[Congressional Record Volume 155, Number 179 (Friday, December 4, 2009)]
[Senate]
[Pages S12356-S12408]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of H.R. 3590, which the clerk will 
report.
  The assistant legislative clerk read as follows:

       A bill (H.R. 3590) to amend the Internal Revenue Code of 
     1986 to modify the first-time home buyers credit in the case 
     of members of the Armed Forces and certain other Federal 
     employees, and for other purposes.

  Pending:

       Reid amendment No. 2786, in the nature of a substitute.
       Whitehouse amendment No. 2870 (to amendment No. 2786), to 
     promote fiscal responsibility by protecting the Social 
     Security surplus and CLASS program savings in this act.
       Hatch motion to commit the bill to the Committee on 
     Finance, with instructions.

  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Mr. President, we are beginning our fifth day of 
consideration on the health reform bill. We will be in a period of 
debate only until about 11:30 a.m. Pending now is the

[[Page S12357]]

amendment by the Senator from Rhode Island, Mr. Whitehouse, on fiscal 
responsibility. Also pending is a motion to commit by the Senator from 
Utah on Medicare Advantage. It would be my hope that the Senate will 
vote on these matters today.
  Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Under the previous order, the time until 11:30 a.m. will be for 
debate only with the time equally divided and controlled between the 
two leaders or their designees, with the majority controlling the first 
portion of time.
  The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, experts and economists of every political 
stripe agree that preserving America's long-term economic security 
means reforming the way we provide and pay for health care. Health care 
spending makes up one-sixth of the U.S. economy. Future generations can 
expect the burden of insurmountable debt if we fail to act.
  The fiscal challenges we may face in years to come pale in comparison 
to the threat of uncontrolled Federal health care spending. The chart 
behind me essentially shows that. The chart shows the percentage annual 
growth rates beginning in 2004. The red is the economy, the blue is 
health care costs. Clearly, over time, especially as the economy dipped 
during this great recession, the gap between economic growth and health 
care spending has widened. Projections are that in future years they 
will widen more and more. As you can see out to 2018, the total economy 
is projected. Near 2018 the economy is above 4 percent and health care 
spending is 7 or 8 percent.
  Doing nothing means health care spending continues to grow faster 
than our economy. That is what that chart shows quite dramatically. 
Doing nothing means entitlement spending more than doubles by the year 
2050. That is taking one-fifth of our gross domestic product.
  But it is not simply the Federal budget on the line, it is the family 
budget too. Incredibly, in total we are spending 80 times as much on 
health care today as we did five decades ago--80 times more on health 
care today than we did five decades ago. Now family budgets are 
breaking under the strain--already. That is going to get worse if we do 
nothing. The cost of the average family health care plan will reach 
$24,000 in the year 2016. That is not too many years away from now. 
This represents an 84-percent increase over 2008 premium levels. That 
means, if we do nothing, in fewer than 10 years most families would 
have to dedicate half of their household budget to health insurance. 
For years we have heard the warnings from Federal budget experts. Now 
we are hearing every day from folks back home who simply cannot afford 
the care they need.
  We have an obligation to act. Now we have an opportunity to act. The 
country's leading economists and Federal budget experts laid out 
strategies and options for getting costs under control. We have taken 
their recommendations to heart. There is a lot of agreement among those 
who study these issues of what we must do. Now we have a bill that does 
what they suggest. It also passes the test of fiscal responsibility.
  We have many reasons to vote for this bill. It protects and even 
increases Medicare benefits for seniors. It achieves near universal 
coverage in less than 10 years. That means it achieves the goal of 
virtually everybody having health insurance in that period of time. It 
slows the growth of Federal health care spending. It stops insurance 
industry discrimination and, based on independent, nonpartisan 
analysis, makes a serious dent in our Federal deficit.
  This chart behind me represents what 2 weeks ago the Congressional 
Budget Office and Joint Committee on Taxation confirmed in no uncertain 
terms, that deficits go down under this plan. The official cost 
estimate reads as follows:

       The Congressional Budget Office and the Joint Committee on 
     Tax estimates that on balance the direct spending and revenue 
     effects of enacting this Patient Protection and Affordable 
     Care Act legislation would yield a net reduction in Federal 
     deficits of $130 billion over the years 2010 to 2019. That is 
     represented by the green bar on the left. It is a net $130 
     billion reduction during the first 10 years of this bill.

  In addition to reducing the Federal deficit, in the first decade, the 
CBO also tells us that the bill decreases the deficit by a much greater 
amount, by $650 billion, in the second decade.
  According to the CBO, this bill also slows the growth of Medicare 
costs, which has been a principal goal in our Medicare debate since day 
one. Medicare spending would grow 6 percent annually instead of 8 
percent annually. In other words, Medicare would continue to grow but, 
unlike today, it will grow at a sustainable rate.
  Of course, no projections, even from the Congressional Budget Office, 
can be certain. We can safely say this bill will put us on the right 
track. We can safely say this bill is better than doing nothing. No 
honest assessment challenges the case for acting now to slow the growth 
of Federal spending. No honest assessment challenges the case. And no 
honest assessment of this bill challenges the CBO analysis. I have not 
heard one. I have not heard an honest challenge to the CBO analysis, 
nor have I heard of a good, honest case for not acting now to slow the 
growth of Federal spending, which means we have many reasons to pass 
health care reform, not the least of which is the long-term financial 
health of the economy and our Nation. But the reasons for passing this 
are much more than simply facts and figures. This is about Americans 
from every corner of this great country, struggling to make ends meet, 
forced into bankruptcy by medical tragedy. This is about stopping 
insurance industry discrimination; this is about saving Medicare for 
our seniors and reducing the deficit for our grandchildren.
  I don't know which other Senators wish to speak. Senator Bingaman 
wishes to gain recognition in the time we have.
  Let me ascertain how much time we have and how many speakers we have.
  The ACTING PRESIDENT pro tempore. The Senator has 40 minutes.
  Mr. BAUCUS. I yield 15 minutes to the Senator from New Mexico.
  The ACTING PRESIDENT pro tempore. The Senator from New Mexico.
  Mr. BINGAMAN. Mr. President, let me thank Senator Baucus for his 
leadership on this issue. I have mentioned to him many times that I 
strongly believe without his leadership, we would not be where we are 
today in our effort to reform health care. I congratulate him on the 
superb effort he has made.
  I want to spend a few minutes talking about health care reform both 
as it affects the country but also as it affects my home State of New 
Mexico. First, I would like to discuss the context for this health 
reform bill, and that is the very serious problem we face in the 
country with the growing cost of health care, if the Congress fails to 
act. We have a chart I will put up, since everyone has charts. This is 
a chart that shows what is happening to all health care costs and has 
been happening since 1960. We can see that as a percent of the gross 
domestic product, back in 1960 we were spending right at 5 percent of 
GDP on all health care. Today we are spending much more like 16 percent 
of the gross domestic product on health care. The projections for the 
future, if we do not act to reform the health care system, are very 
serious indeed.
  Let me allude to an article in the morning New York Times. This is by 
Nobel award-winning economist Paul Krugman of Princeton University. He 
talks about this issue of fiscal responsibility and the impact of 
health care reform on the deficit. It talks about how some Senators 
have concerns about going ahead with this health care reform bill 
because of what it might cost. He makes the point:

       But if they're really concerned with fiscal responsibility, 
     they shouldn't be worried about what would happen if health 
     reform passes. They should, instead, be worried about what 
     would happen if it doesn't pass. For America can't get 
     control of its budget without controlling health care costs--
     and this is our last, best chance to deal with these costs in 
     a rational way.

  I ask unanimous consent that the full column from the New York Times

[[Page S12358]]

of this morning be printed in the Record following my remarks.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  (See exhibit 1.)
  Mr. BINGAMAN. As this chart demonstrates, according to the 
Congressional Budget Office, if we don't act to deal with the growth in 
health care costs, Federal spending on Medicare and Medicaid combined 
will grow from 5 percent of GDP today to almost 10 percent by 2035. By 
2080, the government would be spending almost as much as a share of the 
economy on just its two major health care programs as it has spent on 
all of its programs and services in recent years.
  Let me put up another chart that demonstrates that most of this 
increase in cost is not the result of our aging population. We do have 
an aging population; that does add to the cost of health care because 
as people get older they tend to need more health care. The dark blue 
shows the increase expected in health care costs by virtue of aging. 
But the lighter blue talks about the effect of excess cost growth that 
is not related to aging; that is, the growth in health care cost is out 
of control in our current system. Such spending is unsustainable. It 
has led the Congressional Budget Office to say:

       Slowing the growth rate of outlays for Medicare and 
     Medicaid is the central long-term challenge for fiscal 
     policy.

  Moreover, across the country, premiums continue to increase. They are 
becoming more and more unaffordable for individuals and for businesses. 
I hear on a regular basis when I go around New Mexico--and I am sure 
all my colleagues hear from their constituents as they travel in their 
States--that people cannot continue to pay more and more each year for 
their health care coverage. According to an August report by the 
Commonwealth Fund, nationally, family premiums for employer-sponsored 
health insurance increased 119 percent between 1999 and 2008. If cost 
growth continues on its current course, those premiums could increase 
another 94 percent to an average of $23,842 per family by 2020. I am 
not sure what the circumstance is in many States, but I know in New 
Mexico there are many families who cannot afford to pay $23,800 in 
health care premiums.
  Nowhere is the unsustainable growth felt more acutely than in my home 
State. Without health reform, in my State we are projected to 
experience the greatest increase in health insurance premiums of any 
State in the Union. For example, the average employer-sponsored 
insurance premium for a family in New Mexico was about $6,000 in the 
year 2000. By 2006, this rate had almost doubled, or the cost had 
almost doubled to $11,000. By 2016, the amount is expected to rise to 
an astonishing $28,000. In addition, health insurance premiums in New 
Mexico make up a larger percentage of New Mexico's income, the income 
of the average New Mexico family, than almost all other States. We are 
paying 31.18 percent. Over 31 percent of the average income of a family 
in New Mexico is going to pay for health care. This is expected to grow 
to 56 percent if we do not reform our health care system.
  It is important to highlight that the higher spending on health care 
in the United States does not necessarily prolong lives. I hear a lot 
of speeches about how we have the greatest health care system in the 
world. We are the envy of the world. People would just love to have 
access to our health care system. This chart illustrates that in 2000, 
the United States spent more on health care than any other country in 
the world, an average of $4,500 per person. That was in 2000. 
Switzerland was the second highest at $3,300, substantially less. 
Essentially, its cost per person was 71 percent of what it was in the 
United States during that year. Nevertheless, the average U.S. life 
expectancy comes out at 27th in the world. Our life expectancy average 
is 77 years. Many countries, 26 to be exact, achieve higher life 
expectancy rates with significantly lower spending on health care.
  Data from the McKinsey Global Institute clearly indicates there is a 
considerable level of waste in our current system. McKinsey estimates 
that the United States spends nearly $\1/2\ trillion annually in excess 
of other similarly situated nations. Of this, about $224 billion in 
excess costs are found in hospital care. About $178 billion are found 
in outpatient care. Together these account for more than 80 percent of 
U.S. spending above the levels of other nations.
  Here is one other chart. This is one I have used before on the Senate 
floor. Not surprisingly, as costs and inefficiencies continue to build, 
access to health care is becoming more and more difficult for middle- 
and lower-income Americans. This chart indicates the rate of 
uninsurance throughout the country. First, on the left-hand side is the 
year 2000; on the right-hand side is 2008. We can see the dark blue 
States are States where 23 percent or more of the population ages 18 to 
64 are uninsured. Back in the year 2000, New Mexico and Texas were the 
only two States where the rate of uninsurance exceeded 23 percent. Now 
we can see the rate of uninsurance exceeds 23 percent for many of the 
States, particularly across the southern part of the country.
  We have a very serious problem that needs addressing. It is clear 
that the U.S. health care system is failing many Americans. The 
situation is becoming more and more urgent. According to a study 
published by the Harvard Medical School in August, medical costs have 
led to almost two-thirds of the bankruptcies in this country. More than 
26 percent of bankruptcies are attributable to health care problems. 
The study found that most medical debtors were well educated, owned 
their own homes, had middle-class occupations and, shockingly, three 
quarters had health insurance. So these were people who had coverage, 
but the coverage was not adequate to meet the needs. Unfortunately, for 
many individuals, the very high cost of medical care leads them to 
delay or to avoid receiving medical care altogether.
  The Urban Institute reports that 137,000 people in this country died 
between 2000 and 2006 because they lacked health insurance. That 
includes 22,000 people in 2006. Clearly, the need for national health 
reform has never been so great.
  The Patient Protection and Affordable Care Act, the legislation we 
are debating, introduced by Senator Reid and others a few weeks ago, 
includes the key reforms we have come up with and that the experts have 
come up with, aimed at addressing these very serious problems, while 
protecting the aspects of our health system that are working today.
  First, this bill includes long-overdue reforms to increase the 
efficiency and quality of the health care system while reducing overall 
cost. For example, the legislation includes payment reforms that I have 
championed to shift from a fee-for-service payment system to a bundled 
payment system. This will reshape our health care reimbursement system 
to reward better care and not simply more care as it currently does 
today.
  Second, it includes a broad new framework to ensure that all 
Americans have access to quality and affordable health care. This 
includes creation of a new health insurance exchange in each State 
which will provide Americans a centralized source of meaningful private 
insurance as well as refundable tax credits to ensure that coverage is 
affordable.
  Finally, these new health insurance exchanges will help improve 
choices by allowing families and businesses to compare insurance plans 
on the basis of price and performance. This puts families, rather than 
the insurance companies or the government bureaucrats, in charge of 
health care. It helps people to decide which quality, affordable 
insurance option is right for them.
  The Congressional Budget Office, which is cited here--quite frankly, 
I notice that the Congressional Budget Office is cited by both 
Democrats and the Republicans in this debate, and that is a credit to 
the CBO. They are seen as nonpartisan, and they are nonpartisan. I 
congratulate Doug Elmendorf for the good work CBO has been doing in 
support of our efforts to come to the right answer on health care 
reform--the CBO forecasts that this legislation would not add to the 
deficit.
  As the chart Senator Baucus had a few minutes ago clearly indicates, 
the deficit would be reduced in the first 10 years by $130 billion. It 
would be reduced in the second 10 years, going up to 2029, by something 
over $600 billion.
  Let me also point out the contrast. We are talking about a bill which 
the

[[Page S12359]]

Congressional Budget Office says will reduce the size of the deficit in 
future decades. I can remember a couple Congresses ago when we had a 
debate on adding subpart D to Medicare, Part D to Medicare. There are 
many on the floor who are concerned about cost today--at least they say 
so in their speeches--who were very anxious to add that legislation to 
Medicare, adding another $500 billion. That was estimated by the CBO at 
that time: another $500 billion over a 10-year period to the cost that 
Medicare was bearing.
  The efforts we are making in this legislation to bring under control 
the cost growth in Medicare is essential if we are going to keep 
Medicare solvent in the future, and part of the solvency problem 
Medicare has in the future, frankly, is related to what we did in 
subpart D.
  On the subject of premium cost, CBO has also found that in the 
individual market, the amount that subsidized enrollees would pay for 
non coverage would be roughly 56 percent to 59 percent lower, on 
average, than the premiums charged in the individual market under 
current law. Among enrollees in the individual market who would not 
receive new subsidies, average premiums would increase by less than 10 
to 13 percent. The legislation would have smaller effects on premiums 
for employment-based coverage. Its greatest impact would be on smaller 
employers qualifying for new health insurance tax credits. For these 
businesses and their employees, CBO predicts premiums would decrease by 
about 8 percent to 11 percent compared with their costs under current 
law.
  This is consistent with estimates of the impact in my home State of 
New Mexico, where average families may see a decrease in premiums of as 
much as 60 percent. In addition, about two-thirds of New Mexicans could 
potentially qualify for subsidies or Medicaid and nearly a quarter 
would qualify for near full subsidies or Medicaid.
  An overall decrease in premium costs also is consistent with the 
experience in Massachusetts where there has been an enormous reduction 
in the cost of nongroup insurance in the State after they enacted 
similar reform to what we are considering now in the Senate. After 
reform the average individual premium in Massachusetts fell from $8537 
at the end of 2006 to $5143 in mid-2009, a 40 percent reduction while 
the rest of the Nation was seeing a 14 percent increase.
  Finally, much of the debate on health care reform has focused on 
insurance coverage but it is important to recognize that as we expand 
coverage to include more Americans, the demand for health care services 
will also increase. A strong health care workforce is therefore 
essential for successful health reform. Within the United States, 
approximately 25 percent of counties are designated health professions 
shortage areas--a measure indicating that there is insufficient medical 
staff to properly serve that geographic area. The problem is even more 
apparent in rural States such as New Mexico. For example, 32 out of 33 
counties in my State has this shortage designation. As a result, New 
Mexico ranks last compared to all other states with regard to both 
access to health care and utilization of preventative medicine.
  The Patient Protection and Affordable Care Act we are debating 
contains key provisions to improve access and delivery of health care 
services throughout the Nation. These provisions include increasing the 
supply of physicians, nurses, and other health care providers; 
enhancing workforce education and training; and providing support to 
the existing workforce.
  I applaud Senators Reid, Baucus, Dodd, Harkin, and many other 
colleagues who have worked so hard on this bill. This legislation 
represents true healthcare reform. It is time for the Senate to put 
partisanship aside and enact this critical and long overdue 
legislation.
  I see my time is up and there are others waiting to speak. I yield 
the floor.

                               Exhibit 1

                [From the New York Times, Dec. 4, 2009]

                             Reform Or Else

                           (By Paul Krugman)

       Health care reform hangs in the balance. Its fate rests 
     with a handful of ``centrist'' senators--senators who claim 
     to be mainly worried about whether the proposed legislation 
     is fiscally responsible.
       But if they're really concerned with fiscal responsibility, 
     they shouldn't be worried about what would happen if health 
     reform passes. They should, instead, be worried about what 
     would happen if it doesn't pass. For America can't get 
     control of its budget without controlling health care costs--
     and this is our last, best chance to deal with these costs in 
     a rational way.
       Some background: Long-term fiscal projections for the 
     United States, paint a grim picture. Unless there are major 
     policy changes, expenditure will consistently grow faster 
     than revenue, eventually leading to a debt crisis.
       What's behind these projections? An aging population, which 
     will raise the cost of Social Security, is part of the story. 
     But the main driver of future deficits is the ever-rising 
     cost of Medicare and Medicaid. If health care costs rise in 
     the future as they have in the past, fiscal catastrophe 
     awaits.
       You might think, given this picture, that extending 
     coverage to those who would otherwise be uninsured would 
     exacerbate the problem. But you'd be wrong, for two reasons.
       First, the uninsured in America are, on average, relatively 
     young and healthy; covering them wouldn't raise overall 
     health care costs very much.
       Second, the proposed health care reform links the expansion 
     of coverage to serious cost-control measures for Medicare. 
     Think of it as a grand bargain: coverage for (almost) 
     everyone, tied to an effort to ensure that health care 
     dollars are well spent.
       Are we talking about real savings, or just window dressing? 
     Well, the health care economists I respect are seriously 
     impressed by the cost-control measures in the Senate bill, 
     which include efforts to improve incentives for cost-
     effective care, the use of medical research to guide doctors 
     toward treatments that actually work, and more. This is ``the 
     best effort anyone has made,'' says Jonathan Gruber of the 
     Massachusetts Institute of Technology. A letter signed by 23 
     prominent health care experts--including Mark McClellan, who 
     headed Medicare under the Bush administration--declares that 
     the bill's cost-control measures ``will reduce long-term 
     deficits.''
       The fact that we're seeing the first really serious attempt 
     to control health care costs as part of a bill that tries to 
     cover the uninsured seems to confirm what would-be reformers 
     have been saying for years: The path to cost control runs 
     through universality. We can only tackle out-of-control costs 
     as part of a deal that also provides Americans with the 
     security of guaranteed health care.
       That observation in itself should make anyone concerned 
     with fiscal responsibility support this reform. Over the next 
     decade, the Congressional Budget Office has concluded, the 
     proposed legislation would reduce, not increase, the budget 
     deficit. And by giving us a chance, finally, to rein in the 
     ever-growing spending of Medicare, it would greatly improve 
     our long-run fiscal prospects.
       But there's another reason failure to pass reform would be 
     devastating--namely, the nature of the opposition.
       The Republican campaign against health care reform has 
     rested in part on the traditional arguments, arguments that 
     go back to the days when Ronald Reagan was trying to scare 
     Americans into opposing Medicare--denunciations of 
     ``socialized medicine,'' claims that universal health 
     coverage is the road to tyranny, etc.
       But in the closing rounds of the health care fight, the 
     G.O.P. has focused more and more on an effort to demonize 
     cost-control efforts. The Senate bill would impose 
     ``draconian cuts'' on Medicare, says Senator John McCain, who 
     proposed much deeper cuts just last year as part of his 
     presidential campaign. ``If you're a senior and you're on 
     Medicare, you better be afraid of this bill,'' says Senator 
     Tom Coburn.
       If these tactics work, and health reform fails, think of 
     the message this would convey: It would signal that any 
     effort to deal with the biggest budget problem we face will 
     be successfully played by political opponents as an attack on 
     older Americans. It would be a long time before anyone was 
     willing to take on the challenge again; remember that after 
     the failure of the Clinton effort, it was 16 years before the 
     next try at health reform.
       That's why anyone who is truly concerned about fiscal 
     policy should be anxious to see health reform succeed. If it 
     fails, the demagogues will have soon, and we probably won't 
     deal with our biggest fiscal problem until we're forced into 
     action by a nasty debt crisis.
       So to the centrists still sitting on the fence over health 
     reform: If you care about fiscal responsibility, you better 
     be afraid of what will happen if reform fails.

  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Mr. President, how much time remains under the control of 
the majority?
  The ACTING PRESIDENT pro tempore. Twenty-four minutes.
  Mr. BAUCUS. Mr. President, I yield 10 minutes to the Senator from 
Massachusetts.
  Mr. KIRK. Mr. President, I thank the Senator.
  Mr. BAUCUS. We might be able to find extra time, too, if the Senator 
is looking for extra time. Right now, according to the number of 
Senators who

[[Page S12360]]

want to speak, that is all we have in this first block. But sometimes 
we can work things out--if the Senator wants to talk a little longer. 
But right now it is 10 minutes.
  The ACTING PRESIDENT pro tempore. The Senator from Massachusetts.
  Mr. KIRK. Mr. President, I thank Senator Baucus.


                           Amendment No. 2870

  Mr. President, today in the United States of America, approximately 
200 million of our citizens are elderly or disabled. These are not mere 
statistics. They are family members and loved ones--vulnerable, 
challenged, and often forgotten. But they were not forgotten by their 
friend and advocate, Senator Ted Kennedy. He understood a fair and 
civilized society should be judged on how it treats its most vulnerable 
citizens.
  Sadly, millions of seniors and persons living with disabilities 
struggle to obtain the services and supports they need to live 
fulfilling lives and to remain in their communities among their friends 
and families--in what they hoped would be their productive golden 
years.
  As Senator Kennedy understood, it is morally wrong for so many 
disabled men and women who need assistance to be forced to face the 
heartbreaking choices: Do I abandon my job, spend down my savings, move 
out of my home, give up my American dream in order to qualify for 
Medicaid, the only government program that can provide me with the 
supports I need, or do I forgo my independence and resign myself to 
living the rest of my life confined to a facility?
  Senator Kennedy also understood it is morally wrong when that infirm 
or elderly individual's friends or loved ones must also face 
heartbreaking choices: Do I give up my job and commit my time to care 
for my infirm parent at the expense of my own family and children or do 
I resign myself to confining my aging mother or father to a facility?
  Families across this country understand this heart-wrenching crisis 
all too well. A recent SCAN poll found that nearly 60 percent of those 
surveyed had a personal experience with long-term care. As this chart 
demonstrates, nearly 80 percent would be more likely to support health 
care reform if--if--it included a long-term care program. These 
families know the current long-term care industry is not meeting their 
current needs and that change must come.
  As always, Senator Kennedy cared how our society would be judged. He 
did not just sit by. He acted. He drafted the Community Living 
Assistance Services and Supports Act, known as the CLASS Act, which we 
are debating this morning. This program was at the heart of his effort 
to help people with functional limitations and their families to obtain 
the services and supports they need. It gives them the chance to 
maintain their independence and remain active, productive members of 
their communities.
  Under the CLASS Act, a worker in Massachusetts, or any other State, 
can choose to pay a premium into this voluntary insurance program 
through affordable payroll deductions. After contributing for 5 years, 
they become eligible for a cash benefit of at least $50 a day if they 
become disabled. That cash benefit can make the difference in allowing 
a disabled person to live with independence, self-respect, and dignity.
  For example, it can pay for having a ramp installed to their home or 
to pay for needed transportation or to purchase a computer to work from 
home and remain self-sufficient. It can also pay for a caregiver to 
come to their home, help them bathe, get dressed, and cook meals--
services that otherwise often fall to family and friends who are forced 
to work reduced hours on their own jobs or quit those jobs altogether 
to provide that needed care.
  Currently, long-term care, as we know it, is paid for through a 
fragmented combination of sources, including family budgets, Medicaid, 
Medicare, and private insurance. Without a prior and voluntary 
insurance investment, which the CLASS Act offers, paying for long-term 
care can be financially catastrophic for many individuals and families, 
since home care and nursing homes can cost over $70,000 a year.
  Only one in five individuals can afford private long-term care 
insurance, and many are excluded because of preexisting conditions. 
Medicare's role in providing long-term services is extremely limited, 
covering only short-term skilled nursing care and home health. This 
lack of options forces many people to turn to Medicaid, which is our 
Nation's primary payer and only safety net program providing 
comprehensive long-term care services and supports.
  But who is eligible for Medicaid? People only qualify for Medicaid if 
they are or become poor. This criterion forces many families to 
impoverish themselves to obtain the Medicaid support they need. We have 
all heard the stories: The family member works hard all his or her 
life, and then due to an accident they cannot afford to pay for needed 
services and supports out of their pocket. So they now must give up 
their savings to become eligible to turn to the government and to 
Medicaid to provide the proper care they need to survive. No one wins--
not the disabled or elderly parent, not the family caregiver, not the 
government, and not Medicaid.
  I have a letter from a woman who lives on Cape Cod in Massachusetts. 
She knows firsthand how powerful the CLASS Act could be for families. 
Jerilyn has been caring for her sister who is brain damaged, legally 
blind, paralyzed, and incontinent. Jerilyn writes:

       Caring for my sister at home has saved the state thousands 
     and thousands of dollars every year and we have done this 
     care for 38 years. We fight every year to get sufficient 
     hours for PCA care with Mass Health. We are holding down full 
     time jobs which also supplement my sister's care. This is so 
     wrong. Instead of encouraging families who want to keep their 
     loved ones at home and save the state money, they work 
     against us so I believe we will give up and just place them 
     in nursing homes . . . which in turn cost the state more 
     money . . . is this not totally crazy?

  She is asking the right question. The CLASS Act will help turn this 
serious, no-win situation into an everyone-wins result. It gives 
individuals with disabilities and their families the funds they need to 
obtain some of the services they need without having to resort to 
Medicaid.
  The current reliance on Medicaid is not only a strain on our 
families, it is also a strain on our already overburdened Medicaid 
system. Today, Medicaid spends nearly $50 billion a year on long-term 
services and supports. Estimates indicate that by 2045 that spending 
could exceed $200 billion. Obviously, this current course is 
unsustainable.
  In addition, the private insurance industry is not doing enough to 
meet the growing demand for such care. Aging baby boomers and longer 
lifespans will increase the demand for long-term care dramatically for 
decades to come. Yet 95 percent of people over age 45 do not have 
private long-term care insurance, and fewer and fewer people are able 
to buy such coverage.
  Make no mistake, as it stands today, if someone without adequate 
long-term care coverage becomes disabled, they will more than likely 
have to turn to the already overburdened Medicaid system to get the 
help they need. The CLASS Act is designed to specifically remedy this 
looming crisis by giving people an affordable option other than 
Medicaid. The act will save the system over $1.6 billion over the first 
4 years that people start receiving benefits.
  Some opponents of the CLASS Act argue that the program will not be 
sustainable over time and that it will become insolvent and end up 
costing taxpayers large amounts. That argument could not be further 
from the truth.
  Let's give proper credit where it is due. With the help of our 
friends on the other side of the aisle, we have taken real steps to 
ensure that the program remains solvent for years to come. The act 
establishes a strong work requirement to make sure the funds continue 
to come into the program from the payroll tax deduction or from an 
individual's voluntarily paid premium. It requires the Secretary of HHS 
to review and set the premiums annually to ensure that the program will 
remain solvent for the next 75 years. It directs the Secretary, in 
addition, to review the cost projections 20 years into the future. 
Finally, it mandates that no taxpayer funds will be used to pay 
benefits.
  Let me repeat that final point, since I have often heard it 
misrepresented.

[[Page S12361]]

No taxpayer funds will be used to pay benefits. Benefits will be paid 
through self-funded and voluntary premiums.
  During the markup in the HELP Committee this summer, Senator Dodd led 
a main discussion about this program. With the help of the Republicans 
on the committee, especially Senator Gregg of New Hampshire, additional 
safeguards were included to ensure that the act will stand on strong 
financial footing for years to come. After the committee adopted 
Senator Gregg's 75-year solvency amendment, the program won strong 
words of support from both parties. We credit Senator Gregg for that 
constructive contribution.
  This CLASS Act will do all the things it should do. It will provide 
financial and health security to elderly and infirm Americans. It will 
strengthen Medicare. It will make health reform the exact thing the 
American people need.
  With that, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I yield 8 minutes to the Senator from 
Wisconsin, the chairman of the Special Committee on Aging.
  The ACTING PRESIDENT pro tempore. The Senator from Wisconsin.
  Mr. KOHL. Mr. President, I thank very much Senator Baucus.
  I come to the floor to talk about the many ways in which this bill 
will have a positive impact for seniors.
  Over the past year, we have seen confusion about what health care 
reform will mean for Americans and particularly for seniors. I had 
hoped that once the Senate voted to move forward with debate on one 
merged bill, we could offer some definitive answers on how health 
reform will help them. Unfortunately, here we are on the floor, 
continuing to send mixed messages about some very concrete provisions. 
As chairman of the Aging Committee, I wish to help set the record 
straight for older Americans.
  This health reform bill is not going to cut Medicare benefits. 
Independent groups such as the AARP and the National Committee to 
Preserve Social Security and Medicare have said this bill will 
strengthen Medicare and not harm it. AARP believes this bill will 
transition Medicare to a more efficient system, where quality health 
care outcomes are rewarded and waste, which experts believe accounts 
for up to 30 percent of Medicare spending, is reduced.
  In terms of the cuts to Medicare Advantage, this bill will only cut 
back on overpayments to these private Medicare plans. Benefits will not 
be affected. AARP also supports these cuts because they understand that 
most of the overpayments are going to insurance company profits, not to 
seniors' benefits, and that this overspending is putting Medicare on a 
faster path to insolvency. Experts say by making these cuts, health 
reform will extend the solvency of the Medicare trust fund by 5 years, 
without making one cut to guaranteed benefits.
  I understand people complain that this bill is too long. But any bill 
that seeks to offer choice and meet the needs of so many Americans is, 
by necessity, complex. We cannot gloss over these vital issues. So I 
would like to take a minute to share with you some of the provisions 
that have not received as much attention but are, nevertheless, crucial 
to improving America's health care system. There is a lot in this bill 
for older Americans, retirees, and those planning ahead for a healthy 
and happy long life. The Aging Committee has worked closely with the 
leadership of the HELP and Finance Committees to improve several of our 
provisions, most of which have bipartisan support. I wish to 
particularly thank Senator Baucus, Senator Dodd, Senator Harkin, and 
Majority Leader Reid for being so willing to work with us on these 
important issues.

  We have enlisted help from seniors groups of every stripe to ensure 
health reform makes commonsense improvements that, in some cases, are 
desperately needed.
  This bill will significantly improve the standard of care in nursing 
homes nationwide for the first time in 22 years. I thank my colleague, 
Senator Grassley, for working together to make sure this important 
issue was not overlooked as part of health reform. In and of itself, 
this is a huge undertaking, but it is just one piece of the puzzle to 
comprehensively reform our health care system.
  This bill will also train and expand the health care workforce so 
they are prepared to care for the growing elderly population. By 
implementing recommendations from the Institutes of Medicine, we will 
begin to address the severe shortage we face of direct care workers.
  This bill will protect vulnerable patients by creating a nationwide 
system of background checks for long-term care workers. This policy is 
more than just a good idea in theory. We have implemented it in seven 
States and seen its results. Comprehensive background checks are 
routine for those who work with young children, and we should be 
protecting vulnerable seniors and disabled Americans in the same way.
  This bill will make it easier for seniors to get the care they need 
in their own homes because when it comes to long-term care, one size 
does not fit all. The goal of long-term care should be to allow older 
or disabled Americans to live as independently as possible.
  This bill will help update our current long-term care system in order 
to offer choices tailored to an individual's needs. It will also help 
to alleviate the huge financial and emotional burden on married couples 
who need long-term care. I worked with my colleague, Senator Cantwell, 
to ensure that married couples who receive care in their home and 
community are not required to spend the vast majority of their assets 
to receive assistance.
  The committee has also helped to include a provision that will 
benefit all Americans regardless of age by helping to lower the costs 
of prescription drugs and medical devices.
  Our policy aims to make transparent the influence of industry gifts 
and payments to doctors.
  Although these are only a few of the Aging Committee's priorities, 
this bill makes many other improvements to our current health care 
system for older Americans.
  The Senate bill will reduce the cost of preventive services and add a 
new focus on paying doctors to keep patients well and not just paying 
them for when their patients get sick.
  Today, seniors pay 20 percent of the cost of many preventive 
services. By eliminating the copayment and deductibles through Medicare 
for important services such as immunizations, cholesterol screenings, 
bone calcium-level screenings, and colonoscopies, we will help save 
lives as well as lower health care costs.
  The bill will also provide for the first time an annual wellness 
visit at no cost to the beneficiary. Patients will be able to receive a 
personalized health risk assessment for chronic disease, have a 
complete review of their personal and family medical history, and 
receive a plan for their care.
  This bill will remove the ability of insurance companies to deny 
access to consumers based on preexisting conditions. We know having 
health care is essential throughout one's life from beginning to end, 
but many older Americans count the days until they become eligible for 
Medicare because they are not able to find insurance coverage at any 
cost due to a health condition in their past.
  I could go on about the many other improvements, small and large, 
that will benefit our Nation's seniors, but I will stop here and simply 
urge my colleagues to work to educate seniors and not scare them about 
the important changes this bill will make to provide them with better 
health care at lower cost.
  Thank you, Mr. President. I yield the floor.
  Mr. BAUCUS. Mr. President, how much time remains for the majority?
  The ACTING PRESIDENT pro tempore. Five minutes.
  Mr. BAUCUS. I ask unanimous consent that there be an additional 5 
minutes on each side.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. BAUCUS. Mr. President, I yield the remaining time to the Senator 
from Oregon, which should be 10 minutes.
  The ACTING PRESIDENT pro tempore. The Senator from Oregon is 
recognized.
  Mr. WYDEN. Mr. President, I wish to spend a few minutes this morning 
talking about Medicare Advantage and particularly to highlight the fact 
that I

[[Page S12362]]

think it is important to support the language put together by the 
chairman of the Finance Committee on Medicare Advantage and to reject 
the amendment offered by our friend from Utah, Senator Hatch.
  I wish to begin my comments with respect to Medicare Advantage by 
pointing out that it is clear that not all Medicare Advantage is 
created equal. Some of Medicare Advantage is a model of efficiency, and 
some of it is pretty much a rip-off of both taxpayers and seniors. I 
would refer, as it relates to the abusive plans, to the very important 
hearings chaired by Senator Baucus in the Finance Committee. I recall 
on one occasion sitting next to our friend from Arkansas, Senator 
Lincoln. We had witnesses describe how Medicare Advantage was being 
sold door-to-door in her part of the country by individuals dressed up 
in scrubs as physicians and health care providers. In the discussion of 
how to handle it, we looked at various kinds of reforms to rein in 
abusive practices. I came to the conclusion that when you do something 
such as that, the CEOs ought to be put in jail. That is what is 
documented on the record as it relates to the hearings held in the 
Senate Finance Committee and why I come to the floor to make it clear 
that I think it is important to distinguish between the good-quality 
Medicare Advantage plans and those that have been living high on the 
hog through some of the overpayments we have documented on this floor.
  My State has the highest percentage of older people in Medicare 
Advantage in the country. I had an opportunity to work closely with 
Chairman Baucus in terms of addressing Medicare Advantage, and I think 
that with the chairman's leadership, it has been possible to show you 
can find savings in the Medicare Program without harming older people, 
without reducing their guaranteed benefits, their essential benefits, 
as we have learned, with Medicare Advantage. The way Chairman Baucus 
goes about doing that is by forcing the inefficient Medicare Advantage 
plans to follow the model of the efficient ones. The way we have been 
able to do that is essentially through a two-part strategy: first, 
encourage competitive bidding and, second, provide incentives for 
quality, which is done through the bonus payment provisions that are in 
the legislation.
  First, on competitive bidding, you have plan bids, and you use the 
plan bids to set Medicare Advantage benchmarks which would encourage 
the plans to compete more directly on the basis of price and quality 
rather than on the level of extra benefits offered to those who are 
enrolling. With the competitive bidding, plans compete to be the most 
efficient and hold down costs. I commend Chairman Baucus for 
making this a central part of the way Medicare Advantage would be 
handled. Certainly our part of the country has shown this as a path to 
get more value for the Medicare Advantage dollar in the days ahead.

  In addition, in the Finance Committee I offered an amendment with 
several colleagues that would boost the payments to those plans that, 
according to the government--and the government uses a system of stars, 
in effect, to reward quality--our amendment would boost the payments to 
those Medicare Advantage plans with four- and five-star quality 
ratings.
  So, in effect, with our legislation there are both carrots and 
sticks. Competitive bidding plus bonus payments offers both, so the 
plans compete to provide the best value for seniors. By encouraging the 
plans to be more efficient, it is possible to achieve significant 
savings for older people, help shore up the solvency of the Medicare 
trust fund, and meet the cost-saving goals of the legislation.
  One point that has been discussed by colleagues on the floor of the 
Senate is this matter of individuals being able to keep what they have. 
I have heard that is not the case with Medicare Advantage plans; that 
somehow, under the legislation that has been offered by the Finance 
Committee, older people would not be able to keep what they have, 
according to some on the floor. That is simply inaccurate. Seniors who 
have Medicare Advantage plans under the Baucus legislation will be able 
to keep those plans. They will be able to stay with what they have, 
keep their guaranteed, essential benefits, and through the language 
that has been authored now in the legislation before us, there will be 
lower costs for taxpayers.
  Last point. I have heard a lot of talk about grandma on the floor of 
the Senate. I spent the bulk of my professional life in effect working 
with grandma. I was the cofounder of the Oregon Gray Panthers and ran 
the legal aid program for older people in our home State for a number 
of years. I want it understood that I think with the Baucus legislation 
on Medicare Advantage, that proves it is possible to make savings in 
the Medicare Program without cutting essential benefits. Using 
commonsense principles of competitive bidding, No. 1, and incentives 
for quality, I think grandma is going to be just fine under our 
language for Medicare Advantage.
  Mr. President, with that, I yield the floor.
  Mr. BAUCUS. Mr. President, how much time is remaining on the majority 
side?
  The ACTING PRESIDENT pro tempore. Three minutes.
  Mr. BAUCUS. And on the minority side?
  The ACTING PRESIDENT pro tempore. Fifty-five minutes.
  Mr. BAUCUS. Mr. President, I reserve the remainder of the majority 
time.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, during the next 55 minutes, we will 
have several Republican Senators come to the floor. I ask unanimous 
consent that during that time, Senator McCain be allowed to be the 
manager of a colloquy among the Republican Senators.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. ALEXANDER. Mr. President, before Senator McCain begins, if I may, 
I wish to take a moment to establish where we are today and what 
happened yesterday as a lead-in to what he is about to discuss.
  Yesterday, Senator McCain offered an amendment on the floor of the 
Senate that would do two things: It would send this 2,074-page 
Democratic health care bill back to the Finance Committee and say to 
them, No. 1, take out the cuts in Medicare, and No. 2, any savings in 
Medicare must go to make Medicare more solvent. That is what the McCain 
amendment would have accomplished. That was defeated. Fifty-eight 
Democrats said yes to the cuts in Medicare. They said yes to using the 
money that comes from these cuts to create a new entitlement program. 
Forty Republicans and two Democrats said, no, we don't want cuts to 
Medicare and we do not want a new entitlement program.
  So yesterday we made it clear that the central core of this bill 
includes nearly $\1/2\ trillion in cuts to Medicare. There is no 
question about that. Everyone concedes that. The President said that 
when he addressed us. The Congressional Budget Office says that. The 
question is whether it is a good idea or a bad idea, and yesterday, by 
58 votes, the Democrats said yes to these cuts in Medicare.
  Today, we want to talk about one aspect of those cuts which is 
Medicare Advantage. We are going to talk about these cuts in a careful, 
accurate way so the 11 million seniors who have Medicare Advantage 
understand exactly what the risk is to their Medicare Advantage 
policies.
  We can see that a portion of the overall Medicare cuts that the 
Democrats approved yesterday is a $120 billion cut over the next 10 
years to the Medicare Advantage program. Now, what is Medicare 
Advantage? Medicare Advantage is an option seniors have. If you choose 
this option, Medicare pays a fixed amount every year for your care, to 
companies that might come to you and offer a Medicare Advantage plan 
which you can choose instead of the original Medicare plan.
  Many seniors choose these plans--11 million seniors. Nearly one out 
of four seniors in America who are part of Medicare chooses the 
Medicare Advantage plan. In my home State of Tennessee, the number is 
about 230,000 Tennesseans.
  Why do they choose it? Well, it includes some benefits they may not 
have in the original Medicare plan. These benefits include dental care, 
vision care, hearing coverage, reduced hospital deductibles, lower co-
payments, lower premiums, coordinated

[[Page S12363]]

chronic care management, and physical fitness programs.
  The distinguished Senator from Oregon was on the floor and he 
mentioned grandma. I have mentioned grandma a few times--no disrespect 
to grandpa; he is in the same boat. He said grandma didn't need to 
worry about her Medicare Advantage plan because none of the benefits 
would be cut. That is not what the Director of the CBO, who is often 
cited by the chairman of the Finance Committee, has said. He said that 
half of the benefits currently provided to seniors under Medicare 
Advantage would disappear under the Finance Committee plan, which is 
much like the plan we are considering. The benefits that would 
disappear would include those I mentioned.
  Today, with Senator McCain leading the discussion, we wish to talk 
about the Medicare Advantage plan, and why cuts to Medicare Advantage 
play a central part of this $2.5 trillion bill. Cuts to Medicare pay 
for about half of that $2.5 trillion cost, and the ones we are talking 
about today are the Medicare Advantage plans. I understand there will 
be an amendment by Senator Hatch, who has joined us, and I am sure he 
will talk about his own amendment. He was present on the Finance 
Committee when Medicare Advantage was created. I understand there will 
be an amendment to send this back to the Finance Committee saying don't 
cut Medicare Advantage.
  Mr. McCAIN. Yes. For those who missed Senator Hatch's important 
statement last night, which he will add to today, I point out that he 
was able to take a trip down memory lane. In June 2003, when the 
Medicare Modernization Act was before the Senate, several of our 
colleagues, including Senators Schumer and Kerry, offered a bipartisan 
amendment on the floor to provide additional funding for benefits under 
the Medicare Advantage Program.
  But amnesia is not confined to one side of the aisle around here. I 
ask my friend from Tennessee--you know this discussion about Medicare 
Advantage--we have to better understand what is this program and why is 
it so popular. Is it because it offers seniors a chance to get 
additional benefits? Maybe the Senator can give a short definition of 
that. I think the American people may not be totally clear on what we 
are discussing here and why 11 million Americans--over 300,000 citizens 
in my own State--have chosen Medicare Advantage, and that has prompted, 
according to Bloomberg, Senator Casey of Pennsylvania, to say, ``We are 
not going to be able to say 'if you like what you have, you can keep 
it.''' ``That basic commitment that a lot of us around here have made 
will be called into question.''
  The title of that is ``Dem Senator Says Medicare Advantage Cuts Break 
President's Pledge.''
  Maybe the Senator from Tennessee can give me a brief outline of what 
seniors get under Medicare Advantage and why it is so popular with 
330,000 senior citizens in my State and 11 million in the country.
  Mr. ALEXANDER. I can do that. The Senator is correct. If the Senator 
from Pennsylvania, Senator Casey, said that, he is merely repeating 
what the Director of the CBO stated, when he said that fully half of 
the benefits of Medicare Advantage will be lost.
  To answer the Senator's question, Medicare Advantage is an option 
that 11 million of the 40 million seniors who are on Medicare have 
chosen. The reason they choose it is because it is a plan offered by 
private companies, often to people in rural areas, often to 
minorities----
  Mr. McCAIN. Lower income seniors.
  Mr. ALEXANDER. Yes, lower income Americans also choose these. They 
often choose it because the plans generally offer these benefits: 
dental care, vision care, hearing coverage, reduced hospital 
deductibles, lower co-payments, lower premiums, coordinated chronic 
care management, and physical fitness programs.
  Mr. McCAIN. I thank my friend. The reason I ask this, he mentioned 
that Medicare Advantage would allow seniors to have dental care, vision 
care, hearing care, physical fitness--it is fascinating. This allows 
our senior citizens to have dental, vision, hearing, and physical 
fitness care, and that is a little strange because, as was pointed out 
to me, that is exactly what we have here in the Senate. About 100 paces 
from here, if I need some doctor care immediately, if I need some 
vision care, if I need some dental care, I can get it. Next to my 
office in the Russell Senate Office Building, for the last several 
months--and I don't know at what cost, but I would like to get entered 
into the Record how many tens of millions of dollars it is. But they 
are renovating a gym. So my colleagues yesterday voted against keeping 
the Medicare Advantage Program, when we have, right here, the best 
Medicare Advantage Program ever heard of in the world--free hearing, 
free vision, free dental--and they are expanding a gymnasium in a many-
months-long project. I will get the cost of that, although that may be 
hard to do.
  Let me get this straight. Again, the American people should 
understand this. We voted to cut drastically a program that seniors 
have taken advantage of, which gives them additional hearing, vision, 
dental, and physical fitness care, while we practice it here every 
single day. Every day, there is a physician on duty--more than one--not 
very far from where I speak, who is ready to give us instant care. If 
hospitalization is needed, we can get instant transportation to the 
Bethesda Naval Hospital, where we will get free care. Incredibly, the 
Senate, on largely partisan lines, yesterday voted against senior 
citizens in this country, most of whom have paid a lot more into the 
program than we have. We are going to deprive them of what we have 
every single day we are members of the Senate.
  That is an exercise in hypocrisy. The Senator from Pennsylvania has 
it right, because the President, time after time, said to the American 
people: If you like the insurance policy you have today, you can keep 
it. How many hundreds of times have we heard him say that at townhall 
meetings? And his administration mouthpieces say the same thing. The 
Senator from Pennsylvania is right when he says, ``We are not going to 
be able to say if you like what you have, you can keep it. That basic 
commitment that a lot of us around here have made will be called into 
question.''
  I will say a couple words, and I will talk more about this later. 
Every time the Senator from Montana and others are on the floor, they 
talk about the fact that AARP now supports this blatant transfer of 
funding from the Medicare Program, which the seniors have earned, into 
a brandnew entitlement--a $2.5 trillion entitlement program. That is 
what this bill is all about.
  For your information, AARP has received $18 million in stimulus 
money. There is a job creator for you. AARP, which has given its full-
throated support to the Democratic health care legislation, even though 
seniors remain largely opposed, received an $18 million grant in the 
economic stimulus package for a job training program that has not 
created any jobs, according to the Obama administration's recovery.gov 
Web site. That is astonishing to me because from everything I have ever 
seen, they have created millions of jobs, including in the ninth 
congressional district of Arizona, where they said they created 
thousands of jobs. Unfortunately, we only have eight congressional 
districts, but that is OK.
  In February, Politico reported that AARP was putting pressure on 
Republican Members of Congress to support the stimulus package. Since 
then, AARP has moved on to lobbying for passage of health care 
legislation, even though Democratic proposals have called for several 
hundred billion dollars in cuts to Medicare--a program that the group 
typically defends tooth and nail when Republicans propose cutting it. 
It turns out that AARP is also in a position to benefit financially if 
the health care legislation passes, because seniors losing benefits as 
a result of cuts to Medicare Advantage will be forced to buy Medigap 
policies, which is the main source of AARP revenue. Barry Rand, chief 
executive of AARP, was a big donor to the Obama campaign and has 
retained a cozy relationship with the administration. That is shocking 
news.
  So, my friends, also I might add that in 2006, AARP received $18 
million from the Federal Government, and we are reserving additional 
Federal moneys that they get.
  The most important thing is this, and let's make it clear: AARP will 
receive direct benefits because seniors

