[Congressional Record Volume 155, Number 163 (Wednesday, November 4, 2009)]
[Senate]
[Pages S11064-S11066]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. JOHANNS. Mr. President, I rise today to speak about health care. 
I want to focus my comments today, if I could, on specifically the 
Medicare cuts and the impact that will have across this great Nation, 
and also I would like too zero in on what those Medicare cuts mean for 
my home State, the great State of Nebraska.
  Medicare is a program that is a source of health care for about 45 
million Americans. As we all know, it is essentially a program for 
those who are 65 and older. It dates back a lot of years.
  In my State, the State of Nebraska, there are 272,000 Nebraskans who 
are Medicare beneficiaries. As I have talked to them--and I have done 
townhall meetings and roundtables all around the State--they are 
pleased with the health care they receive. If they get sick, they have 
this program, this Medicare Program, that is there for them.
  I want to start out saying that I believe the current plan, which 
cuts Medicare and claims reform, is really off base with this 
population. The proposal says Medicare will be cut by over $400 
billion.
  Let me, if I might, just walk down through the various programs that 
will be impacted within Medicare.
  There will be a $130 billion cut for the Medicare Advantage Program. 
If anybody has spent any time talking to senior citizens about Medicare 
Advantage, they will tell you they like this program.
  Mr. President, $45 billion will be cut from hospitals that care for 
recipients of Medicare; $40 billion will be cut from home health 
agencies; $14.6 billion will be cut from skilled nursing facilities; 
and nearly $8 billion will be cut from hospice programs.
  I suggest, very respectfully, that this health care reform, which 
will cut Medicare by over $400 billion, is not an improvement. These 
cuts ultimately will compromise the ability of Medicare beneficiaries 
to access the care they need.
  If I may spend a moment this morning to talk about the profound 
impacts this will have in Nebraska, the Medicare Advantage Program, as 
I said, will be impacted by about a $130 billion cut. Nationally, there 
are 11 million seniors enrolled. One Democratic Senator described these 
cuts as ``intolerable.'' I agree with that description. Mr. President, 
35,000 Nebraskans have Medicare Advantage plans. The plans provide 
choice and options that people like.
  The President said that ``if you like your plan, you can keep it.'' 
And relative to the Medicare Advantage beneficiaries, he said you will 
get a plan that is ``just as good.''
  The Finance Committee markup was very instructive on this issue. The 
CBO Director stated that those people who have Medicare Advantage 
``will see changes and reductions in their benefits.''

[[Page S11065]]

  Let me turn to hospitals. The news is no better with hospitals. 
Hospitals that serve large numbers of seniors and the poor will have 
reduced payments. The current government programs actually underpay for 
these services. Hospital administrator after hospital administrator has 
told me in my State: We could not keep our hospital open on Medicare 
and Medicaid. They need the additional payments they get from private 
insurance to keep the doors open. Yet this so-called reform bill cuts 
Nebraska hospitals by about $142 million; that is, 36 percent of 
Nebraska hospitals will be affected.
  Relative to home health care--a $40 billion cut nationally--seniors 
receive care in the home instead of going to a nursing home. That is 
what this program is all about. Under ``reform,'' Nebraska home health 
programs will lose $126 million over 10 years. By 2016, two-thirds of 
Nebraska home health agencies will be in the red.
  It is especially devastating to rural areas where 80 percent are 
expected to lose money under this reform plan. It is hard to keep the 
infrastructure in place right now, much less to look at what is coming. 
A home health director in a small rural hospital in Cherry County, NE, 
said this to me:

       Nebraskans are a tough and a convicted people. We have 
     chosen to live in a more rural environment and respect the 
     fact that not all services can be provided.
       However, there are two registered nurses that provide home 
     health services for seven counties. Our radius to see 
     patients is 100 miles one way. If a citizen was sick or 
     injured, they may have to travel 100 miles to see a doctor. 
     If they are unable to travel, they would just not receive the 
     care they need.

