[Congressional Record Volume 154, Number 116 (Tuesday, July 15, 2008)]
[Senate]
[Pages S6705-S6710]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT OF 2008--VETO

  The PRESIDING OFFICER. The Senate having received the veto message 
from the House of Representatives on H.R. 6331, the Medicare 
Improvements for Patients and Providers Act of 2008, the message will 
be considered read, spread upon the Journal, and printed in the Record.
  The PRESIDING OFFICER laid before the Senate a message from the 
President of the United States to the House of Representatives, as 
follows:

To the House of Representatives:
  I am returning herewith without my approval H.R. 6331, the ``Medicare 
Improvements for Patients and Providers Act of 2008.'' I support the 
primary objective of this legislation, to forestall reductions in 
physician payments. Yet taking choices away from seniors to pay 
physicians is wrong. This bill is objectionable, and I am vetoing it 
because:
  It would harm beneficiaries by taking private health plan options 
away from them; already more than 9.6 million beneficiaries, many of 
whom are considered lower-income, have chosen to join a Medicare 
Advantage (MA) plan, and it is estimated that this bill would decrease 
MA enrollment by about 2.3 million individuals in 2013 relative to the 
program's current baseline;
  It would undermine the Medicare prescription drug program, which 
today is effectively providing coverage to 32 million beneficiaries 
directly through competitive private plans or through Medicare-
subsidized retirement plans; and
  It is fiscally irresponsible, and it would imperil the long-term 
fiscal soundness of Medicare by using short-term budget gimmicks that 
do not solve the problem; the result would be a steep and unrealistic 
payment cut for physicians--roughly 20 percent in 2010--likely leading 
to yet another expensive temporary fix; and the bill would also 
perpetuate wasteful overpayments to medical equipment suppliers.
  In December 2003, when I signed the Medicare Prescription Drug, 
Improvement, and Modernization Act (MMA) into law, I said that ``when 
seniors have the ability to make choices, health care plans within 
Medicare will have to compete for their business by offering higher 
quality service. For the seniors of America, more choices and more 
control will mean better health care.'' This is exactly what has 
happened--with drug coverage and with Medicare Advantage.
  Today, as a result of the changes in the MMA, 32 million seniors and 
Americans with disabilities have drug coverage through Medicare 
prescription drug plans or a Medicare-subsidized retirement plan, while 
some 9.6 million Medicare beneficiaries--more than 20 percent of all 
beneficiaries--have chosen to join a private MA plan. To protect the 
interests of these beneficiaries, I cannot accept the provisions of 
this legislation that would undermine Medicare Part D, reduce payments 
for MA plans, and restructure the MA program in a way that would lead 
to limited beneficiary access, benefits, and choices and lower-than-
expected enrollment in Medicare Advantage.
  Medicare beneficiaries need and benefit from having more options than 
just the one-size-fits-all approach of traditional Medicare fee-for-
service. Medicare Advantage plan options include health maintenance 
organizations, preferred provider organizations, and private fee-for-
service (PFFS) plans. Medicare Advantage plans are paid according to a 
formula established by the Congress in 2003 to ensure that seniors in 
all parts of the country--including rural areas--have access to private 
plan options.
  This bill would reduce these options for beneficiaries, particularly 
those in hard-to-serve rural areas. In particular, H.R. 6331 would make 
fundamental changes to the MA PFFS program. The Congressional Budget 
Office has estimated that H.R. 6331 would decrease MA enrollment by 
about 2.3 million individuals in 2013 relative to its current baseline, 
with the largest effects resulting from these PFFS restrictions.
  While the MMA increased the availability of private plan options 
across the country, it is important to remember that a significant 
number of beneficiaries who have chosen these options earn lower 
incomes. The latest data show that 49 percent of beneficiaries enrolled 
in MA plans report income of $20,000 or less. These beneficiaries have 
made a decision to maximize their Medicare and supplemental benefits 
through the MA program, in part because of their economic situation. 
Cuts to MA plan payments required by this legislation would reduce 
benefits to millions of seniors, including lower-income seniors, who 
have chosen to join these plans.
  The bill would constrain market forces and undermine the success that 
the Medicare Prescription Drug program has achieved in providing 
beneficiaries with robust, high-value coverage--including comprehensive 
formularies and access to network pharmacies--at lower-than-expected 
costs. In particular, the provisions that would enable the expansion of 
``protected classes'' of drugs would effectively end meaningful price 
negotiations between Medicare prescription drug plans and 
pharmaceutical manufacturers for drugs in those classes. If, as is 
likely, implementation of this provision results in an increase in the 
number of protected drug classes, it will lead to increased beneficiary 
premiums and copayments, higher drug prices, and lower drug rebates. 
These new requirements, together with provisions that interfere with 
the contractual relationships between Part D plans and pharmacies, are 
expected to increase Medicare spending and have a negative impact on 
the value and choices that beneficiaries have come to enjoy in the 
program.
  The bill includes budget gimmicks that do not solve the payment 
problem for physicians, make the problem worse with an abrupt payment 
cut for physicians of roughly 20 percent in 2010, and add nearly $20 
billion to the Medicare Improvement Fund, which would unnecessarily 
increase Medicare spending and contribute to the unsustainable growth 
in Medicare.
  In addition, H.R. 6331 would delay important reforms like the Durable 
Medical Equipment, Prosthetics, Orthotics, and Supplies competitive 
bidding program, under which lower payment rates went into effect on 
July 1, 2008. This program will produce significant savings for 
Medicare and beneficiaries by obtaining lower prices through 
competitive bidding. The legislation would leave the Federal 
Supplementary Medical Insurance Trust Fund vulnerable to litigation 
because of the revocation of the awarded contracts. Changing policy in 
mid-stream is also confusing to beneficiaries who are receiving 
services from quality suppliers at lower prices. In order to slow the 
growth in Medicare spending, competition within the program should be 
expanded, not diminished.
  For decades, we promised America's seniors we could do better, and we 
finally did. We should not turn the clock back to the days when our 
Medicare system offered outdated and inefficient benefits and imposed 
needless costs on its beneficiaries.
  Because this bill would severely damage the Medicare program by 
undermining the Medicare Part D program and by reducing access, 
benefits, and choices for all beneficiaries, particularly the 
approximately 9.6 million