[[Page S12364]]

who have cuts in their Medicare Advantage and other Medicare programs 
can buy--guess what--a Medigap insurance policy from AARP--in other 
words, to cover the things being cut back under this legislation, and 
it costs $175 a month. The Medicare Advantage premiums are zero for 
most seniors or $35 a month. Again, if the Medicare Advantage plans go 
away, people would have to buy a Medigap plan sold by--you got it--
AARP. And some low-income seniors could not afford $175 a month.
  That is why the Senator from Tennessee stated that if we drive people 
out of Medicare Advantage, we are harming low-income seniors all over 
this country. We are harming them. We are doing them a great 
disservice. If you think with 17 percent real unemployment in my State 
that seniors who are unemployed and down on their luck are going to be 
able to afford the AARP Medigap policy for $175 a month, come and visit 
my State and I will tell you they can't.
  It is interesting, the conversation about high-income seniors, and 
how we are going to tax people with Cadillac plans and all of those 
things, when what we are doing is harming the lowest income seniors in 
rural areas of America.
  Mr. KYL. Will my colleague yield for a quick point?
  Mr. McCAIN. Yes.
  Mr. KYL. The Senator was making the point that you cannot take $120 
billion out of the program without hurting folks. Those on the other 
side of the aisle said we can do that--we can cut it by $120 billion 
and it still won't hurt anybody. My colleague asked the Senator from 
Tennessee exactly what some of the benefits were and he repeated them. 
I went to get the actual statistical number of how much it will 
actually reduce benefits in terms of actuarial value. According to the 
Congressional Budget Office, in the year 2019, when fully implemented, 
here is the statistic: The actuarial value of the reduction in benefits 
under Medicare Advantage is 64 percent; in dollar terms, it goes from 
$135 a month down to $49 a month. In other words, the very things my 
colleague talks about--vision care, dental, all of those things----
  Mr. McCAIN. All of the things we routinely use in the Senate. I hope 
those who voted to harm the seniors in this country and not allow them 
to have dental, vision, and other health care would unilaterally 
disavow the use of the physician care and vision care and hearing care 
available to all of us 24 hours a day right here in the Senate.
  Mr. KYL. The last point. I want to say that I hear my colleague 
loudly and clearly. I hope the American people do too because you 
cannot call a $120 billion cut something that doesn't hurt people, and 
especially when the Congressional Budget Office itself says, yes, that 
reduces these very benefits from a value of $135 a month down to $49 a 
month. That is a huge cut in the value of the services they receive 
under Medicare Advantage. That is what we are trying to prevent by this 
amendment.
  Mr. McCAIN. Could I mention one other thing? I will not spend that 
much more time on AARP. But the reason I do is because every time the 
Senator from Montana stands up, he talks about AARP endorsing this rip-
off of the American people.
  Let me quote again from a Bloomberg article entitled ``AARP's Stealth 
Fees Often Sting Seniors With Costlier Insurance.'' I quote from the 
Bloomberg article just briefly:

       Arthur Laupus joined AARP because he thought the nonprofit 
     senior-citizen-advocacy group would make his retirement years 
     easier. He signed up for an auto insurance policy endorsed by 
     AARP, believing the advertising that said he would save 
     money.
       He didn't. When Laupus, 71, compared his car insurance rate 
     with a dozen other companies, he found he was paying twice 
     the average. Why? One reason, he learned, was because AARP 
     was taking a cut out of his premium before sending the money 
     to Hartford Financial Services Group, the provider of the 
     coverage. . . .
       AARP uses the royalties and fees to fund about half the 
     expenses that pay for activities such as publishing brochures 
     about health care and consumer fraud--as well as for paying 
     down the $200 million bond debt that funded the association's 
     marble and brassstudded Washington headquarters.
       In addition, AARP holds clients' insurance premiums for as 
     long as a month and invests the money, which added $40.4 
     million to its revenue in 2007. . . .
       During the past decade, royalties and fees have made up an 
     increasing percentage of AARP's income, rising to 43 percent 
     of its $1.17 billion in revenue in 2007 from 11 percent in 
     1999, according to AARP data.

  This is a Bloomberg article. This is not from the Republican Policy 
Committee.
  The point is, who gains? Who gains from this legislation? Who is 
going to make hundreds of millions of dollars more because they provide 
the Medigap policies people will be deprived of when we kill off 
Medicare Advantage? AARP.
  Mr. ALEXANDER. Mr. President, I see the Senator from Texas, the 
Senator from Idaho, and the Senator from Wyoming have all come to the 
floor, in addition to the sponsor of the motion, Senator Hatch. I am 
sure they are prepared to reflect on who is hurt by these cuts.
  The only thing I would emphasize is what the Senator from Arizona has 
said is that disproportionately low-income Americans in Texas, Idaho, 
Tennessee, Wyoming, and Utah are hurt. Only one-third of eligible White 
seniors who do not have Medicaid or employer-based insurance are 
enrolled in Medicare Advantage. But the number increases to 40 percent 
for African Americans and 53 percent for Hispanics.
  Mr. McCAIN. May I ask the Senator again, he described the benefits 
that are provided under the Medicare Advantage program that seniors can 
have if they want, right? Are those same benefits--dental, vision, 
hearing, and fitness care--available under regular Medicare today?
  Mr. ALEXANDER. My understanding is the answer is no. That it is the 
reason 11 million Americans choose Medicare Advantage because these 
benefits are not available under the original Medicare plan.
  Mr. McCAIN. In Montana, there are 27,000 enrollees who will see a 24-
percent decrease. In Connecticut, there are 94,000 enrollees who will 
see a 14-percent decrease. By the way, some special deals have been cut 
for three States I understand--Oregon, New York, and Florida. We are 
going to try to fix that. There is no reason one State should be 
shielded any more than another from these draconian measures. We are 
going to try to fix that situation.
  The reason I bring up this issue, present-day Medicare beneficiaries 
do not have vision, they do not have dental care, they do not have 
fitness. Yet we in the Senate enjoy it every single day. So yesterday 
we voted to deprive seniors from the ability to have the same 
privileges that we enjoy every single day in the Senate. I would argue 
that is an exercise in hypocrisy.
  Mr. ALEXANDER. I might say we are operating under a colloquy managed 
by Senator McCain. So Republican Senators are free to engage in 
discussion.
  Mrs. HUTCHISON. Mr. President, I very much appreciate what the 
Senators have been talking about because what Senator McCain is saying 
is that these seniors who are low income have an affordable option, and 
it is less expensive than the AARP option that would give them this 
extra care--the eye care, the dental care, the hearing aids. It is an 
affordable extra option.
  In Texas, we have over 500,000 seniors enrolled in Medicare 
Advantage. One of the great things about Medicare Advantage is that it 
is available in rural areas, and it gives them choices that they might 
not be able to afford with other programs that are Medigap. This one is 
affordable. That is why we are fighting so hard to restore the cuts to 
Medicare Advantage.
  Medicare Advantage costs about 14 percent more than traditional 
Medicare because it provides a wide range of these extra benefits we 
have discussed--dental, eye care, hearing aids and, in many cases, it 
pays providers more. Republicans, of course, are open to discussing how 
to improve the Medicare Advantage payment formula. We want to be more 
efficient with taxpayer dollars, but do we want to do that in the 
context of creating a massive new entitlement program and ask Medicare 
to pay for it or to cut lifesaving benefits for seniors? Is that what 
we want to do, I ask Senator Crapo?
  Mr. CRAPO. That is absolutely the case. I would like to point out, 
when we had the Finance Committee markup, I asked CBO Director 
Elmendorf directly whether provisions in the bill,

[[Page S12365]]

which are still in the bill, would reduce the benefits that Medicare 
recipients received. His response was:

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

  There has been a lot of talk here about we are not cutting Medicare 
benefits or we are or it is this or that. The bottom line is, the CBO 
Director said it: Yes, we are cutting benefits.
  I would like to ask the sponsor of this motion a question because I 
know there are some who are saying the reason we are cutting Medicare 
Advantage is that it is so expensive, and we should be cutting Medicare 
and controlling its costs; that it is about 14 percent more expensive 
than fee-for-service Medicare.
  Some people say if you are defending Medicare Advantage, you are 
defending overpayments in health care plans. Would the Senator from 
Utah like to respond to that criticism some are making?
  Mr. HATCH. I would be delighted to. To be clear, so-called 
overpayments to Medicare Advantage plans do not go to the plans. As a 
matter of fact, they go to the seniors in the form of extra benefits. 
That is a pretty important point a lot of people miss. Seventy-five 
percent of the additional payments to Medicare Advantage plans are used 
to provide seniors with extra benefits, including chronic care 
management--you would think you would want to do that--hearing aids, 
eyeglasses. The other 25 percent of any extra payments are returned to 
the Federal Government. I cannot imagine why anybody would not want to 
do that.
  Mrs. HUTCHISON. Mr. President, I ask the distinguished Senator from 
Utah to also respond to the arguments that claim that the government 
cannot afford now to continue overpaying these private plans and that 
the Medicare trust fund is going broke. Of course, we tried actually 
several years ago to shore up the Medicare Program, trying to do it in 
a responsible way, not cutting out the Medicare benefits these seniors 
can receive as an affordable option. What does the Senator say to that?
  Mr. HATCH. The Senator from Texas pointed out the Medicare trust fund 
is going broke. Yet what do we have on the other side? They take almost 
$500 billion out of Medicare. Trust me, I am deeply concerned about the 
solvency of the Medicare trust fund.
  Mr. McCAIN. May I say it is my understanding that Dr. Barrasso has 
actually seen Medicare Advantage patients. He and Dr. Coburn are 
probably the only two. Maybe we could let him give us the benefit of 
his experience and also not only the benefit of his experience, but I 
am sure he is going to tell us what the impact is going to be on the 
low-income seniors from his State.

  Mr. BARRASSO. I agree with the Senator from Arizona that people 
choose to be on Medicare Advantage. Mr. President, 11 million people 
have chosen to be on Medicare Advantage because it is a wise choice to 
make because they get better benefits. They get dental care, they get 
the vision care, they get the hearing aids, they get the fitness thing.
  Mr. McCAIN. Just as we do.
  Mr. BARRASSO. Just as we do. It works in preventive care and 
coordinated care.
  Mr. McCAIN. I don't think they have as nice a gym, though, as we are 
going to get.
  Mr. BARRASSO. It is also no surprise when people read about this and 
learn about it that they would want to be on Medicare Advantage. What 
the Senator from Utah has said, the sponsor of this motion, is that the 
money that goes into this program is for the benefit of the seniors. It 
is for services for the seniors on Medicare. To me, this whole bill 
basically guts Medicare, raids Medicare to start a whole new program.
  Today, as the Senator from Arizona has mentioned in these articles, 
the Associated Press and USA Today said:

       Senate Democrats closed ranks Thursday behind $460 billion 
     in politically risky Medicare cuts at the heart of health 
     care legislation. . . .

  It goes on to say:

       Approval would have stripped out money to pay for expanding 
     coverage to tens of millions of uninsured Americans.

  So they are going to take $460 billion, it says, away from our 
seniors who depend on it for their Medicare and start a whole new 
government program. The Washington Times, front-page story headline, 
reads: ``Democrats Win $400B in Medicare Cuts. McCain Pushed for 
Another Way to Pay for It.''
  I look at this and say this is not fair to our seniors, not fair to 
the patients I have taken care of for 25 years in Wyoming, taken care 
of folks--taken care of folks--when grandmom breaks her hip, what we 
need to do for our patients. These are choices people have made.
  Mr. President, 11 million Americans have chosen Medicare Advantage 
because there is an advantage to them for the health care they get--the 
additional services, the coordinated care, the preventive care. Anyone 
who looks at this and studies it says: I want to sign up.
  It has been wonderful in rural areas and big cities. This has helped 
a lot of people in the country. It is not surprising that one out of 
four people in the country on Medicare have chosen Medicare Advantage, 
but yet what we are seeing here is Democrats want to get rid of 
Medicare Advantage.
  Mr. McCAIN. Let me get this straight. Basically, by removing the 
choices that seniors have as a part of Medicare Advantage--dental, 
vision, hearing, fitness--we are taking away from them what we 
ourselves enjoy every single day in the Senate?
  Mr. BARRASSO. We are taking it away from seniors and using all that 
money to start a new government program when we know Medicare is going 
to go broke by 2017.
  Mr. HATCH. We are listening to only one of the two doctors in the 
Senate who knows, who has been on the ground, has met with the people, 
who understands what this means to senior citizens. One-quarter of them 
are on Medicare Advantage.
  In the end, I believe we not only actually help seniors be more 
healthy but save a lot of money in the end. Trust me, I am deeply 
concerned about the solvency of the Medicare trust fund. We have been 
sounding that alarm for years. That is why it is so shocking we are 
debating a $2.5 trillion health reform bill that does almost nothing to 
make sure Medicare is sound and, in fact, does a lot of things to make 
it unsound, or almost nothing to make sure Medicare is around for 
future generations.
  Instead, we are just creating another Federal entitlement program 
that we cannot afford while Medicare has $38 trillion in unfunded 
liabilities.
  Mr. CRAPO. The Senator is absolutely right. A lot of people trying to 
defend these cuts are saying these extra costs in the Medicare 
Advantage Programs are just going to make insurance companies' profits 
bigger and help pay for large CEO salaries. Nothing could be further 
from the truth. The reality is, as the Senator from Utah already 
indicated, 75 percent of this 14 percent extra payment in these plans 
go to provide the seniors with the extra benefits we are talking about, 
and then 25 percent is returned to the Federal Government, not to 
insurance companies, not to CEOs.
  I have a chart. We are going to make it into a bigger one. But those 
who support this program say we are not cutting Medicare benefits. This 
chart--I apologize it is a little bit small--but this is a chart of the 
United States. It shows what is happening to the benefits of Medicare 
Advantage beneficiaries. As you might guess, the dark red is more than 
50 percent reduction in the benefits of the people in those dark red 
States. In the medium red color, it is between a 25- and 50-percent 
reduction in coverage. The only States that do not have a reduction in 
coverage are the white ones. There are three or four States that are 
not seeing deep cuts in Medicare Advantage benefits.
  Those who say--like the President who said it was one of his goals--
if you like what you have, you can keep it--not if you live in one of 
the States that is not in white on this chart because your benefits 
will be cut.
  Mr. ALEXANDER. I wonder if I might ask the Senator from Idaho to go 
back over a point he made a moment ago because he went over it quickly 
and it is such an important point and one reflected by the chart behind 
him about what he just said. Repeatedly we are told that seniors won't 
lose benefits if you cut nearly $\1/2\ trillion in Medicare. So if you 
could take

[[Page S12366]]

a moment--I believe you were in the Finance Committee markup where the 
bill was being written that was offered by the distinguished Finance 
Committee chairman, and I believe you were talking to the head of the 
Congressional Budget Office, who is often cited by our friends on the 
other side as the nonpartisan authority for exactly what the bill does, 
and you asked him whether the benefits of Medicare Advantage recipients 
would be cut. Would you describe that in a little more detail so people 
understand exactly the scenario?

  Mr. CRAPO. Yes, I would. This chart shows the last two sentences of 
our colloquy when we were in the Finance Committee, but it went on for 
some time. But the bottom line is that I was asking the Director of CBO 
whether the cuts to Medicare Advantage that are in the bill would 
reduce benefits to senior citizens, and he said yes. And the reason he 
used this phrase here, which says ``for those who would be enrolled 
otherwise under current law,'' the reason he prefaced it that way--
which we don't have on the chart--is that for future seniors it will 
not be a viable option. So in the future, those who are not on it now 
won't have a significant viable option to get on it because it is going 
to be gutted.
  So he was saying that for those 75 percent--and by the way, Medicare 
Advantage is the most popular part of Medicare today. It is the fastest 
growing part of Medicare. It is popular because it provides these 
additional benefits that seniors have to pay so significantly for to 
get in supplemental insurance that AARP is going to provide. So what 
the CBO Director said was that for the future, those who aren't already 
on it won't get it.
  Mr. McCAIN. Could the Senator from Texas and I go back to one of the 
things I mentioned earlier, because in Texas, how many are under 
Medicare Advantage?
  Mrs. HUTCHISON. Five hundred thousand of my constituents are on 
Medicare Advantage.
  Mr. McCAIN. Five hundred thousand in your State, and there is no 
``shielding.'' According to this Bloomberg article and according to our 
knowledge, it says:

       Senators Charles Schumer of New York, Bill Nelson of 
     Florida, and Ron Wyden of Oregon are among those who secured 
     special provisions shielding constituents from cuts. Casey--

  Referring to Senator Casey of Pennsylvania--

     says he wants ``very comparable'' protections for his State--
     surprisingly enough--where more than one-third of Medicare 
     beneficiaries participate in Medicare Advantage. ``It's the 
     kind of thing that will likely be addressed on the floor,'' 
     he said.

  Well, I eagerly look forward to working, on the other side of the 
aisle, with all the Members from those States, with the exception of 
New York, Florida, and Oregon, who have earned special shielding from 
these cuts. I look forward to working with them, and let's fix it for 
all of us; right, Senator Hatch?
  Mr. HATCH. That is right. Go ahead.
  Mrs. HUTCHISON. Yes, I would say to the Senator from Arizona, I was 
wondering if every State could have the same treatment. Why not have 
every State get this shielding for their Medicare Advantage? That is 11 
million people in this country who would then be helped by a fair 
assessment of this all over the country.
  But let me just point out one other provision. The way they have been 
shielded is through grandfathering. What about people who----
  Mr. McCAIN. And was that shielding done on the floor of the Senate, 
in open debate and in discussion of the issue?
  Mrs. HUTCHISON. Oh, no. Now, amazingly----
  Mr. McCAIN. It was done in an office over here, where we still await 
the white smoke.
  Mrs. HUTCHISON. The white smoke, that is correct. But then the 
question arises: What about the future, where people will say: That is 
what I can afford and what I want to have. But grandfathering doesn't 
include anyone who might want to join in the future; it is only the 
people already in the system. And for how long they live, that is 
great, but what about the future?
  So this is a great program. It is affordable for the lower income 
people. This shielding is only for three States now, but I would like 
to see us all have the same capabilities for our constituents. And what 
about our future constituents?
  Mr. GREGG. Would the Senator yield on that point, because the Senator 
from Arizona has raised an important point. If this is such a good 
program for these four States, why isn't it a good program for 
everybody?
  But more importantly, the Senator is the expert around here on 
earmarks. Is this not a classic earmark? And didn't we hear from the 
other side of the aisle that we were going to have open government; 
that we were not going to have this type of exercise occur within major 
bills; that bills weren't going to be loaded up with special earmarks 
assisting one Member or another? As the expert on the issue of 
earmarks, would the Senator comment?
  Mr. McCAIN. I would say this is probably the classic hometown 
protectionism that we see in earmarking and benefits that we see in the 
earmarking process.
  But also, I would remind the Senator from New Hampshire, as we have 
all discussed several times, a year ago last October, our then-
candidate for President said: It is all going to be on C-SPAN. Well, 
the C-SPAN cameras are still waiting outside Senator Reid's offices to 
go in and film these negotiations so that, as President Obama said, all 
Americans can see who is on the side of the pharmaceutical companies 
and who is on the side of the American people.
  C-SPAN, keep waiting. We are going to try to get you in.
  Mr. GREGG. If I could ask one more question because I have been 
listening to this debate, and I came over because I wanted to 
participate a little. I think it has been an excellent and informative 
debate.
  I have been looking at the numbers here, and I know the numbers are 
big--big--in this first 10-year period--almost $500 billion in 
reductions in Medicare spending. But I think the point we need to make 
is that it doesn't end there. It doesn't end there. Those Medicare 
spending reductions go on into the next decade, too, and over the first 
two decades of this bill, Medicare spending reductions will account for 
$3 trillion--$3 trillion. How can anybody argue against what the 
Senator from Idaho said, which is that this translates into real 
reductions in Medicare benefits?
  Mr. McCAIN. Isn't the vitally important point in this discussion that 
this massive mountain being carved out of Medicare is not being used to 
save Medicare? It is creating a huge new entitlement program. So here 
we are with Medicare going broke in 7 years, and we are taking money 
out of it in order to create a new program. That is the crime that is 
being committed here.
  Mr. GREGG. The Senator is absolutely right. And the new program, by 
the way, will not be solvent either. So we are compounding the 
insolvency of the future, and we are passing that on to our children.
  Mr. HATCH. We are taking $\1/2\ trillion out of a program that is 
going to be insolvent before the end of this decade and we are giving 
it to another program that is already insolvent.
  Mr. GREGG. That will be insolvent.
  Mr. HATCH. That will be insolvent. It is almost insane what they are 
doing. And they wonder why the American people are having such a 
difficult time, why we have 10 percent unemployed, why the 
underemployment is 17 percent in this country. Those are people who are 
trying to get part-time jobs because they can't get full-time jobs. So 
17 percent is the real number.
  This whole program is about helping low-income people and minorities, 
when you stop and think about it. That is what Medicare Advantage does. 
As the distinguished Senator from Arizona has said, they can't afford 
these supplemental policies on which AARP will make a lot of money if 
they can kill this program. There are a lot of gaps in traditional 
Medicare benefits, including high cost sharing and no out-of-pocket 
limits. That is why 89 percent of seniors have some form of 
supplemental coverage on top of Medicare. For many low-income Americans 
and minorities, Medicare Advantage is the only way they can afford the 
supplemental coverage.
  I compliment all of my colleagues here on the floor--the 
distinguished Senator from Arizona; the distinguished Senator from 
Idaho; the distinguished Senator from Texas; our only

[[Page S12367]]

doctor on the floor right now and one of only two in the Senate, 
Senator Barrasso from Wyoming; and, of course, our leader in the 
Senate, both on the Budget Committee, Senator Gregg and, of course, 
Senator Alexander. You guys have really summed this up.

  Mr. McCAIN. Could I say again that we have had spirited debate and 
discussion on this floor, but it is clear the majority of the American 
people do not support the proposal that is before us, and they do not 
support meeting in private, mostly in secret, closed negotiations.
  Again, I renew our offer to the Democrats and to the administration: 
Let's get together in a room with the C-SPAN cameras and any other 
outlet, and let's sit down and do some serious negotiations on the 
areas we can agree on, which there are many, and let's save Medicare, 
let's fix this system, and let's do it together in the way the American 
people want us to--in a bipartisan fashion, not behind closed doors, so 
the American people can see us work together for a change.
  I thank all of my colleagues for their many contributions. We are 
ready to talk. We are ready to talk, but we won't be driven.
  Mrs. HUTCHISON. Mr. President, I would like to return to a point that 
was made earlier about the President promising, and it being understood 
by everyone, that if you like what you have, you can keep it. On 
Medicare Advantage, once again, the CMS has estimated--and I would ask 
the distinguished Senator from Utah to verify this--that enrollment in 
Medicare Advantage will decrease by 64 percent under this bill.
  Mr. HATCH. A lot of seniors are going to be badly hurt by these cuts, 
no question, and the poor.
  Mrs. HUTCHISON. And 8.5 million seniors would be deprived.
  Mr. HATCH. And a lot of them are minorities, by the way. This is 
amazing to me, how we go through all kinds of demagoguing about low-
income people and minorities, and yet they are going to take one of the 
most important benefits away from them. That benefit is mentioned in 
the Medicare handbook for 2010, yet they act as if it is not part of 
Medicare. I can't believe some of the arguments that have come from the 
other side.
  Mr. McCAIN. Could I ask the Senator from New Hampshire, the senior 
member on the Budget Committee, a person who is well-known for his 
knowledge of the economy, of the budgetary situation in America, what 
happens if we pass this massive bill? What happens to America's 
economy?
  Mr. GREGG. Well, my view is this: First off, we know a couple of 
facts--that we grow the government by $2.5 trillion over a 10-year 
period when this bill is fully implemented. We also know the tax 
increases during that period will be approximately $1.2 trillion, tax 
increases and fees, and they are not going to fall on the wealthy, they 
are going to fall on the small businessperson trying to create the 
extra job. We also know there will be an entire sea change in the way 
people get their health care, that the government will be stepping in 
between you and your doctor and basically making a decision as to what 
your doctor can tell you you can have for health care, what the 
provider will tell you you can have for health care.
  There is something that hasn't been discussed much. We know the 
innovations in health care which have done so much to make America the 
best place to get health care in the world and which have put us on the 
cutting edge of drugs that have improved the lives of millions of 
people, not only in the United States but across the world, will be 
significantly chilled because there will not be an interest in 
investing capital in a market that is so controlled by the government.
  In the end, it is fairly obvious to anybody who has been around this 
place that there isn't going to be $3 trillion in reductions of 
Medicare spending over the next 20 years and there isn't going to be 
$500 billion in Medicare spending cuts in the next 10 years. So all 
that spending is going to fall on the backs of our children in the form 
of debt.
  We already have a nation that is on an unsustainable path under the 
present budget scenario without this health care bill. Our deficits are 
$1 trillion a year, on average, for the next 10 years. That is without 
this bill. Our public debt goes from 35 percent of the gross national 
product to 80 percent of the gross national product. We become 
insolvent at the end of this decade--not this decade but the decade 
starting today, 10 years from today. That is aggravated dramatically by 
exploding the size of the government under this bill rather than taking 
the step-by-step approach that has been proposed by our side to reform 
health care, to make it more effective and make it deliver more 
services to more people at a better cost.
  A number of times I have heard people on the other side of the aisle 
get up and say that CBO says this bill reduces the cost of health care 
spending to the Federal Government. It is just the opposite--just the 
opposite. The CBO letter specifically said that the cost to the Federal 
Government of health care goes up--goes up--under this bill in the 10-
year period. So this bill does not turn down the cost of health care, 
it does explode the size of government, it does put the government into 
the business of managing your health care, and as a result, I think it 
is going to reduce the quality of life of our children.
  Mr. HATCH. Will the Senator yield on that point?
  Mr. GREGG. I do not have the floor.
  Mr. McCAIN. Go ahead.
  Mr. HATCH. The Senator has pointed out he does not believe they can 
afford all these programs. The Senator is not suggesting this is a 
game, is he?
  Mr. GREGG. I am suggesting it is very difficult, under any scenario, 
to believe this Congress is going to do anything other than spend the 
money that is put in this bill. It is certainly not going to end up 
making the reductions in Medicare it proposes in this bill. If it does 
make those reductions, though, I think the Senator from Utah has been 
absolutely right in saying those reductions should go to making the 
Medicare system solvent. They should not go to creating a brand new 
entitlement.
  Mr. McCAIN. On that point I think Senator Crapo wishes to exactly 
emphasize the point of Senator Gregg.
  Mr. CRAPO. I wish to make a comment or two and then engage with the 
ranking member of the Budget Committee.
  Often people talk about driving the cost curve down. Frankly, when 
you talk to Americans about what they want in health care reform, the 
vast majority of them say the reason we need health care reform is 
because of the skyrocketing cost of health care and health care 
insurance. Those who are promoting this bill say they are bending that 
cost curve down. My question is which cost curve are they talking 
about? Is it the size of government? Are they bending the size of 
government growth down? No, as the Senator from New Hampshire said, 
they are growing government by $2.5 trillion for the first true 10-year 
period of the bill.
  Are they driving personal health care costs down? No, the CBO report 
we recently got said 30 percent of Americans will see their health 
insurance go up, and the other 70 percent will, at best, see it stay 
about what it is today, rising at the same levels it is today.
  Are they talking about the Federal deficit? The chairman of the 
Budget Committee has indicated to us we are going to see skyrocketing 
deficits. Those who claim this bill is going to reduce the deficit can 
say so only if they take into account all of their budget gimmicks, 
such as not counting the first 4 years of the spending, or the hundreds 
of billions of dollar of taxes that are going to be imposed on the 
American people, or the Medicare cuts we have been talking about. Take 
any one of those three out of this bill and it drives the deficit up in 
a skyrocketing fashion, is that not correct, Senator?
  Mr. GREGG. Absolutely.
  Mr. McCAIN. Has the Senator from New Hampshire ever heard of 
legislation where you pay in the first 4 years before a single benefit 
comes about? Nowadays I see these advertisements that you can buy a car 
and you don't have to make a payment for a year and then you can start 
making payments. In this deal it is the reverse; you make payments and 
then perhaps you get the benefits after some years.
  The Senator from Tennessee, I think, wishes to comment, too.
  Mr. ALEXANDER. I would direct my comment to the Senator from New

[[Page S12368]]

Hampshire, too. The President of the United States said something a few 
weeks ago that I thought was profound and that I agreed with, he said 
this debate is not just about health care; it is about the role of the 
Federal Government in the everyday lives of the American people. I 
believe he is exactly right about that, which is why so many Americans 
are turning against this bill.
  Would the Senator from New Hampshire agree the President was correct, 
that this debate is about, in my words now, Washington takeovers, more 
taxes, more spending, and more debt? It is not just about health care. 
The enormous interest across the country in these votes comes from a 
much larger picture than this health care bill.
  Mr. GREGG. I think the Senator from Tennessee has once again hit the 
nail on the head. I respect the President's forthrightness. The 
President has said very simply he believes that prosperity comes from 
growing the government. When this bill passes, we will see the largest 
growth in government in the history of our country. This is going to be 
16 percent of our economy basically managed by the Federal Government. 
You are going to see the Government explode in size. Does that lead to 
prosperity? I don't happen to think it does. It certainly doesn't lead 
to prosperity if along with that massive expansion in the size of the 
government you are going to see your deficit go up significantly, your 
debt go up significantly, or the tax burden go up significantly, which 
reduces productivity, or if you take a large segment of our society, 
our seniors, 35 million today, 70 million by the year 2019, and say to 
them they are not going to have the ability to have a solvent Medicare 
system because the way that system might have been made more solvent is 
now being used to create a brandnew entitlement, a massive new 
entitlement for a whole group of people who never paid for an insurance 
policy and never paid into the Medicare insurance fund.
  I think the Senator has touched the base. We have seen automobiles, 
we have seen financial institutions, we have seen the student loans, 
and now we are seeing health care all taken over by the government or 
partially taken over by the government. Clearly the goal is, as the 
President said, expand the size of the government, create prosperity, 
use the European model. I don't happen to be attracted to the European 
model. I think the American model works better where you have a 
government you can afford and give entrepreneurs a chance to go out and 
take risks and create jobs.
  Mr. McCAIN. Senator Hutchison will conclude.
  Mrs. HUTCHISON. We have been talking about Medicare Advantage and 
losing this great option for lower income seniors, which is so 
important. I was reminded that we have not even talked about the $135 
billion that would be taken out of hospitals in this bill. These are 
the care providers. We are talking about taking away benefit options in 
eye care and dental care and hearing aids, sort of basic things seniors 
need, but also undercutting the hospitals that treat them, so the care 
provided in the hospitals themselves would also have to be cut back.
  It does not pass common sense to cut Medicare in order to create a 
new big entitlement program. We have all said that Medicare is on life 
support anyway, everyone understands that. So you take almost a $\1/2\ 
trillion out of a program that is working for seniors, that gives 
options to seniors such as Medicare Advantage, and you take away their 
care to pay for another entitlement program that is not specifically 
designed for them.
  I thank the Senator from Arizona and ask him to finish the comments 
on what is happening to this bill, this country, and our seniors. We 
need to stop it.
  Mr. McCAIN. I thank my colleagues. It has been a lot of fun. I yield 
the floor.
  Mr. BAUCUS. Mr. President, if I may, I ask unanimous consent that we 
extend for an additional hour the period for debate only with no 
further amendments or motions in order during the hour; and that the 
time be equally divided between the two sides, with the Republicans 
controlling the first 30 minutes and the majority controlling the 
second 30 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. I believe there is 3 minutes remaining on the first 
block, on the majority side?
  The ACTING PRESIDENT pro tempore. There is 2 minutes 20 seconds.
  The Senator from Ohio is recognized.
  Mr. BROWN. Mr. President, I ask unanimous consent to be added as a 
cosponsor to the Coburn amendment No. 2789 requiring all Members of 
Congress to enroll in the new public health insurance option. I wish to 
add my name to Senator Coburn's amendment. Seventeen years ago when I 
first ran for Congress I promised I would pay my own health insurance 
until Congress paid health insurance for everyone. I have paid out of 
my pocket since then. I look forward with great eagerness to joining 
the public option as soon as it is available.
  Mr. BAUCUS. Mr. President, I think I will use my 2 minutes 20 
seconds.
  The ACTING PRESIDENT pro tempore. And 15 seconds.
  Mr. BAUCUS. OK. I want to make three basic points. The Senator from 
Arizona talks about, gee, all these Medicare Advantage plans have 
dental and vision coverage. He goes on to say, so do Members of 
Congress.
  The fact is that is not automatically true. The fact is Members of 
Congress choose among various private plans. Some plans offer dental 
and vision, some do not. Aetna is a company that Members of Congress 
could choose from under FEHBP and others that Members of Congress can 
choose from. Those do provide dental and vision coverage. But there are 
others--I think Blue Cross and Blue Shield does not provide dental and 
vision coverage.
  I make that point because this is exactly what we are trying to set 
up in these exchanges. People could participate in the exchanges, where 
they would buy private coverage and they could choose among various 
private plans which coverage they want. Do they want a plan that covers 
dental and vision, or not? That is exactly what we are trying to do in 
the exchange, as is the case for Members of Congress. Medicare 
Advantage plans do provide dental and vision. I think that is great.
  I see my time has expired. At the appropriate time I wish to go into 
greater detail and explain why what we do in this bill I think makes 
eminent sense.
  The ACTING PRESIDENT pro tempore. The Senator from Iowa is 
recognized.
  Mr. GRASSLEY. Mr. President, I yield myself such time as I might 
take. I don't think I am going to speak more than 6 or 7 minutes, for 
the benefit of my colleagues who may want some of this time.
  I want to tell my colleagues why I am supporting the Hatch amendment. 
In my home State of Iowa there are 64,000 seniors enrolled in Medicare 
Advantage. These are seniors who have come to rely on lower cost and 
particularly additional benefits that Medicare Advantage provides, as 
opposed to traditional Medicare. Yesterday I came to the floor to point 
out that my colleagues on the other side of the aisle are playing word 
games to cover up the fact that they are raiding Medicare, cutting 
benefits by 64 percent for these 11 million seniors who have chosen 
voluntarily to go on Medicare Advantage as opposed to traditional 
Medicare. Let me repeat: This bill cuts Medicare benefits, or let's say 
raids Medicare, by 64 percent for 11 million Medicare beneficiaries.
  My friends on the other side of the aisle keep saying they are not 
cutting and they use these words, ``they are not cutting guaranteed 
benefits.'' But this is not even the case. Because we have this new 
independent Medicare advisory board that is set up in this legislation, 
it is given very specific authority to cut payments to Medicare Part D. 
This will result in higher costs and less guaranteed benefits for 
Medicare beneficiaries enrolled in Medicare Part D.
  But I want to leave that debate for later. I want to visit with my 
colleagues now about Medicare Advantage. Mr. President, 64,000 seniors 
in Iowa and 11 million seniors nationwide do not care about the 
gobbledy-gook type words we use here in town, as legal as they are--
``guaranteed benefits'' on the one hand and the words ``additional 
benefit'' on the other hand. In other words, guaranteed benefits or,

[[Page S12369]]

as the other side wants us to believe, somehow additional benefits 
provided under Medicare.
  I say that is Washington nonsense. I want to bring a little bit of 
Midwestern common sense to this debate. Our constituents want to know 
that Congress is not cutting Medicare benefits they have come to rely 
upon and that would include, under Medicare Advantage, dental care, 
eyeglasses, hearing aids, and other additional benefits provided by 
this program that they voluntarily chose, Medicare Advantage.
  I know that to be the case. I have at least 1,000 letters I have 
received since last summer on this point. But I want to read one from 
Miss Purificacion S. Gallardo of Iowa City, IA.

       I am writing to urge you to oppose cuts to Medicare 
     Advantage. . . . This plan was a great help to me when my 
     late husband, who passed away in May, was hospitalized. . . 
     . I was able to afford to pay the hospital without going 
     bankrupt. We seniors who live on a fixed income depend on 
     our benefits from Medicare Advantage. I am retired and 
     don't know how I would have managed without [Medicare 
     Advantage].

  Some of my colleagues on the other side of the aisle don't want 
seniors, even people such as my constituent from Iowa City, Ms. 
Gallardo, to know that this 2,074-page bill is cutting their benefits. 
Because the other side will say they are simply cutting so-called 
overpayments to Medicare Advantage plans. That doesn't make any 
difference to Ms. Gallardo. They fail to mention, 75 percent of these 
so-called overpayments must be spent for additional benefits--not only 
free money for a company to use or free money that benefits a Medicare 
Advantage recipient without any concern about what it costs--75 percent 
of these payments must be spent for additional benefits. Then where 
does the rest of it go? The rest of it comes back to the Federal 
Treasury. Cuts to these Medicare Advantage payments are, in fact, cuts 
in Medicare benefits.
  I am more than happy to have a debate on how to reform Medicare 
Advantage payments. We should always be looking for ways to make 
payments more efficient. But the solution is not to cut benefits by 64 
percent, on which seniors have come to rely, to fund an entirely new 
entitlement program this country can't afford. At a time when seniors 
are in the midst of the biggest economic crisis since the Great 
Depression, we should not be debating a bill that forces them to spend 
more money on health care, and that is exactly what this 2,074-page 
bill will do. Seniors who lose their Medicare Advantage as a result of 
this bill may be forced to buy a Medigap plan to fill in all the holes 
in traditional Medicare. That is why more low-income seniors enroll in 
Medicare Advantage. The so-called overpayments my colleagues on the 
other side of the aisle keep decrying help fill in the significant cost 
sharing and premiums that exist in traditional Medicare.
  This bill will force low-income seniors, who pay little to nothing 
under Medicare Advantage, to come up with $175 per month to buy a 
Medigap plan. That doesn't sound like that is a very good way to help 
seniors. That sounds like this bill is paying for an entirely new 
entitlement program and paying for it, quite frankly, on the backs of 
11 million Medicare beneficiaries.
  I support the Hatch amendment. Let's take the $120 billion in 
Medicare Advantage cuts back to the Finance Committee and find a way to 
improve the program without hurting 11 million seniors.
  I yield 5 minutes, as the manager on this side, to Senator Hutchison.
  The ACTING PRESIDENT pro tempore. The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, I appreciate what the distinguished 
Senator from Iowa has discussed. I specifically liked the fact that he 
is relating this to where we are today. Sometimes it seems as though we 
are in a vacuum, not realizing how stretched people are right now. We 
are in a time of joblessness, people are worried about keeping their 
jobs, worried about having lost their jobs, where they are going to get 
their health care. We have seniors who are stretched because they are 
not able to earn income. We are in a distressed time. There is no doubt 
about it. To talk about cutting Medicare by almost $500 billion is 
astounding. I am concerned about hospitals. We talked for the last 45 
minutes about the cuts to benefits--the hearing aids, the dental work 
seniors need, the eye care seniors need.
  What about the cuts to care provided in a hospital? Hospitals that 
treat a large share of low-income seniors get an extra payment from 
Medicare. Medicare already makes reduced payments to providers, to 
doctors but also to hospitals, to hospice, to nursing homes, and home 
health agencies for senior services. And yet proposed is a cut of 
almost $500 billion. All of these serve our seniors in such great ways. 
Look at the cuts, almost a $\1/2\ trillion over 10 years. This is not 
sustainable. We cannot take away from Medicare, cut services, cut 
reimbursements to providers. What is going to happen to a hospital? 
What is going to happen to a hospital in a rural area, especially that 
is barely hanging on right now because they are trying to make ends 
meet in a more expensive treatment area and they lose the added payment 
that would make them whole in the treatment of low-income seniors?
  The Texas Hospital Association estimates that $2 billion will cut in 
payments to hospitals for treating a large volume of low-income 
Medicare patients, $2 billion out of our economy. Mr. President, 254 
counties in Texas, more than one-fourth, do not even have an acute care 
hospital within their boundaries. With these kinds of cuts to rural 
hospitals, we are talking about losing more hospitals. There is no 
doubt about it. They are already struggling. Why would we pay for 
health care reform on the backs of our senior citizens? Why would we 
take away a program they have that is tailored for their needs in order 
to pay for another big government program that is going to cost $2.5 
trillion, most of which is going to be added to the deficit, added to 
the debt, and we are already hitting the ceiling of the debt at $12 
trillion? We are in a very tough financial time. We are in a time that 
is hard for people who have lost jobs, hard for seniors stretched to 
make ends meet, hard for hospitals serving seniors and not getting paid 
the full cost of the treatment. Yet we are talking about cutting these 
services.
  Of the $135 billion in Medicare cuts to hospitals, $2 billion is for 
the reimbursement rates that will no longer be making hospitals whole. 
I went to the major medical centers in Texas--in Dallas, Houston. Then 
I went to rural areas. It is the topic of conversation. Anyone who is 
dealing with a hospital in a rural area, they are all saying: What are 
you doing?
  Of course, we are not doing anything. We are fighting these health 
care cuts. But we have to make sure they know what is happening so we 
can achieve that result.
  I understand my time has expired. I think the Senator from Oklahoma 
has the rest of the time on our side.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Oklahoma.
  Mr. INHOFE. Mr. President, I thank the Senator from Texas. I yield 
myself the remainder of our time, which I understand is until 10 after 
the hour.
  I wish to talk about taxes, which is our subject, and in a different 
way than others did. The stated purpose of the Democrats' health care 
proposal is to do two things: lower cost and increase coverage. This 
bill is a miserable failure on both counts. Under the plan, premiums 
are expected to increase, as a result of new taxes, new regulations, 
and restrictions. In general, you are going to pay more for your health 
insurance thanks to the Democrats' 2,000-page bill. This is in direct 
contradiction to the stated goals of the bill itself. I will be 
specific about that in a moment.
  The second issue is coverage. Again, we find a miserable failure. The 
most often cited number of uninsured Americans is 47 million Americans. 
I saw some interesting numbers in a Washington Post opinion piece the 
other day which kind of ranks out the uninsured and how they are broken 
down. This is very significant. Of the 47 million, 39 percent reside in 
the five States of California, Florida, New Mexico, Arizona, and Texas. 
Those are our border States. Indeed, it is estimated that 9.1 million 
of the 47 million are illegal immigrants, people in this country 
illegally. Secondly, of the 47 million, 9.7 million have incomes above 
$75,000 and choose not to purchase health insurance. This bill would 
solve that issue by using the coercive power of the Federal Government 
to force citizens to allocate their resources in a manner that

[[Page S12370]]

meets the approval of bureaucrats in Washington and of politicians. The 
bill makes it a crime not to have health insurance. If you don't get 
it, you get taxed.
  Lastly, a total of 14 million of the 47 million are currently 
eligible for current government programs--Medicaid, Medicare, SCHIP, 
and so forth--and choose not to sign up. If you do the math, that 
reduces that 47 million down, if you take out the illegals and the 
others for the reasons I stated, to about 14 million. So this, by and 
large, is what people are talking about when they mention the 47 
million uninsured Americans. These numbers shed some interesting light 
on the composition of the number of uninsured Americans that gets 
thrown around. President Obama, interestingly, uses a different number. 
He doesn't use 47 million. He uses 30 million. I think he wants to 
avoid the immigration issue, and it is probably wise of him to do so. 
He doesn't want to be accused of giving rich benefits to people who are 
here illegally. I noted, with great interest, the CBO's estimate of the 
number of Americans who will not have health insurance, even if this 
bill were to be enacted over the wishes of the majority of the American 
people, 24 million. This bill still leaves 24 million Americans 
uninsured, after spending $2.5 trillion to do just that, while at the 
same time making health care more expensive for the rest of us.
  I hear the other side often throwing numbers around without any 
documentation. I use the CBO and other nonpartisan, credible sources so 
we can avoid doing that. President Obama wants to spend $2.5 trillion 
in new health care promises at a time when the country can't afford the 
promises we have already made, and we have a record 1-year budget 
deficit which, by the way, means that 47 cents out of every dollar the 
Federal Government spends this year is borrowed. In 10 years, 16 
percent or nearly $1 out of every $5 the government spends will be 
spent solely on interest payments on the debt. President Obama's budget 
doubles the Federal debt in 5 years and triples it in 10 years. We have 
talked about this on the floor. I don't think there is disagreement.
  On top of this, we face $67 trillion in unfunded liabilities from our 
current entitlements of Social Security, Medicare, and Medicaid. This 
health care plan layers yet another unaffordable entitlement on top of 
Medicare and Medicaid and Social Security and the other entitlements we 
have, all in a system that is already crumbling. It seems to me this 
bill is exactly what the American people do not need. That is why most 
Americans are reporting that this bill is something they do not want at 
this time or ever. I think it is common sense.

