[Congressional Record Volume 155, Number 178 (Thursday, December 3, 2009)]
[Senate]
[Pages S12300-S12317]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009--(Continued)

  (Mrs. SHAHEEN assumed the Chair.)
  Mr. WHITEHOUSE. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.

[[Page S12301]]

  The assistant legislative clerk proceeded to call the roll.
  Mr. WHITEHOUSE. Madam President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WHITEHOUSE. Madam President, I intend shortly to call up an 
amendment once the procedural posture is clarified and has been cleared 
on the Republican side, an amendment to protect the Social Security 
surplus and the CLASS program savings in this act. When I do, I will 
then ask for its immediate consideration, but at the moment, that is 
still being worked out from a parliamentary standpoint, so my words 
will come in advance of that.
  I wish to describe the amendment for my colleagues. It is a sense-of-
the-Senate resolution that demonstrates the Senate's commitment to 
meaningful deficit reduction in this legislation while also protecting 
both the Social Security surpluses generated by the legislation and 
savings generated from a significant element of the bill, the long-term 
voluntary insurance program created by the Community Living Assistance 
Services and Supports Act, what we call the CLASS Act. The amendment 
expresses the sense of the Senate that surpluses generated by this bill 
for the Social Security trust fund be reserved for Social Security and 
that the savings for the long-term insurance program created by the 
CLASS Act be reserved for the CLASS program.
  The CBO has estimated that this bill will save $130 billion over the 
first 10 years and roughly $650 billion over the next 10 years. This 
amendment stands for the proposition that these impressive savings will 
be protected vis-a-vis the CLASS Act and the Social Security trust 
fund.
  I wish to speak in particular today about the CLASS Act. This act 
creates a voluntary insurance program for seniors and individuals with 
disabilities. This program will enable them to afford long-term care 
even after they have exhausted coverage offered by Medicare or their 
private insurer. Let me make clear that this is not a mandatory 
program. It does not increase taxes on anyone. It is a completely 
voluntary program that offers an additional insurance option for the 
disabled. Without such insurance, disabled people often cannot afford 
the massive costs of long-term care. Under current law, they are often 
forced to sell their homes or otherwise what is called ``spend down'' 
their assets until they meet a poverty threshold before they can begin 
receiving the help they need.
  Certain colleagues on the other side of the aisle have argued that 
the CLASS plan would lead to a financially unstable entitlement program 
and would rapidly increase the Federal deficit. That is simply not 
accurate. The CLASS plan is fully self-sustaining and actuarially 
sound, funded by the premiums paid by those individuals who voluntarily 
opt into this insurance plan. There are no taxpayer dollars involved.
  After individuals pay premiums for 5 years, they become eligible to 
receive a cash benefit of no less than $50 per day to assist with the 
various costs associated with the onset of a disability or long-term 
health condition. These benefits could be used to pay for 
transportation to work, for instance, or the construction of a 
wheelchair ramp or the hiring of a personal aide--the sorts of things 
that so often make the difference between somebody remaining an 
independent and productive member of society and requiring the support 
of assisted living or nursing home care.
  I think we can all agree that it is in everyone's best interest to 
try to provide this kind of assistance to people when an unexpected 
disability begins to affect their lives, to allow them the support they 
need to continue as best they can in their homes, in their apartments, 
with their families, at their jobs, and remain, as I said, both 
independent and productive.
  The Congressional Budget Office has concluded that this plan is 
fiscally solvent. In fact, it projected that the program would be 
solvent for at least 75 years.
  There was a helpful amendment offered in the HELP Committee when we 
considered and debated and passed that piece of legislation. The 
amendment was offered by the distinguished Senator from New Hampshire, 
your colleague, Senator Gregg, the ranking member on the Budget 
Committee. It passed unanimously, and it ensures and requires that the 
program be actuarially sound for 75 years.
  CBO has projected that, in fact, it would be solvent for at least 75 
years. CBO further estimated that the program would reduce the deficit 
by $72 billion over 10 years, saving $1.6 billion for Medicaid during 
the first 4 years of the program. So it has a substantial fiscal 
upside.
  I am surprised that our colleagues on the other side are criticizing 
this element of the bill. It seems to run contrary to the findings that 
have been made by the nonpartisan Congressional Budget Office. It is 
certainly a stark contrast to their tolerance for their own Medicare 
Part D Program, the pharmaceutical program the other side touted so 
proudly, which is different from the CLASS Act in many respects: It was 
vastly expensive; it was completely unpaid for; it was a massive 
handout to the pharmaceutical industry, containing within it the, to 
me, appalling proposition that the government was forbidden by law, 
forbidden by a previous Congress, to negotiate with the pharmaceutical 
industry over the price of drugs and had to take it or leave it, 
whatever the pharmaceutical industry charged. Frankly, it is 
irresponsible to put the government into that situation. It is fiscally 
irresponsible, and it is irresponsible from a management point of view. 
It is irresponsible in more ways than I can name. Yet they happily went 
that way, the path of fiscal irresponsibility, when it suited the 
pharmaceutical industry. Of course, in order to do so, they had to 
leave a hole in the Part D pharmaceutical program for seniors to fall 
into, what the Presiding Officer knows well and what my colleagues know 
well as the dreaded doughnut hole that has caused so many unsuspecting 
seniors so much surprise, chagrin, fear, anxiety, and misery. Now, 
having been the architects of that program, they criticize the CLASS 
Act even though the CBO has found it to be fiscally sound.
  It seems there is an enormous double standard between programs 
designed for the benefit of, say, the pharmaceutical industry, or 
perhaps the insurance industry, and the standards they would apply to 
programs that benefit people who suffer from the onset of a 
disability--regular Americans, regular families. This is something that 
happens to people across this country all the time.
  That is really the most important effect of the CLASS Act. As good as 
it is on deficits, as much as the CBO has confirmed that it is to our 
fiscal advantage to proceed with the CLASS Act, the most important 
effect is not on deficits, it is on people.
  It is on families. This insurance program will allow disabled people, 
young and old, to live more financially secure and productive lives, 
free from the fear that medical expenses will impoverish or bankrupt 
them, able to make those investments in their own adaptation to their 
disability so they can maintain the lifestyle, the job, and the home 
they are accustomed to and comfortable with. Studies show that less 
than a quarter of private long-term care insurance policies provide a 
lifetime of benefits. The CLASS Act fills an important void that has 
been left by the public sector for people who seek this protection and 
this insurance on a paid-for basis. The CLASS plan is a win-win for 
reducing costs in our health care system and protecting Americans who 
require long-term care. Our current system plain fails to protect those 
who aren't healthy or wealthy enough for private market coverage. It 
fails to create an opportunity for individuals to plan and save for 
their future lifetime care needs. It fails to provide a sustainable 
safety net for individuals who require long-term services and supports 
to keep the familiar aspects of their life around them--job, family, 
home, hearth.
  I will shortly ask that my colleagues support the amendment when it 
is called up. It will put the Senate on record as protecting Social 
Security. It will put the Senate on record as protecting the CLASS Act 
savings scored by CBO. It will put the Senate on record as supporting 
the impressive deficit reduction in the bill. I look forward to 
favorable consideration when we have a parliamentary agreement on 
calling it up.

[[Page S12302]]

  I yield the floor.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The Senator from New 
Hampshire.
  Mr. GREGG. I appreciate the proposal of the Senator from Rhode 
Island, but I think it needs to be put in its proper context. This is a 
sense of the Senate. It has no legal implications. The CLASS Act, as 
proposed in the underlying bill, was described by the Senator from 
Rhode Island but not fully. The way the CLASS Act works, it is an 
insurance program theoretically where people in their thirties and 
forties and fifties can buy insurance to cover their retirement years 
when they have to go into some sort of long-term care facility and may 
be institutionalized. People are paying into this program for decades, 
maybe four decades, maybe their thirties right into their seventies or 
their twenties into their sixties. The cost of this program does not 
actually start to be incurred until these folks move into a long-term 
care facility or a managed care facility type of situation for their 
retirement years where they need skilled nursing assistance of some 
sort.
  There is a huge amount of premium that comes in under this program 
early which goes against virtually no expenses, because this is a 
brandnew program. It is a startup program. It is created by the Federal 
Government. It is a government insurance program much like Social 
Security and Medicare. The practical effect of that is that money will 
come in for years to the Federal coffers. In the first 10 years of this 
bill, it is estimated around $90 billion will come in. In the second, 
as we move out in the second 10 years, the total over those two periods 
of 10 years is about $212 billion. Then more money will come in in the 
third 10 years, probably somewhere in the vicinity of $300 billion to 
$400 billion potentially. None of this will be spent on the purposes of 
this insurance, because almost everybody who is paying in for these 
premiums is going to be too young to go into one of these 
institutionalized care facilities during those first three decades.
  So what happens is that the Federal Government gets this large 
windfall of money from these people who are paying their premiums and 
spends it, spends it on something else--education, roads, highways, 
arts, whatever is the decision on where to spend the money. It gets 
spent. That is the way the Federal Government works. It doesn't have 
any place to put this money and keep it safe. It comes in, and it gets 
spent. When these people retire, when they do go into a situation where 
they need assisted living of some sort, then the government gets the 
bill. Not us, not those of us who are here. We will be long retired by 
then, everybody in this Chamber, except maybe Senator Bennet from 
Colorado who is rather young and vibrant. The rest of us will probably 
not be around to take advantage of this. It will be our children and 
grandchildren who will end up with that bill.
  That bill will be staggering. We are talking hundreds of billions, if 
not trillions, of dollars of outyear costs as a result of this type of 
program; much like Social Security which basically has nothing in the 
coffers today, even though trillions of dollars have been paid in, but 
which has a lot of obligations. The same thing with Medicare. That was 
an insurance program which was supposed to have money in the coffers. 
Not there. In fact, it goes into negative cashflow and will be 
insolvent beginning in 2010. There is no money when these folks retire 
and need it. It will have been spent.
  This amendment, well intentioned as a statement, has absolutely no 
effect on that series of events. That money will still be spent under 
this amendment. After this amendment is passed--and I presume it will 
be passed; it is a nonevent amendment having no purpose other than a 
political statement--CBO will still score this bill as spending that 
money, absolutely score this bill as spending that money, the $90 
billion for the next 10 years, the $212 billion for the next 20 years, 
the $400 billion after that. That is my guess. The third 10-year 
period, my guess is $500 billion. When we get out there 30, 40 years 
from now and these people expect to get their insurance paid, then when 
our children get the bill for that insurance, it becomes a tax on them, 
a direct tax on their earnings. It will affect their lifestyle, their 
earning capacity, their ability to buy a home, to send a child to 
college, to buy a car. This money will be spent under this bill.
  One of my colleagues on the other side of the aisle who is pretty 
respected around here on financial matters I believe referred to this 
CLASS Act proposal as a Ponzi scheme. That is not too far off. 
Basically, we are taking the money from these folks who buy into this 
insurance program today. We are spending it on something we want to 
spend it on as a Congress today, whether it is something worthwhile 
such as a road or education or our national defense, but we are 
spending it. We are leaving the people who paid that premium out to 
lunch unless 30 or 40 years from now, when they go into that situation 
where they need that insurance, the country is strong enough and our 
kids are making enough money to pay for the cost of that program. That 
is a real gamble for them, and that is called a Ponzi scheme, which is 
exactly what this is. This bill, this sense of the Senate, although a 
good political document because it allows Members to wander around 
their districts and say: I voted to protect the CLASS Act dollars, I 
voted that it not be accounted for under this bill, that was a sense of 
the Senate. In actuality, it has no effect at all in that area.
  All the money that comes into this, insurance money, is going to be 
spent somewhere else. And the CBO will still score this bill as taking 
credit for that insurance under this program. It is Bernie Madoff 
accounting one more time under this bill. You would think after a while 
people would get embarrassed--really, it would become embarrassing 
after a while. When you match up 10 years of tax increases, 10 years of 
Medicare cuts, to 5 years of programmatic spending and claim you have a 
program that is fully paid for and is only an $840 billion program, 
when you know that if the program, the entire bill is fully phased in, 
it is $2.5 trillion in cost. It isn't $500 billion in Medicare cuts 
when this thing is fully phased in, it is $1 trillion in Medicare cuts. 
It isn't $500 billion of tax increases in this bill and fee increases 
on small businesses mostly or on provider groups, it is over $1 
trillion of increases. You would think after a while people would be 
embarrassed about the manipulation of numbers in that way. But that 
doesn't seem to occur. Yet we get this proposal that says, OK, let's do 
it again. Let's claim we are doing something we are not doing. Let's 
claim we are protecting the dollars that come in under this new CLASS 
Act proposal, assuming this program goes into place. Let's claim we are 
segregating them somehow so the people who pay their hard-earned 
dollars and buy into this CLASS Act think they are getting something 
for it, when in fact that will not happen at all, is not going to 
happen at all. That money is going to be spent the day it comes in. In 
fact, it is already spent. We are already borrowing so much and 
spending so much in this government right now. We already have an 
obligation of debt that will spend this money.
  I guess everybody can walk away feeling good about this amendment, 
but substantively, it has no impact at all.
  Mr. THUNE. Will the Senator yield for a question?
  Mr. GREGG. I am happy to yield.
  Mr. THUNE. My understanding is as to the CLASS Act, to make the 
deficit situation with the enactment of this bill look better, they 
argue they are actually going to reduce the deficit as a result of this 
bill because of the revenues that come in early from the CLASS Act. I 
think the Senator from New Hampshire has accurately described this. You 
get a short-term infusion of revenues and another long-term liability 
which is why the Senator from North Dakota described it as a Ponzi 
scheme of the highest order, something of which Bernie Madoff would be 
proud. I guess my question to the Senator would be, how does this 
impact deficits in the long run and the debt in the long run? There was 
a lot of discussion around here, probably more rhetoric than action, 
about doing something to reduce the deficit and deal with the debt that 
continues to pile up and accumulate and at some point will be handed 
off to future generations. This Ponzi scheme, as it has been described 
by the Senator from North Dakota on

[[Page S12303]]

the other side, in the form of the CLASS Act does seem in the short 
term to understate the fiscal impact of the cost of this health bill 
which, as the Senator from New Hampshire has described, is $2.5 
trillion. But could the Senator elaborate on what happens in the 
outyears? You talked about the impact down the road when all the bills 
come due. You get all the revenue in the short term, and then some time 
down the road that revenue gets spent and you are stuck with all these 
liabilities. How is this going to affect deficits and debt in those 
years in the future when our children and grandchildren will have to 
pay for it?