[[Page S6706]]

beneficiaries in MA, I must veto this bill.
  I urge the Congress to send me a bill that reduces the growth in 
Medicare spending, increases competition and efficiency, implements 
principles of value-driven health care, and appropriately offsets 
increases in physician spending.
                                                      George W. Bush.  
                                        The White House, July 15, 2008.

  The Senate proceeded to reconsider the bill (H.R. 6331), the Medicare 
Improvements for Patients and Providers Act of 2008, returned to the 
House by the President on July 15, 2008, without his approval, and 
passed by the House of Representatives, on reconsideration, on July 15, 
2008.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, 43 years ago, we created Medicare because 
this country recognized that no American should go without health care, 
especially once they reach retirement age.
  As President Johnson was signing the Medicare bill into law, he 
praised Congress for its ability to ``see beyond words to the people 
that they touch,'' to put politics aside, and to create legislation 
that truly transforms society.
  Well, today President Bush failed to heed those words, to see beyond 
politics and think of the seniors who have spent their lives paying 
into the Medicare system, and the doctors who treat them. Instead, he 
told millions of struggling American seniors, and military families as 
well, that he simply did not care. He vetoed a bill that would make 
vital improvements to the program that has helped ensure that millions 
of seniors and the disabled can get the care they need.
  One of the most important provisions of that bill would have 
postponed a 10.6-percent reimbursement payment cut for doctors. That 
was a cut that would have forced many of our doctors across this 
country to stop seeing Medicare patients and would severely limit their 
access to health care. I believe the President was wrong to veto that 
bill.
  Today, we can stand up for Medicare. We did it last week when we came 
together and voted for this bill by a veto-proof margin, and I believe 
we can do it today by overriding that veto. So I hope we can come 
together on the floor of the Senate today and override the President's 
veto and make sure that 44.1 million seniors who are enrolled in 
Medicare, as well as all the military families who rely on TRICARE, 
will continue to have access to health care.
  We have spent a lot of time in the Senate debating this. My 
colleagues have thoroughly explained the improvements this legislation 
would make, but I wish to speak for a few minutes this evening on some 
of the provisions that illustrate why it is so important to take this 
vote tonight and override the veto.
  First of all, many of our rural communities in Washington State and 
across the country are struggling today to provide health care 
services. This bill will help them strengthen their health care 
networks and extend the services that are available.
  Importantly, this bill puts an emphasis on preventive care that will 
help our seniors stay healthy, and it will help to keep costs down by 
enabling those patients to get care before they get seriously ill. This 
bill will improve coverage for low-income seniors who need expert help 
to afford basic care. It will help make sure our seniors get mental 
health care. Currently, the copays for mental health care are 30 
percent higher than those for physical care. The legislation we are 
about to vote on and override the President's veto, if it is passed, 
will treat mental and physical health care the same. Also, importantly, 
as we have talked about, this bill will block the cut in reimbursements 
for providing Medicare services. It will block that cut and ensure that 
doctors can afford, again, to take Medicare patients.
  All the improvements I talked about are important, but it is critical 
we take action as soon as possible to ensure that the cut in payments 
to doctors does not go into effect. No doctor should have to choose 
between staying in business and taking care of their patients, but if 
we don't override this veto, that is exactly what will happen; our 
seniors and disabled will end up paying the price.
  Cuts in payments would mean seniors will face longer drives in order 
to find doctors, they will see closed doors, and they will see fewer 
choices, even though they have spent their lives paying into this 
Medicare system. Out in our rural communities, the problem, I know, 
would be even worse because out there we already face a shortage of 
doctors and nurses and health care providers.
  Finally, this cut would limit access to health care for our military 
retirees and our servicemembers at a time when we see many of our 
troops returning home from war. TRICARE uses the Medicare formula to 
pay their doctors, too, and doctors have said those lower 
reimbursements would force them to drop TRICARE patients. I think we 
can all agree this country cannot afford to jeopardize the health care 
for our servicemembers, especially during a time of war.
  So this country took a huge step forward when we created Medicare 
back in 1965--when we agreed as a nation that all seniors should have 
access to health care services. We cannot afford, at this critical 
time, to let our country take a step backward. We have the opportunity 
this evening to do the right thing. Let's support our seniors, let's 
support our military families, let's stand together and override the 
President's veto and keep our commitment to the people who depend on 
us.
  I yield the floor.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the time 
reserved for the majority leader be reduced to 3 minutes and that the 
remainder be returned to the time under control by the majority.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. I ask that Senator Stabenow be recognized for 2 minutes.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Ms. STABENOW. Mr. President, we have a historic opportunity in a few 
moments to reaffirm the fact that Medicare is a great American success 
story and to join with our colleagues from the House--383 Members of 
the House--who voted to override a Presidential veto and squarely side 
with our seniors, our military families and our veterans and to side 
with those in the disability community who use Medicare. We have an 
opportunity to vote to strengthen Medicare, to add mental health 
services, prevention, to focus on low-income seniors, to modernize 
Medicare with e-prescribing and telehealth. This is an opportunity to 
move Medicare into the future.
  I am very proud to have offered the original bill to extend or block 
the cuts for 18 months into the future that were to be given to our 
physicians. I am proud of the work of the Finance Committee. I wish to 
thank Senator Max Baucus for his leadership and our leader, Senator 
Reid, for coming to the floor and bringing this back, over and over, 
until we got it done.
  This is an opportunity for us to join together on a bipartisan basis 
to do the right thing, to overturn a very misplaced veto, and to say to 
all the seniors, our military families, and the disabled in this 
country that we understand what Medicare is all about and we stand with 
you to strengthen it, to add to the services available, and to 
modernize it for the future.
  I urge a strong bipartisan vote to override this President's veto.
  Mr. DURBIN. Mr. President, I ask to be recognized for 2 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Mr. President, we have an opportunity once every decade--
maybe once every generation--to reaffirm our commitment to some of the 
most fundamental values in this country. The Medicare Program is not 
just another Government program. The Medicare Program said in the early 
1960s that the United States was committed to our senior citizens and 
that commitment involved making certain they would always have access 
to affordable, quality health care. There were many at the time who 
were skeptical and said it was too much Government and socialism; it 
goes too far. Thank goodness their voices were drowned out by reason, 
the understanding that without this protection, seniors could lose 
every penny they had saved to a medical crisis.
  Medicare passed and it worked. The proof of its success is the fact 
that senior citizens now live longer than ever

[[Page S6707]]

