[Congressional Record Volume 155, Number 183 (Tuesday, December 8, 2009)]
[Senate]
[Pages S12648-S12664]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 SERVICEMEMBERS HOME OWNERSHIP TAX ACT

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of H.R. 3590, which the clerk will 
report.
  The 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.
       Nelson (NE) amendment No. 2962 (to amendment No. 2786), to 
     prohibit the use of Federal funds for abortions.
       McCain motion to commit the bill to the Committee on 
     Finance, with instructions.

  The ACTING PRESIDENT pro tempore. Under the previous order, the time 
until 12:30 p.m. will be for debate only, with the time equally divided 
and controlled between the two leaders or their designees, with 
Senators permitted to speak for up to 10 minutes each, with the 
majority controlling the first hour and the Republicans controlling the 
next hour.


                   RECOGNITION OF THE MINORITY LEADER

  The ACTING PRESIDENT pro tempore. The Republican leader is 
recognized.


                           Health Care Reform

  Mr. McCONNELL. Mr. President, over the past several days, Americans 
have seen in vivid detail what some supporters of this plan plan to do 
for the Medicare Program for seniors. They plan to use it as a giant 
piggy bank to pay for an entirely new government program. Yesterday, we 
heard floated, for the very first time, that they want to radically 
expand Medicare. So what is becoming abundantly clear is that the 
majority will make any deal, agree to any terms, sign any dotted line 
that brings them closer to final passage of this terrible bill. They 
entertain adding new experiments without any assessment of the impact 
this backroom deal-making will have on the American people or our 
economy. They are, for lack of a better term, winging it on one of the 
most consequential pieces of legislation affecting our country in 
memory.
  Let me suggest to the majority, Americans would much rather we get it 
right than scurry around, throwing together untested, last-minute 
experiments in order to get 60 votes before Christmas. Let me say that 
again. Americans would much rather we get it right than scurry around, 
throwing together untested, last-minute experiments in order to get 60 
votes before Christmas.
  Over the past several days, our friends on the other side repeatedly 
voted to preserve nearly $\1/2\ trillion in Medicare cuts to finance 
their vision of reform, a vision that includes cutting nearly $8 
billion from hospice care, $40 billion in cuts to home health agencies, 
$120 billion in cuts to Medicare Advantage, $135 billion in cuts to 
hospitals that serve Medicare patients, and nearly $15 billion in cuts 
to nursing homes. What these cuts really illustrate is a lack of vision 
because cutting one troubled government program in order to create 
another is a mistake. I will say that again: $\1/2\ trillion in cuts to 
Medicare for seniors is not reform.

  But Medicare cuts are just one leg of the stool holding up this 
misguided vision of reform. Let's take a look at another. Let's look at 
how this bill punishes not only seniors but how it kills jobs at a time 
when 1 in 10 working Americans is looking for one. This bill doesn't 
just punish seniors, it punishes job creators too.
  That is the message we got yesterday from small businesses across the 
country. They sent us a letter opposing this bill because it doesn't do 
the things proponents of this bill promised it would. It doesn't lower 
costs, it doesn't help create jobs, and it doesn't help the economy. 
Here are just some of the groups that signed that letter: the 
Associated Builders and Contractors, the Associated General 
Contractors, the International Food Service Distributors Association, 
the National Association of Manufacturers, the National Association of 
Wholesale Distributors, the National Retail Federation, Small Business 
and Entrepreneurship Council, and the U.S. Chamber of Commerce.
  Here is what these groups had to say about this bill. I am reading 
from their letter dated December 7, 2009, a letter that was addressed 
to every Member of the Senate:

       In order to finance part of its $2.5 trillion price tag, HR 
     3590 imposes new taxes, fees and penalties totaling nearly 
     half a trillion dollars. This financial burden falls 
     disproportionately on the backs of small business. Small 
     firms are in desperate need of this precious capital for job 
     creation, investment, business expansion, and survival.

  The letter goes on to detail all the ways in which this bill punishes 
small businesses, thus making it harder for them to retain or hire 
workers. These groups point out that under this bill, small businesses 
in the United States would see major cost increases as a result of new 
taxes on health benefits and health insurance, costs that would be 
passed on to employees and which would make health insurance more 
expensive, not less.
  Under this bill, self-employed business owners who buy coverage for 
themselves could see a double-digit jump in their insurance premiums. 
For other small businesses, the bill won't lead to a significant 
decrease in cost--something they were promised as a result of the bill.
  Under this bill, jobs would be lost and wages depressed as a result 
of a new law that would require businesses either to buy insurance for 
their employees or to pay a fine.
  Needless to say, this is not the kind of legislation the American 
worker needs or wants at a moment of double-digit unemployment. Perhaps 
that is the reason that poll after poll after public opinion poll shows 
that the American worker opposes this bill.
  Some business groups may have supported this plan earlier in the year 
because they thought it was inevitable.

[[Page S12649]]

They didn't want to be critical of a bill they thought they had no 
power to stop. But something happened between then and now: The 
American people realized what this bill meant for them. They realized 
what it would mean for seniors, for business owners, for the economy, 
for our future as a country. Americans stood up, they made their voices 
heard, and now the tide has turned. The American people oppose this 
bill. They want us to start over. They want us to make commonsense, 
step-by-step reforms that everyone can support, not some backroom deal 
to have the government take over the health care system that is then 
forced on the American people without discussion.
  Our friends on the other side can read the writing on the wall. They 
know the American people oppose this bill. But they have apparently 
made a calculation to force it through Congress over the next several 
days before the American people even have a chance to absorb the 
details. The only thing that can stop them is the realization by 
Democrats themselves that this plan would be a tragic mistake for 
seniors, for the economy, and for our country and that a better path 
would be the kind of step-by-step reforms Americans have been asking of 
us, reforms Americans really want. Americans don't think reform should 
come at the expense of seniors, and they don't think it should come at 
the expense of jobs. They don't think it should make current problems 
worse.


                                  TARP

  Mr. President, we are now hearing talk that the administration is 
thinking of using the bank bailout TARP money that taxpayers 
reluctantly handed over during last year's credit crisis on another 
spending spree like the stimulus which they said would stop 
unemployment at 8 percent but hasn't. One trillion dollars later, 
unemployment is now at 10 percent. This is not only irresponsible, 
since the purpose of these emergency funds was to prop up the credit 
system in the midst of a crisis, it also violates both current law and 
the pledge we made that every dollar we got back would be returned to 
the taxpayer to reduce the national debt. That is the pledge we made 
when we passed the TARP proposal.
  This proposal from the administration is completely wrongheaded, but 
it is perfectly illustrative of the way Democrats in Congress have been 
dealing with taxpayer money all year--by throwing it at one problem 
after another without much regard for the consequences. Whether it is 
the stimulus, Cash for Clunkers, or the health care bill that is 
currently on the Senate floor, Americans are running out of patience 
with politicians who promise jobs but who deliver nothing but more 
debt, higher taxes, and longer unemployment lines.

  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Mr. President, for the benefit of all Senators, I would 
like to take a moment to lay out today's program. It has been more than 
2\1/2\ weeks since the majority leader moved to proceed to the health 
care reform bill, and this is the ninth day of debate. The Senate has 
considered 18 amendments or motions. We have conducted 14 rollcall 
votes.
  Today, the Senate will debate the amendment by the Senator from 
Nebraska, Mr. Nelson, on a woman's right to choose. At the same time, 
we will debate the motion by Senator McCain on Medicare Advantage.
  The time between now and the caucus lunches is for debate only. The 
majority will control the first hour of debate this morning; the 
Republicans will control the second hour.
  We are hopeful the Senate will be able to conduct votes on or in 
relation to the Nelson amendment, a side-by-side amendment to the 
McCain motion, and the McCain motion sometime this afternoon.
  Thereafter, we expect to turn to another Democratic first-degree 
amendment, which is likely to be the amendment by the Senator from 
North Dakota, Mr. Dorgan, on drug reimportation, and another Republican 
first-degree amendment. We are working on lining up those amendments.
  I note that the pending McCain motion is the third such effort by the 
Republicans to defend the private insurance companies that run the 
program called Medicare Advantage. That is the same so-called Medicare 
Advantage Program that the nonpartisan MedPAC says is overpaid--
overpaid by 14 percent--compared with traditional Medicare, which does 
the same thing.
  That is the same so-called Medicare Advantage Program whose 
overpayments add $90 to the Medicare premiums of a typical retired 
couple, even though that couple gets nothing in exchange.
  That is the same so-called Medicare Advantage Program that has been 
the major source of strong profits for the private insurance companies 
that receive those overpayments. And that is the same so-called 
Medicare Advantage Program that helps those private insurance companies 
to pay their CEOs $8 million a year, $9 million a year, and in one 
instance more than $20 million a year in compensation.
  So that is the same so-called Medicare Advantage Program that, in our 
view, needs a healthy dose of competition. That is all our bill would 
do. Our bill would move to competitive bidding in the private insurance 
Medicare market. It is high time we did so.
  This morning we are going to have a colloquy among many new Senators, 
the group of Senators who were just elected last year, which is a very 
active group. I have met with them many times. They are very 
thoughtful, very active, and they have a lot to say.
  The ACTING PRESIDENT pro tempore. The Senator from Connecticut is 
recognized.
  Mr. DODD. Mr. President, I will be very brief because we want to take 
the time to hear from our colleagues. I, too, want to commend them. A 
number of them serve on the Health, Education, Labor, and Pensions 
Committee and were tremendously valuable in helping us craft the 
legislation we now have before us in this compromised, melded bill.
  I also want to make a note. I listened to the Republican leader this 
morning--and I will talk more about this later--but you would almost 
begin to believe that 300 days ago Barack Obama arrived as President of 
the United States, and all these problems emerged miraculously. The 
fact is, in the previous 8 years we watched the Nation accumulate more 
debt in one administration than all prior 43 administrations combined.
  The situation we find ourselves in economically did not happen 
overnight. It happened over a number of years of carelessness, with a 
lack of regulation and a lack of the enforcement of the regulation that 
existed. We have been grappling with these problems. In December of 
last year, more than 700,000 people lost their jobs--in that 1 month 
alone. In January, almost 700,000 again, and the same was true in 
March. Almost 3 million jobs were lost before the ink on the 
inauguration papers was dry.
  We are now finding ourselves--while still too high an unemployment 
rate--with a vastly improved economic condition in this country. Much 
more needs to be done. Yet we hear the same sort of ``Chicken Little'' 
arguments. Just say no, every time, to an idea that might make a 
difference to this country getting back on its feet again.
  Certainly the decisions made a year ago to provide the stabilization 
of major financial institutions contributed directly to the benefits we 
are seeing today. Certainly the efforts of taking some of these 
resources that have gone to bail out major financial institutions now 
being used to try to create jobs in the country is something I think 
would be welcomed by the American people--not rejected by Members of 
Congress who seem only to be interested in whether we are going to take 
care of those large firms that got us into this mess in the first 
place.
  So I welcome the President's ideas in this area. We welcome 
particularly this effort on health care, to make a difference not only 
for individuals but for our economy, to reduce those costs, reduce 
those premiums, and make those insurance products available to all 
Americans who worry every night about whether they are going to fall 
into that abyss because of a health care crisis that happens to a 
family member or a loved one.
  So today we are going to hear from a number of our colleagues who 
have been deeply engaged in these issues over the last several years 
and in their new membership in this wonderful body of the Senate. I 
welcome tremendously their efforts.

[[Page S12650]]

  Mr. President, I yield the floor to allow them to discuss their 
ideas. I believe the first one to speak is our new colleague from 
Delaware.
  The ACTING PRESIDENT pro tempore. The Senator from Delaware is 
recognized.
  Mr. KAUFMAN. Mr. President, I want to start by agreeing--and I 
practically always agree with the Senator from Connecticut--with his 
summation as to how we got to where we are, and why it is important we 
do something about it. He is right. The chairman of the Finance 
Committee is right too.
  The freshman Senators who come from all over this country got 
together and, frankly, with the leadership of Senator Warner from 
Virginia, put together a package which I think is a very constructive 
package for the Health Care Reform Act we have to pass.
  I appreciate the opportunity to join with the other freshmen, 
including the Acting President pro tempore, to discuss the unique 
opportunity we have to finally enact meaningful health care reform.
  Make no mistake, we need health care reform now. When you look out 
there and you see everything from rising premiums to insurers denying 
coverage for people with preexisting conditions, the health care system 
is failing individual Americans. There is no doubt about that.
  Not only is it doing that, it is threatening the fiscal solvency of 
our country. Medicare and Medicaid are swallowing up more and more of 
our Federal spending. If we do not act soon, it will become the largest 
contributor to the deficit.
  The time for reform is now. We cannot wait any longer. As the Senator 
from Connecticut said, this is not something that just came out of 
nowhere. It has been there for a long time. But we cannot let any more 
time go by. We have to act now.

