[Congressional Record Volume 154, Number 107 (Thursday, June 26, 2008)]
[Senate]
[Pages S6225-S6231]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT OF 2008--MOTION TO
PROCEED
The PRESIDING OFFICER. The motion to proceed to H.R. 6331 is
considered to have been made under the previous order.
The clerk will report.
The legislative clerk read as follows:
Motion to proceed to Calendar No. 836 (H.R. 6331) an act 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 PRESIDING OFFICER. There are now 60 minutes for debate on that
motion.
The Senator from Illinois.
Mr. DURBIN. Mr. President, when we finally vote on the floor, it is
on the Medicare Program. The Medicare Program is literally a life-and-
death program for 40 million Americans. For 40 million Americans who
are either over the age of 65 or disabled, this is their health
insurance program.
It was created back in the 1960s. When it was created by President
Lyndon Baines Johnson, its critics said: This is too big. This is too
much government. This is socialized medicine, they said. And many voted
against it, saying it was a mistake. Well, after 40 or more years, we
know it wasn't a mistake. It may be one of the most thoughtful and
important programs enacted since Social Security because it gave peace
of mind to senior citizens. They knew when they reached that moment in
life when they were likely to be more vulnerable to illness and
disease, they would have health insurance. They could go to a hospital
or doctor and get basic care and not worry about whether they were
wealthy enough to have health insurance or enough savings to cover a
medical catastrophe. So this program, which was derided and criticized
for being too much government, has been one of the great success
stories of this country, and the seniors value it. Every one of them
values it.
My brother, who retired from the private sector in his early
sixties--a pretty conservative fellow when it comes right down to it,
politically--turned out to have had some heart problems. And it turned
out he also didn't have any health insurance after he retired. He was
really waiting and hoping he could make it to the age of 65 before
something else would happen because a few more trips to the hospital
and a few more surgeries might have really hurt his retirement plans.
He made it. He is covered by Medicare and doing well. And that is just
one example of thousands that can be given.
So we have a vote today which should be a pretty simple vote. It was
a very simple vote in the House of Representatives. There is a proposal
to cut the reimbursement, the compensation, for doctors under Medicare
by about 10 percent on July 1. I think that is a bad idea. These
providers don't get paid a lot of money for treating Medicare patients,
and to cut their reimbursement may force many doctors to say: We just
can't see as many Medicare patients or maybe none at all. So fewer
doctors, if this pay cut goes through, are likely to treat Medicare
patients. That is not a good outcome. It means that many of the
Medicare patients won't be able to go to the doctors who have been
treating them for long periods of time and there will be real
uncertainty about their future. So we wanted to make sure this pay cut
did not go into effect July 1.
The House of Representatives considered this, and in an overwhelming
bipartisan vote they voted not to cut the pay for doctors treating
Medicare parents. The vote was 355 to 59. That is a 6-to-1 margin in
the House of Representatives--totally bipartisan. You would think a
bill with that kind of vote would come over here without much
controversy. But, of course, those people don't know how to measure the
Senate.
In the Senate, there have been those on the other side of the aisle,
the Republican side, who have found reason to object to this effort to
make sure Medicare doctors get fair pay. It comes down to a lot of
reasons they have given, but as they say in politics--or as one old
fellow I used to work for by the name of Cecil Partee, a State senate
president in Illinois, used to say--for every vote, there is a good
reason and a real reason. Well, they are using as a good reason here to
vote against this protection of Medicare doctors that, unfortunately,
it might involve some increase in taxes or changes in private health
insurance. The real reason? The real reason is that this bill goes
after--in a small way--private health insurance companies that are
selling Medicare coverage, the so-called Medicare Advantage companies.
You see, there are many on the Republican side who haven't gotten
over the debate in the 1960s. They still think Medicare is socialism.
They still think this is too much government. They want to privatize
this. They believe we could rest easy every night if we were in the
loving arms of a health insurance company. They obviously haven't had
to pick up the phone and talk to some clerk in the middle of nowhere
who is denying your claim because of something in the policy you didn't
know existed--which has happened to many people across America. No, on
the Republican side, they are afraid that any cutback in the profit
taking by these private health insurance companies will be
uncomfortable for some of their friends. So they are prepared to allow
this cut in pay for doctors under Medicare to go through to protect the
private health insurance companies offering Medicare coverage.
So I guess the honest question is, Are the private health insurance
companies
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doing a better job than the Medicare Program? The honest answer is no.
Do you know how much more they charge than the Government's Medicare
Program? About 17 percent more. They will throw in a few bells and
whistles, but about 17 percent more. So it isn't as if they are
cheaper. They are not.
Secondly, it turns out they are using bullying and strong-arm tactics
to convince a lot of senior citizens to sign up for those so-called
Medicare Advantage Programs, so much so that we have had to investigate
this, and we are going to have to do everything we can to stop this
from continuing.
Third, we just had a report from the General Accounting Office. These
so-called private health insurance companies--it turns out the medical
care they were reporting for seniors was overstated. They weren't
giving them the care that was promised. Instead, they were taking more
profit out of the system.
If you are a free market advocate who believes that it is caveat
emptor--let the buyer beware--you can buy into this idea of private
health insurance companies doing so well, making so much money,
bullying seniors, and not giving them medical care promised. I don't
buy it and I think they ought to be held accountable. If there is one
thing we ought to protect, it is the seniors in America, who have done
so much for this country and now need our help in their retirement
years. That is what Medicare is all about.
We are going to have a vote in about 45 or 50 minutes. We need 60
votes to protect these doctors who are providing help under Medicare.
We only have 51 on our side of the aisle, the Democratic side. We need
nine Republicans to cross the aisle to join us in this effort to do the
right thing for Medicare.