because of the quality of the health care they have available through 
Medicare. Skeptics have returned and said: Let's get rid of that 
system; what we ought to do is bring in private health insurance 
companies. They call it Medicare Advantage. We let them try. Over the 
last 10 years or so they have tried, and at considerably more expense 
they are not offering benefits as good as basic Medicare.
  This bill we are going to consider overriding the President's veto on 
very shortly says some of the money they have taken out of the system 
and out of the program has to be returned to taxpayers. That is fair. 
It is fair compensation for doctors, to make certain Medicare is there 
for the seniors who need it; to make certain TRICARE is kept up to date 
in reimbursement, but most importantly this vote today on overriding 
President Bush's ill-fated veto is a reaffirmation of how important 
Medicare is to America's future.
  It was a strong bipartisan vote of 69 who voted a week or so ago in 
favor of this measure. I hope the vote today in the Senate reflects an 
even stronger bipartisan commitment to the future of Medicare.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. DURBIN. Mr. President, I suggest the absence of a quorum. It is 
my understanding the time from the quorum call will be taken evenly 
from both sides.
  The PRESIDING OFFICER. It requires unanimous consent.
  Mr. DURBIN. I ask unanimous consent for that, unless there is someone 
on the Republican side who is seeking recognition.
  The PRESIDING OFFICER. Is there objection?
  Mr. KYL. Mr. President, reserving the right to object, Senator 
Grassley, on our side, is responsible for this. I am waiting to consult 
with him. I would ask my colleague to wait a moment on that request, 
and we will see if we can find Senator Grassley.
  Mr. DURBIN. I ask unanimous consent that we go into a quorum call and 
it not get charged against either side.
  Mr. KYL. Mr. President, if we can have the time run----
  Mr. DURBIN. Mr. President, I see Senator Dorgan is on the floor, so I 
withdraw my request and ask that Senator Dorgan be recognized for 2 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, my colleagues have described it well. This 
is a very important vote. I think the reason we have gotten to this 
point shows how difficult it is to get anything done in this Chamber. I 
come from a State that is first in the Nation in the number of people 
80 years old or older as a percentage of our population. I think we are 
in the top five or six, of people 65 years of age or older as a 
percentage of our population.
  Medicare is so unbelievably important to the folks who live in my 
State. Does anybody think it serves the interests of this Medicare 
program to say: Well, let's decide on provider cuts--in this case 
physician cuts--of 10.6 percent? Let's take a big whack, a 10.6-percent 
whack out of the reimbursements and it would not matter; it would not 
affect the program. It doesn't make any sense to me at all that we 
would do that.
  What we need to do is strengthen this program, and that is what the 
underlying bill does. We have had an awful time trying to pull it 
through the Congress. We finally got it through the Congress, and then 
we had the President veto the bill. We had a colleague come out of his 
sick bed and fly to Washington, DC, to cast the 60th vote, after which 
the other side collapsed and we got 9 other votes. This is very 
important. This is about who we are as a country, what we decide to 
invest in.
  It is said that 100 years from now we will all be dead. I guess that 
is not just said; it is a fact. Only historians will take a look at our 
value system. They can take a look at what we decided to do as a 
Congress: How did we decide to spend money? What did we invest in? What 
did we think was important? What were our value systems? Did we believe 
the Medicare Program--providing health care to America's elderly--was a 
successful program, or did we decide we wanted to begin to take it 
apart?
  That is what this vote is about. I don't understand at all why the 
President decided to veto this.
