
don't want to debate anything on the floor of the Senate this week. And
that is exactly what we have done. We have debated nothing.
If Members of the Senate were paid for the votes they cast, this
Senate this week has not earned a minimum wage. I don't know how we can
continue to do this in what is euphemistically called the world's
greatest deliberative body. Mr. President, do you know what the problem
was? One of the provisions in our bill angered the Republicans. We
suggested that the oil companies, if they are going to charge these
outrageous amounts for their products, should be subject to a higher
tax for windfall profits. I support that. I think it is the right thing
to do, to discourage the profit taking that is going on. Many
Republicans oppose it, and I don't question their motives on it. Isn't
it worth debating? Isn't it worth a vote? At the end of the day
somebody wins and somebody loses. That is what happens on the floor of
the Senate. But on the Republican side, they stopped us from even going
to that debate over the oil companies.
Surely, they must hear from their voters at home how bad the
situation is. I know they hear from the oil company lobbyists who are
roaming these hallways that they need to be protected.
Let's take a look and see how the oil companies have been doing. Not
bad. Starting in 2001 when President Bush arrived on the scene, this is
an indication of the profits of the oil companies. Profits of the oil
companies under this administration have gone up 400 percent.
Some of the numbers are startling. In 2006, profits reported by
ExxonMobil were $39.5 billion, the largest recorded profit in U.S.
history. Listen to that. Not the largest recorded profit by an oil
company; the largest reported profit by any business in the history of
the United States of America.
Come 2007, ExxonMobil broke its own record. Profits went up to $40.6
billion; the annual salary for their CEO, $21.7 million. A retirement
package for ExxonMobil's previous CEO--job well done--no gold watch for
this man, a gold mine, $400 million as his farewell gift. What a great
party that must have been to say thanks for all the good work you have
done for ExxonMobil. Here is $400 million. Have a nice day.
People across America are not having a nice day. When they pull into
an Exxon station, when they fill up their
[[Page S5546]]
gas tank, it is a bad day, it is a tough day for a lot of American
families.
The total combined net profits of the big five oil companies under
this administration are $556 billion. How much money did they invest
back into more oil wells, more production? About an 80-percent increase
in their capital investment, a 300-percent increase in the cash they
held back to buy back stock and improve their profitability--not
improve their productivity, their profitability.
Investments in alternative fuels by these big five oil companies?
Negligible. That is the reality.
I think that is worth a debate, don't you? Isn't that what the Senate
is supposed to be about? We come in and say it is time for this to end,
it is time for Americans to stop being taken to the cleaners by the oil
companies, and it is time for them to pay higher taxes to discourage
them from profit taking. I support that position. Others oppose it.
On Tuesday, the Republicans said: No, there will be no debate. And
that is the end of the story, at least for this week. We will go home
and the voters will ask the same question: What did the Senate do about
oil prices, gas prices this week? And the honest answer is nothing.
This is not the first time we faced this filibuster. The Republican
filibusters so far in this 2-year session, 75 Republican filibusters
and still counting--75. To put it in perspective, a filibuster is when
you delay or stop debate on an issue, delay or stop a bill, an
amendment, a nomination. It is your right in the Senate to do that. But
people were careful not to abuse it in the past.
In the history of the Senate, the largest number of filibusters in
any 2-year period of time was 57. So far in this session, with another
6 or 7 months to go, the Republicans have initiated 75 filibusters, 75
attempts to stop progress in the Senate, to stop debate in the Senate,
to stop us from moving forward on bills related to everything under the
Sun. They even went so far as to filibuster a technical corrections
bill. These are the bills that go in and take a hard look and see, oh,
we forgot the punctuation or there is a reference that needs to be
changed slightly. It is the kind of housekeeping you do when you have
huge pieces of legislation, where even though staff works hard and the
Members work hard, they miss something. So the technical corrections
bill came up, we thought this would be easy, so let's get this over
with, but it took a week because we faced a filibuster on it. They
wanted to filibuster a technical corrections bill. That doesn't take us
to where we need to go as a nation.
We at least owe the American people a healthy, spirited, fair, and
open debate on the issue when it comes to this energy crisis. We can't
get it in this Senate. We have been stopped. A 51-to-49 Senate does not
allow us to come up with the 60 votes we need to move the debate
forward. Well, the final vote will be in the hands of the voters of
America on November 4. They will decide whether they want change in
this town and change in this Chamber; whether they want to elect some
people who will come, roll up their sleeves, and get down to work.
We have a lot of things to do in this country--an energy crisis,
global warming, carbon pollution, a health care crisis, two wars, a
looming recession, and the bankruptcy of Medicare and Social Security.
We don't need more filibusters. We need more work right here in the
Senate. I hope we can return to that after the next election, or maybe,
if there is a miracle, even next week, if the minority party decides
that is what will happen.
Medicare
Mr. President, we are debating a motion to proceed, once again, to a
bipartisan bill to help Medicare. It has the support of AARP, the
American Medical Association, and lots of others. It picks up where we
left off in December, when we passed a bill that was a short-term fix.
We bought 6 months then, and we are back again.
The bill we are considering prevents physicians from facing a 10.6-
percent cut in Medicare payments on July 1, and gives them a 1.1-
percent payment increase for 2009. The physicians who work under
Medicare will also receive a 2-percent bonus, if they participate in a
program to reduce the number of errors and improve the quality of their
service, called the Physician Quality Reporting Initiative. It is a
responsible way to avoid a severe cut in payments to physicians and to
ensure payments are adequate for the next 18 months.
As important as it is to ensure that our physicians are paid
adequately for the good work they do for millions of Americans--some 40
million Americans covered by Medicare--we didn't want this bill to just
be a doctor fix. The bill contains a lot of changes in Medicare that
will help beneficiaries.
The Medicare Savings Programs provide financial assistance to low-
income Medicare beneficiaries who can't afford Medicare's premiums,
copayments, and deductibles. Many low-income beneficiaries are excluded
from this assistance because they have accumulated modest savings.
These are retired people, by and large.
Today, if you have assets of more than $4,000, $6,000 for couples,
you can't qualify for Medicare Savings Programs. We haven't changed
that number for almost 20 years--$4,000. Under the bill before us, the
asset limit will roughly double, providing real assistance to those who
don't have much money and still need Medicare.
This bill, which the chairman of the Finance Committee, Chairman
Baucus, brings to us, also makes an important move toward mental health
parity. It is hard to imagine it has been more than 5 years, almost 6
years since Senator Paul Wellstone died in a plane crash. What a great
guy. What a great Senator. His heart was there for so many issues but
especially when it came to mental health issues because his family was
touched by this challenge. Paul Wellstone used to ask: Why don't we
treat mental illness like an illness, instead of a curse? Why don't we
treat mental illness like a physical illness when it comes to health
insurance? He worked on us and worked on the issue and Senator
Domenici, a Republican from New Mexico, joined him to make it a
bipartisan effort.
I am sorry to say that some 6 years later, we haven't passed that
Wellstone-Domenici bill. Senator Kennedy was working on it before he
had his problems. I hope we can return to it. This bill takes a modest
step forward in that debate.
Over the years, our understanding of mental health and the ways to
treat it have grown, but Medicare continues to discriminate against
services for those who are mentally ill by imposing a 50-percent cost-
sharing requirement compared to 20 percent for most other services.
This bill phases out that higher copayment over 6 years. It is a step
in the right direction.
We have made some progress in recent years, adding preventive health
services to Medicare, such as screenings for heart disease, diabetes,
and cancer, but it literally requires an act of Congress to add a new
preventive benefit. The Baucus bill will make it easier to add
preventive services to Medicare. It would create a process for the
Secretary of Health and Human Services to add them, if recommended by
the U.S. Preventive Services Task Force.
We also address market abuses in this bill. There is a program called
Medicare Advantage. Private health insurance companies love it. You
know why. They make a bundle off these programs. They sell them to
seniors, and they charge more than 12 percent over basic Medicare
premiums. Frankly, I happen to believe they do not show the results for
their effort, and they are involved in some marketing practices which
we have to try our best to curb.
Seniors are vulnerable. You know as well as I do that many people who
reach their elderly years don't have someone at hand to give them good
advice, and many times, frankly, they sign up for things they
shouldn't. This bill addresses disturbing reports of abusive and
fraudulent sales-and-marketing practices by Medicare Advantage plans
and Medicare drug plans. Medicare beneficiaries have been enrolling in
private plans they didn't understand, and many of them have faced
outright fraud and exploitation by these Medicare Advantage companies.
This bill will rein that in.
Senator Chuck Grassley of Iowa, a man I respect and like, is going to
offer an alternative to our bill, which I have described, but it
doesn't provide assistance to low-income Medicare beneficiaries. It
doesn't deal with mental health parity, and it doesn't ease the process
of adding preventive services.
[[Page S5547]]
There are many other provisions in this bill. It has been long
overdue, and a lot of people have asked us to take up this bill because
Medicare is so important at a time when people are losing their health
insurance coverage. For the seniors and disabled who count on Medicare,
this bill is important. But we need 60 votes. I hope we will get 60
votes. I hope we don't face another filibuster on this critically
important bill.
This is something that should pass. This bill is balanced, it
provides needed improvements to Medicare, but it is responsible. We
fully offset any cost to the Treasury, primarily by reducing
overpayments in the private Medicare Advantage plans, which are paid 13
percent--I said 12 percent earlier, but it is 13 percent--more than it
would cost to cover someone in traditional Medicare.
I think it is responsible. Rather than adding new costs to Medicare
and to the deficit, we pay for it. Pay as you go. In the old days, that
used to be called being a fiscal conservative. The other side of the
aisle used to be very proud to say they were fiscally conservative.
Now, ironically, the table is turned. In fact, it is turned upside
down. The Democrats are calling for fiscal conservatism--pay as you go,
don't add to the deficit, be responsible--and the Republicans--some--
are saying no. I hope they do not prevail. I hope we can prevail with a
paid-for bill.
It is a bipartisan bill. Senators Snowe, Rockefeller, and Smith have
joined Senator Baucus. I am going to support it, and I hope all my
colleagues do when it comes up for a vote later this afternoon.
I yield the floor.
The PRESIDING OFFICER. The senior Senator from Utah is recognized.
Mr. HATCH. Mr. President, I rise to oppose cloture on the motion to
proceed to the Baucus Medicare bill, and there is reason to oppose at
this time.
I will keep my comments brief, but I wish to make one point perfectly
clear. I have said, time and time again, I am willing to work with my
colleagues on the other side of the aisle to get a bipartisan Medicare
bill through the Senate. I have always prided myself on being someone
who is fair, honest, and who wants to get the job done. Unfortunately,
others in this body don't seem to want to get the job done, and that
disappoints me more than most of you will ever know.
My biggest frustration is we are not that far apart. Both sides wish
to restore physician Medicare payments so doctors are not cut by 10
percent on July 1. We also agree we need to implement the provisions on
e-prescribing, electronic health records--where my home State of Utah
is the leader--and value-based purchasing for Medicare providers and
beneficiaries. We both believe a strong, robust rural health care
package is necessary and, therefore, should be included in the Medicare
package. Both the Democratic and Republican Medicare bills include
marketing reforms for Medicare Advantage plans in order to ensure
beneficiaries are treated with respect and are given truthful and
helpful information so they may choose the Medicare Advantage plan that
best suits their personal needs. Medicare Advantage has worked
amazingly well. Democrats want to take the ``pay for'' out of the
Medicare Advantage plans, and 90 percent of the people in this country
who are on Medicare Advantage want to continue on it because they
believe they are better treated. They are, as a matter of fact. It is a
system that works. Why change it?
We include provisions that would allow both hospital-based renal
dialysis centers and skilled nursing facilities to be sites for
telehealth services. As a strong supporter of telehealth services, I am
very supportive of this provision, and both bills have it in.
Finally, both bills extend the Special Diabetes Program for 2 more
years. This program is very important to me. So as you can see, we
agree on a lot. Unfortunately, the two outstanding issues, in my
opinion, are Medicare beneficiary protections and offsets.
The Baucus Medicare provisions include provisions that would increase
Medicare beneficiary protections in the Medicare Program. It would
increase the low-income subsidies for beneficiaries, extend the
availability of the ``Welcome to Medicare'' physical examination from 6
months to 1 year.
I wish to make it clear our side could support these beneficiary
changes, but we are very concerned about the impact these changes would
have on long-term entitlement spending. The prices are going to
continue to ramp up all the time, and our friends on the other side
don't ever seem to worry about that. With 76 million baby boomers
retiring over the next three decades, the Medicare Program is already
headed for serious fiscal disaster. So we need to be thoughtful about
these provisions and not just do what our colleagues on the other side
want to do.
Therefore, we believe it makes sense to means test the Medicare Part
D beneficiary premiums for higher income beneficiaries. Although my
friends on the other side are constantly arguing that the rich don't
pay their fair share, unfortunately, when we suggested this, colleagues
on the other side of the aisle--and, in fairness, some on our side as
well--objected to means testing Part D premiums. I do not understand
their objections.
We already means test Medicare Part B premiums, and that had
bipartisan support. Making that change would not only have wealthier
beneficiaries shouldering a greater share of their Part D premiums, it
could also pay for some of the beneficiary protections included in the
Baucus Medicare bill.
It is greatly disappointing to me that our friends on the other side
of the aisle are not willing to accept this offset. In fact, we have
been told pointblank that they cannot support increasing Part D
premiums for rich Medicare beneficiaries in order to provide more
assistance and benefits to lower income seniors. That is despite the
fact that they have cut some very serious programs for the poor in
order to find offsets for some of the things they want to do. I am
going to say it again. I do not understand it. Especially since both
sides supported means-tested Medicare Part B premiums.
Hopefully, we will be able to change their minds when we begin our
work to improve the Medicare Program so it will be more efficient for
both beneficiaries and providers. That is the reason why we should vote
against cloture, so our friends on the other side have to come together
with us to have a better bill, and I believe we can.
The second major issue concerns the offset used in the Baucus bill to
pay for its provisions. The White House has told us, time and time
again, the President will only be able to accept very minimal
reductions to the Medicare Advantage Program. Time and time again he
has said that. Otherwise, he is going to veto the bill.
That is why Senator Grassley and I have insisted the White House be
included in the Senate Medicare negotiations. We do not want to send a
Medicare bill to the White House that is going to be vetoed and,
therefore, put the physicians' Medicare payments in jeopardy. It is
another reason to vote against cloture, so we don't go through the
charade we will have to go through if we don't.
But that is exactly what is going to happen if the Baucus Medicare
gets cloture today. It will probably pass the Senate and then be
considered by the House of Representatives. The House will make changes
to the bill, too, that will probably not be acceptable to the White
House. Then the Senate will have to consider the Medicare bill with the
House's changes before it is sent to the White House for a certain
veto. It is ridiculous. Why do they have to do a partisan bill? Why not
work with us, since we want to work with them?
We will not have the votes to override the President's veto of the
Medicare bill, so we will be back to square one and we will have wasted
a lot of time and maybe even have done some very bad damage.
I believe the Grassley Medicare legislation, which I strongly
support, would not suffer the same fate as the Baucus legislation. That
is why I believe this bill should be considered by the Senate instead
of the Baucus Medicare bill. We are so close together on almost all
these provisions, except for these few I have mentioned. The Grassley
bill is a better bill. The President will sign it into law.
I would like to take a moment to highlight the major differences
between the Grassley Medicare bill and the Baucus Medicare legislation.
On this chart, first, as you can see the Grassley Medicare bill
encourages e-prescribing sooner rather than later.
[[Page S5548]]
The Grassley bill requires physicians to e-prescribe by 2010, while the
Baucus bill delays mandatory e-prescribing until 2011.
In addition, the Grassley Medicare bill repeals the Deficit Reduction
Act provision on the transfer of ownership of oxygen equipment to
Medicare beneficiaries. The Baucus bill cuts Medicare payments for
oxygen and oxygen equipment. It is somewhat shocking to me, but that is
what they do.