  Thanks to the hard work of Senators Reid, Baucus, Dodd, and Harkin 
and their staffs, we have a bill before us that can finally reform our 
health care system. It is a good bill. It is a bill that truly protects 
what works in our system and, at the same time, fixes what is broken.
  No longer will Americans be denied coverage on the basis of 
preexisting conditions. No longer will their coverage be revoked when 
they get sick and need it the most. This bill will help protect seniors 
by offering new preventive and wellness benefits.
  It will extend the solvency of the Medicare trust fund by an 
additional 5 years. It will also help our economy by significantly 
cutting health care costs and reducing the Nation's deficit by $130 
billion.
  You hear a lot of numbers. You see a lot of numbers. You read about 
it in the newspaper. Especially, you hear about it on the other side of 
the aisle. This will cut the deficit by $130 billion for the first 10 
years and maybe up to $650 billion in the second 10 years. This will 
truly bend the cost curve, which we have to do if we are not going to 
go into insolvency.
  It is interesting, when the other side talks about deficits, 
deficits, deficits--the thing that is driving the deficit is health 
care costs because what drives Medicare and Medicaid costs is health 
care costs.
  This bill makes quality, affordable health care within reach of all 
Americans. But there is always more we can do. That is why I am pleased 
to join my other freshman colleagues to support a very promising 
amendment to the bill.
  So much of what is broken in our present health care system revolves 
around basic inefficiencies that drive up costs, while simultaneously 
driving down quality. That is right. Costs go up, quality goes down. 
That is not the way we want to have it. We want costs to go down and 
quality to go up.
  Even worse, inefficiencies in the system often give way to the waste, 
fraud, and abuse that drains somewhere between $72 and $220 billion 
annually from doctors, patients, private insurers, and the State and 
Federal Governments. This is significantly increasing health care costs 
for Americans. These are inefficiencies that can and will be curbed.
  By seeking creative ways to encourage innovation and lower costs even 
further--and more quickly--for Americans across the country, this 
amendment complements the underlying health care bill.
  It adopts the full spectrum of 21st-century technologies and 
innovative methods of delivery to further cut through the redtape that 
continues to plague our system and stifle innovation. It provides 
commonsense, practical solutions that help contain costs, improve 
value, and increase quality. It increases penalties for health care 
fraud and enhances enforcement against medical crooks and utilizes the 
most sophisticated technology to better detect and deter fraud in the 
health care system.
  It quickens the implementation of uniform administrative standards, 
allowing for more efficient exchange of information among patients, 
doctors, and insurers. It provides more flexibility in establishing 
accountable care organizations that realign financial incentives and 
help ensure Americans receive high-quality care. It provides greater 
incentives to insurers in the exchange to reduce health care 
disparities along racial lines.
  These are just a few examples of the provisions in the amendment that 
I believe will mesh well with the Patient Protection and Affordable 
Care Act. As I have said before, it is time to gather our collective 
will and do the right thing during this historic opportunity by passing 
health care reform now. I think this amendment can help us reach that 
goal. We cannot afford to wait any longer. We need to act now. We can 
do no less. The American people deserve no less.
  Thank you, Mr. President.
  The ACTING PRESIDENT pro tempore. The Senator from Virginia is 
recognized.
  Mr. WARNER. Thank you, Mr. President.
  I thank my colleague, the Senator from Delaware, for his comments and 
for his leadership on this issue. I also thank all of the freshmen. 
This is, I think, the seventh time the freshmen have come to the floor 
on this very important issue. Our colleagues have had to now endure 65 
speeches from the freshmen on the subject of health care.
  Before I get into my remarks, I want to personally thank Senator 
Baucus, Senator Dodd, the majority leader, and their staffs, for 
working with the 11 freshmen Members who have come together today to 
unveil a package of health care amendments focused on the issue of cost 
containment.
  We have been working on this now for close to 3 months.
  Let me say at the outset, I am proud of the enormous broad-based 
support we are receiving for this package of amendments. The Business 
Roundtable has endorsed the amendments. Companies such as Walmart, 
Intel, Target and Quad/Graphics endorse this package. Groups such as 
the AARP and the AFL, and important think tanks such as the New America 
Foundation have endorsed this package. We also have support from Mark 
McClellan, who was the head of CMS under President Bush. While the 
merged bill starts to move us in the right direction in addressing 
health care spending in this country, this package strengthens that 
movement. Our package further moves us away from a current system that 
makes no financial sense--one that rewards volume over quality and one 
that reimburses hospitals for higher, rather than lower, readmission 
rates.
  We are taking the payment reform aspects of the health care bill--
sections that increase accountability, and focus on data mining and 
administrative simplification--and accelerating them. We are giving the 
Secretary, as we move forward, the ability to take pilot programs and 
broaden their approach and appeal. And if it works, we'll bring that 
reform to our whole system.
  While we anticipate a very good score from CBO in terms of lowering 
health care costs overall, another thing we focused on with this 
package is not just health care reform in the context of government-
related programs, such as Medicare and Medicaid, but also how we 
partner with those in the private sector.
  One of the reasons the Business Roundtable is so supportive is the 
fact that our package recognizes that well over half of the American 
public still receives their health care through private insurance or in 
conjunction with their employers. With these amendments, we look at how 
we take the best of the private sector, and the lessons we've learned 
from them, and bring those into health care reform.

[[Page S12651]]

  My friend, the Senator from Delaware, has raised this point. There 
are still issues to be resolved in this bill.
  I still have some concerns, particularly with the public option 
portion. But I know that with a good-faith effort, we are going to get 
those issues resolved.
  One thing that needs to be reaffirmed, time and time again, is what 
happens if we don't enact health care reform. Not acting is a policy 
choice; it is every bit as much of a policy choice as moving forward on 
this bill. What many don't realize is that the largest driver of our 
Federal deficit is not education funding, transportation funding, and 
not even TARP funds or the stimulus. The largest driver of our Federal 
deficit is health care spending.
  If we fail to act now, Medicare, which provides health care to 
millions of senior citizens, will go bankrupt in the next 8 years. If 
we fail to act now, an average Virginia family will see their health 
care costs eat up 40 percent of their disposable income in the next 
decade.
  One of the reasons we are seeing so much broad-based business support 
for our amendment package is business understands that if we can't 
drive down overall health care costs, the ability of the United States 
to come out of this recession and remain competitive in a global 
marketplace will be seriously undermined. As long as American business 
has to pay twice as much per person--as much as $3,000 to $4,000 more 
per employee--for their health care costs than any of our industrial 
competitors around the world, regardless of how productive the American 
workforce is, American businesses will be at a serious disadvantage.
  Our amendment package is complex. It is a bit dense. There are some 
30-odd different provisions that take very good parts of the merged 
bill and move them faster. It increases price transparency in health 
care pricing, and increases our ability to take programs and pilots 
that work and roll them out on a wider basis. My good friend, the 
Senator from Colorado, has been working hard on the administrative 
reform portion.
  This is a good package of amendments. I was asked yesterday by 
somebody in the press how I would describe the package. I guess I would 
sum it up--because some of this stuff gets fairly dense--with two 
things that this package of amendments is trying to do.
  I think we all remember, years back, in the travel industry, when you 
called up and tried to get an airline reservation and depending on whom 
you called and what time you called, you might get a totally different 
price on your airline ticket. Well, this package of amendments is 
trying to do for health care what Travelocity did for the airline 
business. And that is bring some true pricing transparency to the 
health care system.
  Our package of amendments will move us--it will not get us all the 
way there--but it will move us further down the field. I say this 
modestly, again, to the originators of the bill--it is a very good 
bill, a very good framework. But humbly I might say, as some know, I 
was lucky enough in the old days to fall into the cell phone industry. 
I managed to eke out a small living in that industry. I like to think 
about the cell phone industry as a metaphor for this package of 
amendments. If we think of the original bill as creating the cell phone 
of the 20th century, our package of amendments is basically the iPhone 
version to your Motorola flip phone original version. We literally 
provide dozens of new applications on a good, basic framework that has 
been provided by this merged bill. And we take these applications a 
little bit further into the 21st century.
  I am very proud of the work all these freshmen Senators and their 
staffs have done over the last 3 or 4 months. Again, I thank the 
chairman of the Finance Committee, the chairman of the HELP Committee, 
the majority leader and their staffs for helping us work through this 
package, and I look forward to its adoption.
  With that, I yield the floor, and I believe the junior Senator from 
Colorado will speak next.
  The ACTING PRESIDENT pro tempore. The Senator from Colorado is 
recognized.
  Mr. BENNET. Mr. President, I wish to thank our colleague from 
Virginia, Senator Warner, for his extraordinary leadership throughout 
this process of the freshmen coming together to see what we can do to 
move this legislation forward to improve it. I think a lot has been 
said about how the bill that was drafted by the HELP Committee, by the 
Finance Committee, and now by the majority leader is directionally 
correct in its efforts to get a handle on these skyrocketing costs. I 
think this amendment package will move us much further in the right 
direction of trying to hold down costs for our working families and 
small businesses across the country.
  Throughout this entire debate and going back to the very beginning, 
what I have said is, no matter where you are on many of the issues, 
there can't be any disagreement that the current system, with respect 
to costs, is completely insane. Our families in Colorado faced double-
digit cost increases every year over the last decade. Their median 
family income has actually gone down by $300, and the cost of health 
care has gone up by 97 percent over that period of time. Our small 
businesses are paying 18 percent more for health insurance than large 
businesses just because they are small. As the Senator from Virginia 
was mentioning, we are spending, as a country, more than twice what 
almost any other industrialized country in the world is spending as a 
percentage of our gross domestic product on health care. We are 
spending roughly 18 percent, going to 20 percent in the blink of an 
eye. We can't hope to compete in this global economy if we are devoting 
a fifth of our economy to health care and everyone else in the world is 
devoting less than half that. Finally, as the Senator from Virginia 
also said, if you have any concern about these deficits we are facing 
in Washington becoming completely untenable, what you need to know is, 
the biggest driver of those is rising Medicare and Medicaid costs and 
the biggest driver of those is, of course, health care costs.
  So my view has been, from the start, no matter what your entry point 
was into this debate, cost was the central question for our working 
families and for our small businesses. We have stressed the need over 
and over for health care reform to contain the rising costs that are 
plaguing our current system. That is why I think the Senate needs to 
adopt the freshman amendment package, which would cut costs, save 
taxpayers money, and in this bill it can make our health care system 
function more efficiently.
  This package of amendments will help strengthen the reform proposal's 
ability to deliver affordable, quality health care to all Americans, 
whether they are in private plans or whether they are in public plans. 
These provisions will remove much of the redtape that, for so long, has 
slowed the delivery of care. Doctors from all over Colorado have told 
me, time and time again, their medical practices are mired in paperwork 
and their staffs spend far too much time and money jumping through 
administrative hoop after hoop. The time our doctors and nurses spend 
on unnecessary paperwork is time they can't spend becoming better 
professionals and, most importantly, providing quality care to their 
patients. This amendment will require the Secretary of Health and Human 
Services to adopt and regularly update a single national standard for 
some of the most basic electronic transactions that occur between 
insurers and providers, and meeting these standards will be enforceable 
by penalties if insurance providers don't take steps to comply. My 
provision will make sure that as we implement health care reform, we 
are consistently identifying and implementing new standards.
  There are also terrible inefficiencies in the way we pay health care 
providers and allow them to deliver care to patients. This package 
helps eliminate bottlenecks so patients are cared for in a reasonable 
amount of time.
  This package of amendments also expands the Senate bills reforms 
being made to Medicare and Medicaid. There is a provision that will 
allow accountable care organizations to work with private insurance 
companies to better craft strategies for Medicare and Medicaid and 
private sector plans to improve care. In the current system, doctors 
are forced into requesting a multitude of tests to confirm a diagnosis 
they have already made. This creates

[[Page S12652]]

unnecessary work for doctors, their administrative staffs, lab 
technicians, and so on. It is time we create a system that empowers 
doctors to practice medicine and do their jobs efficiently.
  Under the current broken system, doctors have to endure needless 
hurdles to even set up a practice. It is no wonder the number of 
primary care doctors has been steadily declining for some time now.
  This package of amendments would create an environment that attracts 
doctors back to the field rather than make it more difficult for them 
to provide care. Along with the savings this bill already creates, 
these amendments will help doctors remove the redtape that has limited 
their ability to help patients in a timely manner.