  This passed the House of Representatives by a margin of 6 to 1 and 
got 69 votes in the Senate, and the President decides to exercise his 
veto.
  It is unfathomable to me how much money we shovel out of this 
building and how much the President recommends when we spend overseas: 
$170 billion, $180 billion this year in emergency funding for Iraq and 
Afghanistan and all these programs to replenish all these accounts; 
contractor abuse. Somehow that doesn't matter so much. All of a sudden 
we want to make an investment in the Medicare Program, and that is not 
something that is valuable to us, the President suggests. It makes no 
sense to me.
  In this bill, we have also tried to address the problem of disparate 
reimbursements for the various States. Some of the smallest States in 
this country--mine included--receive reimbursements under the Medicare 
program for providing health care that are dramatically different than 
reimbursements in other areas. Without fixing that, there will be a 
degradation of medical services and the delivery of services. This bill 
addresses part of that. That is why this bill is so critically 
important.
  I hope we will have a resounding vote overriding the President's veto 
this evening at 6 o'clock.
  Mr. KYL. Mr. President, if Senator Grassley arrives, I will defer to 
him, but let me make some comments. It is distressing that the effect 
of this bill has been misrepresented to the extent it has. There have 
been some very wild claims that this has to do with killing Medicare, 
that it has to do with punishing America's doctors, that it has to do 
with hurting America's seniors. This is not the language of a reasoned 
debate of the Senate. The bill has nothing to do with any of those 
things, and all my colleagues know that.
  Let me describe why we are where we are today. I will take a minute 
to remind everyone of the promise we made to America's seniors 5 years 
ago. The 2003 Medicare Modernization Act achieved two very important 
goals. The first was to provide comprehensive drug coverage, 
prescription drug coverage, a very important benefit for America's 
seniors.
  Secondly, to explain private health plan choices, similar to the 
options available to Members of Congress and other Federal employees. 
We wanted America's seniors--the Medicare patients--to have the same 
kind of private health insurance options for Medicare that all of us 
have.
  Today, as a result of this plan, somewhere in the neighborhood of 
one-fourth of America's seniors have taken advantage of this private 
insurance alternative to traditional Medicare. From the beginning, I 
know a lot of people on the other side of the aisle didn't like that. 
They wanted a one-size-fits-all program, one program. Republicans said 
we need more choices. Seniors have been happy with the prescription 
drug benefit and with those choices.
  The problem with this bill is it cuts both the choices for America's 
seniors and negatively impacts the prescription drug coverage. That is 
why Members on this side of the aisle have said they would like to see 
an opportunity to amend the bill, to try to fix the bill, to have a 
bipartisan bill instead. But, no, we were jammed--not once, twice, but 
three times: Take it or leave it. It is the partisan approach, despite 
the fact that the chairman and ranking member negotiated a bipartisan 
bill in good faith. Nonetheless, we had to revert to a strictly 
partisan approach.
  That is what this was all about. It was never about covering the 
physicians to make sure they didn't take a pay cut. I doubt that there 
is any Senator who doesn't support the 1.1-percent increase in 
physician reimbursement, an increase for physicians who treat Medicare 
patients. We all support that. It was in the Grassley proposal, it was 
in the Baucus proposal, and it was in the bipartisan Grassley-Baucus 
proposal. So this was never about that. None of the Republicans ever 
opposed providing the physicians their update. It had to do mostly with 
an attempt that has been undertaken for many years to undercut the 
private insurance part of Medicare that many on the other side of the 
aisle have never liked. It is one of the signature