  Mr. GREGG. The Senator has asked a very pointed and appropriate 
question, because the answer is pretty startling. The point I think 
most people don't understand is that this money gets spent as it comes 
in. In other words, let's say over the next 30 years, younger people 
pay into this new alleged insurance program, accurately described as a 
Ponzi scheme. All that money that comes in will be spent on other 
activities of the government and, therefore, the other activities of 
government will be allowed to grow fairly dramatically. There will be a 
lot of money here. You are talking potentially $1 trillion over the 
next 30 years.
  Those expenditures, which will have occurred as a result of this 
money coming in, which will have nothing at all to do with paying for 
the cost of the health care which these people who buy into this CLASS 
Act think they are getting--in other words, long-term care insurance, 
it has nothing to do with that--it will be on, as I said, education, 
roads, national defense, whatever we spend it on around here. Those 
expenditures will be built into the baseline forever. They will presume 
that there is going to be revenue to pay for them. What happens when 
that generation that has bought into the CLASS Act starts to actually 
need the money it is alleged it is going to get? Two things happen. The 
younger generation is going to have to pay taxes to cover that cost 
because the money will not be there. There will be no money in the 
kitty, none, zero. There will be zero money in the kitty, the alleged 
kitty to pay for this insurance program. Second, ironically, the 
government will have been grown by all the money that came in and was 
spent on new programs. So you are basically going to double down on the 
cost here.
  Our children and our grandchildren are going to have to pay twice, 
not only to pay for the long-term care which allegedly has been 
promised to these people under these insurance programs but also to pay 
for all the new spending that will occur as a result of spending the 
premiums which were supposed to be saved for these programs. So they 
are going to get hit twice. The implications are, quite honestly, 
staggering.
  We already know we have a $38 trillion unfunded liability in 
Medicare. We know, when you combine Medicare, Medicaid, and Social 
Security, we have a $60 trillion unfunded liability. If you calculate 
in the cost of the CLASS Act on top of that, you are adding potentially 
trillions more of unfunded liability, which will all have to be paid by 
our children and our grandchildren.
  At the essence of this bill, there are a number of problems, but the 
problem I find most inappropriate in the way we are doing this is we 
are creating a government which our kids cannot afford under any 
circumstance. We are absolutely guaranteeing that our children are 
going to have a lower standard of living than we had because of the 
burden we are going to put on them as a result of these expansive new 
programs, which we know cannot be afforded in the outyears.
  We already know we cannot afford the government we have in the 
outyears. We already know the public debt is headed above 80 percent of 
GDP by 2019. So the Senator from South Dakota has touched on a core 
issue. What is the real cost of this? Well, it is extraordinary. As I 
said, it hits the next generation twice. First, they will have to pay 
the taxes to pay for the program that was put on the books, which is 
allegedly there, plus they will have to pay to support all the programs 
which the money that came in was supposed to be preserved for.
  Mr. THUNE. I say to my colleague from New Hampshire, it is the 
classic definition of a Ponzi scheme, which, as I said, is how it has 
been described not just by the chairman of the Budget Committee from 
North Dakota but also by others who have looked at this. Editorial 
pages in newspapers across this country have looked at this CLASS Act 
and said it does not add up, and it does not add up. I think Ponzi 
scheme is a good description.
  The Senator from New Hampshire has correctly outlined the impact this 
will have on future generations, on deficits and debt, and spending and 
the growth of government. That is why it is such a bad idea to include 
this. The sense of the Senate resolution is simply that. It has no 
legal binding effect on spending. It simply is sort of a political 
statement that makes everybody feel better, but in the end it is going 
to be our kids who pay.
  Mr. GREGG. I think the Senator from South Dakota touched on another 
point. The sense of the Senate, basically, confirms the fundamental 
flaw of the CLASS Act. The fact that you would think a sense of the 
Senate is necessary pretty much proves that everybody around here 
understands there is a big game going on with the CLASS Act. The 
problem is, of course, the sense of the Senate has no effect of law 
and, therefore, the problems the CLASS Act creates in the area of 
spending, the revenues that come in for the purpose of something other 
than what the CLASS Act alleges people are buying when they pay for 
that insurance, will still exist, and the CBO will still score the 
CLASS Act as benefiting the budget situation, when it should not be 
scored that way at all.
  As I said, this is a nice resolution from a political standpoint, but 
substantively it has no effect on correcting the problems which the 
CLASS Act generate in the area of fiscal policy.
  I understand there is a unanimous consent request that somebody 
wishes to offer. I was asked if I would listen to it.
  Mr. DURBIN. Mr. President, does the Senator yield the floor?
  Mr. GREGG. I ask the assistant leader, is he offering a unanimous 
consent request? I will yield the floor for the purposes of a unanimous 
consent request.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the next 
amendment in order be one offered by Senator Whitehouse of Rhode 
Island, which is at the desk; that the other matter in order during 
today's session be a Hatch motion to commit regarding Medicare 
Advantage; that no other amendments or motions to commit be in order 
during today's session; and that the time in sequence following this 
unanimous consent request--I do not want to disadvantage the Senator 
from New Hampshire, but if it is our turn on this side of the aisle, I 
would ask that Senator Whitehouse first be recognized for the purpose 
of calling up his amendment and then I be recognized next, for no more 
than 15 minutes; and at that point it is my understanding Senator Hatch 
has asked for the floor for 1 hour on his motion.
  If there are any other requests, I would be glad to add them to the 
unanimous consent request at this point.
  Mr. GREGG. Reserving the right to object, my only concern would be 
that will take us past 7 o'clock, so you may want to adjust the time.
  Mr. DURBIN. I am going to finish this as soon as I have gone through 
my preliminary work here. I also ask unanimous consent that the time 
until 8 p.m., this evening, be equally divided and controlled between 
Senators Whitehouse and Hatch or their designees; that it be in order 
during this time for Members to engage in colloquies, as long as those 
Members entering into the colloquy remain on the floor.
  Mr. GREGG. Is it my understanding, then, the order of recognition 
will be Senator Whitehouse, the assistant leader, and then Senator 
Hatch?
  Mr. DURBIN. Yes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Rhode Island.


                Amendment No. 2870 to Amendment No. 2786

  Mr. WHITEHOUSE. Mr. President, I now call up amendment No. 2870, an 
amendment to protect the Social Security surplus and CLASS program 
savings in this act and ask for the amendment's immediate 
consideration.
  The PRESIDING OFFICER. The clerk will report.

[[Page S12304]]

  The assistant legislative clerk read as follows:

       The Senator from Rhode Island [Mr. Whitehouse] proposes an 
     amendment numbered 2870 to amendment No. 2786.

  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The amendment is as follows:

  (Purpose: To promote fiscal responsibility by protecting the Social 
        Security surplus and CLASS program savings in this Act)

       At the appropriate place, insert the following:

     SEC. __. SENSE OF THE SENATE PROMOTING FISCAL RESPONSIBILITY.

       (a) Findings.--The Senate makes the following findings:
       (1) Based on Congressional Budget Office (CBO) estimates, 
     this Act will reduce the Federal deficit between 2010 and 
     2019.
       (2) CBO projects this Act will continue to reduce budget 
     deficits after 2019.
       (3) Based on CBO estimates, this Act will extend the 
     solvency of the Medicare HI Trust Fund.
       (4) This Act will increase the surplus in the Social 
     Security Trust Fund, which should be reserved to strengthen 
     the finances of Social Security.
       (5) The initial net savings generated by the Community 
     Living Assistance Services and Supports (CLASS) program are 
     necessary to ensure the long-term solvency of that program.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that--
       (1) the additional surplus in the Social Security Trust 
     Fund generated by this Act should be reserved for Social 
     Security and not spent in this Act for other purposes; and
       (2) the net savings generated by the CLASS program should 
     be reserved for the CLASS program and not spent in this Act 
     for other purposes.

  Mr. WHITEHOUSE. Mr. President, I yield the floor to the distinguished 
assistant majority leader.
  Mr. DURBIN. Mr. President, I have listened carefully to the profound 
and eloquent statements from my friend and colleague from New 
Hampshire, Senator Judd Gregg. He has frequently invoked the name of 
the Ponzi family, though I am not personally familiar with them. I 
believe they have had some skeletons in their closet by virtue of the 
references that have been made. But I will tell him that what he said 
about the CLASS Act is inaccurate.
  I know that Senator, I see, is leaving the floor. I hope he does not 
miss out on this conversation. But--
  Mr. GREGG. I was just wondering if the Senator would yield for a 
question.
  Mr. DURBIN. I would be happy to.
  Mr. GREGG. Is the Ponzi family from Chicago?
  Mr. DURBIN. No, they are not. I think they are from New England--
Patriots' fans.
  I would like to ask the Senator from New Hampshire, if he would 
yield, if he is familiar with Doug Elmendorf and the Congressional 
Budget Office and the letter of November 18, 2009, to the majority 
leader, Harry Reid, in relation to the deficit impact of the CLASS Act.
  Mr. GREGG. I appreciate the assistant leader asking me that question. 
Regrettably, I am not immediately familiar with it. I have probably 
seen it, although I apologize for not being immediately familiar with 
it. Therefore, I presume the assistant leader is going to remind me or 
at least reacquaint me with its terms. I would note the term ``Ponzi 
Act'' did not come from me. It came from the chairman of the Budget 
Committee.
  Mr. DURBIN. I would just say, it is unfortunate the Senator from New 
Hampshire has not seen this letter because if he had had an 
opportunity--and it is impossible to read everything--if he had had an 
opportunity to read that letter, I do not think he would have made the 
speeches he just made on the floor about the CLASS Act because the 
Congressional Budget Office tells us that in the first 10 years, the 
CLASS Act will reduce the Federal budget deficit by $72.5 billion; in 
the second 10 years by a substantial amount, though somewhat less than 
$72.5 billion; and in the third 10 years--30 years out--it is 
anticipated it will add to the deficit, but, in the words of the letter 
from the Congressional Budget Office, by a very small amount over that 
next decade.
  Mr. GREGG. If the Senator would allow me to comment on that one 
point?
  Mr. DURBIN. I would be more than happy to allow that.
  Mr. GREGG. I fully agree with that analysis. The first 30 years of 
the CLASS Act will generate revenues. It will add to the Federal 
Treasury and will--and that was the purpose of my discussion; that is 
the point I made--during the first 30 years of this proposal, younger 
people will be paying in and very few people will be taking out because 
they will not have yet qualified for the insurance because they will 
not be old enough to go into assisted living.
  Mr. DURBIN. Reclaiming the floor, I would just say, if I understand 
what the Senator said, he is concerned that in the year 2040, this 
program may not work as effectively as we had hoped it would work. I 
trust in the wisdom of future Members of the Senate and the House, if 
that is necessary, to modify the program.
  But it certainly is worthwhile for us to at least reflect on what 
this program is. It is a voluntary, self-funded insurance fund for 
long-term care for American citizens. It was one of the visions of 
Senator Kennedy as part of health care reform, understanding we are 
living longer and many times need help in our late years in life and it 
can be expensive and deplete a family's savings. Senator Kennedy said: 
Let's try to put together a voluntary program where you can pay in and 
have, in fact, long-term care insurance available to you, if you need 
it.
  The fact that this program is virtually solvent for 30 straight years 
is an indication of the wisdom of that idea and the way it is planned.
  I might add one other thing. We just finished a motion to commit on 
the floor relative to Medicare, and many of us argued that the bill 
before us, the bill that represents health care reform in this debate, 
protects Medicare and guarantees the basic benefits of Medicare. Those 
on the other side of the aisle protested and said: No, it does not.
  Well, then, Senator Michael Bennet of Colorado offered an amendment 
which said, pointblank and clearly, nothing in this bill will, in any 
way, diminish guaranteed Medicare benefits, and a surplus generated 
here will be to give a longer life to the existing Medicare Program. 
The Bennet of Colorado amendment passed 100 to nothing, so not only 
does the bill originally protect Medicare, the Bennet amendment 
repeated that, and all the Republicans voted for it. Yet they continue 
to come to the floor and say: We do not believe what we voted for. We 
believe this bill is going to hurt Medicare.
  The same thing is true with the CLASS Act because Senator Whitehouse, 
who was on the floor momentarily, came forward and said: I will put it 
in writing. We are going to put it in writing that the surplus in the 
CLASS Act program cannot be used for other purposes and has to be saved 
and used for the purposes stated here for long-term care insurance. I 
think the Whitehouse amendment is likely to get another 100 votes.
  So every time we address a concern from the Republican side of the 
aisle, and say the bill addresses that concern or a separate amendment 
addresses that concern, they protest: It is not enough. We need more. I 
think they protest too much.
  I would also say I am troubled today, as I have been for several 
weeks, by the position taken from the Republican side of the aisle 
about health care reform. For about 13 or 14 days, this bill, in its 
entirety, has been available to the American people. You can find it by 
Googling ``Senate Democrats'' and it will direct you to our Web site 
and you can click on this bill, H.R. 3590, and read it, page after 
page--all 2,074 pages of it. That is the way it should be.
  There was a lot of angst and worry last August in townhall meetings: 
Well, are you going to get this bill sneaked by us? Are we going to get 
a chance to read it? Everybody has a chance to read it. But then I 
would recommend to those who are searching the Internet to read health 
care reform bills that if you want to find the Republican health care 
reform bill, look for ``Senate Republicans'' and go to their Web site 
and you will be able to click on ``health care reform bill'' and you 
will find the Democratic health care reform bill because, 
unfortunately, there is no Republican health care reform bill. They 
have not offered one. They have had a year to prepare

[[Page S12305]]

it. They have had plenty of ideas they have expressed on the floor. 
They have been critical of our efforts. They have offered literally 
hundreds of amendments in committee, and yet they cannot come up with a 
bill.
  It leads you to conclude this is not an easy task. It is not easy at 
all. It certainly is not easy to produce a bill such as this one, the 
Democratic bill, which generates, over the first 10 years, a $130 
billion Federal surplus in our Treasury. This bill adds more in terms 
of surplus and deficit reduction than any bill in the history of the 
Senate. In the second 10 years, the Congressional Budget Office says 
there will be another $650 billion in savings on our deficit.
  So for those who argue if we pass this bill we are going deeper in 
debt, they ignore the Congressional Budget Office, that referee that 
takes a look at all the bills and tells us that over the span of 20 
years, we are going to reduce our deficit by some $700 billion or $800 
billion, just by virtue of this bill. Republicans have been unable to 
produce a bill that reduces the deficit, when it comes to health care, 
by a penny. They come here and criticize what we have done, but they 
can't produce a bill. All the great legislative minds on their side of 
the aisle, and we have been waiting patiently for them to produce a 
health care reform bill. They can't or they don't want to. Maybe they 
like the current health care system. Maybe they think this is the way 
America should be.