  We cannot go on allowing the middle class to absorb the rising costs 
of our Nation's health care system. We need health care reform that 
will control costs and put us back on a path toward fiscal 
responsibility. This package of amendments will help us do that.
  I wish to, again, say thank you to my colleagues from the freshman 
class for their work. This sometimes has seemed tedious and sometimes 
hard to describe, but these amendments are very critical if we are 
going to get hold of costs as we go forward. That is the relief working 
families in this country need more than anything. In order to have 
stability in their lives, we have to get hold of our rising health care 
costs.
  With that, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Massachusetts is 
recognized.
  Mr. KIRK. Thank you, Mr. President.
  With great joy and enthusiasm, I can say that today we are closer 
than ever to guaranteeing that all Americans, at long last, will have 
full access to quality, affordable health care. The Patient Protection 
and Affordable Care Act, which our colleague and fellow freshman 
Senator Jeff Merkley of Oregon suggests, as Senator Kennedy of 
Massachusetts would have subscribed to, that this is the health care 
bill of rights. It will help fix a health care system that is failing 
to meet the needs of the American people. I am extremely proud to join 
with Majority Leader Reid, with Senator Baucus, with my good friend, 
Senator Dodd of Connecticut, and with my fellow freshman Senators. I 
wish to single out, if I may, the Senator from Virginia, Mark Warner, 
one of the more enlightened business leaders of our time, who brought 
his wisdom and innovation and skills and practices of the private 
sector to help improve the important challenge we have in the public 
sector. I thank the Senator for his leadership on this effort, in 
contributing to legislation that will mark a historic stride forward 
for the American people.
  I wish to say a word as well, a particular word, about the chairman 
of the Finance Committee who has enormous responsibilities in the 
Senate chairing the effort to reform our financial regulations and our 
financial systems so the American people will understand we are one 
country, with one important financial system and not somehow second 
tier, unrelated and unconnected to the decisions made on Wall Street 
and elsewhere. When Senator Kennedy of Massachusetts was stricken, 
Senator Dodd of Connecticut stepped forward, not only because Senator 
Kennedy was his very close friend but because the Senator from 
Connecticut understood the enormity of the challenge and important 
effort that is being made in the Senate. I wish to salute him for 
sharing his wisdom and his strength and his leadership, not only in the 
areas of financial reform but in this important area as well.
  As I said, this is nothing less than a bill of rights for the 
American people on the issues of health care. With this legislation, 
all Americans, finally, will be guaranteed access to the affordable 
health care coverage they deserve. Families who need a helping hand to 
care for an aging relative will be protected. Insurance companies will 
be prohibited from arbitrarily refusing coverage and from stopping 
benefits when they are needed the most. Doctors will be given the 
support they need to practice the best medicine possible. That is why 
they took their oath. With the help of the measures in this total 
legislation and some of the particular reforms suggested by our 
freshman colleagues, that best medicine will be practiced. The American 
economy will be protected from the skyrocketing costs of health care, 
with which every American family is now inflicted.
  Over the past month, I have had the privilege of working with my 
fellow freshman colleagues on a series of amendments that we are 
discussing this morning to make this health care bill of rights even 
stronger. These amendments plant the seed for an innovative 21st-
century health care system that offers what American families want 
most: better results for lower costs. It is as simple as that. These 
amendments focus on the root causes of our skyrocketing health care 
costs to provide Medicare the support it needs to become a leader in 
moving away from the reimbursement models that increase costs without 
improving care.
  Public-private arrangements will be established to smooth reform and 
prevent private insurance from shifting costs onto public plans. The 
redtape, with which we are all familiar, which weighs down the current 
health care system in both the public and private sectors will be 
reduced. All of this will contribute to lower costs and higher quality 
in our health care system.
  One focus that is particularly of interest and important to me is the 
delivery system reform. We must move toward a system of paying 
hospitals and doctors for the quality of care they provide rather than 
the quantity of tests and procedures they perform. Our amendment 
rewards providers of Medicare who give high-quality care rather than 
high-volume procedures. We will also allow Medicare to test promising 
new models to reduce costs, increase quality, and improve patient 
health. We must make these changes for the sake of our patients and for 
the sake of our economy.
  In short, our amendments strengthen the reforms of the Patient 
Protection and Affordable Care Act. I urge all my colleagues to support 
these amendments and take these important steps with us to bring 
America's health care system into the 21st century.
  I thank the leadership once again, and I thank the Senator from 
Virginia and my other freshman colleagues for their good work on this 
historic health care bill of rights.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Colorado is 
recognized.
  Mr. UDALL of Colorado. Mr. President, my freshman colleagues and I 
have come to the floor on a regular basis over the last few months to 
make clear to both sides of the aisle just how critical it is that we 
succeed in reforming our health care insurance system.
  Right now, too many Americans lack the freedom to move to a new job, 
further their education, or start a small business because doing so can 
put them at risk of losing health care coverage for their family. If 
you think about it, freedom is, after all, about choices. What 
motivates me--and I know it motivates my freshman colleagues--is the 
desire to preserve and enhance the freedom of all Americans.
  This legislation we have been debating and amending over the past 2 
weeks can and should be a vehicle that we use to enhance freedom for 
all of our American citizens. We are going to repair and modernize a 
broken health care system. If we fail to do so, we perpetuate an 
antiquated status quo that stalls economic growth, stifle the 
entrepreneurs who make up the American business landscape, and keep 
stability and security out of reach for millions of American families.
  The package of amendments we present today is designed to inject more 
cost containment into the bill, cut down on regulatory and bureaucratic 
redtape, and push us more aggressively toward a reformed health care 
system that rewards better patient care rather than simply more care.
  In developing these ideas, my fellow freshmen and I have relied upon 
the input of people back home. And through my discussions with 
constituents, health care providers, and businesses from all over 
Colorado, a common theme has emerged: They want a health care system 
that tackles costs, while keeping the focus on patients and quality. I 
believe we have accomplished that with our freshman proposal because 
more than 30 groups have come out in the past few days in support of

[[Page S12653]]

our efforts. This is a wide-ranging number of groups, including 
consumer champions such as AARP, business leaders such as the Business 
Roundtable, and health providers such as Denver Health in my home 
State.
  My freshman colleagues have spoken about individual pieces of this 
effort that combine to make the whole. I will single out a section that 
I think will have a particularly strong influence on the future of our 
health care system.
  Senator Rockefeller has authored an important provision that creates 
the independent Medicare advisory board. This board would be tasked 
with keeping down the costs in the Medicare system by issuing proposals 
to cut spending and increase the quality of care for beneficiaries.
  I applaud this contribution to the bill, but I have wondered why we 
cannot take it a step further by looking at the whole health care 
system and not just Medicare in isolation. If we are going to tackle 
spiraling health costs across the country, we need to push each area of 
our health care system to be smarter and more efficient in dealing with 
cost growth.
  One of my contributions to the package is a provision to expand the 
scope of the Medicare advisory board to examine not just Medicare but 
the entire health care system and task the board with finding ways to 
slow down the growth of health costs across the country. This would 
include providing recommendations on the steps the private sector 
should take to make our delivery system more efficient. Health care 
leaders and economists agree that such an approach can help push our 
system toward a more streamlined and coordinated way of delivering 
health care to all Americans.
  In sum, I thank the Senator from Virginia for his leadership, the 
Senator from Oregon, Mr. Merkley, and Senator Shaheen from New 
Hampshire. It has been a delight to work with 11 of my fellow Senators. 
This is a bold contribution to the package that I know we will pass out 
of the Senate. We come from varying parts of the country and have 
varied political outlooks and backgrounds. This will attract broad 
support in our Chamber. It is a winning addition to health care reform, 
and I encourage all Senators to support our efforts.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from New Hampshire is 
recognized.
  Mrs. SHAHEEN. Mr. President, I am so pleased this morning to join my 
freshman colleagues in introducing our innovation and value package.
  For the last several months, the freshmen in the Senate have been 
coming to the floor to help make the case for health care reform, to 
tell our colleagues and the public about what we have heard from our 
constituents, and to come together as one voice in support of reform.
  Today, we back up that rhetoric with action. Today, we propose 
something concrete. We have talked about the importance of reforming 
the way we deliver care, about how we need to slow down the 
skyrocketing costs of health care, while improving quality, and about 
the need to provide incentives to make the changes happen. Today, we 
deliver on that talk. Our proposals are about containing costs, about 
looking into the future, thinking about our delivery system, and 
finding ways to make small but very important changes that will make a 
difference.
  Throughout this debate, I have been talking about the importance of 
increasing the quality of care while reducing the cost. This amendment 
package does just that.
  This amendment package matters. It matters to all the health care 
consumers who are interested in reducing costs and increasing the value 
in our health care system. It especially matters to business. The high 
cost of health care and insurance coverage eats away at the bottom line 
for businesses. If we can reduce waste and inefficiency, attack fraud, 
and simplify our system, we can reduce costs. The innovations in this 
package attract business because business understands that we need to 
take steps in our public and private health care systems to lower costs 
and deliver value.

  I am proud that, with this amendment, we are able to promote the good 
work of Elliot Fisher and his colleagues at the Dartmouth Institute for 
Health Policy and Clinical Practice and to recognize the work they have 
done on accountable care organizations.
  Accountable care organizations are about coordinating care among 
providers--hospitals, primary care physicians, specialists, and other 
medical professionals. These accountable care organizations make 
decisions with patients. I think that is the operative phrase. They 
make decisions ``with'' patients about what steps they can take 
together to improve care. When these efforts result in cost and quality 
improvements, providers and consumers can share in the savings. This is 
the essence of true reform. We must demand performance, quality, and 
value from our health care system. This package makes great strides.
  I will close by thanking all of my fellow freshmen. I am so proud to 
be part of this freshman class and all of the great work they have 
done.
  I especially wish to recognize Senator Warner, who has really been 
the driving force behind this health care package. I am not sure I 
agree with his cell phone analysis, but I certainly agree with the 
leadership he has shown on this package.
  Also, I recognize our senior colleagues, Senators Dodd, Baucus, Reid, 
and Harkin, for the leadership they have shown in getting us to this 
point.
  Finally, I recognize all of the staff of all of us freshman Senators, 
many of whom are here today, who have worked so hard to get us to this 
point. I single out my assistants, Alison MacDonald and Dr. Manny 
Jimenez, for the work they have done on this package. It is a great 
effort, and I am pleased to be here with my fellow freshmen.
  I urge all of our colleagues to join us in support of this effort.
  The ACTING PRESIDENT pro tempore. The Senator from North Carolina is 
recognized.
  Mrs. HAGAN. Mr. President, I rise in support of the freshman value 
and innovation package, which builds on efforts to provide quality, 
affordable health care at a lower cost to families. I, too, applaud our 
colleague, Senator Mark Warner, for helping to initiate this package.
  I wish to take a moment to talk about two provisions in the package 
that I included: curbing fraud and abuse with 21st-century technology 
and medication therapy management.
  Today, Medicare spends about $430 billion annually; Medicaid, 
approximately $340 billion; the States Children's Health Insurance 
Program, an additional $5 billion, for a total of $775 billion.
  In Medicare alone, annual waste amounts to between $23 billion and 
$78 billion. Yet, despite these sky-high numbers, investigations are 
pursued only after payment has been made, which means government fraud 
investigators have to recover funds that have already been paid. As a 
result, it is estimated that only about 10 percent of possible fraud is 
ever detected, and of that amount only about 3 percent is ever actually 
recovered. This means the government recovers, at best, about $130 
million in Medicare waste, fraud, and abuse. Again, when estimates are 
between $23 billion and $78 billion, we are only recovering $130 
million.
  ``Doctor shopping'' is an example that was profiled in a recent USA 
TODAY news article and GAO report. This involves a patient receiving 
multiple prescriptions from numerous doctors in a short period of time, 
without getting caught. Each of the claims gets paid by Medicare, 
Medicaid, or even private health insurers.
  The current technology exists to assess in real time if a claim 
warrants further investigation, and this technology will prevent 
fraudulent claims from being paid on the front end. A software company 
in Cary, NC, SAS, has developed this technology.
  This amendment will require the Department of Health and Human 
Services to put into place systems that will detect patterns of fraud 
and abuse before any money leaves our Federal coffers.
  Another source of waste in the system is people not sticking to their 
medication regimen. As much as one-half of all patients in our country 
do not follow their doctors' orders regarding their medications. The 
New England Health Care Institute estimates that the overall cost of 
people not following directions is as much as $290 billion per year.

[[Page S12654]]

  This waste can be eliminated with medication therapy management. That 
is a program where seniors bring all of their prescriptions, in a 
little brown bag, and their over-the-counter medications and their 
vitamins and supplements to the pharmacy to be thoroughly reviewed in a 
one-on-one session. The pharmacist follows up and educates the patient 
about his or her medication regimen.
  North Carolina has some successful medication therapy management 
programs already in place.
  In 2007, the North Carolina Health and Wellness Trust Fund Commission 
launched an innovative statewide program called Checkmeds NC to provide 
medication therapy management services to our seniors. During the 
program's first year, more than 15,000 seniors and 285 pharmacists 
participated. Just this small program saved an estimated $10 million, 
and countless health problems were avoided for our seniors.
  This amendment takes this successful North Carolina model and 
implements it nationally, permitting pharmacies and other health care 
providers to spend considerable time and resources evaluating a 
person's drug routine and educating them on proper usage.
  I urge passage of this freshman amendment package which will further 
reduce health care costs for American families. Thank you.
  Mr. UDALL of New Mexico. Madam President, I seek recognition.
  The PRESIDING OFFICER (Mrs. Gillibrand). The Senator from New Mexico.
  Mr. UDALL of New Mexico. Madam President, this package today is a 
result of collaboration that began months ago when the Senate's 
freshman class united as advocates for comprehensive health reform, 
when we united in the belief that the status quo is not an option.
  The health care status quo does not work for Americans and it does 
not work for America either. If we fail to act, every person, every 
institution, every small business in this country will pay the price.
  Achieving true reform means making insurance available and affordable 
to all Americans. It also means reining in out-of-control spending. For 
some, those two goals seem diametrically opposed. They ask: How can you 
contain costs when you are expanding access to millions of additional 
people?
  One of our country's great economic thinkers, Paul Krugman, recently 
challenged this hypothesis. First, he said a majority of Americans 
uninsured are young and healthy. Covering them would not increase costs 
very much. Second, he noted that this reform links coverage expansion 
to ``serious cost-control measures.''
  These goals are two sides of the same coin. Without one, we cannot 
have the other. As Mr. Krugman said:

       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.