On durable medical equipment for competitive bidding, the Grassley
bill includes a sense of the Senate to delay competitive bidding for
durable medical equipment for 18 months. The Baucus Medicare proposal
as filed does not even address competitive bidding.
Let's go to chart No. 2.
The Grassley bill also has provisions on hospital value-based
purchasing. The Baucus Medicare bill does not include a similar
provision. You would think we would want to go to hospital value-based
purchasing.
The Baucus Medicare bill reduces the Medicare reimbursement rates for
power wheelchairs, of all things. The Grassley Medicare bill does not
cut Medicare payments for power wheelchairs. You would think we could
get together on that.
The Grassley Medicare bill provides continued relief for hospitals
with high numbers of undocumented individuals. The Baucus bill does not
include a similar provision. Again, as anybody can plainly see, the
Grassley bill is a better option.
I am going to conclude with one very valid and important point. My
colleagues need to vote against cloture today so we can begin work on a
bipartisan bill that will be signed by the President. We do not need to
be wasting our time going back and forth on a bill that does not have a
chance of becoming law. In fact, we need to roll up our sleeves and get
to work immediately so we can get this legislation to the White House
before the July 1 deadline. Otherwise, our Medicare beneficiaries and
doctors participating in the Medicare Program will lose. But you know
who the biggest loser will be in this process. That is the Senate,
because we have failed to do our job, therefore letting down both
Medicare beneficiaries and Medicare providers.
I urge my colleagues to vote against cloture to avoid this terrible
situation and to take the more appropriate, better designed, and more
compassionate bill. Frankly, that is what our bill is. I just hope our
colleagues will see this and vote against cloture.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. BINGAMAN. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Tester). Without objection, it is so
ordered.
Habeas Corpus
Mr. BINGAMAN. Mr. President, I will speak very briefly here to call
to the attention of all Senators the very important decision that was
just handed down this morning by the Supreme Court regarding the
prisoners who are detained in Guantanamo.
The Supreme Court has once again rejected the administration's
approach in disregarding basic due process rights and our Nation's
longstanding commitment to the rule of law. The Court, in a decision
written by Justice Kennedy, held that individuals detained at
Guantanamo have a constitutional right to challenge their prolonged
detention in civilian courts.
Furthermore, the Supreme Court found that the Military Commissions
Act of 2006 amounted to an unconstitutional suspension of the writ of
habeas corpus. The Court today reiterated that the Great Writ, the writ
of habeas corpus, remains as a fundamental protector of individual
liberty and as a safeguard against arbitrary detention by the
Government. This right, which is enshrined in our Constitution, simply
allows for an independent and meaningful review of a person's
confinement by the Government.
Nothing in today's decision requires that the Government release the
prisoners held at Guantanamo. Many of those prisoners have been held
there for over 6 years without access to meaningful judicial review.
The decision simply allows these individuals to ask a court whether
their continued confinement is in accordance with our Constitution.
The President has asserted extraordinary authority to indefinitely
imprison anyone he designates as a so-called enemy combatant--that
would include U.S. citizens, according to the administration's legal
position--and that that detention could continue without any judicial
review.
It is time that we change course and recognize that acting in a
manner consistent with our Constitution and with our core American
values is not a sign of weakness.
It is a sign of our strength and a sign of who we are as a people. I
am very pleased that our highest Court has reaffirmed our Nation's
respect for the rule of law and sent a clear message that the
Constitution remains strong.
I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. DORGAN. I ask unanimous consent that the order for the quorum
call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Mr. President, I was just visiting with my colleague from
New Mexico. I was unaware of the Supreme Court decision this morning.
But the decision by which they have overturned some legislation that
retracted the right of habeas corpus for those who might be suspected
of some sort of illegal activity and so on in this country, that
decision by the Supreme Court is a very important decision.
I could not believe when the Senate passed a piece of legislation
saying that someone who is apprehended or detained in this country
would not have the right of habeas corpus. That is a different kind of
country than I know. There are countries in this world where they can
pick you up right off the streets and say: Do you have papers? Even if
you have papers they can throw you in jail, and you have no right to
anything, including filing a writ to say: A government cannot hold me.
A government must prove there is reason to hold me.
That is unbelievable that this Congress it--not with my vote. But I
commend the Supreme Court. I haven't had much opportunity to do that
recently, I must say. But their ruling this morning gives me some hope.
Mr. President, we have a cloture vote at 3 o'clock this afternoon. I
wanted to mention the important subject of the cloture vote is dealing
with some Medicare changes.
Medicare is an unbelievably important program. Prior to Medicare, not
many people look back and remember this because most of us have lived
our lives with Medicare in existence. Before Medicare, one-half of the
American senior citizens had no health insurance at all. Does anybody
think that an insurance company says: You know what. We have a new
business plan. Our plan is we want to find people who are old and
provide health insurance for them. That is not the way a business plan
works. If you are selling insurance, you like to find somebody young
and healthy.
As a result, if you go back to the 1950s, early 1960s, you will find
that one-half of senior citizens of this country had no health
coverage. Now, it is a very small percentage that have no health
coverage. The vast majority of American senior citizens are covered by
Medicare. It is a good program.
I grew up in a little town of 300 people. We had a guy named Doc
Hill, Dr. Simon W. Hill. He came into town and he stayed until he died.
He practiced medicine. We did not have a Medicare Program, but he tried
to give everybody whatever health care they needed. He tried the best
he could. We had no lawyer in our town, so he was never sued. He pulled
the tooth of my neighbor. He was not a dentist, but he was a doctor.
The neighbor had a terrible toothache, we were 50 miles from the
nearest dentist, so Doc Hill pulled his tooth. It turns out he pulled
the wrong tooth. But, you know, the fact is, Doc Hill did the best he
could. He practiced medicine in my hometown. I think he delivered close
to 2,000 babies decade after decade after decade. He ran his own
Medicare and Medicaid Program. If you did not have any money, you got
health care to the best he could give it.
[[Page S5549]]
If you had money, he would charge you an arm and a leg. If you had 24
fryer chickens, he would take that; maybe a quarter beef, maybe half of
a hog--whatever it was, he ran a program in a little town.
Well, that is all gone. That does not exist anymore. The fact is, we
now have a Medicare Program that serves America's senior citizens with
health care and says to them: If you get sick, here is a program that
is to provide some help to you.
Now, my colleague, Senator Baucus, and the Finance Committee have
brought a piece of legislation to the Senate floor, and we have to have
a cloture vote on it this afternoon because the other side is
objecting. My hope is that we will have sufficient votes this afternoon
to advance this bill.
It makes some changes in Medicare that need to be made because we are
bumping up against a deadline at the end of this month. Among other
things, it reauthorizes the special diabetes program. That is something
in which Senator Domenici from New Mexico and I have been involved. We
have introduced some reauthorization legislation here.
The diabetes issue is a scourge in this country. I chair the Indian
Affairs Committee in the Senate, and the fact is, we have some areas on
Indian reservations in this country where 40 or 50 percent of the adult
population are affected by diabetes. Go there and go to their dialysis
units and see all of them sitting hooked up to dialysis units. Then see
how many have lost their legs through amputation. See how many of them
have early heart disease as a result of their diabetes. This piece of
legislation by Senator Baucus and the Finance Committee begins to
address some of those issues.
It also makes reforms to what is called the Medicare Advantage
Program. Now, some of my colleagues have come to the floor and said,
well, this bill cuts Medicare. That is total rubbish. This does not cut
Medicare. It takes one portion of Medicare, called the Medicare
Advantage Program, which pays more for healthcare as opposed
traditional Medicare.
This is one of those little pilot programs that some in this Chamber
wanted, so they seeded it with extra funding. Well, the extra funding
has been a waste of money, a tragic waste of money. And this gets some
of the waste and abuse out of it. If my colleagues are upset about
getting rid of waste and abuse, I am sorry. Maybe they will not sleep
very well if we pass this bill. But the fact is, when we see waste and
abuse, we ought to go after that. That is what the Finance Committee
and Senator Baucus have done.
They have used that funding they have achieved by getting rid of some
waste and abuse in the Medicare Advantage Program. They have used that
funding to address some other urgent issues.
If we do not do anything by the end of this month, we will see a 10-
percent cut to physician payments. Well, physicians in my State are
already at the bottom of the wage index on physician payments. And the
fact is, a 10-percent cut would be devastating to senior citizens in my
state who rely on Medicare. It seems to me we should not be doing
things that will predict a degradation of health care. We should not be
doing those things.
The Finance bill and Senator Baucus have brought a piece of
legislation to the floor that avoids that 10-percent payment cut and
establishes a 1.1-percent increase instead through fiscal year 2009.
It is the right thing to do. Now, if you decide you do not want to
vote for cloture, to even allow this to proceed, then you are saying:
You know what, just whack these programs. It does not matter what kind
of health care exists in our States. It does not matter what happens to
the senior citizens.
If that is your view, you know, God bless you. But it is sure a far
cry from my view. I think we have responsibilities to make Medicare
work, to provide decent funds for the providers so that our senior
citizens have health care that all of us can be proud of.
There are many other features in this piece of legislation that are
important. It talks about prompt payment to Main Street pharmacies. We
have drugstores and pharmacists on the Main Streets across this country
that are not getting the kind of prompt payment they should get. And
some of them are threatened with the closure of their business because
we have a system that is not reimbursing them as it should.
It improves access to telehealth, which is very important. This is a
rather new form of delivery of health care, and Medicare is a part of
it. It works. I have been in clinics, and I have seen the delivery of
very sophisticated CAT scans and the delivery of x rays to a
radiologist 150 miles away to get a reading and to be sent back to that
rural clinic.
All of that makes a lot of sense. It gives us access to some of the
best in the country through telemedicine. Then, in addition, the
telemental health part of that is an opportunity for psychologists and
psychiatrists to be engaged in telemental health, particularly on
Indian reservations and elsewhere, where we have some of the highest
rates of suicide any place in the country. Accessing telemental health
services can be very important.
On the northern Great Plains--I know the Presiding Officer is from
Montana. In Montana, North Dakota, on the northern Great Plains, the
rate of suicide among Indian youth--I am talking about Indian teens--is
not double, triple, or quadruple the rate across the country, it is 10
times the national rate. That is why telemental health is so important
for all elements of our population, but also especially in Medicare for
senior citizens. We are doing it in other areas. Extending it to
Medicare makes a great deal of sense.
The improvement of the quality of health care in Medicare, the
prevention of the 10 percent in payment cuts to physicians, the
diabetes prevention program, the elimination of the wasteful payments
to Medicare Advantage, are just a few of the examples of why we must
expect our colleagues will vote for cloture at 3 o'clock this
afternoon. This is the right vote. It is an important vote.
Now, we have been through--yesterday it was energy, with gas at $4 a
gallon, and oil at somewhere around $130, $140 a barrel, the minority
decided to embrace once again their just-say-no policy on everything.
It does not matter what it is, just say no.
It reminds me of an old codger in his eighties who was once asked by
a news reporter who said: Well, you have been around a long time. You
must have seen a lot of changes in your life.
He said: Yeah, I have been against all of them.
We have people on the floor of the Senate who have decided they are
against everything--just say no. My hope is after just saying no
yesterday to energy issues at a time when gas is $4 a gallon, it is
unbelievable to me they would just say no to begin addressing that, but
they did.
My hope is that today, on behalf of health care for senior citizens,
they would finally decide to just say yes. If they will do that at 3
o'clock, we will pass this cloture petition and we will take what the
Finance Committee and Senator Baucus have offered in the spirit of
improving Medicare and saying to senior citizens and saying to their
health care providers: We are going to do the right thing.
There is a time urgency. By the end of June we have to solve this
matter. And I hope my colleagues will be listening and understand that
we need this cloture petition to prevail at 3 o'clock this afternoon.
I yield the floor.
The PRESIDING OFFICER. The Senator from Ohio.
Mr. BROWN. I so appreciate the Senator from North Dakota and his
comments about the just-say-no philosophy around here. I have been in
this institution only 15 months. I have seen his leadership on a whole
host of issues, and I have also seen the disappointment that it is one
filibuster after another--74, 75 filibusters, more than anytime in
Senate history--on such commonsense legislation as the Energy bill
yesterday and the Medicare bill today.
I am happy to see that Senator Baucus and Senator Reid have brought
the Medicare Improvements for Patients and Providers Act to the Senate
floor today. It is crucial not just immediately for physicians and
hospitals, not just immediately for patients, most importantly, but it
is also crucial to the future of Medicare.
The bill not only prevents a 10.6-percent cut to payments for
physicians
[[Page S5550]]
and other health care professionals, it gives these providers a small
payment increase. The cost of providing health care has increased;
payments to health care professionals should increase too.
Our history with Medicaid should teach us about the importance of
preserving Medicare by keeping payment rates viable for providers.
Inadequate Medicaid payment rates have compromised access to dentists
and other health professionals. I visited with the dental unit at
Children's Hospital in Columbus and talked to dentists all over the
State, talked to hygienists and others. It is pretty clear that we do
not have enough dental care, we do not have adequate dental care,
especially for low-income young patients. The reason is we do not have
adequate reimbursement for dentists to provide Medicaid dental care,
particularly for those children. We need to fix that Medicaid problem,
not recreate that same problem in Medicare.
This bill is about so much more than provider payment, as Senator
Dorgan said. It contains important measures to improve Medicare for
beneficiaries. It increases subsidies for low-income patients. It
invests in preventative health care. It reduces out-of-pocket costs for
mental health treatment.
Senator Durbin spoke of Senator Wellstone's work and Senator
Domenici's work on mental health treatment; to treat it like a disease
not a stigma, and how important that is. This makes some downpayment on
that solution.
This bill eliminates late enrollment penalties for Part D and
modernizes Medigap policies. It bolsters rural health care, something I
have discussed in my roundtables around Ohio. I have done some 90-plus
roundtables in 65 counties and seen how inadequate rural health care is
in rural areas of my State, as it is in the Presiding officer's State
of Montana. The bill authorizes a special diabetes program.
This morning in my every-Thursday-morning coffee, which I have for
Ohio residents in Washington, I met with Ohioans from Cincinnati,
Columbus, Toledo, and Cleveland. Ohio's children are suffering from
type 1 diabetes. They told devastating stories. One man told about his
teenage daughter going blind. Another told me that by the time a young
child with diabetes turns 18, she will have endured more than 30,000
shots.
Diabetes is one of the most prevalent and pressing health threats we
face as a nation. The cost to the health care system is more than any
other single disease. Reauthorizing the cost-effective Medicare
diabetes program serves patients and taxpayers.
The bill has other crucial provisions. It exempts the value of life
insurance from counting against seniors attempting to qualify for the
low-income subsidy in Part D. Constituents have written to me telling
me they are afraid of saving for the future, of all things, because
they might lose their eligibility for subsidized drugs. What kind of
system is that? This bill will help fix that.
One of the most common stories I have heard in my 90-plus
roundtables, where I convene meetings of 15, 20, 25 people and ask them
questions for an hour and a half, 2 hours, and we talk about their
hopes, dreams, and problems, and where we, as a Senate, might be able
to work with them and make their lives better, one of the most common
stories I hear from Defiance and Gallipolis, from Middletown and
Ashtabula, whether I am meeting with providers or patients, is about
Medicare. My office receives thousands of constituent letters about
Medicare. I recently heard from an infectious disease doctor in Lima,
who explained how he is squeezed by current Medicare rates. He said:
As health care costs have escalated and reimbursement has
fallen, we have had to make some hard decisions.
He told me he has had to let go of employees, cut office hours, and
that the financial stress is at the breaking point. He said:
Last year, a doctor would call me [about a patient] with an
infected abscess. Commonly, I had the patient sent to my
office, lance the boil, pack the wound, and give IV
antibiotics daily in my office until transitioned to pills.