  Well, many of us don't believe that, and a lot of Americans don't 
either. There are a lot of good parts of our system we want to protect, 
but there are many parts that need to be changed. We need to make 
health care and health insurance more affordable for families and 
individuals and businesses. This bill does.
  We just had another report from the Congressional Budget Office that 
said yes, the cost of premiums will be coming down for many Americans 
as a result of this bill. We also understand that some 50 million 
Americans don't have health insurance at all. This bill will reach the 
highest level of protection for health insurance in the history of the 
United States. Ninety-four percent of people in this country will have 
the peace of mind and security of health insurance--a dramatic 
increase. The Republicans have been unable to come up with any proposal 
that moves us toward more coverage for people who don't have health 
insurance.
  This bill also has many provisions to finally give consumers across 
America a chance to fight back when the insurance companies say no, and 
they do all the time. People who need critical surgical procedures and 
medicines, people who need the kind of care their doctors recommend end 
up fighting with the clerk at an insurance company. This bill, the 
Democratic health care reform bill, gives these families a fighting 
chance against these health insurance companies. I have yet to see the 
first bill coming from the Republican side of the aisle in the course 
of this debate that would give our families a chance against these 
health insurance companies.
  I wish to also say when I finish speaking, and we finish on this side 
of the aisle, the Senator from Utah will come and speak. I understand 
it is the Medicare Advantage Program he will speak to. Now, the 
previous motion to commit by Senator McCain of Arizona said: Send this 
bill back and make sure you take out any reference to savings in the 
Medicare Advantage Program. That was defeated. The vote was 42 to 58. 
There were two Democrats who joined the Republicans. They needed 60 
votes; it didn't make it. I take it the Senator from Utah may offer 
another motion to commit relative to Medicare Advantage. I expect it to 
have the same fate, but he has his chance to argue his point of view, 
and he may be persuasive to more Members on this side of the aisle. 
Unfortunately, although we are good, close friends, and I bask in his 
wisdom on a daily basis, he is not going to change my mind on this 
issue because the Medicare Advantage Program is a program that needs to 
be changed.
  Let me tell my colleagues about this program. We started years ago 
with the health insurance industry telling us: Government cannot do a 
good job when it comes to insurance. Let us show you how private health 
insurance companies can sell a Medicare policy more cheaply than the 
government. And we invited them to do it.
  Over the course of the years, some of them did. They showed some 
savings, and they demonstrated to us they could provide Medicare at a 
cost lower than the government. But then things changed, and the health 
insurance companies kept coming back and saying: Well, we actually need 
more money now to provide the same benefits in Medicare that the 
government provides.
  At last count, the Medicare Advantage Program costs 14 percent more 
to provide the same Medicare benefits as the government program. So 
these leaders in the private sector who were going to teach us a lesson 
about how to sell insurance ended up failing their own lesson plan, and 
now this Medicare Advantage Program has turned out to be a flatout 
subsidy to the health insurance industry--$170 billion over 10 years. 
In other words, the Medicare Program is paying more for Medicare than 
what it has to pay so it can subsidize health insurance companies which 
are turning multimillion-dollar profits and giving bonuses to their 
CEOs.
  Some on the other side of the aisle think we need to preserve this; 
that we need to preserve this subsidy, make sure we protect the profits 
of the health insurance companies, and we need to protect Medicare 
Advantage. Well, as Senator Dodd has said so frequently on the Senate 
floor, Medicare Advantage is neither Medicare nor an advantage.
  I believe, and most agree, it is time for this party to end. These 
private health insurance companies didn't keep their word, didn't keep 
their promise, and because of that we are in a situation--a 
predicament--where we are asking other people covered by Medicare to 
subsidize the profits of these private health insurance companies. What 
does it cost every Medicare recipient in America to provide this 
subsidy and profits to these private health insurance companies under 
Medicare Advantage? Ninety dollars a year, on average.
  So those who are defending the Medicare Advantage Program as we 
currently know it and don't support the reforms in this bill are also 
supporting a $90 annual tax on Medicare recipients. My fiscally 
conservative Republican friends who run against taxes every chance they 
have should reflect on the fact that they are protecting a tax on 
Medicare recipients. That, to me, is indefensible.
  Mr. WHITEHOUSE. Will the assistant majority leader yield?
  Mr. DURBIN. I am happy to yield to the Senator from Rhode Island.
  Mr. WHITEHOUSE. I just wanted to ask the distinguished assistant 
majority leader to yield for a question through the Chair. Since the 
distinguished assistant majority leader was here at the time, and I am 
newer to this body and was not here at the time when the Medicare 
Advantage Program was originally proposed, I wonder if the 
distinguished assistant majority leader would remind us of what the 
promises and assertions were that were made by the private insurance 
industry at that time as they sought this foothold to get their hands 
on this Medicare population.
  Mr. DURBIN. It was very basic, I would say to the Senator from Rhode 
Island through the Chair. They just said: Now, listen. When it comes to 
insurance, the government never gets it right. The bureaucrats who work 
for the government, those Federal employees, don't get it right. We do 
this for a living. We can show you how to provide Medicare benefits and 
save money. So, please, would you just step aside? The private health 
insurance companies are going to demonstrate to you how much money we 
can save.
  Initially, there were some savings; I will say that in fairness. But 
over the years, they got greedy, and their greediness led in most 
recent times to--I think in 2003, if I am not mistaken, with the 
Medicare prescription drug program, when they came in and these same 
private health insurance companies said: Now we really need subsidies 
to keep offering our wonderful programs, now they tell us they are 
charging 14 percent more than basic Medicare.
  The PRESIDING OFFICER. The Senator from Illinois has used 15 minutes.

[[Page S12306]]

  Mr. DURBIN. Mr. President, I ask unanimous consent for 5 additional 
minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BROWN. Mr. President, will the Senator yield?
  Mr. DURBIN. I am happy to yield.
  Mr. BROWN. I thank Senator Durbin for his recollection and Senator 
Whitehouse for his question and the comments and understanding of this. 
My recollection was back 10 years ago when it passed it was the 
insurance companies that said: We will do it 5 percent cheaper. We will 
save taxpayers 5 percent. But as soon as they did that, as soon as 
President Bush was elected in 2000, I remember they started lobbying 
Congress for more insurance subsidies. It sort of peaked in 2003 with 
the prescription drug deal giveaway where the drug companies and the 
insurance companies both got huge government subsidies. They formed the 
doughnut hole, and seniors ended up paying a lot more so the drug and 
insurance companies could get subsidies. Then that is when the tax was 
increased, that $90 tax, if I recall.

  Am I right about that, that originally it was actually a good thing 
for taxpayers, but then during the Bush years the insurance company 
lobby was able to increase that tax on the other 80 or 85 percent of 
Medicare beneficiaries, the people who were in what was called fee for 
service, who would go to the doctor, go to the hospital and submit to 
Medicare and not do it through a private insurance company? Is that 
what has happened?
  Mr. DURBIN. I would say to the Senator from Ohio that is exactly what 
happened because what we have is that in order to pay for the subsidy, 
the private health insurance companies that are selling Medicare 
Advantage, they had to take the money out of the Medicare system, which 
meant less money for everybody else. It translated into $90 a year more 
for every Medicare recipient to pay for the subsidy, for the private 
health insurance companies that are protected by Medicare Advantage.
  Mr. BROWN. If the Senator from Illinois would yield, so these 
subsidies then went directly to the insurance companies and then the 
insurance companies--they had to live under the Medicare laws, of 
course--but these insurance companies then began to insure generally 
some healthier people so they could make more money, right?
  Mr. DURBIN. That is right.
  Mr. BROWN. In those days, the insurance companies--Senator Whitehouse 
has talked often about this, as has Senator Harkin who is standing here 
now too--that the insurance companies' business model has been to hire 
a lot of bureaucrats. They say they are more efficient than Medicare, 
but surely they are not. Their administrative costs are 15 percent and 
Medicare is 5 percent. But they hire all of these bureaucrats to keep 
people from buying policies if they are sick--a preexisting condition--
and then they hire a second group of bureaucrats on the other end to 
make sure those people who submit bills for their health care, their 
claims, that 30 percent of them are initially denied. So they hire 
bureaucrats on both ends to restrict care, add a lot of administrative 
costs.
  Medicare, I don't think, prohibits people for a preexisting 
condition, right? They don't do anything like that.
  Mr. DURBIN. No. I would say to the Senator from Ohio the difference 
is obvious. With Medicare, anyone who shows up age 65 is eligible for 
coverage, no questions asked, other than your age and whether you have 
contributed over the course of your lifetime. These health insurance 
companies cherry-pick the healthiest people they can, then try to deny 
coverage where they can as well, and that is how they make their 
profits.
  Mr. BROWN. They are pretty good at it.
  Mr. DURBIN. So good at it that they are one of the most profitable 
sectors in the American economy, and virtually everybody knows somebody 
they work with or someone in their family who has had a bad experience 
with a health insurance company in America. That is the reality we are 
facing today.
  Mr. WHITEHOUSE. Mr. President, if I could ask the Senator to yield 
for a question, it would appear, then, that not only is there this 
subsidy that goes to the private insurance industry, funded by a tax on 
all other Medicare recipients, but those private insurance companies 
are actually doing their level best to try to pick out a 
disproportionately healthy Medicare-eligible population, so what we end 
up doing is not only paying more for Medicare Advantage but also for a 
healthier population. So it is a double subsidy.
  Mr. DURBIN. Make it a triple whammy because the third impact, of 
course, is that the healthier people are not part of Medicare. Those 
left in Medicare are sicker and more expensive, so the government-run 
program ends up being more expensive because those private health 
insurance companies cherry-pick out the healthiest people they can 
find.
  There are those who want to defend Medicare Advantage who think it is 
great that we would pay $170 billion in subsidies to these companies 
over a 10-year period of time. This bill moves us away from that and 
says if these private health insurance companies can't basically 
compete and match what government Medicare offers, then it is time for 
them to get out of the business and get out of the way. I don't see why 
in the world we are arguing about a subsidy for private health 
insurance companies when they already make so much money.
  So I would at this point yield the floor. I know Senator Hatch has 
asked for an hour to speak on his motion. I believe it is a motion to 
commit. I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah is recognized.
  Mr. HATCH. Mr. President, I thank my friend and colleague who has 
been making these extraordinary arguments on the Senate floor. I will 
spend a little bit of time chatting about those in just a minute.


                            Motion to Commit

  Mr. HATCH. Mr. President, I send a motion to commit with instructions 
to the desk and ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report the motion.
  The legislative clerk read as follows:

       The Senator from Utah [Mr. Hatch] moves to commit H.R. 3590 
     to the Committee on Finance with instructions to report the 
     same back to the Senate with changes that do not include 
     cuts in payments to Medicare Advantage plans totaling 
     -$120 billion.

  Mr. HATCH. Mr. President, I always enjoy my colleague from Illinois. 
He is as good a populist speaker as we have in the Senate. No matter 
what comes up, he can talk about it.
  I get a big kick out of him saying there are not any Republican 
bills. Well, there are six of them. You can get a hold of those bills. 
The problem is, we only have 40 votes, and we know it.
  The fact is, the more I thought about it, I thought to myself, where 
are the printed bills that we always have on our desks? Where is the 
Democratic printed bill? I am sure it is somewhere. Usually when we 
debate any bill on this floor, we have the bill printed and put on our 
desks. Maybe it has been printed, but it isn't on our desks, and I 
think there is a good reason for it. It is 2,074 pages long. It is 
enough to make you barf.
  When you stop and think about it, why do we need 2,074 pages when 85 
percent of persons basically like the health insurance they have? The 
other 15 percent, if you break it down, you get down to about 7 million 
to 15 million people who need our help.
  By the time you knock off those who work for a company that provides 
health insurance but they don't choose to take it because they would 
rather have the money or you take the approximately 11 million people 
who qualify for CHIP, the Child Health Insurance Program, or Medicaid, 
but aren't enrolled; or you take those who earn over $75,000 a year and 
just won't buy it but can afford it, or you take those undocumented 
workers or others who are legal aliens who for some reason do not have 
coverage, you get down to about 15 million people, at most. We can 
subsidize them, and we wouldn't have to throw our whole system out into 
the trash can--a system that 85 percent of the American people 
basically thinks is working relatively well for them.