  With these amendments, we take additional steps to transform our 
delivery system, to contain costs, and to curb abuses and excess 
spending. With these amendments, we encourage a faster transition to a 
21st-century system that is more efficient, costs less, and holds 
providers and insurers accountable.
  I am proud to sign on to all of the amendments in this package. But 
there is one proposal that is particularly important to the people of 
New Mexico. In my State, 30 of 33 counties are classified as medically 
underserved. Residents of these highly rural counties are more likely 
to be uninsured. They are more likely to have higher rates of disease. 
And because of a shortage in health care providers, they are often 
forced to travel long distances for care.
  This amendment would help us take the first steps toward alleviating 
the growing shortage of primary care physicians in New Mexico and 
across the country. By 2025, there will be a shortage of at least 
35,000 primary care physicians in the United States. As this shortage 
grows, our rural areas will be hardest hit.
  In this amendment, we call for expert recommendations on how to 
encourage providers to choose primary care and to establish their 
practices in medically underserved areas. These experts would analyze 
things such as compensation and work environment. They would recommend 
ways to increase interest in primary care as a career.
  We are closer than ever to providing all Americans with access to 
quality, affordable health care. I am proud to be a part of a group of 
freshmen who refuse to sit on the back bench and watch this reform 
develop from the sidelines. I am proud to be part of a group that from 
the beginning refused to accept the status quo as an option.
  I thank the staff of all these fine Senators and thank personally my 
staff members, Fern Goodheart and Ben Nathanson.
  I look forward to continuing the work with this outstanding group as 
we debate a bill that will improve our health care system for 
generations to come.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. BURRIS. Madam President, it is also my pleasure to stand with my 
colleagues and be a part of this health reform package, to give 
recognition to those distinguished senior Senators who have put so much 
heart into drafting this important legislation, to our Leader Reid and 
to Senator Baucus, Senator Dodd, and all the individuals. It is a 
pleasure for me to be a part of this freshman colloquy on this major 
package.
  Over the past several months, my freshman colleagues and I have taken 
the floor many times to speak about the need for comprehensive health 
care reform. I am pleased to join them today as we discuss our cost 
containment package.
  This set of provisions will help promote accountability, increase 
efficiency, and reduce disparities in our health care system. Our 
amendment will reinforce and improve the principles of high-value, low-
cost care that is central to the Patient Protection and Affordable Care 
Act.
  Our amendment will strengthen Medicare's ability to act as a payment 
innovator, paying for value and not for volume. In speeding this 
process, our amendment gives Medicare more of the resources it needs to 
gather data, expand programs that work, and reach the neediest 
patients.
  We also work to strengthen waste, fraud, and abuse provisions in the 
Patient Protection and Affordable Care Act in order to make sure that 
the Department of Health and Human Services has the tools to not only 
punish offenders but to prevent fraud from happening in the first 
place.
  But this is not just about our public programs. We also promote 
private-public data sharing to get a better picture of our whole 
medical system.
  Our amendment further takes aim at administrative costs, another 
barrier often cited to getting the most effective care, by encouraging 
public-private collaboration to create uniform standards and reduce the 
mountain of paperwork that takes doctors' time away from their 
patients.
  Finally, we put pressure on private insurers to change the way they 
pay. By encouraging insurers to reward programs that reduce 
disparities, providers will increasingly focus attention on populations 
that need it most.
  By proactively targeting these needy folks through cultural 
competency training, language services, and community outreach, our 
amendment will increase wellness and reduce the use of costly emergency 
room care.
  My colleagues and I are supported by top business groups, consumer 
groups, and providers because they all know we have to transform the 
way care is delivered in this country. Businesses know that without the 
reduced cost of care and promoting transparency, the cost of premiums 
continues to rise, putting a stranglehold on wage increases and making 
them less competitive.
  Consumer groups want to ensure the patients get more value for their 
dollar, that they do not just get more care but they get the type of 
coordinated, effective care that will keep them healthy and out of the 
emergency rooms. Those providers who focus on targeted care to get the 
best patient outcome want to be rewarded for doing so.
  The evidence could not be clearer, the conclusions could not be more 
decisive that the Patient Protection and Affordable Care Act, coupled 
with our amendment, will lower costs for ordinary Americans.

[[Page S12655]]

  I call upon my colleagues to take an honest look at what we are 
doing, and I defy them to say that health care reform will not reduce 
costs and improve the functioning of our health care system.
  The debate over health care reform cannot be scoring political 
points. It must be about the health and well-being of the American 
people. All of our great work will bear fruit, and we will reform our 
Nation's health system because there is no other option. Our citizens 
demand it, and they deserve no less.
  I thank our distinguished colleagues. I am happy to be a part of this 
freshman colloquy in presenting such an important issue at this time in 
history in this great country of ours.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. BEGICH. Madam President, I seek the floor to talk about this 
package of cost containment offered by the freshmen. I am proud to join 
them in offering this amendment today.
  The technical work in this package is complex and complicated, but 
the themes it addresses are simple and straightforward, which I know 
our colleagues on the other side will appreciate and we hope support--
value, innovation, quality, transparency, and cost containment.
  The full legislation now under debate in the Senate makes wonderful 
strides in fixing what is broken in America's current health care 
system. Under the leadership of Senators Baucus, Dodd, Harkin, and our 
Majority Leader Reid, the committees have done incredible work.
  What the freshmen are saying today is we believe our package can 
help. We can go further. We can do better. Our goal is a health care 
system that is more efficient and more affordable.
  In a few moments, I will stand together at a news conference with all 
my freshman colleagues to formally announce this package. What I most 
appreciate is that we will do so with the support of consumer and 
business groups.
  While the language of this amendment promotes efficiency and 
encourages innovation within the health delivery system, what it is 
about is helping individual Americans and businesses get a better deal 
on health care. I am proud of that, especially when we know that cost 
containment is the No. 1 priority of small business owners in this 
health reform debate.
  Insurance premiums alone in the last 10 years for small businesses 
have risen 113 percent. It was reported in the media that small 
businesses in this country face another 15-percent increase in the 
health premiums in the coming year.
  What about families, our friends, and our neighbors? Health insurance 
premiums are eating up ever growing chunks of the family budget. 
Nationwide, family health insurance purchased through an employer at 
the start of this decade cost about $6,700, almost 14 percent of the 
family income. Last year, the same premium cost $13,000--21 percent of 
the family income.
  If we do nothing, if we do not reform the system and do not contain 
costs, this country will be in big trouble. By 2016, the same family 
health insurance will cost more than $24,000. Because health costs are 
skyrocketing compared to wages, that $24,000 will represent 45 percent 
of the family budget. Enough is enough. The package we are offering 
today will help.
  I want to focus briefly on a small but significant piece of this 
package that addresses rural health care. It will help hospitals in 
several States, including Alaska, my home State, by extending the Rural 
Community Hospital Demonstration Program. We are building on known 
success. The program is small. Even with this amendment, the number of 
eligible hospitals nationwide will expand from 15 to 30, and 20 rural 
States will be eligible to participate instead of the current 10.
  Part of what we are saying in this package is this: If something is 
working to provide better health care access and value, for goodness 
sake, let's keep it going and do what we can to improve on it.
  My thanks go to Senator Ben Nelson who has been a champion of this 
program and is also pushing for the extension.
  As I conclude, I wish to stress once again how proud I am to stand 
with my freshman colleagues. The cost containment package we are 
proposing today will help all Americans, and I hope it will move the 
Senate that much closer to a historic vote on the landmark legislation 
that is before us today.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. WARNER. Madam President, I know our time is about to expire. I 
wish to close by thanking all my freshman colleagues and their staffs 
for the great work they have done on this legislation.
  I see a number of my colleagues from the other side of the aisle. 
This is an amendment package that brings greater transparency, greater 
accountability, greater efficiency, and greater innovation, and is 
supported by the Business Roundtable, small businesses and health care 
systems around the country. I ask for their consideration.
  I again thank the Chair, Senator Dodd, for allowing us to lay out 
this package of amendments. I think it will add an important component 
to this bill in trying to rein in costs not just on the government side 
but systemwide.
  I yield the floor.
  Mr. DODD. Madam President, quickly, because I know my colleagues are 
here on the other side, I want to commend 10 of the 11 new freshmen who 
are here and who have spoken with great eloquence and passion about 
this issue. I think all of us, regardless of which side of the aisle we 
are on, owe them all a great deal of gratitude for putting together a 
very fine package.
  I particularly thank Senator Mark Warner, our colleague from 
Virginia, who has led this effort, but obviously so much of this has 
happened because of the cooperation and ideas that each Member who has 
spoken here this morning has brought to this particular cluster of 
ideas on cost containment. All Americans owe them a deep debt of 
gratitude and can feel pretty good about the future of our country with 
this fine group of Americans leading it.
  The PRESIDING OFFICER. The minority now has 60 minutes.
  Mr. BAUCUS. Madam President, may I ask unanimous consent to speak for 
a couple of minutes to comment on the freshman package? It will just 
take a few minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Madam President, I join my good friend from Connecticut 
in thanking--I don't know if calling them freshmen would be wise, 
because our colleagues act as though they have been here for years and 
know the subject extremely well.
  Delivery system reform has always been something I have been pushing 
for, and I am happy to see it is part of your package, and also with 
additional emphasis on rural areas and Indian reservations. We clearly 
need more of that, and more transparency. I firmly believe that will 
help us get costs down and get quality of care up. Your work on the 
independent Medicare advisory board is great too.
  To be honest, these are all the next steps in ideas that are pretty 
much in the bill, but they are the proper next steps, and the next 
steps I firmly believe should be taken. So I compliment you and thank 
you very much, and I thank my friend from Arizona for allowing me this 
time.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Madam President, I wish also to add my words of 
congratulations to the new Members for their eloquence, their passion, 
and their well-informed arguments, although they are badly misguided. 
But I do congratulate them for bringing forth their ideas and taking 
part in this spirited debate. We welcome it, and I hope that someday we 
will be able to agree on both sides for us to engage in real colloquy 
between us, back and forth. I think the American people and all Members 
would be well informed.
  Madam President, I ask unanimous consent for the next 30 minutes to 
engage in a colloquy with my colleagues.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. Madam President, I talk a lot about C-SPAN. I am a great 
admirer of C-SPAN. And the President--at least when he was running for 
the presidency--believed in C-SPAN as

[[Page S12656]]

well, because he said C-SPAN would be in on the negotiations. Here is 
what was posted by a reporter from Politico last night at 5:48 p.m., 
entitled ``No C-SPAN Here.''

       Right now a group of moderate Senators is meeting behind 
     closed doors to try to hash out a compromise on the public 
     option. Reporters, waiting for the meeting to break, were 
     just moved out of the corridor nearest the meeting and 
     shunted around the corner, making it harder for the press to 
     catch Senators as they leave. C-SPAN this is not.

  I would remind my colleagues that the amendment we are discussing 
here is drafted to prevent drastic Medicare Advantage cuts from 
impacting all seniors in Medicare Advantage. The amendment says simply: 
Let's give seniors who are members of Medicare, who have enrolled in 
Medicare Advantage, the same deal that Senator Nelson was able to get 
for the State of Florida--at least most of the seniors who enrolled in 
the Medicare Advantage Program. There are 11 million American seniors 
who are enrolled in the Medicare Advantage Program. This amendment 
would allow all 11 million to have the same benefits and there would be 
no carve-out for various groups of seniors because of the influence of 
a Member of this body.
  I want to quote again the New York Times, my favorite source of 
information, from an article entitled ``Senator Tries to Allay Fears on 
Health Overhaul.''

       . . . Mr. Nelson, a Democrat, has a big problem. The bill 
     taken up this week by the committee would cut Medicare 
     payments to insurance companies that care for more than 10 
     million older Americans, including nearly one million in 
     Florida. The program, known as Medicare Advantage, is 
     popular--

  And the article lists the benefits, and then continues as follows:

       ``It would be intolerable to ask senior citizens to give up 
     substantial health benefits they are enjoying under 
     Medicare,'' said Mr. Nelson, who has been deluged with calls 
     and complaints from constituents. ``I am offering an 
     amendment to shield seniors from those benefit cuts.''

  He is offering an amendment to shield senior citizens. Well, I am 
offering a motion that deals with all of the 11 million seniors who are 
under Medicare Advantage, as the Senator from Florida said, to shield 
seniors from benefit cuts. That is what this motion is all about. We 
should not carve out for some seniors what other seniors are not 
entitled to. That is not America. That is not the way we should treat 
all of our citizens, and I hope my colleagues will understand this 
amendment is proposed simply in the name of fairness.
  I ask the Senator from Tennessee and the Senator from Texas, who have 
a large number of enrollees in the Medicare Advantage Program, whether 
they feel this would be unfair?
  Mr. ALEXANDER. Well, I thank the Senator from Arizona for his motion, 
and I thank the Senator from Florida for his amendment, because 
Medicare Advantage is very important to Tennesseans. We have 243,000 
Tennesseans who have opted for Medicare Advantage. About one-fourth of 
all Americans who are on Medicare have chosen Medicare Advantage 
because it provides the option for increased dental care, for vision 
care, for hearing coverage, for reduced hospital deductibles, and many 
benefits. It is helpful to low-income and minority Americans, and it is 
especially helpful to people in rural areas.
  What the Republicans have been arguing all week is that, contrary to 
what our friends on the other side are saying, this bill cuts those 
Medicare Advantage benefits. The Director of the Congressional Budget 
Office says that fully half--fully half--of the benefits in Medicare 
Advantage for these 11 million Americans will be cut. Our Democratic 
friends say: No, that is not true. That is not true. We are going to 
cut $1 trillion out of Medicare over a fully implemented 10-year period 
of this bill, but nobody will be affected by it.
  Well, the Senator from Florida apparently doesn't believe that. He 
says: We have 900,000 Floridians who don't want their Medicare 
Advantage cut. And he is saying, in effect, we don't trust this 
Democratic bill to protect these seniors in Medicare Advantage.
  So I ask the Senator from Texas: If the people of Florida and the 
Senator from Florida don't trust the Democratic bill to protect 
Medicare Advantage, why should 240,000 Tennesseans trust the Democratic 
bill to protect Medicare Advantage?
  Mr. CORNYN. I agree with the distinguished Senators from Tennessee 
and Arizona, that what is good enough for the seniors in Florida ought 
to be good enough for all seniors. In my State of Texas, we have 
532,000 seniors on Medicare Advantage, and they like it, for the 
reasons that the Senator from Tennessee mentioned. They do not want us 
cutting those benefits.
  But I say to the Senators from Arizona and Tennessee, I seem to 
recall that we had amendments earlier which would have protected 
everybody from cuts in Medicare benefits, and now we have a targeted 
effort, negotiated behind closed doors, to protect States such as 
Florida and Pennsylvania and others, and I wonder whether the Nelson 
amendment to protect the seniors of Florida would even be necessary if 
our colleagues across the aisle had agreed with us that no Medicare 
benefits should be cut.
  Mr. McCAIN. As the Senator points out, a few days ago, by a vote of 
100 to 1, we voted to pass an amendment proposed by the Senator from 
Colorado, Senator Bennet, which included words such as ``protecting 
guaranteed Medicare benefits'' or ``protecting and improving guaranteed 
Medicare benefits.'' The wording was: ``Nothing in the provisions of or 
amendments made by this act shall result in the reduction of guaranteed 
benefits under title XVIII of the Social Security Act.''
  Is there any Member on the other side who can guarantee that seniors 
in his or her State in Medicare Advantage will not lose a single 
benefit they have today--not the guaranteed benefit the other side goes 
to great pains to talk about. I think those who are enrolled in the 
Medicare Advantage system believe that since they receive those 
benefits, they are guaranteed benefits as well.
  I would ask our two physicians here on the floor, who both have had 
the opportunity to deal directly with the Medicare Advantage Program, 
if you have a patient come in and you say: By the way, you are having 
your Medicare Advantage Program cut, but don't worry, we are protecting 
your guaranteed Medicare benefits, do you think they understand that 
language?
  Mr. COBURN. I would respond to the Senator from Arizona in the 
following way. First of all, they won't understand that language. But 
more importantly, if you look at the law, there is Medicare Part A, 
Medicare Part B, Medicare Part C, and Medicare Part D. They are all 
law. They are all law. What is guaranteed under the law today is that 
if you want Medicare Advantage, you can have it. What is going to 
change is that we are going to take away that guarantee. We are going 
to modify Medicare Part C, which is Medicare Advantage.
  So we have this confusing way of saying we are not taking away any of 
your guaranteed benefits, but in fact, under the current law today, 
Medicare Advantage is guaranteed to anybody who wants to sign up for 
it. So it is duplicitous to say we are not cutting your benefits, when 
in fact we are.
  Let me speak to my experience and then I will yield to my colleague 
from Wyoming, who is an orthopedic surgeon.
  What is good about Medicare Advantage? We hear it is a money pot to 
pay for a new program for other people. Here is what is good about it. 
We get coordinated care for poor Medicare folks. Medicare Advantage 
coordinates the care. When you coordinate care, what you do is you 
decrease the number of tests, you prevent hospitalizations, you get 
better outcomes, and consequently you have healthier seniors.
  So when it is looked at, Medicare Advantage doesn't cost more. It 
actually saves Medicare money on an individual basis. Because if you 
forgo the interests of a hospital, where you start incurring costs, 
what you have done is saved the Medicare Trust Fund but you have also 
given better care.
  The second point I wish to make is that many people on Medicare 
Advantage cannot afford to buy Medicare supplemental policies. Ninety-
four percent of the people in this country who are on Medicare and not 
Medicare Advantage are buying a supplemental policy. Why is that? 
Because the basic underlying benefit package of Medicare is not 
adequate. So here we have this