  Reading through the legislation, one is struck by the myriad of ways 
this bill raises taxes on America's citizens--from job-creating small 
businesses, to middle-class families. I count about a dozen of them, 
adding up to about $500 billion in tax increases over the next few 
years--$\1/2\ trillion in new taxes. So everyone should get ready to 
pay a higher health care bill and a higher tax bill should this measure 
become law.
  Some might be inclined to say: But President Obama promised he would 
not raise taxes. That was, indeed, a campaign promise of the current 
administration, that no one making under $250,000 per year would see 
their taxes go up.
  Let me just go ahead and quote that. This is what President Obama 
said during the campaign:

       I can make a firm pledge . . . no family making less than 
     $250,000 will see their taxes increase--not your income 
     taxes, not your payroll taxes, not your capital gains taxes, 
     not any of your taxes.

  So we started analyzing this bill, and guess what we found out. When 
the bill is fully enacted, the nonpartisan Joint Committee on 
Taxation--keep in mind, I am quoting sources here that are credible 
sources and nonpartisan sources--the Joint Committee on Taxation found 
that, on average, individuals making over $50,000 and families making 
over $75,000 would see their taxes go up. Let me repeat that. 
Individuals making over $50,000 and families making over $75,000 would 
have their taxes go up under this bill. Indeed, according to the Joint 
Committee on Taxation, 42 million middle-class families and 
individuals--those making less than $200,000, on average, will pay 
higher taxes in this bill. President Obama's health care reform bill 
currently under consideration in the Senate raises revenues to a large 
extent on the backs of middle-class Americans despite Candidate Obama's 
pledge not to do that.
  So let's look at some of these instances where we get taxed. I am 
getting this, again, from the Joint Tax Committee and from CBO. If you 
have health insurance, you get taxed. According to the nonpartisan 
Congressional Budget Office, new excise taxes applied to health 
insurance providers will end up taxing the beneficiaries. This tax also 
has the effect of increasing premiums as well. So you are double-taxed 
on this deal.
  Now, that is if you do have health insurance. What if you do not have 
health insurance? You still get taxed. Under this bill, you get taxed 
if you do not carry health insurance, as a penalty. Where does this 
burden fall? You guessed it: middle-class Americans. CBO has said that 
half of the Americans affected by this provision make between $22,800 
and $68,000 for a family of four. That is middle-class America.
  If you take prescription drugs, you get taxed. That is another area. 
According to the JTC and CBO, new taxes in the bill applied to the 
provision of prescription drugs will end up raising the cost of those 
drugs. So you are taxed again.
  If you happen to need a medical device--this is something I am really 
sensitive to, and I have not heard much discussion of this issue on the 
floor so far. It is a difficult thing. I was talking to Senator Enzi. 
He said people do not really know what medical devices are. The 
stents--these are things that are available here in America. You cannot 
find them in many of the other countries. So if you need a medical 
device, you get taxed. If you have high out-of-pocket medical bills, 
you get taxed.
  My son-in-law, Brad Swan, installs pacemakers and defibrillators. 
This morning, I was talking to him, and he told me what happened last 
night. He said that at 1 o'clock in the morning, they got a call to go 
out to the emergency room of St. Francis Hospital in my city of Tulsa, 
OK, and they had an 8-year-old boy who had no heartbeat. He was born 
with congenital heart disease. He put in a pacemaker at that time, and 
he was perfectly healthy in the morning. I think most doctors would 
agree that without it, that child would not have lived. My older sister 
Marilyn faced a similar situation 9 years ago. She is alive today. She 
is healthy today. She would not be alive today without it. That is how 
serious this is.
  Dr. Stanley DeFehr is from Bartlesville, OK. I talked to him this 
morning about this, about the significance of the medical devices. I am 
going to quote his answer. I wrote it down. He said:

       The decision of who needs a pacemaker could be complicated, 
     particularly the decision to put in a pacemaker on someone we 
     might consider quite elderly. But it's a false economy to 
     deny putting one in because of their risk of falling 
     (breaking a hip or shoulder). In the case where they fall, 
     the costs become quite high. The cost of a pacemaker pales in 
     comparison to the cost of a stroke or multiple fractures.

  A pacemaker, by the way, costs about $5,000 and lasts about 10 years. 
That is $500 a year--not a bad deal. So I think this is a quality-of-
life issue that we could lose with the Democrats' government-run health 
care schemes.
  So those are some examples of what we can do to pay higher taxes 
under this bill. If you have health insurance, you pay higher taxes. If 
you do not have it, you pay higher taxes. If you purchase a medical 
device, you have higher taxes. If you pay your own medical bills out of 
your pocket, you have higher taxes. If you take prescription drugs, you 
have higher taxes. All of these activities are taxed mercilessly under 
this legislation.
  I want to turn now to examine one tax provision in particular that I 
find strikingly dishonest, damaging, and expensive to the taxpayer. It 
is an additional Medicare payroll tax that is in this legislation, and 
it is a perfect example of how this bill is going to tax you. You have 
to go into the bill to find these things. There are clandestine taxes 
in the bill that will hit you when you do not expect them to.
  Basically, the bill says that people making $200,000 a year are going 
to pay an additional payroll tax called the

[[Page S12371]]

hospital insurance payroll tax that raises over $53 billion. Keep in 
mind, this is above the taxes we are already paying. They are getting 
these people at $200,000. You might think that is a lot of money. But 
there is a catch to this. They did not index it. So if you do not index 
the $200,000, then a period of time goes by, and it is far less than 
the amount it sounds like today. In fact, I would say in 10 years from 
now that $200,000 would pretty much fit a lot of the middle-income 
people in America. So there is this increase with an additional 
Medicare payroll tax in this bill that raises $50 billion. It is not 
indexed, and we know how that is going to extend to other people now.
  I remember Candidate Obama making a firm pledge not to raise taxes on 
middle-class Americans. However, this health care reform bill before us 
breaks that pledge on numerous occasions. But it is not unlike the new 
taxes which will be imposed on other measures the Democratic Congress 
and President Obama would like to enact. I just mentioned the $500 
billion in new taxes this health bill raises.
  There is another tax in another program going on, which I have talked 
about on this floor many times; that is, the cap and trade. That is 
still on the floor. That could come up at any time. Of course, that is 
not something that would be $500 billion over a 10-year period; that 
would tax the American people in excess of $300 billion every year.
  I have quoted as my sources the Wharton School of Economics, MIT, 
CRA, and others that have done evaluations. So it is not just this 
bill, even though this bill is what we are talking about today; we 
still have the problem of other legislation being promoted by the 
President and by the Democrats here.
  The Obama administration's own Treasury Department estimated that 
cap-and-trade legislation would cost each family in America $1,761 a 
year. It is much more than that in heartland America. In Oklahoma, it 
would be closer to $3,300 a year. So we are talking about some very 
large tax increases.
  But, again, back to the health care bill, I noted earlier that the 
government-run health care system, as proposed by the President and by 
the Democrats, is expected to cost $2.5 trillion on top of the already 
exploding record deficits. This bill will increase payments we make on 
our country's ever-exploding Federal debt. This Democratic Congress's 
agenda clearly includes more tax on Americans. They may be hidden, but 
they are there. It is disingenuous. It is costly. It is another reason 
this bill should not be passed by the Senate. I say ``another.'' The 
other and the main reason is that a government-run health system does 
not work.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Burris). The Senator from Montana.
  Mr. BAUCUS. Mr. President, I understand we are now under the order 
where there is a half hour allocated to the majority side; is that 
correct?
  The PRESIDING OFFICER. That is correct. The Senator has 30 minutes.
  Mr. BAUCUS. Mr. President, I yield myself 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, I just want to help people understand this 
legislation. I am sure many do, but I am sure there are some who do not 
with respect to the choices people will have.
  We have a uniquely American system of health care in America. It is 
roughly half public, half private. The goal of this legislation is to 
retain what we have; that is, basically have that same balance of 
public and private. It has worked pretty well for America. It is 
uniquely American. We are not Canada. We are not Great Britain. We are 
not Switzerland. We are the United States of America. I think it is 
good to build on our current system and make our current system work 
better.
  I am prompted to explain the choices, in part by the statements by 
the senior Senator from Arizona, who said Medicare Advantage plans 
enable people to get eyeglasses and dental care. And that is true. But 
he went on to say that, gee, shouldn't Members of Congress, who like 
all that and want to keep all that--that Members of Congress get free 
dental and free eyeglasses. Well, that is really not true. Members of 
Congress do not get that. But it is true Members of Congress 
participate in--all Federal employees, Members of Congress, people in 
the Forest Service, people all around the country--all Federal 
employees participate in the same system. It is called FEHBP. It is the 
Federal Employees Health Benefits Plan, where Federal employees and 
Members of Congress, all together, the same, can choose among many 
different private health insurance plans. There is an open enrollment 
season--in fact, we are in the midst of it right now--where Members of 
Congress and all Federal employees can look to see if they want to 
choose a different insurance company or not. Some of those companies do 
provide dental and vision coverage. Some do not. So if a Federal 
employee wants to choose a plan that covers dental and vision, he or 
she can do so. Just pay the premium, and you are covered with dental 
and vision.
  We are setting up under this legislation an exchange that is very 
similar--almost identical--to the FEHBP, where people who do not have 
health insurance can go look on the exchange and choose, among private 
companies, which one makes the most sense for them. Some may have 
dental, some may have eyeglass coverage, some may not. That is just a 
choice people can make.
  In addition to that, there is even more choice, because currently a 
Federal employee does not have to join FEHBP. A Federal employee can 
choose not to get health insurance if he or she does not want to or 
maybe they get it through their spouse someplace else. The same can be 
true with the exchange set up in this legislation. The person could buy 
among different competing private plans that offer health insurance on 
the exchange or a person can go outside the exchange because he or she 
thinks they can get a better deal, if that person wants to.
  So I just want to make it clear that we are encouraging choice. We 
are encouraging competition. And I might say that under the 
legislation, Members of Congress who fully participate in this will be 
coequal with others. If there is a private option, Members of Congress 
can participate in that as well. In fact, we are requiring Senators and 
their staffs--they do not have to participate in the exchange, but it 
is certainly available to them, and they can opt out if they want to.
  Let me just say a little bit about Medicare Advantage. What does 
MedPAC say about Medicare Advantage? Several years ago, Congress 
established an advisory board that is now called MedPAC to advise them 
on how Medicare should pay providers in traditional fee for service and 
private health insurers in Medicare Advantage. Again, Medicare 
Advantage is with private companies. They have executives. They have 
stockholders. They are private companies. MedPAC advises us how much 
Congress should pay MedPAC and other Medicare providers in traditional 
fee for service. It is an independent agency. Its experts are 
nonpartisan, highly respected.
  Each year, they send a report to Congress that examines issues in 
Medicare. Here is what MedPAC had to say about the current state of 
Medicare Advantage in its 2009 June report. I am going to quote now 
from this independent advisory panel:

       First, we estimate that in 2009 Medicare pays about $12 
     billion more for enrollees in Medicare Advantage plans than 
     it would if it were fee-for-service Medicare.

  Second:

       Current high payments have resulted in some plans that 
     bring no innovation but simply mimic fee-for-service Medicare 
     at a much higher cost to the program.

  In other words, they are saying that Medicare Advantage plans get 
paid for a lot more but with no innovation compared to the fee-for-
service Medicare.
  MedPAC says:

       This situation is unfair to taxpayers and beneficiaries not 
     enrolled in Medicare Advantage who subsidize the higher 
     costs.

  Well, that is pretty obvious.
  In addition, MedPAC goes on to say:

       The excessive payments encourage inefficient plans to enter 
     the program, further raising costs to Medicare.

  There are so many dollars currently given to Medicare Advantage 
plans, according to MedPAC, that encourages inefficient plans to enter 
the program. Why not? They are getting all of this extra money.
  Further quoting:


[[Page S12372]]


       The cost of Medicare Advantage subsidies is borne by 
     taxpayers who finance the Medicare program and by all 
     Medicare beneficiaries via Part B premiums.

  Or to say it differently, about 78 percent of Americans who are not 
in Medicare Advantage plans are paying, in effect, a $90-per-year tax 
for which they get no benefit which goes into the Medicare Advantage 
plans.
  In addition:

       The Part B premium for all beneficiaries is increased by 
     about $3 a month, regardless of whether you receive the 
     benefit.

  A couple of more quotes from MedPAC:

       The additional Medicare Advantage payments hasten the 
     insolvency of the Medicare Part A trust fund by 18 months.

  That is an interesting statement. The additional payments hasten the 
insolvency of the Medicare Part A trust fund by 18 months.
  Going with quotes from MedPAC:

       Although many plans are available, only some are of high 
     quality.

  In addition, continuing the quote:

       Only about half of the beneficiaries nationwide have access 
     to a plan that CMS rates as above average in overall plan 
     quality.

  This is what MedPAC says. That is the nonpartisan expert that helps 
advise Congress on what reimbursement levels should be.
  We have heard day after day that this bill is cutting Medicare 
benefits for our seniors. When my colleagues on the other side of the 
aisle realized this bill does not cut, reduce, ration, or eliminate a 
single guaranteed benefit, they turned their argument to Medicare 
Advantage. I think they finally recognize there are no guaranteed 
benefits cut in this legislation, so they turn to Medicare Advantage. 
They argue that the efficiencies and savings achieved by ending 
billions of dollars of overpayments to these private plans will either 
end the program or dramatically cut services to beneficiaries.
  But let's just look at the numbers. I have a chart behind me. This 
chart shows the yearly spending for Medicare Advantage in billions of 
dollars. So you can see from the chart that in the year 2009, $110 
billion will be spent on Medicare Advantage plans. That is the far 
left. Moving to the right, 10 years later, in the year 2019, about $204 
billion is spent. So if we total it all up, about $1.7 trillion will be 
spent on Medicare Advantage plans over the next 10 years.
  You see that little--what color is that? It is kind of orange, it is 
kind of an interesting sort of red--whatever it is, at the top of that 
chart. That represents the reduction in Medicare Advantage plan 
payments under this legislation. It is not very much, as you can tell 
by looking at the chart. It averages out, I think, to around a 10-
percent reduction in Medicare Advantage payments.
  So when we see these big crocodile tears, and we hear Medicare 
Advantage is being cut; when we hear all of these dramatic statements 
that so much is going to be taken away from seniors because Congress is 
cutting Medicare Advantage, the fact is, we are reducing the rate of 
increase in Medicare Advantage payments by only about 10 percent, and 
under this legislation about $1.7 trillion will be spent on Medicare 
Advantage plans. Remember, MedPAC says these are overpayments. MedPAC 
says this 10 percent reduction is what they should be paid.
  Remember, too, these are private plans. These are private companies. 
It is not Medicare. These are private companies receiving these 
payments, and they are insurance companies. It is interesting to me 
that a lot of Members of Congress aren't too wild about insurance 
companies. Well, Medicare Advantage companies are insurance companies. 
That is what they are. They are private insurance companies. They are 
private insurance companies. They have their private insurance company 
chief executive. They have their private insurance company officer. 
They have their private insurance company stockholders. They have their 
private insurance company administrative costs and marketing expenses. 
They are private insurance companies. That is what they are. So we 
should not lose sight of all of that.
  I wish to also point out that as private insurance companies, these 
Medicare Advantage plans are doing pretty well. Let me quote from an 
Oppenheimer Capital analyst in a November 12 report about Medicare 
Advantage plans. He said:

       Between 2006 and 2009, we estimate that Medicare Advantage 
     accounted for nearly 75 percent of the increase in gross 
     profits among the larger plans in the industry, highlighted 
     by an estimated gross profit increase of $1.9 billion in 
     2009, relative to commercial risk earnings gains of nearly 
     $600 million.

  Commercial risk earnings gains are the ordinary health insurance 
companies, but 75 percent of the gross profit increase was under 
Medicare Advantage plans, not traditional health insurance.
  I might say, too--I don't have the papers; maybe I can find them. It 
is worth noting, it underlines the point that these are private 
companies. It is not traditional Medicare.
  Here it is. Because it is interesting, let's look at the compensation 
of these insurance company executives of these Medicare Advantage 
plans, the CEOs. The total compensation of a CEO at Aetna is $24 
million a year. The total compensation of the CEO at Coventry is $9 
million a year; at Wellcare, $8 million; at Humana, $4.7 million a 
year; and at United Health Care, $3 million. Now, people should be able 
to make some money and officers of companies should be able to do OK, 
but here we are talking about very high salaries that these insurance 
companies pay to their top executives. Frankly, if there is a 10-
percent reduction in the $1.7 trillion over 10 years, they could, you 
would think, take some of that 10 percent maybe in salary reduction or 
dividends to stockholders, make other cost savings. It doesn't have to 
come out of the beneficiaries. It is they, the executives, who are 
making these decisions of where the 10-percent reduction is allocated.
  Bottom line, I just wish to say I am not opposed to Medicare 
Advantage plans. Frankly, I think it is good we have Medicare Advantage 
plans. Medicare Advantage plans provide the competition to Medicare. 
They help keep the system on its toes. But we have an obligation as 
Members of this Senate to the taxpayers and to seniors to cut waste and 
to cut overpayments in a way that does not harm beneficiaries. These 
are reductions recommended to Congress by the best advisory board of 
experts we could find. They didn't just come out of thin air and 
Members of Congress thought this up. This was recommended to us by the 
MedPAC advisory board.
  Second, there is no reduction in guaranteed benefits to seniors. That 
is absolute. There is no reduction in guaranteed benefits to Medicare 
Advantage participants. So A, we are being fair. This chart shows it. 
We are trying to find the right level of reimbursement set up in a way 
so there is no reduction in beneficiaries' benefits. In fact, in this 
legislation, we add more benefits for Medicare participants, Medicare 
Advantage, as well as traditional fee-for-service Medicare. I might add 
in this legislation we give an increase to Medicare Advantage plans 
that show demonstrated improvement in quality.

  As I mentioned, MedPAC said a lot of these plans are totally 
inefficient. A lot of these plans have no coordinated care. A lot of 
these plans don't have any quality, but they get the extra money. So we 
are saying let's get to a compensation level that is fair. We do it on 
a competitive bidding basis, take the average bid for an area, and we 
also say let's make sure there is no reduction in guaranteed benefits 
at the same time. I think that is a responsible thing to do.
  So all of these arguments, these sound bites, frankly, that you hear 
from the other side of the aisle are just that, they are sound bites. 
They are not the honest analysis of what is going on.
  So I encourage us to keep in mind, keep in perspective what we are 
doing so we can help provide a better health care system for our 
country. This is only one part of it. There are many other parts, but 
this is just this one part.
  How much time do we have remaining, Mr. President?
  The PRESIDING OFFICER. There are 13\1/2\ minutes.
  Mr. BAUCUS. I see Senator Dodd is on the floor. At this time I yield 
to the Senator from Michigan.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Ms. STABENOW. Mr. President, first, I wish to thank our distinguished 
chairman of the Finance Committee

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for debunking what has just been said on the Senate floor by our 
colleagues on the other side of the aisle, laying out the facts of what 
is and is not happening with Medicare Advantage. I wish to build on 
that as well.
  I would encourage anyone who is interested to go to the Web site of 
AARP, one of the organizations we know to be champions for seniors, and 
take a look at what they say about the myth that health care reform 
will hurt Medicare. They lay out several things. One is:

       None of the health care reform proposals being considered 
     by Congress would cut Medicare benefits or increase your out-
     of-pocket costs for Medicare services.

  Then, just this week, in supporting our efforts, they have put out a 
statement, a letter, and at the end, again, they reiterated:

       Most importantly, the legislation does not reduce any 
     guaranteed Medicare benefits.

  I find it interesting that a few years ago our colleagues quoted AARP 
all the time when we were debating the Medicare prescription drug 
bill--I would guess that every single one of our Republican colleagues 
used their support in putting forward their bill--and now they are 
trying to disparage AARP, which is a very credible organization, 
because they don't agree with what AARP is saying. But I think the 
millions of people who belong to AARP will be listening to what they 
are saying about the fact that we are not, in fact, cutting the 
guaranteed Medicare benefits.
  In addition to that, we have the Alliance for Retired Americans and 
the National Committee to Preserve Social Security and Medicare all 
saying they support what we are doing and they have debunked the 
Republicans' scare tactics point by point.
  So what is happening here? The reality is that colleagues on the 
other side of the aisle, since the inception of Medicare, have been 
fighting even the existence of Medicare. It was Democrats and a 
Democratic President in 1965 who passed Medicare over their objections. 
The same arguments we are hearing today, we heard then. Now everyone 
sees that Medicare is a great American success story. But we have seen 
so many efforts.
  In the 1990s, when I was a Member of the House, Speaker Gingrich said 
in his Contract With America in 1994 that they wanted to come in and 
change Medicare, they couldn't directly do it so they would do it 
through the back door and let it ``wither on the vine''--those famous 
words that we heard at that time in terms of trying to privatize 
Medicare, which is what I believe Medicare Advantage really is.
  Then, recently, in the debate on the floor of the House of 
Representatives, we had 80 percent of the House Republicans support an 
effort to do away with Medicare at all, as we know it, as a guaranteed 
benefit. Instead, give vouchers to seniors to buy from private for-
profit insurance companies. We know the reality of this. This is about 
the for-profit insurance industry that right now is receiving 
overpayments. Whether it is the CBO or MedPAC--any analysis will say 
they are receiving overpayments right now, and we are trying to ratchet 
that back.

  What is happening? Why should folks care? Of course, taxpayers care 
about overpayments. We have maybe 15 to 20 percent of seniors right now 
who are in the Medicare Advantage Program. We have been told by the 
Budget Office that 80 to 85 percent will see their premiums go up to 
pay for overpayments to for-profit insurance companies. That is not 
fair. The vast majority of seniors and people with disabilities would 
see their premiums go up under Medicare to pay for for-profit insurance 
companies that try to get a piece of the action under Medicare.
  Secondly, we know the Medicare Advantage Program, as the chairman has 
said, and in reading the report, has actually made the solvency of the 
Medicare trust fund worse. It is going to run out of money sooner if we 
don't stop these overpayments. Our legislation, rather than having it 
run out of money 18 months earlier, will increase the solvency by 5 
years. We are committed to increasing and continuing the solvency of 
the trust fund and protecting Medicare for the future. We believe it is 
a great American success story. We are proud that Democrats were the 
ones who created Medicare, with a Democratic President. We are proud 
that it is Democrats now who are coming forward to be able to make sure 
we protect Medicare for the future.
  What is happening here is that we are seeing a variety of stalling 
tactics, a variety of efforts on the other side not only to stop us 
from moving forward on health insurance reform, but efforts time and 
time again to protect the for-profit insurance companies.
  For the record, I want to read to you the list of Medicare benefits 
everyone receives now, which will continue regardless of this--whether 
we cut back on some of the profits of the for-profit insurance 
companies: inpatient hospital care and nurses; doctor office visits; 
laboratory tests and preventive screenings; skilled nursing; hospice 
care; home health care; prescription drugs; ambulance services; durable 
medical equipment, such as wheelchairs; emergency room care; kidney 
dialysis; outpatient mental health care; occupational physical therapy; 
imaging, such as x rays, CT scans, and so forth; organ transplants, and 
a ``welcome to Medicare'' physical.
  They are all covered now and will be covered under this legislation. 
The difference is we are going to take the overpayment to the for-
profit insurance companies and put it back into Medicare to reduce the 
cost of prescription drugs, which has become the infamous doughnut 
hole, the gap in coverage. We will begin to close that by taking the 
excess profit for the for-profit companies and putting it back into 
Medicare. We are going to reduce the premiums seniors pay for drugs and 
medical care and eliminate copays so that people can get preventive 
care without a fee, and we are going to strengthen Medicare for the 
future.
  I will wrap up by saying this: This legislation, in total, is about 
saving lives, about saving money, and about saving Medicare. We admit 
our goal is not to save the profits of the for-profit insurance 
companies. We are guilty of that. We are focused on making sure 
Medicare is strong, vibrant, and solvent for our future generations, as 
well as our seniors today. By the way, we are going to make sure we are 
saving lives and money in the process.
  I strongly urge us to oppose any effort that is put forward that 
would be done in the interest of the insurance industry and at the 
expense of seniors in America. That is what these efforts to commit are 
all about. I hope we will reject them.
  The PRESIDING OFFICER. The Senator from Connecticut is recognized.
  Mr. DODD. Mr. President, let me, first of all, commend our colleague 
from Michigan, who is a member of the Finance Committee and has been a 
stalwart defender of the traditional Medicare Program and of our 
elderly not only in her State but around the country. She has offered, 
I think, some very cogent and worthwhile information this morning once 
again on this subject matter.
  We keep going around and around in this debate. It is a little 
frustrating because we are talking about basically whether we are going 
to limit to some degree the profits of some private insurance companies 
that are under the rubric of something called Medicare Advantage. 
Again, these are private companies that are receiving subsidies, 
supported by Medicare beneficiaries and the taxpayers of this country. 
We are not talking about eliminating Medicare Advantage but rather--we 
had a big chart a few minutes ago. We will get it in a few minutes. It 
shows we are not eliminating the program, we are restraining profit 
growth in the program.
  We are rewarding Medicare Advantage in the bill, as the chairman 
pointed out. Based on performance and quality, we actually give bonuses 
in Medicare Advantage--contrary to the arguments you have heard by 
those who are heralding Medicare Advantage, despite the fact that the 
very companies who argued for it to begin with, promised they were 
going to prove how they could reduce costs and be more efficient. In 
fact, today, it is quite the opposite. Right now the government pays 
these Medicare Advantage insurance companies $1.14 to do the same thing 
for seniors that Medicare does for $1. That is basically, on average, 
what it amounts to.
  The question is, can we reduce the cost of the overpayments, which 
are basically ending up in the pockets of insurance companies? There is 
nothing wrong with profits in private companies, but let's declare them 
what they

[[Page S12374]]

are. This is not traditional Medicare. They are private companies that 
are anxious not only, I presume, to provide benefits to their 
beneficiaries, but they are also looking to make a profit. There is 
nothing wrong with that, but since the premiums were set by statute, 
and we have an obligation to try to keep our costs down, we are trying 
to do so because the promises that were made have not been kept. The 
costs are vastly exceeding the promises made.
  The amendment we are going to hear about from our friends on the 
other side is nothing more than a recycled compilation of some of the 
``greatest hits'' we have heard: stalling with arcane obstruction 
tactics, while standing up for some of the private companies--and I 
have no objection to standing up for private companies that do a good 
job, but when you do so at the expense of scaring seniors with baseless 
claims, then I do object. That is what is going on here because, quite 
frankly, today almost 80 percent of our elderly are paying $90 a year 
in additional premium costs, without getting any benefit from it 
whatsoever, to provide benefits under the Medicare Advantage Program. 
That is not equitable. The 80 percent of our elderly need to know that 
they are being disadvantaged by this.
  What the Finance Committee, under the leadership of Max Baucus, is 
trying to do is bring some equity back into this. He pointed out--and 
it deserves being repeated--that nothing in the bill does away with 
Medicare Advantage. We are trying to get it back to a sense of reality 
and not, again, disadvantage 80 percent of our seniors.
  Right now, there is Medicare ``disadvantage''--that is what it ought 
to be called, because that is what it does--disadvantages. Why should 
80 percent of the elderly in this country pay higher premiums, with no 
benefits, at the expense of the 20 percent who are going to get some 
small advantage under this--but very little, because most of it ends up 
in profits. I will tell you why that happens in a minute.
  To make my point, according to the Oppenheimer Capital analyst Carl 
McDonald, in a report issued a month ago:

       Between 2006 and 2009, we estimate that Medicare Advantage 
     accounted for nearly 75 percent of the increase in gross 
     profits among the larger plans in the industry, highlighted 
     by an estimated gross profit increase of $1.9 billion in 
     2009, relative to commercial risk earnings gains of nearly 
     $600 million.

  I know the chairman of the Finance Committee made that point. 
Seventy-five percent of the increase in gross profits came from the 
Medicare Advantage plans. These profits come out of the pockets of the 
American taxpayer because of the subsidies and, of course, the Medicare 
beneficiaries who are paying those extra dollars every year, without 
receiving any of the benefits at all. Our bill will protect and 
strengthen Medicare and extend the life of the trust fund, as you have 
heard over and over again. That is not a fact to dispute. That is a 
fact. We extend the life of the Medicare Program. Part of the way our 
bill adds to the use of Medicare is to eliminate wasteful overpayments. 
These are overpayments far beyond what was anticipated when the program 
was written.
  As I mentioned a moment ago, the government pays insurance companies 
in the Medicare Advantage Program $1.14 to do the very same things for 
seniors that traditional Medicare does for $1. So those are the 
overpayments we are trying to rein in. There is no evidence these 
wasteful overpayments do anything to improve the care of our seniors. 
At the same time, they speed Medicare's descent into bankruptcy and 
raise premiums for all Medicare beneficiaries.
  Our bill would end that waste and use the money we save to help 
seniors pay for prescription drugs by closing the doughnut hole. For 
the second time in less than a week, our friends on the other side are 
using these tactics to halt progress completely, fighting for these 
profits and overpayments that, again, come out of the hide of taxpayers 
and our elderly.
  If you look at this chart, if you extend to 2019, almost 10 years 
from now, what is the difference between what our bill does and what 
those who want no change do? The difference is $20 billion. In the 
post-reform period, in 2019, it is $183 billion going to Medicare 
Advantage. What the opposition wants is to hold it at $204 billion in 
2019. That is $20 billion. That is the savings we are looking for in 
order to reduce overpayments and provide those resources to the elderly 
so they can afford prescription drugs.
  If you want to side with these companies--they are still going to 
make a profit. This will not deprive them of that. The profit margins 
will be far more realistic and it will reduce subsidies, as well as 
overpayments being made by the elderly who receive nothing from this 
program at all.
  Let me make my case on this point. Senator Stabenow listed the 
guaranteed benefits under Medicare. The chairman did it as well. Also, 
we add benefits as a result of our bill. In addition to the inpatient 
hospital care, doctor office visits, lab tests, kidney dialysis, 
emergency care, occupational therapy, organ transplants--all of these 
issues--we also do things in our bill that are not available presently. 
We reduce the size of the Medicare doughnut hole. That is an added 
benefit that does not exist today. We reduce premiums to pay for drugs 
and medical care. We eliminate the copays. What an advantage that is 
here. Ask yourself whether you would like to eliminate copays or watch 
private companies make an additional $20 billion in 10 years. Which is 
the better choice? Ask the overwhelming majority of seniors which they 
would rather have--an elimination of the copays they are paying today, 
or continue to provide excess profits for the companies here that have 
made so much under the Medicare Advantage Program.
  Lastly, of course, and most important, we help keep Medicare solvent. 
People say: Give me some examples on why the differences exist between 
Medicare and Medicare Advantage. I have a couple of examples from my 
home State that I think highlight the point. These come from the Center 
for Medicare Advocacy, or CMA, which is a nonprofit organization, as my 
colleagues know, that does casework on behalf of individuals who need 
assistance dealing with Medicare Advantage plans. They provided two 
cases from my State. I presume most of my colleagues could find cases 
in their own States.

  A woman living in Madison, CT, a shoreline community in Connecticut, 
had Lou Gehrig's disease, ALS. We are all familiar with ALS. We know 
the stories people go through with that disease. She was in a Medicare 
Advantage plan. She was denied coverage for home health care because 
she was said to be ``stable.'' That was the quote, ``she was stable.'' 
That is not a valid reason for denial, and she was hardly stable with 
ALS. CMA, the Center for Medicare Advocacy, had to go to Federal court 
to get her care covered despite firm written support regarding her 
medical condition from her doctors.
  Here is a woman under Medicare Advantage with ALS being declared by 
Medicare Advantage ``she was stable.'' Her doctors said anything but 
the case.
  When my friends talk about rationing of care under the present 
system, here is Medicare Advantage, a private firm, making a medical 
decision that should have been made between her and her doctor. They 
eventually got it overturned, but they had to go to Federal court to 
get it overturned. That would not have happened under Medicare. If she 
had been under Medicare, she would have gotten that help, no questions 
asked.
  When people say there is no distinction, this is a live case.
  Let me give the second one. A woman from Vernon, CT, and her husband 
traveled to Florida to visit their daughter living there. When she got 
to Florida, she fell down and sustained some physical injuries. While 
being treated at a Florida hospital for her injuries, it was discovered 
that she had a brain tumor, the reason she had the fall. She had no 
idea of this beforehand.
  The Medicare Advantage plan covered treatment for the fall as an 
emergency--which Medicare Advantage plans must cover, even out of 
network, by the way--but not any diagnosis or treatment for the brain 
tumor.
  The woman had another daughter who was a nurse who lived in Utah. So 
they traveled from Florida to Utah where she went for the cancer 
treatment for the brain tumor. While undergoing chemotherapy, this 
woman had a

[[Page S12375]]

life-threatening reaction to one of the medications from which she 
almost died. The Medicare Advantage plan denied coverage for all of 
this care because it was out of network. She was in Utah. They said no, 
leaving the client and her husband with $100,000 in bills.
  Again, the Center for Medicare Advocacy went to court and battled 
against this decision. They were successful in recovering $90,000 out 
of the $100,000. This woman is now deceased, but she and her family 
were left with over $10,000 in bills, all of which would have been 
covered under traditional Medicare, but she had gone into a Medicare 
Advantage plan. In both instances, they would have avoided having to go 
to Federal court, having to fight as hard as they did, going through 
the trauma and turmoil. It is bad enough you have to wrestle with 
cancer or wrestle with a brain tumor, but then you get saddled with 
$100,000 in bills and Medicare would have taken care of them. This 
Medicare Advantage Program disadvantaged her in the process.
  These are examples of how private Medicare Advantage does not always 
operate in good faith. They are not always there when you need them.
  There are significant differences between Medicare Advantage and 
Medicare. With traditional Medicare, you know what services you get.
  I ask unanimous consent to have printed in the Record a list of 
services so people can read about it, if people have not already done 
that.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       No one is removing Medicare benefits. Every senior in 
     America will still get these benefits: Inpatient Hospital 
     Care and Nurses; Doctor's Office Visits; Laboratory Tests and 
     Preventive Screenings; Prescription Drugs; Ambulance 
     Services; Durable Medical Equipment--i.e., Wheelchairs; 
     Emergency Room Care; Kidney Dialysis; Outpatient Mental 
     Health Care; Occupational and Physical Therapy; Imaging (X-
     rays, CTs, and EKGs); Organ Transplants; and ``Welcome to 
     Medicare'' Physical.
       And under our legislation: Reduces the Size of the Medicare 
     ``Donut Hole''; Reduces premiums seniors pay for drugs and 
     medical care; Eliminates copays; and Helps keep Medicare 
     solvent.

  Mr. DODD. Mr. President, all medically necessary hospital care and 
doctor office visits are covered under Medicare. You know you can get 
these services from any Medicare provider anywhere in the country. Out 
of network you get this kind of help, whether you are in Utah, Florida, 
or Vernon, CT, where one woman was from. Medicare would have provided 
that care. Here she was bouncing around the country and denied one 
place after another under Medicare Advantage. With traditional 
Medicare, she would not have had to worry about a private insurance 
plan playing games with her coverage.
  The Medicare Advantage plans run the show. They change the benefits. 
Cost sharing goes on. This is why Medicare Advantage is not like 
traditional Medicare. So when people say it is just like Medicare, no, 
it is not just like Medicare. If you doubt me, then call that family in 
Madison, CT, or call that woman's family from Vernon, CT. Ask them 
whether Medicare Advantage is just like Medicare. You will get an 
earful from them on what they went through.
  We should be clear that we are not eliminating Medicare Advantage. 
Again, I appreciate Senator Baucus making this point. It needs to be 
made over and over again. We are not eliminating it at all. We are 
reducing payments to private plans and making the system work more 
uniformly. We actually give bonus payments for care coordination and 
quality improvements. These plans can use those payments to improve 
benefits for beneficiaries. So we are hardly eliminating it. We are 
making it work better.
  I have serious reservations about how this plan operates, I will say 
that, but I would not advocate on the floor of the Senate the 
elimination of Medicare Advantage. I do want to make it work better, 
and I do want to cut back when we have overpayments occurring. I don't 
think it is fair that 80 percent of the seniors in my State or 
elsewhere are paying $90 a year extra to cover this program and get 
none of the help from it and people under Medicare Advantage, who could 
have been protected, are not because they opted to be in that plan and 
then found out it is anything but what they thought it was.
  We are going to hear these arguments over and over about Medicare 
Advantage. A little truth in advertising is necessary here. So people 
understand, it is not Medicare and it is not an advantage, not under 
the present system, not at all. That is what we have been trying to say 
over and over again here so people understand.
  This is a good bill. This is a solid bill. This took a tremendous 
amount of work in the Finance Committee, which had the responsibility 
of crafting these provisions which are highly complicated and very 
delicate in what they do. What we have done is preserve and strengthen 
our Medicare system, expanding benefits for people, eliminating copays, 
allowing those preventive and screening services to be available to our 
elderly, seeing to it they will have prescription drugs at lower costs. 
That is all in this bill. That is a great advantage.
  What a tragedy it would be if in these next few days, after all the 
debate, that we lose all the work that has been done to make these 
improvements in our health care system.
  I commend my colleague from Montana and my colleagues on the 
committee who worked so hard to put this bill together, this balance 
together that can make a great difference in people's lives.
  I also thank our colleague from Rhode Island for offering his 
amendment, which we are going to be considering at some point when we 
get to vote occasionally on some matters here. I hope at some point we 
get to do that. We have done it a couple of times. There has been over 
a year of debate and discussion. I think the American people want to 
see some action.
  We think we have a good bill. It is going to take on important market 
insurance reforms that ensure Americans can get access to health care 
promised by their insurance plans. It is going to make sure if someone 
loses his or her job, they can get insurance. It is going to improve 
the quality of health care and focus our system more on prevention and 
wellness.
  On top of all these things, it is going to reduce the deficit. As we 
have heard over and over again, CBO is talking about saving $130 
billion in the first 10 years and $650 billion in the second.
  I have to say something. The other day we got the news that CBO said 
the premiums on the individual plans, the small business plans and the 
large business plans, are actually going to reduce premiums costs by as 
much as 20 percent in one area, and 3 percent in another. I would have 
thought there would be wild applause. Even those who oppose the bill 
would have said: Isn't this great news? What we got was almost a deep 
disappointment that CBO gave us a report that people are actually going 
to save money under this bill. All of a sudden they attack CBO because 
they did not like the results coming out of CBO. I guarantee had they 
come back and said they are going to increase premiums, we all would be 
talking about that. Here we get a report that actually we are going to 
save premium costs, reduce the costs to the Federal budget as has been 
pointed out.
  Senator Whitehouse is going to offer an amendment that makes clear 
these savings we are talking about are used to strengthen Social 
Security, reduce the deficit, and contribute to the long-term solvency 
of the CLASS Act, that it will be for that purpose and that purpose 
alone.
  The third part of his amendment is particularly important. Many of 
our colleagues have come to the floor in the last few days to claim the 
CLASS Act will be a long-term drain on the budget. It is not true. 
Thanks to our colleague from New Hampshire, Senator Gregg, the CLASS 
Act will be required by law to be solvent for 75 years. This was not in 
our original proposal. It was added in the HELP Committee markup by 
Senator Gregg, and I thank him for it.
  The Gregg amendment was unanimously adopted in our markup. CBO says 
it produces $72 billion in savings for the Federal Government over the 
first 10 years of its existence and it will save nearly $2 billion for 
Medicaid.
  We further added language to the bill to require the Secretary to 
maintain enough reserves after the first 10 years to pay off any claims 
that may emerge. We have included language to prevent

[[Page S12376]]

Federal appropriations from being used to pay benefits to ensure the 
program is self-funded.
  Finally, at the request of several Senators, the distinguished 
majority leader made sure we did not use any of the savings in the 
CLASS Act for any other purpose than to pay for the CLASS Act itself. 
This amendment offered by Senator Whitehouse will give Senators a 
chance to commit themselves to that purpose. Senators who claim the 
CLASS Act will hurt the Federal budget, of course, should vote for this 
amendment because statutorily it will prohibit any of those funds from 
being used for any other purpose other than for the CLASS Act and the 
recipients who want to use them. I commend him for that move and thank 
him. When that vote occurs, I urge colleagues to vote for the 
Whitehouse amendment.
  Lastly, I ask unanimous consent to be included as a cosponsor, along 
with my colleague from Maryland, Senator Mikulski, of Senator Coburn's 
amendment No. 2789 which adds Members of Congress to the public option.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DODD. Mr. President, we added that provision to the HELP 
Committee bill. Senator Coburn offered that amendment. Senator Kennedy, 
myself, and others voted for that Coburn amendment. I think it may have 
shocked the Senator from Oklahoma at the time that we actually voted 
for his amendment. I know Senator Brown has been added as a cosponsor. 
I have no objection to that amendment. That is how much I think the 
public option would be worth. If we have a public option in this plan--
and my hope is we will--there is nothing wrong with insisting Members 
of Congress be included in that public option proposal. His amendment 
suggests that. We supported it in committee, and I am prepared to 
support it again on the floor of the Senate.
  I point out, I wish we could get Members as well who are reluctant to 
support this bill to recognize that as Members of Congress today, we 
all have pretty good health care plans under the Federal employees 
benefits package, some 23 options every year that are available to us, 
along with the 8 million Federal employees in this country under those 
plans. I wish we could get others to recognize how valuable that is to 
all of us and our fellow Federal employees. Unfortunately, that does 
not seem to be the case.

  I hope before this is concluded we will have far more support for 
this effort we have crafted and provided to our colleagues for their 
consideration.
  Again I compliment the Finance Committee and my friend from Montana 
for the work he has done on this issue. It is very well thought out, 
very balanced and fair.
  I said this over and over: I challenge any Member to come to the 
floor and identify a single guaranteed benefit under Medicare that is 
cut out under this bill. There is not one. Three days have gone by 
since I made the charge that not a single guaranteed benefit under 
Medicare is cut. You will not find one; not one.
  I see my friend from Wyoming has come to the floor. I know I have 
probably gone over my time.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, we are playing things by ear. I ask 
unanimous consent that the Senator from Wyoming be recognized to speak 
for debate only, and at a later point, we will figure out allocation of 
time on both sides, if he wishes to speak now.
  Mr. ENZI. Yes, Mr. President, I wish to speak.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, it is my understanding that I would be in 
charge of the next 30 minutes and then it would revert to the other 
side for 30 minutes after that.
  Mr. BAUCUS. I might modify that so this side gets the next 30 minutes 
after that.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ENZI. It is also my understanding that at any time there is an 
agreement to vote, we will cancel out what we are doing. But there is 
no agreement yet.
  I thank the Senator from Connecticut for setting up my speech so 
well. He said there was not anyplace that anybody can show any decline 
in guaranteed benefits. With what I am about to say, I will try to do 
that. Of course, the words ``guaranteed benefits'' do not show up 
anywhere in what we are doing. ``Benefits'' does but not ``guaranteed 
benefits.'' In my opinion, getting to be in a nursing home or being 
able to see a doctor, some of those ought to be considered guaranteed 
benefits. I will get into that a little bit in my speech and cover some 
of these areas that I think are very important to seniors. I am opposed 
to the $\1/2\ trillion of Medicare cuts in the Reid bill that are not 
going only to solve Medicare.
  Some of my Democratic colleagues have attempted to argue this bill 
does not cut the Medicare Program. They further said that such cuts are 
justified and will not harm the program. They have also argued that no 
beneficiaries will lose their benefits--their guaranteed benefits. They 
are very careful on that, and I understand why they are careful on that 
because there are other benefits that are being cut that will be 
considered by those people who will lose that benefit to be a 
guaranteed benefit.
  Unfortunately, all of those statements are false. It does not matter 
how many times my colleagues repeat these claims, they do not become 
any more accurate. This bill cuts $464 billion from the Medicare 
Program. It slashes payments to hospitals, nursing homes, home health 
agencies, and hospices. These are cuts to the Medicare Program, and I 
even have the page numbers on those.
  The moneys from these cuts do not go to shore up Medicare. The money 
goes to new programs for others. These cuts will affect the care 
provided to Medicare beneficiaries.