I don't think it is an unreasonable idea that 9 out of the 49
Republicans would join us when in the House of Representatives the same
measure passed by a vote of almost 6 to 1 in favor of it.
This is a good bill, not only because it helps Medicare to continue
to thrive because it helps beneficiaries pay their premiums if they are
in a low-income category, it helps pharmacists, it helps many others.
It has been endorsed by virtually every major organization of
physicians, seniors, pharmacists, and hospitals. They know this bill is
critically important.
If the Republicans fail to give us the votes necessary to reach 60
votes on the next rollcall, doctors across America treating Medicare
patients will take a 10-percent cut in pay in a few days. That is the
reality. Those who have voted that way are doing it in order to protect
private health insurance companies who are trying to compete with
Medicare. Those private health insurance companies have plenty of
lobbyists. They are politically articulate. They can be found in the
corridors of the Capitol day in and day out. But those folks are not
speaking for the seniors. The seniors want us to stand up and make sure
we keep Medicare strong and Medicare providers are there to make sure
they get the very best care.
I hope my Republican colleagues will not go in lockstep with the
private health insurance companies but will, in fact, stand for the
Medicare Program, join the overwhelming bipartisan majority in the
House of Representatives who supported this bill. If it costs these
private health insurance companies 1 or 2 percent, is that the end of
the world, that they would have to give back a little bit of the money
they are taking out of our Federal Treasury? I do not think it is. I
think they have been shown to charge more than the Medicare Program, to
provide less than they publicly disclose in terms of medical benefits,
and to engage in marketing tactics which should not be condoned by the
Senate.
I hope we will have a good bipartisan rollcall here. It will be a
great way to end the session as we break for the Fourth of July recess.
I yield.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. KYL. Mr. President, I don't understand why this has to be
characterized as a partisan issue as my colleague from Illinois has
done. He said there is a proposal to cut doctors' pay. There is no such
proposal. Nobody wants to cut physicians' pay. In fact, I daresay all
100 Senators here are in support of ensuring that physicians get paid
an increase in the pay next year from what they are paid this year.
What happens is that the law provides an automatic pay cut so we have
to pass a bill to prevent that automatic pay cut from taking effect.
I am on the Finance Committee. A few weeks ago Senator Baucus, the
chairman of that committee, who has a long history of working with
Senator Grassley regardless of which party is in the majority, proposed
that we work in a bipartisan way to draft a bill to ensure the
physicians would be paid. Those discussions commenced. They produced a
bipartisan agreement. Then, before that agreement was brought to the
Senate floor, the majority announced it wanted instead to substitute a
partisan bill that we would seek to consider on the Senate floor. We
had a cloture vote on that bill and it failed to get cloture.
My colleague says he hopes Republicans will not vote in lockstep. I
can assure my colleagues here Republicans will not vote in lockstep.
Democrats will vote in lockstep. There will not be a single Democrat
who votes differently. Republicans will be divided.
If this is a partisan issue, it is only a partisan issue because
Democrats will vote in lockstep and because the Democrats insisted on
bringing a partisan bill to the floor. That was rejected, so Senators
Baucus and Grassley returned to their negotiations. Again they were
about done with those negotiations 2 days ago when the House scheduled
a vote on its own bill and that bill passed. Again that upset the
bipartisan discussions that were occurring here in the Senate. As a
result, the majority leader decided to bring the House bill to the
Senate and ask us to support the House bill. Again, the negotiations
stopped.
The vote we are going to have today will either allow the Baucus-
Grassley negotiations, bipartisan negotiations, to be completed or send
a bill to the President which he will veto--meaning a great deal of
time will be lost by the time that bill gets to the President, he ends
up vetoing it, he sends it back to the Congress and we presumably
sustain the veto. Then what happens after that? Bipartisan negotiations
resume.
We can cut out all of that political folderol by simply returning
this bill to the people who were negotiating it in the first place.
Either way, July 1 will come with no solution. That is a problem for
the physicians. The veto route virtually assures that physicians will
feel the impact of a 10.6 percent cut in payment because of the amount
of time it will take for us to complete our work.
On the other hand, if cloture is defeated and the bipartisan
negotiations can quickly resume, then, depending upon when we could
pass something after July 4, it is possible that the reimbursement
checks could reflect the new rates without the cuts ever being applied.
If you are interested in a truly bipartisan solution in a body that
is 51 to 49, if you are interested in minimizing the potential impact
on physicians, do not vote for the House bill that we know will never
become law.
Let me conclude with this point. The House bill makes some radical
changes in Medicare. It doesn't just reimburse physicians; it increases
Medicare spending by $17 billion over 10 years. It makes larger cuts to
Medicare Advantage, the highly successful insurance program for
America's seniors. This will minimize patient choice in both rural and
urban areas and, according to the Congressional Budget Office, 2
million seniors would lose their fee-for-service plans by the year 2013
under the House bill. It would significantly restrict Part D plans'
ability to negotiate prescription drug prices.
We can do better than this. We should return to the bipartisan
negotiations and pass a truly bipartisan bill which will ensure that
physicians will be paid and Medicare patients will be served.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, here we are again. Once again the Senate
is being asked to vote to proceed to a bill that is written on a
partisan basis. As everybody knows who knows how the Senate functions,
anything that is on a partisan basis does not get done.
Once again we are being asked if we want to agree to a process where
no
[[Page S6227]]
amendments will be allowed. Once again we are being told to take it or
leave it. The damage that is being done to the ability of this body to
function is extraordinary. It should not be this way and it doesn't
have to be this way.