[[Page S12657]]

group of people who are benefitted because they have chosen a 
guaranteed benefit of Medicare Part C, and all of a sudden we are 
saying: Time out. You don't get that anymore.
  Mr. McCAIN. So a preponderance of people who enroll in Medicare 
Advantage are low-income people, and a lot of them are rural residents?
  Mr. COBURN. A lot of them are rural. I don't know the income levels, 
but I know there is a propensity for actually getting a savings, 
because you don't have to buy a supplemental policy if you are on 
Medicare Advantage.
  Mr. BARRASSO. I would add to that, following on my colleague from 
Oklahoma, that there is the coordinated care, which is one of the 
advantages of Medicare Advantage, but there is also the preventive 
component of this. We talk about ways to help people keep their health 
care costs down, and that has to do with coordinated care and 
preventing illness.
  Mr. COBURN. And we heard from the freshman Democrats that they want 
to put a new preventive package into the program. Yet they want to take 
the preventive package out of Medicare Advantage. It is an interesting 
mix of amendments, isn't it?
  Mr. BARRASSO. We want to keep our seniors healthy. That is one way 
they can stay out of the hospital, out of the nursing home, and stay 
active. Yet with the cuts in Medicare Advantage, the Democrats have 
voted to do that--to cut all the money out of this program that seniors 
like. Eleven million American seniors who depend upon Medicare for 
their health care choose this because there is an advantage to them.
  My colleague from Oklahoma, the other physician in the Senate, has 
talked, as I have, extensively about patient-centered health care--not 
insurance centered, not government centered. Medicare Advantage helps 
keep it patient centered. So when I see deals being cut behind closed 
doors where they are cutting out people from all across the country and 
providing sweetheart deals to help seniors on Medicare Advantage in 
Florida in order to encourage one Member of the Senate to vote a 
certain way, I have to ask myself: What about the seniors in the rest 
of the country, whether it is Texas, Oklahoma, Tennessee, or Arizona?
  A lot of seniors have great concern, and I would hope they would call 
up and say this is wrong; we need to know what is going on, and to ask 
why it is there is a sweetheart deal for one selected Senator from one 
State when we want to have that same advantage; and why are the 
Democrats voting to eliminate all this Medicare money.
  Mr. CORNYN. May I ask my colleagues a question--maybe starting with 
the Senator from Arizona--on a related issue. Medicare Advantage is a 
private sector alternative or choice to Medicare, which is a 
government-run program. I am detecting throughout all of this bill sort 
of a bias against the private sector and wanting to eliminate choices 
that aren't government-run plans.
  Am I reading too much into this or do any of my colleagues see a 
similar propensity in this bill?
  Mr. ALEXANDER. If I may respond to the Senator from Texas, I think he 
is exactly right. There is a lot of very appealing talk that we hear 
from the advocates of the so-called health reform bill. But when we get 
right down to it, and when we examine it closely, we find a big 
increase in government-run programs. What does that mean for low-income 
Americans, and what does it mean for seniors who depend on our biggest 
government-run programs, Medicare and Medicaid? It means they risk not 
having access to the doctor they want. The Senator from Wyoming 
mentioned the Mayo Clinic, widely cited by the President and by many on 
the other side as an example of controlling costs, is beginning to say: 
We can't take patients from the government-run programs in some cases 
because we are not reimbursed properly.
  What is going to happen behind all this happy talk we are hearing 
about health care is, we are going to find more and more low-income 
patients dumped into a program called Medicaid. Under this program half 
the doctors will not see a new Medicaid patient. It is akin to giving 
someone a bus ticket on a bus line that runs half the time. Medicare is 
going to increasingly find itself in the same shape as Medicaid. The 
Mayo Clinic has already said they can't afford to serve patients from 
the government-run programs. The Senator from Texas is exactly right. 
We don't have to persuade the 11 million Americans who have chosen 
Medicare Advantage that it is a good program. They like it. In rural 
areas, between 2003 and 2007, more than 600,000 people signed up for 
it. In a way, the Senator from Florida may have a sweetheart deal, but 
in a way he has done us a favor. We have been trying to say all week 
the Democrats are cutting Medicare. They are saying: Trust us, we are 
not cutting Medicare. The Senator from Florida is saying: Floridians 
don't trust you. You are cutting their Medicare Advantage. I want to 
have an amendment to protect them. Senator McCain is saying: Let's 
protect all seniors' Medicare Advantage.
  Mr. McCAIN. May I also point out, for the record, on September 20, 
2003, there was a letter to the conferees of Medicare, urging them to 
include a meaningful increase in Medicare Advantage funding for fiscal 
years 2004-2005--a group of 18 Senators, including Senators Schumer, 
Lautenberg, Clinton, Wyden, et cetera, including Senator Kerry, who now 
obviously wants to reduce the funding for Medicare Advantage. Again, 
perhaps he was for it before he was against it.
  I would also like to point out, as short a time ago as April 3, 2009, 
a group of Senators, bipartisan, including Senators Wyden, Murray, 
Specter, Bennet, Klobuchar, and others, wrote to Charlene Frizzera, 
acting administrator of the Centers for Medicare and Medicaid Services:

       We write to express our concerns regarding the Centers for 
     Medicare and Medicaid Services' proposed changes to Medicare 
     Advantage rates for calendar year 2010. The advance notice 
     has raised two important issues that, if implemented, would 
     result in highly problematic premium increases and benefit 
     reductions for Medicare Advantage enrollees across the 
     country.

  Again, as recently as last April, there was concern on the other side 
about cuts in the Medicare Advantage Program.
  Mr. COBURN. I wonder if the Senator is aware, in Alabama, there will 
be 181,000 people who will get a Medicare Advantage cut; in California, 
1,606,000 seniors are going to have benefits cut; Colorado, 198,000; 
Georgia, 176,000; Illinois, 176,000; Indiana, 148,000; Kentucky, 
110,000; Louisiana, 151,000; Massachusetts, 200,000; Michigan, 
406,000--that is exactly what Michigan needs right now, isn't it, for 
their seniors to have their benefits cut--Minnesota, 284,000; Missouri, 
200,000; Nevada, 104,000; New Jersey, 156,000; New York, 853,000; Ohio, 
499,000; Oregon, 250,000; Pennsylvania--maybe, maybe not because they 
may have the deal--865,000; Tennessee, 233,000; Washington State, 
225,000; Wisconsin, 243,000.
  I ask unanimous consent that the list of what the enrollment is by 
CMS on Medicare and Medicare Advantage enrollment, as of August 2009, 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 
----------------------------------------------------------------------------------------------------------------
                                                           MA Enrollment                         MA Penetration
                         State                             (August 2009)        Eligibles          (percent)
----------------------------------------------------------------------------------------------------------------
Alabama-...............................................            181,304            819,112               22.1
Alaska-................................................                462             61,599                0.8
Arizona-...............................................            329,157            876,944               37.5
Arkansas...............................................             70,137            515,175               13.6
California-............................................          1,606,193          4,562,728               35.2
Colorado...............................................            198,521            591,148               33.6
Connecticut............................................             94,181            553,528               17.0
Delaware...............................................              6,661            142,716               4.7-
DC.....................................................              7,976             75,783               10.5

[[Page S12658]]

 
Florida................................................            946,836          3,239,150              29.2-
Georgia................................................            176,090          1,176,917             15.0 -
Hawaii.................................................             79,386            197,660               40.2
Idaho..................................................             60,676            218,225              27.8-
Illinois...............................................            176,395          1,792,581                9.8
Indiana................................................            148,174            973,732               15.2
Iowa...................................................             63,902            508,942              12.6-
Kansas.................................................             43,867            421,593               10.4
Kentucky...............................................            110,814            735,953             15.1 -
Louisiana..............................................           151,954-            664,692              22.9-
Maine..................................................             26,984            256,214               10.5
Maryland...............................................             56,812           754,638-                7.5
Massachusetts..........................................            199,727          1,029,357               19.4
Michigan...............................................            406,124          1,597,119              25.4-
Minnesota..............................................            284,101            758,981              37.4-
Mississippi............................................             44,772            483,403               9.3-
Missouri...............................................            195,036            976,397              20.0-
Montana................................................             27,592            162,779              17.0-
Nebraska...............................................             30,571            273,589             11.2.-
Nevada.................................................            104,043            336,581             30.9.-
New Hampshire..........................................             13,200            208,125                6.3
New Jersey.............................................            156,607          1,294,052               12.1
New Mexico.............................................             73,567            299,538               24.6
New York...............................................            853,387          2,909,216               29.3
North Carolina.........................................            251,738          1,424,360               17.7
North Dakota...........................................              7,633            106,969               7.1-
Ohio...................................................            499,819          1,852,596               27.0
Oklahoma...............................................             84,980            585,906               14.5
Oregon.................................................            249,993            593,232               42.1
Pennsylvania...........................................            864,040          2,233,074               38.7
Puerto Rico............................................            400,991            631,298               63.5
Rhode Island...........................................             65,108            179,044              36.4-
South Carolina.........................................            110,949            734,772              15.1-
South Dakota...........................................              8,973            133,420                6.7
Tennessee..............................................            233,024          1,015,771               22.9
Texas..................................................            532,242          2,853,472               18.7
Utah...................................................             85,585            269,378              31.8-
Vermont................................................              3,966            106,562               3.7.
Virginia...............................................            151,942          1,094,976              13.9-
Washington.............................................            225,918            919,899               24.6
West Virginia..........................................             88,027            375,303               23.5
Wisconsin..............................................            243,443            883,419               27.6
Wyoming................................................              3,942             77,197                5.1
----------------------------------------------------------------------------------------------------------------