The patient was never admitted to the hospital.
Since his office is less and less able to provide outpatient
services--remember, I said he had laid people off--similar patients are
now admitted to the hospital. What happens?
``The admission day alone,'' he says, ``costs more than the entire
course of therapy in my office.''
It is obvious how inefficient and expensive this is. We need to fix
the current payment system, and we will. But we should not grossly
underpay those professionals while we work on a better system. Until
that day, we should pass this bill. Medicare is one of the great
accomplishments of our Government and of our country. Senators Dorgan
and Durbin both talked about in 1965, half of America's seniors didn't
have any health insurance. Today that number is less than 1 percent.
Because Medicare is one of the great accomplishments of our Government
and our country, we have to preserve it. This bill takes major strides
to do so.
In addition to voting yes at 3 o'clock on cloture, there has been
another piece of related legislation I want to speak on for a moment.
It is the alternative bill offered by Senator Grassley, who I think is
one of the single best legislators in this body. The bill he wrote as
an alternative to our bill, to the Baucus legislation, perpetuates a
shameful politically motivated subsidy program that overpays private
insurance health maintenance organizations to the tune of $10 billion a
year. What this does is it overpays private insurance companies,
undercutting fee-for-service traditional Medicare, causing taxpayers--
requiring taxpayers--to give huge, frankly, unearned dollars to these
insurance companies as they try to privatize Medicare. The Baucus bill
redirects these taxpayer-funded windfall payments from HMOs to concrete
improvements in the Medicare Program.
In the beginning of my speech, the first 6 or 7 minutes, I talked
about improvements we are making in the Medicare Program. We are able
to do so by taking money away from the private for-profit Medicare HMOs
that have reaped a windfall in the last 10 years as this Congress,
particularly the Republican House and Senate for most of the last
decade, shoveled more and more public dollars into these private
insurance programs, these private HMOs, and private HMO executives have
had grossly inflated salaries and benefits and retirements, all of
that. Ending those gratuitous overpayments to HMOs should not be an
option for this Congress; it should be an imperative that we finally do
that.
Taxpayers can't afford to coddle private, for-profit health
maintenance organizations, and we can't continue to do it. I encourage
my colleagues to vote for the very crucial Baucus Medicare legislation.
I yield the floor.
The PRESIDING OFFICER. The Senator from Texas.
Mr. CORNYN. Mr. President, you don't have to be an expert in health
care policy to know that our health care system is in need of reform.
Today we spend $2 trillion on health care or almost $7,500 per person.
In 10 years, national health care spending is expected to reach $4.3
trillion. That is more than double or $13,000 per person, which would
comprise almost 20 percent of our gross domestic product. Clearly, this
rate of growth is unsustainable. While we should be enacting
legislation to address this health care crisis, Congress is once again
bogged down in debate over how to prevent physician payment cuts from
going into effect. Meanwhile, the sustainable growth rate, the SGR,
which is the formula for these Medicare payments to physicians, has
only increased costs, decreased beneficiary access and quality of care,
and discouraged future generations of physicians, especially in primary
care.
If Congress fails to act, Texas physicians will lose $860 million
between July 2008 and December 2009. That is $860 million which is a
cut of $18,000 per Texas physician. That figure balloons to $16.5
billion by 2016, due to nearly a decade of scheduled cuts. It is great
that Members of Congress and outside coalitions are presenting health
care reform plans, but they are ignoring the fundamental problem. You
can have a great plan. You can have great coverage. But none of that is
any good unless you have access to that coverage.
Physicians' reimbursement cuts have been looming over our heads for
years; in fact, since 1996 and the passage of the Balanced Budget Act.
Yet Congress continually decides to put off for tomorrow what
desperately needs to be done today. So every year Congress
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cuts segments of health care services, either rightly or wrongly, to
prevent these cuts. I firmly believe--and physicians in my State firmly
believe--that short-term fixes are not the solution. This last one was
a 6-month fix which will expire shortly. I don't know anyone else in
the private sector, whether they be a physician or a small business,
who can continually plan based on the vagaries of a 6-month fix,
without knowing whether they will simply be put out of business or what
the Congress will come up with as a solution on a 6-month basis. We
need a longer term solution, in other words. We can't address greater
health care costs until we fix the mess caused by the SGR or the
sustainable growth rate formula for Medicare reimbursements.
Over 3 months ago, in anticipation of the looming physician payment
cut set for July 1, I introduced legislation that addressed the issue
at hand permanently. Even the proposal we will vote on at 3 is only
good for 18 months. I think we need a permanent solution. My
legislation is entitled Ensuring the Future Physician Workforce Act of
2008. It provides positive reimbursement updates for providers. It
eliminates the ineffectual expenditure cap known as SGR, and it
increases incentives for physician data reporting. At the same time
this bill facilitates the adoption of health information technology by
addressing costs and legislative barriers. It educates and empowers
physicians and beneficiaries in relation to Medicare spending and
benefits usage and studies ways to realign the way Medicare pays for
health care.
My bill doesn't mandate whether physician payments should be based on
utilization, performance, care, coordination, or any other particular
methodology. My bill does start to lay down a new path toward reform,
innovation, and restoration of the eroded physician-patient
relationship. It does say that providers and beneficiaries should not
be the ones to be punished by Congress's inaction.
Why Congress decided in 1996 to try to balance the budget on the
backs of health care providers is beyond me. Because beyond the
challenges that presents to the health care providers, it has
diminished access to health care. More and more physicians refuse to
take new Medicare patients, because the reimbursement rates are simply
so low. In Travis County, where Austin, TX is located, there was a
story published in the Austin American Statesman that said only 18
percent of physicians in Travis County are accepting new Medicare
patients. I would like to say that was an isolated incident, but it is
not.
This is a huge issue and deserves serious and thoughtful
deliberation. The last time the majority party held a hearing on
physician payment reform was almost 16 months ago, almost exactly a
year before I introduced Ensuring the Future Physician Workforce Act of
2008. Yet there has been zero legislative activity, let alone
introduction of language addressing this critical issue from a long-
term perspective. Again, we have been stuck in the same old rut of
coming up with temporary fixes, including the 6-month fix that will
expire on July 1.
I am disappointed in Congress's inaction in this regard. I do believe
that Congress needs to do more than simply kick the can down the road
for another few months and put off a solution that we ought to be
working toward on a bipartisan basis and embracing today.
My colleagues on the other side of the aisle have missed a major
opportunity to take positive steps forward. They presented a bill,
unfortunately, on which we will vote at 3 o'clock, that bypassed the
committee, ignored the importance of bipartisan input and contribution,
and they are determined to have a vote on a bill that they know has no
chance of becoming law. Because as we all know around here, no bill has
a chance of becoming law unless it is truly a bipartisan product. The
rules and traditions of the Senate guarantee that. That is one of the
things that makes sure that when we vote on things, they have broad
support, represent a consensus position, and that they are, in the view
of the vast majority of Senators, in the best interest of the American
people. But when you try to force a bill that is strictly partisan,
that has very little bipartisan support, we know what will happen. That
is what is going to happen this afternoon on this vote: It won't become
law.
The American people were promised a different way of legislating by
the majority when they took power. But we have seen, unfortunately,
this sort of gamesmanship occur time and time again. I heard Senator
Schumer, the Senator from New York, chairman of the Democratic
Senatorial Campaign Committee, rail against obstruction of their
legislative agenda. But it is almost a sure thing, when all you do is
take a partisan position on legislation and you refuse, as the majority
leader has done, to allow an amendment process, as he did last week on
the climate tax bill, and you deny full and fair debate, it is
virtually a guaranteed result of failure when you take that sort of
approach to legislation. That is what is going to happen again this
afternoon.
Because the chairman of the Finance Committee has chosen to take a
partisan approach on this legislation, we have come up with an
alternative that offers solutions to physicians, seniors, and
taxpayers. This alternative will provide doctors with a positive
increase in their reimbursement rates, extend critical programs, and
reform payments to Medicare Advantage plans, and also implement many
other necessary changes to the Medicare Program. This alternative
legislation includes provisions for e-prescribing, closely mirroring
legislation I cosponsored earlier this year.
We need to change our ways in the Senate. Rather than trying to check
off a box saying, yes, we threw it up, a partisan effort we knew was
going to fail, and now we can claim we were the champions of reform,
while the ones who would not allow this partisan process to go forward
are obstructing it, we need to get together and work in a bipartisan
way to ensure that Medicare beneficiaries not only have the coverage
they need and deserve but also the access which is guaranteed by a fair
rate of compensation for physicians.
I yield the floor.
The PRESIDING OFFICER. The Senator from Vermont.
Habeas Corpus
Mr. LEAHY. Mr. President, while I was chairing a Judiciary Committee
meeting today, I received notice of the Supreme Court's ruling this
morning in Boumediene v. Bush. I normally do not come to the floor to
talk about Supreme Court rulings, whether I agree or disagree with
them, but this one is of fundamental importance to all Americans, and I
wish to take just a moment.
We Americans know there is nothing more fundamental than the right of
habeas corpus--the right to challenge your detention by the Executive
as unlawful. It was part of our reason for fighting a revolution. It is
enshrined in our Constitution. We have preserved it through two world
wars. We cherish it as something that has set us apart from so many
other countries around the world.
This administration has tried repeatedly to push the limits of
Executive power, including its effort to extinguish the Great Writ for
certain detainees. In three separate decisions, a conservative U.S.
Supreme Court in recent years has rejected this administration's
erosion of fundamental rights. I applaud the Supreme Court for doing
that because these protections set the United States apart from those
who wish to harm us.
Today's decision repudiating the administration's efforts to curb
judicial review of detainees echoes earlier court decisions that have
solidified our constitutional system of checks and balances.
The administration has rolled back essential rights that have long
guided our Nation's conscience. The administration has acted as though
the President--and the President alone--can decide the rights of
Americans.
But the Great Writ has kept us strong as a nation from the time we
fought a Revolution. We fought that Revolution to say that we will
protect our own rights and we will set up three branches of Government
to do so, including an independent Federal judiciary.
Today's Supreme Court decision in Boumediene v. Bush is a stinging
rebuke of the Bush administration's flawed detention policies. It is
also a vindication for those who have argued from the beginning that it
was unwise as well as unconstitutional for Congress, at the
administration's request,
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to try to override a core constitutional protection.
A majority of the Court has ruled that the constitutional right to
habeas corpus extends to territories, including Guantanamo Bay, Cuba,
where the United States exercises de facto control. The Court further
held that the administration's detention procedures used at Guantanamo
Bay are a constitutionally inadequate substitute for habeas corpus
rights. Therefore, the provisions of the Military Commissions Act that
stripped away the habeas rights of detainees held at Guantanamo Bay are
unconstitutional.
As a result, those detainees who have been determined to be
``unlawful enemy combatants'' are entitled to seek habeas relief in
Federal courts, just as they had been doing before Congress' ill-
advised decision to endorse the administration's detention policies
through passage of the Military Commission Act in 2006. No detainee is
set free as a result of this decision. Rather, detainees will simply be
able to challenge their detention before a neutral, life-tenured judge.
The Court's 5-to-4 decision sustains the long held and bipartisan
belief that I and others have always maintained: Congress made a grave
error when it voted to strip habeas corpus rights in the run-up to the
2006 mid-term elections, and leave in place hopelessly flawed
procedures to determine whether detainees could be held indefinitely
with no meaningful court review, merely by the President's decree.
I have said many times on the floor of this Senate that we are the
conscience of the Nation. Certainly, part of our job is to uphold our
Constitution. It is easy to uphold our Constitution when we see no
threats on the horizon. It is more difficult but even more important to
uphold it when we do see threats on the horizon. So Congress, as I
said, made a grave error in trying to diminish habeas corpus, and I am
gratified that today's Supreme Court decision takes a significant step
in reversing that action.
Mr. President, the Great Writ--the Great Writ of habeas corpus--
protects you and protects me. It protects all 300 million Americans. It
protects people who look to the United States to be a beacon of
freedom. I am grateful that the Supreme Court believes, as I do, that
this fundamental right must be preserved.
Mr. President, I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. COLEMAN. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Energy
Mr. COLEMAN. Mr. President, I rise to speak about the rising cost of
energy, at a time when Americans are suffering from gas prices that are
seeing $4 a gallon and diesel fuel is higher than that. The price of
diesel fuel has gone up 65 percent from where it was a year ago. That
impacts farmers, it impacts small businesses. The Medicare bill is a
critical issue, but right now we need to address the impact the cost of
gas and energy is having. It is having a devastating effect on folks as
they sit around the dining room table trying to figure out how to make
ends meet. It is getting tougher and tougher to find money for food and
fuel. I wish to say up front that the principal culprit right here is
our addiction and our dependence on foreign oil.
My folks in Minnesota--families, farmers, and businesses--can't
afford these rising costs. They are talking about commodity prices
rising. On the other hand, the cost of commodity prices is rising
because of the cost of oil. The cost of energy, gas, and diesel on
those folks who are producing the food is having a devastating impact.
My State has one of the highest housing foreclosure rates in the
Nation. The State of Minnesota is always seen as being somehow outside
the economic woes that affect so many. The unemployment rate is going
up, not down. Record fuel costs are the final straw for a lot of folks.
It should be the final straw for partisan bickering on energy that is
getting us nowhere and is letting the American people down.
Mr. President, 232 years ago yesterday, Thomas Jefferson, John Adams,
Benjamin Franklin, and other Founders were set to work by the
Continental Congress on a document that set America on a new course,
just as the American Army was retreating from the British to Lake
Champlain.
The invasion we have today is the invasion of hundreds of billions of
dollars of foreign oil. This year nearly a half a trillion dollars will
be sent overseas for energy we should be capable of producing at home.
This is America. We should have the technological ability, the
capacity, and the resources to end that addiction. The fact is we are
being held hostage by a world oil market where much of the supply is
controlled by thugs and tyrants such as Chavez and Ahmadinejad.
Just as the Founders, we have a choice. We can focus on our
differences as Republicans and Democrats or we can work together to
fight a common foe. Are our differences greater than those of the
colonists, most of whom had never been outside their home States? We
know that is not true.
Now is the time to write our own declaration of independence. Now is
the time to use every resource at our disposal to address this energy
crisis.
Now is the time for us to declare that American freedom, liberty, and
security are not going to be held hostage over a barrel of oil. That is
what it is about. It is about being held hostage. We may in the future
always import foreign oil, but we are being held hostage by our
dependency.
Our Nation's future depends on the decisions we make right now. The
good news is that we possess the resources to take our energy prices
head on. If we were, in fact, to make that commitment, we could stand
up and say we are not being held hostage anymore. July 4 is just around
the corner. If we were to do that, I think it would have a dramatic
impact on speculation because they would know America is now
committed--Democrats and Republicans--to doing the right thing. It is
simple: renewables, increased production, and redoubling of our clean
energy technologies efforts.
To make this happen, we not only have to transform how we do energy
in this country, we have to transform how we do business in the Senate.
On Tuesday we had a contentious vote on an energy package that wasn't
a bipartisan product. I voted to go forward on the debate of that
package because I believe we must get going on a new energy bill.
However, I think the only thing yesterday's process was set up to
deliver was finger pointing. We must sit down together, Democrats and
Republicans, and find out what policies we can agree on and then send
an energy bill to the President.
The energy bill proposed by the other side of the aisle includes many
ideas we have seen before. I am reminded of a quote by H.L. Mencken,
who wrote:
There is always a well-known solution to every human
problem--neat, plausible, and wrong.
I believe we need to stop rehashing ideas that don't get to the heart
of the problem and begin an energy revolution by dramatically
increasing production of every energy resource at our disposal. I still
don't support drilling in ANWR. We have the opportunity, though, to do
deepwater exploration off the Outer Continental Shelf and tap into
substantial resources. That is increased production. We had the worst
natural disaster in the history of this country, Hurricane Katrina, and
there wasn't a drop of oil spilled, so there shouldn't be an
environmental issue there to increase production. We need to
dramatically increase investment in renewable fuels. I support that. It
is critical to my State. Energy efficiency, boost nuclear energy
production, and take advantage of coal to liquids--coal to jet fuel.