  The American Health Care Association, which represents nursing homes, 
said the cuts in the Reid bill would force layoffs, lower salaries, 
reduce benefits, and ultimately would hurt patients' quality of care. A 
commission was set up to make even more cuts to save Medicare. It is in 
the bill. There is a commission in there.
  So with the side deals that have been made with lobbyists, the only 
place these cuts can come from is from seniors. I will cover that in a 
little more detail later. I have heard similar statements from home 
health providers, that is more than $40 billion in cuts; hospice 
providers, which is $8 billion in cuts; and hospitals, which is $130 
billion in cuts. If these Medicare cuts go into effect, it could drive 
many providers out of the Medicare Program. That will mean patients do 
not have the care they expect and they need.
  Some of my Democratic colleagues have accused us of trying to scare 
Medicare beneficiaries. If seniors are scared by our statements, they 
should be terrified by what the administration has to say about the 
Democrats' health reform bill. The administration's own chief actuary, 
Richard Foster, recently wrote that the steep Medicare cuts in the 
House-passed health reform bill would make it difficult for many 
providers to remain profitable and cause them to end their 
participation in Medicare. He went on to note this could jeopardize 
Medicare beneficiaries' access to care.
  As the senior Senator from Tennessee noted yesterday, it is the 
Medicare cuts in the Reid bill that are actually scaring seniors. 
Medicare beneficiaries understand that if providers are no longer able 
to take Medicare patients, they--the seniors--will not get care. A lot 
of grandmas and grandpas have figured it out, and they are not going to 
stand for it.
  The chairman of the Finance Committee has repeatedly said this bill 
will not cut or reduce any guaranteed Medicare benefit. That statement 
seems to ignore what this bill will do to providers. If a Medicare 
patient cannot get into a nursing home, they do not have nursing home 
benefits. If they can't find a home health aide willing to take 
Medicare patients, they do not have home health benefits. So the 
promise for coverage, when you can't get a doctor to see you, is not 
health care. You don't have benefits if you can't get a provider to 
treat you. Unfortunately, that is exactly what this bill will do.
  Some of my Democratic colleagues have also attempted to justify the 
Medicare cuts in the Reid bill by arguing that many of the trade 
associations

[[Page S12377]]

representing health care providers have endorsed this bill. They are 
correct that several Washington-based trade associations and their 
lobbyists have endorsed the Reid bill. It is probably worth exploring 
why some of the groups have chosen to endorse this legislation.
  In some cases, motivation is obvious. Some drug manufacturers are 
clearly motivated by self-interest and greed. They negotiated a secret 
deal with the White House that will actually increase what Medicare 
spends on brand-name drugs--brand-name drugs. They didn't touch the 
generics. They are interested in the brand-name drugs.
  Under the terms of their deal, the drug manufacturers will provide 
discounts on brand-name prescription drugs when the seniors are in the 
Medicare coverage gap--known as the doughnut hole. They make the 
payments directly to the customer. It doesn't go through Medicare but 
directly to the customer. That way they can maintain the customer 
contact and keep them addicted to the brand name.
  Generics are cheaper. A lot of people, when they go to the doughnut 
hole, switch to generics because that saves them money, and it saves us 
money. When they get through the doughnut hole, they will stay with 
whatever they are on while in the doughnut hole. So if they are forced 
to stay on a brand name to get a little extra discount as they go 
through the doughnut hole, they will stay with the brand name when the 
taxpayers are paying for it when it goes above the doughnut hole, which 
is the rest of the year. That could be a huge number. So while it looks 
generous by the drug companies, beware; their generosity is suspect 
with what they will make when it gets through the doughnut hole.
  Under the terms of the sweetheart deal between the White House and 
the drugmakers, discounts are provided for these brand-name drugs. This 
will encourage seniors to continue to get those more expensive drugs, 
and it will actually cost the taxpayers $15 billion because the deal 
will actually increase Medicare costs.
  In other cases, provider groups were promised special deals if they 
agreed to support the Reid bill--or whatever bill we were working on at 
that time. For instance, recent press reports have described how the 
American Medical Association was promised a permanent fix to the 
Medicare payment formula for doctors if they agreed to support this 
bill or a 1-year fix if there was an end to junk lawsuits. Under 
current law, doctors' Medicare payments are scheduled to be cut by more 
than 40 percent over the next decade. That is already in place. That is 
not a part of the bill. The cost of fixing the flawed government-
mandated formula will be more than $250 billion. We know that because 
we have debated it on the Senate floor, and we decided we were going to 
have to pay for that if we were going to do it.
  So let's see, $464 billion in Medicare money we are using on other 
things. That is why I keep saying Medicare money only ought to go to 
Medicare benefits, and that $250 billion for the doctors' fix might 
make it possible for people to see the doctors.
  I can understand why doctors want to fix this flawed government 
price-control system--and that is what it is because they are telling 
the doctors what they can charge a customer, regardless of how long a 
time it is going to take them to take care of that patient. For a lot 
of them, they have discovered it costs more than what they are able to 
get. If they continue to do that, they have to go out of business. That 
is kind of the small business philosophy: You take in less money than 
what it costs to be in business, and you are out of business. So I 
don't think they like that kind of a government price-control system.
  As a result, 40 percent of the doctors will not take a patient on 
Medicaid, and it is growing in percentage now on Medicare in the same 
way. When you fix the price, some people can't afford to provide it for 
that, so they can't take those patients.
  I was talking to a friend of mine from Florida who said: Every time 
you call a doctor now, they say: Are you on Medicare? If you say yes, 
they say: We are not taking any new patients.
  If you can't see a doctor, you don't have a benefit. It shows the 
exact problems that result from letting government bureaucrats use 
price controls to set payment rates. What I don't understand is why the 
AMA continues to support the bill when they got nothing for their deal. 
We didn't fix the $250 billion problem, and we haven't fixed the junk 
lawsuit problem.
  I remember the President appearing at the National Convention of the 
American Medical Association and promising that there would be tort 
reform; that there would be an end to these junk lawsuits. All of our 
attempts, either in the HELP Committee or in the Finance Committee, to 
even bring that up have been either voted down or denied. As a result, 
there is nothing in this bill that is going to solve that problem. The 
bill does nothing to fix the Medicare payment formula for the doctors. 
Instead, it cuts $464 billion from Medicare and uses that money to 
cover the uninsured.
  Even if these cuts can be made without hurting seniors, the 
Republicans are saying: Use the money only for Medicare. Medicare money 
for Medicare. Medicare funds should be used to fix Medicare's problems, 
such as this flawed payment formula that keeps doctors from taking 
seniors. Taking hundreds of billions of dollars out of the Medicare 
Program now will only guarantee that it will be much harder to 
permanently fix the doctor payment issue in the future.
  I cannot understand why the AMA continues to support this terrible 
deal for doctors. If you can't see a doctor, your benefits--your 
guaranteed benefits--have been cut. Apparently, the members of the AMA 
don't like the deal either. At a recent convention, up to 40 percent of 
the current membership of the AMA voted to reject this deal. I know 
that is not a majority, but most associations survive by consensus 
agreements. That means almost all of their membership agrees with the 
tack they are taking, not just slightly more than half. Their 
membership is less than 20 percent of all doctors. It is a dwindling 
association.

  Let's see, less than 20 percent of the doctors had 40 percent that 
opposed it. We are getting down to some pretty small percentages of 
those who supported what the AMA did in their deal.
  Finally, many provider groups have been reluctant to speak out 
against this bill because they have received threats from the White 
House and congressional Democrats. Nursing homes, home health agencies, 
and hospice providers have all reportedly been threatened with further 
cuts--further cuts--if they speak out against the bill. Is that freedom 
of speech, or is it just bad ethics? They have reportedly been told 
that any public statements of opposition to the Reid bill will lead to 
even more severe cuts.
  These providers have had to make the choice to silently accept 
devastating cuts rather than oppose them and risk being utterly 
destroyed. One of the Medicare Advantage providers is Humana, and I 
will use them as an example. CMS said they couldn't let their customers 
know what was about to happen, and chastised them for sending out a 
letter. I thought the customer deserved to know and that we were in a 
new era of transparency. That doesn't sound very transparent to me. So 
how can that happen in America?
  At any rate, I hope my colleagues and the American people will take 
these facts into account when they hear Senators talk about provider 
groups supporting this bill. Unfortunately, health care provider 
support for this bill is being driven primarily by greed or stupidity 
or fear. We know this bill will not fix the problems in the American 
health care system. It will not lower health care costs. It will not 
lower insurance premiums. It will still leave 25 million people 
uninsured.
  What this bill will do is spend $2.5 trillion and guarantee a much 
bigger role for the government in dictating how health care will be 
provided in this country. If you are not under Medicare, yes, your 
government is going to tell you what is adequate coverage, and they are 
going to force you to buy it or pay a penalty.
  Given the recent experiences that doctors have had with Medicare 
price controls, this is not an outcome that bodes well for America's 
health care providers or their patients. I remind everybody that in 
August there was an uproar, and that uproar continues. We don't notice 
it as much because we are not going to get to go home this weekend to 
talk to our constituents. That

[[Page S12378]]

might be by design because we already know what our constituents are 
saying.
  They are saying: This bill is a bad deal for us. Where is the promise 
that you were going to cut costs for us? Where are the other promises 
that were made with this health care reform?
  I would mention that the CBO found that premiums in the individual 
market will rise by 10 to 13 percent more than if Congress did nothing. 
That is CBO. Family policies under the status quo are projected to cost 
$13,100 on the average, but under this health care bill it should jump 
to $15,200. That is not very good news for the people in my State or 
any other State. No big cost rise in U.S. premiums is seen in the 
study, said the New York Times.
  The Washington Post declared: Senate health bill gets a boost. The 
White House crowed that the CBO report was more good news about what 
reform will mean for families struggling to keep up with skyrocketing 
premiums under the broken status quo. The Finance chairman, the Senator 
from Montana, chimed in from the Senate floor that health care reform 
was fundamentally about lowering health care costs.
  Yes, lowering costs is what health care reform is designed to do--
lowering costs.
  But then he said: And it will achieve this objective. Except that it 
won't.
  CBO says it expects employer-sponsored insurance costs to remain 
roughly in line with the status quo. That is the failure of this bill. 
Meanwhile, fixing the individual market is expensive and unstable, 
largely because it does not enjoy the favorable tax treatment given to 
job-based coverage. You know, if you are buying insurance on your own, 
you are not getting a tax break on it. If companies buy insurance for 
the people working for them, they are getting a tax break.
  In my 10 steps to solving health care, I mentioned and worked on 
making that fair. You have to be fair for both sides.
  The Wyden-Bennett bill concentrates on making it fair for both sides. 
That is one of the issues people in this country are concerned about, 
making it fair for both sides. This bill doesn't make it fair for both 
sides.
  Talking about fixing the individual market, that is expensive and it 
is largely unstable, I will say again, due to the favorable tax 
treatment given to job-based coverage which was supposed to be the 
purpose of reform. But CBO is confirming that new coverage mandates 
will drive premiums higher.
  Democrats are declaring victory, claiming these high insurance prices 
don't count because they will be offset by new government subsidies. 
About 57 percent of the people who buy insurance through the bill's new 
exchanges that will supplant today's individual market will qualify for 
subsidies that cover about two-thirds of the total premium so the bill 
will increase cost but then disguise those costs by transferring them 
to taxpayers from individuals. Higher costs can be conjured away 
because they are suddenly on the government balance sheet.
  The Reid bill has $371.9 billion in new health taxes that are 
apparently not a new cost because they would be passed along to 
consumers. Or perhaps they will be hidden in lost wages. This is the 
paleoliberal school of brute force wealth, redistribution and a very 
long way from the repeated White House claims that reform is all about 
bending the cost curve. The only thing being bent here is the budget 
truth.
  Moreover, CBO is almost certainly underestimating the cost increases. 
Based on its county-by-county actuarial data, the insurer WellPoint has 
calculated that this bill will cause some premiums to triple in the 
individual market. I don't go by WellPoint, I go by what I found out in 
Wyoming itself and that is an accurate picture, particularly for the 
young people in our State. Those who are young and healthy will see a 
300-percent increase. I think they are going to notice that. I don't 
think they are going to be happy with it. Other associations have come 
to similar conclusions. The reason for that is the community rating, 
which forces insurers to charge nearly uniform rates regardless of 
customer health status or habits. Habits is an important one on that. 
CBO does not think this will have much of an effect, but costs 
inevitably rise when insurers are not allowed to price based on risk. 
That is why today some 35 States impose no limits on premium variation 
and 6 allow wide differences among consumers.
  That is not just WellPoint that is saying that. I have some peer-
reviewed documents that also show that same thing from people from 
different colleges. They have found that the State community rating 
laws raise premiums in the individual market by 21 percent to 33 
percent for families and 10 to 17 percent for singles. In New Jersey, 
which also requires the insurers to accept all comers, so-called 
guaranteed issue, premiums increased by as much as 227 percent.
  Let's see, we just had some elections in New Jersey and things didn't 
go well there. It probably wasn't just tied to insurance costs.
  The political tragedy is that there are plenty of reform alternatives 
that would reduce the cost of insurance. According to CBO, according to 
the Congressional Budget Office which we quote a lot, they did an 
evaluation on the relatively modest House GOP bill. The Republicans in 
the House were limited to one amendment. There were three amendments 
total in a 1-day debate and passage of the health care bill over there. 
That roused a lot of people in America, too. If you only get one 
amendment, they had to do what we have avoided doing. We have four 
different bills out there that solve what the President said he wanted 
solved. That is not counting the Wyden-Bennett bill that also solves 
what the President said, that is not included in this bill.
  What the House put together--it is relatively modest, but it would 
actually reduce premiums by 5 percent to 8 percent in the individual 
market in 2016 and by 7 to 10 percent for small businesses. It would 
not increase the premiums, it would decrease the premiums.
  The GOP reforms would also do so without imposing huge new taxes. We 
have concentrated in the last few days about talking about the Medicare 
money that is being stolen to provide for the changes. We have not 
talked yet about the extra taxes that are going to be put into place. 
That is the other half of the package. But the Democrats do not care 
because this bill, they say, is about lowering costs. No, it is about 
putting Washington in charge of health insurance at any cost.
  I see the Senator from Wyoming is here. We have 10 minutes remaining 
on our time. If the Senator wishes to make some additional comments? He 
and I have been traveling in Wyoming.
  The PRESIDING OFFICER. The Senator has 7\1/2\ minutes remaining.
  Mr. ENZI. I yield the time to my colleague.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.
  Mr. BARRASSO. Mr. President, I ask my colleague from Wyoming, with 
whom I have the privilege of serving, I saw a large story in USA Today. 
This story says ``Senate Keeps Medicare Cuts in the Bill.''
  What it says is:

       Senate Democrats closed ranks Thursday behind $460 billion 
     in politically risky Medicare cuts at the heart of health 
     care legislation.

  It goes on to say:

       Approval would have stripped out money to pay for expanded 
     coverage to tens of millions of uninsured Americans.

  As I read this, it says the Republicans tried to keep the Medicare 
money for people on Medicare, but the Democrats want to take $460 
billion away from seniors who depended upon Medicare and use it to 
start a whole new government program. Am I reading this correctly?
  Mr. ENZI. That is the way I read it. That is the way the people in 
Wyoming are reading it and that is apparently the way people all over 
the country are reading it, particularly seniors. Seniors are the ones 
upset about what is happening and it is easy to see why. Even though 
the AARP says this is a good bill, they are saying: Wait a minute. I 
know people in the nursing home. I know people--some of them are saying 
I am in the nursing home. I am hearing what is going to happen at my 
nursing home if these cuts go into place.
  As I said continually, we can call them anything we want but the 
seniors are saying those are cuts. Those are cuts in my benefits. Those 
are cuts in what I expect. Those are cuts in what I have been getting. 
Whether you call it guaranteed benefit or just plain old

[[Page S12379]]

benefits or whatever it is, they are saying, yes, we are being cut.
  Mr. BARRASSO. Mr. President, I would say when my colleague from 
Wyoming and I held townhall meetings around the State of Wyoming, 
people have said don't cut our Medicare. Yet what I see this bill doing 
is cutting our Medicare and specifically, right now, there are 
thousands of people in Wyoming who are on a program called Medicare 
Advantage. There is an advantage to this program. That is why so many 
Americans have signed up for the program.
  As a matter of fact, about one in four Americans who depend upon 
Medicare for their health care in this country has chosen Medicare 
Advantage, because there are some advantages being in this program 
called Medicare Advantage: dental, vision, hearing, fitness. Also, as a 
practicing doctor for 25 years, taking care of families in Wyoming, 
what I saw, the reason they liked this, if they were on Medicare, is 
because it dealt with prevention and it actually helped coordinate 
care.
  One of the things Medicare does not do as well is coordinate care and 
work with prevention. We know how important prevention is in helping 
people keep down the cost of their care--how good it is in terms of 
giving people opportunities to stay healthy. That is why they call it 
prevention.
  The bill in front of us, as I see it--I ask the Senator from 
Wyoming--is a bill that is going to cut $120 billion from Medicare 
Advantage, the program the people in our State like?
  Mr. ENZI. The Senator from Wyoming is absolutely correct. We are 
getting a lot of calls and mail, letters about that. Another thing the 
President promised, of course, is that everybody would have 
catastrophic coverage. It fascinates me that the Wyoming people and the 
people across America have figured out that Medicare doesn't have 
catastrophic coverage. But Medicare Advantage provides catastrophic 
coverage as well as a number of other things that Medicare does not 
cover. I think they realize, too, that if Medicare Advantage goes away, 
yes, they can get Medigap but Medigap is more expensive. It is also 
interesting that the AARP sells Medigap.
  Mr. BARRASSO. I actually heard somebody say Medicare Advantage is not 
Medicare. But if you turn to the Centers for Medicare Services' 2010 
Official Government Handbook--we are going to go into 2010 next month. 
If you go to the official handbook for 2010, and the handbook is called 
``Medicare And You,'' it says a Medicare Advantage plan is ``another 
health coverage choice you may have as part of Medicare.'' People who 
actually look at this choose this. They make the choice because they 
say this is a good deal for me. That is what Americans want. They want 
to get value for their money.
  A recent poll said, in terms of Americans, when they send money to 
Congress, how much of that do they get back in value? They think about 
50 cents on the dollar. That is a national Gallop Poll. They have been 
polling on this for a long time and it is the highest number ever of 
what Americans think, in terms of the fact that they are getting very 
little value for their tax dollars. They see games being played. That 
is what I hear when I have telephone townhall meetings in Wyoming. They 
know Senator Reid's bill steals $464 billion from Medicare. They know 
it raids the health care program they depend upon, not to make Medicare 
stronger, not to make Medicare more solvent, but as my colleague from 
Wyoming tells me, to create a brandnew entitlement program. They are 
raiding Medicare to start another government program that is itself 
going to be insolvent.
  I ask my colleague from Wyoming, are you seeing what I am seeing?
  Mr. ENZI. I am seeing what you are seeing. I am noticing some people 
do not know what an entitlement actually is. That is a bill that goes 
on forever, that the Secretary of Health and Human Services has to make 
sure that it is paid in perpetuity unless there is some other major 
Congressional action that happens. We keep paying that bill over and 
over again. I think the Senator from Wyoming recognizes entitlements 
and some of the difficulties involved with that.
  Mr. BARRASSO. Mr. President, an article in Bloomberg yesterday said 
the Kaiser Family Foundation poll released this past month found that 
60 percent of seniors said they would be better off if Congress did not 
change the health care system.
  We know we need to do some changes. But this massive bill, this 
2,000-page bill that weighs 20 pounds, is not the right change we need. 
For our seniors, people who rely on Medicare for their health care, to 
absolutely raid $464 billion from Medicare, almost $\1/2\ trillion, 
there is a point where more people--the baby boomers, more and more 
people are added to the rolls every day. To raid this program to start 
a whole new government program is not the right prescription for 
America. It is not what our seniors want. It is not what they signed up 
for. It is not why they are choosing Medicare Advantage. It is because 
it is a choice they make and that is why we right now have 11 million 
Americans who are on Medicare Advantage. We have 11 million seniors--
that represents almost one-quarter of all Medicare patients in this 
country.
  Mr. ENZI. We are being notified our time is up. We will continue. I 
have several letters from Wyoming organizations that I want to have 
printed in the Record, and I will do that at a later time.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. DODD. Mr. President, a few moment ago I started to describe an 
amendment that will be offered by our colleague from Rhode Island, 
Senator Whitehouse, regarding the CLASS Act.
  As a bit of background, the CLASS Act is a proposal that was 
originally conceived by a former colleague and dear friend, Ted Kennedy 
of Massachusetts, years ago, the idea behind it being that we ought to 
try to figure out a way to support people in this country who end up 
with disabilities. Their disabilities are not so dramatic that they 
would deprive them of the opportunity to continue with work but serious 
enough that they would require some additional help in order to provide 
a basic standard-of-living, either a driver, some help on food 
assistance, whatever it may be.
  Under present disability formulas, which are basically income-
replacement bills, in order to get some help if you are disabled, you 
almost have to impoverish yourself to qualify and then be restrained 
about how much you can actually earn, if you want to continue to work. 
So while it has been a good program and certainly has helped a lot of 
people, in a sense there are catch-22s in it, that to qualify for it, 
you have to divest whatever you have acquired or earned and impoverish 
yourself. Then, even though you may be capable of continuing to work, 
you are limited on how much you can actually earn under those programs.
  It was the vision of Senator Kennedy years ago to try to come up with 
a different idea, not to replace that but an idea that might allow for 
people who are disabled to get some help during that period of 
disability, however long it might last, without necessarily having to 
then impoverish themselves or to limit their outside earnings, given 
the fact that they may be able to continue to perform and, in fact, 
would like to continue to work.
  The question was, how could we do this, particularly in light of the 
fact that we don't want to necessarily be adding a cost to taxpayers. 
It was his idea to come up with a totally voluntary program that 
individuals would have to contribute to out of their own pocketbooks, 
not out of taxpayers pocketbooks, by putting aside resources on a 
monthly basis over a period of years--5 in the case of this bill--where 
the plan would become vested and then to contribute that amount 
thereafter. Then, in such case if you found yourself disabled--and 
there are criteria that would determine whether you met those 
thresholds--you would then qualify, based on the fact that you have 
paid your own money into this program continuously, without exception, 
to receive at least about $75 a day, providing assistance to you so 
that you might get along and be able to continue to operate without 
having to impoverish yourself and put limitations on your work. At $75 
a day, that would provide over $27,000 a year for those individuals who 
meet it. Again, entirely voluntary, your money, not public money--no 
taxpayer money goes into the plan.

[[Page S12380]]

  Five million people under the age of 65 living in the community 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. Long-term care supports and services 
are an area that is not currently affordable or accessible for millions 
of our fellow citizens. It is estimated that 65 percent of all those 
who are 65 or over today will spend some time at home in need of long-
term care services, for which average costs run at least $18,000 a 
year.
  Mr. President, 1\1/2\ million people today are in nursing homes, and 
roughly 9 million of our fellow elderly Americans will need help with 
activities of daily living during the current year. By the year 2030, 
that number will increase to 14 million, as we watch the baby boom 
population age. And while those lives will be extended and hopefully 
the quality improved, we all accept the notion that as we get older, we 
have greater needs physically. That certainly is something anyone over 
the age of 65 can tell you. So as the years progress, the quality of 
care, longevity tables increase, the number of people who will need 
some form of services or another will jump from 9 million today to 
roughly 14 million. Those numbers are apt to increase.
  Many people who need long-term services and supports rely on unpaid 
family and friends to provide that care. They have children or 
grandchildren who are around to provide that kind of assistance. A lot 
can't, of course. But ultimately many of these individuals have to 
impoverish themselves to qualify for Medicaid. We know what happens. 
They transfer the house, their assets. They shove everything over to 
their children or someplace else so that they qualify for that title 
XIX window. They become desperately poor, so they can then qualify for 
Medicaid, which remains the primary payer for these services. The CLASS 
Act is designed to avoid that, if we can, in as many cases as possible 
by providing a lifetime cash benefit--voluntary, totally paid for by 
the beneficiaries--that offers seniors and people with disabilities 
some protection against the cost of paying for long-term care services 
and supports and helps them obtain services and supports that will 
enable them to remain in their homes, reside in their communities, and, 
in many cases, continue to work.
  Let me tell you how the program works. The program is a totally 
voluntary, self-funded insurance program with enrollment for people who 
are currently employed. Affordable premiums will be paid through 
payroll deduction, if the individual's employer decides to participate. 
It is totally voluntary, nothing required whatsoever. If the employer 
does not want to participate, the employee would have to find some 
other way. If the employer decides to allow a payroll deduction, they 
can do that. Participation by workers, again, is entirely voluntary. 
Self-employed people or those whose employers do not offer the benefit 
will also be able to join this program through a government payment 
mechanism.
  Individuals qualify to receive benefits when they need help with 
certain activities of daily living and they have paid premiums for at 
least 5 years and have worked for at least 3 of those 5 years. 
Beneficiaries receive lifetime cash benefits based on the degree of 
impairment, expected to average roughly $75 a day or roughly $27,000 a 
year. Benefits can be used to maintain independence at home or in the 
community and should be sufficient to cover typical costs of home care 
services or adult daycare. Benefits can also be used to offset the cost 
of assisted living and nursing home care.
  Let me tell you how the improved version of this act protects the 
taxpayer. There have been issues raised about how they are going to be 
protected under this program. All CLASS Act benefits are paid by 
voluntary participants, not taxpayers. The CLASS Act actually would 
save taxpayer dollars by reducing Medicaid costs--according to CBO, 
almost $2 billion. CLASS Act premiums must be set at a level sufficient 
to guarantee actuarial soundness of the program.
  We thank Senator Gregg for his amendment in the debate on the CLASS 
Act bill when it came up in committee.
  The current CLASS Act includes significant improvements over earlier 
versions, such as tighter eligibility standards, a new reserve 
requirement, and an absolute prohibition on the use of taxpayer dollars 
to pay benefits. The Congressional Budget Office determined that the 
improved program is totally actuarially sound.
  This bill, the Patient Protection and Affordable Care Act, creates a 
voluntary insurance program. Under the program, working people pay 
premiums for at least 5 years before it would vest. After that point, 
if the individual has paid in for 5 years and worked for at least 3 of 
those 5 years and develops a disability, they can receive a cash 
benefit of no less than $50 a day for as long as that disability 
persists. Contrary to popular belief, Medicare and most private health 
insurance only pay for long-term care for a short period, meaning that 
most people pay out of their own income or assets or their family's 
assets to provide this kind of benefit. Those with the most intense 
needs will frequently exhaust these assets and have to rely on 
Medicaid, thus impoverishing themselves in order to qualify.
  The CLASS Act provides essential options for 65 percent of those age 
65 and older who will need long-term care services at some point in 
their lives and for the 70,000 workers with severe disabilities in the 
Nation today who need daily assistance to maintain their jobs and their 
independence.
  It has been said that this program is not financially stable and 
amounts to nothing more than a Ponzi scheme. This program, they say, 
will create a new government entitlement program. It is not a 
government entitlement program--anything but. The CLASS Act does not 
confer rights or an obligation on the government funding, nor does it 
affect receipt of or eligibility for other benefits. The program stands 
on its own financial feet.

  CBO has estimated the program to be actuarially sound for the next 75 
years. The CLASS Act is solvent, according to the CBO. The program 
would run only on its own cashflows. CBO estimates an average monthly 
premium of $123 for an average daily cash benefit of $75 for those who 
qualify. It may not seem like much, but over a year that would provide 
needed assistance for those who suffer under disabilities.
  CBO uses very conservative participation rates. CBO assumes 
participation rates that do not consider that CLASS would offer a 
lifetime cash benefit, be endorsed by the government, and provide a 
convenient way for employees to auto-enroll through their employers 
with a voluntary opt-out. All of these features would increase 
participation rates, which will result in lower premiums, encourage 
enrollment, and make the program even stronger financially.
  Solvency of the program is bolstered by flexibility to adjust the 
program. In their November 25 letter to the Congress, the CBO 
acknowledges that the legislation gives flexibility to the Health and 
Human Services Secretary to adjust premiums and benefits where or if 
ever needed. This provides a lever to ensure that the program stays 
solvent even if real life does not perfectly mirror the models of the 
CBO, as good as they are.
  As the Congressional Budget Office discusses, the CLASS Act would 
function just like any other private long-term care insurance program 
which finances benefit payments from a premium reserve and interest 
income off that reserve. Due to budget scorekeeping, the CBO finds that 
premium revenue exceeds benefit payments in the third decade but does 
not take into consideration accumulated reserves and income off those 
reserves that keep the program fiscally independent.
  Beyond being self-supporting and voluntary, this program can actually 
generate savings in Medicaid. Direct offset of the $75 daily benefit is 
applied toward any Medicaid long-term care costs. Beyond that, the 
CLASS Act program will help people live independently at home or in the 
community. When people with disabilities get the services they need, 
they are less likely to spend down to get Medicaid and less likely to 
enter a nursing home or hospital, all of which generates additional 
Medicaid savings.
  Of course, what we don't calculate here, because I don't know how one 
would calculate it, is that notion of independence. I suspect maybe all 
of us

[[Page S12381]]

know people who are on Medicaid and know the frustration particularly 
of someone who is otherwise healthy but suffers from disabilities who 
would like to work and wants to keep independent. Yet if you go into 
the Medicaid Program, there are huge restraints on your ability to do 
so. So by this program, aside from financially reducing Medicaid costs, 
we are actually providing that additional sense of human dignity and 
decency that just because you have a disability and you need help 
doesn't mean you don't want to be self-sufficient and keep 
working. There is the gratification of knowing you are contributing in 
some way other than being shuttered away, having impoverished yourself, 
relying on others' assets to take care of you because you do not have 
those resources.

  Senator Kennedy generated this idea years ago, and now I think it is 
improved because of the amendments and ideas that have been suggested 
by a number of our colleagues here, as well as others, and we have 
actually strengthened the concept to give it the kind of financial 
independence Members want it to have, sheltering these dollars against 
being used for other purposes, such as going off to some other program 
that people may have a great desire to fund by tapping into these 
resources. We prohibit that from happening.
  If employers do not want to have a payroll deduction, they do not 
have to have that. No one is required to join the program. We believe, 
though, when members of our society and country see the benefits of 
this, they will gravitate to it as a wonderful way to ensure against 
that dreaded possibility all of us face; that is, becoming disabled, 
being unable to work as much as we would like to, needing additional 
assistance and help, and, of course, having very few places to turn to 
get it.
  The disability groups and others that support this, 275 
organizations, aging, religious groups, disability organizations across 
the country--I am not going to read all of them here because 275 names 
is a lot, but I have here the list of all 275 organizations that have 
strongly supported this proposal. I cannot think of any finer way to 
celebrate the memory of our former colleague, who cared so much about 
this bill we are now engaged in debating, who brought this idea to the 
table years ago, and who championed it for so many years.
  Today, we have a chance to include this wonderful concept, this 
creative, innovative idea. It saves money. It provides independence for 
people. It gives them a chance to lead good lives. It provides support 
to their families who otherwise have to bear a lot of that burden. None 
of us want our children or our grandchildren to have to bear burdens as 
they are trying to raise their own families. So here is a little idea 
that has generated support, totally by voluntary contributions. There 
is no government money involved at all. And it is to give people a 
chance to live out the remaining time of their lives with decency and 
dignity, having the sense of making a contribution and making a 
difference.
  All of those facts I cannot put a dollar amount on. I cannot tell you 
what the financial benefit is of someone getting up in the morning, 
getting a little help but going off to a job and knowing they are 
needed and have worth and value as a human being. What is the dollar 
amount on that? I cannot tell you, except I know it has value in our 
country. Or the alternative? Getting rid of all your assets, 
impoverishing yourself, relying on your family or friends to take care 
of you in order to try to survive, when you could be doing more.
  So I hope my colleagues will support the Whitehouse amendment when it 
is offered to strengthen this program and that they will resoundingly 
defeat the effort to cut this program out of the bill altogether. I 
cannot think of a worse thing we could do with a piece of legislation 
that is designed to be creative, innovative, reduce costs, and make a 
difference for millions of our fellow citizens. And a growing number--
as was pointed out, by the year 2030, 14 million Americans in our 
country, and I suspect more--will be in need of services such as these.
  I see my colleague and friend from Iowa on the floor, who has been as 
strong a champion as this Congress has ever had when it comes to the 
disabled in our country, having been the author of the Americans with 
Disabilities Act, along with others but nonetheless the principal 
architect of that effort, and he can speak more eloquently than any 
other human being I have ever known about why this program is important 
and what it means.
  Mr. President, I ask unanimous consent that the list of 275 
organizations that strongly endorse and support Senator Kennedy's CLASS 
Act be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       Health Care Reform/CLASS Act of 2009 National Support List


                           Disability Groups

       ADAPT, America Psychological Association, American 
     Association on Health and Disability, American Association on 
     Intellectual and Developmental Disabilities, American 
     Association of People with Disabilities, American Association 
     on Mental Retardation, American Congress of Community 
     Supports and Employment Services, American Foundation for the 
     Blind, American Medical Rehabilitation Providers Association 
     (AMRPA), American Music Therapy Association, American 
     Physical Therapy Association, American Network of Community 
     Options and Resources, Anxiety Disorders Association of 
     America, The ALS Association, Assisted Living Federation of 
     America, Association of Assistive Technology Act Programs, 
     Association of Programs for Rural Independent Living, 
     Association of University Centers of Disabilities, Autism 
     Society, ACCSES.
       Bazelon Center for Mental Health Law, Brain Injury 
     Association of America, Center for Disability Issues and the 
     Health Professions at Western University of Health Sciences, 
     CSAVR (Council of State Administrators of Vocational 
     Rehabilitation), Consortium of Citizens with Disabilities 
     (umbrella organization for 114 advocacy groups), Children and 
     Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), 
     Council for Learning Disabilities, Center for Accessible 
     Living, Depression and Bipolar Support Alliance, Disability 
     Policy Collaboration, Disability Rights Education and Defense 
     Fund, Easter Seals, Epilepsy Foundation, Higher Education 
     Consortium for Special Education Teacher Education, Helen 
     Keller National Center, Division of the Council for 
     Exceptional Children, Justice for All, Mental Health America, 
     National Academy of Elder Law Attorneys, National Alliance on 
     Mental Illness, National Association for Anorexia Nervosa and 
     Associated Eating Disorders.
       National Association of Councils on Developmental 
     Disabilities, National Association of County Behavioral 
     Health and Developmental Disability Directors, National 
     Association of State Directors of Developmental Disabilities 
     Services, National Association of State Head Injury 
     Administrators, National Center on Learning Disabilities, 
     National Coalition on Deaf-Blindness, National Council on 
     Independent Living, National Disability Rights Network, 
     National Down Syndrome Society, National Down Syndrome 
     Congress, National Multiple Sclerosis Society, National 
     Organization on Disability, National PACE Association, 
     National Rehabilitation Association, National Spinal Cord 
     Injury Association, Paralyzed Veterans of America, 
     Rehabilitation Engineering and Assistive Technology Society 
     of North America, Research Institute for Independent Living, 
     Self-Advocates Becoming Empowered, Special Olympics, Inc.
       TASH, The Arc of the United States, The Autistic Self 
     Advocacy Network, Tourette Syndrome Association, United 
     Cerebral Palsy, United Spinal Association, US Psychiatric 
     Rehabilitation Association.


                              Aging Groups

       AARP, Alliance for Retired Americans, Alliance for Quality 
     Long Term Care, Alzheimer's Association, Alzheimer's 
     Foundation of America, American Association for Geriatric 
     Psychiatry, American Association for Homecare, American 
     Association for Homes and Services for the Aging, American 
     Health Care Association, Association of BellTel Retirees, 
     Association of Retired Americans, ATAP (Assistive Technology 
     Programs), Burton Blatt Institute, National Alliance for 
     Caregivers, National Association for Homecare and Hospice, 
     National Association of Area Agencies on Aging, National 
     Association of Nutrition and Aging Services Programs, 
     National Association of Professional Geriatric Care Managers, 
     National Association of State Units on Aging, National 
     Council on Aging, National Family Care Givers Association.
       National Indian Council on Aging, National Respite 
     Coalition, Notre Dame du Lac Assisted Living, OWL--The Voice 
     of Midlife and Older Women, Prima Council on Aging, 
     ProtectSeniors.org, The National Consumer Voice for Quality 
     Long-Term, The National Voice for Quality Long-Term Care, 
     Therapeutic Communities of America, United Neighborhood 
     Centers of America, Volunteers of America, Wider 
     Opportunities for Women.


                           Healthcare Groups

       American Academy of Pediatrics (AAP), Ambulatory Behavioral 
     Healthcare, American Association for Marriage and Family 
     Therapy, American Congress of Rehabilitative Medicine, 
     American Counseling Association, American Diabetes 
     Association, American Group Psychotherapy Association,

[[Page S12382]]

     American Hospital Association (AHA), American Mental Health 
     Counselors Association, American Occupational Therapy 
     Association, American Society on Consultant Pharmacists, 
     American Therapeutic Recreation Association, Association for 
     Ambulatory Behavioral Healthcare, Assoc. of the Advancement 
     of Psychology, Bazelon Center for Mental Health Law, Center 
     for Medicare Advocacy, Families USA, Family Voices, Gay Men 
     of African Descent, Medicare Rights Center.
       Mujeres Unidas Contra el SIDA, National Alliance to End 
     Homelessness, National Partnership for Women and Families, 
     National Association of Children's Behavioral Health, 
     National Association of Mental Health Planning Councils, 
     National Association of School Psychologists, National 
     Coalition of Mental Health Consumer/Survivor Organizations, 
     National Committee to Preserve Social Security and Medicare, 
     National Council for Community Behavioral Health Care, 
     National Foundation for Mental Health, National Health 
     Council, National Minority AIDS Council, The Center for 
     Medical Advocacy, Visiting Nurses Association of America.


                                 Unions

       American Federation of Labor-Congress of Industrial 
     Organizations (AFL-CIO), American Federation of State, 
     Country, and Municipal Employees (AFSCME), Service Employees 
     International Union (SEIU), American Federation of Teachers 
     (AFT), National Association of Active and Retired Federal 
     Employees (NARFE).


                        Religious Organizations

       American Association of Pastoral Counselors, American 
     Baptist Home Mission Societies, Association of Jewish Aging 
     Services of North America, Association of Jewish Family and 
     Children's Agencies, B'nai B'rith International, Catholic 
     Health Association of the United States, Council of Health 
     and Human Service Ministries of the United Church of Christ, 
     Episcopal Community Services in America, Evangelical Lutheran 
     Good Samaritan Society, Evangelical Lutheran Church in 
     America, Friends Committee on National Legislation, Hindu 
     American Foundation, Islamic Society of North America, Jewish 
     Council for Public Affairs, Lutheran Services in America, 
     L'Arche USA, Mary Immaculate Health/Care Services, Masonic 
     Communities and Services Association, National Council of 
     Jewish Women, Presbyterian Church (U.S.A.).
       Presbyterian Association of Homes and Services for the 
     Aging, Sisters of Charity, United Jewish Communities, The 
     Jewish Federations of North America, The Union for Reform 
     Judaism, Unitarian Universalist Association of Congregations, 
     United Methodist Church.


                         HIV/AIDS Organizations

       ActionAIDS, Philadelphia, PA; African Services Committee, 
     New York, NY; AIDS Action Baltimore, Baltimore, MD; AIDS 
     Action Council, Washington, DC; AIDS Action Committee of 
     Massachusetts, Boston, MA; AIDS Alabama, Birmingham, AL; AIDS 
     Alliance for Children, Youth & Families, Washington, DC; AIDS 
     Coalition of Southern New Jersey, Bellmawr, NJ; AIDS 
     Foundation of Chicago, Chicago, IL; AIDS Housing Alliance/SF, 
     San Francisco, CA; AIDS Law Project of Pennsylvania, 
     Philadelphia, PA; AIDS Legal Council of Chicago, Chicago, IL; 
     AIDS Legal Referral Panel, San Francisco, CA; AIDS 
     Partnership Michigan, Detroit, MI; AIDS Project Los Angeles, 
     Los Angeles, CA; AIDS Services Foundation Orange County, 
     Irvine, CA; AIDS Task Force, Wheeling, WV; AIDS Treatment 
     Data Network, New York, NY; AIDSNET, Bethlehem, PA; American 
     Dental Education Association, Washington, DC.
       Asian & Pacific Islander Wellness Center, San Francisco, 
     CA; Association of Nurses in AIDS Care, Akron, OH; 
     Association of Nutrition Services Agencies (ANSA), 
     Washington, DC; Better Existence with HIV (BEHIV), Chicago, 
     IL; Black Coalition on AIDS, San Francisco, CA; CAEAR 
     Foundation, Washington, DC; Catholic Charities CYO, San 
     Francisco, CA; Colorado AIDS Project, Denver, CO; Center on 
     Halsted, Chicago, IL; The COLOURS Organization, Inc., 
     Philadelphia, PA; Common Ground--the Westside HIV Community 
     Center, Santa Monica, CA; Community Care Management 
     Corporation, Ukiah, CA; Community Healthcare Network, New 
     York, NY; Community HIV/AIDS Mobilization Project (CHAMP), 
     New York, NY & Providence, RI; Community Research Initiative 
     of New England (CRI), Boston, MA; Face to Face/Sonoma County 
     AIDS Network, Santa Rosa, CA; Fenway Community Health, 
     Boston, MA; Gay Men's Health Crisis (GMHC), New York, NY; 
     Harlem United Community AIDS Center, New York, NY; Hawaii 
     Island HIV/AIDS Foundation, Keaau & Kailua-Kona, HI; Health 
     and Home Support Services, Inc., Newport News, VA.
       Health Imperatives, Brockton, MA; HIV ACCESS, Alameda 
     County, CA; HIV/AIDS Services for African Americans in 
     Alaska, Anchorage, AK; HIV/AIDS Services/Greater Love 
     Tabernacle Church, Dorchester, MA; HIV Dental Alliance, 
     Atlanta, GA; HIV Health and Human Services Planning Council 
     of New York, New York, NY; HIV Health Services Planning 
     Council, Sacramento, CA; HIV Health Services Planning 
     Council--San Francisco EMA, San Francisco, CA; HIVictorious, 
     Inc., Madison, WI; HIV Medicine Association, Arlington, VA; 
     Housing Works, New York, NY; Hyacinth AIDS Foundation, New 
     Brunswick, NJ; Inova Juniper Program, Springfield, VA; JRI 
     Health/Sidney Borum Health Center, Boston, MA; Lansing Area 
     AIDS Network, Lansing, MI; L.A. Gay & Lesbian Center, Los 
     Angeles, CA; Legacy Community Health Services, Inc., Houston, 
     TX; LifeLinc, Baltimore, MD; Lifelong AIDS Alliance, Seattle, 
     WA.
       Lower East Side Harm Reduction Center, New York, NY; 
     Michigan Positive Action Coalition (MI-POZ), Detroit, MI; 
     Minnesota AIDS Project, Minneapolis, MN; Nashville CARES, 
     Nashville, TN; National Alliance of State and Territorial 
     AIDS Directors, Washington, DC; National Association of AIDS 
     Education and Training Centers, Detroit, MI; National 
     Association of People with AIDS, Washington, DC; The National 
     Coalition for LGBT Health, Washington, DC; National Minority 
     AIDS Council, Washington, DC; National Pediatric AIDS 
     Network, Boulder, CO; National Women and AIDS Collective, 
     Brooklyn, NY; New York City Health and Hospitals Corporation, 
     New York, NY; NYC AIDS Housing Network (NYCAHN), New York, 
     NY; The New York State Nurses Association, Latham, NY; New 
     York State Wide Senior Action Council, Inc., Albany, NY; 
     Okaloosa AIDS Support and Informational Services, Inc. 
     (OASIS), Ft. Walton Beach, FL; Open Arms of Minnesota, 
     Minneapolis, MN; Partnership Project, Portland, OR; Paterson 
     Counseling Center, Inc., Paterson, NJ; People Living With 
     HIV/AIDS Committee of the Baltimore Planning Council, 
     Baltimore, MD.
       Positive East Tennesseans, Knoxville, TN; Project Open 
     Hand, San Francisco, CA; Project Inform, San Francisco, CA; 
     Ryan White Medical Providers Coalition, Arlington, VA; San 
     Francisco AIDS Foundation, San Francisco, CA; Sisters 
     Together And Reaching, Inc. (STAR), Baltimore, MD; Southern 
     NH HIV/AIDS Task Force, Nashua, NH; Strong Consulting, 
     Crescent City, CA; Test Positive Aware Network, Chicago, IL; 
     The AIDS Institute, Washington, DC & Tampa, FL; The Albany 
     Damien Center, Albany, NY; The International Community of 
     Women Living with HIV/AIDS (ICW), Washington, DC; The 
     Sexuality Information and Education Council of the United 
     States (SIECUS), Washington, DC; Treatment Action Group 
     (TAG), New York, NY; Triad Health Project, Greensboro, NC; 
     United Methodist Mexican-American Ministries, Garden City, 
     KS; Victory Programs, Inc., Boston, MA; Village Care of New 
     York, New York, NY; Wilson Resource Center (WRC), Arnolds 
     Park, IA; Women Together for Change, St. Croix, U.S. Virgin 
     Islands.