  Mr. McCAIN. The point of all this is, the Senator from Florida, a 
member of the Finance Committee, felt so strongly that Medicare 
Advantage was at risk he decided to carve out, and was able to get the 
majority on a party-line vote of the Finance Committee to carve out a 
special status for a group of seniors under Medicare Advantage in his 
State. My motion simply says, everyone whom the Senator from Oklahoma 
made reference to deserves that same protection. That is all this 
motion is about.
  Mr. CORNYN. If the Senator would yield for a question, if this motion 
is not agreed to, which protects all Medicare Advantage beneficiaries--
all 11 million of them, 532,000 in my State--and as a result of not 
only these cuts but perhaps additional cuts to come in the future to 
Medicare Advantage, which will make it harder for Medicare 
beneficiaries to get coverage, I ask particularly my doctor colleagues, 
what is the impact of eliminating Medicare Advantage and leaving people 
with Medicare fee for service, which is, as I recall, the Bennet 
amendment earlier? You have to parse the language closely, but it 
talked about guaranteed benefits. I think the Senator from Oklahoma 
makes a good point. Right now, Medicare Advantage has guaranteed 
benefits.
  Mr. COBURN. Absolutely.
  Mr. CORNYN. What is the consequence of seniors losing Medicare 
Advantage and being forced onto a Medicare fee-for-service program?
  Mr. COBURN. Limited prevention screening, no coordinated care, loss 
of access to certain drugs, loss of accessory things, such as vision 
and hearing supplementals, but, more importantly, poorer health 
outcomes. That is what it is going to mean--or a much smaller 
checkbook, one or the other. A smaller checkbook because now the 
government isn't going to pay for it--you are--or poorer health 
outcomes. If your checkbook is limited, the thing that happens is, you 
will get the poorer health outcome.
  Mr. BARRASSO. Additionally, the Senator from Arizona talked about the 
closed-door meetings, secretly trying to come up with things.
  There was an article in the paper today that the Democrats are 
turning to actually throwing more people on the Medicare and Medicaid 
rolls as they are trying to come up with some compromise; the idea 
being it is going to be compromising the care of the people. They are 
trying to put more people onto the Medicaid rolls. The Senator from 
Tennessee has said many physicians don't take those patients because 
reimbursement is so poor. It is putting more people into a boat that is 
already sinking. They want to put more people on Medicaid and more on 
Medicare, but at the same time they are cutting Medicare by $464 
billion. This is a program we know is already going broke. Yet they 
want to now put people age 55 to 64, add those to the Medicare rolls, 
which is a program we have great concerns about.
  Special deals for some, cutting out many others, now adding more 
people to the Medicare rolls--to me, this is not sustainable. Yet these 
are the deals that are being cut less than 100 feet from here off the 
floor of the Senate, when we are out here debating for all the American 
people to see the things we think are important about health care. Jobs 
are going to be lost as a result, if this bill gets passed. People who 
have insurance will end up paying more in premiums, if this bill is 
passed. People who depend on Medicare, whether it is Medicare Advantage 
or regular Medicare, will see their health care deteriorate as a result 
of this proposal. I turn to the Senator from Arizona, who has been a 
special student of this.
  Mr. McCAIN. So seniors, by losing Medicare Advantage, would then lose 
certain provisions Medicare Advantage provides and then they would be 
forced, if they can afford it, which they are now paying zero because 
it is covered under Medicare Advantage, then they would have to buy 
Medigap policies that would make up for those benefits they lost when 
they lose Medicare Advantage.
  Guess who offers those Medigap insurance policies. Our friends at 
AARP, which average $175 a month. We are telling people who are on 
Medicare Advantage today, when they lose it, they can be guaranteed, if 
they want to make up for those benefits they are losing, they would be 
paying $175 a month, minimum, for a Medigap policy. A lot of America's 
seniors cannot afford that.
  Mr. COBURN. That is $2,000 a year.
  Mr. McCAIN. They can't afford it.
  Mr. COBURN. I will make one other point. Over the next 10 years, 15 
million baby boomers are going to go into Medicare. We are taking $465 
billion out of Medicare; on the 10-year picture, $1 trillion. So we are 
going to add $15 million and cut $1 trillion. What do you think is 
going to happen to the care for everybody in Medicare? The ultimate

[[Page S12659]]

is, we are going to ration the care for seniors, if this bill comes 
through.
  Mr. McCAIN. How much time remains, Madam President?
  The PRESIDING OFFICER. Five minutes is remaining.
  Mr. McCAIN. I ask Dr. Barrasso, have you treated people under 
Medicare Advantage?
  Mr. BARRASSO. I have. People know there is an advantage to being in 
this program, and that is why they sign up for it. That is why citizens 
all around the country have signed up for Medicare Advantage. They 
realize there is value in prevention and there is value in coordinated 
care. There is value in having eye care, dental care, hearing care. 
There are advantages to wanting to stay healthy, to keep down the cost 
of care.
  Mr. McCAIN. So you are making the case that even though it may cost 
more, the fact that you have a weller and fitter group of senior 
citizens, you, in the long-run, reduce health care costs because they 
take advantage of the kind of care that, over time, would keep them 
from going to the hospital earlier or having to see the doctor more 
often.
  Mr. BARRASSO. That is one of the reasons that Medicare Advantage was 
brought forth. I know a lot of Senators from rural States supported it 
because it would allow people in small communities to have this 
advantage to be in a program such as that. It could encourage doctors 
to go into those communities to try to keep those people well, work 
with prevention. The 11 million people who are on Medicare Advantage 
know they are on Medicare Advantage. They have chosen it. It is the 
fastest growing component because people realize the advantages of 
being on Medicare Advantage. If they want to stay independent, healthy, 
and fit, they sign up for Medicare Advantage. I would think people all 
across the country, who are seniors on Medicare but are not on Medicare 
Advantage, would want to say: Why didn't I know about this program? As 
seniors talk about this at senior centers--and I go to centers and 
meetings there and visit with folks and hear their concerns--they are 
converting over and joining, signing up for Medicare Advantage because 
they know there are advantages to it. For this Senate and the Democrats 
to say: We want to slash over $100 billion from Medicare Advantage, I 
think the people of America understand this is a great loss to them and 
a peril to their own health, as they lose the coordinated care and the 
preventive nature of the care.
  Mr. McCAIN. I ask the Senator from Tennessee, do you know of any 
expert economist on health care who believes we can make these kinds of 
cuts in Medicare Advantage and still preserve the same benefits the 
enrollees have today?
  Mr. ALEXANDER. The answer to the Senator from Arizona is no. I do not 
know of one. I know of one Senator at least who does not believe it. He 
is the Senator from Florida. It is interesting that all week we have 
been going back and forth. We have been saying to the Democrats: You 
are cutting Medicare benefits. They have been saying: No, we are not.
  We have been saying: Yes, you are.
  No, we are not.
  I am sure the people at home must say: Well, who is right about this? 
Well, the Senator from Florida, who sits on the other side of the 
aisle, has said: I am not willing to go back to Florida and say to the 
people of Florida that your benefits are going to be cut if you are on 
Medicare Advantage, so I want an amendment to protect you. The Senator 
from Texas wants and amendment to protect 11 million seniors and so 
does the Senator from Oklahoma and so does the Senator from Louisiana 
and so does the Senator from Wyoming, and the Senator from Tennessee.
  So the Senator from Arizona is saying, we believe you are cutting 
Medicare Advantage benefits for 11 million Americans. The Senator from 
Florida does not trust your bill. We do not either. We want an 
amendment that protects 11 million seniors.
  Mr. CORNYN. Madam President, I would ask our Senators to expand in 
the brief time we have. It seems as if all of the discussion about 
health care reform is a bit about accountable care organizations, 
coordinating care, particularly in the later part of life, avoiding 
chronic diseases in life.
  When I was at Kelsey-Seybold Clinic in Houston, TX, they told me it 
is Medicare Advantage that allows them to coordinate care, to hold down 
costs, to keep people healthier longer. Yet the irony, to me, it seems, 
is that by cutting Medicare Advantage benefits, we are going backward 
rather than forward when it comes to that kind of coordinated, less 
expensive care.
  Would the Senator concur with that?
  Mr. BARRASSO. I would concur that this is actually taking a step 
backward. That is why the Senator from Florida has demanded they make 
accommodations for the people of Florida. The people of Wyoming want 
those same accommodations, as do the people of Arizona and Texas. 
Because 11 million Americans have chosen the Medicare Advantage Program 
because it does help coordinate care. It has preventive care. It keeps 
it more patient centered as opposed to government centered, insurance 
company centered. That is the way for people to stay healthy, live 
longer lives, and keep their independence.
  We have seen cuts across the board on Medicare, whether it is home 
health, nursing homes, hospice care, Medicare Advantage. And across the 
board, they are cutting Medicare in a way that certainly the seniors of 
this country do not deserve. They have paid into that program for many 
years and they deserve their benefits.
  Mr. ALEXANDER. If I may say to the Senator from Arizona one other 
thing, we have talked a lot about our good friend, the Senator from 
Florida, and how he has been so perceptive on noticing that his 
Floridians with Medicare Advantage may lose their Medicare benefits.
  The PRESIDING OFFICER. The Senator's time is expired.
  Mr. McCAIN. Madam President, I ask unanimous consent for an 
additional 30 seconds for the Senator.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ALEXANDER. I say to the Senator from Arizona, I believe there are 
other Medicare benefits that are likely to be cut in this bill. Aren't 
there cuts to hospice? Aren't there cuts to hospitals? Aren't there 
cuts to home health care, which we talked about yesterday? So if 
Floridians do not trust the Democratic bill to protect their Medicare 
benefits from Medicare Advantage, why should they trust the Democratic 
bill to protect any of their Medicare benefits?
  Mr. McCAIN. I wish to finally point out what Dr. Coburn said. 
Medicare Part C, which is Medicare Advantage, is part of the law, and 
to treat it in any way different, because those on the other side do 
not particularly happen to like it, I think is an abrogation of the 
responsibilities we have to the seniors of this country.
  I thank my colleagues and yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.


                           Amendment No. 2962

  Mrs. HUTCHISON. Madam President, I rise today to talk about another 
amendment that is pending, the Nelson-Hatch-Casey amendment. This is an 
amendment that I think has been discussed in the last day as well. That 
is the amendment that would assure that no Federal funds are spent for 
abortion. That was unclear. It is unclear in the underlying bill. I 
think it is very important we talk about it, that we make sure it is 
very clear exactly what the Nelson-Hatch-Casey amendment does; and that 
is, it would bar Federal funding for abortion, which is basically 
applying the Hyde amendment to the programs under this health care 
bill.
  Since the Hyde amendment was first passed in 1977, the Senate has had 
to vote on this issue many times, probably just about every year, and I 
have consistently voted to prohibit Federal funding for abortions, as I 
know my colleague and friend from Utah has done, as well as the 
Democratic sponsors of this amendment.
  Yet it seems that some Members were on the floor last night 
misconstruing exactly what the Nelson-Hatch-Casey amendment does. 
Specifically, their claim was that the Hyde language only bars direct 
funding for elective abortions while the Nelson-Hatch-Casey amendment 
bars funding of an entire benefits package that includes elective 
abortions and therefore is unprecedented.

[[Page S12660]]

  I wish to ask the distinguished Senator from Utah, what exactly did 
the Hyde language say? Let's clarify what Hyde was, so we can then 
determine if your amendment is the same.
  Mr. HATCH. I thank the Senator so much.
  The current Hyde language contained in the fiscal year 2009 Labor-HHS 
Appropriations Act says the following:

       Sec. 507. (a) None of the funds appropriated in this Act, 
     and none of the funds in any trust fund to which funds are 
     appropriated in this Act, shall be expended for any abortion.
       (b) None of the funds appropriated in this Act, and none of 
     the funds in any trust fund to which funds are appropriated 
     in this Act, shall be expended for health benefits coverage 
     that includes coverage of abortion.

  Mrs. HUTCHISON. So Federal funds are prohibited from being used in 
abortions in that particular bill.
  What about programs such as CHIP, that was created in the Balanced 
Budget Act? And in 2009, it was reauthorized by Congress and signed by 
the President earlier this year. What about the CHIP program?
  Mr. HATCH. I know a little bit about CHIP. That was the Hatch-Kennedy 
bill. I was one of the original authors of the program and insisted 
that the following language be included in the original statute:

                  limitation on payment for abortions

       (A) In general.--Payment shall not be made to a State under 
     this section for any amount expended under the State plan to 
     pay for any abortion or to assist in the purchase, in whole 
     or in part, of health benefit coverage that includes coverage 
     of abortion.
       (B) Exception.--Subparagraph (A) shall not apply to an 
     abortion only if necessary to save the life of the mother or 
     if the pregnancy is the result of an act of rape or incest.

  That is what the CHIP bill said, and that was the Hatch-Kennedy bill.
  Mrs. HUTCHISON. I would assume you do know what is in that bill. What 
about the Federal Employees Health Benefits Plan, what does it say?
  Mr. HATCH. The reason I mentioned Senator Kennedy is because he was 
the leading liberal in the Senate at the time, and yet he agreed to 
that language.
  As to the Federal Employees Health Benefits package, the following 
language appears in the Financial Services and General Government 
Appropriations Act for fiscal year 2009:

       Sec. 613. No funds appropriated by this Act shall be 
     available to pay for an abortion, or the administrative 
     expenses in connection with any health plan under the Federal 
     employees' health benefits program which provides any 
     benefits or coverage for abortions.
       Sec. 614. The provisions of Section 613 shall not apply 
     where the life of the mother would be endangered if the fetus 
     were carried to term, or the pregnancy is the result of an 
     act of rape or incest.

  Mrs. HUTCHISON. Well, isn't that the same as the language in the 
Nelson-Hatch-Casey amendment?
  Mr. HATCH. You are absolutely right.
  Let me read the language for you in the Nelson-Hatch-Casey amendment.

       In general.--No funds authorized or appropriated by this 
     Act (or an amendment made by this Act) may be used to pay for 
     any abortion or to cover any part of the costs of any health 
     plan that includes coverage of abortion.