This week I have been listening to my colleagues speak about energy.
Some say what we need is more efficiency. The others say we need more
renewables in nuclear, oil, and gas development. I believe we need all
of those sources of energy. I don't think our debate should be about
whether to drill or whether to tax those who drill. You are not going
to increase production by simply taxing the oil companies. That is not
going to solve the problem. It may make a political point somewhere,
but it is not going to solve the problem. Instead, I believe the answer
to breaking through our energy crisis and our political energy logjam
[[Page S5553]]
is to couple domestic oil and gas development with responsible
environmental protection--you can do both--to fully utilize the clean
energy technologies at our disposal, such as nuclear, while we look to
emerging technologies, to grow more fuel on the farm and save energy at
home. We need to move forward with at least the potential of cellulosic
ethanol.
Today I have introduced an energy bill, the Energy Resource
Development Act of 2008, that I hope will foster the bipartisan
discussion we need to have. It is not about holding my idea of the
perfect energy bill in the air, pointing a finger and saying: This is
what they won't do. No, this bill is about asking the other side what
we might be able to do together.
Here is what I think we can do together: We could open the Outer
Continental Shelf to oil and gas development outside of Florida in a
way that protects the economy, the environment, and the economy of
States in new development areas. There is an estimated 2.8 billion
barrels of crude oil and 12 trillion cubic feet of natural gas that
could be produced between now and 2025 in areas currently under
moratoria. If developed, this could reduce America's trade deficit by
$145 billion by offsetting oil imports.
We must open development in a way that recognizes that many States
are opposed to opening development in the Federal waters off their
coasts, which is why my bill does not allow the Federal Government to
allow development unless the State's Governor approves of the plan.
And, to get the discussion going between the Secretary of the Interior
and the Secretary of Defense and coastal Governors, this proposal will
give the Governors an opportunity to make a counterproposal and to
propose long-term protection of Federal waters off their shores. The
Federal Government can then accept this proposal and begin negotiation
with the Governor. The idea is to move past the take-it-or-leave-it
approach to Outer Continental Shelf development and provide States the
authority and process they need to make a deal that protects their
economic and environmental interests.
My bill would require that an oil company holding an OCS lease
develop the oil and gas on that tract in a reasonable timeframe or lose
the right to develop that area. Existing leases that come up for
renewal will face the same limitation.
No. 2, this proposal would create an energy independence trust fund
to be funded with the Federal share of additional royalties that would
be collected when more of the Outer Continental Shelf is opened for
development. This trust fund, which could receive tens of billions of
dollars from new royalties, would go to fully fund all renewable
energy, energy efficiency, research and development, and technology
deployment programs from the Energy Policy Act of 2005 and the Energy
Independence Security Act of 2007. We have made a big commitment to new
technology in past energy legislation. This is a way to fund it. This
would make sure programs we already have on the books to develop
technology such as fuel cells, hybrid vehicles, solar, wind, advanced
batteries, building efficiency--the list goes on and on--are fully
funded. We want to make sure they are fully funded.
Additionally, the fund will provide resources for a new ethanol
pipeline loan guarantee program and provide new nuclear energy
production incentives.
No. 3, the bill would utilize our 250-year supply of coal by creating
a new standard of production of fuel from clean coal, often called
coal-to-liquid technology. My bill would take a new approach by
tightening the environmental standards required of this fuel.
No. 4, my bill would recognize the fact that nuclear energy is one of
America's energy solutions as it provides an affordable, zero-emissions
source of energy. The French are not braver than we are. Close to 90
percent of their energy is nuclear. This proposal will improve the loan
guarantee for nuclear production, create a nuclear production tax
credit, and increased training for the nuclear workforce.
I believe these measures do a great deal to address our current
energy crisis. But I promise my colleagues I am open to their ideas and
initiatives as well. The only thing I am not open to is more political
gamesmanship and bickering.
The American people want and need bipartisan energy legislation that
goes to the root causes of our energy problems. I urge my colleagues to
consider this proposal. I urge my colleagues and leadership on the
other side of the aisle to sit down with a bipartisan coalition. I urge
all of us on my side of the aisle to sit down and put together a
bipartisan coalition that will produce a bill that truly transforms how
we do energy as we, as Senators, work together for the American people.
That is what they are looking for right now. They are frustrated.
They are scared. They are facing economic stress. They are looking to
us. We have a responsibility to put the gamesmanship aside, put the
ideological divide aside, and figure out a way--can't we do renewables?
Can't we do conservation? Can't we do production? It doesn't mean
drilling in every corner of the universe.
If there ever was a moment for us to come together as a nation to
protect and preserve our freedom and our liberty, that moment is now.
Mr. President, I yield the floor and I note the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. CHAMBLISS. 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. CHAMBLISS. Mr. President, I ask unanimous consent that I be
allowed to speak for up to 7 minutes. I know it is unusual, but I ask
unanimous consent that the time be charged to the Democrats.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. CHAMBLISS. Mr. President, I rise today to speak on the issue of
Medicare reimbursement for doctors. Doctors are reimbursed through
Medicare by a formula known as the sustainable growth rate, SGR. Due to
the formula's methodology, it has mandated physician fee cuts in recent
years. This has forced Congress to place a band-aid over the possible
cuts that doctors and their practices have hanging over their heads.
So every year, or now 6 months, doctors must come to Washington, DC
and plead with their Representatives and Senators to pass legislation
that will allow them to receive the adequate Medicare reimbursement
they need.
Medicare reimbursement is already well below the actual cost of
providing patient services, and physicians tell me every year that if
these cuts go into effect, they will be faced with the tough decision
of either laying off employees or no longer treating Medicare patients,
or both.
Oftentimes, we in Congress wait until the last possible moment of
each year to pass legislation that will provide these physicians with
their much-needed relief. While we all know that there is a need to
replace the current SGR formula, this afternoon I want to focus on the
relevant legislation pending before the Senate.
The bill before the Senate would alleviate the 10.6 percent physician
fee cut and replace it with a 1.1 percent increase over 18 months. I
support this element of the legislation and believe that an 18-month
fix will not only keep physicians from worrying that their
reimbursements will be cut, but will also give Congress time to look at
possible alternatives to the SGR.
However, I do not agree with other aspects of this legislation. First
and foremost, the President has threatened to veto this legislation. In
December of last year, we passed legislation that would remove the SGR
cuts until June 30 of this year.
Even if this legislation had overwhelming support, which it does not,
the process of this bill passing both Houses, getting vetoed by the
President, and returning for a veto override would be quite a feat to
accomplish in 18 days, and simply cannot practically happen.
Second, this legislation expands entitlement spending such as the
Part D Low-Income Subsidy and Medicare Savings Program. While these are
good programs, I do not understand why we would expand these programs
when there are already significant numbers
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of seniors who are eligible for the programs at current levels but are
not enrolled.
This is not the time to expand entitlement spending when it is
already out of control and unsustainable.
Here we are trying to put a bandaid on reimbursement to our doctors
and, at the same time, talking about additional expenditures in
Medicare, so that the next year when we come back, it is going to be
even harder if we don't have a permanent fix to use this bandaid
approach for physicians and hospitals.
Third, this legislation reduces access to Medicare advantage plans.
These plans aren't perfect, but Medicare Advantage has been the one
reform in the Medicare system we have seen that works. It needs some
modification to it, but the fact is it is working.
These plans, which are approved by medicare, save beneficiaries an
average of $86 per month compared to premiums in traditional fee-for-
service medicare. They have been especially important in enrolling low-
income and rural beneficiaries.
We should have learned from past congresses' mistakes that cutting
payments to medicare advantage plans results in them being forced to
drop seniors. In my home State of Georgia, more than 138,000
beneficiaries rely on these plans.
Senator Grassley has introduced alternative legislation that would
provide physicians with the exact same 1.1 percent fee increase that is
included in the pending legislation. And it would do this while
eliminating duplicative indirect medical education payments to medicare
advantage plans, making reforms to curb controversial and abusive
medicare advantage marketing practices, and spending 25 percent less
than the pending legislation.
Most importantly, this alternative legislation would not be vetoed by
the President and could be signed into law before the July 1 deadline.
Unfortunately, the majority will not allow us to bring this legislation
to the floor. I hope that decision changes.
Doctors and seniors deserve a serious and responsible effort that
addresses the impending fee cut without playing politics, cutting
essential services, and creating a major expansion of entitlement
spending.
It is my hope that Congress will work toward a bipartisan agreement
that will provide doctors with the relief they need before July 1. With
that, I yield the floor.
The PRESIDING OFFICER. The Senator from Maine is recognized.
Ms. SNOWE. Mr. President, I am pleased to join Chairman Baucus in
sponsoring this bipartisan legislation, which both abrogates severe
cuts to provider payments, and also takes steps to reform Medicare
spending to address the distressing fiscal trajectory of this critical
health entitlement.
The bill before us today represents a product of what has become an
annual--and recently a semiannual task--that of extending Medicare
financing. It is a sad state of affairs when we see two Medicare bills
emerge from the Finance Committee. For months Chairman Baucus and
Ranking Member Grassley have worked to build consensus on Medicare--
just as they did last year. In fact, their reputation for
bipartisanship is legendary.
Ranking Member Grassley saw that we achieved the landmark benefit
that is in part enhanced in this bill--the coverage of prescription
drugs under Medicare. I have long regarded his leadership so highly,
and I am confident that--as this debate continues--we will see him
forge agreement to address critical Medicare issues because of his
bipartisanship.
And in fact--but for intransigence to compromise from the
administration last December--we would not need to be here today
debating these issues. But instead only a 6-month extender bill could
be enacted--and now our providers and beneficiaries face cuts on July
1.
The fact is, that just a few weeks ago, with compromise achieved on
so many issues, we appeared to be separated by approximately $3 billion
in spending directed to beneficiaries. The fact is, that amount of
funding represents less than what should be committed to meet critical
needs of our most economically challenged beneficiaries, and it
represents less than two-tenths of 1 percent of total Medicare
spending. And under this legislation, these funds would be obtained
from fiscal savings which Medicare must begin to realize. Not from
taxes. Not from deficit spending.
And as we debate this difference between these two Medicare bills, we
must enact sound fiscal policy--not ideological dogma. As CBO has told
us repeatedly, the factors of an expanding senior population--and more
significantly, as this chart illustrates, a rise in per capita health
care spending--are working together to make Medicare the number one
fiscal concern on the horizon. So it is critical that we take
substantial steps to ensure the fiscal health of Medicare for future
generations.
It was an attempt to do so which set us on this course. The creation
of the sustainable growth rate formula--or ``SGR''--was originally
intended to serve as a limiter of spending, and it did so effectively
for a time. Yet, today, the SGR operates crudely and irrationally to
simply restrain payments to physicians. Next month, without
intervention, physician payments will be reduced 10.6 percent. Yet it
is also essential to recognize that these annual Medicare bills
encompass more than just the SGR. A number of other programs are
renewed on this same schedule. We call these ``extenders'' and they
represent critical parts of Medicare--including items such as
assistance to low income beneficiaries and programs which support rural
health delivery--and they face termination without our action.
As we consider this bill today, it must be viewed in the light of how
it will address two crucial issues. First, does it fairly assure
reasonable payments to those who serve our beneficiaries to preserve
access to care? And second, does it take action to change the course of
health spending to help assure the fiscal security of Medicare--
particularly when you see the growth and trajectory of growth in
Medicare spending?
First, as it must, this legislation takes action to prevent a large
reduction in payments to physicians. So too it enacts a number of
critical extensions to programs critical to assure that beneficiaries
will have secure access to health care.
We act to see that health centers receive relief from an artificial
cap which prevents them from being fully reimbursed for the services
they provide to beneficiaries. This bill grants some relief from that
cap and is a step towards the reform which my legislation with Senator
Bingaman would achieve to prevent health centers from serving Medicare
at a loss.
In similar fashion this bill would ensure that pharmacies will be
paid promptly for the medications they provide seniors under the Part D
drug benefit. And just as critical, we assure that Medicaid payment
policy does not discourage the dispensing of generic drugs through
inadequate reimbursement.
And as we avert a pending physician payment cut it is unconscionable
that we would leave the most vulnerable beneficiaries behind. In
passage of the Medicare Modernization Act in 2003, we worked in a
bipartisan fashion to assure that our most vulnerable beneficiaries
would receive a low income subsidy, LIS, to provide extra assistance
with drug costs. Today, a beneficiary qualified for full LIS support
must have income below 135 percent of the Federal poverty level and
assets not exceeding $7,790 for an individual and $12,440 for a married
couple.
Yet, our Medicare Savings Plans--which assist very low income
beneficiaries outside of Part D--utilize a very different assets test
standard--just $4,000 for an individual and $6,000 for a couple--
despite even more stringent income standards. In fact, the Qualified
Medicare Beneficiary--Quimby program--enacted in 1988--has not seen an
update in the assets test over two decades. Were the amount to have
been indexed to a measure of inflation such as the Consumer Price
Index, today that amount would nearly equal the assets limit for full
Low Income Subsidy under Part D. So it is common sense that we align
the assets tests for Medicare savings program with the full LIS limit
so that truly needy seniors will realize the help we intended. We act
to index these asset tests to inflation, and critically, extend
outreach including through the
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Social Security Administration. These provisions represent long-overdue
corrections--not an entitlement expansion.
As I stated earlier, this bill should also help us to change our
spending trajectory. Because what we spend is in fact more critical to
Medicare's fiscal health than even the aging demographics of our
population, this legislation aims to help re-orient our spending to
assure that Medicare implements more ``best practices,'' beginning with
greater support for preventive services. This follows what we began
with the enactment of the Medicare Modernization Act in 2003.
This bill allows the HHS Secretary to add support for services
recommended by the U.S. Preventive Services Task Force. This is a key
step in payment reform. Because the fact is, we can no longer expend
our first dollar on a disease for an individual's hospitalization. We
must be more proactive and cost effective.
Similarly, we address the inequity of access to mental health
services. Today, beneficiaries pay 50 percent of the cost of outpatient
mental health services--compared to 20 percent for other care. So as
the Senate acts to ensure mental health parity in the private sector,
we must not leave our beneficiaries behind. Tragically, only half of
seniors with mental health problems receive treatment, and the toll is
seen in the fact that suicide rates among older Americans far exceed
those of other age groups.
This legislation includes provisions of legislation that I introduced
with Senator Kerry and accomplishes a phased-in elimination of the
copayment disparity.
This legislation takes a balanced approach, one which averts unfair
cuts to providers, and meets the critical needs of our most vulnerable
beneficiaries.
Then one could rightly ask: Why are we here? If there was some
agreement on such priorities, what is the obstacle?
The answer to that question, as it is so often, lies in how spending
is paid for. Today, as we consider legislation affecting provider
payments in particular, the issue of equity is central. When equity is
considered, the subsidies of private plans in Medicare constitute an
issue which must be addressed.
Today we are subsidizing such private Medicare plans by paying an
average of at least 112 percent above the rate of traditional fee-for-
service Medicare. Last year, the 5-year subsidy cost was estimated at
$50 billion over 5 years. This year, we have already received revisions
of cost projections which may indicate the total cost is much higher.
One might ask why, at a time when we are concerned about the fiscal
health of Medicare and when we face critical needs, such as those of
the lowest income beneficiaries, would we spend this sort of subsidy?
The Chairman of the Medicare Payment Advisory Commission, Glenn
Hackbarth, succinctly stated the problem last year when he stated that
``right now, Medicare is sending the signal that we want private plans
even if they cost substantially more than the traditional Medicare.''
He added:
I think what we need, not just in Medicare, but in the
country more broadly, is to send the signal that we want
plans that more efficiently manage care.