  It seems crazy to me. Why are we doing that? Fifty percent of the 
people in this country basically don't pay

[[Page S12307]]

Federal income taxes as we sit here. The upper 50 percent pay 97 
percent of all income taxes. The bottom 50 percent pay about 3 or 4 
percent, at the very most. Think about that. What are we going to do--
go to 60 percent so that one side can keep the numbers here so they can 
stay in majority control? Are we going to get people to be more 
responsible for their own health care?
  On top of it all, they want a government plan. Why do they want that? 
Medicare is the government plan. For all intents and purposes, it is 
very well-intentioned, but it has $38 trillion in unfunded liabilities 
as we sit here--mainly because the Federal Government is running it. If 
the State governments ran it and we had 50 State laboratories, I doubt 
seriously we would be in this terrible fix. We are saddling our 
children and grandchildren and great-grandchildren with tremendous 
debt. What is their answer? We are going to take $464 billion--almost 
$500 billion--out of Medicare, and we are going to put it towards 
making our health plan deficit neutral.
  They have used every accounting and budgetary gimmick they can to get 
this plan below $1 trillion, because they charge taxes from the day it 
is passed, but the plan is not implemented for 4 years--until 2014. 
That way, they can try to indicate to the American people that they are 
bringing the cost of the bill in at under $1 trillion. That is a lot of 
money because today we are spending $2.4 trillion on health care, run 
primarily by the Federal Government--two-thirds of which is run by the 
Federal Government. I might add that there are estimates that $1.2 
trillion of that $2.4 trillion is wasted money. Yet we are going to add 
another $2.5 trillion, which is what this bill really costs if you 
extrapolate it out over 10 years and not just from 2014 to 2020. We are 
going to spend another $2.5 trillion, if you extrapolate it out. No 
wonder the American people are so up in arms. They ought to be. We are 
going to be spending $5 trillion on health care if my friends are 
successful in what they are doing. They know we have 40 votes, at most.
  I have been here a long time. Senator Lugar and I are the most senior 
Republicans on the floor of the Senate. We came at the same time. I 
have to say that, having been here all these years, we have never 
really had a fiscally conservative majority in the Senate, except 
through great Presidential leadership--Reagan, Bush 1, even President 
Clinton on occasion, and Bush 2. We have always had enough liberals on 
our side to go with the liberal Democrats so we have never really had a 
fiscally conservative majority. It would take 60 votes to get this 
country under control, from a spending standpoint.
  I appreciate the comments of my friend from Illinois about Medicare 
Advantage, but he is just plain wrong. Medicare Advantage has made a 
tremendous difference in the lives of almost 11 million Medicare 
beneficiaries. He failed to mention that the program has given choice 
to every Medicare beneficiary across the country, regardless of where 
they live. Medicare Advantage saves beneficiaries' dollars. Seniors 
have lower copayments, cost sharing, and deductibles through Medicare 
Advantage Programs. That is why many lower income seniors participate 
in the Medicare Advantage Program. Up to 25 percent of all seniors 
participate. Why? Because it works for them.
  I was on the Medicare modernization conference committee. We came up 
with it because beneficiaries living in rural America did not have 
access to Medicare HMO plans before Medicare Advantage was created. If 
my friends will take the time to listen to my statement on Medicare 
Advantage, I believe they will find it insightful and it will rebut 
most everything they are saying.
  Mr. President, the motion I just sent to the desk is to commit the 
Reid health care bill to the Finance Committee in order to eliminate 
the Medicare Advantage cuts of $120 billion contained in this 
legislation.
  I know I mentioned this point over and over again, but it bears 
repeating. Throughout the health care debate, we have heard the 
President say he is not going to mess with Medicare. Unfortunately, 
that is not the case with the Reid bill we are currently considering. 
To be clear, the Reid bill cuts Medicare by $465 billion to fund a new 
government program. Unfortunately, our seniors and the disabled will 
suffer the consequences as a result of these reductions.
  Throughout my Senate service, I have fought to strengthen, preserve, 
and protect Medicare. I think most Republicans have, in spite of what 
my colleagues say on the other side. Unless we are pouring money down 
the drain, they do not believe we are doing anything. Medicare is 
already in trouble today. The program faces serious challenges in the 
future. The Medicare trust fund will be insolvent by 2017. The program 
has more than $37 trillion in unfunded liability. The Reid bill will 
make this situation much worse.
  Look at the cuts to Medicare. Hospitals, cut $134.7 billion in this 
bill. Where are they going to get that money? How are we going to keep 
hospitals going in the future? Hospices, cut $7.7 billion. Nursing 
homes, cut $14.6 billion. I have been to all kinds of nursing homes in 
this country, and they have a rough time. We are going to take over $14 
billion from nursing homes, and they are critical to our senior 
citizens. For Medicare Advantage, $120 billion is coming out of the 
program. Home health agencies, $4.1 billion. So there is $135 billion 
from hospitals, $120 billion from Medicare Advantage, about $15 billion 
from nursing homes, more than $40 billion from home health care 
agencies, and close to $8 billion from hospice providers.
  These cuts will threaten beneficiaries' access to care as Medicare 
providers find it more and more challenging to provide health services 
to Medicare patients. And what is their argument? They say it is the 
awful insurance companies causing these problems. No, it is the awful 
Federal Government causing these troubles. It is the awful bureaucracy 
and the awful Federal Government that dominates all of our lives. If 
this bill passes, ``Katy, bar the door.'' Our lives will be completely 
controlled by the Federal Government on one-sixth of the American 
economy.
  Today, I want to focus my comments on the Medicare Advantage Program. 
It has been totally distorted by my colleagues, in my opinion--I am 
sure not intentionally. They would never do that.
  By the way, here is the bill. This is not the printed version; this 
is the bill. It is no small bill. It is one of the largest I have seen 
in my time here.
  Mr. President, I am strongly opposed to the deep cuts--$120 billion 
over 10 years--that the Reid bill would impose on the benefits of 
almost 11 million Medicare beneficiaries, Medicare beneficiaries who 
currently are enrolled in the Medicare Advantage Program.
  While they knock Medicare Advantage, they are pushing people toward 
the AARP Medigap insurance program. AARP makes hundreds of millions and 
billions of dollars off senior citizens. It is small wonder that AARP 
supports this monstrosity of a bill. It is in their best financial 
interest.
  As we consider the serious threat these cuts pose to seniors, I want 
to point out that during the Finance Committee markup this fall, we saw 
Senator Bill Nelson from Florida, and other Democrats, work to 
partially mitigate the impact of the bill's Medicare Advantage funding 
cuts. This effort, while taking very small steps, clearly demonstrated 
that a number of our Democratic colleagues recognize the value offered 
by Medicare Advantage plans and the danger of enacting the deep cuts 
proposed by the pending bill. Unfortunately, only a limited number of 
States would benefit from the Nelson amendment, so most Medicare 
Advantage beneficiaries are not protected from the cuts. But they 
recognize how important this program is.
  I also recall that 6 years ago, when Congress enacted the Medicare 
Modernization Act, we intentionally provided new funding to stabilize 
the Medicare health plan program. This was one of the few issues on 
which there was strong bipartisan agreement during the 2003 Medicare 
debate. I was here. I was on the conference committee. I happened to 
bring about that Medicare Modernization Act. In fact, in June 2003, 
several of our colleagues, including the Senator from New York and 
Senator Kerry from Massachusetts--great Democrats--offered a bipartisan 
amendment on the Senate floor to provide additional funding for 
benefits under the Medicare Advantage Program. Why would they do that 
if it

[[Page S12308]]

is such a lousy program? Now, all of a sudden, it is a lousy program 
because they want the money to be used for a massive, new government-
run program. Back then, they wanted additional money for Medicare 
Advantage, recognizing how important the program was.
  Later that year, as the Medicare conference committee completed its 
deliberations, a bipartisan group of 18 Senators signed a letter urging 
the conferees to provide a meaningful increase in Medicare Advantage 
funding. This letter was signed by a diverse group of colleagues, 
including Democratic Senators such as Dianne Feinstein from California, 
Christopher Dodd from Connecticut, Ron Wyden from Oregon, Frank 
Lautenberg from New Jersey, Patty Murray from Washington, Arlen Specter 
from Pennsylvania, Mary Landrieu from Louisiana, and Maria Cantwell, 
just to mention a few. It was bipartisan. They recognized how important 
this program was, and they recognized we were trying to solve major 
problems for people, especially in rural areas.
  I think it would be worthwhile to reflect back on the 2003 debate and 
remember the reasons this issue inspired such strong bipartisan 
consensus. You don't hear it at all from that side at all--after the 
program has proven its efficacy and that it works. We supported the 
Medicare Advantage plan 6 years ago. It was the right thing to do for 
beneficiaries. The same logic holds true today.
  We owe it to the beneficiaries to provide a strong, adequately funded 
program that provides them with high-quality health care choices. Every 
Medicare beneficiary can go into Medicare Advantage if they desire, 
under current circumstances.
  During the Finance Committee's consideration of the Baucus health 
bill, I offered an amendment to protect extra benefits currently 
enjoyed by Medicare Advantage beneficiaries. Unfortunately, the 
amendment was defeated. In other words, the President's pledge assuring 
Americans they would not lose their benefits was not met by either the 
Finance Committee bill or the Reid bill currently being considered by 
the Senate.
  Here is how supporters of the Finance bill justified the Medicare 
Advantage reduction: They argued that the extra benefits that would be 
cut, such as vision care and dental care for these poor people, reduced 
hospital deductibles, lower copayments and premiums, were not statutory 
benefits. They claim they were not statutory benefits offered in the 
Medicare fee-for-service program.
  Therefore, those extra benefits did not count, although a quarter of 
the Medicare beneficiaries were getting them from Medicare. But try 
telling them that they did not count to a Medicare Advantage enrollee 
who has been receiving these additional benefits.
  I want to talk about the differences between fee-for-service Medicare 
and Medicare Advantage. Because of the gaps in traditional Medicare, it 
is incumbent for most beneficiaries to buy a Medigap policy which wraps 
around the Medicare benefit. Guess who provides these Medicare 
policies, among others, but really in a big way. Why, the AARP.
  On average, these policies cost a couple hundred dollars a month. In 
comparison, the average monthly premium in a Medicare Advantage plan is 
$54 in 2009. These plans also fill in the coverage gaps of Medicare.
  Moreover, almost half of all Medicare Advantage beneficiaries are in 
plans that charge no monthly premium. Let me say that again. If you 
have to buy a Medigap policy for traditional fee-for-service Medicare, 
you will have to buy a policy that costs a few hundred dollars a month 
compared to Medicare Advantage plans which cost beneficiaries on 
average $54 a month in 2009. This is why several studies have shown 
that Medicare Advantage is one of the most popular choices for the low-
income elderly because they do not have to buy a Medigap policy.
  This week we have had Members on the other side of the aisle claim 
that Medicare Advantage is not part of Medicare. That is how far they 
have gone to distort the record. Again, I hope nobody was doing that 
intentionally and that it is a lack of knowledge about the Medicare 
program. Keep in mind, we have Members on the other side of the aisle 
who claim Medicare Advantage is not part of Medicare. It is absolutely 
unbelievable. I invite every Member making this claim to turn to page 
50 of the 2010 Medicare handbook. It expressly says:

       A Medicare Advantage Plan . . . is another health coverage 
     choice you may have as part of Medicare.

  That argument has been not only fallacious but should never have been 
made. The bottom line is simple. If you are cutting Medicare Advantage 
benefits, you are cutting Medicare. I raised this point yesterday, but 
I want to raise it again.
  Yesterday the distinguished Senator from Connecticut, my friend 
Senator Dodd, mentioned that the bureaucrat-controlled Medicare 
commission will not cut benefits in Part A and Part B. Once again, my 
friends on the other side are only telling you half the story. So much 
for transparency. On page 1,005 of this bill I can hardly lift, it 
states in plain English:

       . . . include recommendations to reduce Medicare payments 
     under C and D.

  Let me translate that in English for everybody. That means the 
commission can cut Medicare Advantage, which is Medicare Part C, and 
the Medicare prescription drug benefit which is Medicare Part D.
  Making sure that we take enough time to discuss a 2,074-page bill 
that will affect every American life and every American business is the 
sacred duty of every Senator in this Chamber. We must take the time to 
fully discuss this bill, and it is going to take some time, believe me.
  I have heard several Members from the other side of the aisle 
characterize the Medicare Advantage Program as a giveaway to the 
insurance industry. Let me say a few words about the creation of 
Medicare Advantage.
  I served, as I said, as a member of the House-Senate conference 
committee which wrote the Medicare Modernization Act of 2003. So did 
the distinguished Senator from Montana, Mr. Baucus. Among other things, 
this law created the Medicare Advantage Program. When conference 
committee members were negotiating the conference report, several of us 
insisted that the Medicare Advantage Program was necessary in order to 
provide health care coverage choices to Medicare beneficiaries.
  At that time, there were many parts of the country where Medicare 
beneficiaries did not have adequate choices in coverage. In fact, the 
only choice offered to them was traditional fee-for-service Medicare, a 
one-size-fits-all government-run health program, which I might add, did 
not work well. By creating the Medicare Advantage Program, we provided 
beneficiaries with choice in coverage and then empowered them to make 
their own health care decisions as opposed to the Federal Government. 
We gave them the empowerment to make their own decisions. That is 
unique around here. There will not be any empowerment if this bill 
passes. In fact, there are almost 2,000 decisions that the Secretary of 
Health and Human Services has the authority to make. You might like the 
current Health and Human Services Secretary today, but what if a good 
conservative gets in that position? Of course, it is very difficult 
because a good conservative would be filibustered.
  Today every Medicare beneficiary may choose from several health plans 
because of what we did through the Medicare Modernization Act of 2003. 
We should have learned our lessons from legislative changes made in the 
Balanced Budget Act of 1997 when we cut payments for Medicare HMOs. 
These plans collapsed, especially in rural areas, because Washington--
our wonderful people here in Washington--decided to set artificially 
low payment rates. In fact, in Utah, all Medicare HMOs eventually 
ceased operations because they were operating in the red.
  I fear history could repeat itself if we are not careful. During the 
Medicare Modernization Act conference, we fixed the problem. We 
increased reimbursement rates so that all Medicare beneficiaries, 
regardless of where they live, be it in Fillmore, UT, or New York City, 
had choice in coverage. Again, we did not want beneficiaries stuck with 
a one-size-fits-all government plan which, by the way, this monstrosity 
is.
  Today Medicare Advantage works. Every Medicare beneficiary has access 
to a Medicare Advantage plan if they

[[Page S12309]]

so choose. One-quarter of them have so chosen, and it has worked 
amazingly well. Close to 90 percent of Medicare beneficiaries 
participating in the program are satisfied with their health coverage, 
but that could all change should this health care reform legislation 
currently being considered become law. Choice in coverage has made a 
difference in the lives of more than 10 million Americans nationwide. 
Beneficiaries in every State have benefitted from Medicare Advantage.
  Let me show you some things here. Since this is very difficult to 
read on television, let me go through all these States. These charts 
show the number of Medicare Advantage beneficiaries in each state.
  Alabama has 181,304 people on Medicare Advantage; Alaska, 462; 
Arizona, 329,157; Arkansas, 70,137; California, 1,606,193; Colorado 
198,521; Connecticut, 94,181; Delaware, 6,661; the District of 
Columbia, 7,976. How about Florida--946,836, almost 1 million people on 
Medicare Advantage. Good reason. It works. Georgia, 176,090; Hawaii, 
79,386; Idaho, 60,676; Illinois, 176,395; Indiana, 148,174; Iowa, 
63,902 people enrolled in Medicare Advantage.
  Let's proceed further. Kansas, 34,867 people enrolled in Medicare 
Advantage; Kentucky, 110,814; Louisiana, 151,954; Maine, 26,984; 
Maryland, 56,812; Massachusetts, 199,727; Michigan, 406,124; Minnesota, 
284,101; Mississippi, 44,772; Missouri, 195,036; Montana, 27,592; 
Nebraska, 30,571; Nevada, 104,043; New Hampshire, 13,200; New Jersey, 
156,607; New Mexico, 73,567; look at New York, 853,387; North Carolina, 
251,738 people enrolled in Medicare Advantage who love the program; 
North Dakota, 7,633; Ohio, 499,819. Gee whiz, that is a lot of people 
who are satisfied with Medicare Advantage. Oklahoma, 84,980; Oregon, 
one of the most liberal States in the Union, 249,993; Pennsylvania, 
864,040; Puerto Rico, even 400,991; Rhode Island, 65,108; South 
Carolina, 110,949--these are senior citizens--South Dakota, 8,973; 
Tennessee, 233,024; Texas, 532,242; my own State of Utah, 85,585; 
Vermont, only 3,966, but 3,000 people, 4,000 people in Vermont; 
Virginia, 151,942; Washington, 225,918; West Virginia, 88,027; 
Wisconsin, 243,443; and Wyoming, 3,942.
  These are people who benefit from Medicare Advantage who would not 
like to lose their current health coverage.
  This choice in coverage has made a difference in the lives of more 
than almost 11 million people, 11 million individuals nationwide and 
families who benefit from this program. The extra benefits I mentioned 
earlier are being portrayed as gym memberships as opposed to lower 
premiums, copayments, and deductibles.
  Let me read some letters from my constituents. These are real lives 
being affected by the cuts contemplated in this bill. You should see 
some of the beautiful handwriting. Some of it is very shaky but 
beautiful, to me anyway.
  From Cedar City, UT:

       Senator Hatch, I am writing you to request your help in 
     preserving our Medicare Advantage plans from being cut.
       My Medicare Advantage plan provides me with benefits and 
     savings that traditional Medicare did not provide.
       I like my plan very much. It allows me my choice of 
     Doctors, Hospitals and various specialists if needed.
       I do not want to see a single national Health Care Plan.
       I do not want cuts in Medicare Advantage Programs.
       Senator Hatch, when you go to Washington, DC, please do not 
     cut our Medicare Advantage Programs.
       Vote to maintain our present system. Thank you for your 
     service.
       Sincerely. P.S.--I speak for my husband, too.