I say this from a lot of experience I have had on the Finance
Committee and, most importantly, my experience working with Senator
Baucus, the chairman of the committee. During the last several years,
the Finance Committee has produced numerous bipartisan health care
products.
In 2003, Senator Baucus and I joined together, defied the long odds
against it and produced a Medicare Prescription Drug bill.
In 2005, we worked together on a relief package in the aftermath of
Hurricane Katrina.
In 2006, we passed the Tax Relief and Health Care Act.
In 2007, we worked together on a bipartisan Children's Health
Insurance Program Reauthorization Bill. We also passed the Medicare,
Medicaid, and Children's Health Insurance Program Extension Act of
2007.
I could go on and on. For years the Finance Committee has been the
model of how a committee can work on a cooperative--and that basically
means on a bipartisan--basis. I think we work best when we work
together. For some reason that has not seemed to be the case this year
and that is not Senator Baucus's fault.
I have tried to work this year to get a bill that could get signed
into law. I personally think the White House is drawing lines in the
sand that are unreasonable. However, there is a fact of our
Constitution: The President holds the veto pen and if this bill passes
today, we will see it used, and that is regardless of this Senator's
position that maybe the White House has been too strict.
I tried to work toward a bill that can be signed by the President,
because those are the facts of life. Obviously that was not the path
the majority of the Senate--meaning the majority party--could follow.
Even after the first cloture vote, even after it failed in the Senate,
I tried to get a bipartisan compromise that could be signed into law.
That effort was abandoned when the House voted to support the bill on
which the Senate couldn't get cloture. That is not a realistic position
for the other body to take but it doesn't matter; they took it, so we
are here.
When we were in charge around here, I can say we certainly didn't
appreciate it when, under Republican control in the House of
Representatives, the Ways and Means Committee tried to dictate terms to
this body. When Ways and Means Chairman Thomas tried to roll the
Senate, I think I successfully defended the bipartisan Senate position.
When I was chairman of the Finance Committee, I don't recall our
bipartisan efforts being determined by House votes. To the contrary, I
think we worked together in spite of House votes. In fact, the House
budget--or the congressional budget adopted in the year 2003 that had
provisions in it for taxes when the President of the United States
wanted a $700 billion tax cut--I told enough Republicans in the Senate
that I would not bring out of conference a tax bill that had more than
half that amount, $350 billion.
I didn't tell the House of Representatives that before they voted on
their budget, but they passed a budget that we could get enough votes
to pass in the Senate because of the promise I made to some Republicans
that we were not going to be dictated to by the White House or by the
House of Representatives. And we didn't do more than a $350 billion
package. Was there an uproar among House Republicans against me, when I
had told enough Republicans in the House what we would do on that tax
bill. So I think I have defended our position.
But let's be clear about another thing. That House vote I referred to
went the way it did because Members were assured that the Senate was
going to fix the problem in this bill. But we are in a process where we
cannot fix that problem. They are counting on us to fix it so we would
have a bill the President would sign. They are right about one thing:
This bill does need to be improved. The bill the Democrats are trying
to pass is woefully lacking in what it provides for rural America as
opposed to what Senator Baucus and I were agreeing to by 11 o'clock
Tuesday of this week.
I wish to call out one specific provision. Senator Harkin and I have
worked extensively on a provision for so-called ``tweener'' hospitals.
These are hospitals which are too large to be critical access hospitals
but too small to do well under the current Medicare payment systems. We
had a provision to improve payments to these hospitals. It is not in
the House Democrats bill, so a vote for cloture misses an opportunity
to provide critical assistance to rural hospitals all over the country.
I am sure Senator Harkin and others are disappointed, as I am, with
this omission. This is not something just for Iowa and for Senator
Harkin and for Senator Grassley; this is something that affects 181
hospitals in 31 different States in this country. But that was left out
in the House of Representatives. Why? Because the House of
Representatives is controlled by the big States, by the big cities, and
they don't care about rural America.
Voting for this bill accomplishes nothing. It will not become law.
How much more clear can we be about that? To keep the pay cut of
doctors from happening, we have to defeat this motion so we can sit
down and finally produce a bill that can become law.
To improve Medicare, we have to produce a bill that can become law,
and that means being signed by the President of the United States. To
make sure that beneficiaries continue to have access to essential
therapy services, we have to produce a bill that can become law. To
help beneficiaries, we have to produce a bill that can become law. How
many times do I have to say that?
To preserve access for durable medical equipment for seniors, we have
to produce a bill that can become law. We have to be allowed to do our
work in the Senate. And that work only gets done if we have
bipartisanship.
We have to be allowed to produce the best bill possible through
bipartisan compromise. Let's show that we can work on a cooperative
basis. We have to defeat this motion so that we preserve the right of
the Senate to have input on legislation, that we are not simply a
rubberstamp for the House.
We should defeat this motion so that we can show that bipartisanship
is not dead on important health care issues that matter to millions of
people who depend on us as stewards of Medicare. Let's do the right
thing and vote no. Vote no so this body does not abdicate its duties
under the Constitution. Vote no so that we can get a bill done this
week that can become law. Vote no so that we can get the job done.
A ``yes'' vote accomplishes nothing because it is going to delay for
2 weeks everything to be considered because of the President vetoing
this bill.
I yield the floor.
The PRESIDING OFFICER. The Senator from New Mexico is recognized.
Mr. BINGAMAN. Mr. President, how much time remains on this side?
The PRESIDING OFFICER. The majority has 20 minutes, of which 10
minutes are reserved for the majority leader.
Mr. BINGAMAN. Mr. President, I will use a maximum of 5 minutes to
respond to some of the points that were made.