I think we have an agreement that we expect these plans to deliver
value for beneficiaries and taxpayers alike--to employ prevention,
early screening and detection, and prompt effective care to improve
health and reduce costs.
Yet what we have seen in Medicare Advantage is deeply troubling.
First, there is the paucity of data regarding outcomes. This chart
quotes the CBO Director Orszag, who decried the absence of
substantiation of performance, stating he was ``continuing to beg'' for
data from plans demonstrating performance. He noted the subsidies these
plans enjoy. He said:
It's almost as if they're conducting a variety of
experiments in disease management and various other things.
And they are doing so with public subsidies.
Yet while the average Medicare Advantage plan receives a subsidy at
least 12 percent above traditional Medicare, a new plan type receives
much more, as much as 121 percent of fee-for-service rates. These
private fee-for-service plans primarily involve a redesign of the
Medicare benefits package. So a beneficiary might initially see a plan
as offering better value, such as offering vision benefits. Yet while
private fee-for-service plans must cover the same benefits as fee for
service, they can substantially alter a senior's cost sharing so one's
out-of-pocket costs can be much higher.
But the enticement of new benefits and aggressive and even abusive
marketing practices, as we learned in a number of hearings--I know, Mr.
President, you were there at some of those hearings in the Senate
Finance Committee--has resulted in explosive growth in these plans.
As we see on this chart, it demonstrates the increased enrollment
from less than 26,000 beneficiaries in 2003 to 1.5 million at the
beginning of this year. So far this year, another 400,000 beneficiaries
have enrolled.
I am pleased we have seen bipartisan agreement to address the
grievous marketing abuses which have plagued beneficiaries. Many of our
constituents have been confronted in their homes by high-pressure,
door-to-door, and telemarketing sales efforts. We have seen seniors
enticed to events by free meals and gifts and frequently enrolled
unknowingly in new plan coverage they neither needed nor wanted. Much
of this has been fueled by high commissions.
Such abuses led me to introduce a bill with Senator Rockefeller in
March to ban these practices and protect beneficiaries. In fact, I can
say my State of Maine has been in the forefront passing legislation on
its own. States are taking unilateral action to foreclose these
practices that get people to join plans unnecessarily and adding to
their costs and their problems.
The legislation Senator Rockefeller and I introduced has provisions
that will include prohibitions on the activities I described earlier.
It is abundantly clear such plans not only cost more and are plagued
by marketing abuses, but they lack the mandates which HMO and PPO plans
carry to actually act to improve care. In fact, the Congressional
Budget Office Director, Peter Orszag, said again, ``The type of things
we are talking about--disease management, care coordination--is much
less salient and much less prevalent in private fee-for-service.''
Also, because private fee-for-service plans are not required to
establish contracted networks of providers, such plans use deeming, a
practice in which, by serving a patient, a provider is deemed to have
accepted the plan's terms. That shortchanges providers. Since these
plans are also not required to provide care management, they
shortchange beneficiaries. So we are paying more through subsidies and
they are providing less and are capturing them through the deeming
process, which is inherently unfair and extremely costly.
With these deficits, private fee-for-service plans require subsidies
to function, and today they are paid far more than the traditional fee
for service--which I mentioned earlier--and are a large and growing
share of Medicare Advantage costs. They are subsidized, as I said, as
much as 121 percent above the rates Medicare was paying local providers
before this so-called innovation.
So as we see an escalation in the cost of subsidizing Medicare
Advantage, it is wholly appropriate that we examine a reduction in
unfair subsidies to these plans, subsidies that are provided by the
taxpayers.
We recognize, as does the administration, that built into these
higher Medicare Advantage rates is a duplication of the institutional
medical education payment which institutions already receive directly
today. The cost of that duplication was estimated at $8.7 billion
earlier this year. Yet today, with rapid growth in these plans, the
Congressional Budget Office tells us the cost of the unnecessary
subsidy is now an estimated $12.5 billion. The fact is, that estimate
does not reflect a deeper rate of reduction than we discussed 6 months
ago. It simply reflects the escalation in costs as a growth of these
subsidized, uncompetitive plans continue.
So as we examine areas in which we could save, there can be no doubt
that the duplicate payment is a prime candidate. In fact, the Medicare
Payment
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Advisory Commission, MedPAC, recommended we bring all Medicare
Advantage plans to parity and specifically recommended eliminating this
duplicate payment, as indicated by their comments on this chart.
On the latter recommendation, the President has agreed we must
eliminate the duplicate payment. I note the President included a
proposal in his budget this year to eliminate it, but he has imposed
reductions which would affect the rate of reduction we have now
discussed, which would reduce subsidy spending by $12.5 billion. The
President also prefers to eliminate payments to the institutions
responsible for this Institutional Medical Education Program and
instead would rely on plans to funnel payments to teaching
institutions. Although we differ with him in terms of how to eliminate
the duplicate payment, reducing the plan subsidy for this savings is
reasonable, and agreement should be possible.
As I said earlier in my statement, it is a difference of $3 billion,
and therein lies the difference in the subsidy. The Congressional
Budget Office recalculated the original cost of savings of achieving
this reduction in the Institutional Medical Education Program earlier
this year at $8.5 billion. They recalculate to $12.5 billion. You say:
Why won't the President support that now? It is the same savings, the
same plan. It has been recalculated, and we achieve greater savings in
order to offset the additional provisions we provided for the lowest
income beneficiaries. So it seems to me this is an area in which we
should achieve agreement. If we agree we should eliminate the duplicate
payment--and it has now been estimated in savings from the
Congressional Budget Office at $12.5 billion instead of $8.7 billion--
we ought to be able to agree on the pending legislation.
This legislation effects a second savings in Medicare Advantage by
eliminating deeming wherever two managed care plans have succeeded in
establishing networks. It simply makes sense that if managed care plans
can contract providers, these private fee-for-service plans should as
well.
By reducing the duplicate IME payment by $8.7 billion and modifying
the deeming provisions for plans, this legislation realizes $12.5
billion in savings. Still just less than one-fourth of the current
Medicare Advantage subsidy cost.
I note these savings fall far short of the fiscal responsibility
which MedPAC, the Congressional Budget Office, and others suggest is
absolutely necessary and vital. Yet some still claim these savings
jeopardize Medicare Advantage. But the fact is, they are modest in
terms of changing an environment which is both fiscally irresponsible
and anticompetitive.
For those who suggest subsidies should be maintained, they must
answer some critical questions: When will these plans be economically
viable? When will savings be realized by the taxpayers who are
providing these subsidies to private insurance companies, in fact, far
more than the traditional fee for service? When will more effective
care be demonstrated? Again, they don't provide for prevention,
effective disease management, screening or many of those tests that are
so essential today that a provider in traditional fee for service, and
yet not under these private plans, who are getting paid more than what
we pay under fee for service in Medicare. What costs must the rest of
Medicare bear as a result of these anticompetitive subsidies?
The fact is the limited savings we accomplish in this legislation do
not even threaten the continued operations of these uncompetitive
plans. Even Wall Street knows that. I note in this final chart that an
analyst for Goldman Sachs actually stated that savings exceeding those
we make here do not affect the viability of these plans and that the
Medicare Advantage Programs actually could ``absorb $15 billion in cuts
over 5 years without materially undermining the fundamentals.''
As I said earlier, we are using $12.5 billion, not even $15 billion,
and they are saying it would have no negative impact on those private
programs.
Further, we should, in fact, be fostering competition. In fact, that
is what it was all about originally, providing those subsidies so there
would be some competition. Business will respond, they said, and
thereby achieve some of the objectives on which these plans were
predicated.
There is always political risk. As Simon Stevens of United Health
Care noted, ``There is always political risk in government programs,''
he said, ``but we will weather it by evolving as Medicare evolves.''
There are urgent Medicare financing needs today which must be met. We
must fix the physician payment formula. We must reform Medicare to see
that care is improved and beneficiaries and taxpayers receive better
value. We have so much more to do. Yet here we are being stymied by a
difference of less than two-tenths of 1 percent of Medicare spending,
that all is accomplished by reducing the subsidies to private health
insurance companies. That is the difference in the pending legislation
and those who object to it.
This legislation, in fact, reflects many issues on which we have had
bipartisan agreement. It bridges the critical gap between us in
considering the vital and essential requirements of beneficiaries, by
taking actions to see best practices emphasized and low-income
assistance standards are at least updated for inflation. It also acts
to see that Medicare policies are not penny-wise and pound-foolish.
I hope we will see this very modest compromise on this legislation
that will produce progress for the providers, for current
beneficiaries, and for generations to come to achieve the savings we
think is essential--and it is offset because we think that is the
fiscally responsible approach to take--and also not to skew
disproportionately the subsidies we are providing to private health
insurance companies for private fee for service, for both to work in a
competitive fashion, and what we are seeing are subsidies growing by
leaps and bounds.
To reach that compromise, we have to support this legislation.
Hopefully, the Senate will express its support for sound fiscal policy.
Hopefully, we can override the cloture. If that fails, I hope we can,
again, come to together and resolve these differences and demonstrate
to the American people that we have the capacity to solve problems at
this very crucial juncture in our Nation's history.
Mr. SPECTER. Mr. President, this is a very important bill for reasons
which I am discussing in this statement. I believe that it is vital for
the Senate to take up this important measure to have open debate to
give Senators an opportunity to offer amendments and to have the Senate
work its will on these important questions.
As noted in previous floor statements, I have been concerned about
the majority leader's practice of employing a procedure known as
filling the tree, which precludes Senators from offering amendments.
That undercuts the basic tradition of the Senate to allow Senators to
offer amendments. Regrettably, this has been a practice developed in
the Senate by majority leaders on both sides of the aisle, so both
Republicans and Democrats are to blame.
I announced publicly at a Senate Judiciary Committee executive
session this morning, June 12, 2208, that I would vote with Senator
Baucus for cloture if I knew the majority leader would not fill the
tree. In a telephone conversation this afternoon, June 12, 2008,
Majority Leader Harry Reid advised me that he would not fill the tree.
This will provide an opportunity for a full range of debate and
decisions by the Senate on many important issues.
On the Medicare bill specifically, S. 3101 has a number of issues
which are important to Medicare beneficiaries in Pennsylvania and
across the Nation. Foremost of those issues is the prevention of a
10.6-percent reduction in the Medicare reimbursement for physicians. A
decrease of this size could result in doctors limiting the number of
Medicare beneficiaries they take on as patients or refusing to take
them on as patients at all. To resolve this grave problem, the
legislation prevents the scheduled reduction, continues the current .5
percent increase for 2008, and provides an increase of 1.1 percent for
2009. This is a needed increase that will improve access to physicians
for seniors.
This legislation also contains an important provision to extend the
section 508 wage index reclassification program. This program,
established in the Medicare Modernization Act in 2003,
[[Page S5557]]
provides important funding for hospitals that have been disadvantaged
by Medicare's wage index reclassification. This is of particular
importance in northeastern Pennsylvania where hospitals struggle to
meet the wages needed to keep employees from commuting to other areas
which have a higher reimbursement rate. This is an important extension;
however, a permanent solution is needed to solve this problem for all
hospitals.
I am informed that the bill will include a delay in the Medicare
durable medical equipment, DME, competitive bidding program. This is
critical to western Pennsylvania, as it is one of the regions selected
to begin the program. While competitive bidding can be productive in
lowering the cost of medical equipment, the manner in which this
program was implemented was unacceptable. During the competition for
bids, half of the bids were disqualified, often for clerical problems.
Further, the program is set to begin in just over 2 weeks and seniors
have not been notified of these changes. This legislation will delay
the implementation of this program to allow for the proper
implementation of this program and correction of these problems.
I am also informed that the bill will include a provision to increase
Medicare payments to oncologists and other physicians for the cost of
patient treatment. Physicians are facing shortfalls in their
reimbursement, especially pertaining to cancer treatment. This
provision will provide an accurate and up-to-date reimbursement for
drug costs, ensuring cancer treatment will be accessible to Medicare
beneficiaries.
I am concerned about a change that this legislation makes in the
ability of beneficiaries to purchase power wheelchairs. S. 3101
requires the rental of standard wheelchairs for 13 months instead of a
physician determining if the beneficiary should purchase the equipment
immediately. This provision removes the problem of purchasing
wheelchairs for short term users but increases the cost 5 percent for
the purchase after those 13 months. To insure that beneficiaries get
the wheelchairs they need without overspending, a physician should be
required to certify that a power wheelchair is needed for at least 13
months. I am confident as we consider this bill we can work out the
differences we have and come to an agreement.
Mr. ENZI. Mr. President, today, we will continue to discuss the
political exercise surrounding the Medicare ``doc fix'' bill. I am
hopeful that after the vote this afternoon, bipartisan discussions can
resume so that we can get a bill to the Senate floor that we can all
support. While others have fully outlined all of the problems with the
process and content of S. 3101--the Democrats version of the bill--I
want to take the time to discuss a small aspect of the Republican
version of the bill.
Just last week, I came to the floor to discuss Senator Thomas,
acknowledging that just over a year ago the State of Wyoming and our
Nation lost one of the great cowboys ever to ride this land. Although a
year has passed since Craig left us, his spirit is alive and it is felt
by all of us within this body. Work he championed on behalf of Wyoming
residents and all Americans is ongoing today. In fact, we continue to
acknowledge his great work to improve health care in rural areas within
the Grassley Medicare bill--the Preserving Access to Medicare Act.
There is a whole subtitle named after Senator Thomas with provisions
to assist providers and patients in rural areas. These provisions will
help keep the doors open for rural hospitals so that critical care is
available. In addition, they will ensure that individuals in rural
areas have the emergency transport services available to get them from
the scene of an accident to immediate care, to expand access to
laboratory services so one can quickly obtain test results for a
potential cancer diagnosis, and to ensure greater access to telehealth
capabilities at skilled nursing facilities and dialysis centers. These
are just to name a few of the key rural health provisions. Given the
work of Senator Thomas, I do hope that these provisions can be
maintained in future bipartisan discussions.
Mr. CARDIN. Mr. President, I rise in strong support of S. 3101, the
Medicare Improvements for Patients and Providers Act of 2008.
This bill merits the support of every Senator. Action on this
legislation is mandatory now because, in 18 days, the temporary fix we
passed at the end of last year for providers will expire. If we fail to
act, reimbursements to physicians and other providers who are paid
under the physician fee schedule will be cut by 10.6 percent.
On Tuesday, I met for over an hour with several physicians from
Maryland. They cannot sustain a 10 percent cut in their Medicare
payments, and they know that if these cuts are put into effect, many of
their colleagues will stop accepting new Medicare patients into their
practices.
These pending cuts are the result of a flawed system that pegs
reimbursement to the growth of GDP. We all recognize that this system,
known as SGR, does not work. Every year since 2001, Congress has had to
act to prevent the cuts from going into effect. We know that SGR must
be repealed.
I have introduced legislation in past years to eliminate SGR and
replace it with a system that reimburses based on the actual reasonable
costs of providing care. S. 3101 provides another temporary fix through
December 31, 2009. That is sufficient time for Congress, working with a
new administration and the provider community, to develop a new system
of reimbursement that will contain unnecessary increases in volume
while ensuring that reasonable costs are covered.
But this bill is so much more than a ``doctor fix bill.'' Also
expiring on June 30 is the exceptions process for outpatient therapy
services. Therapy caps for physical, occupational and speech language
therapy were added to Medicare law more than 10 years ago for purely
budgetary reasons. The authors of that provision had no policy
justification for limiting services, and the amount of the caps was
purely arbitrary.
Unless the exceptions process is extended, seniors recovering from
more complex conditions, such as hip replacement and stroke, will face
unreasonable and arbitrary dollar limits on the rehabilitation services
available to them.
This urgently needed legislation will help not just providers, but
also the millions of seniors that Medicare was created to serve. This
Senator is proud that the bill's title reflects the right priorities
for Medicare--this is The Medicare Improvements for Patients and
Providers Act.