[[Page S6708]]

achievements of the Bush administration, and it is no wonder that the 
President vetoed the bill because of the fact that was hurt.
  First of all, according to the nonpartisan CBO, as a result of this 
bill, 2.3 million seniors will be removed from their private coverage 
option under Medicare. That is one of the effects of this bill. Instead 
of all the scare tactics you have heard, I can honestly say that voting 
for this override of the President's veto will result, according to the 
CBO, in the removal of 2.3 million American seniors from this private 
health care option. That is not a good result.
  Here is what the President's veto message personally said today:

        . . . the provisions that would enable the expansion of 
     protected classes of drugs would effectively end meaningful 
     price negotiations between Medicare prescription drug plans 
     and pharmaceutical manufacturers for drugs in those classes. 
     If, as is likely, implementation of this provision results in 
     an increase of a number of protected classes, it will lead to 
     increased beneficiary premiums and copayments, higher drug 
     prices, and lower drug rebates.

  That is the second pernicious effect of the bill. It will undermine 
the Medicare prescription drug plan's ability to negotiate good drug 
prices for seniors.
  I know some on the other side were always skeptical of the ability to 
bring down drug prices. In fact, the Medicare Part D has reduced them 
precisely because of this competition in the market. This bill 
partially eliminates that competition. That is the reason some of us 
oppose the bill, and they are good and legitimate reasons. I believe 
the President was correct to veto the bill because of these provisions.
  Five years after the Medicare passage, we are rewinding the clock, 
chipping away at the very plan choices and prescription drug coverage 
that seniors asked us to provide.
  These are not pro-patient policies. Rather, the bill reduces access, 
benefits, and choice for Medicare beneficiaries.
  In conclusion, it was a very flawed process. As we know, there was an 
attempt at a bipartisan solution. There are 51 Democrats and 49 
Republicans. You would think that Republicans could have a say in 
writing the legislation. But, no, that was not to be. We were required 
to deal with the take-it-or-leave-it proposal of the majority.
  Twice the majority walked away from these bipartisan negotiations I 
talked about before. When we tried to suggest, at a minimum, that we 
should extend existing law so that doctors would not see the reduction 
in their payments, we were told it was a ``phony exercise.'' It was, in 
fact, a good-faith effort on our part to ensure that physicians would 
be protected.
  As I stated earlier, I support the need for a positive physician 
update. We all do. I know physicians in Arizona know I mean that when I 
say it. I have led the fight for this in past years. However, I am 
strongly disappointed that the Senate was blocked from a bipartisan 
solution, and I regret that seniors, as a result, will suffer if this 
legislation is adopted.
  The PRESIDING OFFICER. Who yields time?
  Mr. REID. Mr. President, I yield 1 minute to the Senator from 
Michigan.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Ms. STABENOW. Mr. President, with all due respect to my friend from 
Arizona, I wanted to make it clear that there are no rate cuts for any 
provider in this legislation. As it relates to rate increases, the 
privatization that has been put into place over the last 3 years has 
actually raised rates, according to the CBO, for the 85 percent of the 
seniors and the disabled who use traditional Medicare. But there are no 
rate cuts.
  There is a small change, which doesn't even take effect until 2011, 
to give the opportunity for the private fee-for-service entities to be 
able to make the changes by 2011. So with all due respect, this is in 
no way a dramatic change, a cut in services, or rate reductions for any 
provider, including the private insurance providers.
  Mr. KYL. Mr. President, I never said there was a rate reduction. I 
said all Senators, I suspect, on both sides support not having a 10.6-