First, let me say how much respect I have for Senator Grassley. He is
the ranking member on our Finance Committee. He is a very conscientious
and fair individual with whom I have enjoyed working on many matters.
On this particular issue, I disagree with him. Let me point out there
were three arguments made: First, that this is not bipartisan; it is
clearly not the bipartisan agreement he and Senator Baucus were working
to develop, but it is clearly a bipartisan agreement.
I am informed that 129 Republicans in the House voted for this bill.
That is two-thirds of the Republicans who serve in the House. The vote
in the House was 355 in favor. So this is a bipartisan bill by any
definition. The fact that it has come from the House of Representatives
rather than originating in the Senate, of course, is another matter.
But it is bipartisan.
The second point, of course, is that there are important things that
have been left out. I do not doubt that there are important things that
have been left out and that I would like to see included. But the
reality is, we have a bill that does important things; particularly, it
heads off the expected cut in physician payments that is scheduled to
occur next Tuesday. That is a
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very important provision. And I think it makes all the sense in the
world for us to pass what we have in front of us, pass what the House
of Representatives has passed, fix the problems that legislation fixes,
and then come back at a future time and try to solve these other
problems, many of which I am sure I would wind up agreeing with my
colleague from Iowa.
The third point is that we should oppose this because the President
has said he would veto it. Frankly, I am not clear as to the
substantive reason the President thinks this bill should be vetoed.
I believe strongly that the way the system is intended to operate is,
Congress sends bills to the President. If he vetoes them, then Congress
sees whether it has got enough votes to override the veto. If we do
not, of course we have to take a different course.
In this circumstance, it looks to me like at least the House of
Representatives has enough votes to override a Presidential veto, if
the President were to take that course. I do not know what we would
have in the Senate. I hope very much we would have the necessary 67
votes. I think it would certainly be in the interests of the people I
represent in New Mexico to see this legislation enacted and enacted
quickly.
So I urge my colleagues to support it and hope that colleagues on
both sides of the aisle will support the legislation.
Mr. LEVIN. Mr. President, I support the Medicare Improvements for
Patients and Providers Act, H.R.6331, which makes a number of needed
changes related to Medicare reimbursement, including reimbursement for
physicians' services.
Medicare physician fee schedule payments are updated each year
according to a complex formula based on a sustainable growth rate, SGR.
Unfortunately, because of the way the formula is calculated, even if
Congress prevents the cuts in a given year, scheduled reimbursements
cuts are likely to increase in subsequent years unless Congress takes
additional action, such as developing a permanent alternative to the
SGR formula.
I support efforts to ensure that physicians receive adequate
reimbursement for their services. It could be financially unsound for
physicians to continue to provide services to Medicare beneficiaries if
reimbursement is inadequate. As a result, allowing reimbursement cuts
to enter into effect could pose significant access problems as
physician's are unable to afford providing services to Medicare
beneficiaries in need of medical attention.
While I believe past measures to alleviate this burden on physicians
have been helpful, I know from my discussions with health care
providers throughout Michigan that more needs to be done. For the long
term, Congress must find an alternative to the SGR. The SGR is linked
not to the cost of providing health services, but to the performance of
the overall economy. The cost of health care has been rising much
faster than inflation. Our Nation should address the rising costs of
health care as part of a larger discussion on health care reform.
Reimbursement should more accurately represent the cost of providing
services.
In the meantime, I support this legislation, which includes a delay
on Medicare reimbursement cuts for physicians' services and replaces
the cut with a 1.1-percent increase for 2009. I am hopeful that the
Senate will pass this legislation and that the President will heed the
will of Congress and the American people and sign this bill into law
before the cuts enter into effect on July 1.
Mr. GRAHAM. Mr. President, today I wish to express my disappointment
in the straight extension of the current temporary assistance for needy
families, TANF, supplemental grant program, which is included in the
Medicare bill. I oppose the extension of this program without updating
the 10-year-old statistics that qualify States for participation in the
program, and without the appropriate reauthorization and consideration
of changes necessary to ensure that this assistance is being afforded
to the States that need it most.
The TANF Supplemental Grant program was created in 1996 to provide
additional assistance to States that spend less money per poor person
on TANF services. Seventeen States qualified for additional TANF
benefits under this program based on certain statistics collected at or
around that time. More than 10 years later, these States are still
receiving supplemental grant benefits based on the same 10-year-old
statistics. A straight extension of this program does not award this
assistance based on current conditions in States.
There is no doubt that our nation is facing challenging economic
times. Rising gas prices, rising unemployment States, the housing
crisis and rising food prices all place a particularly significant
burden on less fortunate families. Some state TANF programs are seeing
increased caseload pressure.
South Carolina can only afford to spend 29 percent of the national
average per poor child on TANF services compared to some States that
spend well over the national average. To make matters worse, South
Carolina did not and has not qualified for the supplemental grant
program due to an old statistic that has since changed.
Senator Rockefeller and I introduced a proposal to allow States that
spend below the national average on TANF services to participate in the
supplemental grant program. Using updated statistics, our legislation
would ensure that the dollars spent on this program are appropriately
directed to States that need it most so that they can help struggling
families get on their feet and back to work.
Unfortunately, the Senate Finance Committee chose to quickly pass
this extension as a part of a larger bill in order to avoid the
discussion of reauthorization and changes necessary to update the
supplemental grant program. I am disappointed some States, like South
Carolina, and families that might otherwise receive this additional
assistance will not have the opportunity to benefit from a mere update
of the current program, or from the consideration of Senator
Rockefeller's and my proposal.
I am committed to ensuring that Federal dollars spent on welfare
services and benefits are spent efficiently. I am disappointed that the
reauthorization of the supplemental grant program did not receive the
attention it deserves, and I am hopeful that this can be addressed in
the future.