  Mrs. HUTCHISON. So based on what you have said, this is not new 
Federal abortion policy. The Hyde amendment currently applies to the 
plans discussed, including the plans that Members of Congress have. And 
the abortion protections for all of the Federal health programs all say 
exactly the same thing.
  The amendment we are going to vote on that is the Nelson-Hatch-Casey 
amendment would preserve the three-decades-long precedent--that is what 
your amendment does--and that we must pass it if we are going to 
guarantee that the bill that is on the floor is properly amended so it 
is the same as our 30 years of abortion Federal policy in this country?
  Mr. HATCH. Right. The reason it is so critical we pass the Nelson-
Hatch-Casey amendment is that it is the only way to guarantee that 
taxpayers' dollars are not used by the insurance plans under the 
Democrats' bill to pay for abortions. In other words, the Hyde language 
is in the appropriations process. We have to do it every year rather 
than making it a solid amendment. But this bill is not subject to 
appropriations. So if we leave the Hyde language out of this bill, the 
language we have in the amendment, the Nelson-Hatch-Casey amendment, 
then we would be opening up a door for people who believe that abortion 
ought to be paid for by the Federal Government to do so. And we should 
close that door because that has been the rule since 1977.
  Mrs. HUTCHISON. I thank the Senator for the explanation. I thank the 
Senator from Utah because I do think it is important people know. There 
has been a lot of questions raised about the bill and whether it would 
be a foot in the door for changing a policy that has been the law of 
our country, and accepted as such. Whether it was a Democratic-
controlled Congress or a Republican-controlled Congress, I think 
everyone has agreed this Hyde amendment language has protected Federal 
taxpayers who might have a very firm conviction against abortion so 
they would not have to be subsidizing this procedure.
  Mr. HATCH. I appreciate the Senator from Texas pointing this out. The 
current bill has language that looks like it is protective, but it is 
not. That is what we are trying to do: close the loophole in that 
language and get it so we live up to the Hyde amendment, which has been 
in law since 1977.
  To be honest with you, I do not see how anybody could argue that the 
taxpayers ought to be called upon to foot the bill for abortions. Let's 
be brutally frank about it. The taxpayers should not be called upon to 
pay for abortions. The polls range from 61 percent of the American 
people, including many pro-choice people, who do not believe taxpayers 
should pay for abortions, to 68 percent. The polls are from 61 to 68 
percent of those who do not believe the taxpayers ought to be paying 
for abortion, except to save the life of the mother or because of rape 
or incest. And we have provided for those approaches in this amendment. 
So anybody who argues otherwise is plain not being accurate.
  Mr. SPECTER. Madam President, will the Senator from Utah be willing 
to yield for a question?
  Mr. HATCH. Sure.
  Mr. SPECTER. My question relates to the provisions of the pending 
bill, section 1303(2)(A), which specifies that the plan will not allow 
for any payments of abortion, and where there is, as provided under 
section 1303(2)(B), there will be a segregation of funds. So that under 
the existing statute, there is no Federal funding used for abortion. 
But a woman has the right to pay for her own abortion coverage. And 
with the status of Medicaid, where the prohibition applies to any 
Federal funds being used to pay for an abortion, there are 23 States 
which allow for payment for abortion coverage coming out of State 
funds.
  So aren't the provisions of this statute, which enable a woman to pay 
for an abortion on her own, exactly the same as what is now covered 
under Medicaid, without violating the provisions of the Hyde amendment?
  Mr. HATCH. Well, the way we view the current language in the bill is 
that there is a loophole there whereby they can even use Federal funds 
to provide for abortion under this segregation language, and that is 
what we are concerned about. We want to close that loophole and make 
sure that the Federal funds are not used for abortion.
  Like I say, there are millions of people who are pro-choice who agree 
with the Hyde language. All we are doing is putting the Hyde language 
into this bill in a way that we think will work better.
  Mr. SPECTER. If the Senator will yield further.
  Mr. BROWNBACK. Will the Senator yield for a comment?
  Mr. HATCH. I would be happy to yield.
  Mr. BROWNBACK. In responding to the Senator from Pennsylvania as 
well, I wish to quote Bart Stupak, who carried the same sort of 
amendment you are putting forward, only on the House side. The same 
sorts of questions, naturally, were coming forward, saying: OK, you are 
blocking abortion funding for the individual. He said this--and I am 
quoting directly from Representative Stupak:

       The Capps amendment--Which is in the base Reid bill here--
     departed from Hyde in several important and troubling ways: 
     by mandating that at least one plan in the health insurance 
     exchange provide abortion coverage, by requiring a minimum $1 
     monthly charge for all covered individuals that would go 
     toward paying for abortions and by allowing individuals 
     receiving Federal affordability credits--


[[Page S12661]]


  Those are Federal dollars--

     to purchase health insurance plans that cover abortion. . . .

  In all those ways, the Capps amendment--which is in the Reid bill--
expands and does allow Federal funding of abortion that we have not 
done for 33 years.
  Going on with Representative Stupak's statement:

       Hyde currently prohibits direct federal funding of 
     abortion. . . . The Stupak amendment--

  Which is also the Nelson-Hatch amendment--

     is a continuation of this policy--

  Of the Hyde amendment--

     nothing more, nothing less.

  I think it is important to clarify that this is a continuation of 
what we have been doing for 33 years that the Senator from Utah and the 
Senator from Nebraska are putting forward with this amendment.
  I thank my colleague for yielding.
  Mr. HATCH. Madam President, I thank my colleague for bringing it 
forward. The segregation language is very problematic language. That is 
what we are trying to resolve. We basically have all agreed with the 
Hyde amendment, which is from 1977, and this would, in effect, 
incorporate the language in the bill.
  Mr. JOHANNS. Would the Senator yield for another comment?
  Mr. HATCH. Sure.
  Mr. JOHANNS. I might just offer a thought here on that language. The 
National Right to Life group saw through that gimmick immediately. It 
took them about 20 seconds to figure out what was happening here. I 
think they referred to it as a ``bookkeeping gimmick,'' that somehow 
there would be some segregation if the Federal money went in your left 
pocket but you paid for abortions out of your right pocket. It doesn't 
make any sense. That segregation isn't going to work. They saw through 
it. They saw the gimmick it was.
  Let me just say, I support the Senator's amendment. I applaud Senator 
Hatch and Senator Nelson and Senator Casey for bringing this very 
important issue forward. I applaud you for keeping this effort that 
started with the Hyde amendment--or Hyde language, rather--because what 
we are really doing here is we are saying very clearly to the American 
people, whether directly or indirectly, your tax dollars are not going 
to be used to buy abortions.
  Thank you for your leadership on this issue. I am happy to be here to 
support that.
  Mr. SPECTER. Would the Senator from Utah respond to my question? How 
can you disagree with the provisions of section 1303(2)(A) of the bill 
which is pending which specifies that if a qualified health plan 
provides services for abortion--this is the essence of it--if a 
qualified health plan provides coverage for services for abortion, the 
issuer of the plan should not use any amount of the Federal funds for 
abortion? So there is a flatout prohibition for use of Federal funds. 
And under section 1303(2)(B), there is a segregation of funds which is 
identical to Medicaid.
  So however you may want to characterize it, how do you respond to the 
flat language of the statute which accomplishes the purpose of the Hyde 
amendment and allows for a payment by collateral funds, just as 
Medicaid pays for abortions without Federal funds?
  Mr. HATCH. Let me respond to the distinguished Senator, although I am 
not going to ask him a formal question. If that is true, then why have 
the Capps language in there? Why don't we just take the Hyde language, 
which is what we are trying to do. It isn't true. We know in this bill 
there will be subsidization to help people pay for health insurance. In 
fact, the subsidization can go to people up to $88,000 a year, and that 
could be indirectly used for abortion. It is a loophole that Hyde 
closes.
  If the distinguished Senator from Pennsylvania believes the Capps 
language does what Hyde meant to begin with and what it has been since 
1977, what is wrong with putting the Hyde language in here and solving 
the problem once and for all? We see it as a loophole through which 
they can actually get help from the Federal Government directly and 
indirectly to pay for abortion.
  Now, let's think about it. There are no mandates in this language 
that we have for elective abortion coverage. Plans and providers are 
free from any government mandate for abortion. There is no Federal 
funding of elective abortion or plans that include elective abortion 
except in the cases where the life of the mother is in danger or the 
pregnancy is caused by rape or incest. The amendment allows individuals 
to purchase a supplemental policy from a plan that covers elective 
abortion as long as it is purchased with private dollars. The amendment 
prohibits the public plan from covering elective abortions. It prevents 
the Federal Government from mandating abortion coverage by private 
health plans or providers within such plans. And insurance plans are 
not prevented from selling truly private abortion coverage, even 
through the exchange. This amendment doesn't prohibit that.
  The bottom line: The effect on abortion funding and mandates is 
exactly the same as that of the House bill changed by the Stupak 
amendment.
  Now, look, if the distinguished Senator from Pennsylvania believes 
the Capps language is the same as Hyde, he is wrong. And if he believes 
it does what Hyde would do, he is wrong there. Why not just put the 
Hyde language in once and for all, which has been there since 1977? 
That is what the Stupak language is.
  The Hyde amendment specifically removes abortion from government 
programs, but the Reid bill specifically allows abortion to be offered 
in two huge new government programs. The Reid bill tries to explain 
this contradiction by calling for the segregation of Federal dollars 
when Federal subsidies are used to purchase health plans. This 
``segregation'' of funds actually violates the Hyde amendment which 
prevents funding of abortion not only by Federal funds but also by 
State matching funds within the same plan. Simply put, today, Federal 
and State Medicaid dollars are not segregated. So that is the 
difference.
  If the distinguished Senator from Pennsylvania believes the current 
language in the Reid bill meets the qualities of the Hyde language, 
then why not just put the Hyde language in once and for all since it 
has been in law since 1977?
  It is important to note that today there is no segregation of Federal 
funds in any Federal health care program. For example, the Medicaid 
Program receives both Federal and State dollars. There is no 
segregation of either the Federal Medicaid dollars or the State 
Medicaid dollars.
  With that, I know I have some colleagues who have asked for some time 
to speak, so I will yield the floor.
  Mr. VITTER addressed the Chair.
  Mr. SPECTER. The Senator from Utah has not yet answered the question.
  The PRESIDING OFFICER. The Senator from Louisiana is recognized.
  Mr. VITTER. Thank you, Madam President.
  I strongly support the efforts of the distinguished Senator from Utah 
and his amendment offered along with Senator Nelson and Senator Casey. 
And I think this exchange and this colloquy is very helpful. In fact, I 
think it proves the point, particularly the participation of the 
Senator from Pennsylvania in it. The only folks who are defending the 
language in the Reid bill are folks who are clearly and strongly pro-
choice, pro-abortion. Folks who have a fundamental problem with that 
all say the underlying language in the Reid bill has huge loopholes. 
That includes people who want to support the bill otherwise. I am 
strongly against this bill. I am not in that category. But, as the 
distinguished Senator, Mr. Brownback, mentioned, Representative Stupak 
wants to support the underlying bill. He supported it in the House, but 
he was very clear in his efforts on the House floor that the underlying 
language, which is now in the Reid bill, had huge loopholes, wasn't 
good enough, needed to be fixed. That is why he came up with the Stupak 
language, and that is essentially exactly what we have in this 
amendment.
  Similarly, the U.S. Conference of Bishops is very supportive of the 
concepts of the underlying bill, but they have said clearly that the 
Reid bill is ``completely unacceptable'' on this abortion issue and 
``is actually the worst bill we have seen so far on the life issues.''

[[Page S12662]]

  So this colloquy involving the distinguished Senator from 
Pennsylvania, I think that general debate proves the point clearly.
  I again compliment the Senator from Utah, along with Senator Nelson, 
Senator Casey, and others--I am a cosponsor of the amendment--on this 
effort. We need to pass this on the bill. This will do away with the 
loophole. This will be real language to truly prohibit taxpayer funding 
of abortions. This constitutes exactly the same as that long tradition, 
since 1977, of the Hyde amendment. This marries the Stupak language, so 
it should be crystal-clear.
  What will this amendment specifically do? It will mean there are no 
mandates for elective abortion coverage. Plans and providers are free 
from any government mandate for abortion under this amendment language. 
It would mean there is no Federal funding of elective abortion or plans 
that include elective abortion except in the case of when the life of 
the mother is in danger or in case of rape or incest. It means this 
amendment would allow individuals to purchase a supplemental policy or 
a plan that covers elective abortion as long as that separate policy is 
purchased completely with private dollars. It would prohibit the public 
plan from covering those elective abortions and prevent the Federal 
Government from mandating abortion coverage by any private plan. 
Insurance plans are not prevented from selling truly private abortion 
coverage, including through the exchange, but taxpayer dollars would 
have nothing--absolutely nothing--to do with it.
  Bottom line: The effect on abortion funding and mandates is exactly 
the same as the long and distinguished tradition of the Hyde amendment 
with this amendment, and it would be exactly the same as the Stupak 
language on the House side.
  I also agreed with the distinguished Senator from Utah when he said 
this should not be of any great controversy. Abortion is a deeply 
divisive issue in this country, but taxpayer dollars being used to pay 
for abortion is not. There is a broad and a wide and a deep consensus 
against using any taxpayer dollars to pay for abortion. The Senator 
from Utah mentioned polls. That is why the Hyde amendment has been 
longstanding since 1977. That is why it has been voted for and 
supported and passed again and again in Congresses with Democratic 
majorities and Republican majorities. It is a solid consensus. It does 
represent the common sense of the American people. Certainly, I will 
follow in a similar, proud tradition of Louisiana Senators supporting 
that consensus. Every U.S. Senator from Louisiana since the Hyde 
amendment was originally adopted has strongly supported this 
commonsense consensus view--every Senator. Everyone but me has been 
Democratic, but every sitting U.S. Senator from Louisiana has supported 
that commonsense consensus view, and I surely hope that tradition 
continues today.
  Again, I applaud the Senator from Utah and his leading cosponsors, 
Senator Nelson and Senator Casey, on this effort, and I encourage all 
of my colleagues, Democrats and Republicans, to come together around 
what the American people consider a real no-brainer, a true consensus, 
something that clearly reflects the common sense of the American 
people. Is abortion a divisive issue? Yes. Is using taxpayer dollars to 
fund abortion a close question? No. There is a clear consensus in 
America not to use any taxpayer dollars to fund abortion. It is 
crystal-clear that we need to pass this amendment, and the underlying 
language in the Reid bill is completely unacceptable.
  With that, thank you, Madam President. I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Madam President, I am very appreciative of the Senator 
from Texas, the distinguished Senator from Louisiana, the distinguished 
Senator from Nebraska, and, of course, the distinguished Senator from 
Kansas and the distinguished Senator from South Dakota who are here on 
the floor and participating. I believe we have until 12:27, so I am 
going to relinquish the floor.
  Mr. THUNE. Before the Senator leaves, I wish to put one fine point on 
something the Senator said in response to the question from the Senator 
from Pennsylvania about the use of Medicaid funds in the States.
  There are a number of States that do provide programs that have 
abortion funding, but I think there is a very clear distinction that 
needs to be made in Medicaid funds which are matching funds, and none 
of those funds can be used to fund abortions. You said that in response 
to his question, but I think that point needs to be made very clearly 
because the Senator from Pennsylvania was implying that somehow, since 
States have created programs to fund abortions and since Medicaid is a 
Federal and State program, that somehow those two are being mixed, and 
that this idea that because they are calling for ``segregation,'' that 
really doesn't exist in the Medicaid Program.
  The Medicaid Program--those are matching funds--is a Federal-State 
program. The Federal dollars that go into the Medicaid Program--the 
prohibition that exists on Federal funding of abortions applies to 
Medicaid dollars that go to the States, to the degree that States have 
adopted programs that fund abortion. Those are State funds and not 
Medicaid funds, which are matching funds.
  Mr. HATCH. I am glad the Senator made that even more clear. Last 
night, a number of Democrats completely distorted this issue. If they 
think the Capps language equals the Hyde language, why not put it in? 
They want to be able to fund abortion any way they possibly can, to 
fund it in a variety of ways, with Federal dollars, if we don't put the 
Hyde language in. That is what this is about.
  Mr. BROWNBACK. Will my colleague yield?
  Mr. HATCH. I am happy to.
  Mr. BROWNBACK. If you are not clear about this, then abortion will be 
funded. If there is any of this that needs clarity one thing is for 
certain with the Capps language in the baseline of the Reid bill, that 
abortion will be funded.
  The Commonwealth of Massachusetts recently passed its State-mandated 
insurance, Commonwealth Care, without an explicit exclusion on 
abortion. Guess what. Abortions there were also funded immediately. In 
fact, according to the Commonwealth Care Web site, abortion is 
considered covered as outpatient medical care. That is a point about 
being clear with the Hyde-type language, which is the Nelson-Hatch 
language, which says: No, we are not going to fund this, and we are 
going to continue the 33-year policy. If we keep the Capps language in 
that funds abortion--the last time the Federal Government funded 
abortions was during that 3-year period after Roe, but before Hyde, and 
we were funding about 300,000 abortions a year. The Federal taxpayer 
dollars funded abortions through Medicaid.
  I cannot believe any of my colleagues would say: Yes, I would be 
willing to buy into that 300,000 abortions a year when President Obama 
and President Clinton said we want to make abortions safe, legal, and 
rare. Well, 300,000 a year would not be in that ballpark. That is the 
past number that happened when you didn't have Hyde language in place 
at the Federal level.
  Mr. HATCH. That is what it will do here too. All this yelling and 
screaming when they say it equals the Hyde language--it doesn't. That 
is the problem. If they want to solve the problem, why not use the Hyde 
language that has been accepted by every Congress since 1977? The 
Senator is right that there were 300,000 abortions a year between 1973 
and 1977 because we didn't have the Hyde language. We got tired of the 
taxpayers paying for them. Why should they pay for it? Why should 
taxpayers who are pro-life--for religious reasons or otherwise--have to 
pay for abortions, elective abortions by those who are not? They should 
not have to.
  To be honest, the language in the current bill is ambiguous and it 
would allow that. Anybody who is arguing this is the same as the Hyde 
language hasn't read the Capps language. We want to change it to go 
along with Hyde. It doesn't affect the right to abortion, except that 
we are not going to have taxpayers paying for it.
  Mr. THUNE. If the Senator will yield----
  Mr. HATCH. Yes.
  Mr. THUNE. That is what Stupak and other Members of the House of 
Representatives saw; that this created