  I bet.
  Here is another one:

       Honorable Senator Hatch: Please do not vote for any bill 
     which would compromise my Medicare Advantage plan. I am 92 
     years old, and of necessity worked until I was 87, and have 
     taken pride in being self supporting. I had to retire six and 
     a half years ago because of pancreatic cancer. Amazingly, I 
     recovered and live an active, useful life. My Medicare 
     Advantage plan makes the difference between living with self 
     respect and having to depend on others. Once again, I beg of 
     you--don't deprive me of my self respect. Let me keep my 
     Medicare Advantage plan. Sincerely.

  Here is another one:

       Dear Senator, we understand our President and Congress 
     wants to eliminate the Medicare Advantage program for the 
     elderly.
       We were both on Blue Cross/Blue Shield program for several 
     years, costing us hundreds of dollars each year. Since we 
     joined the Medicare Advantage program it provides dental, 
     fitness, vision, and full medical coverage. The cost of this 
     program has saved us hundreds of dollars.
       Please don't let them take this program from the elderly 
     who are on low fixed incomes and will cause us further 
     problems. We ask you for your support to save the Medicare 
     Advantage program.

  Here is another one:

       Dear Senator Hatch, it has again been brought to my 
     attention that the Administration is seriously considering 
     cutting the funding to the Medicare Advantage program. I 
     would like to encourage you to oppose these funding cuts 
     because of the negative repercussions seniors and those with 
     disabilities will suffer if they lose a program due to 
     insufficient funding.
       [Medicare Advantage] health plans give individuals the 
     freedom to afford the care they need. The premiums and out-
     of-pocket costs are allowing recipients to save money on 
     regular doctor visits as well as medication. These savings 
     are essential for someone on a low fixed income like many of 
     the individuals who participate in the program.
       If Congress continues to cut the [Medicare Advantage] 
     program, beneficiaries will not only be forced to pay higher 
     premiums and higher out of pocket costs but will also lose 
     the unique benefits that the [Medicare Advantage] health 
     plans offer, such as disease management and preventive care, 
     which reduce their daily discomforts and help them avoid 
     unnecessary hospital visits.
  What about this one?

       As a retired voter in your state, I would ask you to please 
     do all that you can to eliminate the proposed cut in Medicare 
     Advantage funds in the proposed Senate bill. You have 
     demonstrated the sensitivity for the elderly in our state. I 
     hope you continue to take our needs as fixed income residents 
     into consideration.

  How about this?

       I am greatly concerned about efforts to reduce benefits to 
     the Medicare Advantage plans. I am a member of the Humana 
     plan. It has been working for me because of the low premiums, 
     low deductibles and co-pays, wellness and enhanced preventive 
     benefits, and coordinated care and disease assistance 
     programs. I have been unemployed for over a year now for 
     several reasons, among them my age, I am sure. I received a 
     monthly $527 social security check as my only income. I can 
     survive only because I am living with my son and family. 
     Please do what you can. Thanks so much.

  Here is another one:

       Dear Senator, I realize times are tough, but my medicare 
     advantage plan through DMBA is a real blessing to me. I'd 
     like to think that with all the talk of health care change, 
     that plans that are working now would not be abandoned, or at 
     least replaced with something as good, or better. Please 
     think carefully and with sincere prayer, about the 
     consequences to old retired people like me, before you vote 
     on these issues. Thank you.

  He recommends that I pray--which I do--about this.
  Here is another one:

       We like the Medicare Advantage Plan. Seniors need to have a 
     choice in health care, and help in keeping that program. 
     Medicare seems to always be cutting benefits for seniors. 
     Have you talked to seniors lately? Doctors are not accepting 
     anyone on Medicare and turn them away. This is an issue that 
     needs to be addressed in health care. Keeping the Medicare 
     Advantage Plan helps doctors accept a patient that has 
     Medicare. Without an additional supplemental plan, seniors 
     are in trouble with health care physicians. Please don't 
     cause more suffering for seniors by cutting the Medicare 
     Advantage programs.

  Here is one:

       Senator, we implore you to not allow the Medicare Advantage 
     Plan to be compromised. As seniors, on fixed incomes, my 
     husband and I find the monies, which have soared in 2009/2010 
     to allow us to participate in the Medicare Advantage Plan. 
     Please see that this plan will remain available to all 
     seniors with the same coverage. Sincerely.

  Here is one:

       As retired, fixed income, senior citizens we benefit by and 
     rely on a Medicare Advantage Plan. We cannot afford the 
     premiums that the Medigap insurance would cost if the 
     Advantage Plans were not available. If not for our Advantage 
     Plan, we would now be financially destitute because of the 
     cost of my husband's health care these last 2 years. Without 
     our Advantage Plan, we would not be able to afford yearly 
     physical exams and preventive care. We also benefit from the 
     Silver Sneakers exercise program as part of our plan. Senator 
     Hatch, we urge you in any new health care plan, to: Keep 
     Medicare Advantage Plans available; provide no government 
     option/single payer; give no health care for illegals; fix 
     the existing health system before adopting something new.

  Here is another one:

       Medicare Advantage Plans work great. Please don't let 
     President Obama take them from us.

  Here is another one:

       We are Republicans from the State of Utah. Our concerns 
     have to do with the

[[Page S12310]]

     Medicare Advantage Program as offered currently to senior 
     citizens and participants in Medicare. Part of this plan 
     includes our participation in the Silver Sneakers Program 
     which gives us the opportunity to use the local recreation 
     center in Roy, UT. Our current Medicare Advantage Program 
     covers the cost of the Silver Sneakers Program. Daily use of 
     the Roy Recreation Center would be prohibitive to us if we 
     had to carry the burden of the cost of this program. Thus, we 
     encourage you to keep in mind these concerns as any health 
     plan is proposed in Congress over the next few months. Thank 
     you for your consideration in this matter. Please let us know 
     your position in this matter.

  How about this one?

       I would like you to support the medicare advantage system 
     and vote against any cuts to the advantage system. I am a 
     member of the Humana Advantage program and very happy with 
     the program. They provide additional benefits over Medicare 
     with no additional cost, which is a direct financial 
     advantage to seniors.

  Let me just read one more. I have so many of these I could go on for 
hours, but let me just read one more.

       I'm very concerned about the President's determination to 
     do away with ``Medicare Advantage.'' My coverage is with 
     DMBA, which is a nonprofit. It is my understanding DMBA 
     actually pays some medical expenses over and above what 
     Medicare authorizes. In addition, they administer the whole 
     plan, which means I don't have to deal with Medicare 
     directly. I feel that the amount of premium I pay to DMBA is 
     worth these benefits. I'm willing to bet that Medicare costs 
     will increase, if they have to start spending time dealing 
     with seniors who currently have this kind of third party 
     intervention. If there are really 10 million seniors who have 
     ``Medicare Advantage,'' how can any of the members of 
     Congress vote to eliminate it? Thanks, so much, for your time 
     and efforts.

  Well, I think that last letter kind of sums it up. How can anybody 
vote to do away with the Medicare Advantage Program?
  Just to be clear, the SilverSneakers Program--which has been much 
maligned by the other side, who helped to enact the program, and who 
talk about prevention and care all the time--is one that has made a 
difference in the lives of many seniors because it encourages them to 
get out of their homes and remain active. It has been helpful to those 
with serious weight issues and valuable to women suffering with 
osteoporosis and joint problems.
  In fact, I have received several hundred letters telling me how much 
Medicare Advantage beneficiaries appreciate the program. I would like 
to read a couple of those letters at this time, if I can. I will just 
read a few of them because there are many letters.

       I recently have suffered from a heart attack and now 
     receive treatment as a member of the Silver Sneakers. Being a 
     part of the Silver Sneakers has helped my life immensely. The 
     treatment I receive at the Silver Sneakers has readily 
     increased my quality of life after my heart attack. I hope 
     the funding for Silver Sneakers is not cut.

  Well, that is Medicare Advantage. Here is the last I will read on the 
list.

       I would like to express to you the need for the 
     SilverSneakers program to continue. I have participated in 
     this program for about 3 years now. I cannot begin to tell 
     you the difference it has made since joining the program. I 
     have not felt better health wise since joining the 
     SilverSneakers program. My overall wellbeing both physically 
     and mentally have improved. I go to the gym 3 times a week. I 
     look forward to this physical activity. I feel physically 
     better and my joints and body are in better shape than ever. 
     I feel I have improved my immune system and go to the doctor 
     less than when I did not participate in this program. I am 
     retired with a fixed income and it would be difficult for me 
     to have to pay for a gym membership if this program were to 
     be eliminated. So I ask you to please consider keeping this 
     program.

  Look, the SilverSneakers Program is a prevention and wellness 
program, and almost all of us--if we are really honest about it--would 
admit that if we could get our seniors out there walking and exercising 
and doing the things that will help them to stay vibrant, alert, and 
physically well, it would save us billions of dollars. It is a very 
well-thought-out program, but it is a small part of Medicare Advantage. 
I thought I would cover it since it has been so maligned by some. If 
you read at least the HELP bill, there are a lot of provisions on 
wellness and prevention.
  Well, in conclusion, I cannot support any bill that would jeopardize 
health care coverage for Medicare beneficiaries, and I surely believe 
if the bill before the Senate becomes law, Medicare beneficiaries' 
health care coverage could be in serious trouble.
  I have been in the Senate for over 30 years. I pride myself on being 
bipartisan. I have coauthored many bipartisan health care bills since I 
first joined the Senate in 1977. As much as anyone in this Chamber, I 
want a health reform bill to be enacted this year. Every Republican 
does. But we want it to be bipartisan. We want it to be something both 
sides can support, such as the CHIP bill, which had a huge bipartisan 
vote. This is one-sixth of the American economy. If it doesn't get 75 
to 80 votes, it is a lousy bill. I want it to be done right. History 
has shown if it is done right, it needs to be a bipartisan bill that 
passes the Senate with a minimum of 75 to 80 votes.
  We did it on the CHIP bill and on Hatch-Waxman. We did it on a whole 
raft of bills in which I have been a major player. There has never been 
a bill of this magnitude affecting so many American lives that has 
passed this Chamber on an almost straight party-line vote, or maybe 
just a straight party-line vote.
  The Senate is not the House. This body has a different constitutional 
mandate than the House. We are the deliberative body. We are the body 
that has, in the past--and should today--worked through these difficult 
issues to find clear consensus. True bipartisanship is what is needed. 
In the past, the Senate has approved many bipartisan health care bills 
that have eventually been signed into law. I mentioned a few: the 
Balanced Budget Act of 1997 which included the CHIP program--that was a 
Hatch-Kennedy bill--the Ryan White Act, I named the bill after Ryan 
White who died from AIDS, with his mother sitting right in the 
audience. I stood on the Senate floor and named it the Ryan White Act. 
And the Orphan Drug Act, the Americans with Disabilities Act, the 
Hatch-Waxman Act, which created the modern generic drug industry. These 
are just a few of the success stories. I could go through many, many 
others.
  If the Senate passes this bill in its current form with a razor-thin 
margin of 60 votes or thereabouts, this will become one more example of 
the arrogance of power being exerted since the Democrats secured a 60-
vote majority in the Senate and took over the House and the White 
House.
  I dream someday of having the Republicans having 60 votes. I tell you 
one thing, I think we would finally have the total responsibility to 
get this country under control, and I believe we would be successful. 
There are essentially no checks or balances found in Washington today, 
just an arrogance of power with one party ramming through unpopular and 
devastating proposals one after the other.
  Let me talk now about other negative impacts of this bill, at a time 
when we are in a terrible recession, with the current unemployment rate 
at 10.2 percent. And if you take away some of the part-time and some of 
the other statistics, we are at an effective 17 percent unemployment 
rate.
  The Reid bill is a job killer. It has a disproportionate impact on 
small businesses. This 2,046-page bill contains nearly one-half 
trillion dollars in new taxes, fees, and penalties that will 
disproportionately affect small businesses, which are the job-creating 
engine and the lifeblood of our economy. Seventy percent of all jobs 
are created by the small business sector, and actually more if you 
really look at it.
  According to a recent National Federation of Independent Businesses 
Survey, at least 50 percent of small businesses pay taxes at the 
individual level through owners that report income of more than 
$200,000 and will be hit hardest under the Democratic tax-and-spend 
plan with their mandate--their job-killing employer mandate--in this 
bill. This is small business. This is not the large corporate world. It 
is small business where most of the jobs are generated. Every dollar 
lost to new taxes on these businesses will be a dollar taken away from 
job creation.
  The Reid bill includes a job-killing employer mandate. More 
specifically, it contains a $28 billion new tax penalty on employers 
for failing to provide coverage. Economists and CBO both agree that 
this will hurt employee wages and job creation. That is economists and 
CBO--the Congressional Budget Office. According to the Congressional 
Budget Office, although this new tax is levied on the employers, it is 
the ``workers in those firms who would ultimately bear the burden of 
those fees'' in the form of reduced compensation.