Mr. AKAKA. Mr. President, I support the Medicare Improvement for
Patients and Providers Act of 2008. We must quickly enact this
legislation in order to ensure that Medicare beneficiaries continue to
have access to health care, enhance Medicare benefits, and extend
Medicaid disproportionate share, DSH, allotments for Hawaii.
This essential legislation will maintain Medicare physician payment
rates for 2008 and provides a slight increase in 2009. If this
legislation fails to pass, doctors will be faced with a 10.6-percent
cut in Medicare reimbursements. Rising costs, difficulty in recruiting
and retaining staff members, and declining reimbursement rates make it
necessary to make improvements in Medicare reimbursements to ensure
that Medicare beneficiaries have access to health care services.
The bill will enhance Medicare benefits. It will increase coverage
for preventive health care services and make mental health care more
affordable. In addition, the Act will help low-income seniors access
health care services that they need.
In addition, this legislation includes a provision that extends
Medicaid DSH allotments for Hawaii and Tennessee for another 18 months.
Medicaid DSH resources support hospitals that care for Medicaid and
uninsured patients.
Hawaii and Tennessee are the only two States that do not have
permanent DSH allotments. The Balanced Budget Act of 1997 created
specific DSH allotments for each State based on their actual DSH
expenditures for fiscal year 1995. In 1994, Hawaii implemented the
QUEST demonstration program that was designed to reduce the number of
uninsured and improve access to health care. The prior Medicaid DSH
program was incorporated into QUEST. As a result of the demonstration
program, Hawaii did not have DSH expenditures in 1995 and was not
provided a DSH allotment.
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection
Act of 2000 made further changes to the DSH program, which included the
establishment of a floor for DSH allotments. States without allotments
were again left out.
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The Medicare Prescription Drug, Improvement, and Modernization Act of
2003 made additional changes in the DSH program. This included an
increase in DSH allotments for low DSH States. States without
allotments were again left out.
In the Tax Relief and Health Care Act of 2006, DSH allotments were
finally provided for Hawaii and Tennessee for 2007. The act included a
$10 million Medicaid DSH allotment for Hawaii for 2007. The Medicare,
Medicaid, and SCHIP Extension Act of 2007 extended the DSH allotments
for Hawaii and Tennessee until June 30, 2008.
This extension authorizes the submission by the State of Hawaii of a
State plan amendment covering a DSH payment methodology to hospitals
which is consistent with the requirements of existing law relating to
DSH payments. The purpose of providing a DSH allotment for Hawaii is to
provide additional funding to the State of Hawaii to permit a greater
contribution toward the uncompensated costs of hospitals that are
providing indigent care. It is not meant to alter existing arrangements
between the State of Hawaii and the Centers for Medicare and Medicaid
Services, CMS, or to reduce in any way the level of Federal funding for
Hawaii's QUEST program.
I look forward to continuing to work with Chairman Baucus, Ranking
Member Grassley, and Senators Alexander, Corker, and Inouye to
permanently restore allotments for Hawaii and Tennessee. I thank the
chairman and ranking member of the Finance Committee for all of their
efforts on this issue of great importance to my home State of Hawaii.
Mr. President, Hawaii's health care providers continue to struggle to
care for our growing number of individuals that are uninsured. These
DSH resources will strengthen the ability of our providers to meet the
increasing health care needs of our communities.
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. BINGAMAN. 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. BINGAMAN. Mr. President, I ask unanimous consent that any time
under a quorum call on this bill be equally divided.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BINGAMAN. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. McCONNELL. I ask unanimous consent that the order for the quorum
call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCONNELL. Mr. President, under the consent agreement that was
entered, I have 10 minutes?
The PRESIDING OFFICER. The Senator is correct.
Mr. McCONNELL. I will yield back the remainder of my time, and then
am I correct that the only remaining speaker is the majority leader?
The PRESIDING OFFICER. That is correct.
Mr. McCONNELL. Mr. President, let me be clear, my side, led by
Senator Grassley, has been willing to compromise to get a bill that
could become law. Everyone agrees we need to fix the physician payment
system. There is no disagreement on that. As Senator Grassley has
pointed out, we have offered to negotiate. We have offered to extend
current law. We have tried to find a way to solve the problem.
Unfortunately, the majority apparently is not interested. The bill we
are voting on would cause 2 million seniors to lose the extra benefits
they currently get in their Medicare Advantage plans. It would rob
millions of rural seniors of the ability to choose a private fee-for-
service plan. I worry about the impact that it would have on the
Kentucky teacher retirement system.
We have a solution that would protect seniors' access to care, that
would prevent a 10.6-percent cut in physician payments in Medicare,
that would provide billions of dollars to help rural beneficiaries
access care. This is a solution that could become law right away. I
hope the majority can find a way to take one of the solutions we are
offering so that physician payments are not cut and seniors' Medicare
benefits are not put in jeopardy.
I yield back the remainder of my time.
The PRESIDING OFFICER. The majority leader.
Mr. REID. Mr. President, these are some of the organizations that
support the Medicare bill now before the Senate. We have the American
Association of Retired Persons, the AARP; Alzheimer's Association; the
American Academy of Oncology; the American Academy of Audiology; the
American Academy of Family Physicians; the American Academy of
Opthalmology; American Ambulance Association; American Association of
Nurses Anesthetists; American Cancer Society; American College of
Cardiology; American Heart Association; American Hospital Association;
American Medical Association, the AMA; American Medical Technologists;
American Optometric Association; the American Osteopathic Association;
American Psychological Association; American Society of Plastic
Surgeons; Campaign for Tobacco Free Kids; Cleveland Clinic--to name a
few institutions--National Osteoporosis Foundation; National Renal
Administrators Association; National Rural Health Association;
Parkinson's Action Network; Schizophrenia and Related Disorders
Alliance of America; Society for Thoracic Surgeons; Suicide Prevention
Action Network; Medical Rights Center; National Community Pharmacists
Association.