  Mr. DODD. I yield the floor.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Iowa.
  Mr. HARKIN. Mr. President, I wish to thank our friend and leader on 
this issue, Senator Dodd, for his eloquence in supporting what so many 
of our elderly in this country want more desperately than just about 
anything else; that is, the peace of mind of knowing that if they 
should become disabled, they will not be forced to go into a nursing 
home, they will have some support, and they will be able to live in 
their homes in their communities. Talk to anyone with a disability--not 
just the elderly, anyone with a disability--and they will tell you how 
important it is that you have that kind of assurance that if, God 
forbid, you become disabled, your only hope will not be to go into a 
nursing home for the rest of your natural life.
  Senator Kennedy worked on this for years. The couple times I talked 
to him this summer and this spring, this is what he wanted to talk to 
me about: making sure we included this in the bill. This was his cause, 
to make sure we had a program people could contribute to that would 
afford them some support if, in fact, they became disabled.
  I do not understand the move by my Republican friends to strike this. 
This is not a mandatory program. This does not force anyone to pay a 
dime. It is all voluntary. We say, if you want to, you can put some 
money aside during your working years in a fund that will vest so that 
if you become disabled, you can get some support to stay at home, maybe 
with your own family, maybe with just enough support so you can get 
another job and work even though you have a disability. This is 
voluntary.
  I ask my friends on the other side of the aisle, why are you against 
a voluntary program that will enable people to have that kind of peace 
of mind? Well, I have heard it said: Well, maybe the taxpayers will 
have to pay for this and everything.
  I will tell you this: In the committee, Senator Gregg--Senator Gregg 
from New Hampshire, Republican Senator Gregg, my good friend--offered 
an amendment to make sure the contributions were the only things that 
would sustain this program, that it would not become an entitlement. 
Here is what he said, his own words:

       I offered an amendment, which was ultimately accepted, that 
     would require that

[[Page S12383]]

     CLASS Act premiums 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.

  The CBO has scored this. This is completely paid for over 75 years--
over 75 years. I do not understand why anyone would want to strike it.
  What Senator Whitehouse has said--again, I think this is very 
appropriate for us--is that any savings we get from this be reinvested 
either in the CLASS Act--so when people do get disabled, maybe they 
will get a little bit more money. So we have some savings in the CLASS 
Act. What Senator Whitehouse has said is, put those savings back in the 
CLASS Act or Social Security. It makes sense to me. So again, I think 
it is an improvement on the bill, what Senator Whitehouse is 
suggesting.
  I plead--I plead--with my fellow Senators, do not kill this program 
aborning. We stood here on this floor 19 years ago, on July 20, 1990. 
We stood on this floor to pass the Americans with Disabilities Act. 
There were a few votes against it. In fact, there are one or two people 
still here who voted against it. I think if you asked them now, they 
would say it has been a pretty darn good bill. It has broken down a lot 
of barriers, opened a lot of doors for people with disabilities in our 
country, changed our environment in this country, not only in terms of 
physical access, but I think, more importantly, it has changed how we 
view people with disabilities, no longer looking at people with a 
disability to say, what is their disability, we now look at those 
people and say, what are your abilities, what can you do--not just 
looking at someone's disability. So we have come a long way.
  The one thing we have never been able to really do is to set up a 
functioning system so people could put some money aside to protect 
themselves in case they got disabled. Well, this is it. This is our 
chance. This is a big part of this health care bill, a big part.
  Well, maybe, I suppose, if you are trying to kill the bill, you would 
want to kill the CLASS Act. But this is vitally important for our 
country. It is really the next logical step after the Americans with 
Disabilities Act. It is going to provide for so many people in this 
country that security and that peace of mind of knowing they will not 
have to go into a nursing home or an institution if they become 
disabled. And it can happen to any one of us here on the Senate floor, 
our families, our staff, our loved ones. No one knows what might happen 
to us either from an accident or a physical ailment. No one knows. But 
shouldn't we at least have some part of this health care bill that 
provides that kind of voluntary program? No one is forced into 
anything. I guess that is what perplexes me more than anything else--
why my Republican friends want to prevent something like a voluntary 
program--a voluntary program--from going into existence that would do 
this, that is fiscally sound for 75 years. I just do not get it.
  So I hope we will support the Whitehouse amendment and make sure this 
fund is totally solvent. I think he is on the right track, that if 
there are savings, to put the money back in there, so maybe that $75 a 
day could be maybe $80 a day, or something like that, to help people.
  I see, Mr. President, we now have a statement from the AARP about the 
CLASS program. Here is what they said. They said:

       Decades of talking to our members tell us that older 
     Americans want to live in their homes as they age. That's why 
     AARP strongly supports the Community Living Assistance 
     Services and Supports (CLASS) program, which recognizes that 
     older individuals and people with disabilities should have 
     the right to live independently in their own homes and 
     communities, and to receive the help they need without having 
     to spend down to poverty.

  Mr. President, I ask unanimous consent to have that statement from 
the AARP printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

AARP Statement on the Community Living Assistance Services and Supports 
                                Program

       Washington.--AARP Executive Vice President Nancy LeaMond 
     released this statement today in support of the Community 
     Living Assistance Services and Supports (CLASS) program:
       ``Decades of talking to our members tell us that older 
     Americans want to live in their homes as they age. That's why 
     AARP strongly supports the Community Living Assistance 
     Services and Supports (CLASS) program, which recognizes that 
     older individuals and people with disabilities should have 
     the right to live independently in their own homes and 
     communities, and to receive the help they need without having 
     to spend down to poverty.
       ``With nearly 40 million members age 50-plus, AARP has 
     fought to strengthen long-term services and supports. We 
     thank the House and Senate for including the CLASS program in 
     their health care reform bills. The voluntary CLASS insurance 
     program will promote independence, choice, dignity and 
     personal responsibility. It is self-funded and fiscally 
     responsible. AARP believes the CLASS program has been 
     strengthened throughout the legislative process. We look 
     forward to working with Senate, House, and the Administration 
     to enact this critical program. America's seniors and persons 
     with disabilities deserve nothing less.''

  Mr. HARKIN. Mr. President, I am going to put this in personal terms--
personal terms. I have told this story before, and I am going to tell 
it again because I think it indicates why we need a program such as 
this.
  I have a nephew, Kelly; my sister's boy. He got injured at a very 
young age; he was only 19 years old. It made him a severe paraplegic, 
almost a quadriplegic. My sister and her husband did not have any money 
at all. Yet Kelly was able to go to college--go to school. He was able 
to get a job, able to live in a house by himself. He had his own little 
home. He had his own van he drove that had a lift on it, and he could 
get his wheelchair in there and drive it to work. He actually started a 
small business and employed some people. He has lived a full life. He 
is now a man of about 50. He has had a great life. Even with that 
disability, he has been able to get around and do things. He is a 
taxpayer. He has paid taxes. He has employed people. Every night when 
he goes home, he has to have a nurse come in the home and get him ready 
for bed and for him to do his exercises and things such as that. Then, 
in the morning, he has to have another nurse to get him out of bed and 
take care of his needs, get him ready to go. Actually, Kelly gets his 
own meals and stuff. Then he goes off to work and comes back. This 
happens every day.
  How was he able to afford to do that? He did not have any money. He 
did not have any insurance. How was he able to afford to do that? He 
got injured in the military. He got injured in the military. So for all 
these years, the Veterans' Administration has been paying for this. It 
has been wonderful. It has kept him out of an institution, kept him out 
of a nursing home, and it has allowed him to live by himself, to go to 
school, to go to work, to be with his family, to be with his friends.
  I have often thought, this is wonderful, but why should that just be 
for people who are injured in the military? What about so many other 
people who get injured like my nephew Kelly who are not in the 
military, maybe even injured before they could go into the military? He 
was only 19 when it happened to him. So for all these years, I have 
thought we should have some system in this country that would allow 
people like my nephew--who were not in the military but who, through an 
unfortunate accident, became disabled--that they could have that same 
kind of life, where they could live in their own homes in their own 
communities with their own families, have their own friends. That is 
why this is so important. This is perhaps one of the most important 
things we have done since the passage of the Americans with 
Disabilities Act to make sure people with disabilities have a full, 
enjoyable, productive, quality life.

  I hope Senators will decisively defeat the amendment that wants to 
strike this. Say yes. Say yes to so many people with disabilities and 
young people today and working people today. Say yes that we are going 
to have a system whereby you will have the peace of mind of knowing 
that if you want to contribute the money, you will be able to do so. 
Say no to the amendment that would strike that, and say yes to the 
Whitehouse amendment that actually supports the CLASS Act, makes sure 
that any savings from it are reinvested in that program.
  I thank the President and I yield the floor.

[[Page S12384]]

  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. DODD. Before we go to our next speaker, I wish to ask if I could 
request that the next half hour be equally divided; is that OK?
  The PRESIDING OFFICER. The Republican deputy leader.
  Mr. KYL. I had hoped to take the next half hour, but if we could do 
40 minutes, equally divided, I could take 20.
  Mr. DODD. Forty minutes, equally divided.
  Mr. KYL. Would I be able to take the first 20 minutes then?
  Mr. DODD. Yes. That would be under the same order as we had before, I 
would ask the Chair.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Arizona is recognized.
  Mr. KYL. Mr. President, we are discussing the Hatch motion to 
preserve Medicare Advantage. I wish to give a little bit of background 
about the Medicare Advantage Program. It was established with the goal 
of ensuring that beneficiaries all across the country would actually 
have Medicare choices. Under the program, private health plans receive 
government payments in order to serve Medicare beneficiaries. In 
addition to offering comparable coverage to Part A, which is for 
hospitals, and Part B, physician services, Medicare Advantage plans can 
also offer Part D coverage, prescription drug benefits.
  The central goal of the Medicare Advantage provisions was to ensure 
that beneficiaries across the Nation, not just those in populous areas, 
would have access to health plan options. Under the law, Medicare 
Advantage plans must provide all physician and hospital Medicare 
benefits.
  Here is the key. I hope my colleagues will think about this for a 
moment because this has been a little bit perhaps distorted in the 
conversation we have had. If a plan's costs to provide all the Medicare 
benefits is less than the government payment, then by law, the plan 
must apply the difference to provide additional benefits to the 
beneficiary or to reduce premiums.
  It seems to me that is what this whole reform was about in the first 
instance, to try to ensure quality care and reduce the cost of 
insurance to beneficiaries.
  But what are these extra benefits? We have heard them discussed. They 
include, first of all, lower cost sharing, including out-of-pocket 
limits on beneficiary cost sharing, as well as specific health benefits 
such as vision, dental care, hearing services, routine physical, cancer 
screenings, and so on. Plans can also offer management services, which 
can be particularly important to beneficiaries with chronic illnesses, 
and that is a protection, by the way, that does not exist in regular 
fee-for-service Medicare.
  Today, every beneficiary has health plan choices. Since 2003, the 
number of Medicare beneficiaries enrolled in private plans has nearly 
doubled from 5.3 million to 10.2 million in the year 2009, according to 
the Kaiser Family Foundation. So these are very popular plans and 
growing in popularity.
  Let's go back in time just a little bit to consider the history, back 
to 1972, because in past years my colleagues on the other side of the 
aisle were all for Medicare Advantage. Over the years, Congress has 
tried to control spending by reducing payments to private Medicare 
plans. One problem was, severe payment reductions resulted in the 
elimination of plan options. For example, in 1997, the Balanced Budget 
Act reduced plan payments by $74.5 billion over 10 years. What 
happened? Well, about three-quarters of a million beneficiaries, from 
1999 to 2003, had to change plans or else lose their health plan 
altogether. This included not only less populous and more rural areas 
of the country but also areas such as Long Island, NY.
  Well, Congress heard from these seniors loudly and clearly. They were 
angry about losing their coverage. Many remember that the Medicare 
Modernization Act was a landmark achievement which provided seniors 
with prescription drug coverage, but it was necessary for another 
reason as well and that was to respond to the call of the seniors who 
wanted their private options back.
  So, in 2003, the Medicare Modernization Act expanded plan options to 
include regional PPOs and restore plan payments. It was a deliberate, 
bipartisan decision to increase the plan's payments so they could enter 
rural areas of the country and even some of the urban areas--as I 
mentioned, Long Island. If my colleagues don't remember, let me remind 
them.
  Former Senator Clinton from New York, for example, said that these 
Medicare+Choice plans--that is now what we call the Medicare Advantage 
plans, and I am quoting:

       . . . are feeling the squeeze in a system caught between 
     rapidly exploding costs and rapidly imploding finances. While 
     we debate the future of Medicare, we need to recognize that 
     there are people right now in our States who depend on these 
     plans today.

  The current senior Senator from Massachusetts said at the time, and I 
quote:

       I urge my colleagues to support the additional funding that 
     is urgently needed to strengthen the Medicare+Choice program 
     for seniors. This should be among our highest priorities in 
     this year's Medicare debate.

  It was, and we did. So this is not something bad that we provided 
this money to these plans. We provided it so the plans could provide 
the benefits to seniors, particularly in areas where otherwise they 
wouldn't have those choices.
  So why has this all of a sudden become unpopular with our friends on 
the other side of the aisle? Well, obviously, first and foremost, they 
need trillions of dollars to fund their bill, so they look around for 
where they can get some money and decide: Well, we can get $120 billion 
from here; this is one way we can help pay for the new entitlements 
under their bill. But to them, there has to be some kind of 
justification to take that money, so the idea is: Well, it is not fair 
that the government would pay money into this program for extra 
benefits for seniors when that money could be spent on regular fee-for-
service Medicare. Of course, that argument presupposes that government 
health care is always superior to the plans offered in the private 
market, which these seniors have made clear, by doubling the enrollment 
in the private plans, is not the case. As I said, they have made their 
preference clear.
  They asked us for choices, as Members of Congress enjoy. They want 
access to private plans and these additional benefits, and we delivered 
as promised. We gave them the choices, Republicans and Democrats alike. 
Now they need the money, so they decide this is a way to get some money 
to pay for their new entitlement.

  Our friends on the other side of the aisle have been talking about 
overpayments. There is no such thing as an overpayment in this program 
under the law. No money goes to the plans. It is not as if the 
insurance companies get the money from the government. The insurance 
companies, if their bid is under what the traditional Medicare bid is, 
have to return 25 percent of it to the U.S. Government and the other 75 
percent, by law, must go to their beneficiaries, either in the form of 
lower premiums or additional benefits. So these aren't overpayments to 
the plans, as has been represented. As I said, 75 percent of the 
additional payments must be used to provide seniors with extra 
benefits, which could include lowering premiums, including chronic care 
management, and so on. The other 25 percent is returned to the 
government, so there is no overpayment.
  Some on the other side argue that they are protecting guaranteed 
benefits. Well, this is semantics. Nobody is going after the benefits 
Medicare has traditionally supplied. What we are pointing out and what 
this amendment would prevent from happening is, the benefits under 
Medicare Advantage would not be cut, and there is no question--nobody 
can deny--that those benefits would be cut. In fact, according to the 
CBO, by the year 2019, they will have been cut by 64 percent, a huge--
almost $90--over $90 in actuarial value. So my point is, seniors, of 
course, would like to keep what they have.
  What about this promise if you like what you have, you get to keep 
it. Sorry. Not if you are on Medicare Advantage. As I said, according 
to the Congressional Budget Office, the legislation would cut benefits 
from $135 a month actuarial value to $49 actuarial

[[Page S12385]]

value. That is a real cut. It may not sound like much to some people, 
but to our seniors, it is a huge hit. They are asking what happened to 
this promise to let them keep what they have.
  There is an interesting memo by James Capretta and Robert Book, who 
write for the Heritage Foundation, on the Medicare Advantage cuts, and 
here is what they say:

       Reform should mean more patient choice and health plan 
     accountability. But these current proposals would lead in the 
     opposite direction--toward a system of less choice, less 
     accountability, and eventually lower-quality health care.

  That is what the Hatch motion is attempting to prevent, to preserve 
these benefits for seniors.
  I have gotten tons of calls, about 500 calls just in the last several 
days, opposing cuts to Medicare Advantage. I haven't, by the way, 
received a single call from a senior citizen asking us to make these 
cuts. I have been reading from these letters. I have read about a dozen 
of these letters. Let me read a few from constituents who tell us the 
real effect these cuts would have on them. Bear in mind, in my State we 
have about 329,000 seniors who are enrolled in Medicare Advantage 
plans.
  One constituent from Phoenix says:

       For the past month I have heard a lot about proposed 
     Medicare cuts. Finally, after years of being self-employed 
     and being able to afford only high deductible insurance, I am 
     now in Medicare and have a Medicare Advantage plan. Please 
     tell me you are not cutting Medicare Advantage. Have a heart. 
     Leave Medicare and Medicare Advantage alone.

  We are trying.
  A constituent from Peoria, AZ, says:

       I oppose cuts to Medicare Advantage. I have two family 
     members receiving health care under this program. The care 
     has consistently been outstanding due to the efforts of our 
     case manager in coordinating patient care between providers 
     and patients. We have a voice in determining type and scope 
     of our care. Please do not cut Medicare Advantage!

  Here is a note from a constituent from Apache Junction:

       I have heard reports that if passed, the new government 
     health care plan would do away with or cut Medicare 
     Advantage. If so, it would nearly double my health care costs 
     with my present health care provider. I do not want any 
     legislation passed that would take away the Medicare 
     Advantage option for seniors.

  Another constituent from Peoria:

       President Obama has said we can keep the insurance we have 
     if we like it, but has said he wants to cut or eliminate 
     Medicare Advantage. What happens to the millions of people 
     who have Medicare Advantage? These are all seniors, many of 
     whom cannot afford to pay more. Why should so many seniors 
     have to sacrifice in order to help pay for universal 
     coverage? Why do we not hear more debate on this issue?

  Well, to my constituent from Peoria, that is what this debate is all 
about. We are trying to prevent these cuts.
  Here is a constituent from Prescott Valley:

       I have Medicare Advantage. My husband wants to retire from 
     his job where he has excellent health coverage for some 
     serious health concerns. So long as he has good medical 
     coverage, he does well. Should Medicare Advantage be cut, his 
     health would necessarily suffer after his retirement. We 
     cannot afford higher supplemental coverage. I don't want to 
     lose my husband. I have spent many a sleepless night 
     wondering how to keep my husband healthy once he retires. I 
     have several friends currently undergoing chemotherapy and 
     they are wondering if their health would be in jeopardy if 
     Medicare Advantage were cut. Are we not worth saving? 
     Clearly, there are many who want to spend our money on their 
     own priorities. God bless you, sir, for advocating on our 
     behalf!

  These are real concerns from real people. They don't want us to cut 
Medicare Advantage.
  The final point I wish to make is one of our colleagues was saying: 
Well, there are bad Medicare Advantage plans and good Medicare 
Advantage plans. How do we know which ones are good and bad? It turns 
out the senior Senator from Florida devised a formula which protects a 
lot of folks in his State, especially in Broward County, Miami Dade 
County, and Palm Beach but doesn't protect very many other folks.
  Maybe this is the definition of good versus bad. There are a few that 
are protected in Colorado, Maryland, Mississippi, Oklahoma, and Texas. 
In my State of Arizona, with a lot of retirees, very few are exempted 
from the cuts. This is not going to go over well--to exempt only a few 
in certain key areas, and none of the others.
  Again, what happened to the promise that everyone gets to keep what 
they have?
  My bottom line in supporting the Hatch amendment is that we should 
not punish seniors who signed up to have the choice of Medicare 
Advantage. There are better ways to reform health care. We have talked 
about those ways. Our senior citizens have paid into the program. They 
have asked us for this program. Democrats and Republicans have 
supported it in the past. Now, simply because somehow or other we have 
to scrape up money for the new entitlements in this legislation, we are 
going to attack the very program all of us have supported in the past.
  It is unfair, it is not right, and we need to defeat those cuts in 
Medicare, and that is why the Hatch motion to preserve Medicare 
Advantage should be supported by my colleagues.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, before the Senator from Arizona leaves, 
on the point he made and the efforts by the members of the other party 
to strike Medicare Advantage, I have a letter that was sent to members 
of the Medicare conference on September 30, 2003, with more Democratic 
signers who are still in the Senate than Republican signers who were in 
the Senate, which set out all of the reasons Medicare Advantage was so 
very important and why it needed to have more money put into the year 
2003.
  For instance, I will read from the letter:

       For nearly 5 million Medicare beneficiaries across America, 
     Medicare Plus Choice--

  That is what it was called before Medicare Advantage--

     is an essential program that provides high quality, 
     comprehensive, affordable health coverage. These seniors and 
     disabled Americans have voluntarily chosen to receive their 
     health coverage through Medicare HMOs and other private 
     sector plans because they have excellent value. To preserve 
     this important option for seniors across the country, 
     bipartisan legislation was introduced in the Senate as S. 
     590, the ``Medicare Plus Choice Equity and Access Act.''
       Cosponsored by Senators Schumer and Santorum, S. 590 sought 
     to increase reimbursement rates and add new reimbursement 
     options. . . .

  Et cetera, et cetera. We have plenty of history in the Senate that is 
bipartisan that we ought to maintain--Medicare Advantage--rather than 
do an injustice to it, as this legislation before the Senate is trying 
to do.
  I ask unanimous consent to have this letter printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                  U.S. Senate,

                               Washington, DC, September 30, 2003.
       Dear Medicare Conferee: We are writing to ask you, as a 
     member of the Medicare conference committee, to ensure that 
     the final Medicare bill includes a meaningful increase in 
     Medicare+Choice funding in fiscal years 2004 and 2005. While 
     the Senate bill makes a modest step toward this goal, we hope 
     that the stronger provisions in the House bill will be 
     preserved in conference.
       For nearly 5 million Medicare beneficiaries across America, 
     Medicare+Choice is an essential program that provides high 
     quality, comprehensive, affordable health coverage. These 
     seniors and disabled Americans have voluntarily chosen to 
     receive their health coverage through Medicare HMOs and other 
     private sector plans because of their excellent value. To 
     preserve this important option for seniors across the 
     country, bipartisan legislation was introduced in the Senate 
     as S. 590, the ``Medicare+Choice Equity and Access Act.''
       Co-sponsored by Senators Schumer and Santorum, S. 590 
     sought to increase reimbursement rates and add new 
     reimbursement options for Medicare+Choice programs. Although 
     the Senate version of the Medicare bill does include a modest 
     increase in reimbursement rates in FY 2005, we were pleased 
     to see that the House version contains a more comprehensive 
     commitment to strengthening Medicare+Choice beginning in 
     2004.
       Medicare+Choice uses private sector innovations to offer 
     all of the traditional Medicare benefits in addition to extra 
     benefits such as prescription drug coverage, vision benefits, 
     and hearing aids. These added services are particularly 
     important to low-income seniors who cannot afford the high 
     out-of-pocket costs they would incur under the Medicare fee-
     for-service program. In many cases, this program is the only 
     option for low-income seniors to receive comprehensive, 
     affordable health coverage.
       But in recent years, lack of adequate government funding 
     for the Medicare+Choice program has steadily reduced the 
     health plan choices and benefits of seniors across the 
     nation. As funding increases have continually fallen short of 
     rising health care costs, seniors have watched the quality of 
     their health

[[Page S12386]]

     care decline. Each year, health plans deprived of essential 
     funding have been forced to eliminate benefits, increase 
     seniors' out-of-pocket costs, or even withdraw completely 
     from certain areas.
       We strongly support additional Medicare+Choice funding for 
     two very important reasons: (1) to protect the health care 
     choices and benefits of the nearly 5 million Medicare 
     beneficiaries who are currently enrolled in private sector 
     health plans; and (2) to strengthen the foundation for future 
     health plan choices.
       We believe that the Medicare+Choice funding provisions in 
     H.R. 1 are critically important to preserving choice and 
     quality for America's seniors. We urge you to include these 
     provisions in the final bill reported out of the Medicare 
     conference committee.
           Sincerely,
         Rick Santorum, John F. Kerry, Arlen Specter, Jon Corzine, 
           Gordon Smith, Jim Bunning, Dianne Feinstein, Joseph I. 
           Lieberman, Patty Murray, Charles E. Schumer, Frank R. 
           Lautenberg, Hillary Rodham Clinton, Ron Wyden, Mark 
           Dayton, Norm Coleman, Mary L. Landrieu, Maria Cantwell, 
           Christopher J. Dodd.

  Mr. GRASSLEY. Mr. President, does the Senator from Wyoming want the 
remainder of our 20 minutes?
  Mr. BARRASSO. Yes.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.
  Mr. BARRASSO. Mr. President, to correct something I heard on the 
floor today, when the senior Senator from Connecticut had some concerns 
about this, he said how private health plans deny claims. He said 
Medicare doesn't deny claims.
  In the United States of America, the No. 1 denier of claims for 
health care is Medicare. The study that is out from a full year, from 
March 2007 to March 2008, Medicare rejected 475,000 claims of its 6.9 
million claims filed, at the rate of 6.85 percent. When you compare 
that to private insurance companies, the industry average for the 
claims that are rejected is about 4.05 percent.
  So Medicare rejects, by number, 10 times more than the largest 
private insurance company. A lot of these claims--I have followed this 
closely because I have been the medical director of something called 
the Wyoming Health Fairs, where people can get their blood tested at a 
low cost. It is a preventive or prevention-designed program. Yet 
Medicare refuses to pay for prevention. It refuses to pay for these 
blood tests because they are preventive as opposed to diagnosing a 
specific problem in a specific patient with a specific symptom.
  What do our seniors in America do? They turn to a program called 
Medicare Advantage because it gives them the advantage to choose this 
program. It is one of the choices they have under Medicare. At this 
point, 11 million Americans have chosen to participate in Medicare 
Advantage and receive their health care through Medicare Advantage. We 
are talking about seniors who depend on Medicare for their health care.
  The number of people signing up for Medicare Advantage has continued 
to increase, and now there are 11 million people--or one out of every 
four seniors--on Medicare in this country. They know who they are and 
they like the program. The reason they like the program is because they 
get additional services--services beyond what someone on the 
traditional Medicare Program receives, such as dental care, hearing 
care, eye care, preventive care, and coordinated care.
  We hear a lot about the failings of the health care system, and there 
are many in this country, and one of them is that care is not 
coordinated. People go from specialist to specialist. We need 
coordinated care. Medicare Advantage does a much better job at 
coordinating care than traditional Medicare.
  It is baffling to me that the plan in front of us in the Senate today 
is trying to eliminate Medicare Advantage to the tune of over $100 
billion. When one looks at the cuts that are in this plan--it is $464 
billion in Medicare cuts, $135 billion for hospitals, $42 billion for 
home health agencies, $15 billion for nursing homes, and $8 billion for 
hospice providers. But it is $120 billion for Medicare Advantage--the 
program that more seniors, as they learn about it, want to sign up for, 
because it is an advantage to them to have their health care through a 
program which focuses on preventive care, coordinated care, and helps 
them stay healthy and live longer. Yet this Senate and this bill that 
Senator Reid has brought to the floor is trying to completely gut that 
program and deny our seniors who rely upon it from receiving the care 
they have earned.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, I yield 5 minutes to the Senator from 
Wisconsin.
  The PRESIDING OFFICER. The Senator from Wisconsin is recognized.
  Mr. FEINGOLD. Mr. President, I rise in strong support of the 
Community Living Assistance Services and Supports Act, or CLASS Act, 
which was introduced by the late Senator Ted Kennedy. The CLASS Act 
would create an optional insurance program to help pay for home care 
and other assistance for adults who become disabled. Those choosing to 
participate would pay monthly premiums into an insurance trust, and 
after 5 years, could access a cash benefit if they become disabled and 
need assistance.
  Over 10 million Americans are currently in need of long-term care, 
and that number is expected to rise to 15 million in the next 10 years. 
These individuals struggle to remain independent with limited 
assistance, and many turn to Medicaid as an insurer of last resort. In 
order to qualify, however, people need to go through a substantial 
``spend down'' of their assets and commit to unemployment to remain 
eligible. Mr. President, this is totally inefficient. Instead of 
ensuring that an individual can remain an independent and functional 
member of society, the current policy requires that to receive 
assistance, a person basically becomes a ward of the State. Medicaid 
pays for half of long-term care costs and increased expenditures are 
expected to add $44 billion each year to Medicaid over the next decade. 
Not only is this unsustainable it is nonsensical.
  This is as much about protecting people's dignity as it is about 
fiscal responsibility. Too many Americans fall on hard times, becoming 
disabled from an accident or illness, with no safety net to help them 
stay independent. Ensuring that these people have an alternative to 
Medicaid, so that they can remain active and independent, will reduce 
the Federal deficit by $73.4 billion over 10 years and save Medicaid 
$1.6 billion in the first 4 years benefits are available. Medicaid 
savings will continue to grow over time as more beneficiaries utilize 
CLASS Act benefits instead of Medicaid.
  And thanks to amendments accepted in the Senate Health, Education, 
Labor, and Pensions Committee, the bill language is stronger than ever. 
Senator Gregg, my colleague on the Budget Committee, amended the bill 
to require the Secretary of Health and Human Services to set premiums 
that are actuarially sound for a 75-year window, and maintain 
sustainable enrollment and benefit structure. While some have suggested 
that the CLASS Act is fiscally not sound, the Gregg amendment should 
put those concerns to rest.
  Long-term care reform has been a cornerstone of my work in public 
office since my days in the Wisconsin State Senate. I have seen how 
important it is to give people options so that they can match the level 
of care and assistance to their personal needs. Pushing anyone and 
everyone into Medicaid, or into a nursing home, is a waste of 
potential, a waste of opportunity, and a waste of money. Medicaid and 
our Nation's nursing homes have a critical role to play for some 
Americans. But for many Americans, it is simply not the right fit. The 
CLASS Act will ensure that taxpayer dollars are spent enrolling only 
those who truly need Medicaid into the program, and help others save 
for a time when they might need some assistance to remain independent. 
The CLASS Act is a critical part of this health reform bill, and I urge 
my colleagues to oppose any effort to weaken or strike this program 
from the bill.
  I yield the floor.
  Mr. DODD. Mr. President, the Senator from Rhode Island wants to be 
heard.
  The PRESIDING OFFICER. The Senator from Rhode Island is recognized.
  Mr. WHITEHOUSE. Mr. President, I will speak for just a moment because 
I know the Senator from Pennsylvania wishes to speak. When he comes to 
the floor, I will quickly yield to him. While there is a moment in 
between, I want

[[Page S12387]]

to speak to some of the arguments we have heard.
  There is always the question of the substance of an argument. There 
is also the question of the credibility of an argument. I think as 
people watch this debate and discuss the credibility of the concern 
expressed by our friends on the other side of the aisle about the 
deficit impact of the CLASS Act, it is worth considering a few facts 
just to evaluate that.
  First is that the CLASS Act is required to be actuarially self-
sustaining. People pay into it and, from those funds, under the 
insurance principle, funds come back out. It is required to be self-
sustaining that way.
  Second, it is voluntary. Nobody has to contribute. If you want to 
contribute, then you can become eligible for the benefit once you have 
vested. But nobody is forced into this; it is entirely voluntary. The 
CBO, on which we rely in a nonpartisan fashion, has said this is 
solvent for 75 years.
  Finally, because we think--at least on this side--this matters. It 
will help the disabled and elderly at that critical point of decision, 
when their ability to stay home, their ability to stay independent, or 
their ability to stay at work depends on just a little bit of help to 
accommodate their age or disability, it is then that this will make a 
difference. What a difference it will make in human lives.
  I know the Senator from Connecticut wishes to use an example. I will 
yield to him on his signal. We have seen this before. We saw this not 
long ago on the public option, which would compete with insurers head 
to head on a fair and level playing field. It was completely voluntary, 
and it had to be actuarially self-sustaining. It had to meet the 
solvency laws of the State in which it operated. In both cases, our 
colleagues on the other side have rushed to the floor to talk about 
deficits and how these will contribute to the deficit.
  These are both actuarially self-sustaining programs required to stay 
solvent. Yet here they come to raise the specter of deficits. But this 
is the same party that pays for 14-percent subsidies to private 
insurers to compete with Medicare. As my son would say, duh, if you are 
getting 14 percent extra, it is pretty easy to compete.
  When they asked for that deal, they promised they would drive costs 
down. In fact, they have driven costs up, and they put it in their 
pockets. It is not fair to the insurers that are not in the program. It 
is greedy on their part. All we want to do is hold them to their 
promises.
  Do we hear any concerns about the deficit problem on the 14-percent 
subsidy for the Medicare Advantage Program? No, dead silence--guess 
what--because it helps the insurance industry.
  When the Part D program came in, our friends on the other side forced 
through a provision--a unique provision--that gave the pharmaceutical 
industry a special privilege that the U.S. Government could not 
negotiate with it over price--could not negotiate with it. Lord knows 
how much that has added to our deficit. But have they ever come to 
complain? No, because the beneficiary is the pharmaceutical industry. 
But when things help regular people, when things help competition in 
the insurance market, even where they are required to be actuarially 
self-sustaining and solvent, then suddenly they turn up. They can 
detect the threat of deficit in parts per billion when it helps 
somebody. But a patent, actual living, breathing, deficit-enhancing 
subsidy that is on the books right now, they don't care about if it 
helps the pharmaceutical industry or the insurance industry.
  As we have this discussion, that is a point worth bearing in mind 
because it is not just the substance of the amendment, it is the 
credibility of the argument that counts.
  I said I would yield to the distinguished Senator from Pennsylvania 
when he arrived, and he has arrived. Without further ado, I yield the 
floor.
  Mr. CASEY. Mr. President, I thank my colleague from Rhode Island, 
Senator Whitehouse, who has been among the more forthright and capable 
advocates of what we are talking about today, not only with regard to 
health care generally, but in particular what brings us to the floor at 
this moment, among several issues, but principally his work and the 
work over many years that Senator Kennedy did for the so-called CLASS 
Act, the Community Living Assistance Services and Supports Act.
  What is this all about? I wish to talk for a couple of minutes about 
how it works. I think sometimes we get lost in the discussion about the 
finer points of a policy or program and we tend to forget what it 
means. Here is what it means. Here is what it means for an American who 
is working and wants to continue working to support his or her family 
or to support themselves, contribute to our economy, demonstrate that 
people who happen to live with a disability of one kind or another can 
be so significant in our economy, can contribute so much with their 
ability and their brain power and their ability to contribute in a very 
positive way.
  We are talking about the dignity of work, whether the Senate is going 
to stand up and say: With this act, with this program for someone who 
happens to have a disability and wants to work and wants to voluntarily 
contribute premiums so they have some security, some peace of mind down 
the road if they should need this help, we are talking about the 
dignity of that work.
  This is a test of the Senate, whether we are going to stand up for 
people who have a disability and their opportunity to work. It is a 
very simple question. You either stand with them or you do not.
  It is also about one important word, I think--independence, whether 
we are going to say to someone who wants to work and has a disability, 
are they going to have the independence, the freedom to work and live 
the life they choose?
  Here is how it works. This is not complicated. This is not some 
mysterious program. Here is how it works. Here is how they qualify to 
get these benefits. They qualify to receive benefits when they do three 
things. First, they need help with certain activities of daily living. 
We all know what those are. There are so many people out there who can 
work and can contribute if we give them a little help, just a little 
bit of help that we are talking about today to do the basic things in 
life--to be able to wake up in the morning and, if you have a 
disability, maybe have someone help you get ready for work, whether 
that is getting in the shower, shaving, whatever you have to do to get 
ready for work in the morning--activities of daily living, things that 
people who do not have disabilities take for granted. That is the first 
thing you have to have is that need that we can all understand.
  Secondly, this person would have to pay premiums for at least 5 years 
before they could benefit from the program. I said ``premiums.'' I did 
not say a ``government subsidy.'' We are talking about premiums here, 
and this is a program that certainly has its origin in government, but 
this is not exactly similar to the Children's Health Insurance Program, 
for example, or Medicaid, where it is a government program that helps a 
particular person, a person who happens to have a disability or is a 
child. In this case, people are paying premiums, and they have to pay 
those premiums for 5 years.
  In addition to the need and paying premiums, the third requirement is 
they have to work at least 3 of those 5 years. We are talking about 
people who are employed, working people who happen to have a 
disability. This is a creative program to help them do that.
  Why do we get the opposition we do from across the aisle? I think it 
is pretty simple. We have a lot of folks across the aisle who want to 
kill this bill. So they are going to try to strike the CLASS Act, which 
is outrageous and insulting. They are going to try to strike whatever 
they can, if they can, to kill the bill. So this is a bill-killing 
exercise. This is not a debate about the finer points of the CLASS Act. 
This is a bill-killer exercise. It is very simple, and I think it will 
tell a lot about where people stand.
  Let me go into a couple more details. I know we are almost out of 
time. Here is what happens to that beneficiary--a person working, a 
person who has a need, and a person who has paid premiums. That 
beneficiary receives a lifetime cash benefit based on the degree of 
impairment, not just any old formula. We want to make sure the benefit 
corresponds to someone's impairment, their inability to do their job or 
live their life the way they hope

[[Page S12388]]

to. It is expected to average about $75 a day or more in the case of an 
individual. That is what we are talking about here.
  We are not talking about, in this case, a government entitlement 
program. Few people are as passionately supportive of the Children's 
Health Insurance Program or Medicaid as I am. I believe there are 
programs that are funded by the government, run by the government, that 
work very well. But in this case, we are not talking about that kind of 
a program. We are talking about a program that does not confer rights 
or an obligation on government funding, nor does it affect the receipt 
or eligibility for other benefits. The program stands on its own 
financial feet because people are paying premiums out of their own 
pocket for 5 years to save for that day when they have a need because 
they have some kind of disability. And it is solvent--solvent. It is a 
program that people sign up for voluntarily. It is a voluntary program.
  When you line up all of the reasons to support this program that 
Senator Dodd, as the chairman of our committee, the Health, Education, 
Labor, and Pensions Committee, this summer when we were debating this 
bill--he carried the ball for Senator Kennedy in the chairmanship of 
our committee and in our hearings and also for this program. I am 
grateful for his leadership and also grateful for Senator Harkin's 
leadership to support this voluntary program. I am also grateful that 
Senator Whitehouse has lent his voice and his expertise and his focus 
on getting this program as part of our health care reform bill.
  It makes a lot of sense. It is solvent, and it will help those who 
have a disability who want to work, who want to go to work every day 
and live a full life.
  Mr. President, I yield the floor.
  Mr. DODD. Mr. President, I yield whatever time we may have remaining 
to Senator Kirk of Massachusetts, who has done an incredible job in 
very difficult circumstances--replacing our beloved former colleague 
Ted Kennedy from Massachusetts. He has been a valuable contribution 
over these days he has been here. I know he wishes to say a few words 
as well.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  There is 3 minutes remaining.
  Mr. KIRK. Mr. President, I thank Senator Dodd and Senator Baucus for 
their tireless leadership on this entire health care bill.
  I wish to say a word about the CLASS Act. We have heard Senator Dodd 
and others say this is the core element of this health reform bill 
championed by Senator Edward Kennedy. I say if he were here today, he 
would say this is not about politics; this is about the content of the 
character of our Nation. He believed, as I do, and I know Senator Dodd 
does, this Nation is judged or should be judged on how we treat the 
infirm and the weakest among us. This CLASS Act, as was eloquently 
pointed out by Senator Casey of Pennsylvania, involves no taxpayer 
funds, is fiscally solvent, and does what everyone says we must do: 
provide independence, self-respect, and dignity to the infirm in our 
society.
  Second, it keeps the caregivers and the loved ones from carrying that 
burden all by themselves and not having to sacrifice their jobs and 
their time and their heartache to share their children with perhaps one 
of their parents and dividing a family in that way.
  This is at the heart of what our country should be about. It is not 
who wins--the Republicans or the Democrats. It is not a government 
program. It is self-funded. It is voluntary. There is no taxpayer money 
involved. So what other reason could there be but politics to keep 
people from coming together on this issue?
  I urge my colleagues--all on this side and my Republican colleagues 
on the other side--to think about those families who are facing this 
plight. They are Republicans, they are Independents, and they are 
Democratic families as well. This is an American program for some 
veterans and others who have sacrificed.
  I think the only thing we can do, the only right thing we can do, if 
this is going to be a reflection of the character of this Nation, is to 
support the CLASS Act.
  I thank Senator Dodd once again. I am proud to be standing at the 
desk of Senator Edward Kennedy who believed deeply in this issue, who 
started a long time ago and wanted to see it fulfilled this afternoon.
  I yield the floor.
  The PRESIDING OFFICER. The time of the majority has expired.
  Mr. DODD. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. DODD. 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. DODD. Mr. President, I am about to, on behalf of the majority 
leader, propound a unanimous consent request.
  Mr. President, I ask unanimous consent that at 3:30 p.m. today, the 
Senate proceed to vote in relation to the following amendments and 
motion to commit, as listed in this agreement, with no other 
amendments, motions to commit, or any other motion except a motion to 
reconsider and table upon the conclusion of any vote, being in order 
during the pendency of this agreement; further, that prior to the 
second and succeeding votes, there be 2 minutes of debate, with all 
time equally divided and controlled in the usual form; that any 
amendment or motion covered under this agreement be subject to an 
affirmative 60-vote threshold, and that if any achieve that threshold, 
then it be agreed to and the motion to reconsider be considered made 
and laid upon the table; that if it does not achieve that 60-vote 
threshold, then it be withdrawn; that after the first vote in this 
sequence, the succeeding votes be 10 minutes in duration:
  A Senator Whitehouse amendment re: Social Security fiscal 
responsibility; the Republican leader's designee amendment re: fiscal 
responsibility; Senator Stabenow's side-by-side amendment re: Medicare 
Advantage; and Senator Hatch's motion to commit re: Medicare Advantage.
  Further, that once this agreement is entered, the Republican leader's 
designee be recognized to call up the fiscal responsibility amendment; 
and that once it has been reported by number, Senator Stabenow be 
recognized to call up the Medicare Advantage side-by-side amendment; 
that upon disposition of the amendments and the motion in this 
agreement, the next two matters for consideration will be a Senator 
Lincoln amendment regarding insurance executive compensation, and 
Republican leader's designee motion to commit regarding home health 
agencies; that for the remainder of today's session, no further 
amendments or motions to commit be in order, with the time until then 
being equally divided between the leaders or their designees, with 
Members permitted to speak up to 10 minutes each.
  The PRESIDING OFFICER. Is there objection?
  Mr. McCONNELL. Mr. President, reserving the right to object, and I 
will not be objecting, I see the assistant majority leader on the 
Senate floor. I think it would be helpful, as soon as the majority 
leader or someone on that side can do so, to indicate at what point 
during the day tomorrow and at what point during the day on Sunday we 
might be having additional votes. It might be helpful to our colleagues 
on both sides of the aisle in terms of planning for the weekend.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Mr. President, I would say through the Chair to my 
distinguished colleague, the senior Senator from Kentucky, that we are 
going to come in at 10 in the morning. At this time, it appears Senator 
Lincoln will be offering an amendment, and I would hope we can be ready 
at that time to have whatever the minority wants to do in regard to 
that amendment. Then we are going to have an amendment offered by the 
Republicans. I would hope that we can dispose of those two amendments 
tomorrow, maybe in the early afternoon--maybe 2:30 or 3 o'clock start 
voting on them.
  Mr. McCONNELL. So am I correct in assuming that the votes are most 
likely going to be in the afternoon tomorrow, or both morning and 
afternoon?
  Mr. REID. In the afternoon. I think we will need some debate in the 
morning.

[[Page S12389]]

  Then Sunday morning, at the request of the Republican leader, we are 
not going to come in until noon, or thereabouts.
  Mr. McCONNELL. I think we are going to need some debate time. Oh, we 
will have that in the afternoon.
  Then on Sunday, obviously, we would not go in until noon on Sunday, 
and the votes will be----
  Mr. REID. There is an event in Washington that a number of Senators 
are obligated to go to that is in the evening, so we will get everybody 
out of here by 6, 6:30 that night, at the latest.
  I would also say, Mr. President, through the Chair to my friend, that 
we Democrats are going to have a caucus--tentatively scheduled to have 
one Sunday afternoon.
  The PRESIDING OFFICER. Is there objection to the request?
  Hearing no objection, it is so ordered.
  The Senator from South Dakota.


                Amendment No. 2901 to Amendment No. 2786

  Mr. THUNE. Mr. President, I would like to call up amendment No. 2901 
and ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The bill clerk read as follows:

       The Senator from South Dakota [Mr. Thune] proposes an 
     amendment numbered 2901 to amendment No. 2786.

  The amendment is as follows:

     (Purpose: To eliminate new entitlement programs and limit the 
     government control over the health care of American families)

       Beginning on page 1925, strike line 15 and all that follows 
     through line 15 on page 1979.

  Mr. THUNE. Mr. President, I want to speak to the amendment that we 
just filed at the desk. This amendment is very straightforward and very 
simple. It does what a number of my colleagues on the other side have 
asked to do, and that is to strike the CLASS Act from the underlying 
health care reform bill that is being debated on the floor of the 
Senate right now.
  I want to read some excerpts from a letter that seven Democratic 
Senators, including the chairman of the Senate Budget Committee, 
Senator Conrad, put together asking that this CLASS Act not be included 
as part of this legislation.
  Mr. President, I ask unanimous consent to have printed in the Record 
the letter from which I will be quoting.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                  U.S. Senate,

                                  Washington DC, October 23, 2009.
     Hon. Harry Reid,
     Majority Leader, The Capitol, Washington, DC.
       Dear Leader Reid: We write regarding the merger of the 
     Finance and HELP Committee health reform bills. We know you 
     face a great many difficult decisions now, one of which is 
     whether to include provisions from the HELP Committee bill 
     known as the CLASS Act in the merged bill.
       We urge you not to include these provisions in the Senate's 
     merged bill, nor to use the savings as an offset for other 
     health items in the merger.
       While the goals of the CLASS Act are laudable--finding a 
     way to provide long term care insurance to individuals--the 
     effect of including this legislation in the merged Senate 
     bill would not be fiscally responsible for several reasons.
       CBO currently estimates the CLASS Act would reduce the 
     deficit by $73 billion over ten years. But nearly all the 
     savings result from the fact that the initial payout of 
     benefits wouldn't begin until 2016 even though the program 
     begins collecting premiums in 2011. It is also clear that the 
     legislation increases the deficit in decades following the 
     first ten years. CBO has confirmed that the legislation 
     stand-alone would face a long-term deficit point of order in 
     the Senate.
       Some have argued that the program is actuarially sound. But 
     this is the case because premiums are collected and placed in 
     a trust fund, which begins earning interest, and because the 
     HHS Secretary is instructed to increase premiums to maintain 
     actuarial solvency. We have grave concerns that the real 
     effect of the provisions would be to create a new federal 
     entitlement program with large, long-term spending increases 
     that far exceed revenues. This is especially the case if 
     savings from the first decade of the program are spent on 
     other health reform priorities.
       Slowing the growth of health care costs should be a top 
     priority as we move forward with health reform. Inclusion of 
     the CLASS Act would reduce the amount of long-term cost 
     savings that would otherwise occur in the merged bill. The 
     CLASS Act bends the health care cost curve in the wrong 
     direction and should not be used to help pay for other health 
     provisions that will become more expensive over time and 
     increase deficits.
       Thank you for your consideration. We hope that fiscally 
     responsible measures to improve access to long-term care can 
     be considered in the future.
           Sincerely,
     Kent Conrad.
     Joe Lieberman.
     Mary L. Landrieu.
     Evan Bayh.
     Blanche L. Lincoln.
     E. Benjamin Nelson.
     Mark R. Warner.
       U.S. Senators.