percent cut in physician fees and that we all support the 1.1-percent 
positive update. That was never the issue.
  The issue had to do with the other items I talked about. The fact 
that 2.3 million seniors will lose their private coverage option has to 
do with the way that the Medicare Advantage Program was used as an 
offset to pay for the additional benefits in the bill as a result of 
which CBO claims and believes--and I believe they are probably 
correct--that 2.3 million seniors will lose their private option 
coverage.
  Mr. GRASSLEY. Mr. President, it is a very unfortunate and 
disappointing set of circumstances that got us to the point we are in 
today.
  I want to make very clear where we stand on the physician fix. There 
is widespread Republican support to block the 10.6-percent reduction in 
physician fees and replace it with a 1.1-percent update.
  I introduced S. 3118 on June 11 with Senators McConnell and Kyl and 
others to do just that.
  In fact, the doctors would not be getting a 1.1-percent update in 
this bill if it had not been for Republicans who announced support for 
the higher update.
  Everything that I have been trying to do is to get to a bipartisan 
solution that would avoid a veto and avoid the pay cut from going into 
effect even for a short time.
  But the other side decided to play politics with this issue.
  They ran the clock right up to the deadline and then refused to agree 
to an extension to keep the cut from going into effect. They repeatedly 
objected to an extension even though the Senate had passed 28 
extensions on other matters just during this session alone.
  And, to my absolute amazement, the majority leader said that 
Republicans had been given months to work out a Medicare bill so that 
was why no amendments would be allowed.
  The fact is that Republicans and Democrats had been working together 
for months until the Democratic leadership pulled the rug right out 
from under that effort.
  Let's review the facts here. At the end of last year, we agreed to a 
short-term Medicare extension so that we could complete work on a 
bipartisan Medicare package this year. We were very close to a deal 
then and needed time to finish that work.
  Both sides agreed we would work quickly to get a bill that could be 
signed into law.
  Unfortunately, that effort has been intentionally derailed by the 
majority's desire to play politics with Medicare.
  The fact is that the majority has twice walked away from good faith 
bipartisan negotiations.
  The fact is that we had been working for months before they pulled 
the plug.
  The fact is that we had actually completed that bipartisan deal 2 
weeks ago. It was a deal that would get signed into law, not vetoed.
  But the other side thought they saw a political advantage and they 
have taken it. They scuttled that deal in favor of a bill that would 
get vetoed.
  So it is a bit on the laughable side to blame us for failed 
negotiations that they seem to have intentionally sabotaged.
  The fact is that the other side is more than willing to play politics 
with this issue. I believe that has been the wrong approach. It was not 
the approach I took as chairman of the Finance Committee. It was not 
the approach that Republicans took while we were in the majority.
  Playing this kind of brinksmanship politics with Medicare and with 
people's lives is not what we should be doing around here.
  I also warned the White House early on in this debate that their 
position on private fee for service was not defensible. As Republicans, 
we should not support the idea of allowing private plans to use 
government-set payment rates.
  The basic premise of Medicare Advantage is that the private sector 
can do a better job than government in delivering health benefits to 
seniors. When we allow those private plans to force providers to accept 
the government rates, we undermine the philosophy behind the Medicare 
Advantage program. When we do that, we have conceded defeat up front.
  There are some serious problems with this bill. I think the bill has 
some significant flaws that need to be addressed. I am going to be 
looking for opportunities to fix this bill and look forward to coming 
to the floor to do so.