I ask unanimous consent to print in the Record more than 200
organizations that want every Senator to vote to finish this
legislation, to complete this legislation, to pass this legislation.
There being no objection, the material was ordered to be printed in
the Record, as follows:
H.R. 6331, ``Medicare Improvements for Patients and Providers Act of
2008'' List of Supporting Organizations
Alliance for Aging Research; Alliance for Retired
Americans; Alzheimer's Association; AMAG Pharmaceuticals,
Inc.; American Academy of Audiology; American Academy of
Dermatology; American Academy of Family Physicians; American
Academy of Ophthalmology; American Academy of Otolaryngology;
American Academy of Physical Medicine and Rehabilitation;
American Ambulance Association; American Association of
Bioanalysts; American Association of Cardiovascular and
Pulmonary Rehabilitation; American Association for Clinical
Chemistry; American Association for Geriatric Psychiatry;
American Association for Homecare; American Association of
Homes and Services; American Association of Medical Colleges;
American Association of Nurse Anesthetists; American
Association of Retired Persons (AARP).
American Cancer Society Cancer Action Network (ACS CAN);
American Clinical Laboratory Association; American College of
Cardiology; American College of Emergency Physicians (ACEP);
American College of Nurse Midwives; American College of
Obstetricians and Gynecologists; American College of
Osteopathic Internists; American College of Physicians;
American College for Preventive Medicine; American College of
Radiology; American College of Surgeons; American Counseling
Association; American Diabetes Association; American
Federation of Labor & Congress of Industrial Organizations
(AFL-CIO); American Federation of State, County and Municipal
Employees; American Geriatrics Society; American Health Care
Association; American Heart Association; American Hospital
Association; American Kidney Fund; American Lung Association;
American Medical Association (AMA); American Medical Group
Association.
American Medical Technologists; American Mental Health
Counselors' Association; American Nephrology Nurses'
Association; American Occupational Therapy Association;
American Optometric Association; American Osteopathic
Association; American Pharmacists' Association; American
Physical Therapy Association; American Podiatric Medical
Association; American Psychiatric Association; American
Psychological Association; American Public Health
Association; American Regent, Inc.; American Renal
Associates, Inc.; American Society of Anesthesiologists;
American Society of Cataract and Refractive Surgery; American
Society for Clinical Laboratory Science.
American Society for Clinical Pathology; American Society
for Microbiology; American Society of Nephrology; American
Society for Nutrition; American Society of Pediatric
Nephrology; American Society of Plastic Surgeons; American
Speech-Language-Hearing Association; American Stroke
Association; American Telemedicine Association; American
Thoracic Society; American Osteopathic Association; American
Urological Association; Amgen; Association of American
Medical Colleges (AAMC); Association for Community Affiliated
Plans; Board of
[[Page S6230]]
Nephrology Examiners and Technology; California Dialysis
Council; California Medical Association; Campaign for Tobacco
Free Kids; Center for Clinical Social Work.
Center for Medicare Advocacy; Centers for Dialysis Care;
Cleveland Clinic; Clinical Laboratory Coalition; Clinical
Laboratory Management Association; Clinical Social Work
Association; Coalition of State Rheumatology Organizations;
College of American Pathologists; Colorectal Cancer
Coalition; National Osteoporosis Foundation; National
Partnership for Women and Families; National Patient
Advocate Foundation; National Renal Administrators
Association; National Rural Health Association; Northwest
Kidney Centers; Parkinson's Action Network; Partnership
for Prevention; Prevent Cancer Foundation; Prostrate
Cancer Coalition; Quest Diagnostics.
Renal Advantage, Inc.; Renal Physicians Association; Renal
Support Network; Renal Ventures Management, LLC; Roche
Diagnostics; Satellite Healthcare; Schizophrenia and Related
Disorders Alliance of America; Society of Gynecologic
Oncologists; Society of Hospital Medicine; Society of
Thoracic Surgeons; Society for Vascular Surgery; Suicide
Prevention Action Network USA (SPAN USA); Susan G. Komen for
the Cure Advocacy Alliance; U.S. Renal Care; Watson Pharma,
Inc.; Y-ME National Breast Cancer Organization.
Consortium for Citizens with Disabilities Health Task
Force, The Council for Quality Respiratory Care; Da Vita,
Inc.; Diabetes Access to Care Coalition; Dialysis Patient
Citizens; DSI, Inc.; Easter Seals; Emergency Department
Practice Management Association; Families USA; Federation of
American Hospitals; Food Marketing Institute; Fresenius
Medical Care North America; Fresenius Medical Care Renal
Therapies Group; Genzyme; Health Industry Distributors
Association; ITEM Coalition; Kidney Care Council; Kidney Care
Partners; Laboratory Corporation of America; Lance Armstrong
Foundation; Leadership Council of Aging Organizations.
Lutheran Services in America; Marshfield Clinic; Mayo
Clinic; Medical Group Management Association; Medicare Rights
Center; Mental Health America; National Alliance on Mental
Illness; National Association of Anorexia Nervosa and
Associated Disorders; National Association of Chain Drug
Stores; National Association of Community Health Centers;
National Association for Medical Direction of Respiratory
Care; National Association of Nephrology Technicians and
Technologists; National Association of Social Workers;
National Association of State Long-Term Care Ombudsmen
Programs; National Association of State Mental Health Program
Directors; National Association for the Support of Long-term
Care.