  Mr. THUNE. Mr. President, the letter said:

       We urge you not to include these provisions in the Senate's 
     merged bill, nor to use the savings as an offset for other 
     health items in the merger. While the goals of the CLASS Act 
     are laudable--finding a way to provide long term care 
     insurance to individuals--the effect of including this 
     legislation in the merged Senate bill would not be fiscally 
     responsible for several reasons.

  The letter goes on to say:

       [N]early all the savings result from the fact that the 
     initial payout of benefits wouldn't begin until 2016 even 
     though the program begins collecting premiums in 2011. It is 
     also clear that the legislation increases the deficit in 
     decades following the first 10 years.

  They go on to say in this letter, Mr. President:

       We have grave concerns that the real effect of the 
     provisions would be to create a new Federal entitlement 
     program with large, long-term spending increases that far 
     exceed revenues. This is especially the case if savings from 
     the first decade of the program are spent on other health 
     reform priorities.

  That, Mr. President, is a letter that was signed by the chairman of 
the Senate Budget Committee, Senator Conrad of North Dakota, Senator 
Lieberman, Senator Landrieu, Senator Lincoln, Senator Warner, Senator 
Nelson, and Senator Bayh. Seven Democratic Senators have gone on the 
record saying the CLASS Act shouldn't be included in this legislation 
because it is not fiscally responsible.
  The fact is, the chairman of the Senate Budget Committee, Senator 
Conrad, has described this as a Ponzi scheme of the first order--
something that Bernie Madoff would be proud of.
  Now, I have heard my colleagues get up and talk about how solvent 
this is and what a great program this is. Well, there are programs out 
there that are available for people to buy long-term care insurance. 
The problem with this one is that it takes all the money that comes in 
in the early years and spends it on other government programs--in this 
case health care reform--but who knows what other government programs 
are going to be created that will use the revenues that come in from 
this plan that supposedly a lot of people are going to sign up for, and 
CBO says it is going to be fewer than 4 percent that will sign up.
  In fact, no senior today is going to benefit from it because you have 
to work for 5 years. If you are a senior who is retired, you will not 
see any benefit. This doesn't impact seniors, contrary to the assertion 
of some of my colleagues on the other side. It will impact future 
generations of Americans who are going to be stuck with the deficits 
and the debt that gets piled on them because of the outyears when this 
liability is incurred as people start getting paid out, from having 
paid in, and there is no money there. It is the classic definition of a 
Ponzi scheme: The money comes in today, it gets spent on other things, 
and then someday, when the liability comes in and people start saying: 
I paid into this program, and I should get some benefit, there will be 
no money there. So we will borrow for it or tax for it or something 
else.
  They say, well, it is actuarially solvent over 75 years. Well, maybe, 
because you are running surpluses in the early years. But in the later 
years, you are running huge deficits. In the early years the surpluses 
are being spent. They are not being put into paying benefits for this 
program, when those benefits start being demanded by the people who 
have participated in the program.
  Just look at what others have said about this program, Mr. President. 
I have quoted for you what the chairman of the Budget Committee, 
Senator Conrad, said with regard to this program; that it is a Ponzi 
scheme of the first order, and that is being echoed by others. But this 
is what the administration's chief health actuary said about the CLASS 
Act. He said it would result ``in a net Federal cost in the longer 
term.'' The chief actuary also determined the program faces ``a 
significant risk of failure'' because the high cost will attract sicker 
people and lead to low participation.

[[Page S12390]]

  The Congressional Budget Office agreed, saying:

       The CLASS program included in the bill would generate net 
     receipts for the program in the initial years when total 
     premiums would exceed total benefit payments, but it would 
     eventually lead to net outlays when benefits exceed premiums. 
     . . . In the decade following 2029, the CLASS program would 
     begin to increase budget deficits.

  This particular quote could come as a bit of a surprise because this 
comes not from the CBO or the CMS actuary, but it comes from the 
Washington Post. The Washington Post called the CLASS Act a ``gimmick'' 
``designed to pretend that health care is fully paid for.'' The Post 
goes on to say:

       [T]he money that flows in during the 10 year budget window 
     will flow back out again. These are not ``savings'' that can 
     honestly be counted on the balance sheet of reform.

  Even the Washington Post recognizes this for what it is. It is a 
sham. This is a budget gimmick, Mr. President, that is designed to 
obscure the cost of this program by generating surpluses in the early 
years. It is supposed to generate $72 billion in the first 10-year 
window, so that counts on the balance sheet of health care reform to 
make it look better. But this program is going to run deficits--
deficits as far the eye can see--once the chickens come home to roost. 
Who will pay the bill for that? Future generations of Americans.
  Mr. President, this is not good policy. Certainly, if you look at 
programs we already have on the books, Medicare is destined to be 
bankrupt in the year 2017. We have big problems down the road--unfunded 
liabilities in Social Security. This would create a huge new liability 
down the road that would be unfunded because all the money that comes 
in during the early years is going to be spent. This is more of the 
same old business as usual in Washington, DC, that the American people 
are fed up with. We can make people happy today by saying we are 
creating this new program that makes the majority's health care reform 
bill look better because it obscures the real cost of this bill by 
rolling in these revenues in the early years. But there is a long-term 
impact, according to the CBO, according to the actuary at Health and 
Human Services, and according to a lot of our colleagues on the other 
side--the seven Democrats who signed the letter, including the chairman 
of the Budget Committee, who, as I said, has called this program a 
Ponzi scheme of the first order; something that would make Bernie 
Madoff proud.
  I don't know how my colleagues on the other side, with a straight 
face, can come to the Senate floor and say this is a great program, 
that it is actuarially sound. Sure, it may be a benefit to a few 
people, but I have to tell you, somewhere down the road, when the 
chickens come home to roost, there is going to be a huge liability that 
is going to be facing future taxpayers, future generations of 
Americans, as we start to pile up more deficits and more debt as a 
result of this Ponzi scheme.
  This is a sham, Mr. President. I hope my colleagues will support this 
amendment. It would strike the CLASS Act from the underlying bill, not 
allow those revenues to be assumed in paying for or understating the 
cost of this bill, and not pile mountains of debt onto future 
generations.
  Mr. President, I reserve the remainder of my time.
  Mr. KYL. Mr. President, the Community Living Assistance and Services 
and Supports Act, known as the CLASS act, is a new, government-run, 
government-funded program for longterm care, intended to compete with 
long-term care plans provided by private insurers.
  One of the oft-repeated arguments we have heard in favor of the CLASS 
act is that it would reduce budget deficits between 2010-2019.
  First, when has a government program ever reduced budget deficits?
  Second, the Congressional Budget Office tells us that this program 
will actually add to future Federal budget deficits. The CBO writes: 
``The program would add to future federal budget deficits in large and 
growing fashion.''
  Why would it do this?
  The program offers returns that payments made into the system cannot 
cover--just like a Ponzi scheme, as Senator Conrad said. Participants 
would have to pay into the system for five years before they start 
collecting benefits. Under the Senate proposal, only active workers 
could enroll in the program. So this would not be a program that would 
not benefit seniors or the currently disabled. So, if a worker began 
making payments in 2011, he or she could not collect benefits until 
2016. So, for a time, the program would generate surplus receipts for 
the government while Americans are paying in and not collecting 
benefits. But eventually, we will reach a point when payments made into 
this program cannot sustain promised benefits.
  As the CBO tells us, the program would ``lead to net outlays when 
benefits exceed premiums.'' (By the third decade of program operation--
2030-2039--CBO assumes that CLASS begins to generate net increases in 
Federal outlays. The net increase in Federal outlays is estimated to be 
``on the order of tens of billions of dollars for each (succeeding) 
ten-year period.''
  CBO notes that the increase in net Federal outlays which will begin 
to occur after 2029 results despite the requirement that premiums be 
set to ensure the program's solvency over 75 years. The solvency 
requirement counts interest income paid to the program's trust fund as 
available to pay future benefits. However, CBO notes that those 
interest payments are an intra-governmental transfer within the Federal 
budget. Thus, CBO notes that from a budget scorekeeping perspective, 
the CLASS program would inevitably add to future deficits (on a cash 
basis) by more than it reduces deficits in the near term, even though 
the premiums would be set to ensure solvency of the program.
  The administration's chief health actuary said the CLASS Act would 
result in ``a net federal cost in the longer term.''
  Bottom line, this program is not sustainable outside the 10-year 
window.
  That is why the Washington Post called it, ``a gimmick . . . designed 
to pretend that healthcare is fully paid for.''
  The Post goes on:

       Money that flows in during the 10-year budget window will 
     flow back out again. These are not `savings' that can 
     honestly be counted on the balance sheet of reform.

  Mr. DODD. Mr. President, how much time remains?
  The PRESIDING OFFICER. There is 19 minutes remaining; on the 
Republican side, 10\1/2\.
  Mr. DODD. Mr. President, I see my colleague from Minnesota. Does he 
wish to be heard? How much time does my colleague need?
  Mr. FRANKEN. I thank the Senator. I need 3 minutes.
  Mr. DODD. Take 4.
  Mr. FRANKEN. I will use it.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. FRANKEN. Mr. President, I rise today to ask unanimous consent to 
be added as a cosponsor to the amendment of Senator Coburn, amendment 
No. 2789, to require all Members of Congress to enroll in the public 
option. I am pleased to cosponsor this amendment because I strongly 
support the public option and I will have no qualms at all enrolling in 
this plan.
  There is a lot of misinformation about the public option, so I want 
to be clear about why we need a public option and why I would be proud 
to enroll in a public health insurance plan.
  We need a public option because health insurance premiums for 
Minnesota residents have risen 90 percent since 2000 and because 
444,000 Minnesotans went without health insurance in 2008. We need a 
public option because, while millions of Americans struggle to pay for 
health care, insurance executives continue to make bloated, obscene 
salaries. From 2000 to 2007, American families saw their premiums 
almost double. During that same time, we saw more than 6 million more 
Americans become uninsured. During that same period, insurance 
companies' profits rose 428 percent--428 percent in 8 years. They are 
making outrageous profits by gouging American families. That is why we 
need a public option.
  The public option will offer affordable premiums and a comprehensive 
benefits package for Americans struggling with their health care costs. 
It is going to provide the kind of coverage Americans need to be 
healthy. The public option will foster competition among private health 
insurance companies and lower long-term costs for Minnesotans and for 
families all across the country. There is no cost for the public option 
to the Treasury. In fact, CBO estimates it saves $3 billion. It is a 
win-win situation.

[[Page S12391]]

  It is important to remember that a public option doesn't mean private 
health insurance goes away. In fact, after health reform, 188 million 
Americans will have coverage through a private insurer. Only 2 percent 
of the overall insured population is projected to enroll in the public 
option. This is just another option you will have. It is an option 
because that is what the bill is about.
  Mr. BROWN. Will the Senator from Minnesota yield?
  Mr. FRANKEN. Absolutely.
  Mr. BROWN. I know my colleague joined with Senator Dodd, Senator 
Mikulski, and me to push this amendment that Members of the House and 
Senate actually go on the public option, partly to show we believe in 
it. It is a little curious that two of the sponsors, at least, Senator 
Coburn and Senator Vitter and some others, are so much against the 
public option that they want to pass this amendment. It sounds to me as 
if the Senator is serious about going on it, as I am, correct?
  Mr. FRANKEN. I talked to my wife Franni. We have been married 34 
years now. I talked to her a couple of weeks ago. I said if this 
passes, we should do the public option. She said, absolutely. Yes, I am 
perfectly serious about this.
  The PRESIDING OFFICER (Mr. Reed). The Senator from Minnesota has 
consumed 4 minutes allotted by the Senator from Connecticut.
  Who yields time?
  Mr. GRASSLEY. I yield 5 minutes to the Senator from Utah, Mr. Hatch.
  The PRESIDING OFFICER. Without objection, the request of the Senator 
from Minnesota to be added as a cosponsor of the Coburn amendment is 
ordered.
  The Senator from Utah is recognized.
  Mr. HATCH. Mr. President, we are talking right now about a program 
that was well thought out, that was meant to help the poor and 
minorities. It was a bipartisan effort by Democrats and Republicans, 
and has worked amazingly well and is available to all recipients of 
Medicare.
  Medicare Advantage came about in a bipartisan way to solve real 
problems. We were not getting health care to rural America. We were not 
getting health care, in many respects, to some of the poorer, some of 
the minority folks in our country.
  I want to read a special letter here. Let me read this letter. I know 
it may have been read before, but I am going to read it again. It is 
dated September 30, 2003. ``Dear Medicare Conferees.'' I happened to be 
a member of that conference. I was one of those in there who led the 
fight for Medicare Advantage.

       We are writing to ask you, as a member of the Medicare 
     conference committee, to ensure the final Medicare bill 
     includes a meaningful increase in Medicare+Choice--

  That is the predecessor to Medicaid Advantage--

       funding in fiscal years 2004 and 2005. While the Senate 
     bill makes a modest step toward this goal, we hope the 
     stronger provisions in the House bill will be preserved in 
     conference.
       For nearly 5 million Medicare beneficiaries across America, 
     Medicare+Choice [the predecessor] is an essential program 
     that provides high quality, comprehensive, affordable health 
     coverage. These seniors and disabled Americans have 
     voluntarily chosen to receive their health coverage through 
     Medicare HMOs and other private plans because of their 
     excellent value. To preserve this important option for 
     seniors across the country, bipartisan legislation was 
     introduced in the Senate as S. 590, the ``Medicare+Choice 
     Equity and Access Act.''

  That became Medicare Advantage.

       Co-sponsored by Senators Schumer and Santorum, S. 590 
     sought to increase reimbursement rates and add new 
     reimbursement options for Medicare+Choice programs.

  It goes on to make a compelling case for what came from that 
conference as Medicare Advantage, and that was utterly pleasing to 
everybody who signed this letter.
  By the way, let me just mention the Democrats who signed this letter, 
who wanted Medicare Advantage: John Kerry, Arlen Specter, Dianne 
Feinstein, Joe Lieberman, Patty Murray, Charles Schumer, Frank 
Lautenberg, Hillary Rodham Clinton, Ron Wyden, Mark Dayton, Mary 
Landrieu, Maria Cantwell, and Christopher Dodd. Fourteen Democrats 
signed this letter, along with a number of bipartisan Republicans, who 
believed we really needed to include Medicare Advantage.
  Now, to take advantage, our colleagues on the other side want to do 
away with Medicare Advantage, except in 3 States that are, for the most 
part, Democratic States, leaving all the other 46 States high and dry.
  Let me just say that this letter is in response--it was a letter 
given to the Medicare modernization conference committee. This 
conference committee gave them everything they wanted for Medicare 
Advantage. This legislative grant of power gave the signatories the 
Medicare Advantage Program, which now 11 million senior citizens enjoy 
today.
  Now those on the left want to do away with this important program 
that benefits seniors and minorities in an amazing set of ways. I am 
against that effort. I hope our colleagues on the other side will 
realize what they are doing. It just is not right. Vision care and 
dental care and so many other approaches that really work for this 
program will be taken away from these people. They are going to have to 
spend $175 to $200 a month to get what they got for an average of about 
$54 a month. These are people who need our help.
  Let me change the subject for a minute because I understand my 
colleague from Oregon was discussing Medicare Advantage and talking 
about some Medicare Advantage companies living ``high off the hog'' and 
inferring that is a rationale for $120 billion in Medicare Advantage 
cuts. I have two responses to my colleague from Oregon. This is not 
about Medicare Advantage insurance companies, this is about preserving 
the choice of coverage for seniors.
  The PRESIDING OFFICER. The Senator from Utah has used 5 minutes.
  Mr. HATCH. I ask for another 2 minutes.
  Mr. DODD. How much time remains for both sides?
  The PRESIDING OFFICER. The Senator from Iowa controls 4 minutes 46 
seconds; the Senator from Connecticut, 4 minutes 42 seconds.
  Mr. DODD. The Senator has 4 minutes.
  Mr. HATCH. He also said that under the Reid bill, Medicare Advantage 
beneficiaries will be able to keep what they have. You know, he is 
right about some Medicare Advantage beneficiaries being able to keep 
what they have due to the Nelson grandfathering amendment passed by the 
Senate Finance Committee this fall. But those protections primarily 
apply to Medicare Advantage beneficiaries in Florida, Oregon, and New 
York--beneficiaries living in other parts of the country. Rural areas 
will not be protected.
  So let's be clear when we say Medicare Advantage beneficiaries' 
benefits will not be cut. These extra benefits include lower premiums, 
deductibles, and copayments, dental coverage, and hearing aids, to name 
only a few.
  Bottom line: Most Medicare Advantage beneficiaries may not keep what 
they have, contrary to the President's promise to them.
  The PRESIDING OFFICER. Who yields time?
  Mr. DODD. Mr. President, I yield 4 minutes to the Senator from 
Michigan.
  The PRESIDING OFFICER. The Senator from Michigan is recognized for 4 
minutes.


                Amendment No. 2899 to Amendment No. 2786

  Ms. STABENOW. Mr. President, I have an amendment that will be sent to 
the desk pursuant to the unanimous consent agreement. I now call up my 
amendment No. 2899.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Michigan [Ms. Stabenow] proposes an 
     amendment numbered 2899 to amendment No. 2786.

  Ms. STABENOW. I ask unanimous consent that the reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows.

 (Purpose: To ensure that there is no reduction or elimination of any 
benefits guaranteed by law to participants in Medicare Advantage plans)

       At the appropriate place, insert the following:

     SEC. __. NO CUTS IN GUARANTEED BENEFITS.

       Nothing in this Act shall result in the reduction or 
     elimination of any benefits guaranteed by law to participants 
     in Medicare Advantage plans.

  Ms. STABENOW. Mr. President, this is a very important amendment to

[[Page S12392]]

clarify, once again, that we are not cutting any Medicare benefits. We 
are not cutting any of the guaranteed Medicare benefits people receive 
right now. In fact, AARP, which has been saying this on its Web site 
for months, has released a letter now. It quotes this sentence:

       Most importantly, the legislation does not reduce any 
     guaranteed Medicare benefits.

  Not only AARP but the Association for the Protection of Medicare and 
Social Security, the Alliance for Retired Americans, and other seniors 
organizations all agree.
  What we are talking about is saving Medicare, cutting down on 
overpayments that have been in place. Right now, 80 to 85 percent of 
the seniors who get their benefits, their health care, through 
traditional Medicare are paying more in premiums, according to the 
Congressional Budget Office, than they otherwise would, because MedPAC 
estimates we are paying about $12 billion more for people in the 
private for-profit insurance system right now that is called Medicare 
Advantage. The majority of seniors are subsidizing high insurance 
company profits and overpayments. What we have done in this bill is 
take out the overpayments and, in fact, put in competition, competitive 
bidding. I thought that was something our colleagues on the other side 
of the aisle supported--competitive bidding for reimbursements so we 
are not continuing the overpayments in Medicare Advantage that are 
causing Medicare to go broke much sooner and causing the majority of 
seniors to subsidize high insurance company profits.
  What we are seeing on the effort, unfortunately, of my friends on the 
other side of the aisle is an effort to support huge subsidies instead 
of supporting competitive bidding that is in the bill.
  The reality is that the guaranteed benefits--inpatient care, doctor 
visits, lab tests, preventive screenings, skilled nursing facilities, 
hospice care, home health care, prescription drugs, ambulance services, 
durable medical equipment, emergency room care, kidney dialysis, 
outpatient mental health care, occupational and physical therapy, 
imaging such as x-ray, EKGs, organ transplants, and the ``Welcome to 
Medicare'' physical are all covered, as they have been, for all 
Medicare beneficiaries.
  What we are doing is taking overpayments to for-profit insurance 
companies and putting that back into increased benefits for every 
senior. That is cutting down on prescription drug costs by closing the 
doughnut hole and strengthening preventive care. And the most important 
piece of all: lengthening the solvency of the Medicare trust fund.
  I urge the adoption of my amendment at the appropriate time.
  The PRESIDING OFFICER. Who yields time?
  Mr. GRASSLEY. Mr. President, I yield 2 minutes to the Senator from 
Florida.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. LeMIEUX. Mr. President, I have been reviewing the amendment of 
the Senator from Michigan. This is very important to the people of 
Florida because it deals with Medicare Advantage. Medicare Advantage is 
a very important program. It is not just some extra frills. It is the 
idea that our folks in Florida can get eye care, dental care, hearing 
care, diabetic supplies, preventive medicine. Last week I went down to 
a Medicare Advantage clinic in Miami, the Leone Center. This is a place 
where seniors are getting holistic health care. The intention of this 
amendment is to guarantee the benefits in Medicare Advantage, but I am 
not sure it is phrased that way. I have been reading the bill. I have 
been reading Title XVIII of the Social Security Act. I cannot find the 
phrase ``guaranteed benefit.'' I ask unanimous consent that the 
``guaranteed by law'' phrase in this amendment offered by my colleague 
from Michigan be eliminated so that we would ensure that benefits of 
eye care, dental care, preventative care, diabetic supplies, all the 
other things that are provided in Medicare Advantage, are actually 
preserved. No one is objecting to lower costs. No one is objecting to a 
competitive situation where we have companies providing more services 
for less cost. We want to make sure the services are still there.
  I ask unanimous consent to have that phrase ``guaranteed by law'' be 
eliminated from the amendment.
  The PRESIDING OFFICER. Is there objection?
  Ms. STABENOW. Reserving the right to object, I ask that my colleague 
work with me. We will be happy to talk about how we might address what 
he is concerned about. Unfortunately, the reality is, the for-profit 
companies are objecting to competitive bidding. The language my 
colleague has suggested would include items that have been offered to 
the in people in for-profit plans such as gym memberships and other 
things that have been of great concern. Given that, I would have to 
object.
  The PRESIDING OFFICER. Objection is heard.
  The time of the Senator from Florida has expired.
  Mr. HARKIN. Mr. President, I yield 3 minutes to the Senator from 
Ohio.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. I have watched from my office on C-SPAN and been on this 
floor countless times in the last 3 or 4 days as my friends on the 
other side continue to do the bidding of the insurance companies. I 
hear them talk about Medicare Advantage, how great it is. I was in the 
House of Representatives 10 years ago when Medicare Advantage began, 
when the insurance companies said: We can save Medicare 5 percent on 
all its costs by bringing forward Medicare Advantage. Then when the 
Republicans took control of everything, that savings of 5 percent, the 
insurance companies decided, no, we can't save 5 percent anymore. We 
need a 13-percent bonus. The chickens have come home to roost for the 
insurance companies, for good and bad.
  I refer to a Dow Jones story entitled ``Humana 3rd Quarter Profits Up 
65%, See Strong Medicare Advantage Gains.''
  Let me excerpt from the first few paragraphs.

       Humana Inc.'s third-quarter earnings rose 65% amid improved 
     margins at its government (i.e. Medicare Advantage) segment. 
     The company gave an initial 2010 forecast in which the health 
     insurer projects ``substantial'' Medicare Advantage 
     membership growth, resulting in revenue of $32 billion to $34 
     billion--well above analysts' average estimate of $29.63 
     billion. Humana's forecast takes into account reductions in 
     Medicare Advantage over-payments.

  As the Senator from Rhode Island knows and the Presiding Officer and 
my colleagues who have been strong supporters of Medicare, when we see 
people who have opposed Medicare, opposed the creation of Medicare 40 
years ago, tried to privatize Medicare with Speaker Gingrich down the 
Hall in the House of Representatives a dozen years ago, now they are 
Medicare's biggest defenders? I don't think so. They have been the 
insurance industry's biggest defenders. That is what the debate the 
last 3 days was all about. What is important is we guarantee Medicare 
services, as we will. We quit subsidizing insurance companies, as we 
should. And then that $90 tax every Medicare beneficiary has to pay, 
that $90 that goes to insurance subsidies, will be taken away so 
Medicare fee-for-service, regular Medicare members, which is 81, 82, 83 
percent of Medicare beneficiaries, won't be paying that insurance 
company Republican tax they have had to pay ever since Medicare 
Advantage subsidies to insurance companies were increased.
  We need to get this bill moving. The stalling and delays should be 
over.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. HARKIN. Parliamentary inquiry: How much time remains?
  The PRESIDING OFFICER. The Senator from Iowa controls 6 minutes 45 
seconds, and the Senator from Iowa controls 2 minutes 24 seconds.
  Mr. GRASSLEY. I yield 1 minute to the Senator from Tennessee.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. CORKER. Mr. President, it was interesting to hear my friend from 
Ohio. I plan to support the Hatch amendment regarding Medicare 
Advantage, but it is not because I don't believe we need to do some 
things to cause Medicare to be more solvent. I do believe that Medicare 
Advantage does have some subsidies to insurance companies that are 
higher than they should be. The fact is, this bill is taking money from 
a program that is insolvent, Medicare, and using that to create an 
entitlement. I will support the Hatch amendment, even though I would 
love to work with my friends on the other side of the aisle to do those

[[Page S12393]]

things, to make Medicare more solvent, but I think what is so 
objectionable to all of us is to know that we have an insolvent 
Medicare Program that the trustees have said will be bankrupt in the 
year 2017, and my friends on the other side of the aisle are taking 
money from that program to leverage a new entitlement.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Who yields time?
  Mr. HARKIN. I yield 2 minutes to the Senator from Illinois.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. Mr. President, this is a basic choice. Will we continue 
to subsidize private health insurance companies that are overcharging 
the Medicare Program by 14 percent? Will we take that money out of 
Medicare to continue the subsidy for profitable private health 
insurance companies? It is that basic. I say to the Senator from 
Tennessee, the Congressional Budget Office tells us, yes, untouched, 
the Medicare program in 7 or 8 years faces insolvency. But this bill 
adds 5 years of solvency to Medicare right off the top--something he 
won't acknowledge but he should. Let me also add, if we are going to 
bring down the cost of Medicare so that recipients get quality care, we 
have to get rid of these outrageous subsidies to private health 
insurance companies, the Medicare Advantage Program. We also have to be 
honest about those providers overcharging Medicare. Why does it cost 
twice as much in Miami for the same service that is given to Medicare 
patients in Rochester, MN? It should not. Somebody is ripping off the 
system. If we can't ask those honest questions, then I am afraid we 
will not put Medicare on sound financial footing. We can do that. But 
we can't do that by saying: We have got to continue to subsidize 
private health insurance companies out of Medicare. That is the Hatch 
amendment. That is what we should vote against.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. HARKIN. How much time do I have remaining?
  The PRESIDING OFFICER. The Senator has 5 minutes.
  Mr. HARKIN. I yield 2 minutes to the Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, those of us who have been privileged 
to hear our friends on the other side debate the public option have 
seen a relentless insistence on the public option operating on a level 
playing field with the private insurance industry. I can't tell the 
number of times we have heard that. Indeed, even when we designed the 
public option so that it did operate on a level playing field with the 
private insurance industry, they still complained. But now we have a 
situation in which we have private industry operating at a 14-percent 
advantage and subsidy against Medicare. Suddenly, the other side's 
interest in a level playing field has evaporated. Suddenly their 
interest is in doing what is, once again--in the astonishing 
coincidence that characterizes debate--in the interest of the insurance 
industry.
  I have yet to see an argument made from the other side of the aisle 
that doesn't happen to coincide with the interests of the insurance 
industry. It could not be more stark on this point. If it is a public 
option, they want it to compete on a level playing field. And even then 
they are against it. If it is privately subsidized coverage, getting an 
advantage against the public system, then they are for it.
  I urge consistency and support of the effort to bring some discipline 
to Medicare Advantage, as the private insurance industry promised. We 
are doing no more than holding them to their word.
  The PRESIDING OFFICER. Who yields time?
  Mr. GRASSLEY. I yield the balance of my time to the Senator from 
Texas.
  Mrs. HUTCHISON. I yield 30 seconds to Senator McCain.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Mr. President, I understand the Senator from 
Pennsylvania, Mr. Casey, filed an amendment designed to spend $2.5 
billion to protect Medicare Advantage benefits for Pennsylvanians. What 
is going on? What is going on here? Why can't we protect every citizen? 
That is five States that are ``protected'' and spending extra billions 
of dollars. Let's have an amendment that every State is treated the 
same. Let's do that. I tell my colleagues, I intend to introduce an 
amendment that will do so. That will take away the special exceptions 
that are taken for special States to have special influence around 
here.
  Mrs. HUTCHISON. Mr. President, to put this in perspective, when I 
hear all of this debate, it is as though everything has to be more 
government, bigger government, government is better than the private 
sector. Medicare Advantage is an option. It is not a mandate. It is an 
option that allows seniors another choice to get eye care, hearing 
aids. Let's let seniors have this option. Let's not cut it away from 
them. We need more competition, not less.
  The PRESIDING OFFICER. The Senator's time has expired.
  Who yields time?
  Mr. HARKIN. How much time do I have remaining?
  The PRESIDING OFFICER. There is 2\1/2\ minutes.
  Mr. HARKIN. Mr. President, it was interesting to hear the last 
speaker say: Don't take away the option for seniors in Medicare 
Advantage. Yet they have an amendment to take away the option for 
people who buy insurance against having a disability so they can stay 
in their own homes and have support. It is voluntary. It is not 
mandatory. No one is forcing them to do anything, I say to my friend 
from Texas. Yet there is an amendment on that side to take away that 
voluntary program, the CLASS Act, so that people can voluntarily put 
money into it to protect themselves against a future disability. Let's 
kind of keep our arguments a little bit straight.
  A lot of people have talked about Medicare Advantage. I will not 
close the argument on that. I will close on the necessity of keeping 
the CLASS Act in this bill. I have spoken many times about that. It is 
not a partisan issue. It is like when we passed the Americans with 
Disabilities Act. It was not a partisan issue. This should not be a 
partisan issue too. We should not let politics get involved. Over 275 
groups representing people with disabilities of all ages, from AARP to 
Paralyzed Veterans of America to the Interfaith Coalition, support the 
CLASS Act. It was unanimously adopted by the HELP Committee, 
unanimously adopted by Republicans and Democrats. Senator Gregg offered 
an amendment to insist that it be actuarially sound over 75 years, and 
it is actuarially sound over 75 years.
  Secretary Sebelius said the administration supports it. President 
Obama supports it. There is broad-based support for the CLASS Act.
  Today we received some letters from people around the country. I 
don't have time to read them all but just a couple. Here is one from 
Arkansas:

       My wife has a journalism degree, cerebral palsy and brings 
     money to the state of Arkansas with her stay at home job with 
     occasional travel. If her health worsens she could still earn 
     money for the state under the CLASS Act working from home 
     with the assistance from an attendant, [rather than having to 
     go to a nursing home.]

  Here is Virginia:

       I don't currently need the services under the CLASS Act, 
     but having been born with a disability I've always been 
     acutely aware of the possibility of serious issues down the 
     road . . . it would be a good thing for me, a thirty-year-old 
     working person, [to be able to put some money away.]

  I beg my colleagues, for the sake of people with disabilities, let's 
not adopt the amendment of the Republicans to take away the CLASS Act. 
It was Senator Kennedy's premier goal.
  Mr. GRASSLEY. Mr. President, I take a back seat to no one on issues 
associated with improving the lives of seniors and the disabled.
  As ranking member on the Aging Committee, I oversaw critical hearings 
into deep and persistent problems in our Nation's nursing homes. I was 
the principal author of the Medicare Part D prescription drug bill 
which is currently providing our seniors and people with disabilities 
with affordable prescription medications.
  On the disability front, one of my proudest achievements is the 
enactment of legislation I sponsored along with the late Senator Ted 
Kennedy, the Family Opportunity Act, which extends Medicaid coverage to 
disabled children.
  In large part, through my efforts, the Money Follows the Person 
Rebalancing

[[Page S12394]]

Act, and the option for States to implement a home- and community-based 
services program were included in the Deficit Reduction Act of 2005.
  Along with Senator Kerry, I have introduced the Empowered At Home Act 
which, among other things, revises the income eligibility level for 
home- and community-based services for elderly and disabled 
individuals.
  If I thought that the CLASS Act would add to this list of 
improvements to the lives of seniors or the disabled, I would be first 
in line as a proud cosponsor of the CLASS Act.
  But the CLASS Act does not strengthen the safety net for seniors and 
the disabled.
  The CLASS Act compounds the long-term entitlement spending problems 
we already have by creating yet another new, unsustainable entitlement 
program.
  The CLASS Act is just simply not viable in its current form.
  It is almost certain to attract the people who are most likely to 
need it--this is known as adverse selection.
  That will cause premiums to increase and healthier people to drop out 
of the program.
  It is the classic ``insurance death spiral.''
  On November 13, the administration's own Chief Actuary confirmed 
this. The Chief Actuary issued a dire warning in a report on the CLASS 
Act in the House bill which is virtually identical to the Senate 
version.
  The Chief Actuary said:

       There is a significant risk the problem of adverse 
     selection would make the CLASS program unsustainable.

  The CLASS Act has been characterized by the Washington Post editorial 
page as a ``gimmick.''
  For the first 10 years, the CLASS Act saves money at the beginning 
because it collects premiums before benefits start getting paid out.
  But sometime afterwards, it starts to lose money.
  We all know what happens from there. It will become the taxpayers' 
responsibility to rescue the program as it fails.
  Look at the financial struggles of Social Security. Look at Medicare. 
Look at Medicaid.
  Now go home and look at your children and grandchildren.
  Voting to protect the premiums of a program that you know will fail 
is irresponsible.
  Creating the unsustainable CLASS Act is irresponsible.
  Adding the ticking timebomb of yet another unfunded liability to our 
children and grandchildren through the CLASS Act is irresponsible.
  The responsible vote is to strike the CLASS Act from the bill; I urge 
my colleagues to support this amendment.
  Mr. President, I ask unanimous consent to have printed in the Record 
two items. First is an article from Fortune magazine on the CLASS Act. 
Second is a letter signed by seven of my Democratic colleagues 
objecting to the CLASS Act.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                 [From Fortune Magazine, Sept. 3, 2009]

                  The Crazy Math of Health-Care Reform

                            (By Shawn Tully)

       Embedded in the health-care plan moving forward is a truly 
     gravity-defying new device: a costly entitlement program 
     portrayed as a way to save money. So how can you raise 
     billions with a program that can't even pay for itself? Only 
     by using the crazy math that governs in the world of health-
     care reform.
       The gimmick was hatched on July 15 when the Senate 
     Committee on Health, Education, Labor & Pensions approved a 
     federal insurance plan for long-term care called the 
     Community Living Assistance Services and Supports Act, or 
     CLASS Act.
       The plan, which would provide modest benefits to people who 
     can't perform such simple daily tasks as bathing or feeding 
     themselves, was one of Sen. Ted Kennedy's last crusades. It 
     quickly became a favorite among Democrats, who are now adding 
     the CLASS Act to the leading proposal in the House, H.R. 
     3200, passed by the Energy & Commerce Committee.
       While no one doubts the bill's humane intentions, its 
     ardent champions have another motive as well. A budget 
     gimmick allows them to claim that CLASS Act helps pay for 
     health-care reform.
       The Democrats are promising a ``deficit neutral'' plan, 
     which means that according to rules set by the Congressional 
     Budget Office, they need to find about $1 trillion in new 
     taxes and savings over the next ten years. Right how, the 
     House legislation stands around $250 billion short.
       The CLASS Act looks like a gift: It brings in $58 billion 
     in net tax revenues by 2019, lowering the deficit by an 
     equivalent amount because only minor costs will be booked 
     during that period. Under the CBO rules, the CLASS Act 
     technically covers one-quarter of the $250 billion shortfall 
     in funds needed to pay for health-care reform.
       The gimmick lies in looking only at the CBO's ten-year 
     budget window. The extra revenues are an illusion because of 
     the disaster lurking just beyond that horizon.
       In fact, none of the $58 billion is available to pay for 
     the House bill. The CLASS Act is so poorly designed that the 
     $58 billion reserve and all future premiums won't come close 
     to covering the generous benefits it's promising.
       Here's why the mechanics of the CLASS Act assure its 
     eventual collapse.
       Under the bill, all working Americans would have the option 
     of contributing a payroll tax averaging $65 a month for long-
     term care. The eventual benefit for most recipients would be 
     $75 a day or $27,000 a year.
       It could be used towards nursing-home expenses, but the 
     main goal is to allow infirm Americans to get the care they 
     need from aides or therapists in their own homes so they're 
     not forced into nursing homes.
       But the CLASS Act's premiums aren't remotely high enough to 
     cover a likely deluge of claims. ``It's a microcosm of many 
     of the weaknesses in the health-care reform bills,'' says 
     Steve Schoonveld of the American Academy of Actuaries (AAA), 
     which did an excellent analysis of the CLASS Act.
       The plan's main problem is that it encourages what's known 
     as ``adverse selection''--it will attract an extremely high 
     proportion of people who are sick and near retirement, and a 
     relatively small share of the young and healthy needed to 
     create a sound insurance plan.
       One big weakness is that the CLASS Act doesn't screen for 
     medical problems, or even require information about them. 
     Hence, workers or their spouses can sign up even if they're 
     already ill. By contrast, private plans require strict 
     testing.
       Participants in the CLASS program can also start collecting 
     benefits after just five years, a period the AAA deems far 
     too short. Workers and their spouses can also stop paying 
     premiums, then rejoin when they get sick with no penalty.
       As a result, the AAA expects that the plan will be swamped 
     by people who know they have medical problems when they sign 
     up, and demand benefits right after they've paid for five 
     years.
       The AAA says that the plan would become insolvent by 2021--
     just beyond the CBO's budget window--and would have to raise 
     its premiums to $180 a month to meet its costs, a 177% 
     increase.
       That would put the CLASS Act into a death spiral, since 
     virtually all younger and even moderately healthy 
     participants would drop out. It would become a program 
     exclusively for the old and sick, driving premiums still 
     higher.
       The most likely outcome is that we'll never get to the $180 
     premiums needed to fund the plan. Congress will be forced to 
     pay enormous subsidies to keep the premiums low enough to 
     encourage young and healthy people to sign up. Pressure will 
     also be intense to raise the benefits to pay for more 
     nursing-home expenses.
       Instead of funding the shortfall in the House bill, the 
     CLASS Act will create a giant budget shortfall of its own. 
     Unfortunately, gimmickry like this is the kind of thing that 
     has fanned public fears about health-care reform doing more 
     harm than good.
                                  ____



                                                  U.S. Senate,

                                 Washington, DC, October 23, 2009.
     Hon. Harry Reid,
     Majority Leader, The Capitol,
     Washington, DC.
       Dear Leader Reid: We write regarding the merger of the 
     Finance and HELP Committee health reform bills. We know you 
     face a great many difficult decisions now, one of which is 
     whether to include provisions from the HELP Committee bill 
     known as the CLASS Act in the merged bill.
       We urge you not to include these provisions in the Senate's 
     merged bill, nor to use the savings as an offset for other 
     health items in the merger.
       While the goals of the CLASS Act are laudable--finding a 
     way to provide long term care insurance to individuals--the 
     effect of including this legislation in the merged Senate 
     bill would not be fiscally responsible for several reasons.
       CBO currently estimates the CLASS Act would reduce the 
     deficit by $73 billion over ten years. But nearly all the 
     savings result from the fact that the initial payout of 
     benefits wouldn't begin until 2016 even though the program 
     begins collecting premiums in 2011. It is also clear that the 
     legislation increases the deficit in decades following the 
     first ten years. CBO has confirmed that the legislation 
     stand-alone would face a long-term deficit point of order in 
     the Senate.
       Some have argued that the program is actuarially sound. But 
     this is the case because premiums are collected and placed in 
     a trust fund, which begins earning interest, and because the 
     HHS Secretary is instructed to increase premiums to maintain 
     actuarial solvency. We have grave concerns that the real 
     effect of the provisions would be to create a new federal 
     entitlement program with large, long-term spending increases 
     that far exceed revenues. This is especially the case if 
     savings from the first decade of the program are spent on 
     other health reform priorities.

[[Page S12395]]

       Slowing the growth of health care costs should be a top 
     priority as we move forward with health reform. Inclusion of 
     the CLASS Act would reduce the amount of long-term cost 
     savings that would otherwise occur in the merged bill. The 
     CLASS Act bends the health care cost curve in the wrong 
     direction and should not be used to help pay for other health 
     provisions that will become more expensive over time and 
     increase deficits.
       Thank you for your consideration. We hope that fiscally 
     responsible measures to improve access to long-term care can 
     be considered in the future.
           Sincerely,
     Kent Conrad.
     Joe Lieberman.
     Mary Landrieu.
     Evan Bayh.
     Blanche L. Lincoln.
     E. Benjamin Nelson.
     Mark R. Warner.
       U.S. Senators

  The PRESIDING OFFICER. The Senator's time has expired.
  All time has expired.
  Under the previous order, the question is on agreeing to amendment 
No. 2870, offered by the Senator from Rhode Island, Mr. Whitehouse.
  Mr. HARKIN. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Kentucky (Mr. Bunning).
  Further, if present and voting, the Senator from Kentucky (Mr. 
Bunning) would have voted ``yea.''
  The PRESIDING OFFICER. Are there are any other Senators in the 
Chamber desiring to vote?
  The result was announced--yeas 98, nays 0, as follows:

                      [Rollcall Vote No. 359 Leg.]

                                YEAS--98

     Akaka
     Alexander
     Barrasso
     Baucus
     Bayh
     Begich
     Bennet
     Bennett
     Bingaman
     Bond
     Boxer
     Brown
     Brownback
     Burr
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Coburn
     Cochran
     Collins
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Dodd
     Dorgan
     Durbin
     Ensign
     Enzi
     Feingold
     Feinstein
     Franken
     Gillibrand
     Graham
     Grassley
     Gregg
     Hagan
     Harkin
     Hatch
     Hutchison
     Inhofe
     Inouye
     Isakson
     Johanns
     Johnson
     Kaufman
     Kerry
     Kirk
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     LeMieux
     Levin
     Lieberman
     Lincoln
     Lugar
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (NE)
     Nelson (FL)
     Pryor
     Reed
     Reid
     Risch
     Roberts
     Rockefeller
     Sanders
     Schumer
     Sessions
     Shaheen
     Shelby
     Snowe
     Specter
     Stabenow
     Tester
     Thune
     Udall (CO)
     Udall (NM)
     Vitter
     Voinovich
     Warner
     Webb
     Whitehouse
     Wicker
     Wyden

                             NOT VOTING--2

     Bunning
     Byrd
       
  The PRESIDING OFFICER. On this vote the yeas are 98, the nays are 0. 
Under the previous order requiring 60 votes for the adoption of this 
amendment, the amendment is agreed to.
  Mrs. HUTCHISON. Mr. President, parliamentary inquiry: Are the next 3 
votes 10-minute votes?
  The PRESIDING OFFICER. The Senator from Texas is correct. The next 3 
votes are 10-minute votes.
  Mrs. HUTCHISON. Thank you, Mr. President.
  Mr. LAUTENBERG. Mr. President, I move to reconsider the vote.
  Mr. INOUYE. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                           Amendment No. 2901

  The PRESIDING OFFICER. Under the previous order, there is 2 minutes 
equally divided.
  Who yields time?
  The Senator from Connecticut is recognized.
  Mr. DODD. Mr. President, I urge my colleagues to support the CLASS 
Act and vote against the Thune amendment that would strike the CLASS 
Act from the bill.
  As you have heard, I hope, this afternoon, this bill is totally 
voluntary. There are no requirements by employers or employees to be 
involved. This is a very creative idea using individuals' money to 
contribute to their own long-term financial security if they are faced 
with disabilities.
  We have now, with the adoption of the Whitehouse amendment, secured 
that these funds can never be used for any other purpose than for the 
CLASS Act. That was the concern most of our colleagues had, if these 
funds would drift off. As a result of the Gregg amendment in our 
committee, it has now been determined that these programs will be 
actuarially sound for 75 years. We have fixed the problem CBO raised 
with it.
  It is a very creative and solid program that can make a huge 
difference for millions of Americans to avoid going to Medicare, 
divesting themselves of their assets, and allowing them to lead 
independent lives with dignity. It is deserving of our support. I urge 
the approval of this program.
  The PRESIDING OFFICER. Who yields time?
  The Senator from South Dakota is recognized.
  Mr. THUNE. Mr. President, the CLASS Act is the same old Washington, 
same old smoke and mirrors, same old games. I wish to read what the 
Congressional Budget Office and the chief actuary for the 
administration have said:

       The program would add to future Federal budget deficits in 
     large and growing fashion.