  You see, home health care is not a convenience in our State, it is a 
necessity. Cuts will likely cause them to close that operation and quit 
providing the services. If the mission is to improve access, how does 
that do that?
  Skilled nursing care facilities is another area that is targeted with 
$14.6 billion in cuts. Registered nurses help provide 24-hour care to 
people who can no longer care for themselves. People depend on them for 
both short- and long-term care.
  What is the impact in Nebraska? The impact is $93.2 million. This 
dollar figure does not take into account the job loss and financial 
impact on local communities.
  I will mention a facility, a great facility, like all facilities in 
Nebraska, in Fullerton--the Golden Home Living Center. That is a 
population in that community of 1,300 people. The nursing home there is 
the second largest employer. They have a $1.5 million payroll. However, 
they are already struggling to try to figure out how to stay open, much 
less facing these cuts.
  The hospice program will have $8 billion in cuts nationally. Hospice 
provides dignity and comfort to seniors at the end of their life. With 
this ``reform,'' there will be a nearly 12-percent reduction in 
hospital reimbursements over the next decade.
  We have 38 licensed hospice programs in our State. We are so proud of 
them. Currently, 97 percent of Nebraskans have access to at least a 
hospice program. The cuts, I believe, would negatively impact the care 
of dying Nebraskans.
  Let me wrap up with this point. Every study that is out there says 
Medicare is heading toward insolvency, and 2017 is the date most often 
used. How do we keep Medicare viable? Cutting Medicare to fund a new 
entitlement, I respectfully suggest, is so misguided. Unfortunately, 
that is the determined effort of this reform plan. We can do better. We 
must do better. Nebraskans are watching. Americans are watching. We 
have to improve on what we are doing here. We need to be able to say to 
those who are Medicare beneficiaries: We protected Medicare. You are 
first and foremost in our mind.
  I yield the floor, and I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CRAPO. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. CRAPO. Mr. President, I ask unanimous consent to speak in morning 
business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. CRAPO. Mr. President, I rise today to discuss Medicare also in 
the context of the proposed health care reform we are dealing with in 
the Senate.
  This is one of the most troubling aspects of the health care reform 
proposals that are being considered in the Congress: the massive cuts 
to Medicare that will total, under the legislation that came out of the 
Finance Committee at least, about $500 billion in cuts and similar 
levels of cuts are included in all major legislation being moved at 
this point.
  In this time of economic downturn, all Americans must look to their 
budgets and to their own spending very carefully. The same is true for 
the Federal Government.
  Some will argue these Medicare cuts are necessary for fiscal 
responsibility and that everybody must play a part. Others are going to 
argue that Medicare is facing insolvency in 2017 and that these cuts 
are necessary to slow the growth of Medicare spending. In fact, the 
2009 trustees report shows that Medicare's annual costs were 3.2 
percent of the gross domestic product of the United States in 2008. To 
give a little bit of context, that is about three-quarters of Social 
Security's costs. These costs are projected to surpass Social Security 
expenditures in 2028 and reach 11.4 percent of GDP by 2083.
  The unfunded obligation of the Medicare hospital trust fund is $13.4 
trillion, which is $1 trillion higher than even last year's estimate. 
And Medicare's total unfunded obligations, which include Part B and 
Part D programs, have reached $37.8 trillion.
  Yes, we do need to address the solvency issues related to Medicare. 
We must deal with it. But let's be clear about one thing: These 
proposals in these health care bills do not strengthen the solvency of 
the Medicare Program.
  These cuts accomplish one simple goal; that is, they take money from 
the Medicare Program in order to create a new entitlement program. The 
program is created at the expense of America's seniors. We are not 
shoring up Medicare for America's seniors with these bills; we are 
transferring $500 billion out of the Medicare programs into a new 
government entitlement program.
  A recent article described it like this: Let's imagine that Medicare 
is your family's overall budget. You have lived beyond your means and 
you have run up a huge debt. In order to deal with this new debt, your 
family thinks of creative ways to cut spending and reduce expenses and 
put some of your savings aside to catch up. Then, though, you see all 
this cash that you saved up and you would like to go out and buy a 
brandnew car. So instead of using the cash to help pay off your debts 
and your obligations and shore up your financial circumstances, you 
take this cash and go out and spend it on a brandnew car, in this case 
a government-run car.
  This is what is happening with the Medicare system in the bills 
before us. These cuts damage the existing program in order to create a 
new one, harming America's seniors along the way. They are negatively 
going to impact choice, access, benefits, and quality of care. When 
Americans said they wanted change, I don't think this is what they were 
talking about.
  Let's talk about a few specifics.
  Among the largest cuts to the Medicare Program are the $117 billion 
in cuts to the Medicare Advantage Program. Currently, there are nearly 
11 million seniors enrolled in Medicare Advantage, which represents 
about one out of every four Medicare beneficiaries. In my home State of 
Idaho, there are more than 60,000 Medicare Advantage beneficiaries or 
27 percent of Medicare beneficiaries in the State.

  Since the creation of the Medicare Advantage Program in 2003, overall 
enrollment in private plans has been steadily increasing and 
beneficiaries across the country have had more private plans to choose 
from than they did 10 years ago.
  A 2007 study reported ``high overall satisfaction'' with the Medicare 
Advantage Program. Mr. President, 84 percent of respondents said they 
were happy with their coverage, and 74 percent would recommend Medicare 
Advantage to their friends or family members.