[[Page S12663]]

tremendous ambiguity and they sought to tighten it up and reinstate the 
longstanding policy regarding Federal funds and their use to finance 
abortions since 1977, the Hyde language. The Stupak amendment to the 
House bill passed with 240 votes. There was a sizable, decisive 
majority of Members in the House of Representatives who saw through 
what the ambiguity was that exists regarding the House bill and now the 
Senate bill.
  This is intentionally ambiguous for the reasons you mentioned. This 
simply clarifies, once and for all, what has been standard policy at 
the Federal level going back to 1977. As the Senator stated earlier, I 
believe it represents the consensus view in America of both Republicans 
and Democrats who believe this is ground we can all stand on, 
irrespective of where people come down on this issue; that the idea 
that somehow Federal taxpayer funds ought to finance abortions is 
something most Americans disagree with. That is why there has been such 
broad, bipartisan support for this particular policy, and that is why 
it should be extended into the future.
  As the Senator from Utah said, 61 percent are against funding 
abortions. But I have seen polls that suggest it is much higher than 
that. I know it is much higher in my State of South Dakota. I commend 
the Senator for seeing his way to offer an amendment that clarifies and 
removes all this ambiguity and what, to me, is clearly an intentional 
ambiguity regarding this issue and the underlying bill.
  Mr. HATCH. Madam President, I ask unanimous consent that Senator 
Cornyn be added as a cosponsor to the Nelson-Hatch-Casey amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Nebraska is recognized.
  Mr. JOHANNS. Madam President, how much time remains?
  The PRESIDING OFFICER. There is 4 minutes remaining.
  Mr. JOHANNS. Madam President, I have been on the floor a number of 
times debating this issue, a while back on a motion to proceed and 
since this amendment has come up. I wish to tell the Senator from Utah 
that I don't believe I have seen a more concise, clear explanation of 
the history of the Hyde language than I saw over the last half hour of 
debate on the Senate floor. The Senator laid it out perfectly. The 
Senator laid out how we have, over a long period of time, stayed with 
that Hyde language. That was the agreement that had been reached.
  Our colleague from Texas said this is a foot in the door, and I agree 
with her. If this Reid bill passes with the current language on 
abortion, it is not only a foot in the door but, in my estimation, it 
kicks down the door. It kicks down the door and sets up structure for 
the Federal funding of abortions. That is what we are going to end up 
with.
  A couple weeks ago, I came to the floor when we were debating the 
motion to proceed and I said, at that time, to me, this is the pro-life 
vote, because if this bill goes to the floor, we will now need 60 votes 
to get an amendment passed. I said I don't count the 60. I issued a 
challenge and I said: If there is any Member who has a list of 60 
Members who will vote for this amendment, I am willing to look at that 
and change my view of the world. Well, that hasn't happened.
  In fact, there are many predictions being made that, sadly and 
unfortunately, this amendment will not get the 60 votes it needs.
  Let me put this into context. For pro-life Senators, this is the 
vote, but it doesn't stop here. In my estimation, you are pro-life on 
every vote. You don't get a pass on this vote or that vote or the next 
vote or whatever the vote is. You are pro-life all the way through.
  Even if this amendment doesn't pass, I wish to make the case that 
this bill should not go forward because it literally will create a 
system, a structure, a way to finance abortions. I don't believe that 
is what this country wants. Many Senators, including the Senator from 
South Dakota and the Senator from Kansas, have very clearly made the 
case that the people of the United States do not want their tax dollars 
to go to buying abortions.
  My hope is, 60 Senators will step up on this amendment. I will sure 
support it. I will speak everywhere I can in support of it. I am so 
appreciative that Senator Nelson and Senator Hatch and Senator Casey 
brought this forward. I am glad to be a cosponsor. It is my hope this 
amendment will pass.
  It is my conviction that we need to stand strong throughout this 
debate and make sure this language doesn't end up in the final bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas is recognized.
  Mr. BROWNBACK. Madam President, I think the Catholic bishops have put 
it as concisely as anybody:

       In every major Federal program where Federal funds combine 
     with nonfederal funds (e.g. state or private) to support or 
     purchase health coverage, Congress has consistently sought to 
     ensure that the entire package of benefits excludes elective 
     abortion. For example, the Hyde amendment governing Medicaid 
     prevents the funding of such abortions not only using federal 
     funds themselves, but also using the state matching funds 
     that combine with the federal funds to subsidize the 
     coverage. A similar amendment excludes elective abortions 
     from all plans offered under the Federal Employees Health 
     Benefits Program, where private premiums are supplemented by 
     a federal subsidy. Where relevant, such provisions also 
     specify that federal funds may not be used to help pay for 
     administrative expenses of a benefits package that included 
     abortions. Under this policy, those wishing to use state or 
     private funds to purchase abortion coverage must do so 
     completely separately from the plan that is purchased in 
     whole or in part with federal financial assistance. This is 
     the policy that health care reform legislation must follow if 
     it is to comply with the legal status quo on federal funding 
     of abortion coverage. All of the five health care reform 
     bills approved by committee in the 111th Congress violate 
     this policy.

  Following the Hyde amendment principles is what we have done for 33 
years, until this moment, until the Capps language in the Reid bill. 
Now we have flipped that on its head and are saying you can combine 
Federal funds with non-Federal funds to pay for elective abortions. 
That was the policy prior to Hyde in 1977. That funded 300,000 
abortions, roughly, a year at that point in time. There is no way in 
this country that is a policy the American people support. They don't. 
They may be divided about abortion but not about Federal funding for 
elective abortion. There is no division about that at all. It has been 
very consistent policy, until we have seen the Reid bill, this 
particular piece of legislation. We have been quite consistent about 
this. It is my hope my colleagues will say: I may be pro-choice, but I 
have consistently supported Hyde because I think we should not be 
funding elective abortions.
  I hope they will vote for the Nelson-Hatch amendment because of that 
very feature. It is not about abortion, it is about the funding of 
elective abortions. I hope we don't go in that direction.
  I yield the floor.
  The PRESIDING OFFICER. The Senator's time has expired. The Senator 
from Montana has 3 minutes 17 seconds.
  Mr. BAUCUS. Madam President, with respect to the last debate, let's 
be clear that the underlying bill keeps the three-decades-old agreement 
that has implemented the Hyde amendment to separate Federal funds from 
private funds when it comes to reproductive health care.
  The Nelson-Hatch amendment is unnecessary. It is discriminatory 
against women. Women are the only group of people who are told how to 
use their own private money. That is unfair.
  On another matter, with respect to the McCain motion, let me explain 
a little bit about Medicare Advantage and how it works. Essentially, 
the Medicare Advantage Programs are insurance companies. They are 
insurance companies that have their own officers, directors, their own 
marketing plans and their own administrative costs and they are 
concerned about the rate of return on investment for their 
stockholders. These are simple, garden variety, ordinary insurance 
companies.
  In this case, they are insurance companies that get general revenue 
from payroll taxes and premiums. They are basically insurance companies 
that give benefits to senior citizens. These insurance companies are 
overpaid. There is not much disagreement that they are overpaid. How 
are they paid? Well, believe it or not, these insurance companies--
Medicare Advantage plans--are paid according to the amount Congress 
sets in statute. That is their payment rate, what Congress sets in 
statute.

[[Page S12664]]

  The problem is, by doing so, these preset rates overstate the actual 
cost of providing care by 30 percent. We pay more than it costs to 
provide care by about 30 percent, in many cases. These overpayments 
also clearly promote inefficiencies in Medicare. Also, these payments 
have not been proven to increase the quality of care seniors receive. 
In the estimate I saw, about half the Medicare Advantage plans have 
care coordination and half don't. Half are no better than ordinary fee-
for-service plans. Because of this broken, irrational payment system, 
some plans receive more than $200 per enrollee per month and others 
receive about $36 per enrollee per month.
  Again, the payment rates are set by statute, relating to fee for 
service in the area. It is broken. It doesn't make sense. It causes 
great dislocations and differences in the payment rates. Frankly, under 
this broken system, all beneficiaries are not receiving the same care. 
I believe all beneficiaries should be able to have access to the best 
care, not just those who happen to live in States with high payment 
rates.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. BAUCUS. Madam President, I ask unanimous consent to continue for 
an additional 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Madam President, I have said these Medicare Advantage 
plans are overpaid. Nobody disagrees with that. They are overpaid. The 
Senator from Oklahoma, Mr. Coburn, when I asked him a few days ago if 
he thought they were overpaid, said: Yes, they are overpaid. The MedPAC 
advisory board tells us: Yes, they are overpaid.
  Here is a statement made by Tom Scully, former Administrator of the 
Center for Medicare and Medicaid Services:

       I think Congress should take some of it away. There's been 
     huge over-funding.

  There are lots of other citations from Wall Street analysts and 
others in the industry saying clearly the Medicare Advantage plans are 
overpaid. Frankly, we, in Congress, put a statutory provision in law 
that has caused this overpayment. Clearly, we should fix it.
  In addition, something that is pretty alarming is, according to a 
study I saw, only about 14 cents on the dollar of extra payments to 
Medicare Advantage plans goes to beneficiaries--only 14 cents--which 
means 86 cents on the dollar goes to the company, not to the 
beneficiaries, not to the enrollees but to the companies--``the 
companies'' meaning the officers, directors, administrative costs, 
marketing costs, rate of return. It is to the company, any ordinary, 
garden variety company. Therefore, it behooves us to find a better way 
to pay Medicare Advantage companies so it is efficient, there is not 
waste, and payments go primarily to enrollees, to beneficiaries.
  How do we do that? This legislation moves away from the current 
archaic system which sets statutory amounts in effect. Rather, we say, 
OK, why not have these companies bid? Let them compete based on costs 
in their regions. One region of the country is different from another 
region of the country. We are going to say what is fair here to get rid 
of a lot of waste and overpayments is provide that Medicare Advantage 
plans can compete in their area based on cost.
  The plan will be paid the average bids that are based on competition 
in the area. We, the authors of this bill, think that is a far better 
way of paying for Medicare Advantage.
  Will that reduce payments to beneficiaries? Certainly no. All 
guaranteed benefits are guaranteed in this legislation. In fact, I am 
going to check up on another statistic. I heard somewhere under this 
legislation there will be an increase of enrollees--not a decrease, an 
increase of enrollees. I am going to track that down because I want to 
be sure I am accurate.
  I will conclude. I want to talk more about this issue later. There 
may be a separate amendment on this subject offered on our side. By and 
large, it is wrong to continue a current system that dramatically 
overpays and where 86 percent of the overpayment goes to the company 
and only 14 cents goes to the beneficiaries. We have to come up with a 
fair way of paying Medicare Advantage. I think a fair way is to have 
the companies competitively bid based on cost in their areas. That way 
they are going to get reimbursed at a level that is relevant to their 
area, and it is also relative to the cost they incur when they run 
their plans. I will have more to say about that later.
  I yield the floor.

                          ____________________