  If we don't take this out of this legislation, if we allow this to 
become law, we are locking in future generations to deficits and debt 
as far as the eye can see. This is, as has been described by the other 
side, a Ponzi scheme of the highest order. We need to take it out of 
this bill.
  I urge my colleagues to adopt this amendment.
  The PRESIDING OFFICER. Under the previous order, the question is on 
agreeing to amendment No. 2901 offered by the Senator from South 
Dakota, Mr. Thune.
  Mr. THUNE. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. The yeas and nays have been requested. Is 
there a sufficient second? There appears to be.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Kentucky (Mr. Bunning).
  Further, if present and voting, the Senator from Kentucky (Mr. 
Bunning) would have voted ``yea.''
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 51, nays 47, as follows:

                      [Rollcall Vote No. 360 Leg.]

                                YEAS--51

     Alexander
     Barrasso
     Baucus
     Bayh
     Bennett
     Bond
     Brownback
     Burr
     Carper
     Chambliss
     Coburn
     Cochran
     Collins
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Landrieu
     LeMieux
     Lieberman
     Lincoln
     Lugar
     McCain
     McCaskill
     McConnell
     Murkowski
     Nelson (NE)
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Udall (CO)
     Vitter
     Voinovich
     Warner
     Webb
     Wicker

                                NAYS--47

     Akaka
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Cantwell
     Cardin
     Casey
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Franken
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Kirk
     Klobuchar
     Kohl
     Lautenberg
     Leahy
     Levin
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Specter
     Stabenow
     Tester
     Udall (NM)
     Whitehouse
     Wyden

                             NOT VOTING--2

     Bunning
     Byrd
  The PRESIDING OFFICER. On this vote, the yeas are 51, the nays are 
47. Under the previous order requiring 60 votes for the adoption of 
amendment No. 2901, the amendment is withdrawn.
  Mr. DODD. Mr. President, I move to reconsider the vote and I move to 
lay that motion on the table.
  The motion to lay on the table was agreed to.

[[Page S12396]]

                           Amendment No. 2899

  The PRESIDING OFFICER. There will now be 2 minutes of debate, equally 
divided, on the Stabenow amendment.
  Who yields time?
  The Senator from Michigan is recognized.
  Ms. STABENOW. Mr. President, this amendment is very clear. My 
amendment states that nothing in this act shall result in the reduction 
or elimination of any benefits guaranteed by law to participants in 
Medicare Advantage plans.
  Right now, CBO tells us, and we understand from MedPAC that there is 
$12 billion in overpayments to for-profit insurance companies, which 
are additional costs that the Medicare recipients pay beyond what is 
traditional Medicare.
  Eighty-five percent of our seniors in Medicare are in traditional 
Medicare and, right now, we are told that every single senior citizen 
or person with disability in Medicare pays $90 extra; every couple pays 
$90 extra to pay for the overpayments to private for-profit insurance 
companies.
  As AARP has said, this legislation does not reduce any guaranteed 
Medicare benefits. We are asking for competitive bidding--for-profit 
company competitive bidding--to bring down the overpayments. I ask for 
support for the amendment.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. LeMIEUX. Mr. President, regarding this amendment, I had a 
conversation with my colleague from Michigan. The phrasing ``guaranteed 
by law'' doesn't guarantee anything. This isn't going to protect the 
benefits of Medicare Advantage. The benefits our senior citizens enjoy, 
such as eye care, hearing care, and dental care, are not protected by 
this. You can vote for it if you want to. It sounds good, but it is 
gift wrapping on an empty box.
  The PRESIDING OFFICER. Under the previous order, the question is on 
agreeing to amendment No. 2899, offered by the Senator from Michigan, 
Ms. Stabenow.
  Ms. STABENOW. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Kentucky (Mr. Bunning).
  Further, if present and voting, the Senator from Kentucky (Mr. 
Bunning) would have voted ``yea.''
  The PRESIDING OFFICER. Are there are any other Senators in the 
Chamber desiring to vote?
  The result was announced--yeas 97, nays 1, as follows:

                      [Rollcall Vote No. 361 Leg.]

                                YEAS--97

     Akaka
     Alexander
     Barrasso
     Baucus
     Bayh
     Begich
     Bennet
     Bennett
     Bingaman
     Bond
     Boxer
     Brown
     Brownback
     Burr
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Cochran
     Collins
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Dodd
     Dorgan
     Durbin
     Ensign
     Enzi
     Feingold
     Feinstein
     Franken
     Gillibrand
     Graham
     Grassley
     Gregg
     Hagan
     Harkin
     Hatch
     Hutchison
     Inhofe
     Inouye
     Isakson
     Johanns
     Johnson
     Kaufman
     Kerry
     Kirk
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     LeMieux
     Levin
     Lieberman
     Lincoln
     Lugar
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (NE)
     Nelson (FL)
     Pryor
     Reed
     Reid
     Risch
     Roberts
     Rockefeller
     Sanders
     Schumer
     Sessions
     Shaheen
     Shelby
     Snowe
     Specter
     Stabenow
     Tester
     Thune
     Udall (CO)
     Udall (NM)
     Vitter
     Voinovich
     Warner
     Webb
     Whitehouse
     Wicker
     Wyden

                                NAYS--1

       
     Coburn
       

                             NOT VOTING--2

     Bunning
     Byrd
       
  The PRESIDING OFFICER. On this vote, the yeas are 97; the nays are 1. 
Under the previous order requiring 60 votes for the adoption of this 
amendment, the amendment is agreed to.
  Mrs. MURRAY. Mr. President, I move to reconsider the vote.
  Mr. BROWN. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                            Motion to Commit

  The PRESIDING OFFICER. Under the previous order, there is 2 minutes 
equally divided prior to a vote in relation to the motion to commit 
offered by the Senator from Utah, Mr. Hatch.
  Who yields time?
  Mr. BAUCUS. Mr. President, the pending motion would strike the 
savings the bill achieves from Medicare Advantage.
  Why are we seeking savings from Medicare Advantage? Because MedPAC 
tells us that the government pays the private insurance companies that 
provide Medicare Advantage 14 percent more than we pay traditional 
Medicare; because these extra subsidies to Medicare Advantage cost the 
four-fifths of seniors in traditional Medicare $90 more a year in 
premiums even though they get no benefits from Medicare Advantage; 
because MedPAC says that ``the additional Medicare Advantage payments 
hasten the insolvency of the Medicare Part A trust fund by 18 months; 
because the private insurance companies that provide Medicare Advantage 
are making three-quarters of their profits from these government 
overpayments, and they can find some of the savings there; because 
private insurance companies that provide Medicare Advantage are paying 
their CEOs $24 million, $9 million, and $8 million a year, and they 
could find some of the savings there; and because nothing we do in our 
bill reduces benefits under Medicare.
  Therefore, I urge my colleagues to oppose the motion.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, I urge my colleagues to support my motion 
to commit.
  Simply put, this motion protects Medicare beneficiaries participating 
in the Medicare Advantage Program by eliminating the $120 billion in 
cuts to the Medicare Advantage Program in the Reid bill.
  Let me make this point as clearly as I can. A vote against my 
amendment is a vote for slashing benefits for 11 million seniors and 
low-income Americans, including vision benefits, dental benefits, home 
care for chronic illness, wellness programs, disease management 
programs, limits on cost sharing for primary care physician visits, 
reduced premiums for Part B, reduced premiums for Part D, reduced cost 
sharing for breast and prostrate cancer screening.
  When we did this, 14 Democrats, many of whom are sitting here in the 
Senate right now, supported this development of Medicare Advantage.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. HATCH. Have no doubt, when you vote against my amendment, you 
will be voting to cut these lifesaving and life-enhancing benefits. The 
choice is yours and the choice is clear. Our Nation's seniors are 
watching.
  The PRESIDING OFFICER. The question is on agreeing to the motion.
  Mr. BOND. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Kentucky (Mr. Bunning).
  Further, if present and voting, the Senator from Kentucky (Mr. 
Bunning) would have voted ``yea.''
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 41, nays 57, as follows:

                      [Rollcall Vote No. 362 Leg.]

                                YEAS--41

     Alexander
     Barrasso
     Bennett
     Bond
     Brownback
     Burr
     Chambliss
     Coburn
     Cochran
     Collins
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     LeMieux
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Risch
     Roberts

[[Page S12397]]


     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Webb
     Wicker

                                NAYS--57

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Franken
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Kirk
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Whitehouse
     Wyden

                             NOT VOTING--2

     Bunning
     Byrd
       
  The PRESIDING OFFICER. On this vote the yeas are 41, the nays are 57. 
Under the previous order requiring 60 votes for the adoption of this 
motion, the motion to commit by Mr. Hatch is withdrawn.
  Mr. BAUCUS. Mr. President, I move to reconsider the vote.
  Mr. UDALL of New Mexico. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, the Senator from Arkansas is to be 
recognized to offer an amendment.


                Amendment No. 2905 to Amendment No. 2786

  Mrs. LINCOLN. Mr. President, I call up amendment No. 2905.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The legislative clerk read as follows:

       The Senator from Arkansas [Mrs. Lincoln], for herself, Mr. 
     Lautenberg, Mr. Menendez, Mr. Franken, Mrs. Boxer, and Mr. 
     Reed proposes an amendment numbered 2905 to amendment No. 
     2786.

  Mrs. LINCOLN. I ask unanimous consent the reading of the amendment be 
dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To modify the limit on excessive remuneration paid by certain 
 health insurance providers to set the limit at the same level as the 
             salary of the President of the United States)

       On page 2040, strike line 14 and insert the following:
       (b) Dollar Limit Not To Exceed Compensation of the 
     President.--
       (1) In general.--Paragraph (6) of section 162(m) of the 
     Internal Revenue Code of 1986, as added by subsection (a), is 
     amended by adding at the end the following new subparagraph:
       ``(I) Dollar limit not to exceed compensation of the 
     president.--In the case of a taxable year in which the 
     $500,000 amount in clauses (i) and (ii) of subparagraph (A) 
     exceeds the dollar amount of the compensation received by the 
     President under section 102 of title 3, United States Code, 
     for such taxable year, such clauses shall be applied by 
     substituting the dollar amount provided in such section 102 
     for such $500,000 amount.''.
       (2) Revenue increase to be transferred to medicare trust 
     fund.--Section 1817(a) of the Social Security Act (42 U.S.C. 
     1395i(a)) is amended--
       (A) by striking ``and'' at the end of paragraph (1),
       (B) by striking the period at the end of paragraph (2) and 
     inserting ``; and'', and
       (C) by inserting after paragraph (2) the following new 
     paragraph:
       ``(3) the revenues resulting from the application of 
     section 162(m)(6) of the Internal Revenue Code of 1986, as 
     determined by the Secretary of the Treasury or such 
     Secretary's delegate.''.
       (c) Effective Date.--The amendments made by

  Mrs. LINCOLN. I yield the floor.
  The PRESIDING OFFICER. The Senator from Nebraska is recognized.
  Mr. JOHANNS. I have a motion at the desk.
  The PRESIDING OFFICER. The clerk will report the motion.
  The legislative clerk read as follows:


                            Motion to Commit

       The Senator from Nebraska [Mr. Johanns] 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 home health agencies totaling 
     negative $42.1 billion.

  Mr. JOHANNS. Mr. President, I rise to speak in favor of the motion 
that was just read. One of the things that I think is so very important 
about a debate on the Senate floor is we begin to understand what this 
legislation does to real people. We have come to understand that $466 
billion in Medicare cuts that are shown over my left shoulder have real 
consequences to real people all across the United States. These cuts 
compromise care, they compromise access to services that real people 
need in their daily lives. Robbing these funds from Medicare to create 
a dramatic new entitlement program, in my judgment, is not sound policy 
and it is not sound government.
  That is especially true in this case when the impact on seniors' 
health care is so profound. These cuts will reduce the quality of care 
many Americans are receiving today and reduce the care these Americans 
deserve.
  I have to tell you, out of all these Medicare cuts, one of the 
largest head-scratching cuts is the one to home health. The Senate bill 
cuts $42.1 billion for home health care. Home health is about 3.7 
percent of the Medicare budget. It is an important program. Yet 9.1 
percent of the Medicare cuts in the Senate bill are taken out of home 
health.
  Medicare home health spends less today than it did over a decade ago, 
while serving a similar number of beneficiaries at less cost per 
patient. That is the kind of program we should celebrate. Yet this bill 
has them on the chopping block.
  Maybe there is some misunderstanding about what home health provides, 
so let me clear up the confusion. Home health care agencies care for 
patients of all ages. They provide a broad range of essential health 
care in support services, real security in the comfort of a patient's 
home. Nine thousand Medicare-approved home health agencies existed in 
2007. I am very pleased to report to you that 74 of those are in my 
home State of Nebraska. Nurses, therapists, home care aides, and others 
who serve elderly and disabled patients in their own homes drive nearly 
5 billion miles a year to provide these much needed services. They care 
for about 12 million real people annually, with 428 million visits, 
each one providing that personal touch of care.
  The services that are provided in this very essential program include 
rehabilitation therapies, telemedicine, wound care, pain management, 
and skilled nursing.
  Who is eligible to receive Medicare home health services? We can 
answer that question by going to CMS. According to CMS, to qualify for 
Medicare home health benefits, a Medicare beneficiary must meet one of 
the following requirements: They must be confined to home, they must be 
under a doctor's care, they must need skilled nursing on a periodic 
basis, and they must have a continuing need for occupational therapy. 
These are truly some of the most vulnerable Americans. Yet in order to 
finance this new entitlement, this bill takes money out of that much 
needed program, and it places the cuts on the backs of these Americans, 
our most vulnerable Americans. Yet these cuts risk leaving them without 
care.
  What kind of conditions do people who utilize home health agencies 
suffer from? I will turn to my own State to answer that question. In 
Nebraska, one of our agencies is in rural Cherry County. Cherry County 
is a very large county in western Nebraska--in fact, larger than some 
States. Who gets served in Cherry County? A gentleman with class III 
congestive heart failure. He is awaiting a heart transplant. A 
gentleman who lost a leg from complications from diabetes, they get 
home health care services. These folks are not striving to bilk the 
system. The payments that allow us to provide this much needed service 
to them are not excess payments. These are just average folks who are 
striving to do their best to recover from their condition and manage 
the best they can.
  Keeping these folks out of the emergency room or the nursing home is 
a benefit to everybody. I don't see how anybody could argue this 
doesn't save tax dollars. In fact, there are statistics that support 
that statement. According to the National Association of Home Health 
Care and Hospice, an average per-visit Medicare charge for home health 
is $132. Let me compare that charge of $132 to 1 day at a hospital. 
That would cost 43 times as much, literally--$5,765 per day.
  According to a study of Avalere Health:

       Early use of home health care services following a hospital 
     stay by patients with at least one chronic disease saved 
     Medicare $1.71 billion in the 2-year period of 2005 to 2006.


[[Page S12398]]


  Doesn't it seem like an enormous step backwards when we talk about 
reform, when really what we are doing is cutting a program that serves 
people so much in need and yet saves money in the Medicare Program? 
Home health agencies in Nebraska have been very successful in doing 
exactly what we want--keeping people at home and out of the hospitals 
and nursing homes. Of special interest are patients with congestive 
heart failure. One Nebraska woman turned to home health after facing a 
big stack of hospital bills for rehab. Since then, she has been able to 
remain at home safely at a fraction of the cost. This home health 
agency can see a person for 60 days at a cost of about $2,500. One 
hospital admission, by comparison, would cost Medicare conservatively 
$20,000 to treat a patient with chronic heart failure. Again, home 
health care costs a fraction of hospital care, about 10 times less.
  There are so many stories from patients who are alive today who love 
home health care. This bill threatens them. Somewhere in the next 
hours, I am going to send to every Member of the Senate, all of my 
colleagues, a State-by-State analysis of what these cuts will do in 
their States because they need to know the impact. This bill threatens 
to take that all away. You can't cut $42 billion and just describe it 
as excess payments. You can't cut 42 billion and say: That is just 
fixing those who are bilking the system. When you cut $42 billion out 
of a program like home health care, it has real consequences.
  Earlier this week, I did a video conference with Medicare providers 
in Nebraska. These Nebraska home health providers reported this 
legislation will cost them $120 million. What does that mean, $120 
million? It may not sound like much around here, where we talk about 
trillion-dollar programs, but $120 million to the people of Nebraska in 
home health care, 68 percent of home health agencies in Nebraska will 
be in the red by 2016, 68 percent. In rural areas, as high as 80 
percent will have negative margins. You lose those services in rural 
areas. They are lost. There is nothing that will step in for those 
people.
  Home health providers already have to watch their bottom line, and 
they are already making very hard, painful decisions. During this video 
conference, a nurse in rural Nebraska explained the reality to me this 
way:

       I can give you a human story that just happened yesterday 
     in our agency. We had a referral from a patient that lives 90 
     miles away. The drive time is three hours. To do the 
     administration takes 1\1/2\ to 2 hours. Then you come back to 
     the office and you do at least another hour of paperwork. It 
     would take one person's entire day to serve one patient. 
     Regretfully, we had to say no. We just could not see her. 
     There is no other agency close enough to help this woman.

  Can you imagine? We have a person who desperately needed these 
services, and we are debating whether we should cut $412 billion out of 
this program that will impact a State such as mine to the tune of $120 
million? These agencies and the services they provide absolutely are 
reliant on Medicare.
  According to the National Association of Home Care and Hospice:

       Medicare is the largest single payer of home health care 
     services.

  When we cut the payments in a program like this, we cut access to 
care. These access concerns are rooted in real life experiences. 
Between 1998 and 2000, Medicare home health spending fell from $14 
billion to $9.2 billion or negative 34 percent, as a result of 
congressional action between 1998 and 2000. Those actions triggered the 
closure of 40 percent of home health agencies and reduced access for 
1.5 million Medicare beneficiaries. Access becomes a real issue. If 
there is no home health agency, homebound patients end up with more 
expensive care at hospitals and nursing homes. That costs Medicare 
money. But, you see, we are also cutting hospitals and nursing homes in 
this bill.
  If there is no home health provider near an area, not only are 
Medicare beneficiaries hurt but all citizens who need care. Any 
analysis is going to come to the same conclusion.
  I will quote from one:

       Studies from MedPAC and the Government Accountability 
     Office also suggest that access is a growing problem for 
     patients who require intensive services. In June 2003, MedPAC 
     issued a report indicating that skilled nursing facilities 
     care is now substituting for home health care for some 
     patients, most likely at a much higher cost for Medicare.

  I don't think these are transformational reforms. These cuts are not 
transformational reform. They are just plain cuts, to start a new 
entitlement that will hurt real people, senior citizens who need our 
help. That is why I am offering this motion to recommit this 
legislation back to the Finance Committee to strike these ill-advised 
home health care cuts. I will follow up. I will make sure every Member 
sees the impact of these cuts in their State so they can make an 
assessment if these cuts should be put in place and cause the kind of 
damage I have described this evening.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. I yield Senator Klobuchar 10 minutes.
  Ms. KLOBUCHAR. I ask unanimous consent to speak for up to 12 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. KLOBUCHAR. Mr. President, I rise to speak about a true health 
care reform. The way I look at this in my State, it is a matter of 
affordability and cost. We have one of the highest percentages of 
people covered in the country in Minnesota. The issue is, it is 
becoming more and more expensive for the people to afford health care. 
I always try to remember three simple numbers of all the ones we will 
hear in the next few weeks. Those are the numbers 6, 12, and 24. Ten 
years ago it cost $6,000 for an average family to pay for health care a 
year. Now it is $12,000, with a lot of people paying a lot more. Ten 
years from now, if we don't do anything, it will be somewhere between 
$24,000 and $36,000 a year, something regular people just can't afford. 
It is not going in the right direction.
  If we don't act, costs will continue to skyrocket. The country spent 
$2.4 trillion on health care last year alone. That is $1 out of every 
$6 spent in the economy. By 2018, national health care spending is 
expected to reach $4.4 trillion, over 20 percent of our entire economy. 
Despite spending 1\1/2\ times more per person on health care than any 
other country, many of our people don't even have health care coverage. 
Many of them are losing their coverage because of preexisting 
conditions or because it simply is costing too much. These costs are 
breaking the backs of our families and businesses. We can see here, 
single coverage, 1999, $2,196. Now at 2008, the last figures we have 
available, $4,704, a doubling. Family cost, 1999, $5,791--that is the 
average family's premium--now they are paying $12,680.
  Look what is happening to small businesses. A study by the Council of 
Economic Advisers found that small businesses pay up to 18 percent more 
than large businesses to provide health care coverage. In a recent 
national survey, nearly three-quarters of small businesses that did not 
offer benefits cited high premiums as the reason.

  Look at it this way: Inflation usually raises the cost of most goods 
and services between 2 to 3 percent per year. Health care premium costs 
have been going up close to 8 percent a year. That is an increase 
Americans can't afford. Wages have not kept pace with the increase in 
premiums.
  Look at this. Between 1999 and 2007, the average American worker saw 
his wages increase 29 percent. Obviously, the last few years it has not 
been that rosy. How much did his insurance premiums go up? One hundred 
twenty percent during the same time period. In other words, the health 
care premiums are taking out a bigger and bigger chunk of the average 
worker's paycheck. These costs are breaking the backs of the American 
taxpayer.
  My colleague was talking about Medicare. The truth is, Medicare is 
projected to go into deficit by 2017, if we don't do anything about it.
  Recent Congressional Budget Office estimates show that the majority 
of the projected $344 billion increase in Federal revenues are 
scheduled to automatically go to cover rising health care costs. 
Medicare--something that people who are 55 want to get when they are 
65; people who are 65 want to keep until they live to the ripe old age 
of 95--if we don't do anything about it, is going in the red by 2017.
  How do we do this? How do we get to the place where we want to go? We

[[Page S12399]]

must get our money's worth from our health care dollars. The problem 
now is, we are paying too much and we are not getting a good return on 
what we pay. The solution must be to get the best value for our health 
care dollars; otherwise costs are going to continue to wreak havoc on 
the backs of government, businesses, and individual families.
  Medicare is 57 percent of all Federal health spending. If we want to 
sustain Medicare, which we all do, to provide that kind of high-quality 
health care our seniors deserve, we must do something to address the 
fiscal challenges.
  The root of the problem is that most health care is purchased on a 
fee-for-service basis, so more tests, more surgery means more money. 
Quantity, not quality pays. According to researchers at Dartmouth 
Medical School, nearly $700 billion per year is wasted on unnecessary 
or ineffective care.
  My favorite example is what Geisinger Clinic did in Pennsylvania. 
They were not happy with their diabetes treatment, so they decided we 
are going to have the routine patients see nurses. The more difficult 
cases will see doctors. Then those endocrinologists will review the 
records of the nurses and make sure this patient is progressing as we 
want. Guess what. Patient quality goes way up because they see nurses 
and they see them more regularly. Results go way up because 
endocrinologists are spending time on the most difficult cases and 
reviewing records of the other. Costs go down $200 per month per 
patient. Guess what. They get paid less--way, way, way less for that 
kind of good quality care.
  This system is messed up, and we need to change it so we are 
rewarding based on results. We put the patient in the driver's seat so 
that when that patient gets better results, then we reward with 
payments. In Minnesota, we have several great examples of this 
coordinated outcome system.
  At a place such as the Mayo Clinic, Park Nicollet, St. Mary's in 
Duluth, the priority is value not volume. As this chart shows, if the 
spending per patient with chronic diseases everywhere in the country 
mirrored the efficient level of spending in the Mayo Clinic's home 
region of Rochester, MN--this is Mayo Clinic quality health care.

  For the last 4 years of chronically ill patients' lives, if we used 
that same system all over the country, how much would we save, if we 
used this system in Texas, if we used this system in Florida? We would 
save $50 billion every 5 years for the taxpayers of this country and 
get higher quality care.
  This is not like a hotel right now in this country where if you pay 
more money, you get a better room with a better view. No. The opposite 
is true. In this country, the States where you pay more money, you get 
less quality care. That is what we need to change to bring all of the 
States up to that high-quality care, efficient care, that costs less 
but is a better value. That is what we need to do.
  How do we do it? Well, linking rewards to the outcomes for an entire 
payment area creates the incentive for physicians and hospitals to work 
together to improve quality and efficiency; using bundling, to bill, so 
you look at the whole outcome of everyone working together, so you rely 
on nurses when you want to rely on nurses, so you rely on doctors when 
you want to rely on doctors; by reducing hospital readmissions. Who 
wants to go back in the hospital over and over again just because there 
are a bunch of infections hanging around? In fact, right now, if you go 
back to the hospital, the hospital gets rewarded for that. So we want 
to put in place protocols that make hospitals safer places to treat 
patients. In 1 year, hospital readmissions cost Medicare $17.4 billion, 
and a 2007 report by MedPAC found that Medicare paid an average of 
$7,200 per readmission that was likely preventable. We need to have 
integrated care, where you have a primary care provider, working with a 
team, instead of having 15 specialists running around the field, 
running over each other. You need a quarterback, well, let's just say 
like Brett Favre and the Minnesota Vikings. You have one quarterback 
who is your primary care doctor, who is in charge, with a team of 
doctors who look at all the medical records. That is integrated care. 
That is what we should be rewarding. That is what this bill does.
  Looking at some of the other inefficiencies, the Presiding Officer 
has been a leader on Medicare fraud. Think about the money we can save. 
Medicare fraud alone costs taxpayers more than $60 billion every year. 
Instead of that money going to our seniors, do you know where that 
money is going? It is going to con men, people who are leeching off the 
system, people who are making up that they are providing services when 
they are not. The Presiding Officer and I have a bill we are working 
together on to bring that down so that money can actually go to our 
seniors instead of going out to a bunch of people who are ripping off 
the system, ripping off our seniors.
  If you look at how you save money, if you look at how you reduce 
costs in Medicare, well, you reduce costs in Medicare by making changes 
to this system and making this work. We must look to the future. That 
is why health care reform this year is so crucial. This bill is not 
about today or even next year; it is about 5 years from now, it is 
about 10 years from now, and beyond. We cannot afford for the people of 
this country to hold off any longer. We can bring these costs down. We 
can bring the quality up. And we can reward the people of this country 
for the money they are putting into health care.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. DeMINT. Mr. President, I appreciate the comments of the Senator 
from Minnesota, who brought out a lot of important issues as far as the 
rising costs of health insurance, and I certainly knew that as a small 
businessman. There is only one problem: The bill we are going to vote 
on does not solve those problems. In fact, as CBO basically tells us, 
insurance will continue to increase at the same rate it does now, and 
for those with individual insurance policies, it is very likely to go 
up.
  Mr. President, we are here on a Friday evening being told we are 
going to work through the weekend, maybe next weekend, all the way up 
to Christmas Eve, with the intent to rush through a bill that many have 
called--and I agree--one of the worst pieces of legislation and one of 
the biggest threats to health care we have ever seen here in this 
country. Apparently, the majority wants to rush this through and 
hopefully intimidate the minority into allowing it to go through by 
keeping us here on weekends over the holidays. But I am proud 
Republicans are standing together against this bill and standing with 
the American people to stop the Democratic government takeover of 
health care in America and to stop them from paying for it by cutting 
nearly $500 billion from Medicare and raising taxes on millions of 
Americans.
  I heard from one of our constituents, who was talking about Medicare 
and the cuts in Medicare, explaining very simply that Medicare is 
something he had paid for his entire 40 years of working out of his 
payroll taxes, and now he could not believe we were considering taking 
any money out of Medicare in order to pay for a new government program.
  Americans work and pay for Medicare so that when they retire they 
will have benefits that give them the coverage they need. I think the 
majority must think Americans are not paying attention or maybe even 
they are not real smart, that you can take $500 billion out of a 
program that is already bankrupt and expect the benefits to stay the 
same, when already we know we are not paying doctors enough to see our 
seniors and more and more physicians are not even willing to see 
Medicare patients.
  If there really is waste and fraud in Medicare--and we know there is 
some--we should find it and put that money back into the Medicare 
system so we can keep our promises to seniors.
  Every Democrat in the Senate has already voted for a government 
takeover of health care, to cut Medicare to pay for it, and to raise 
taxes. Some of them said they were just moving the debate forward. But 
I ask you, what debate? Will there be any serious consideration to take 
this government-run plan out of this bill? There will not be.
  We have already seen there is no serious consideration to stop taking 
money out of Medicare to pay for it. In fact, we have had a lot of 
debate about

[[Page S12400]]

what this is going to do: to cut from Medicare, what it is going to 
eventually do to benefits, cut Medicare Advantage. Now we are talking 
about cutting home health, which is so important, particularly in rural 
communities and for the more elderly constituents we serve.
  There is no way you could take this money out of Medicare without 
hurting the programs. Instead, as we look ahead at more people retiring 
than ever in history and Medicare being bankrupt, we need to be looking 
at ways that we can shore up this program so it will be there for 
generations to come.
  Every Republican voted no. Every Republican in this Senate has stood 
with the American people and said no to a health care bill that takes 
over the most personal and private part of our lives. I am proud of our 
party and our leadership.
  Americans have been asking to see the differences between the 
Republican and the Democratic Parties. I think now more than ever on 
this issue they are going to see the Democrats standing with 
government-controlled health care, cuts in Medicare, increased taxes 
and on the other side Republicans who are going to stay here through 
Christmas and New Year's or whatever it takes to stop this bill and to 
sit down and really reform this system in a way that will lower costs 
and improve care to all Americans.
  We need to continue to talk about these bigger issues, particularly 
how it affects Medicare, and we will be doing that over the weekend. 
But I think we owe it to the American people to begin to open this bill 
and explain what is in it. I can almost guarantee you, there is not one 
Member of the Senate who has read it yet. We are going to try to fit 
this in Santa's sleigh this year so it will be delivered to every 
American.
  I have the first part here--1,000 pages, small print, front and 
back--and have started going through it, putting tabs on different 
pages, so we can talk about the different things because sometimes they 
sound so extraordinary, people do not really believe they are in there. 
I am not sure we will ever get through the whole thing, but I just want 
to take a couple parts tonight and just start talking about what is 
really in this bill.

  On page 17, in section 2713 that is titled ``Coverage Of Preventive 
Health Services,'' which is really our jargon for rationing, it says:

       A group health plan and a health insurance issuer offering 
     group or individual health insurance coverage shall provide 
     coverage for . . .
       evidence-based items or services that have in effect a 
     rating of ``A'' or ``B'' in the current recommendations of 
     the United States Preventive Services Task Force.

  We heard from this task force a few weeks ago. This may sound 
harmless enough, as you look at it, but let's see what the really 
means: ``evidence-based . . . `A' or `B'.'' What is not A or B? Well, 
just 2 weeks ago, we found out something that was not A or B. 
Mammograms are a C rating. And the task force came out and said it 
should not be covered on anyone under 50 years old. That is in the 
bill, that it would not cover mammograms for folks under 50 years old 
because it is not A or B. Because of the outcry, we had an amendment 
from the other side to give themselves a little bit of cover on that 
one medical procedure, mammograms. We passed it with some fanfare 
yesterday. But the fact is, there are going to be many C ratings that 
are not covered.
  What are we going to do here in Congress over the next several years 
when we find constituents are not covered for things they need in 
retirement from Medicare? Are we going to pass bills to try to cover 
those individual things? What we should really do is throw out the bill 
that is causing the problem. We should not be rationing care to our 
seniors.
  Let's look at another page. And I know this is not as interesting as 
talking about theoretical stuff. But on page 33, section 2719 is called 
the ``Appeals Process'':

       A group health plan and a health insurance issuer offering 
     group or individual health insurance coverage shall implement 
     an effective appeals process . . .
       [to] provide notice to enrollees, in a culturally and 
     linguistically appropriate manner. . . .

  Now, what do we think that means? Well, in fact, in 2001--this term 
has been used before--the Department of Health and Human Services 
reported that the Department had spent $10 million to figure out what 
that phrase means. And we still do not know. It says: ``Health care 
services that are respectful of and responsive to cultural and 
linguistic needs.'' But what this really means to us, according to the 
2000 census, is there are at least 20 languages spoken by at least 
200,000 Americans in this country, and what we are putting out there is 
a liability for every insurance company that does not have every aspect 
of their plan in those 20 languages. It may sound like a simple thing, 
but every page of this bill, almost--as you read it, you realize it is 
increasing the complexity and the cost of the system here in America.
  I will just cover one more of these because I hear my colleagues in 
the background urging me to finish. But I do think we owe it to the 
American people to begin to talk about what is really in this bill.
  On page 39, it says, under a funding category:

       Out of all funds in the Treasury not otherwise 
     appropriated, there are appropriated to the Secretary 
     $250,000,000 to be available for expenditure for grants under 
     paragraph (1) and subparagraph (B).

  Those subparagraphs are to track the trends in premium increases of 
health insurance once this bill goes into effect. Mr. President, $250 
million to do what the Congressional Budget Office has already told us 
are going to be increases. But this kind of spending and this type of 
bureaucracy and complexity we are creating is not going to make health 
care more accessible and more affordable for Americans. It is creating 
a complex bureaucracy with tens of thousands of workers and bureaucrats 
to tell doctors what to do and hospitals what to do and for us, how to 
manage our health care.
  The Congressional Budget Office has already released a report finding 
that those purchasing insurance through the health insurance exchanges 
that are in this bill could pay up to 16 percent more for health care 
than we do today. Yet we are moving ahead with the bill.
  I will continue throughout this weekend, and every time I get a 
chance to speak, to talk about more of these things that are in this 
bill. But, folks, this is not a bill we should deliver to the American 
people for Christmas this year. This is a bill that we should throw out 
so we can start over and have a step-by-step approach to make health 
insurance more affordable and available to every American.
  With that, Mr. President, I yield back.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I think we are going to go back and forth 
here.
  Mr. ROBERTS. There is no ``forth.''
  Mr. BAUCUS. Sorry?
  Mr. ROBERTS. There is no ``forth,'' Mr. Chairman.
  Mr. BAUCUS. Well, we are going to go back and forth. Here is Senator 
Kaufman.
  Mr. ROBERTS. We could go back and back, sir--I do not care--and then 
forth and forth.
  Mr. BAUCUS. Back and forth, and forth and forth, and to and fro, and 
this and that it works fine for me.
  The PRESIDING OFFICER (Ms. Klobuchar). The Senator from Delaware is 
recognized.
  Mr. KAUFMAN. Madam President, I ask unanimous consent to speak in 
morning business for up to 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Kaufman are printed in Today's Record under 
``Morning Business.'')
  The PRESIDING OFFICER. The Senator from Kansas is recognized.
  Mr. ROBERTS. Madam President, I rise today in support of the motion 
of my good friend from Nebraska, my colleague from Nebraska, Senator 
Johanns to--the official words say: to commit the bill back to the 
Senate Finance Committee with instructions to strike the cuts to the 
Medicare home health care benefit.
  What the distinguished Senator is trying to do is bring some common 
sense to the cuts to a very vital source of health care, not only to 
rural areas but all over this country, and that is home health care. 
The bill we are considering, the bill sometimes called the

[[Page S12401]]

``behind closed doors'' bill, would cut home health care by $42 
billion.
  The Senator from Nebraska says that is a head-scratcher, and it 
certainly is. It is more than a head scratcher; it is a Lizzie Borden 
amputation in regard to a vital program.
  Home health care is critical for our seniors. Obviously, that is the 
truth. As the cochair of the Senate Rural Health Care Caucus, I 
certainly understand that. So does the Senator from Nebraska. He was 
saying yesterday how many times he visits his rural hospitals, rural 
clinics, rural hospices, and you do that a lot if you are from Nebraska 
or Iowa or Texas or Kansas.
  At any rate, in my home State of Kansas and other rural areas, many 
seniors live alone or out in the country miles away from a local 
hospital or a doctor's office. Even if they have a very good doctor, 
they can't get there because of their health condition. So home health 
care allows those seniors the freedom and the independence to stay in 
their home in the comfort of knowing somebody is there assisting their 
health care needs. More importantly, home health care is the cost-
effective care, as the Senator from Nebraska has pointed out, that 
keeps the senior out of a nursing home or hospital and--guess what--
saves the government money. Over the long term, if you cut home health 
care, you are going to increase the cost in regard to nursing homes, no 
question about it.
  In my State I have had the pleasure of being able to see firsthand, 
as has the Senator from Nebraska, the great work our Kansas Home Health 
Care Association members do every day. Last year I was invited into the 
home of a lovely couple in Concordia, KS, America, not too far from 
Nebraska, and despite having multiple health issues, Duane and Phyllis 
were able to stay in their home with their little dog Josie, all thanks 
to the services provided by a home health care aide and a home nurse.
  What is going to happen to seniors such as Duane and Phyllis if we 
slash $42 billion from home health care payments? Forty-two billion 
dollars is one of the largest Medicare cuts in the whole bill next to 
Medicare Advantage and the hospitals. The Senator from Nebraska had 
that chart showing serious cuts to all of our providers. Don't forget 
that this cut comes on the heels of several years of additional cuts to 
home health care--around $35 billion all told--that already have a 
large percentage of Kansas home health care agencies operating at very 
slim or negative Medicare margins. I know the same is true in Iowa, and 
the same is true in Texas, in Montana, in Nebraska, and all over the 
country.
  I keep hearing my colleagues, however, on the other side of the aisle 
insisting that their $\1/2\ trillion cut to all Medicare--here is the 
quote--``won't affect the benefits guaranteed to seniors.'' Please stop 
that. Please stop that. That is the most disingenuous smokescreen in 
this whole debate. It may be true that this bill does not explicitly 
cut benefits. My friends across the aisle, however, cannot deny that 
their cuts in reimbursements to providers will affect those benefits, 
because when you cut the reimbursements to providers, guess who pays 
the price. The patients--Duane and Phyllis and their little dog Josie. 
I tell you what. You come to their house and you make that argument 
that if you close down or make cuts to home health care, Duane is not 
going to like it, Phyllis is not going to like it, and Josie will bite 
you on your leg.
  As I said, many of my Kansas home health care agencies are already 
operating at negative margins. Their projected share of these cuts, as 
provided by the distinguished Senator from Nebraska, is almost $240 
million. To the Senator from Montana, the distinguished chairman of the 
Finance Committee, my dear friend, that is $60 million in Montana; and 
Nevada, where the distinguished majority leader lives, the chart that 
has been provided to me by the Senator, $263 million.
  We have Senator Cornyn sitting right behind me here. Senator Cornyn, 
you are in the $6.8 billion category for Texas. I might ask the 
Senator, What is going to happen if you get cut $6.8 billion in regard 
to home health care service?
  Mr. CORNYN. If the Senator will yield for a response, $6.8 billion 
would cut not just into the muscle but into the bone and deny a lot of 
elderly people, particularly in rural areas, access to care entirely.
  Mr. ROBERTS. I thank the Senator. The Senator from Nebraska has 
already pointed out what happens in Nebraska, and I know what will 
happen in Kansas. Nearly two-thirds of Kansas home health care agencies 
will have negative margins within only 5 years, probably 2 or 3, if 
these cuts are allowed to occur.
  How are these agencies supposed to stay in business with these kinds 
of cuts? The home health care benefit will be worthless to a Kansas 
Medicare patient whose home health care agencies will go out of 
business. So, yes, in fact, this bill will effectively cut benefits. 
Again, get rid of the smokescreen.
  This doesn't apply just to the home health care benefit. The same can 
be said for the effect of the cuts, as demonstrated by the Senator from 
Nebraska, for reimbursements to hospitals. This bill is going to cost 
the Kansas Hospital Association $1.5 billion. They have some outside 
experts who came in. I asked them: What is going to be the effect of 
the cuts? They already have cuts. They only get reimbursed 70 percent 
now, and $1.5 billion on top of that. We ought to have a chart--and I 
am sure we will have a chart--that would show Iowa or Nebraska or any 
State here, Texas especially, because of the number of folks there. So 
hospitals, hospices, skilled nursing facilities, and all of the rest.
  I want every senior to know that while maybe it is technically 
accurate, again, for my friends across the aisle to claim this bill 
doesn't cut Medicare benefits, there is no way--no way--you can slash 
$\1/2\ trillion from payments to providers without affecting their 
ability to keep their door open, especially in rural and small town 
America. Seniors should know they will be left with a worthless 
benefit. To paraphrase my friend Senator Alexander from Tennessee, it 
would be like having a bus ticket without a bus.
  Thank you, Senator Johanns. Thank you for the work you are doing. 
Thank you for this motion. I hope we are successful. I hope people will 
wake up and understand the severity of what these cuts will do. I urge 
every Member of this Senate to support Senator Johanns when we come to 
a vote on this issue.
  Thank you, Mr. President. I yield the floor.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Montana is 
recognized.
  Mr. BAUCUS. Mr. President, I have heard a lot here today about how 
this is going to hurt seniors and so on and so forth, words such as 
``smokescreen.'' The fact is there is no smokescreen here whatsoever. 
This is a very well thought out, considered policy that I think strikes 
a very good balance between getting care to especially seniors at home, 
which is so important on the one hand, and making sure there is not 
waste on the other hand. That is our responsibility here, to make sure 
the program works and works well.
  I have sort of a special interest in this. My mother was in the 
hospital. It happened about 2 weeks ago. She fortunately is doing much 
better. She is out of the hospital. She has spent some time with a home 
health caregiver with whom I was very, very impressed. This home health 
person is doing a great job with my mother. I have seen other instances 
too, but personally I was very happy to see my mother getting very good 
care from a home health care nurse.
  I think it is also important to remind my colleagues that this 
amendment is generally a retread on the McCain amendment we debated 
over the last few days. That is, once again, the opponents of this bill 
are endorsing the status quo that leaves Medicare on the brink of going 
bankrupt and seniors facing higher costs.
  Let me remind my colleagues again what will happen if we stick with 
the status quo. The status quo, meaning no bill, which the other side 
is advocating, means Medicare will go broke in 8 years. That is the 
status quo. In our legislation, that will be postponed for at least 5 
more years. The status quo, as in no bill, which the other side is 
advocating, means seniors will continue to pay higher and higher 
premiums and cost sharing due to wasteful overpayments to health care 
providers.
  There is so much waste in our system. We all know there is a lot of

[[Page S12402]]

waste. I am quite surprised not all of our colleagues want to cut out 
the waste. In effect, they want to keep the waste that, unfortunately, 
is in our system.
  The status quo also means each year billions of Medicare dollars will 
continue to be wasted on lining the pockets of private insurance 
companies. That might be a bit of a strong statement, but the fact is, 
some chief executives of private insurance companies are paid tens of 
millions of dollars to manage Medicare Programs, especially Medicare 
Advantage, and the status quo means that will continue.
  The status quo also means seniors will continue struggling to pay for 
prescription drugs. The stakes for seniors in the Medicare Program have 
never been higher.
  We have a choice. It is a very simple choice: either endorse the 
status quo or strengthen Medicare.
  Let's talk a little bit about home health care. Regarding Medicare 
changes for home health providers, let me describe what is in the 
Senate bill. I don't think our colleagues know specifically what is in 
the Senate bill. That may be a strong statement to make. But if they 
knew what was in the bill, I think some of the statements made tonight 
might be a little bit different.
  As most of my colleagues would agree, home health care is an 
extremely important benefit in the Medicare Program. We are all very 
strong advocates of home health care. Across the country, there are 
more than 9,800 home health agencies providing care to seniors in their 
homes. This helps seniors get better and helps them to avoid expensive 
rehospitalizations.
  We are all champions of home health care. We would like people not to 
be institutionalized. It is much more appropriate to have care in the 
home, and home health care agencies provide that.
  In Montana, home health care providers go the extra mile--literally--
to provide care to patients across vast distances. In some cases, in 
rural areas they have to drive 100 miles just to see one patient. They 
are dedicated people. They go great distances and travel a long way to 
see very few patients.
  Home health providers make a real difference in improving seniors' 
health, and we should support their efforts. We all very much support 
their efforts.
  While I have great respect for the services of home health providers, 
we also have a responsibility to protect the Medicare Program. 
Unfortunately, there is almost always waste somewhere. It is a matter 
of judgment as to how much is waste and how much is not.
  We must make sure Medicare is paying appropriately; that is, that 
Medicare is not overpaying for Medicare services. We must take action 
to root out fraud and abuse in the Medicare Program generally and where 
it may occur in the home health industry as well.
  I think the policies in the Senate bill achieve both goals. First, 
the Senate bill would ``rebase'' home health payments to ensure 
payments reflect actual costs of providing care. These changes are 
based on recommendations by MedPAC, which is the independent advisory 
commission that advises Congress on Medicare reimbursement. It is a 
nonpartisan group. MedPAC advises that we rebase. What do we mean by 
``rebase''?
  When the current home health payments were set, seniors received an 
average of 31 visits per episode. Today, they receive 22 visits; that 
is, they get paid about the same for doing less. We are trying to make 
sure the payment reflects the actual services provided. The Senate bill 
directs CMS to rebase payments to reflect this change. It is common 
sense. MedPAC recommended it and thinks it has to keep up with the 
times. Times have changed over the years, and the payment system should 
reflect that change.
  There is something else I think is pretty important, and most of my 
colleagues would agree, the Senate bill roots out fraud that, 
unfortunately, exists in home health care as well as in other areas of 
Medicare spending. It tries to root out the fraud in Medicare payments 
for outlier cases.
  Medicare provides an extra payment today for providers--home health 
folks--who treat sicker people, otherwise known as outlier patients--
really sick, outliers. Unfortunately, the GAO found that some providers 
were gaming the system and getting much more outlier payments than they 
deserve.
  For example, the GAO found that in one Florida county alone, home 
health providers were receiving 60 percent of all total outlier 
payments. That is nationwide. One county was getting 60 percent, even 
though they had less than 1 percent of the total Medicare population. I 
don't want to just single out Florida. Other counties in the southern 
part of the country clearly have a grossly disproportionate amount of 
high outlier payments.
  The Senate addresses this problem by placing a cap on the amount any 
individual provider can receive in outlier payments.
  Another change is the bill makes ``market basket'' changes in 2011 
and 2012. That was recommended by MedPAC. Why is that important? MedPAC 
is actually much tougher. They wanted to start in 2010. We said we will 
hold off a bit. We wanted to be fair to the home health providers. In 
addition, the bill establishes a productivity adjustment for home 
health providers beginning not right away, not next year or the 
following year but in 2015.
  These changes ask home health providers--like all other providers--to 
offer more efficient and higher quality care over time. We are being 
fair about it. Very importantly, in making these changes we worked 
closely with the home health industry to ensure these changes were 
reasonable and fair.
  What do we do with respect to the agencies to make sure we are fair? 
On the rebasing policy, MedPAC recommended that we fully implement 
these changes in 2011. To ensure that providers can adapt to the new 
payment rates, we in the Senate decided we would phase in these changes 
over 4 years. The home health providers support this phase in. They 
think it is a good idea.
  On the outlier policy and the fraud changes, these policies were 
actually suggested to us by--guess who--the home health industry. They 
came to us and suggested we make some changes in outliers because too 
many agencies are gaming the system. They asked us to make some outlier 
changes and stop that gaming, to make changes to stop the fraud. They 
came to us and gave us some ideas. Obviously, the home health industry 
fully supports the changes they recommended to us. They are in this 
bill.