[[Page S11066]]

  According to Congressional Research Service, as of January 2009, all 
Medicare beneficiaries across the country had access to Medicare 
Advantage plans along with traditional Medicare plans. The choice is 
particularly crucial in rural areas. Between 2003 and 2007, more than 
600,000 beneficiaries in rural areas joined the Medicare Advantage 
Program, which is a 426-percent increase.
  The Medicare Advantage cuts proposed in the Finance bill will force 
plans to cut benefits, increase premiums, or drop coverage altogether. 
In fact, CBO estimates that enrollment in Medicare Advantage will 
decrease by 2.7 million people by 2019, resulting from the changes in 
this proposed legislation.
  This number represents not only people who would lose their plan but 
also those who would no longer be able to choose Medicare Advantage 
because of the decrease in benefits.
  CBO estimates that the value of extra benefits offered by Medicare 
Advantage plans will drop from $135 a month to $42 a month. When we 
were in the Finance Committee markup, I asked CBO Director Elmendorf to 
confirm this point. I asked him:

       So approximately half of the additional benefit would be 
     lost to those current Medicare Advantage policyholders?

  His response was:

       For those who would be enrolled otherwise under current 
     law, yes.

  The point is, the Medicare Advantage cuts in the Finance Committee 
bill will clearly break the President's pledge that if you like the 
insurance you have, if you like the protection you have, you can keep 
it.
  Even if some seniors on Medicare Advantage are able to keep their 
plans, they are not going to be able to enjoy the same level of 
benefits they enjoy today. During the Finance Committee markup, I 
offered an amendment that would have prohibited the implementation of 
the bill's Medicare Advantage provisions if their implementation would 
decrease choice and competition for seniors in Medicare--very simple 
and straightforward. The amendment was defeated on a straight party-
line vote.
  Many congressional Democrats argue that by defending Medicare 
Advantage you are actually defending overpayments to insurance 
companies. That is not true either. Medicare Advantage plans are paid 
14 percent more, on average, than traditional Medicare fee-for-service. 
However, these overpayments--or alleged overpayments--don't go into the 
plans. They go to the seniors enrolled in the plans in the form of 
extra benefits. That is why Medicare Advantage is so popular among 
seniors. Seventy-five percent of the additional payments to Medicare 
Advantage are used to provide seniors with additional benefits--
benefits such as dental coverage or vision coverage or preventive 
medicine or flu shots or hearing aids. The remaining 25 percent is 
returned to the Federal Government. So the cuts to Medicare Advantage 
will reduce benefits and will deprive seniors of choice.
  But that is not the only kind of cuts we have coming to Medicare. In 
addition to the cuts to the Medicare Advantage Program, the Finance 
Committee bill also contains massive cuts to other Medicare providers. 
It contains $40 billion of cuts to home health agencies, there are 
nearly $8 billion of cuts to hospice, and more than $16 billion of cuts 
to skilled nursing facilities. These levels of cuts would be 
devastating for providers and will threaten access as well. As more and 
more providers will not take Medicare patients, it will be harder and 
harder for beneficiaries to find care.
  I spoke to Gary Thietten, the president and owner of Idaho Home 
Health & Hospice, just last week about the impact of the Medicare cuts 
to home health and hospice. He described to me how bad the fiscal 
situation has become for home health, hospice, and other Medicare 
providers in Idaho. Idaho lost nearly 30 percent of its home care 
providers in 1998 and 1999, including the State's largest provider. The 
providers that are still in business in my home State are working under 
the same Medicare reimbursement levels they received in 2001--8 years 
ago. If the cuts from the Finance Committee bill go into effect, on top 
of the current reimbursement issues, the situation will get 
significantly worse for many providers, and the net result, again, 
would be a loss of providers, a loss of options, and a loss of services 
to our seniors.
  Costs have gone up considerably due to the economic downturn, and 
rural Idaho is being hit the hardest. Gary compared the situation for 
home health and hospice providers to the farmers in Idaho. Most farmers 
don't grow just one crop. Similarly, home health agencies don't provide 
just one service. They provide hospice and private-duty care, along 
with medical supplies and equipment. All of these services are going to 
suffer because of the home health and hospice cuts.
  These proposed cuts will not just affect providers in my home State, 
they will affect Medicare providers in every State around the country, 
particularly rural States, which already face significant provider 
access problems. At some point, providers will no longer be able to 
give the best care or any care, for that matter, to Medicare 
beneficiaries. As I indicated earlier, we have already seen the trend 
start with those medical service providers that simply can't afford to 
take Medicare patients.
  I have long supported policies that increase access to high-quality 
affordable health care for all Americans and provide for fair 
reimbursements to providers of the medical services rendered. However, 
the types of blunt, across-the-board cuts we see in these proposed 
bills will result only in increased harm to providers and to Medicare 
beneficiaries around the country.
  It is my hope that as we face these difficult times, and dealing with 
needed health care reform, we will not take the cuts out of the 
Medicare Program that are proposed in this legislation. Specifically, 
and importantly, it is critical that we not cut our Medicare 
beneficiary services in order to simply fund a new, massive government 
entitlement program.
  With that, I yield the floor.

                          ____________________