[[Page S6709]]

  As I have said before, I know the other side wants to argue that 
Republicans are only fighting this fight to protect Medicare Advantage 
plans. That is a good soundbite, but it is simply not true.
  I, for one, could live with some Medicare Advantage reforms.
  There would have been more than enough Republicans who would support 
more reforms, if the Democrats had been willing to make changes in 
other areas.
  So let's talk about some of the problems that would have been fixed 
if this had been a truly bipartisan process.
  First and foremost, if this bill becomes law, it will do serious harm 
to the Medicare drug benefit that millions of seniors have come to 
depend on.
  It would tie the hands of the Medicare Part D plans resulting in 
higher drug prices and higher premiums on seniors.
  Medicare's Office of the Actuary concluded that it will raise Part D 
drug costs. And outside analysts have likewise concluded that this 
provision has the potential to undermine the long-term financial 
sustainability of the Medicare drug benefit.
  This bill also includes entitlement expansions that are well-
intentioned but ill-timed with the pending insolvency of the program.
  Let's spend a moment on what a truly bipartisan bill would have 
looked like.
  A truly bipartisan bill would have included much-needed assistance 
for the so-called ``tweener hospitals.'' This is something myself and 
Senator Harkin consider a high priority because of the tweener 
hospitals we have across Iowa.
  A truly bipartisan bill would have included hospital value based 
purchasing in Medicare.
  A truly bipartisan bill would have included physician payment 
sunshine provisions that Senator Kohl and I have worked out together.
  A truly bipartisan bill wouldn't undermine the Medicare drug benefit 
and cause increased premiums on seniors.
  The bill is riddled with problems and missed opportunities.
  But instead of writing a bipartisan bill, the Democrats twice walked 
away from the table and now here we are. They scuttled a deal that 
could have become law right away.
  Now I believe I have shown myself willing to join in bipartisan 
efforts to solve major issues. We have health care reform and more 
Medicare bills in the future. But this process has called into question 
whether the other side is willing to start and stick with a truly 
bipartisan effort.
  The process that has been followed on this bill has done a great 
disservice to the Senate. But more than that, it does a disservice to 
seniors, doctors and everyone who depends on Medicare.
  And I would hope that the other side will not take us down this path 
again. Bipartisanship is more than lipservice. It requires action and 
sometimes difficult choices. Compromise is not easy work. But if you 
want to tackle the big issues that are ahead of us, then it will 
require a better process than the one followed to produce this bill.
  To my colleagues today, that is the full story on this vote today.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader is recognized.
  Mr. REID. Mr. President, there is 2 minutes left, right?
  The PRESIDING OFFICER. That is correct.
  Mr. REID. I will yield that time to Senator Baucus. I have a short 
statement, and I will use leader time. It is maybe 2\1/2\ minutes. I 
yield 2 minutes to Senator Baucus.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, sometimes when Senators vote in this 
Chamber, the real-world results of our actions are unclear.
  But tonight, we can make a real-world difference for 44 million 
American seniors, and for nine million TRICARE users in America's 
military families.
  In less than an hour, the Senate will vote to override the 
President's veto of the Medicare bill.
  Here is the difference that our votes will make: Will doctors' doors 
stay open to older Americans, and to the children of our fighting men 
and women?
  Our votes tonight will make the difference.
  Will seniors living on a shoestring, and those in rural areas, be 
able to get decent health care when hospitals are few and far between?
  Our votes tonight will make that difference.
  Will the ambulances keep running? Will the medicines be covered by 
Medicare prescription drug plans?
  Our votes tonight will make all the difference.
  The President made his decision. His veto of the Medicare bill would 
shut the doctor's door to seniors and military families, and all on 
ideological grounds.
  My bill does good things for seniors. It makes Medicare better for 
every beneficiary, and it's time to enact it into law.
  The House has already voted to override the veto. Overwhelmingly--383 
to 41.
  Folks in my home State of Montana know I am going to do what is 
right, and vote to make the Medicare bill law--for Montana seniors and 
for our 32,000 folks in TRICARE.
  Today I told a large rally of folks supporting this bill, reversing 
the cuts that keep our seniors and military families from seeing their 
doctors will be our finest hour.
  I hope--and expect--that the Senate will stand together, just as our 
colleagues across the Capitol have done.
  Senators of all parties have one more chance to make all the 
difference.
  Let's do what is right for seniors.
  Let's do what is right for military families.
  Let's do what is right for America. Let's do it together and enact 
the Medicare Improvements for Patients and Providers Act tonight.
  Mr. AKAKA. Mr. President, we must override the President's veto of 
the Medicare Improvements for Patients and Providers Act of 2008.
  This bill will ensure that Medicare and TRICARE beneficiaries have 
continued access to health care. It will also enhance Medicare 
benefits. Finally, the legislation will provide much needed resources 
for Hawaii hospitals that care for the uninsured and Medicaid 
beneficiaries.
  This legislation will maintain Medicare physician payment rates for 
2008 and provide a slight increase in 2009. If this veto override 
fails, doctors will be subject to a 10.6-percent cut in Medicare 
reimbursements for the rest of the year. This severe cut could also 
restrict access to health care for our troops and their families 
because TRICARE reimbursement rates are linked to Medicare 
reimbursement rates. Rising costs and difficulty in recruiting and 
retaining qualified health professionals make it essential that we 
improve reimbursements to ensure that Medicare and TRICARE 
beneficiaries have access to health care services.
  The act will make improvements in Medicare benefits. It increases 
coverage for preventive health care services and makes mental health 
care more affordable. The legislation will also help low-income seniors 
to obtain the health care services that they need.
  Finally, the legislation will provide vital assistance for Hawaii 
hospitals. The legislation extends Medicaid disproportionate share DSH, 
allotments for Hawaii until December 31, 2009. Hawaii hospitals are 
struggling to meet the increasing demands placed on them by a growing 
number of uninsured patients and rising costs.
  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.
  The Medicare Prescription Drug, Improvement, and Modernization Act of

[[Page S6710]]