The 43 million seniors and persons with disabilities who rely on
Medicare deserve a program that meets their health care needs. Our goal
should be to ensure that Medicare provides comprehensive, affordable,
quality care. S. 3101 makes important steps toward a better Medicare.
It is significant that Chairman Baucus has led with important
beneficiary improvements. In 1997, I worked in a bipartisan way to add
to the Balanced Budget Act the first-ever package of preventive
benefits to the traditional Medicare Program. That was 11 years ago. At
that time, the members of the Ways and Means Committee recognized what
medical professionals had long known--that prevention saves lives and
reduces overall health care costs.
Preventive services such as mammograms and colonoscopies are vital
tools in the fight against serious disease. The earlier that breast and
colon cancer are detected, the greater the odds of survival. For
example, when caught in the first stages, the 5-year survival rate for
breast cancer is 98 percent. But if the cancer has spread, the survival
rate drops to 26 percent. If colon cancer is detected in its first
stage, the survival rate is 90 percent, but only 10 percent if found
when it is most advanced.
Seniors are at particular risk for cancer. In fact, the single
greatest risk factor for colorectal cancer is being over the age of 50
when more than 90 percent of cases are diagnosed. Sixty percent of all
new cancer diagnoses and 70 percent of all cancer-related deaths are in
the 65 and older population. Cancer is the leading cause of death among
Americans aged 60-79 and the second leading cause of death for those
over age 80. So preventing cancer is essential to achieving improved
health outcomes for seniors. Screenings are crucial in this fight.
In addition to improving survival rates, early detection can reduce
Medicare's costs. Under Chairman Conrad's leadership on the Budget
Committee, we have had fruitful debates about the
[[Page S5558]]
long-term solvency of Medicare. A more aggressive focus on prevention
will help produce a healthier Medicare Program.
Let me give you some examples. Medicare will pay on average $300 for
a colonoscopy, but if the patient is diagnosed after the colon cancer
has metastasized, the costs of care can exceed $58,000.
Medicare will pay $98 for a mammogram, but if breast cancer is not
detected early, treatment can cost tens of thousands of dollars. One
drug used to treat late stage breast cancer can cost as much as $40,000
a year. There is no question that these vital screenings can produce
better health care and more cost-effective health care.
The 1997 law established place improved coverage for breast cancer
screenings, examinations for cervical, prostate, and colorectal cancer,
diabetes self-management training services and supplies, and bone mass
measurement for osteoporosis. Since then, Congress has added screening
for glaucoma, cardiovascular screening blood tests, ultrasound
screening for aortic aneurysm, flu shots, and medical nutrition therapy
services. In addition, in 2003, a Welcome to Medicare Physical
examination was added as a one-time benefit for new Medicare enrollees
available during the first 6 months of eligibility.
But we can only save lives and money if seniors actually use these
benefits. Unfortunately, the participation rate for the Welcome to
Medicare physical and some of the screenings is very low. I have spoken
with primary care physicians across my State of Maryland about this.
One problem is the requirement to satisfy the annual deductible and
copays for these services.
Patients are responsible for 20 percent of the cost of a mammogram,
between $15 and $20. Most colonoscopies are done in hospital outpatient
departments, where their copay is 25 percent, or approximately $85. Our
seniors have the highest out of pocket costs of any age group and they
will forgo these services if cost is a barrier.
The other barrier to participation is the limited 6-month eligibility
period for the one-time physical examination. By the time most seniors
become aware of the benefit, the eligibility period has expired. In
many other cases, it can take more than six months to schedule an
appointment for the physical exam and by that time, the patients are no
longer eligible for coverage.
I have introduced legislation to eliminate the copays and deductibles
for preventive services and to extend the eligibility for the Welcome
to Medicare physical from 6 months to 1 year. My bill would also
eliminate the time consuming and inefficient requirement that Congress
pass legislation each time a new screening is determined to be
effective in detecting and preventing disease in the Medicare
population. It would empower the Secretary of Health and Human Services
to add ``additional preventive services'' to the list of covered
services. They must meet a three part test: (1) They must be reasonable
and necessary for the prevention or early detection of an illness; (2)
they must be recommended by the U.S. Preventive Services Task Force,
and (3) they must be appropriate for the Medicare beneficiary
population.
S. 3101, the Baucus bill, incorporates several elements of my bill in
the very first section, and I want to thank the Finance Committee for
including them. It will waive the deductible for the physical
examination, extend the eligibility period from 6 months to 1 year, and
allow the Secretary to expand the list of covered benefits.
These provisions are supported by the American Cancer Society, AARP,
the Alliance for Retired Americans, the Leadership Council of Aging
Organizations, SEIU, the National Committee to Preserve Social Security
and Medicare, the American College of Preventive Medicine, the National
Hispanic Medical Association, the American Academy of Nursing, and many
more groups.
This bill will also help low income seniors by raising asset test
thresholds in the Medicare Savings Programs and targeting assistance to
the seniors who most need it.
As this Congress continues to make progress toward passing a
comprehensive mental health parity bill, the Baucus-Snowe bill steps up
for our seniors and provides mental health parity for Medicare
beneficiaries, moving their copayments from 50 percent to 20 percent
gradually over 6 years. Depression, bipolar disorder, and other mental
illnesses are prevalent among seniors, and yet fewer than half receive
the treatment they need. This provision will help them get needed
services.
Section 175 of the Baucus bill will ensure that a category of drugs
called benzodiazepines are covered in Medicare Part D. When the
Medicare prescription drug benefit took effect on January 1, 2006,
millions of beneficiaries found that the prescription medicines they
took were not covered by the new law. A little-known provision in the
Medicare prescription drug bill actually excluded from coverage an
entire class of drugs called benzodiazepines. These are anti-anxiety
medicines used to manage several conditions, including acute anxiety,
seizures, and muscle spasms. The category includes Xanax, Valium, and
Ativan. Most are available as generics.
They constitute the 13th leading class of medications in the U.S.,
with 71 million prescriptions dispensed in 2002. A study of dual-
eligibles in nursing homes found that 12 percent of patients had at
least one prescription for a benzodiazepine. This exclusion has led to
health complications for beneficiaries, unnecessary complexity for
pharmacists, and additional red tape for the states. Beneficiaries who
are not eligible for Medicaid have had to shoulder the entire cost of
these drugs or substitute other less effective drugs. In 2005, I first
introduced legislation that would add benzodiazepines to the categories
of prescription drugs covered by Medicare Part D and Medicare advantage
plans.
I want to thank Chairman Baucus for recognizing the importance of
this coverage and adding section 175 to this bill. Without this
provision, dual eligibles would have to rely on continued Medicaid
coverage for benzodiazepines. Medicare beneficiaries who are not
eligible for Medicaid will have to continue to pay out-of-pocket for
them. For those who cannot afford the expense, their doctors would have
to use alternative medicines that may be less effective, more toxic,
and more addictive. This is a significant improvement for our seniors
who are enrolled in Part D and for the fiscal health of our States.
The Baucus bill is paid for by slight reductions to the overpayments
that the federal government makes to private health plans. The
nonpartisan Medicare Payment Advisory Commission, MedPAC, has
recommended that we equalize payments between Medicare Advantage and
traditional Medicare.
As we discuss the solvency of the Medicare Program, we must take note
that private health plans are not saving the Federal Government money.
In fact, they are costing us money. I was a member of the Ways and
Means Committee when health plans approached us with an offer. If the
Federal Government would pay them 95 percent of what we were spending
on the traditional Medicare Program, they would create efficiencies
through managed care that would save the Federal Government billions of
dollars each year. They promised to provide enhanced coverage, meaning
extra benefits as well as all the services covered by traditional
Medicare, for 95 percent of the cost of fee for service. Congress gave
them a chance to do just that.
Instead, what we saw across the country was cherry-picking of
younger, healthier seniors. Each time Congress indicated that it would
roll back their overpayments to a more reasonable level, they responded
by pulling out of markets. In Maryland, the number of plans declined
over a 3-year period from eight to one, abandoning thousands of
seniors. Since 2003, when payments were substantially increased, the
number of plans has steadily increased as well, but at too high a cost
to beneficiaries, taxpayers, and the future of the Medicare Program.
Right now, these plans are paid up to 19 percent more than the amount
that we would pay if these seniors were in fee-for-service Medicare.
Over 10 years, we are overpaying them by more than $150 billion.
That is enough to make significant valuable improvements in the
overall
[[Page S5559]]
Medicare Program, or to permanently repeal the sustainable growth rate
formula. It is time, for the health of the Medicare Program, to pay
these plans appropriately. This bill would make small reductions to
these overpayments as well as prohibit the abusive marketing practices,
such as cold calling, door-to-door sales, and offering incentives such
as free meals, which have led to many seniors being enrolled in private
plans without their knowledge or consent.
This is a balanced and responsible bill that addresses immediate
reimbursement concerns while setting the foundation for a higher
quality, more cost-effective Medicare Program. I urge my colleagues to
support the motion to proceed to S. 3101 and to vote for this well-
crafted bill.
I yield the floor. I suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. Salazar). The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. GRASSLEY. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Taxes
Mr. GRASSLEY. Mr. President, yesterday afternoon I discussed the
burden that high gas prices are having on all Americans, and not just
on my constituents in Iowa but all over this great country. I think now
that most of my colleagues in the House and Senate know that high gas
prices mean less discretionary income for people--less discretionary
income to spend at the mall, to spend at the farmers market, less
discretionary income to buy ice cream on hot summer days, and less
discretionary income to save for a rainy day.
I can assume my Democratic colleagues know that actions that take
discretionary income away from the American people are detrimental to
those people and detrimental to the overall economy--detrimental to
their way of life and detrimental to our country's future. I guess I
don't have to assume folks on the other side know this. This body has
been debating the issue of escalating oil prices and energy for the
better part of this week. I heard countless accounts from my Democratic
colleagues about how their constituents are hurting. So I think my
friends on the other side get it. They get that taking the hard-earned
dollars out of the pockets of their constituents is detrimental to
those constituents.
What my Democratic friends don't get is that raising taxes has the
same effect. Raising taxes takes hard-earned dollars out of the pockets
of their constituents. Don't folks on the other side think this is a
problem? It is a problem for their constituents' way of life, and it
multiplies into problems for our economy. It is a problem for our
country's future. But I don't think the leadership on the other side
understands this fundamental fact. So I guess folks on the other side
just don't get it.
Is this change Americans can believe in? If they are not being told
the entire story, how can they know what to believe? If the leadership
on the other side isn't telling the entire story, the folks in the
media need to. And I believe folks in the media are well enough
educated to know what the truth is and to spread the truth. So I
challenge our media friends and beltway pundits--a little like I did
yesterday in remarks here--to report that higher taxes means less
discretionary income, it means slower economic growth, and it won't
mean more revenue for the Government to spend. It is too bad that
people are of the frame of mind that if you raise tax rates, you bring
in more revenue, and if you reduce tax rates, you lower revenue. I like
to disabuse people of those facts.
Yesterday, I also told the beltway punditry and related press people
to stop referring to the bipartisan tax relief of 2001 as the Bush tax
cuts. These are the talking points of the leadership on the other side
of the aisle that the press seems to somehow eat up because it gets
repeated. It is just a fact of life: Bush gets all the credit for the
tax cuts. Well, it is intellectually dishonest, and it gives Americans
the impression that the bipartisan tax relief that was passed back
then--7 years ago--is bad.
But then again, what should we expect from the other side of the
aisle and their leadership's campaign? Everything coming out of that
shop tends to be poll-driven. Take a poll the night before, and
whatever the people are telling you the night before, that is what the
message is the next day as opposed to being more concerned about good
policy being good politics.
The 2001 tax relief put more money into the pockets of hard-working
Americans, and they are better off for it. Sure, the leadership on the
other side of the aisle wants the voters to believe tax relief is bad.
The junior Senator from Illinois wants the voters to believe raising
taxes will solve all problems. The distinguished Senator also wants
voters to believe taxes will only be raised on people who earn lots of
money, where there isn't the money to solve all the problems. His party
wants people to believe there are no downsides for taxpayers, no
downsides for economic growth if income taxes go up by 10 percent, even
if taxes are raised on families making $250,000 or more.
Now, it is too bad, but the media seems to believe this propaganda
and ignores the fact that the economics behind it are not responsible
and factual, because that is the report they put out there, so that is
what the people hear.
The Democratic leadership has also successfully convinced the media
that raising taxes will bring in more revenue. I want to remind the
media that the bipartisan tax relief brought in more revenue than was
projected, much more revenue than what the 1993 Clinton tax increase
brought in over a comparable period.
I have a chart here that I would like the media to take a look at, a
chart which illustrates that lower taxes have generated record
revenues.
See, you have the actual revenues that came in and you have the
projected revenues before we lowered taxes. This chart illustrates that
Federal tax revenues have been and generally continue to be coming into
the Federal Treasury at or above the historical average--and the
historical average, the way I say it, is the last four decades--of
about 18.2 percent of gross domestic product. Now, what does that 18.2
percent of gross domestic product mean? It means that by lowering the
tax rates, as we did in 2001, it does not in any way gut Federal tax
revenue.
But how easy is it to explain to people who don't look at economics
every day that if you lower tax rates, you are going to bring in less
revenue; if you raise tax rates, you are going to bring in more
revenue? Because that is kind of what common sense might tell you. But
the study of economics and what really happens by the facts are two
different things. You can keep tax rates where they historically have
been for the last 40 years, about 18 to 19 percent of gross domestic
product--and when they were at 20, we reduced them down to that point;
in fact, even a little bit less growth has brought them back up--and
you can do it without hurting the Federal Treasury. In fact, you can
enhance it. Do you know why? Because of the dynamics of our economic
system, of our market system. When you let 137 million taxpayers, with
more money in their pockets, decide how to spend the money--and
probably in 137 million different ways--it does more economic good than
when 535 Members of Congress decide how to do it. But you know, some
have the attitude around here that the judgment of 535 Members of
Congress is much better than the judgment of 137 million taxpayers, so
we don't need to raise taxes in order to generate revenue.
So to the media people: Don't believe the Chicken Littles. I have a
chart here of Chicken Little, who says that the sky is going to fall if
we keep taxes low.
I can't let my colleagues on the other side and some of the skeptics
in the press say to the American public that if you earn less than
$250,000 a year, you won't see higher taxes, so I have these news
flashes:
News flash: You don't have to be earning $250,000 to invest money in
the stock market.
News flash: You don't have to be earning $250,000 to have real estate
holdings.
News flash: You don't have to be earning $250,000 to have your
savings in mutual funds.
All those flashes prove that if you earn less than $250,000 a year
and you
[[Page S5560]]
hold these investments, guess what--you will be paying more taxes. Let
me take a closer look so I can demonstrate that is what is going to
happen.
In 2003, Congress reduced the top tax rate on capital gains, lowering
taxes again from 20 percent to 15 percent. Congress also did the same
thing for dividend income, tied it with the capital gains tax rate at
15 percent. For lower income taxpayers, we thought they ought to have
an incentive to save, so the tax rate on capital gains and dividends
for low-income taxpayers is zero--that is zero with a ``z.'' Millions
of low-income taxpayers receive dividends and capital gains. All of
these taxpayers are not making more than $250,000.
To help out the media, I will illustrate these points with yet
another chart. As you can see from this chart, over 24 million tax
returns reported dividend income. In Iowa, for instance--my State--over
299,000 families and individuals claimed dividend income on their
returns.
Another chart we have deals with capital gains. The first one dealt
with dividends, now this one with capital gains. Nationally, 9 million
families and individuals claimed capital gains--9 million families--and
in my State of Iowa, over 127,000 of them. Now, that is a lot of
taxpayers who are not earning a lot of money. So I want the media to
report that. It doesn't seem to get reported. I want to see news
reports that say something like this: ``Even if the other side's
Presidential candidate's plan raises taxes on folks making $250,000,
millions of taxpayers make less than $250,000 and will still see a tax
increase.''