[[Page S12311]]

  The Center on Budget and Policy Priorities has stated that the 
employer mandate will have a disproportionate impact on hiring 
practices for low- and moderate-income families. This is the most 
important segment in need of help.
  The Reid bill increases the Medicare payroll tax. In fact, it imposes 
a $54 billion payroll tax increase at a time when we as a nation are 
struggling with an unemployment rate of 10.2 percent and an 
underemployment rate that I have been speaking about of 17.5 percent.
  In addition, the Reid bill fails to lower premiums. Instead of 
lowering skyrocketing health care premiums for small businesses across 
the Nation, this $2.5 trillion bill, according to the Congressional 
Budget Office, will largely maintain the status quo of 5 percent to 6 
percent yearly increases in premiums for small businesses. Why? A 
combination of heavyhanded regulations and a laundry list of new taxes 
on everything from health plans to prescription drugs, to medical 
devices which, according to the Joint Committee on Taxation, will 
simply be passed on to the consumers.
  The Reid bill creates another brandnew Washington-run plan. This 
Washington-run plan comes at a time when families and businesses with 
private insurance are already paying as much as $1,800 a year more in 
premiums, which is nothing more than a hidden tax to make up for the 
underpayment by government programs such as Medicare and Medicaid to 
health care providers. It is no secret some doctors are not willing to 
take Medicare patients and even Medicaid patients because of the 
reimbursement rates, among others things, because of the bureaucracy--
the bureaucratic problems. Creating another government-run program will 
only increase this hidden tax on families and small businesses to keep 
the private coverage of their choice, and I believe it is important for 
my colleagues to hear what businesses are saying about the Reid bill.
  The National Federation of Independent Business, the premier small 
business organization in the country, says:

       The Senate Bill Fails Small Business.

  The U.S. Chamber of Commerce:

       U.S. Chamber stresses disappointment with Senate health 
     bill.

  The National Association of Wholesaler-Distributors:

       Wholesaler-Distributors say ``No'' to the Reid Health Bill.

  The Small Business Entrepreneurship Council:

       Small Business Group Says Reid Health Bill More of the 
     Same: More Taxes, Mandates, Big Spending and Nothing to Help 
     Lower Health Insurance Costs.

  The Associated Builders and Contractors--great employers in this 
country:

       ABC Critical of Senate Democratic Health Care Bill.

  The National Association of Manufacturers:

       NAM says Congress is Taking Health Care Reform in the Wrong 
     Direction.

  The Independent Electrical Contractors sent a letter of opposition to 
every Senator.
  The International Franchise Association:

       Franchise Businesses Oppose Senate Healthcare Reform 
     Efforts.

  There is a better way to handle health care reform. For months, I 
have been pushing for a fiscally responsible and step-by-step proposal 
that recognizes our current need for spending restraint, while starting 
us on a path to sustainable health care reform. There are several areas 
of consensus that can form the basis for sustainable, fiscally 
responsible, and bipartisan reform. We have a lot ideas over here for 
reforming the health insurance market for every American by making sure 
no American is denied coverage simply based on a preexisting condition; 
protecting the coverage for almost 85 percent of Americans who already 
have coverage they like by making that coverage more affordable. This 
means reducing costs by rewarding quality and coordinated care, giving 
families more information on the costs and choices of their coverage 
and treatment options, discouraging frivolous lawsuits, and promoting 
prevention and wellness measures.
  By the way, the other side is not willing to do anything on tort 
reform that some estimate may be costing us as much, in unnecessary 
costs, as $300 billion a year.
  Giving States flexibility to design unique approaches to health care 
reform. Utah is not New York and New York is not Utah.
  As we move forward on health care reform, it is important to 
recognize that every State has its own unique mix of demographics and 
each State has developed its own unique institutions to address its 
challenges and each has its own successes. I believe in 50 State 
laboratories, where the States may be given the money by the Federal 
Government, but they solve their own problems with their own 
demographic needs and fitting their own demographic needs, rather than 
a one-size-fits-all big Federal Government program which is what this 
bill creates.
  There is an enormous reservoir of expertise, experience, and field-
tested reform in the States. We should take advantage of those 
experiences by placing States at the center of health care reform 
efforts so they may use approaches that best reflect their needs and 
challenges.
  My home State of Utah has taken important and aggressive steps toward 
sustainable health care reform. The current efforts to introduce a 
defined contribution health benefit system and implement the Utah 
health exchange are laudable accomplishments. A vast majority of 
Americans agree that a one-size-fits-all Washington solution is not the 
right approach. That is what this bill is bound to foist on us.
  Unfortunately, the path we are taking in Washington right now is to 
simply spend another $2.5 trillion of taxpayer money to further expand 
the role of the Federal Government. I do not know many people who 
believe that is what we should do. I wish the majority would take a 
step back, put their arrogance of power in check, and truly work on a 
real bipartisan bill that all of us can support, or at least a good 
percentage of us can support--not just one or two Republicans.
  The first step in achieving bipartisanship is to support my motion to 
commit this bill so Medicare Advantage beneficiaries may keep the 
benefits they currently enjoy through Medicare Advantage plans. To me, 
it is only fair that the legislation we are currently considering hold 
true to the President's promise to the American people that if they 
like what they have they may keep it.
  I urge my colleagues to support my motion to commit so that promise 
will also apply to Medicare Advantage beneficiaries who have benefitted 
greatly from what we did in a bipartisan way just a few years ago. I 
might add, some of these outside groups have a stake in killing it 
because they can make more money on senior citizens. It is not hard to 
see why they are behind this great big, huge 2,074-page monstrosity of 
a bill. No wonder they don't place this bill on every desk. Maybe they 
will. When they do, they will probably put two pages on one sheet so it 
will look a little bit smaller.
  But it ought to be on every desk. We can even thumb through it while 
we are debating and while others are talking. Think what that would do 
for all of us Members of the Senate if we thumbed through some of the 
things we are doing to America. Remember, this is one-sixth of the 
American economy. We could wreck our country with this bill if we pass 
it. By passing it, we would turn our future 100 percent over to the 
Federal Government that has already put these two wonderful programs, 
Medicare and Medicaid, almost in bankruptcy. Those programs can be 
better, there is no question. But they are run by Washington, so 
naturally we are going to call on taxpayers, over and over again, to 
fund the excesses these bureaucracies in Washington impose on all of 
us.
  The PRESIDING OFFICER (Mr. Begich). The time of the Senator has 
expired.
  Mr. HATCH. I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island is recognized.
  Mr. WHITEHOUSE. I know the Senator from Pennsylvania wishes to speak 
very shortly, and I will yield to him when he is present on the floor. 
But I did wish to react to two points that were made by the very 
distinguished Senator from Utah. I say that with true sincerity. He has 
been a friend to me since I have been in the

[[Page S12312]]

Senate. He sets a very valuable standard in this institution for 
collegiality and dignity and bipartisanship and scholarliness, and he 
comes from an extremely distinguished career, prior to his 
distinguished career in the Senate, as a lawyer, a leader of the Utah 
bar.
  But I do think that, as easy as it is to make fun of a 2,074-page 
bill, the House bill, which is not significantly different in scale 
from this bill, was reviewed. If you look at the substantive language 
in it--in a bill, of course, there is a lot of language that simply 
connects things into place and is tables and indexes and things such as 
that. If you look at the actual language you would read if you were 
interested in the substance of the bill on the House side and do a word 
count on it, it has fewer words than a ``Harry Potter'' novel. I don't 
think it is too much to expect that Members of the Senate should be 
prepared to leaf through the equivalent of a ``Harry Potter'' novel 
when they are embarking on as significant an effort and endeavor as we 
are in reforming the health care system. I think it was about 256,000 
words, if I am not mistaken. It is smaller print, admittedly, than a 
``Harry Potter'' book because of the way in which the bill is presented 
in its traditional format. It is very few words per page, so it looks 
big and one can make very entertaining demonstrations with it on the 
floor. When you actually get down to reading it, it is about the same 
as plowing through--actually less than plowing through a ``Harry 
Potter'' novel, and I don't think that should be too much to expect.
  I also suggest the reason for the lack of current bipartisanship on 
this bill might very well be the arrogance of power of the Democratic 
majority--it might be. But I would suggest the facts might also support 
a different hypothesis. If you look back at the history of the 
development of this bill, it began on a very bipartisan note. It began 
with Senator Baucus's ``prepare to launch'' program at the very 
beginning of the year, a full-day, bipartisan effort to begin to focus 
on the delivery system reform issues. It began with a bipartisan group 
negotiating in the Finance Committee. It began with a HELP Committee 
bill that allowed for 161, I believe was the number, Republican 
amendments in a very open and completely bipartisan process.
  Then along came August and the townhall meetings and the beginning of 
the radicalization of the Republican Party. We heard, out of that 
process, charged buzz words such as ``death panels,'' ``socialized 
medicine,'' ``benefits for illegal immigrants,'' ``rationing of 
care''--all these words that incite and inflame passions but make no 
reasoned case and advance no helpful alternative.
  We saw those words and those arguments presented with a crudeness and 
a venom that are frankly new to American politics; for example, the 
President portrayed with a Hitler mustache. I don't recall, for 8 
years, President Bush ever being portrayed with a Hitler mustache. Poor 
President Obama comes in and within his first months people are running 
around America portraying him with a Hitler mustache because we want to 
reform health care.
  Certainly, there are a great number of us who believed President Bush 
was less than truthful when he came and spoke to us about Iraq and 
other subjects, but nobody yelled out ``You lie.'' In President Obama's 
first appearance, he was heckled from the floor of the Congress of the 
United States.
  This September, after the tea bag group and after the townhall death 
panel group had become active, 179 Republicans in the House of 
Representatives of the Congress of the United States voted to support 
their heckler comrade.
  Something changed with the radicalization of the Republican Party, 
and I am not the only one to have noticed this. A very well-regarded 
Philadelphia columnist wrote recently of the Republican right:

       If they can get some mileage . . . nothing else matters.

  The columnist went on to decry what he called ``the conservative 
paranoia'' and ``lunacy'' afoot in our national debate.
  The editor of the Manchester Journal Inquirer editorial page wrote of 
the GOP, which he called ``this once great and now mostly shameful 
party,'' that it ``has gone crazy,'' that it is ``more and more 
dominated by the lunatic fringe,'' and that it has ``poisoned itself 
with hate.'' He concluded, they ``no longer want to govern. They want 
to emote.''
  The respected Maureen Dowd of the New York Times, in her column 
eulogizing her friend, the late William Safire, lamented the ``vile and 
vitriol of today's howling pack of conservative pundits.''
  A Nobel Prize-winning economist has said:

       The takeover of the Republican Party by the irrational 
     right is no laughing matter. Something unprecedented is 
     happening here, and it's very bad for America.

  A well-regarded Washington Post writer with a quarter century of 
experience covering government and politics, married to a Bush 
administration official--we are hardly talking about commentary from 
the leftward fringe--has noted about the House health care bill and the 
arguments surrounding it ``the appalling amount of misinformation being 
peddled by its opponents.'' She called it a ``flood of sheer factual 
misstatements about the health-care bill.'' She noted that ``[t]he 
falsehood-peddling began at the top'' of the Republican Party. Her 
ultimate question was this:

       Are the Republican arguments against this bill so weak that 
     they have to resort to these misrepresentations and 
     distortions?''

  Even the respected head of the Mayo Clinic has recently described the 
health care antics we have witnessed as ``mud'' and ``scare tactics.''
  It is possible, as the distinguished Senator from Utah suggests, that 
the reason bipartisanship is elusive is because Democrats have been 
gripped by the arrogance of power. But as somebody who has been witness 
to intense efforts to try to recruit Republican support for this bill, 
the evidence at least as well supports the theory that something has 
happened to the Republican Party in the past months, as the radicalized 
Republican right has emerged and taken over and provoked all of these 
responses from respected, neutral, seasoned veterans observing the 
political scene. I suggest that is at least a possibility.
  I would like to change topics for a moment, given that Senator Casey 
is not present, and make an additional point that I believe merits 
mention. I will yield as soon as he appears to have arrived.
  Mr. HATCH. Will the Senator yield for a second?
  Mr. WHITEHOUSE. I am delighted to yield.
  Mr. HATCH. I would like to have a few minutes to wrap up.
  Mr. WHITEHOUSE. Of course. How long would the Senator wish?
  Mr. HATCH. I think I can do it in less than 5 minutes.
  Mr. WHITEHOUSE. I yield 5 minutes to the distinguished Senator from 
Utah right now.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. WHITEHOUSE. Would the Senator yield back for one moment?
  Mr. HATCH. Surely.
  Mr. WHITEHOUSE. I had the opportunity to be on the floor yesterday, 
and the time was all under agreement. My time was concluded, and I was 
leaving the floor. The Senator from Utah had the occasion to offer some 
very kind words about me. Because of the procedural posture we were in, 
I did not have the chance to reply or respond at that time. This is the 
first time we have been on the floor together since then, when I have 
had the chance to have the floor, and I do want to let him know how 
much I value what he had to say. I know there are very well-established 
standards of protocol here in which we say nice things about each 
other, but I felt that what he had to say was not just protocol but was 
sincere and heartfelt, and it really does mean a lot to me and is 
reciprocated on my part.
  I think Senator Hatch brings enormous, as I said earlier, dignity, 
erudition, principle, collegiality--many good characteristics to the 
floor. He is a force for good in this body, and I am delighted to have 
him count me a friend.
  I yield him the next 5 minutes.
  Mr. HATCH. I thank my colleague. I appreciate the eloquence of my 
dear friend. I am going to find fault with some of the things he said, 
but I have to say I am grateful to have the distinguished Senator from 
Rhode Island with us. He is one of the great additions to the Senate, 
in my opinion, a