National Committee to Preserve Social Security and
Medicare; National Committee for Quality Assurance; National
Community Pharmacists Association; National Council on Aging;
National Council for Community Behavioral Healthcare;
National Home Oxygen Patients Association; National
Independent Laboratory Association; National Kidney
Foundation; National MS Society.
Mr. REID. Mr. President, this bill has many items in it, one of which
we call the doctors' fix, which prevents a 10.6-percent pay cut for
physicians who participate in Medicare. It provides a payment freeze
for 2008 and a 1.1-percent update for 2009. These are very important to
the medical community.
The reason this legislation is important is, sure, the doctors should
not have to take a pay cut. But the main thing is, this bill does not
protect physicians; it protects patients because doctors have been
dropping out of Medicare for a long number of years. There are many
physicians in America today who will not treat Medicare patients
because the payments are too low. But it is a spiraling effect. It is a
snowballing effect. Many reimbursements through insurance companies and
other organizations are based on what the Medicare reimbursement is. If
this is low, then doctors all over the country will be affected.
Patients will be affected. People, I repeat, will no longer be able to
be treated by their physicians.
We know all these doctors' organizations that are part of this 200-
plus organizations I submitted, the reason they are in favor of it is
they want their physicians to treat Medicare patients. This will drive
people out of Medicare.
We all recognize that President Bush does not like Social Security.
He does not like Medicare. He wants them to go away. He wants to
privatize Social Security, and he wants to do away with Medicare. This
is his effort to do so. But it is the wrong thing to do. It is
certainly the wrong thing to do.
This legislation will provide help for rural health care deliverers.
Beneficiary investments are significant. Yet there are additional
provisions in this legislation for pharmacies, dialysis patients,
community health centers, ambulances, rural providers, e-prescribing,
psychologist, social workers, and many others.
This is a fine piece of legislation. Remember, we already over here
had an opportunity to do work on this bill. Every Democrat voted for
it, and nine Republicans. Here is where we find ourselves tonight.
Earlier this week, the House passed this identical legislation by a
vote of 355 to 59. The Presiding Officer and I served in the House of
Representatives. That is an overwhelming vote. It was a bipartisan
vote. Democrats and Republicans voted for it. The legislation they
passed would help, as I have stated, Medicare beneficiaries and head
off looming cuts facing doctors.
Why is Medicare important? My first elective job was on a hospital
board. We ran countywide in Clark County, Las Vegas. It was my first
elective job. During the time that I was on that hospital board was a
transition period. During the time I was there, Medicare passed back
here and became the law all over the country. So for a part of my term,
there was no Medicare for patients coming into Southern Nevada Memorial
Hospital. The rest of the term, it was.
Prior to Medicare passing, 40 percent of the senior citizens who came
to that hospital had no insurance. What happened is that wives,
mothers, fathers, sons, daughters, neighbors, friends would have to
sign that they would be responsible for their bill. If they didn't pay
the bill, we had an extremely big collection department. It was a
county hospital. It was an indigent facility. We would go after those
people who would sign that these people needed hospital care.
After Medicare came into being, 99-plus percent of the seniors who
come into a hospital have health care through Medicare. It is a
wonderful program. Is it a perfect program? No. But is it a program
worth following President Bush over the ledge to destroy it? That is
what is going to happen tonight, Mr. President. If the Republicans do
not support this legislation, they are having Medicare go over the
cliff. People will be devastated by what is happening.
We have all had people visit our offices, I hope, this week. They
visited mine, talking about how devastating this would be--not to the
doctors. The doctors are going to survive with a 10-percent pay cut,
most of them. But they are going to drop out of the system. It hurts
the patients, and that is what this is all about.
Medicare is an important program. It is part of the legacy of our
country, and we know our health care delivery system is in trouble.
Medicare is one of the strong parts of it. We should continue it, not
destroy it. A ``no'' vote on this legislation tonight is destroying
Medicare.
The House bill was very similar to a bill drafted by Senator Baucus
and supported by every Senate Democrat and many Senate Republicans
earlier this month. We all know the issue must be resolved by July 1.
It must be resolved by July 1. Our Republican colleagues argue, there
will be other opportunities to address this issue. That, using a term
of the marketplace, is a ``loss leader.'' There is no other way to do
this. We have to do it tonight or it won't be done. July 1 comes next
week. We are out of session next week. The House is out of session now.
If not, they will be shortly. There are no other opportunities to
address this issue. Some ask for a 30-day extension. A 30-day extension
requires passage by this body and the House. The House, if they are not
adjourned, soon will be. Both Speaker Pelosi and the House majority
leader have issued statements that could not be more clear.
Quoting Speaker Pelosi:
The House will not consider any further Medicare
legislation.
This means that the 30-day extension is not an option, a week
extension is not an option, a 10-minute extension is not an option.
The bill we seek to proceed to represents the only chance for
Congress to head off the cuts that doctors will face at the end of this
month. This is a good piece of legislation.
Some Republicans also say the Senate should have more time to speak
on the bill and debate it. Yet the same Senators who make those claims
are the ones who voted against proceeding it 2 weeks ago. You can't
have it both ways. We asked to proceed to this 2 weeks ago. It was
objected to.
We have had an interesting situation in the Senate.
[[Page S6231]]
I have a chart I have asked to be brought out here. Obviously, no one
is running very hard to bring it, but it should be here quickly.
We have had an unusual situation. This is, it appears, the 79th
filibuster. That is too bad: to filibuster something to preserve
Medicare? That is what this is all about. It is too bad. This is
legislation that is important.
I say to everyone within the sound of my voice, there are no excuses.