  On the market basket and productivity changes, the Senate bill holds 
off on applying these reductions while the rebasing policy is taking 
effect.
  This bill gives home health agencies extra time--much more time than 
is recommended by the very aggressive proposed changes by MedPAC, the 
House bill, and the administration. We say those are too aggressive. We 
in the Senate decided to give agencies extra time to adapt to the 
payment changes in the bill rather than having all these implemented at 
the same time as MedPAC and the House and the administration all 
recommended.
  Finally, with respect to rural home health providers, we are all very 
sensitive to the special needs of rural America. What did we do about 
that? From 2010 to 2015, rural providers will receive a 3-percent extra 
payment each year. This payment will ensure that rural providers are 
protected as we reform the home health system.
  In total, the home health changes in the Senate bill, I believe, 
strike a fair balance between ensuring seniors have access to home 
care, while also rooting out inappropriate payments from the system.
  I hear some of my good friends say: Gee, these changes are going to 
hurt seniors. They are not going to hurt them. In fact, most of the 
changes are suggested by the home health care industry. I think all of 
us want to root out fraud and waste. Also, it is claimed that Medicare 
beneficiaries will be harmed by this bill. This is a scare tactic.
  Let me say what the American Association of Retired Persons says 
about these claims that these changes in Medicare reimbursement are 
going to harm seniors.
  AARP says:

       Opponents of the health reform won't rest. [They are] using 
     myths and misinformation to distort the truth and wrongly 
     suggesting that Medicare will be harmed. After a lifetime of 
     hard work, don't seniors deserve better?


[[Page S12403]]


  That is AARP. I don't suggest tonight that any of our colleagues are 
using myths and misinformation to distort the truth. The point is, AARP 
claims that is not true. They support the bill strongly.
  I will remind my colleagues of some of the positive changes in the 
legislation. This legislation improves the solvency of the Medicare 
Program by 5 years. It puts $30 billion back into the pockets of 
seniors in the form of lower Medicare premiums. It makes prescription 
drugs more affordable, which is an added benefit in this bill that 
would not be available if the legislation is not passed. The bill 
guarantees that seniors can continue to see a doctor of their choosing. 
The bill provides free wellness and prevention benefits. Those are new 
benefits. They don't currently exist. It will also include fair and 
appropriate changes for home health that protect access to care.
  I don't question the motives of my colleagues. They believe they are 
standing up for seniors in opposing the home health changes. But in 
truth they will harm them because they are hurting the Medicare 
Program. I don't think we want to hurt the Medicare Program. We are 
trying to help the Medicare Program by making these changes.
  There is one other point I want to make. This is kind of interesting. 
I thought when I saw it--if I still have it--it is kind of interesting. 
The growth rate in home health care spending will continue to be very 
high after this legislation passes. Currently, the growth rate of the 
home health care industry is almost 11 percent per year. After the 
legislation, it will be almost an 8-percent annual growth in the home 
health care industry. That is much faster than the national health 
expenditures.
  I think most things in life are a judgment call. I think one fairly 
decides that the changes in this bill are good for seniors and home 
health care providers because they are sensitive to the needs of the 
industry, sensitive to patients, frankly, but also responsible to the 
American taxpayers by making sure we are rooting out waste.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mr. CORNYN. Mr. President, I think as the American people are 
listening to the debate we are having on health care reform, they are 
being asked to accept some pretty implausible claims. One claim is that 
we can take $\1/2\ trillion out of Medicare and it would not have any 
impact on the delivery of services to Medicare beneficiaries--$\1/2\ 
trillion.
  I think the biggest mistake about the way this bill is paid for, with 
the huge tax increases and huge cuts in Medicare, is the proposal to 
take $\1/2\ trillion out of Medicare, including $40 billion out of home 
health care, in order to pay for a brandnew entitlement program, when 
we already know Medicare itself is on a fiscally unsustainable path.
  I want to talk primarily about another aspect of these cuts, and that 
is the 11 million seniors, including 532,000 Texans, who will lose 
benefits under their Medicare Advantage Program because these are not 
inconsequential cuts in their benefits. They are serious. I want to 
talk about some real human beings, some real Texans, who are going to 
be affected in a negative way by these cuts.
  First of all, I think it is absolutely critical for the American 
people to understand that Medicare itself does not provide complete 
coverage to seniors. That is why so many seniors end up buying 
supplemental insurance coverage--Medigap coverage, as it is sometimes 
called--in order to get their bills paid for. Medicare only pays, on 
average, about 80 percent to providers of what private health insurance 
does. That is the reason, without additional compensation, many doctors 
will not see a new Medicare patient. They simply cannot do it and keep 
their doors open to their other patients.
  The truth is, Medicare Advantage was created to fix some of the flaws 
with Medicare fee for service to give seniors more affordable and 
better coordinated health care. None of us are standing up saying the 
proposed bill is all bad because some of the positive developments in 
the bill call for greater coordination of health care.
  On balance, it makes things worse than it does better because of 
these cuts in things such as Medicare Advantage.
  The President of the United States has said providing Americans with 
a choice of quality, affordable health care was a guiding principle for 
him. I agree with that statement of principle. Medicare Advantage was 
created for that very purpose because, as I said, Medicare itself does 
not always work well for patients.
  Where I live in Austin, TX, which is Travis County, the last time I 
saw a report, only 17 percent of physicians will see a new Medicare 
patient because Medicare reimbursement rates are so low. Those problems 
are avoided in large part by Medicare Advantage because it pays 
physicians and providers better than Medicare fee for service.
  According to the American Medical Association's 2008 national health 
insurance report card, Medicare--not private health insurance--but 
Medicare had the highest percentage and the largest number of denied 
medical claims. In fact, Medicare denied 10 times more medical claims 
than private health insurers. That is another reason why seniors 
deserve a choice between Medicare and private plans that will offer 
them better benefits.
  As I mentioned, today, 11 million Americans made that choice of 
better benefits and better care coordination through the Medicare 
Advantage Program. The proposed bill, the Reid bill, will take away 
those choices and the benefits of those 11 million seniors by cutting 
about $120 billion from the program.
  Many of our friends across the aisle will say we can cut $120 billion 
out of Medicare Advantage, and it will have no impact on delivery of 
services. But the Director of the Congressional Budget Office disagrees 
with them, who says their additional benefits will be cut roughly in 
half.
  We need to set the record straight on these so-called overpayments 
allegedly going to insurance company profits. It is simply a false 
statement. It is not true. Our colleagues know the so-called 
overpayments to Medicare Advantage plans do not go into those plans. 
They go to seniors in the form of additional benefits. That is because, 
under Federal law, 75 percent of additional payments to Medicare 
Advantage plans are used to provide seniors with additional benefits--
benefits which they would not get under Medicare fee for service, 
benefits such as chronic care management, hearing aids, eyeglasses, and 
the like. The other 25 percent of any extra payments is returned to the 
Federal Government.
  Let's be clear. Cuts to Medicare Advantage would be taking away 
seniors' health care benefits for those 11 million seniors. As I 
mentioned, \1/2\ million Texans are on Medicare Advantage, and the Reid 
bill would cut their benefits by well over half. You do not have to 
take my word for it. Listen to what the CBO Director, Dr. Elmendorf, 
said when Senator Crapo asked him during a Finance Committee hearing. 
He said:

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

  Director Elmendorf:

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

  Nearly one out of every four seniors in Texas would lose about $122 a 
month in health care benefits to create a new $2.5 trillion entitlement 
that their grandchildren will ultimately have to end up paying for. And 
$122 a month may not sound like a lot for people inside the beltway, 
but a couple from my hometown of San Antonio recently wrote to me:

       Please vote to leave our Medicare Advantage plans alone. We 
     can't afford anything else as our portfolio was wiped out in 
     the stock market collapse last year. My wife and I have had 
     to go back to work, and we are in our seventies.

  Yet this bill would impose another $122-per-month cut in their 
benefits.
  Another constituent of mine from Conroe, TX, wrote:

       Please do what you can to protect the Medicare Advantage 
     plans. I'm on one and it has been beneficial to me. It has 
     saved me an enormous amount of money and given me the 
     benefits I've needed.

  Some groups that support these cuts to Medicare Advantage have a 
conflict of interest, to say the least, because the benefits under 
traditional fee for service, as I mentioned, for Medicare is about 80 
percent of what private insurance will pay. In order to get coverage, 
in order to pay the bills, many seniors have had to buy additional 
insurance

[[Page S12404]]

coverage. For 11 million seniors, Medicare Advantage provides those 
benefits.
  For many seniors, former employers sometimes provide wraparound 
plans. For retired military, TRICARE provides a wraparound plan. For 
many low-income seniors, Medicaid helps with cost sharing and premiums. 
For many other seniors, they purchase a standalone Medigap policy.
  We heard from our friends across the aisle about AARP's endorsement 
of the Medicare cuts in the Reid bill. If it sounds odd that a seniors' 
advocacy group would support taking nearly $\1/2\ trillion from an 
already near bankrupt program, it should.
  The fact is, as the Washington Post noted on October 27:

     . . . But not advertised in this lobbying campaign have been 
     [AARP's] substantial earnings from insurance royalty and the 
     potential benefits that could come its way from many of the 
     reform proposals . . . Democratic proposals to slash 
     reimbursements for another program, called Medicare 
     Advantage, are widely expected to drive up demand for private 
     Medigap policies, like the ones offered by AARP, according to 
     health care experts, legislative aides, and documents.

  So AARP, the so-called seniors' advocacy group, is advocating for a 
cut in benefits to 11 million beneficiaries of Medicare Advantage. The 
suggestion is one reason they would do so is because they will profit 
from this bill because these seniors will, if they can afford it, have 
to go out and buy Medigap coverage from, lo and behold, entities such 
as AARP.
  The fact is, Medicare Advantage allows private plans to innovate 
better and provides better coordinated care for seniors. Groups such as 
the Kelsey-Seybold Clinic in Houston, TX, which is basically not seeing 
Medicare fee-for-service patients but is seeing Medicare Advantage 
patients because they can afford to coordinate care, the kinds of 
things we know they ought to be doing to provide better care, but they 
cannot afford to do it on the fee-for-service Medicare.
  We have had the Medicare Program around for more than 40 years. The 
fact is, government bureaucrats are still trying to get the complex 
reimbursement formulas right. We know, as the distinguished chairman of 
the Finance Committee has said, that under the fee-for-service program, 
which is part of what needs to be reformed in this health care bill, 
Medicare pays for volume and not value.

  Some of the positive things which I have complimented the bill on is, 
it includes some small steps to change our current pay-for-volume 
program to a pay-for-value approach through various delivery system 
reform demonstration programs.
  The irony is, Medicare did not think of these delivery system 
reforms; rather, Washington is finally catching up on what private 
sector innovators have been doing for years. We heard the distinguished 
Senator from Minnesota talk about the Mayo Clinic. The Mayo Clinic has 
been doing that. I mentioned Kelsey-Seybold in Texas. But private 
sector innovators have been doing this through the Medicare Advantage 
Program already.
  The delivery system reforms in the Reid bill would allow Medicare to 
experiment with different approaches to changing physician incentives, 
such as accountable care organizations or physician quality reporting 
initiatives.
  Will they work? I happen to think they will. We do know private 
sector innovators have already figured out how to change physician 
incentives in the sorts of ways we ought to be doing more of and not 
punishing by cutting Medicare Advantage.
  One Medicare Advantage plan, HealthSpring, serves 20,000 seniors in 
my State. They have been a leader for changing incentives for 
physicians to focus on quality rather than quantity. I met with their 
leadership and heard how they have done it. What they told me is they 
have a collaborative partnership with their physicians. They call it 
Partnership for Quality. Physicians are accountable for both cost and 
quality based on an evidence-based set of quality measures.
  The results are a win-win: better quality care leading to healthier 
seniors and physicians who succeed in meeting evidence-based quality 
standards and ultimately lower health care costs, which I thought was 
supposed to be one of the goals of health care reform.
  Participating physicians were paid financial incentives for meeting 
their goal, but as a result of coordination of care and evidence-based 
quality standards, they actually ended up charging less and patients 
experienced better results too. Members needed fewer hospitalizations 
and emergency room visits. Preventive measures increased mammograms by 
80 percent, diabetic foot exams by 360 percent, and flu vaccinations by 
246 percent.
  I have heard about HealthSpring's success from a couple in Farmers 
Branch, TX, who recently wrote to me. They said:

       We had a Medicare supplemental policy for several years 
     until they priced themselves out of the market. We are now 
     with a Medicare Advantage plan called HealthSpring. We have 
     been very happy with this plan and the way they are saving us 
     money. Please do not change or eliminate this program.

  Let me tell you about one other Texas company called WellMed. While 
the Reid bill would finally give Medicare the ability to experiment 
with medical homes and care coordination, a San Antonio-based company, 
a Medicare Advantage company called WellMed, has been using a medical 
home model to coordinate patient care and emphasize prevention for 
nearly 20 years.
  To quote from an article last month in ``Inside San Antonio:''

       The health care delivery model at WellMed puts the patient 
     at the center of a team directed by a primary care physician. 
     The team may include a nurse, health coach, hospitalist, 
     social service worker and physician assistant.
       According to WellMed CEO Dr. George Rapier, ``We really do 
     have to bring back the old-time primary care doctor who cared 
     for you, who was concerned about you, who was part of your 
     family, and you were part of their family. It's a primary 
     care physician who knows all about you. So if you need a 
     specialist, they know the best specialist to send you to. If 
     you need to go in the hospital, they make sure you get the 
     appropriate care in the hospital. They are your coordinator 
     of care. And that's really the concept of a medical home.''

  There is no question in my mind that the model has been saving lives 
in my State. Here is a story about one Texan whose life was saved by 
physicians caring for him at WellMed:

       For years, Crohn's disease weakened--

  We will call him Ed--

       Ed's immune system and left him susceptible to infections. 
     One morning in 2001, he lacked energy to even get out of bed. 
     His breathing became labored. He developed a cough that 
     sounded ``wet.''
       His worried wife called his primary care physician at 
     WellMed, Dr. Marlene Sanchez, who wanted Ed hospitalized 
     immediately so she could order a nuclear scan of his lungs. 
     He protested.
       ``She told me that if he refused to go, I should call 911 
     and have the paramedics come get him,'' [his wife] Annette 
     recalled. ``He heard Dr. Sanchez talking to me, the urgency 
     in her voice, and that convinced him to go.''
       The scan confirmed Dr. Sanchez's suspicions: A potentially 
     fatal blood clot had traveled from Ed's leg to his lungs. He 
     was successfully treated and recovered. [Ed and his wife] 
     recently celebrated Ed's 74th birthday.
       Annette credits Dr. Sanchez for saving Ed's life and for 
     acting as a catalyst that keeps him thriving in their golden 
     years.
       ``We have seen an abundance of doctors, from the cancer 
     doctors to the dermatologist, gastroenterologist, the blood 
     doctor, the heart specialist--Ed has gone through it all . . 
     . and they've all been coordinated by his primary care 
     doctor. I've been to other doctors outside WellMed and you 
     don't get the feeling that they are communicating like 
     this.''

  Well, many Texas seniors currently enjoy these extra benefits under 
Medicare Advantage, such as--another benefit--the Silver Sneakers 
program, the Nation's leading exercise program for older Americans. 
This past year, one of the Silver Sneakers members personally visited 
my office to deliver testimonials from other Silver Sneakers members. 
One Texan said:

       At my age I need a program to strengthen me all over but 
     primarily to help me with my balance and coordination. I need 
     these skills to keep me from falling and breaking my bones.

  Another participant in the Silver Sneakers program said:

       I am 66, have been in the Silver Sneakers program a year. 
     Prior to that I led a sedentary life, which included many 
     health problems. I had hypertension, high cholesterol, 
     chronic bladder condition, and mild depression. Since coming 
     to classes and utilizing the weights and cardio machines, my 
     life has improved immensely. My blood pressure has dropped, 
     my cholesterol has been

[[Page S12405]]

     lowered, my chronic bladder condition has improved and I just 
     feel better all around. I am no longer depressed because I 
     look better and look forward to going to class and visiting 
     with my friends.

  These cuts in Medicare Advantage are going to have a direct impact on 
the benefits my constituents in Texas are benefiting from--the 532,000 
Texans who are currently on Medicare Advantage--and what they are 
asking me--which I can't answer--is why in the world would we want to 
cut Medicare Advantage, which actually works, as opposed to Medicare 
fee for service, which does not work well? Why would we take a fiscally 
unsustainable program, such as Medicare, which is going insolvent in 
2017, and use that to create a $2.5 trillion new entitlement program?
  My constituents, the seniors who have paid into Medicare all these 
years, are saying: It is not fair to take the money we have paid into 
Medicare and use it to create yet another entitlement program and not 
to fix Medicare itself. So I believe we need to fix Medicare's nearly 
$38 trillion in unfunded liabilities. We need to fix the improper 
payment rate of roughly 1 out of every 10 Medicare dollars which 
results in somewhere on the order of a minimum of $60 billion of 
fraudulent payments each year. We need to put it on a fiscally 
sustainable path, rather than taking $\1/2\ trillion from Medicare for 
another ill-conceived Washington health care takeover.
  I don't believe my constituents believe you can take $\1/2\ trillion 
out of these programs, just as they do not believe you can take more 
than $100 billion out of Medicare Advantage, and it will have no impact 
on their benefits. They don't buy it. They don't believe it, and I 
don't either.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, it is late in the evening. I was going 
to address three different issues tonight, but out of respect for 
Senator Baucus, the chairman of my committee, I am going to address 
just one of these issues and I will come back tomorrow morning, on 
Saturday, and speak on the rest of the issues.
  The one issue I am going to address this evening is my support of the 
Senator from Nebraska and his motion to commit with instructions on the 
home health care aspect of this 2,074-page bill. That is Senator 
Johanns' motion. We are now considering a bill that cuts $\1/2\ 
trillion from a Medicare Program to fund yet another unsustainable 
health care entitlement program. Around $42 billion comes from cuts to 
home health care providers--hence the purpose of Senator Johanns' 
amendment that that not happen.
  You have heard from Members on this side of the grave consequences of 
these cuts. Several Senators have already addressed these. These severe 
cuts pose a legitimate threat to beneficiaries' access to home health 
services. In my State of Iowa alone, there are around 160 home health 
agencies that provide valuable services to Medicare beneficiaries 
across the State. Thanks to these home health care providers, seniors 
in Iowa are able to live at home instead of institutional settings, 
such as nursing homes. These seniors place great value on being able to 
stay in their homes. I would have to say that in all the years I have 
been involved in senior issues, whether it has been chairman of the 
Aging Committee, or chairman and now ranking member of the Finance 
Committee, I haven't run into one single senior citizen in my State who 
said to me: I am just dying to get into a nursing home. They do not 
want to go there.
  So that is the purpose of home health agencies, to save money, but it 
is to retain the quality of life, and maintain the quality of life for 
these citizens. I rarely hear Iowans say anything about living in a 
nursing home, except not to go there.
  Since living at home has been found to be a more cost-effective 
alternative than institutional care, this results in Medicare spending 
less. These cuts that are in this 2,074-page Reid bill will make it 
even harder for Iowa home health care providers to care for Medicare 
beneficiaries. A good part of the Medicare home health cuts come from 
permanent productivity adjustments.
  Let's look at the possibility--or I would say I have concluded the 
impossibility--of bringing greater productivity to nursing home care. 
You have heard this week about how Medicare's chief actuary found 
savings from these productivity adjustments to be very unrealistic. And 
just so you know that the letter I refer to from the chief actuary is 
real, observe this chart. You also heard this week how these permanent 
cuts would make it harder for providers to remain in the black. You 
also heard these providers might end their participation in Medicare 
and possibly then jeopardize access to care for beneficiaries, and 
probably then more people ending up in the more expensive environment 
of a nursing home.
  The threat to access to home health care from these permanent 
productivity cuts isn't theoretical. It is real. Like many other 
Medicare providers, home health agencies provide labor-intensive 
services. It is because of these labor-intensive services that I raise 
the question and the possibility--and I say it ends up being an 
impossibility--for them to be more productive. There are few gadgets in 
home health that will increase productivity. And whatever available 
gadgets there are, they are unaffordable for many Iowa home health 
agencies because they are small operations with limited financial 
resources.
  Home health care is about doctors, it is about nurses, and home 
health aides, and it is about all of these providing care to the most 
needy. So it is incorrect, in my judgment, to assume these providers 
will achieve the levels of productivity like the rest of the economy.
  The HHS chief actuary's findings clearly apply to home health in my 
State of Iowa, as they do nationally. Just to remind you: ``The 
estimated savings may be unrealistic;'' and ``possibly jeopardizing 
access to care for beneficiaries for our seniors.'' More people in 
nursing homes.
  Because of these cuts, the percent of Iowa home health agencies that 
have negative Medicare margins will increase to 75 percent. So over 120 
of the 160 home health providers will have negative Medicare margins 
because of this 2,074-page Reid bill. Iowa providers are not alone. 
From \1/2\ to 90 percent of home health agencies in States across the 
country would have negative Medicare margins.
  I ask a unanimous consent to have printed in the Record three 
letters, which I wish to put in at various places in my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibits 1, 2, and 3.)
  Mr. GRASSLEY. Mr. President, I have here a letter dated September 23 
of this year from Val Halamadaris, the president of the National 
Association for Home Health and Hospice. This organization represents 
home health agencies across the country.
  Mr. President, Mr. Halamadaris wrote this letter in response to the 
$43 billion in home health cuts in the Finance Committee package, which 
presumes to be the same number that is used in the Reid bill. In this 
letter, he stated:

       It is crucial to the survival of the home health services 
     delivery system that you work to reduce the $43 billion in 
     cuts currently contained in the Senate Finance Committee's 
     health reform package. Our analysis indicates that by 2016, 
     the proposed cuts in home health care services payment rates 
     will lead to nearly 70 percent of providers nationwide at 
     risk of closing because their costs will exceed Medicare 
     payments. If that occurs, President Obama's promise that 
     Medicare beneficiaries will not be adversely affected by 
     health care reform will be broken.

  I have yet to hear from a home health care provider in Iowa that 
these permanent cuts will make it easier for them to care for their 
Medicare beneficiaries. Instead, I hear these cuts would reduce access 
to home health services.
  The second letter I asked to have inserted in the Record is from the 
Iowa Alliance in Home Care, and they wrote:

       Ensuring that Medicare home health payments are not reduced 
     further is essential to avoid the resulting limited or no 
     access to home health services for many Iowans who prefer to 
     receive services in their home.

  Not only is the chief actuary saying it, as the chart reflects, but 
people who are connected with the business of home health care are 
saying it: These permanent cuts will in fact jeopardize access to home 
health services in Iowa. So if the home health cuts in the Reid bill 
are allowed to go into effect, then

[[Page S12406]]

Iowa's seniors, who prefer to live full lives from their homes, will be 
forced to live in the more expensive settings of facilities such as 
nursing homes.
  I believe many Members on both sides of the aisle share my concern 
about home health care cuts.
  I have here a third letter, this one dated from July 27, 2007, and it 
is written to Senator Baucus and me.
  Mr. President, I use this letter, even though it is 2 years old, 
because we were getting entreaties from 61 of our colleagues--of which 
52 now still serve in the Senate--about a legislative proposal to cut 
Medicare home health payments in that year--2007--by $9.7 billion and 
hospice payments by more than $1.1 billion. They urged me and Senator 
Baucus, at that time, to ensure that home health and hospice providers 
receive full market basket inflation adjustments. They also urged us to 
oppose any cuts in payment rates through administrative actions.

  In the letter, these Members stated that home health and hospice care 
``have been demonstrated to be cost-effective alternatives to 
institutional care in both Medicare and Medicaid programs.'' They 
stated that ``reducing Medicare home health and hospice payments would 
place the quality of home health care and hospice and the home care 
delivery system at significant risk.''
  Of these 61 Senators who signed this letter 2 years ago, 52 are 
currently here debating this bill in the Senate. Of those 52 Senators, 
37 are from his side of the aisle who are now proposing $43 billion in 
cuts instead of $9.7 billion in home payment cuts and $1.1 billion in 
hospice payments cuts. I would think they would find these kinds of 
cuts three or four times--four times what we were talking about 2 years 
ago to be very unrealistic, and to keep home health as a viable 
organization going.
  We also must look beyond health care when we look at the impact of 
these permanent cuts. I have also heard from providers in Iowa that 
permanent cuts such as these will make it even harder for them to keep 
their doors open. So around 3,500 Iowans who work at home health 
agencies are at risk of losing their jobs at a time when we have 10 
percent unemployment, at a time when more of this country is concerned 
that Congress ought to be working on creating jobs, jobs, jobs as 
opposed to the health care issue and in some cases cutting jobs out. 
The Labor Department reported today that unemployment is 10 percent. 
Now is not the time to consider bills that increase unemployment rates.
  About an hour ago, the Senator from Nebraska offered this motion I am 
speaking in favor of now, to send this bill to the Finance Committee 
with instructions to report a bill without these very enormous home 
health cuts that are in it. We should take this opportunity to fix the 
bill and then come back to the full Senate with a better bill. That is 
why I support the motion of the Senator from Nebraska to commit, and I 
urge my colleagues to do the same.
  I yield the floor.

                               Exhibit 1

                                              National Association


                                      for Home Care & Hospice,

                               Washington, DC, September 23, 2009.
     Re Medicare Home Health Services.

     Hon. Charles E. Grassley,
     U.S. Senate,
     Washington, DC.
       Dear Senator Grassley: I am writing to thank you for your 
     continued support of home care patients nationwide and to 
     enlist your help to ensure that access to home health 
     services remains a reality for more than 3 million senior and 
     disabled individuals that benefit from these important 
     services.
       It is crucial to the survival of the home health services 
     delivery system that you work to reduce the $43 billion in 
     cuts currently contained in the Senate Finance Committee's 
     health reform package. Our analysis indicates that by 2016, 
     the proposed cuts in home health services payment rates will 
     lead to nearly 70% of providers nationwide at risk of closing 
     because their costs will exceed Medicare payments. If that 
     occurs, President Obama's promise that Medicare beneficiaries 
     will not be adversely affected by health care reform efforts 
     will be broken.
       Invariably, providers of services facing rate cuts always 
     cry out that care will be lost. However, history tells us 
     that our warning should be heeded. The Balanced Budget Act of 
     1997 was expected to cut home health services spending by 
     $16.1 billion in five years. Instead, the rate changes cut 
     over $70 billion, leading to the loss of care to nearly 1.5 
     million Medicare beneficiaries. That change also led to 
     higher outlays under state Medicaid programs, as well as 
     greater use of nursing homes, hospitals, and other 
     institutional settings. Still today, about $17 billion is 
     spent on home health services, as compared with about $19 
     billion in home health outlays in 1997.
       Several factors need to be understood about the current 
     Finance Committee proposal. First, the proposal is not 
     consistent with MedPAC advice. The proposal reduces rates to 
     a point where Medicare margins will average zero. MedPAC, in 
     its deliberations, clearly recognized the need for some level 
     of margin in order to stay in business. In fact, we 
     understand that MedPAC's executive director, Mark Miller, 
     informed House Ways and Means members that MedPAC did not 
     recommend a zero margin.
       Second, there is a serious misunderstanding of Medicare 
     margins. MedPAC estimates margins for 2009 will be 12.2%. 
     However, this estimation does not include the impact of 
     nearly 7% in rate reductions planned by way of regulation by 
     2011. Further, it does not include nearly 1,700 important 
     providers of home health services, hospital-based agencies. 
     Also, it does not reveal that the ``average'' is made up of a 
     very wide range of individual agency margins with over 30% 
     below zero already. Finally, reliance on Medicare margins 
     does not convey that the total margin of agencies is 
     estimated at 2% with Medicaid and Medicare Advantage losses 
     driving the overall margin down.
       Third, unlike other health care providers such as 
     hospitals, the expansion of health insurance will not bring 
     additional business of any material level. Home health 
     patients average nearly 80 years of age and are already 
     insured by Medicare or Medicaid. This means that the Medicare 
     cuts to home health agencies are not offset by new revenues 
     from newly insured patients. Instead, the proposed cuts of 
     over 13.5% of spending on home health services will be as 
     real as can be.
       Fourth, the home health services community has put forward 
     a credible and substantive alternative set of proposals for 
     reforming the Medicare payment system. While the Chairman's 
     Mark incorporates many of these proposals, the level of cuts 
     is unsustainable. In fact, the level of cuts exceeds the $34 
     billion President Obama's budget recommended by nearly $10 
     billion. Still, the industry's proposal itself meets or 
     exceeds the Obama budget target.
       Fifth, the home health services cuts are far 
     disproportionate to other provider sectors. The Chairman's 
     Mark seeks 9.4% of all the Medicare cuts from home health 
     care while home health makes up only 3% of the Medicare 
     program currently. That disproportionate impact is further 
     magnified by the fact that, unlike most other health care 
     providers and insurers, expanding health insurance will have 
     no meaningful increase in home health care business.
       This is a historic time in this country, an opportunity to 
     secure health care for all as a fundamental right. However, 
     these reforms should not be done at the expense of our most 
     vulnerable senior citizens, the homebound and infirm. Your 
     leadership on this matter is greatly appreciated. Please let 
     us know what we can do to help you succeed.
       You have my great respect and admiration, now and always.
           Sincerely,
                                              Val J. Halamandaris,
                                                        President.

                               Exhibit 2


                                   Iowa Alliance in Home Care,

                                 Des Moines, IA, December 4, 2009.
     Hon. Charles Grassley,
     Ranking Member, Committee On Finance, Dirksen Senate Office 
         Building, Washington, DC.
       Senator Grassley: I'm contacting you today to urge your 
     assistance concerning an issue of great significance to 
     Iowa's dedicated home care nurses and other providers of 
     valuable and needed in-home health care services to Iowans. 
     The Iowa Alliance in Home Care respectfully requests your 
     support to have the Senate Finance committee report back to 
     the Senate, in response to a motion with instructions, a 
     modified H.R. 3590 bill that does not include cuts in 
     Medicare payments to home health agencies totaling $42.1 
     billion.
       Your urgent action is critically important to ensure that 
     access to quality health care services delivered in the home 
     setting is not compromised. Proposed cuts in Medicare home 
     health reimbursement would be devastating as most of Iowa's 
     home care providers (i.e. public health departments, small 
     businesses) rely largely or exclusively on Medicare and 
     Medicaid payment to justify their operations which includes 
     employment for thousands of Iowans. Insufficient Medicaid 
     home health reimbursement, recently worsened by Governor 
     Culver's ATB state budget cuts, has been reduced by an 
     additional 5% effective 12/1/2009. In short, ensuring that 
     Medicare home health payments are not reduced further is 
     essential to avoid the resulting limited or no access to home 
     health services access for many Iowans who prefer to receive 
     services in their own home.
       Senator, thank you for your past home health care support. 
     We would greatly appreciate your immediate attention to this 
     most critical of needs for our Iowa home health care 
     community.
           Regards,
                                                     Mark Wheeler,
                                               Executive Director.

[[Page S12407]]

                               Exhibit 3


                                                  U.S. Senate,

                                    Washington, DC, July 27, 2007.
     Hon. Max Baucus, Chairman,
     Hon. Charles Grassley, Ranking Member,
     Senate Finance Committee,
     Washington, DC.
       Dear Chairman Baucus and Ranking Member Grassley: Home 
     health and hospice have become increasingly important parts 
     of our health care system. The kinds of highly skilled and 
     often technically complex services that our nation's home 
     health and hospice agencies provide have enabled millions of 
     our most frail and vulnerable seniors and disabled citizens 
     avoid hospitals and nursing homes. By preventing such 
     institutional care, home health and hospice services save 
     Medicare millions of dollars each year. Most importantly, 
     they enable individuals to stay just where they want to be--
     in the comfort and security of their own homes. We therefore 
     urge you to ensure that Medicare beneficiaries continue to 
     have access to important home health and hospice services by 
     supporting full market basket inflation adjustments, as 
     provided under current law, and opposing any cuts in payment 
     rates through administrative actions.
       The Administration's FY 2008 budget includes a legislative 
     proposal to cut Medicare home health payments by $9.7 billion 
     and hospice payments by more than $1.1 billion over five 
     years. It also includes additional administrative cuts in 
     payment rates. The Medicare home health benefit has already 
     taken a larger hit in spending reductions over the past ten 
     years than any other Medicare benefit. In fact, home health 
     as a share of Medicare spending has dropped from 8.7 percent 
     in 1997 to 3.2 percent today, and is projected to decline to 
     2.6 percent of Medicare spending by 2015. This downward 
     spiral in home health spending began with provisions in the 
     Balanced Budget Act of 1997 (BBA), which resulted in a 50 
     percent cut in Medicare home health spending by 2001--far 
     more than the Congress intended or the Congressional Budget 
     Office (CBO) projected.
       We believe that further reductions in home health and 
     hospice payments would be counterproductive to controlling 
     overall health care costs. Home health and hospice care have 
     been demonstrated to be a cost-effective alternative to 
     institutional care in both the Medicare and Medicaid 
     programs. In fact, the Medicare Payment Advisory Commission 
     (MedPAC) has noted the results of a 2002 RAND study which 
     showed ``in terms of Part A costs, episodes in an inpatient 
     rehabilitation facility or skilled nursing facility are much 
     more costly for Medicare than episodes of care among patients 
     going home.'' (MedPAC's June 2005 Report to Congress).
       Further reducing Medicare home health expenditures would 
     also be in direct conflict with the Administration's desire 
     to prioritize health care in the home as a cost-effective 
     alternative to institutional care. During the World Health 
     Congress in February of 2005, Secretary of Health and Human 
     Services Michael Leavitt said: ``Providing the care that lets 
     people live at home if they want is less expensive than 
     providing nursing home care. It frees up resources that can 
     help other people. And obviously, many people are happier 
     living at home.''
       Reducing Medicare home health and hospice payments would 
     place the quality of home health care and hospice and the 
     home care delivery system at significant risk. Several 
     factors have contributed to the increased cost of providing 
     care in the home over the past few years, including:
       The cost of travel by clinicians to patients' homes;
       The use of technology, like telehealth monitors, which is 
     not covered by Medicare;
       The need to pay significantly higher salaries for nurses, 
     therapists, and home health aides to attract these 
     individuals from the scarce supply of clinicians nationwide.
       Many home health providers currently do not have a 
     sufficient number of clinical staff to accept patient 
     referrals from physicians and hospitals. As a consequence, 
     hospital discharge planners have reported that they are 
     finding it more difficult to refer patients for home health 
     care. Additional cuts to the home health benefit could leave 
     home health providers no alternative but to reduce the number 
     of visits and/or patient admissions, which would ultimately 
     affect access to care and clinical outcomes. In addition to 
     these costs, hospices are also experiencing rising costs for 
     pain management pharmaceuticals, and they are also finding 
     that patients with shorter lengths of stay are requiring more 
     intensive services.
       In order to ensure that home health care and hospice remain 
     a viable option for Medicare patients, we urge you to support 
     full market basket updates for home health and hospice, as 
     provided under current law, and to oppose any cuts in payment 
     rates through administrative action. Thank you for your 
     consideration of this important matter.
           Sincerely,
         Susan M. Collins; Russ Feingold; Christopher S. Bond; 
           Jack Reed; Patrick J. Leahy; Arlen Specter; Norm 
           Coleman; Sheldon Whitehouse; Robert Menendez; Ken 
           Salaar; Barack Obama; Kent Conrad; Thomas R. Carper; 
           Barbara Mikulski; Joe Lieberman; E. Benjamin Nelson; 
           Daniel K. Inouye; Tom Harkin; Robert C. Byrd; Frank 
           Lautenberg; Amy Klobuchar; Herbert Kohl; Byron L. 
           Dorgan; Daniel K. Akaka; Barbara Boxer; Tim Johnson; 
           Johnny Isakson; Evan Bayh; Jim Webb; Patty Murray; 
           Chuck Hagel; Joseph R. Biden, Jr.; Robert P. Casey, 
           Jr.; John F. Kerry; Hillary Rodham Clinton; Sherrod 
           Brown; Christopher J. Dodd; John Thune; Carl Levin; 
           John W. Warner; Saxby Chambliss; Ron Wyden; Mark L. 
           Pryor; Maria Cantwell; Robert F. Bennett; Bernard 
           Sanders; Charles E. Schumer; Richard G. Lugar; Dianne 
           Feinstein; Larry E. Craig; John Cornyn; Benjamin L. 
           Cardin; Edward M. Kennedy; Pete V. Domenici; Bill 
           Nelson; Kay Bailey Hutchison; David Vitter; Pat 
           Roberts; John E. Sununu; Mary Landrieu; Sam Brownback.

  The PRESIDING OFFICER. The Senator from Alabama is recognized.
  Mr. SESSIONS. Mr. President, before the Senator leaves, he is a man 
of great character and experience in these matters.
  I have a letter from a constituent who writes to urge a vote against 
this health care bill. This is from Mr. Bill Eberle in Huntsville, AL. 
He says:

       The worst part of this bill is that much of the cost will 
     be paid for by cuts to Medicare.

  I think the Senator has indicated he believes that is accurate.
  He goes on to say:

       I am 68 years old and I have paid into Medicare for 40 
     years, believing it would cover much of my health care costs 
     when I became 65. Now I am being told that the Government has 
     found people who need the coverage more than I do and they 
     will cut the care for which I have paid for 40 years in order 
     to cover people who have paid nothing into the program. It is 
     not the Government's money. The money belongs to those of us 
     who paid into it for so many years and are watching as it is 
     being taken away from us.

  My question to my colleague is, since the Senator has been so 
intimately involved with Medicare over the years, is it not true that 
every working American has money taken out of their paycheck to fund 
their Medicare and that they believe and we have a compact with them 
that when they reach 65, they will have the benefit of that?
  Mr. GRASSLEY. When they reach age 65, they will have that benefit.
  Mr. SESSIONS. Yes, 65. Yes.
  Mr. GRASSLEY. To the tune of 2.9 percent of payroll. That is how much 
a self-employed person would pay. And an employee would pay 1.45 
percent and the employer would pay 1.45 percent. Then, you know this 
2074-page bill adds half a percentage point to those, so you are going 
to get it to a point where it is almost 2 percent for the employer, 2 
percent for the employee, and it would be almost 4 percent for a self-
employed person paying into this that is now going to be raided to 
finance a brandnew entitlement program.
  Mr. SESSIONS. My constituent, then, is fundamentally correct in his 
concern?
  Mr. GRASSLEY. I sense a great deal of resentment coming through in 
that letter, from the words of that letter from that person, that what 
he has paid into, for the probably 45 years of working before he 
retired--that now, with Medicare already being in jeopardy, based on 
the trustees' report which says that by 2017 there is not going to be 
any money in the trust fund, and then having $464 billion taken out of 
that trust fund to help finance a new entitlement program at a time 
when the present entitlement programs are in a great deal of financial 
jeopardy.
  Mr. SESSIONS. I think you stated that so well. Just to reemphasize, 
this gentleman, Mr. Eberle, who paid into Medicare for 40 years, until 
he got to be 65, he got not a dime of Medicare benefit, did he?
  Mr. GRASSLEY. No. The only way he would have gotten benefits is if he 
had become disabled before age 65.
  Mr. SESSIONS. He pays into it all these years and just now gets to 
draw it, and people start taking it out.
  I thank Senator Grassley for his leadership on this issue. I think he 
and I come out of the soil of our States, out of the real world. My 
impression is that nothing comes from nothing. Would you agree? 
Somebody has to pay?
  Mr. GRASSLEY. I say it this way. We are in a town where we are 
dealing with a lot of Washington nonsense, and I hope, from the rural 
areas of Alabama, like the State of Iowa, you bring a lot of common 
sense to this town where there is not a lot of it.
  Mr. SESSIONS. I thank the Senator. I would say the matter is a very 
serious one we are dealing with. Today, I had the opportunity to talk 
to a very experienced person involved in health care issues for many 
years. I expressed my bafflement about some of the disagreements we 
have, about huge issues.

[[Page S12408]]

One of my staffers wrote down what he said. He said: ``In all my years 
I have never seen such transparent dishonesty in the Congress.''
  He said ``it is the biggest fraud that has been perpetrated in the 
history of our country,'' in his opinion.
  Here we have a situation. I want to say I am going to pursue this in 
a little more detail. I am not going to go into great length tonight. 
But we have an amendment--Senator Bennet offered an amendment yesterday 
that said we wouldn't cut guaranteed benefits for Medicare. But the way 
this deal is being done is they are cutting payments to providers of 
Medicare.
  We are already reaching, as Senator Grassley said, a national crisis 
because by 2017 we will not be able to have a surplus in Medicare, we 
are going into default in Medicare. Where are we going to get the 
money?
  Could we have efficiencies? Could we save some money in Medicare? 
Could we do some things to keep the program afloat? Perhaps. But if we 
do so, should not we use it, should not we use any efficiencies in 
savings that we could scrape together without damaging the commitment 
we have to our seniors--should not we use those savings to save 
Medicare that is going into default? I suggest that is a moral and 
legal commitment.
  Mr. Eberle has written to me. He has paid for 40 years. He has not 
been able to draw anything out of it for the 40 years he has paid into 
it. Now he gets ready to draw, and we are telling him we are going to 
cut $465 billion out of the Medicare payment. This is not a little 
bitty matter.
  We seem to have amazing--we seem to have this dispute. One group, 
from the other side, says: Don't worry, we are not taking $465 billion 
from Medicare, and we wouldn't cut Medicare, and we don't believe in 
cutting Medicare, and we don't want to hurt Medicare in any way. Our 
side over here is saying: But you are. According to the numbers that 
are pretty plain in this legislation, hospitals will have a $135 
billion reduction; hospices, you have $8 billion for life-ending care 
that has been so helpful to so many families; nursing homes have a $15 
billion reduction; Medicare Advantage, $120 billion; home health 
agencies that Senator Grassley talked about, a $42 billion reduction. 
Are we imagining this? Have we somehow formulated this? It all totals 
up to about $465 billion.
  This matter, I suggest, is not going away. Either we have reality 
here or not. I believe the facts will show that we are raiding 
Medicare, we are weakening that program when it is already known to all 
of us in this body that Medicare is not actuarially sound.
  I remember when President Bush determined, in a failed effort, to try 
to alter Social Security in a way that he believed would put it on a 
more sound footing. He got no help at all. We had many of our Senators 
on both sides of the aisle saying: If you really want to do something, 
as bad as Social Security is, Medicare is in a much worse financial 
fix. Why aren't you fixing it?
  I remember a number of years ago, 10 or more, when Senator Judd 
Gregg, then chairman of the Budget Committee, tried to come up with 
some legislation to contain a little of the growth in Medicare. Over 5 
years, he had a plan that would contain the growth by $10 billion. Not 
a single Democrat voted for the Gregg proposal. Now they accuse the 
Republicans of trying to damage Medicare when, in fact, every penny of 
the $10 billion to be saved was going to be utilized to strengthen 
Medicare and try to keep it from going into default.
  Now we are talking about taking $465 billion out of Medicare and 
starting a new entitlement program, a new entitlement program at the 
time that this Nation has just passed or just incurred the largest 
single deficit in the history of the American Republic, $1.4 trillion. 
Next year, we will be over $1 trillion, according to the Congressional 
Budget Office--not me.
  Is this smart? To have a program that people have depended on, that 
we have a moral compact to support--to support our seniors who paid 
into this plan for 40 years, now taking money out of that to create a 
new program? It is, in fact, in quite a number of areas, going to cost 
far more than is being suggested by the people who are promoting the 
legislation. We are going to dig into this and try to analyze it with 
more clarity, but the truth is, the numbers just do not add up. They 
will not work. We just ought not to be establishing a new entitlement 
program of massive proportions in a way where we really have little 
concept of how it is going to play out at a time of the largest 
deficits this Nation has ever had, deficits that, according to our own 
Congressional Budget Office, will double the national debt in 5 years 
and triple it to $17 trillion in 10 years.
  It is an unsustainable course, and one of the first things we have to 
do is watch how we spend our money. I talked to an individual today. He 
said: It is like your house is in serious need of repair. You really 
don't have the money to fix it. You finally decide you have to borrow 
money to fix the house, and instead you borrow money and add a wing 
onto the house.
  We need to fix the house we have. We need to make sure we honor our 
commitment to Medicare recipients. They have already paid. That is the 
important point to remember. They have already paid their working life 
under a compact and a commitment that money would be in a fund that 
would be available. We ought not to be taking it away.
  I urge colleagues to think about this. This is perhaps the most 
significant fatal flaw in the legislation. It just doesn't add up. 
There are others, but this one, to me, is the most dramatic, the most 
pernicious, the one that is most unwise. We simply need to slow down, 
ask ourselves how we can make our health care system better, how we can 
do it without breaking the bank. Aren't there some things we can do to 
improve health care without a huge cost? Yes, there are. Let's start 
with every single one of those we can agree on. If we do that, I think 
we could make a lot of progress.
  Who knows, if this economy turns around--and we all hope it will--we 
would be in a better footing to consider a new benefit in the future.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.

                          ____________________