[[Page S12313]]

very good lawyer who has had tremendous experience in State government. 
It is amazing to me that he is supporting this awful bill, this 
monstrosity of a bill. But I can live with that. I have seen a lot of 
decent, honorable people be deceived by their desire on the Democratic 
side to continue to build the Federal Government at the expense of the 
States and everybody else. I will say this: I really enjoy my 
colleague. I have a lot of respect for him.
  I have to take issue with his ``Harry Potter'' comments. Just think 
about that. I like the fact that the distinguished Senator from Rhode 
Island compares this bill here to a ``Harry Potter'' novel. That is, 
perhaps, pretty appropriate because both of them are what I consider to 
be works of fantasy and fiction. This thing has 14 pages as a table of 
contents alone. Notice how my voice goes up as I am holding it; it puts 
that much pressure on your speech diaphragm. I just wish it was as 
valuable and would be as valuable to the American people as the ``Harry 
Potter'' novels have been.
  Let me say one last thing before I close and leave the floor. I 
appreciate my colleague. I appreciate his graciousness in all ways. We 
have worked closely together on the Intelligence Committee and the 
Judiciary Committee and in many other ways. I think he is one of the 
great additions to the Senate. In spite of his dogged determination in 
support of this awful bill, I still think greatly and very highly of 
him.
  Let me make a few things clear to my Democratic colleagues. I am not 
a great believer that we should follow polls at all, but I think it is 
interesting to see what the American people are thinking. My colleagues 
seem to think that some of these people who did the tea parties and 
some of these other things are rightwing crazies. I know a lot of them. 
They are really good people. They are up in arms, and they are really 
upset. They are people from all walks of life. Some of them are very 
far right. Some of them are far left. The fact is, they are sincere. 
They feel what is going to happen here is a denigration of the country.
  Unfortunately, I feel the same way. The more we rely totally on the 
Federal Government, the worse off this country will be. My colleagues 
love the Federal Government. I love it too. I would love to keep it in 
its place. It is much easier to control things when you control them 
through Washington. However, it is also a way of stifling good ideas if 
you do not have the best benefits of the 50 State laboratories that our 
Federalist system actually provides.
  I noticed in a recent Gallup poll, 53 percent of the Independents are 
opposed to this bill. Gallup has been polling for years, is it not 
Republican or Democratic. These are Independents. Thirty-seven percent 
support the bill. These are not radical Americans, these are 
Independents. They are just tired of the tax-and-spend policies of 
Washington, DC. There are people in both parties who are guilty of 
pushing for those types of policies.
  I have to say Democrats are much better at spending Federal dollars 
than Republicans in the sense that they spend a lot more of them. 
Democrats are not better in watching them either.
  Even a Kaiser poll, which is anything but conservative, had 59 
percent of the people in this country opposed to this bill.
  If I were a Democrat, I would be a little concerned about the 
Independents. They are not crazies. They are not people who are out of 
line. And neither are these conservatives who are up in arms.
  I recently met with a number of the tea party representatives in 
Utah. They are fiscal conservatives. They are very concerned. I also 
met with representatives of the so-called 912 Group. They are more 
concerned with social issues as well as economic issues. They are well-
intentioned, well-thought-out people who are sick and tired of what is 
happening here in Washington. The only way they can really get their 
ideas heard is by raising cane about it. Frankly, I think they are 
right to do so.

  We all better stop and take a look at these things and see if we can, 
as honest, decent Democrats and honest, decent Republicans, get 
together to come up with a bill that has broad bipartisan support of at 
least 75 to 80 Senators. I would like it to be more. But that is what 
we need to do. This current bill is not the way to get there.
  I thank my colleague for his gracious remarks about me. I feel 
exactly the same about him. He is a good colleague, a wonderful 
attorney, and a great addition to the Senate. I intend to work with him 
in every way I can. I just think if he would just tell his side: We are 
going to sit down, we are going to work this out, I think we would get 
it done.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, I see the distinguished Senator from 
Iowa as well as the distinguished Senator from Pennsylvania. Whichever 
one of them would like to proceed, I am prepared to yield. It looks as 
if it will be the distinguished Senator from Iowa.
  I had the very great honor of serving on the HELP Committee during 
the time that the HELP Committee section of this bill was prepared. One 
of the most vital and important elements of this bill is its new focus 
on wellness and prevention to help Americans stay healthy so that it 
truly is health care and not just sick care, so that the medical 
establishment is not incented to add more and more tests and procedures 
because that is what they get paid for but won't have an e-mail contact 
or won't have a phone call to help talk a patient through something 
because they can't get reimbursed.
  The potential value of wellness and prevention in this country is 
astonishing. It has been underinvested in because the people who are 
responsible for making those choices really don't get the benefit of 
them under our present perverse system.
  The Senator from Iowa has shown great leadership. He is now chairman 
of the HELP Committee, but he certainly chaired, through the committee 
deliberations, the health and wellness portions. It was my honor to 
watch him in action and see the astonishing results he achieved.
  I yield the floor to him and ask unanimous consent that at the 
conclusion of the remarks of the distinguished Senator from Iowa, the 
Senator from Pennsylvania, Mr. Casey, be recognized.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Iowa.
  Mr. HARKIN. Parliamentary inquiry: What rule are we under right now? 
How much time do we have? Are we under any time constraints?
  The PRESIDING OFFICER. Under the previous order, the Senator controls 
the time until 8 p.m., approximately 15 minutes.
  Mr. HARKIN. Mr. President, first I wish to thank my colleague for all 
the work he did in our committee. I am sorry he is not still on our 
committee. I wish he were. But a lot of the good work we have in our 
bill is due to Senator Whitehouse's involvement in the development of 
this bill. He was a great member of our committee, and as the chairman, 
I sure wish he would come back. That is all I can say.

  I say to the Senator, thank you for all the great work you did on 
this bill and especially all the wonderful work you did on getting us 
the public option that we had in our bill that was adopted by the House 
but also all the great work you did on making sure we had a robust 
prevention and wellness program in our bill. I have always said that 
the best way to bend the cost curve is to keep people healthy in the 
first place and keep them out of the hospital.
  So I thank my colleague for all his great work on the bill.
  Mr. WHITEHOUSE. Mr. President, I thank the chairman of the committee.
  Mr. HARKIN. Mr. President, I would like to engage my friend from 
Pennsylvania in a little discussion on one part of the bill that was 
mentioned earlier today but really has not received much attention. I 
think there are some misconceptions about what it does. It is called 
the CLASS Act.
  Basically, the CLASS Act is a bill that was championed by Senator 
Kennedy for many years. It has its genesis in the kind of convoluted 
system we

[[Page S12314]]

have now in how we provide for people who become disabled.
  Either through their work, through an accident, through illness, or 
whatever, people become disabled. As you know, we have a portion of 
that under the Social Security system, disability insurance. But, in 
fact, it does not take care of any kind of long-term care. So Senator 
Kennedy, for many years, championed the idea of giving people the 
ability to set aside some money during their working years that would 
be sort of like Social Security. It would vest, and then, if, God 
forbid, they became disabled, they would then have a certain monthly 
income that would enable them to live in their own homes, live in their 
own communities, and to ease some of the burdens of their disability.
  Before he passed away, Senator Kennedy talked to all of us on the 
committee about his dream and his hope that we would have this 
incorporated in our health reform bill.
  Well, we did this in the HELP Committee. We brought it forward. We 
had it scored. We know exactly how it operates. As we will make clear, 
I am sure, in our colloquy, it is a program that can be paid for. It is 
voluntary, as we said. It will stand on its own two feet. It is not 
another entitlement program, as I heard someone say here earlier today. 
In fact, it has to be self-financing by the premiums people pay in 
during their working years. It is an affordable, long-term care 
program. Again, it will allow families to plan for any possibility of a 
chronic illness, without having the fear of being put in a nursing 
home. As I said, it is voluntary.
  The CBO gave us a scoring on this that it was actuarially sound for 
75 years--actuarially sound for 75 years. What that means is that the 
premiums paid in and the benefits paid out will be kept in proper 
alignment. It will be fully solvent.
  Quite frankly, Mr. Gregg, the Senator from New Hampshire, on our 
committee, basically talked about this, and here is what he said:

       I offered an amendment, which was ultimately accepted, that 
     would require the CLASS Act premiums to be based on a 75-year 
     actuarial analysis of the program's costs. My amendment 
     ensures that instead of promising more than we can deliver, 
     the program will be fiscally solvent and we won't be passing 
     the buck--or really, passing the debt--to future generations. 
     I'm pleased the HELP Committee unanimously accepted this 
     amendment.

  Well, we did, and that is why I make the point that this is not 
another entitlement program, as was said here earlier today.
  Even better, the CBO believes the CLASS Act will save Medicaid $1.4 
billion in the first 4 years alone--$1.4 billion in the first 4 years 
alone--as a result of families who will be paying into and then using 
the CLASS benefit instead of Medicaid to similarly pay for the help 
they need to remain at home. That is really what people want. People 
want to stay in their own communities. They do not want to have to go 
to a nursing home.
  The CLASS Act would provide money for assisted transportation, in-
home meals, help with household chores, professional help getting ready 
for work, adult daycare, professional personal care. Now, will it pay 
for all those things? No, it will not pay for all those things, but it 
will give you enough of a basic support so that, coupled with other 
things, you would be able to stay at home and maybe even go to work. 
You may be disabled, but you may not be so disabled you cannot do some 
work; therefore, you need a little bit of help at home to get out in 
the morning and go to work or maybe you just need some personal 
assistance care that would enable you to stay in your own home rather 
than going to a nursing home.
  So that is why this amendment is so important. It is voluntary, long 
overdue. I think it will begin to give people the peace of mind of 
knowing if they pay into this system, after it vests--after 5 years of 
vesting--they will then be able to access this program in case they get 
disabled.
  Mr. President, I see my colleague and my friend from Pennsylvania is 
on the floor, a strong supporter of the CLASS Act and what we are 
trying to do here in terms of giving people the ability to maintain 
themselves if, God forbid, they should become disabled. I will be 
delighted to yield whatever time he needs to the Senator from 
Pennsylvania and engage in any colloquies he would like.
  The PRESIDING OFFICER (Mr. Bennet). The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I thank my colleague and friend, Senator 
Harkin, who is now the chairman of the Health, Education, Labor, and 
Pensions Committee, taking over for Senator Kennedy. I know he feels an 
obligation not only to get this health care bill passed, but he also 
feels an obligation to the American people, as I think most people in 
this Chamber do, when it comes to health care. In particular, I commend 
Senator Harkin for his great support for this legislation over a long 
period of time, and in particular for the CLASS Act.
  One of the best moments in our deliberations this summer was when 
Senator Harkin told a story about a relative of his. In a few moments, 
if he would tell that story, it brought home to me how important this 
program is and how it relates to the American people and what they do 
not have now, especially those Americans with disabilities.
  When I step back and look at this program, a couple of things come to 
mind--a couple of themes, really. One is the word ``dignity,'' the 
dignity of work. So many Americans--by one estimate, 5 million 
Americans--under the age of 65 are living in our country who have long-
term care needs, and there are over 70,000 workers with severe 
disabilities in the Nation today, who need daily assistance to maintain 
their jobs and their independence. So we are talking about a program 
which allows them to continue working with a disability. It allows them 
to overcome or surmount the barrier that is in front of them. Why would 
anyone not want to support this kind of a program, just in that brief 
description? But it is a lot more than that. It is about the dignity of 
work. It is about having independence, the ability to continue to work 
even with a disability. But it is also a very strong program for other 
reasons as well.

  One is, as Senator Harkin said so well--and Senator Kennedy led us on 
this program for many years, advocating for this approach--one 
important feature of this, as Senator Harkin says, is it is voluntary. 
It is a voluntary, self-funded--self-funded--insurance program with 
enrollment for people who are currently employed. So we are talking 
about enabling and helping people to work and maintain their dignity 
and contribute to our economy. That is what we are talking about here. 
We are not talking about some government program we are going to create 
that no one knows what the results will be. We know exactly what this 
will do for millions of Americans.
  Let me make a couple of points before I turn again to our chairman, 
Senator Harkin.
  First of all, there have been a lot of arguments made on the other 
side that we do not need this. Boy, I have not heard an alternative, 
which is true in a lot of the debates in the last couple of days. We 
hear a lot of criticism and critiques, some of them grossly inaccurate. 
But I am still waiting--still waiting--to hear an alternative, another 
idea. We do not hear much about that.
  But the other side made a lot of points about cost and the budget and 
how you pay for programs such as this. Well, let's just turn to the 
first chart on my left.
  Medicaid pays for a majority of long-term care in the United States 
of America. For long-term care, 40 percent of it is paid for by 
Medicaid. A lot of people think of the Medicaid Program, which I guess 
covers about 60 million Americans, roughly. We should think about long-
term care. People do not often think about Medicaid as being connected 
directly to long-term care for older citizens, those who fought our 
wars, who worked in our factories, who raised our families, who gave us 
life and love, and all they ask for in the twilight years of their 
lives is a little help with their health care. Plenty of them are given 
skilled care in nursing homes, and for many of those who are in nursing 
homes, they have skilled care, and they have a good experience. For 
some, it is not so good. They would rather be able to stay at home. 
They would rather be able to have opportunities to be provided some 
help at home. So they want the kind of dignity I spoke about earlier. 
The same

[[Page S12315]]

is true of those who might be a lot younger but who have disabilities 
and want to continue working. They want to continue working.
  Here is another way to look at this: Projected Medicaid spending on 
long-term services and supports is unsustainable because if nothing is 
done, Medicaid services for older citizens in America alone will rise 
by 500 percent by 2045. You do not have to be--I am certainly not an 
expert on how these costs are going up, but you do not have to be an 
expert to know that in the year 2000, you are at this level, and by the 
year 2045--not that far in the future--you are going to be over at 
above $200 billion. So Medicaid long-term services and support spending 
for those who happen to be aged 65 or older: $200 billion by 2045. So 
this is going up. This is when you do not do anything to meet a health 
care challenge. If we want to just keep this number going up, well, 
listen to the other side and just not enact any kind of a program.
  Let me do one more chart, and then I will turn to Senator Harkin for 
a discussion about this.
  We hear a lot about spending and savings and how we are going to pay 
for health care. Well, if we want to pay for a part of this health care 
bill--and a big part of the challenge--we should enact the CLASS Act 
because Medicaid savings from this act, as you can see here: $1.6 
billion just over the first 4 years. We are not talking about 10 years 
or 20 years or 40 years; we are talking about, in 4 years, you get $1.6 
billion in savings--over the first 4 years of the implementation of the 
CLASS Act--starting in 2016.
  So this is affirmative in the sense that it ensures people's dignity. 
It allows people to work even with a disability. And it is also 
fiscally responsible. And those who benefit from it are paying into it, 
and it is voluntary. No one has to do it. It is voluntary.
  We have heard a lot of arguments, I say to Senator Harkin, but I 
think we know from the work he did, working so many years with Senator 
Kennedy on these issues and working in the committee this summer, as 
one of our leaders--with Senator Dodd chairing the hearings this 
summer--and now as the chairman of the committee, the Senator has been 
instrumental in getting not just this legislation moving forward but 
especially on the CLASS Act, and I am grateful for him taking on this 
responsibility. I want to get the Senator's sense of what he hears from 
people in Iowa and his own experience with why this is so essential for 
the American people.