This is it. You go home and explain to your family physician: Well, I
wanted to talk about it more or I wanted a 20-day extension; they would
not give it to me.
We have had 79 Republican filibusters, and the sad part about it is,
we are still counting. Remember, this is our Velcro chart. Remember, a
short time ago, it was 78. We stuck on a ``9'' back there, and I guess
when we come back after the recess we will have to peel that off and
put on an ``8'' and a ``0.'' Seventy-nine filibusters: untoward. And
people who refuse to vote to let this legislation pass are destroying
Medicare in the near future--certainly during the next 6 months.
Senate Republicans are playing a dangerous game of chicken, I guess.
They have the audacity to say there are other ways of doing this. But
in this game of chicken, the only losers will be Medicare patients--old
people. Doctors will lose.
The Republicans who choose to block this important bipartisan
legislation are going to lose. If there was any doubt that Republicans
will regret this path of blindly following on this legislation, one
need only look at their own. One need only look at a Congressman by the
name of Wally Herger. Wally Herger is a long-time experienced
Congressman. He represents the Second District of California. Here is
what he did when he realized how good this legislation was. He realized
that by blindly following the Republicans--who he thought knew what
they were doing in the House--he made a big mistake.
Congressman Wally Herger was one of 59 Members in the entire 435
Members of the House of Representatives--one of 59--to vote against
this legislation. Now, this is not some new guy who made a mistake
because he did not know what hole to punch in the deal over there. He
voted, and as soon as dawn broke in the House, he was on the House
floor saying: I made a big mistake. Help me out of the dilemma I am in.
In fact, he was so concerned about this, he sent a letter to all of
his constituents in his congressional district. He said, among other
things:
From my conversations with House Republican leaders, it was
my understanding that the bill--
The bill we are debating right here tonight; this bill--
voted on by the House was primarily a political exercise. . .
.
It was ``primarily a political exercise.''
And he said:
Clearly, the outcome of today's vote changed the dynamics
of the situation.
Now, this is a direct quote from someone in the House of
Representatives, a couple days ago, who voted against this legislation.
Here is what he said:
Clearly, the outcome of today's vote changed the dynamics
of the situation. . . . Had I known the process would play
out this way, I would have supported the House bill. And if
the bill comes back to the House for final approval, I intend
to fully support it.
Now, my friend, Wally Herger, whom I know--I used to see him in the
House gym--recognizes he has made a big mistake, and he takes a full
page and sends this letter to all his constituents saying: I made a big
mistake. Forgive me.
So Senate Republicans do not have the luxury of changing their minds
like Congressman Herger did because right now you have to make a
decision, and you know what the facts are. Wally Herger learned them
later. And I am sure the other 58 who voted ``no'' feel the same way.
This was an overwhelming vote in the House of Representatives on a
totally bipartisan basis to do the right thing for the American people.
We must decide now whether to stick with President Bush as lemmings
going over the cliff, or should we do the right thing and pass this
legislation?
A ``no'' vote will wreak havoc on our health care delivery system in
America. And who will it hurt the most? It will hurt the most senior
citizens. And it would be too bad as we leave here for 10 days that
this legislation will, in the vernacular, go down. It should not. This
is legislation that is meritorious. As Wally Herger said, if he had
understood the dynamics of this legislation, he would not have voted
``no.''
Mr. President, I believe it is time for the vote.
Cloture Motion
The PRESIDING OFFICER. Under the previous order, pursuant to rule
XXII, the Chair lays before the Senate the pending cloture motion,
which the clerk will state.
The assistant 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 H.R. 6331, the Medicare Improvements for Patients
and Providers Act.
Harry Reid, Max Baucus, Debbie Stabenow, Jeff Bingaman,
Patty Murray, John D. Rockefeller, IV, Thomas R.
Carper, Mark L. Pryor, John F. Kerry, Dianne Feinstein,
Richard Durbin, Daniel K. Inouye, Bill Nelson, Bernard
Sanders, Jon Tester, Jim Webb, Frank R. Lautenberg.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call is waived.
The question is, Is it the sense of the Senate that debate on the
motion to proceed to H.R. 6331, 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 legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from Massachusetts (Mr.
Kennedy) is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Arizona (Mr. McCain).
The result was announced--yeas 58, nays 40, as follows:
[Rollcall Vote No. 160 Leg.]
YEAS--58
Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Brown
Byrd
Cantwell
Cardin
Carper
Casey
Clinton
Coleman
Collins
Conrad
Dodd
Dole
Dorgan
Durbin
Feingold
Feinstein
Harkin
Inouye
Johnson
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Mikulski
Murkowski
Murray
Nelson (FL)
Nelson (NE)
Obama
Pryor
Reed
Roberts
Rockefeller
Salazar
Sanders
Schumer
Smith
Snowe
Stabenow
Stevens
Tester
Voinovich
Webb
Whitehouse
Wyden
NAYS--40
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
Specter
Sununu
Thune
Vitter
Warner
Wicker
NOT VOTING--2
Kennedy
McCain
The PRESIDING OFFICER. On this vote, the yeas are 58, the nays are
40. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
Mr. REID. Mr. President, I enter a motion to reconsider the vote.
The PRESIDING OFFICER. The motion is entered.
Mr. REID. Mr. President, we have something that is long overdue. We
have an agreement to take care of this. Nelson Mandela will soon be 90
years old, in a matter of days. The old organization he was a member of
decades ago--and he is probably still a member, but I am not too sure--
the African National Congress is still treated as a terrorist
organization. This takes care of that. We will eliminate that. So the
people coming here from that great country, which has done so well for
so long now, will be able to come in without being considered
terrorists.
____________________