That is end of my proposed quote, but you will never see it in the
newspaper.
I also want my friends in the punditry and media to connect the dots.
If more people are paying higher taxes, the result is less
discretionary income and of course slower economic growth. That is the
same thing that is going on with high gas prices. The press doesn't
seem to have a problem reporting that fact, but it still ends up with
the consumer having less discretionary income.
I fought both Democrats and Republicans. I hope I have a reputation
of taking on a cause and not worrying about whether it is a Republican
cause or Democrat cause. So I have fought both to ensure that our
country is on the right course. That course must be and is economic
prosperity. I wish to see a real discussion of the negative
implications of changing current economic policy. With high gas prices
squeezing taxpayers, it is more compelling than ever.
Let's clear away the fog about what is meant to be negative about the
Bush tax cuts, because broad-based tax increases are not gauzy ``feel
good'' economic changes. Let's examine the benefit of keeping taxes
low.
While I have the floor, I wish to speak on an issue that is coming up
for a vote. This is the Medicare vote in a little while.
The vote we are going to take later today is a very important one--
important for our senior citizens and important for all health care
practitioners around the country. The outcome of that vote will
determine whether we begin working together again on a bill that the
President will sign. For the sake of 40 million Medicare beneficiaries,
I am here now to urge my colleagues to defeat the cloture motion today.
Then we can get to work on a bipartisan basis and write a bill that can
be signed into law. That is something Senator Baucus and I know how to
do.
This afternoon the Senate will be voting to move forward on a bill
that will be vetoed and will mean a lot of lost time--not only for the
Senate, but we have to get these things done by July 1. With a
Presidential veto, I doubt we will. This is a pointless exercise, then,
that can be stopped in its tracks by a ``no'' vote on cloture.
What is worse, the reality is that the bill is not even ready for
serious consideration. Members of the Senate, it is very incomplete,
obviously incomplete. It was introduced with blanks and brackets. It
will not become law.
It cuts oxygen reimbursement. It cuts power wheelchair reimbursement.
It threatens future physician updates. The danger is July 1, doctors
get cut 10.6 percent if we do not intervene. It is a partisan bill that
delays bipartisan consideration of the Medicare bill.
While the Senate wastes time with this bill, millions of taxpayers'
dollars in administrative costs are also going to be wasted because the
Center for Medicare Services has to program their system to not have
the physicians' pay cut go into effect July 1. But they can only do
that if Congress can pass a bill that can be signed by the President.
Voting for this bill is the same as asking for the physician pay cut
to go into effect. If it does, then CMS has to potentially hold
millions of claims, to process them later. That costs millions and
millions of dollars a week. If the Senate votes cloture on this bill,
we may as well be taking a match to millions of taxpayers' dollars.
We had been working in a bipartisan process that could get us a bill
that could be signed into law. For some reason the majority walked away
from the table. That was kind of recently, during the end of May. With
all due respect to my friends on the other side of the aisle, in the 3
weeks since they have produced a bill that, for all the rhetoric we are
hearing about it, is not worth the paper it is printed on. It will not
become law. It will be vetoed.
Meanwhile, doctors in this country are looking at the calendar,
wondering what their payment will be after June 30, and wondering
whether they can still afford to see Medicare patients. They are
wondering if they have enough cash reserves if Congress doesn't get its
act together.
I want to say something to the doctors back home who are listening to
this debate. They tend to be very busy, so I don't expect a lot of them
to be listening, but if they are I want to have them hear this. Your
insider Washington lobbyists are telling you that supporting cloture is
the best way to prevent the physician pay cut from going into effect
July 1. I think these high-paid lobbyists here in Washington are giving
you, the family practitioners and surgeons and interns back home, bad
advice. It is a good thing they are not giving the advice to real
patients, as you do, if this is the kind of judgment they would use.
The fact is, a vote in support of cloture is the absolute worst thing
that could happen if you want the physician payment update addressed by
the date it ought to be ready for CMS to carry it out, July 1.
If 60 Senators support cloture we will move to pass a bill out of the
Senate. Of course that will be a bill that will be vetoed. Then the
Senate will sit down with the House on a partisan basis and produce a
compromise that has even more spending yet, and is even more liberal
and more certain to be vetoed. Then it will be voted on in the House
and come back here for a vote. Then, finally, it will go to the
President where it will be vetoed. Then we will have a veto override
that will certainly fail.
Then and only then--how many weeks away that is I don't know--we will
sit down again on a bipartisan basis to write a bill that will become
law. Given how quickly things move around here, that could well be at
election time. If cloture fails, I am ready to roll up my sleeves and
go to work tonight. So, to all the doctors listening to this wherever
you are--in your hospitals, your homes--and to folks who pay dues to
groups such as the American Medical Association and to the American
College of Physicians, hear me when I say the people telling you that
supporting cloture is the way to get the physician payment update done
fastest do not deserve the jobs they hold and the hundreds of thousands
of dollars you pay them. The answer is a simple one. We need to defeat
the cloture motion today and we need to get back to bipartisan work to
protect Medicare for America's seniors and the providers who serve
them.
Yesterday Senator McConnell, the Republican leader, and I introduced
a bill, S. 3118, to address the problems we face in Medicare. The
Democrats are blocking our bill from getting a vote today. It is too
bad, because this is a very good bill. I spoke of some of the
provisions of this bill in the last several days. It is a bill that
clearly serves Medicare beneficiaries. Our bill reduces medication
errors with stronger e-prescribing provisions. This will help ensure
that our seniors' health care is not compromised by duplicative,
dangerous, and incompatible prescriptions.
Our bill helps patients who have had a heart attack with cardiac and
pulmonary rehab. Our bill ensures that
[[Page S5561]]
seniors who need access to outpatient therapy services will continue to
receive the therapy they need.
I am very pleased our bill pays a tribute to our beloved departed
colleague, Senator Craig Thomas of Wyoming, by including a number of
provisions that protect access for beneficiaries in rural America.
Specifically, our bill would accomplish helping rural America by
addressing inequitable disparities in the Medicare reimbursement
between rural and urban providers, and helps ensure these providers are
able to keep their doors open.
By continuing to fund two important and very successful programs to
combat diabetes, our bill helps people with that dread health problem.
Finally, our bill includes a number of extensions to help low-income
seniors and families.
As we close this debate--and the vote is about 35 minutes away--I
think the vote is a very simple one. The President will sign a bill
that preserves Medicare for American seniors and the providers who
serve them. The President will sign a bill that will provide increases
in payments for rural health care in America. The President will sign a
bill that reduces payments to Medicare Advantage. The President will
also sign a bill promoting value-based purchasing, electronic
prescribing, and electronic health records. The President will then
sign a bill that does not require cuts in oxygen payments or payments
for power wheelchairs.
Unfortunately, regarding the bill we will be voting cloture on, the
vote is to move forward on a bill that is not a bill. I have described
that. I am not going to go into greater detail.
People back home often don't understand votes on procedural motions
such as the one we call cloture, which we will have at 3. But this one
ought to be very easy to understand. Voting for this bill is a step
backward; it is not a step forward. It will not become law, and we have
to get something to the President that he will sign by July 1 to avoid
doctors taking Medicare cuts of 10.6 percent.
I ask my colleagues to vote ``no'' on the cloture motion so we can
get to work on a bill the President will sign. Let's set aside partisan
games and get to work protecting Medicare for America's seniors.
I yield the floor.
Mr. President, since I do not see other speakers, I suggest the
absence of a quorum.
The PRESIDING OFFICER (Mr. Nelson of Nebraska). The clerk will call
the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. BAUCUS. 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. BAUCUS. Mr. President, unless we act, on July 1 the law will cut
Medicare payments to doctors by 10 percent. Today, we have an
opportunity to vote on proceeding to a bill that will stop that cut. In
addition to averting the 10-percent payment cut, the bill on which we
will vote today will also make important improvements for
beneficiaries.
It will help those with very modest incomes to get the help they
need, and it will expand access to preventative benefits in Medicare.
We should all agree that prevention is critical to moving our health
care system from one that treats disease to one focused on wellness.
The bill includes a provision intended to give a boost to primary
care physicians. These represent a downpayment on changes that I would
like to consider in the near future to advance the role of our front-
line physicians.
The bill will improve access to health care in rural areas. The bill
includes many policies from the Craig Thomas Rural Hospital and
Provider Equity Act, all supported so strongly by so many Senators.
The bill will lend a hand to pharmacists. Pharmacists face so many
challenges right now. And the bill will help ambulance providers.
Today, these first responders must contend with record high and rising
gas prices.
That is what this bill will do. It is a good bill, it is a balanced
bill, and it is a bill that my colleagues should be proud to support.
Let me also talk about what this bill would not do. I have heard some
claims made about the bill. I would like to set the record straight.
First, the bill would not make drastic cuts to Medicare Advantage
payments. This is not the House-passed CHAMP bill. Although I believe
there is justification for making significant reductions to Medicare
Advantage benchmarks, this bill will not do that. This bill would not
affect the benchmarks in Medicare Advantage.
Second, this legislation will not eliminate private fee-for-service
plans. What it will do instead is take away the ability of these plans
to ``deem'' doctors and hospitals into their networks. Right now
private fee-for-service plans are permitted to circumvent network
requirements. They can deem any Medicare provider to be part of the
plan network. They can do so without any formal agreement between the
provider and the private fee-for-service plan.
What does that mean? That means that doctors and hospitals are
automatically considered by the plan to have agreed to all the terms
and conditions of the plan automatically. They are automatically
considered to have agreed to payment levels, to patient cost-sharing
obligations, and to billing procedures, even when they have not made
such agreements.
So it is no wonder that we hear from providers that they do not like
dealing with these plans. I would go so far as to say that forcing
doctors and hospitals to accept the terms that plans lay out, without a
chance to negotiate, seems un-American.
How will this legislation address deeming? It will eliminate this
deeming authority in 2011--yes, 2011; not right now but 2011; not next
year, not 2010 but 2011. The plans would have 2.5 years to develop a
network. I believe that is plenty of time.
Moreover, the bill will protect choice in rural areas. The deeming
provisions will only affect areas where there are already two or more
plan options available that have a network. In those areas where
existing plans have contracted with providers to form a network,
private fee for service has a competitive advantage. This bill will
level the playing field across all plans.
Second, this bill will not cut teaching hospitals. It will not
jeopardize access to plans in areas where academic medical centers are
most prevalent.
Right now, Medicare pays twice for indirect medical education on
behalf of patients in Medicare Advantage plans. Medicare pays once when
it reimburses teaching hospitals directly for IME costs, and Medicare
pays a second time by inflating payments to Medicare Advantage plans
for the same costs. So under this bill, teaching hospitals will
continue to receive IME payments directly from Medicare, but the
unnecessary double payments will be eliminated.
Third, this bill will not allow wealthy seniors to qualify for low-
income subsidies, as has been claimed. The bill will raise the asset
test from $4,000 to just under $8,000 for individuals. And it will
raise the asset test from $6,000 to $12,000 for couples. The bill will
give more seniors with very limited means the ability to qualify for
additional subsidies.
The income cut-offs to qualify for the subsidies will remain the
same. Beneficiaries will need to have incomes below $10,200 for the
Qualified Medicare Beneficiaries Program, and below $12,500 for the
Specified Low-Income Medicare Beneficiaries Program. That is under
current law, no change.
I think we all would agree that anyone with an annual income below
$12,500 and personal assets below $8,000 is someone we should want to
help. And if we can get the 60 votes to get to this bill, I will do
something else. I will offer an amendment to delay implementation of
the competitive bidding program for durable medical equipment. That is
a pledge that I made to many of my colleagues, and it is a pledge that
I make publicly, a promise I intend to keep.
I will offer as an amendment the language of the bipartisan bill
introduced earlier today in the House by Representatives Stark, Camp,
Boehner, and Pallone. Their bill is thoughtful, it is balanced, and it
responds to many of the concerns we have all heard from the DME
industry. If we get to this Medicare bill, we will include that
language in this bill.
[[Page S5562]]
Another policy in S. 3101 that I intend to revisit is oxygen cuts.
Congress needs to address overpayments to oxygen. In some cases,
Medicare pays 1,000 percent above what these supplies cost, and
beneficiaries pay the price through inflated copayment rates.
But this is a limited bill. It is not intended to fix all that ails
Medicare. We will revisit oxygen payments when the Congress next takes
up Medicare. By my estimate, that would be next fall when the 18-month
physician fix and other policies will expire.
In sum, time is running out. It is running short. We need to complete
a bill by June 30. That is not many days away. The options before us
are few and fraught with pitfalls. By far, the best option for getting
a Medicare bill done this year is a bill on which we will vote today.
This bill is bipartisan. It is carefully balanced. It does what we
need to do. I urge my colleagues to vote for cloture on the motion to
proceed.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mr. GREGG. Mr. President, I yield myself 5 minutes from time that is
reserved for the leader or, alternatively, from time that is available
at this point that is open.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GREGG. I ask the Chair if there is time presently available?
The PRESIDING OFFICER. There is 10 minutes for the minority leader.
Mr. GREGG. Mr. President, I rise to raise my concerns about the
procedure and about the substance. We all know there has to be a fix
relative to the doctors. We all know we cannot have this sort of
reduction in payments to physicians. That is just a fact.
My own personal preference is that we fix this permanently. It is
going to cost a lot of money, but that is the way it should be done. We
should not be fixing this every year. And, in fact, it is becoming a
geometric progression which is spiraling downward, with every year
becoming a much more difficult effort.
We should basically do Medicare reform. But short of that, we should
do a permanent doctor fix so that the physicians in this country know
they are going to get a reasonable upgrade of their reimbursement every
year. We should not have to go through this.
However, this bill does not accomplish that. In fact, this bill
aggravates the problem significantly. I genuinely wish the
bipartisanship effort which Senator Baucus and Senator Grassley had
been pursuing had been the effort that had come to floor, but it did
not.
What has come to the floor is a partisan effort; regrettably, it is
not a very good one. It has a couple of practical problems, and then it
has a very substantive problem. The substantive problem is that it
spends $2 trillion that we do not have, not to fix the doctor problem
but to add new benefits in certain elements for certain recipients
under Medicare Part D. Well, Medicare Part D is already $36 trillion in
debt, unfunded liabilities. Put $2 trillion more on top of that, it
means we are passing a huge cost on to our children. It is not fair. It
is not appropriate.
The practical problem this bill has--I find it incredible that we are
being asked to vote on it, quite honestly--is that it has blanks. This
is the first time I have ever seen this. This bill literally has blanks
in it. We are being asked to vote on a bill where the numbers, which
are operative relative to how much this bill is going to cost, are left
out. There are actually parentheses with nothing in them. There are
lines where there is a blank. And we are being asked to vote to close
the debate on this and move to final passage on this without even
knowing what the numbers are going to be which are to fill in those
blanks.
This is so egregious, so egregious, that the CBO, which is the
independent scorekeeper around here, which is the fair umpire around
here, has written us and said: They cannot score this bill. They cannot
give us a cost estimate since the introduced version has blanks.
The Congress should not work this way. The Senate should not work
this way. This is totally inappropriate. It is a terrible precedent. It
is worse than a terrible precedent. It is an incompetent precedent to
set to bring to the floor a bill that does not tell us how much it is
going to spend because the other side of the aisle does not want to
tell us how much it wants to spend or, alternatively, because they are
not competent enough to put numbers into the bill.
It is incredible to me that we would be asked to vote cloture on a
bill that the Congressional Budget Office says they cannot estimate the
cost of, which is their responsibility, because it has blanks.
I ask unanimous consent that the letter be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Congressional Budget Office,
Washington, DC, June 11, 2008.
Hon. Judd Gregg,
Ranking Member, Committee on the Budget, U.S. Senate,
Washington, DC.