2003 made additional changes to the DSH Program. This included an 
increase in DSH allotments for low DSH states. Again, States lacking 
allotments were 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 provided an 
additional $7.5 million for a Hawaii DSH allotment.
  This additional extension in the Medicare Improvements for Patients 
and Providers Act of 2008 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. This act will provide 
$15 million for Hawaii DSH allotments through December 31, 2009.
  All States need to benefit from the DSH Program. This legislation 
will make sure that Hawaii and Tennessee continue to have Medicaid DSH 
assistance. I will continue to work with Chairman Baucus, Ranking 
Member Grassley, Senators Alexander, Corker, and Inouye to permanently 
restore allotments for Hawaii and Tennessee. However, we must override 
the veto to help our struggling hospitals.
  Many of our hospitals in Hawaii desperately need resources. Layoffs 
have been announced and reductions in services are possible. These DSH 
resources will strengthen the ability of our providers to meet the 
increasing health care needs of our communities.
  Mr. President, we must enact this legislation. It will protect access 
to health care for seniors, individuals with disabilities, and members 
of our armed services and their families. The bill will improve 
Medicare benefits and provide much needed financial assistance for 
hospitals in Hawaii that care fore the uninsured and Medicaid 
beneficiaries.
  Mr. REID. Mr President, it may have taken just one flourish of a pen 
to affix the name ``Lyndon Baines Johnson'' to the law that created 
Medicare in 1965.
  But that one pen stroke created a program that has come to reflect a 
bedrock American principle: That all those seniors who have worked 
hard--and all those who need a helping hand--will find themselves 
embraced by the care of our compassionate Nation.
  And though Medicare was created by a Democratic Congress and a 
Democratic President, that principle has always been anchored far too 
deep in our soil for the roots of partisanship to entangle.
  When the program has been threatened, Democrats and Republicans have 
risen to the occasion to protect it.
  So it was last month, when the House of Representatives approved the 
``doctor's fix'' by an overwhelming vote of 355-59.
  So it was last week, when Senator Kennedy led a veto-proof majority 
of all Democrats and 18 Republicans voting yes.
  So it was earlier today, when the House voted to override President 
Bush's veto, 383-41.
  So it must be now, as we follow suit to reject the veto and place 
this legislation into law.
  On the July day in 1965 when President Johnson signed the original 
Medicare bill, he said this:

       Just think, because of this document--and the long years of 
     struggle which so many have put into creating it--in this 
     town, and a thousand other towns like it, there are men and 
     women in pain who will now find ease.
       There are those, alone in suffering who will now hear the 
     sound of some approaching footsteps coming to help.
       There are those fearing the terrible darkness of despairing 
     poverty--despite their long years of labor and expectation--
     who will now look up to see the light of hope and 
     realization.

  Since the day President Johnson handed the very first Medicare card 
to President Truman, hundreds of millions of senior citizens and people 
with disabilities have received their own card.
  Each new card issued strengthens our commitment to the health and 
well-being of our most vulnerable.
  Now it is our turn to do our part--to renew the light of hope for 
those who need our help the most, those people in their golden years, 
the senior citizens of America who depend on Medicare.
  The PRESIDING OFFICER. The question is, shall the bill pass, the 
objections of the President of the United States to the contrary 
notwithstanding?
  The yeas and nays are required. The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) and the Senator from Illinois (Mr. Obama) are necessarily 
absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Arizona (Mr. McCain) and the Senator from Virginia (Mr. Warner).
  The PRESIDING OFFICER (Mr. Menendez). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 70, nays 26, as follows:

                      [Rollcall Vote No. 177 Leg.]

                                YEAS--70

     Akaka
     Alexander
     Baucus
     Bayh
     Biden
     Bingaman
     Bond
     Boxer
     Brown
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Clinton
     Cochran
     Coleman
     Collins
     Conrad
     Corker
     Cornyn
     Dodd
     Dole
     Dorgan
     Durbin
     Feingold
     Feinstein
     Harkin
     Hutchison
     Inouye
     Isakson
     Johnson
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     McCaskill
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Roberts
     Rockefeller
     Salazar
     Sanders
     Schumer
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Tester
     Voinovich
     Webb
     Whitehouse
     Wicker
     Wyden

                                NAYS--26

     Allard
     Barrasso
     Bennett
     Brownback
     Bunning
     Burr
     Coburn
     Craig
     Crapo
     DeMint
     Domenici
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hagel
     Hatch
     Inhofe
     Kyl
     McConnell
     Sessions
     Shelby
     Sununu
     Thune
     Vitter

                             NOT VOTING--4

     Kennedy
     McCain
     Obama
     Warner
  The bill (H.R. 6331) was passed.
  The PRESIDING OFFICER. On this vote, the yeas are 70, the nays are 
26. Two-thirds of the Senators voting having voted in the affirmative, 
the bill on reconsideration is passed, the objections of the President 
of the United States to the contrary notwithstanding.
  Mr. REID. 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.
  Mrs. BOXER. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senate will come to order. Senators will take their conversations 
off the floor so the Senator from California can be heard.
  Mrs. BOXER. Mr. President, I wanted to take some time this early 
evening to talk a little bit about our energy crisis and gas prices. 
But I first want to say thank you so much to our leaders, Senator Reid 
in particular, to Senator Baucus, to all those who helped score a real 
victory for the Medicare Program for our senior citizens today. It is 
not every day that a President has a veto overridden, but this 
President is just out of touch in so many areas. This was one area. Now 
I truly think we have saved Medicare for the moment, and that is a good 
feeling.

                          ____________________