  Mr. HARKIN. I thank my friend and my colleague from Pennsylvania for 
laying out why this is so important, the fact that we are actually 
going to get savings for Medicaid from this. That is helping the 
States. That helps the States a lot. So we get a lot of bangs for the 
buck, as one might say, with the CLASS Act that we have in this bill.
  I say to my friend from Pennsylvania I think one of the biggest 
concerns people have--they may not express it when they are younger, 
but once they start working and they start having a family and they see 
one of their friends, a relative, someone in their neighborhood, become 
disabled--and believe me, it happens in our neighborhoods, it happens 
to our friends--they see that and they wonder, Maybe but for the grace 
of God there go I, but what would I do if something like that happened 
to me? How would my family, my children function? Where would the money 
come from?
  So to be able to have the peace of mind, to know there is a program 
whereby they can put some money aside every month, voluntarily, for 5 
years, and then after that, they would then be able to access money if 
they got disabled--talk about a great insurance program. Talk about the 
peace of mind this would provide for people.
  As I said, as we both have pointed out, this is actuarially sound for 
75 years. So it seems to me that for all of these reasons, including 
the savings in Medicaid for the soundness of the program, but also for 
the peace of mind for people who are working, to know they now have a 
program, something they can access, that will provide them--again, I 
don't want to sell this for more than it is. This is not something that 
will make someone 100 percent whole from their earnings. We are not 
trying to tell people that. What this will give them is up to $75 a day 
to help them with all of the things I pointed out: maybe getting up, 
getting ready to go to work; maybe it is personal attendant services. 
It could be a whole host of different things that will enable them to 
live in their home, in their community, and, yes, maybe even be able to 
go to work every day.
  My friend from Pennsylvania referred to the story I told earlier this 
summer, and I like to tell it because I think it illustrates what we 
are talking about here. I have a nephew, Kelly, my sister's boy. Well, 
he is not a boy anymore; he is an older man now, I guess you might say. 
He became disabled at a very young age, age 19, a severe paraplegic, 
but he was able to go to school, go to college. He was able then to 
live by himself in his own home. He had a van with a lift. He could get 
his wheelchair up there and punch the button and the doors would open 
and the thing would come down and he would get in the van. He had use 
of his hands. He could drive to work. He was able to start his own 
small business. But every morning he needed a nurse to come into the 
home, get him ready to go to work, get him up, get him going, get him 
out the door. Every night when he came home, he would stop and do some 
shopping on the way, come home to his own house where he lived, in his 
own community, among his family. His family was close by. They would 
have a nurse every evening do his exercises with him, keep his arms 
strong, do all of his other internal things that needed to be done, 
make sure he could get to bed. It happened every day. But because of 
that, he was able to live a full life, and he still is. Kelly is still 
an active man. But that was--gee, I am trying to remember now. I have 
to think. That was in 1979, 30 years ago. Kelly must be about almost 50 
years old now. I never thought about that. I always think of him as a 
kid. But he was able to do that, and he has lived a full life. He has 
been able to work, live by himself, do all kinds of wonderful things.
  How was he able to afford this? Was his family wealthy? Not a bit, 
not at all. In fact, his mother died shortly after the accident 
happened. My sister, who had breast cancer, died at an untimely, young 
age. But the way Kelly was able to do all this was because he got 
injured in the military. He got injured while he was onboard a ship off 
the coast of Vietnam. So the VA paid for all of this and is still 
paying for it--for his personal services--so that he can live by 
himself and get out the door and go to work. I have seen what that has 
done for him.
  I thought to myself: Well, if we can do this for veterans, what about 
other people in our society who, through no fault of their own or 
through an accident or whatever, become disabled. I thought about how 
much Kelly was able to earn during his lifetime, the fact that he paid 
taxes, had his own business. You know, that was a pretty darn good deal 
for the taxpayers of this country.
  In a small way, that is what we are trying to do here. That is what 
we are trying to do, to build a system for someone who gets injured, 
becomes disabled, has some support mechanisms so they can also live a 
full, rich, and happy quality life without having to go to a nursing 
home. That is what this is all about.
  As I said before, I say to my friend, it has so much to offer. I 
can't imagine there would be any real opposition to this--voluntary, 
actuarially sound. It provides a stipend to help people if they become 
disabled.
  I say to my friend from Pennsylvania it seems to me of all the things 
we have been discussing on this health reform bill so far, to me this 
is one of the most important. This is one of the most important parts 
of this health reform bill. We have never done it before. It is long 
overdue. It will be good for our families. It will be good for 
businesses. It will help our States because of the cutbacks and they 
won't have to pay so much into Medicaid.
  I thank my friend from Pennsylvania for his strong support of this. I 
say to my friend Ted Kennedy: We are going to get it done. It is going 
to happen. We are not going to let this bill get through and go to the 
President without having this in it. It is going to be there. There is 
no doubt about it. We are going to make it work, just as the Veterans' 
Administration worked for my nephew Kelly.

[[Page S12316]]

  I yield back to my friend from Pennsylvania. Actually, he asked me a 
question and I kind of got off a little bit there on telling my 
stories.
  Mr. CASEY. I am glad the Senator told that story. For me, this 
summer, beginning to learn about the details of the CLASS Act, it was a 
way, through the life of the Senator's nephew, to be able to tell the 
story about why it was so important. I was thinking as you were talking 
about the program and the CLASS Act itself and your own personal story 
and why it makes so much sense.
  Sitting here to my left on the floor is Connie Garner. She has worked 
for years on this legislation with Senator Kennedy. She would know 
better than I, and Senator Harkin would know better than I. Ted Kennedy 
not only liked this and fought hard for this program, but he wasn't a 
guy who just liked interesting ideas, he wanted them to work.
  Mr. HARKIN. That is right.
  Mr. CASEY. There are times we will be talking about the Children's 
Health Insurance Program in this legislation. That is a program that 
had its origin in government, and there is a lot of government 
involvement in that program. I support it and will fight to the end of 
the Earth for it. This program, the CLASS Act, the program that results 
from the CLASS Act, is different. It is a hybrid. It is in many ways a 
creative way to provide these kinds of services for people with 
disabilities. It is not a government entitlement program. It is a 
program that doesn't confer rights or an obligation on government 
funding, nor does it affect the receipt of or eligibility for other 
benefits. It stands on its own financial feet, which is the point that 
Senator Harkin made. Why wouldn't we do this?
  This wasn't just dreamed up this summer. Senator Kennedy, Senator 
Harkin, Connie Garner, and plenty of other folks were working on this 
for a lot of years. This is the result of years of work, not a couple 
of weeks or months. So they worked on this to get it right, and we have 
it right. It makes sense fiscally and it makes sense in terms of the 
dignity of people's work, the dignity of people able to stay in their 
home and be provided basic services.
  All of our families are affected by this. At some point or another, 
you are going to have a loved one who wants to work but has a 
disability, maybe; or needs long-term care services and doesn't want to 
leave the home. Everyone is affected by that. There is not a Member of 
the Senate on either side who isn't going to be affected personally 
some day by this challenge. All we are saying is we have a way to make 
it a little easier for folks. As Senator Harkin said, it doesn't solve 
all of the problems, but it helps provide the kind of services we 
should have the right to expect.

  We have this figured out. Some of these things we can figure out 
because of all of the work that was done over many years. This program, 
this voluntary self-funded program is one way to do it. Senator Harkin 
has been a leader on this and we are grateful for that leadership.
  Mr. HARKIN. If the Senator would yield again to me, two other things. 
I am glad the Senator mentioned Connie Garner who again, with Senator 
Kennedy, has worked so many years on this, and has her own personal 
story to tell regarding this, a very poignant story. But I now want to 
thank Connie for all of her wonderful work on this and shepherding this 
through. She is probably sitting over there wishing we had said this 
and that, because we probably forgot something she knows better than we 
know. But we do our best, Connie. We do our best with what we have, 
anyway, to try to explain this. But I thank Connie for all of her great 
work and leadership in getting this to this point.
  I wonder if I might impose upon the Senator, if I might--not digress 
but talk about one other part of the picture here we are talking about, 
in terms of covering people with disabilities. We have been talking 
about the CLASS Act, which is prospective. It looks ahead; it provides 
the mechanism whereby middle-class families can plan for the future 
possibility of an illness or a disability by putting this money away 
every month. We have talked about that. But one might ask the question: 
What about those who are disabled now? What is happening to them, the 
millions of Americans who are already living with a disability? Well, 
in 1990, we passed the Americans With Disabilities Act. We began to 
break down a lot of barriers in terms of people with disabilities and 
accessing daily living, accessing employment, transportation. But what 
happened was a few court cases started interfering with this. There was 
one court case in particular called the Olmstead decision 10 years ago. 
It came out of Georgia. It was a case in Georgia. It went to the 
Supreme Court. The Supreme Court said that based upon the Americans 
With Disabilities Act, a State had to provide the least restrictive 
environment for a person with a disability.
  Well, this was wonderful because the only option for many people with 
disabilities right now is to go to a nursing home. In fact, our Federal 
laws are basically skewed toward putting people in nursing homes.
  Let me explain. Right now, about the only support a person with a 
severe disability has is through Medicaid. As you know, through 
Medicaid you have to spend down until you become poor and then you get 
access to Medicaid. But under our laws, Medicaid must pay for you, if 
you are disabled, and then you qualify--they must pay for you to be in 
an institution or nursing home. They must. They have to pay for you. 
If, however, you are a person with a disability and you say: But I 
don't want to live in a nursing home; I would like to live--like my 
nephew Kelly--in my own house with my friends, in my own neighborhood, 
Medicaid doesn't have to pay for it, and in most cases it does not pay 
for that. In the vast majority of cases, it doesn't pay for that.
  So their beginning movement was in the mid-1990s to provide for 
funding for individuals with disabilities so they can live in their own 
homes in the community and not have to go to the nursing home. Well, 
that bill never--it was called MCASSA, the Medicaid Community Attendant 
Support and Services Act.
  I always like telling people, I say to my friend from Pennsylvania, 
while we sponsored it over in the Senate, the first sponsor of it in 
the House was the Speaker at that time who had taken over, and his name 
was Newt Gingrich. To this day, he is still supportive of that. A few 
years ago, I talked to him, and he was still a strong supporter of 
MCASSA. It later became the Community Choice Act. We could never get it 
enacted into law.
  It is a part of this health care reform bill in this way: It provides 
that if a State implements this Community Choice Act, which would allow 
people with disabilities to live in the community rather than in a 
nursing home, it will then get a bump up. It will get a 6-percent 
increase in its Federal match for Medicaid.
  As you know, now the Federal Government provides some and the State 
provides some for Medicaid. It is roughly 60/40. It varies a little, 
but that is roughly it, 60/40. Well, that means that a State now that 
would do this would not have to come up with its 40 percent; it would 
only have to come up with 34 percent. So it is an incentive for States 
to begin to implement the Supreme Court decision of over 10 years ago 
that people with disabilities have a right to live in the least 
restrictive environment. Again, Medicaid, right now, as I said, will 
provide only for nursing home care. States are obligated to pay for 
that. They must.
  Again, this also is a part of what the elderly in this country are 
concerned about too. A lot of them say that if they become disabled, 
they don't want to go to a nursing home, but that is their only option 
under Medicaid. So that explains why the second biggest priority in 
poll after poll for seniors in this bill, after strengthening 
Medicare--which we do--is changes to the health care system that will 
allow them to get the help they need to stay at home rather than going 
to a nursing home.
  Again, you might say, why is this so important? Well, a couple of 
stories. Two women who brought the Olmstead case, Lois Curtis and 
Elaine Wilson, when asked at a hearing what it changed for them, 
because they were no longer institutionalized, both spoke of things 
that we kind of take for granted: They had new friends. They could meet 
new people. They could attend family celebrations. They said:

[[Page S12317]]

We could make Kool-Aid whenever we wanted to. Simple things. They could 
go outside and walk in the neighborhood. They got a little dog, and 
they could walk the dog in the neighborhood--something they could not 
do in the nursing home. That is another part of the bill--very closely 
aligned with the CLASS Act, but it pertains to those people with 
disabilities right now.
  We know, again, from data and statistics we have that by paying for 
personal care services and home care services--and you might say that 
is really expensive. But we know from data that we get three for one. 
In other words, for every one person in a nursing home, for what that 
costs, we can provide community and home-based services for three 
people. That is three people for every one in a nursing home. So in a 
way, yes, it costs money, but for every person we get out of a nursing 
home, we can pay for three living in the community. Again, that is not 
to mention the kind of quality of life I just mentioned.
  This bill for the first time creates the community first choice 
option, which gives States an extra share of Federal money--6 percent--
if they agree to provide personal care and services to all eligible 
people in their State--I mean those eligible for institutional care. If 
they provide that to them, then they get a bump up. And only by making 
personal care services available on an equal basis to all those 
eligible can we satisfy the promise of the Americans with Disabilities 
Act and really meet the Supreme Court mandate in the Olmstead decision.
  I say to my friend from Pennsylvania, there are two aspects of the 
bill. One is the CLASS Act, which looks ahead and provides that peace 
of mind that people know they can have that access. Then we provide for 
people with disabilities who are living out there, fearful that the 
only thing that will happen to them is they will have to go to a 
nursing home. Now we are going to say to States: You provide community- 
and home-based services, and we will give you more money to do so 
through your Medicaid Program. Hopefully, with that, the States will 
begin to move more rapidly to fulfill the mandate of that Supreme Court 
decision.
  I thank my friend for yielding me this time to explain that.
  Mr. CASEY. Mr. President, I yield the floor and suggest the absence 
of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. CASEY. 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. CASEY. Mr. President, I ask unanimous consent that on Friday, 
December 4, after any leader remarks, the Senate then resume 
consideration of H.R. 3590 with debate only in order until 11:30 a.m., 
with no amendments, motions to commit, or any other motion, other than 
a motion to reconsider a vote, if applicable, in order during this 
period, except those that are currently pending, with the time after 
the leader time equally divided and controlled between the leaders or 
their designees, with the majority controlling the first portion of 
time.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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