Dear Senator: As you requested, enclosed are CBO estimates
of the costs of the provisions of S. 3101, the Medicare
Improvements for Patients and Providers Act of 2008, as
introduced on June 6, 2008.
As you noted in your request letter, some of the provisions
of the introduced bill are incomplete: there are some
elements that are necessary to producing a cost estimate for
the bill that are not included in the current language. In
addition, a number of elements in the bill are bracketed and
thus could be considered subject to change.
The enclosed table contains estimates for those provisions
of the bill for which we can estimate the costs, but does not
include a CBO estimate for the total cost of the bill since
the introduced version has blanks for some of the values for
key provisions. For the purposes of these estimates, CBO
assumed that all bracketed language would have full force and
effect.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Tom
Bradley.
Sincerely,
Peter R. Orszag.
The PRESIDING OFFICER. The Republican leader is recognized.
Mr. McCONNELL. Mr. President, our greatest successes in this Congress
have come when both sides have worked together. We saw it last year on
the Energy bill when we increased the CAFE standards to historic levels
and, more recently, the first thing this year on the economic stimulus
package.
We started initially down the path of compromise when we began the
Medicare discussions. Both sides wanted to prevent cuts to physicians
in the Medicare Program and to preserve access to the quality of
medical care our seniors have come to depend upon.
Unfortunately, the majority walked away from these bipartisan
discussions. In an effort to preserve some of the progress, protect
benefits for seniors, and to produce a bill that can be signed into
law, Senator Grassley crafted a Medicare bill which, if it were to be
passed today, it would be signed by the President of the United States.
Senator Grassley's alternative, which I will shortly ask consent to
go to, includes a 1.1 percent increase in the physician update,
protection for patients who need extensive therapies following a
stroke, 2 years of funding for the special diabetes program, a new
cardiopulmonary rehabilitation benefit--this is, by the way, especially
important to Kentucky where far too many of our citizens struggle with
pulmonary diseases.
There is a new program to improve care and save money by encouraging
doctors to write prescriptions electronically, a very important step in
the right direction. And it also preserves patient choice and access to
Medicare Advantage, which helps retired Kentucky teachers.
We all know what is going to happen. Once this bill is not proceeded
to, we will have bipartisan negotiations, which is the way this process
started out in the first place and, frankly, the way it will ultimately
end. That is the way the Senate does its best work. Having said that, I
have notified my friend, the majority leader, that I did have a consent
agreement to propound. I see that he is now on the Senate floor. I will
ask that consent at this time.
I ask unanimous consent that the pending motion be temporarily set
aside and that it be in order for the Republican leader to move to
proceed to S. 3118, a bill introduced by Senator Grassley to extend
expiring provisions under the Medicare Program and to file cloture on
that motion. I further ask that the cloture vote on the motion to
proceed to S. 3118 occur immediately following the cloture vote on the
motion to proceed to S. 3101. I further ask that if the motion to
proceed to either
[[Page S5563]]
Medicare bill is adopted, no other pending business be displaced.
The PRESIDING OFFICER. Is there objection?
Mr. REID. Reserving the right to object, on the floor now is the
Presiding Officer and the chairman of the Finance Committee. Two more
bipartisan Senators we do not have in the Democratic Caucus, Senators
always willing to work with the other side. They both have
reputations--Baucus in Montana, Nelson of Nebraska--of working with the
other side. There is no partisan advantage in the minds of either one
of these Senators.
Why can't we move to this bill? If there is a way to improve it,
let's improve it. That is all we want.
Mr. McCONNELL. Parliamentary inquiry: Is this an objection?
Mr. REID. Why do we have to go through this routine of stopping--
The PRESIDING OFFICER. Is the leader asking for the regular order?
Mr. REID. I object, Mr. President.
The PRESIDING OFFICER. Objection is heard.
Mr. REID. I have time set aside at this time. Why in the world do we
want to object again?
Mr. President, downtown this morning one of the Republican Senators
whose name I won't mention said, meeting with a number of people
downtown--this Republican Senator said: There is a lot of frustration
within the Republican caucus about blocking motions to proceed.
Of course, there is. The Republicans don't like it. Why do they
continue to do this? We want to legislate on this important piece of
legislation. It is not only a doctors fix, it is a fix to our health
care delivery system.
I am disappointed very much that the Nelsons of the world, the
Baucuses of the Senate world can't work together in a bipartisan basis.
They want to. I received a call before lunch, before I went to our
policy luncheon, from a Republican Senator. He said: Are you going to
fill the tree? I said: Of course, I am not going to fill the tree. Why
would I? He said: OK. I will vote with you. So I know at least we have
one Republican vote. He told me he is going to vote with us on cloture.
I hope others would follow with that.
In 1965, President Lyndon Baines Johnson traveled from Washington, DC
to Independence, MO to join former President Harry Truman in Harry
Truman's hometown of Independence, MO. The purpose of the trip and the
meeting between the current and former Presidents was to sign into law
a bill Harry Truman had conceived and Johnson had championed. The new
law created Medicare.
I know a little bit about Medicare. My first elective job was in
1966. I was elected to the Southern Nevada Memorial Hospital board of
trustees. It might not sound like much to anybody but to me that was
important. I beat an incumbent. At the time I took that job--I was
there for 2 years--40 percent of the senior citizens who came into our
hospital had no insurance. What did we do? We had them sign a
certificate or we would not let them in the hospital, unless a father,
a mother, a husband, a wife, a brother, a sister, or a friend agreed to
pay their bill. If they didn't pay the bill, we had a collection
department, and we went after them big time, as they did every place in
the country.
Medicare came into being. When I was there, before I left, Medicare
came into being. Now 99-plus percent of older people who go into
hospitals in America have Medicare insurance, a pretty good deal. That
is why Truman thought of it. That is why Johnson implemented his
thought process. The new law they were there to celebrate created the
Medicare Program, a program that has ensured quality health care to
America's senior citizens for more than four decades. Since Johnson
signed the bill and gave Truman the first ceremonial Medicare card,
hundreds of millions of senior citizens have also received their
Medicare card. With each new Medicare card issued, our country renews
its commitment to bedrock values of those who have worked hard and made
their contribution to society, and they deserve to know they will be
cared for as they reach those golden years.
But even on the day that bill was signed, President Johnson
acknowledged the bill was imperfect. Who were the Senators who voted
against Medicare when it came into being? Who were the Senators who
recognized they would not vote for that bill? All Republicans. Every
person who voted against Medicare's implementation was a Republican
Senator. They haven't changed. They reluctantly do what they can for
Medicare, but they don't support it.
President Johnson acknowledged it was imperfect. For all the good
Medicare has done our Nation's seniors through the years, for all the
good it has done for them today, it could be better. Our efforts to
make Medicare work better continue today with the Medicare Improvements
Act. That is what the chairman of the committee was trying to do, make
it better. That is what this is all about.
I am grateful for the work of Senator Baucus, chairman of our
committee. Anyone who knows, I repeat, the Senator from Montana is well
aware of his ability to work with both sides of the aisle to forge
bipartisan solutions. On this legislation, Senator Baucus worked
tirelessly with Democrats and Republicans. He reached out to the Bush
administration and to the Republican leader. In these efforts, though,
he was met with a reluctance to move forward, reluctance that has sadly
become the rule, not the exception, among our Republican colleagues.
Nevertheless, Senator Baucus moved forward. He worked side by side with
Democrats and willing Republicans to create a bill that would make
Medicare work better for millions of senior citizens.
Senator Baucus laid out the many virtues of this legislation
yesterday so I will do no more than summarize the key points of this
most important legislation. The Medicare Improvements Act provides
increased coverage for Medicare. This is so important. There is no
better way to treat illness than true preventive care. Not only will
this enhanced preventive coverage improve the health of Medicare
recipients, but it will also save taxpayers in the long run from the
astronomically higher costs associated with treating serious illnesses
which could have been avoided with preventive care.
This legislation also makes mental health care more affordable. I
have worked throughout my time in Congress to shed light on the tragic
but all too often hidden cost of depression and other mental health
problems among older Americans. Sometimes depression among seniors
leads to suicide. There is no group of Americans that dies more than
seniors from suicide. Medicare currently discourages beneficiaries from
seeking care for mental illness by requiring a 50-percent copayment for
mental health services versus a 20-percent copayment for physical
health services. This legislation will eliminate that disparity and
expand coverage for medications to treat mental health illnesses.
The Medicare Improvements Act also makes it easier for low-income
seniors to access benefits by extending the Qualified Individuals
Program, increasing eligibility for the Medicare Savings program and
eliminating the drug benefit penalty. And for all seniors, this bill
provides funds for State and local programs to help navigate through
the program and ensure the greatest benefits possible.
When President Johnson signed Medicare into law in 1965, he
acknowledged that for all the good this program would do, I repeat, it
wasn't perfect. That has not changed today. For all its virtues, far
too many seniors are not accessing the care they earned and to which
they are entitled. Far more can be done to prevent and treat physical
and mental illness to provide older Americans with the very best
quality care we can provide them. Will the Medicare Improvements Act
make Medicare perfect? No. But there is no question it will make it
better, far better. There is no question it will help millions of
Americans access Medicare and get the most of its benefits once they
do.
There has been some talk of Republicans refusing to join Democrats to
support the motion to proceed to this legislation. That is what the
Republican leader said today. He told all of his Republicans: Don't
vote for this. We will work out something better. That is the process.
The process is not the status quo. If there are improvements they want
to make, there is no bigger listener than Max Baucus of the Finance
Committee. He will manage this bill. But if they follow the lead of
[[Page S5564]]
the Republican leader, they are being led off a cliff. Republicans
wouldn't just be refusing to support the bill, they would be refusing
to let us even move to debate it. They would be stopping this crucial
legislation in its tracks and deny any possibility of progress or
compromise in the near future.
I hope people on the other side will follow what I read to them from
a Republican Senator downtown this morning: There is a lot of
frustration within the Republican caucus on blocking motions to
proceed.
And well there should be.
I will use leader time, Mr. President.
I can't imagine why all 100 Senators would not flock to quickly pass
this legislation, much less why they would not all vote eagerly for the
motion to proceed. Denying debate on the Medicare Improvements Act and
denying its passage would be a grave disservice to tens of millions of
Americans over age 65. It would be a slap in the face to all those who
suffer silently through mental illness because they can't afford the
treatment that would make them well. Opposing this legislation and
clinging to the status quo, as I fear some Republicans may choose to
do, would be an abandonment of our decades-old commitment to honoring
and caring for senior citizens in the manner they deserve.
In Independence, MO, 43 years ago, President Johnson said this:
Many men can make many proposals. Many men can draft many
laws. But few have the piercing and humane eye which can see
beyond the words to the people they touch.
Few can see past the speeches and political battles to the
doctor over there that is tending the infirmed, and to the
hospital that is receiving those in anguish, or feel in their
heart the painful wrath at the injustice which denies the
miracle of healing to the old and to the poor.
And fewer still have the courage to stake reputation, and
position, and the effort of a lifetime upon such a cause when
there are so few that share it.
But it is just such men who illuminate the life and history
of [this] nation.
Because times have changed in 43 years, I call upon the men and women
of the Senate to do the right thing and let us move to this
legislation. It is the right thing to do. President Johnson's words go
to the heart of this country. People need to vote their conscience, not
the status quo.
Mrs. BOXER. Will my friend yield for a brief question?
Mr. REID. I have time? OK.
Mrs. BOXER. In a minute or less, I am rather stunned to hear that the
Republican leader is suggesting that Republican Senators vote no to
move to a bill for the purpose of making improvements in Medicare. I
ask my friend, because people sometimes lose track of what happens,
would this not be the third straight bill in a row where the
Republicans have been fierce defenders of the status quo--global
warming, gas prices, and now fixing Medicare? Am I correct on that?
Mr. REID. I say to my distinguished friend from California, it has
gotten so out of hand that we are having trouble keeping up. We now
have on filibusters 75, but we have it on Velcro because we know they
will add another one to it in the near future. We also have Velcro as
to what they are blocking on a given day. We pull it off because
yesterday they were blocking global warming. The day before they were
blocking gas prices, today Medicare improvements. It has gotten so
difficult around here that we have Velcro as to what they are stopping.
If there is no more time to be used on the Republican side, we could
start the vote early. We are going to start the vote early. We were
going to consider having it started at 3 o'clock. There are some people
who want to leave and we have some coming back. Anyway, I have gotten a
nod to yield back all time for both Democrats and Republicans, and I
ask that the vote start.
Cloture Motion
The PRESIDING OFFICER. Under the previous order, pursuant to rule
XXII, the clerk will report the motion to invoke cloture.
The legislative clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
hereby move to bring to a close debate on the motion to
proceed to Calendar No. 772, S. 3101, the Medicare
Improvements for Patients and Providers Act of 2008.
Harry Reid, Max Baucus, Jon Tester, Barbara Boxer,
Benjamin L. Cardin, Bernard Sanders, John F. Kerry,
Patty Murray, Maria Cantwell, Blanche L. Lincoln, Ken
Salazar, Charles E. Schumer, Ron Wyden, Patrick J.
Leahy, Jeff Bingaman, Debbie Stabenow, John D.
Rockefeller, IV, Jack Reed.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call has been waived.
The question is, Is it the sense of the Senate that debate on the
motion to proceed to S. 3101, the Medicare Improvements for Patients
and Providers Act of 2008, shall be brought to a close?
The yeas and nays are mandatory under the rule.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from New York (Mrs. Clinton),
the Senator from Hawaii (Mr. Inouye), the Senator from Massachusetts
(Mr. Kennedy), the Senator from Louisiana (Ms. Landrieu), and the
Senator from Illinois (Mr. Obama) are necessarily absent.
I further announce that, if present and voting, the Senator from
Louisiana (Ms. Landrieu) would vote ``yea.''
Mr. KYL. The following Senators are necessarily absent: the Senator
from Arizona (Mr. McCain) and the Senator from New Hampshire (Mr.
Sununu).
The PRESIDING OFFICER (Ms. Klobuchar). Are there any other Senators
in the Chamber desiring to vote?
The result was announced--yeas 54, nays 39, as follows:
[Rollcall Vote No. 149 Leg.]
YEAS--54
Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Brown
Byrd
Cantwell
Cardin
Carper
Casey
Coleman
Collins
Conrad
Dodd
Dole
Dorgan
Durbin
Feingold
Feinstein
Harkin
Johnson
Kerry
Klobuchar
Kohl
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Mikulski
Murkowski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reed
Roberts
Rockefeller
Salazar
Sanders
Schumer
Smith
Snowe
Specter
Stabenow
Stevens
Tester
Webb
Whitehouse
Wyden
NAYS--39
Alexander
Allard
Barrasso
Bennett
Bond
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Corker
Cornyn
Craig
Crapo
DeMint
Domenici
Ensign
Enzi
Graham
Grassley
Gregg
Hagel
Hatch
Hutchison
Inhofe
Isakson
Kyl
Lugar
Martinez
McConnell
Reid
Sessions
Shelby
Thune
Vitter
Voinovich
Warner
Wicker
NOT VOTING--7
Clinton
Inouye
Kennedy
Landrieu
McCain
Obama
Sununu
The PRESIDING OFFICER. On this vote, the yeas are 54, the nays are
39. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
Mr. REID. Madam President, I enter a motion to reconsider the vote by
which cloture was not invoked on the motion to proceed to S. 3101.
The PRESIDING OFFICER. The motion is entered.
Mr. REID. Madam President, I now withdraw the motion to proceed.
The PRESIDING OFFICER. The motion is withdrawn.
The majority leader is recognized.
Mr. REID. Madam President, first of all, let me say I really
appreciate the nine Republicans who voted to proceed. I appreciate
that. We want to legislate. I think there is an indication that maybe
things are getting to a point where we are going to be able to do that.
I hope that, in fact, is the case.
____________________