[Congressional Record Volume 156, Number 44 (Monday, March 22, 2010)]
[Senate]
[Pages S1787-S1790]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             RECONCILIATION

  Mr. ENZI. Mr. President, I rise in opposition to the reconciliation 
legislation the Senate will be considering later this week. Similar to 
many of my colleagues, I first read this legislation when it was hot 
filed in the House last week. One of my first thoughts was, what a 
difference 15 months makes. This week the Senate will debate 
legislation that will increase health care costs for working Americans 
and wipe out a successful bipartisan 45-year-old student loan program 
without a single committee hearing or even a markup.
  This bill is an attempt to fix what is perceived to be the problem 
with health reform legislation that the Senate passed on Christmas Eve 
of last year. These fixes are being considered because the American 
people overwhelmingly opposed that legislation. Unfortunately, this 
bill, the reconciliation bill, does nothing to fix the problem that 
prompted this opposition. Nothing in the bill we are going to be 
considering will prevent $\1/2\ trillion from being cut from the 
Medicare Program to create a brandnew entitlement program for the 
uninsured. If this bill is passed, millions of Medicare beneficiaries 
will lose the extra benefits they currently receive. In fact, this bill 
will actually make matters worse, cutting even more money than the 
provisions in the Senate bill. One out of every four Medicare 
beneficiaries is already enrolled in a Medicare Advantage plan, and 
every one of them will see their benefits reduced.
  If this bill is passed, the care of Medicare beneficiaries across the 
country will still be put at risk because of the unsustainable payment 
cuts to hospitals and nursing homes. The President's own Chief Medicare 
Actuary said these costs could jeopardize Medicare's beneficiaries' 
access to care. He said, as a result of these cuts, roughly 20 percent 
of all hospitals and nursing homes in the country would become 
unprofitable which, of course, could lead them to end their 
participation in the Medicare Program. It is either end it or go broke.
  If you can't go to a hospital or get a doctor to treat you, you do 
not have health care. But this bill does nothing to fix the Medicare 
payment cuts in the Senate health reform bill passed on Christmas Eve. 
This bill will still cause health insurance premiums to increase. The 
Congressional Budget Office said the Senate bill would increase 
premiums by 10 percent to 13 percent for individuals. They said that 10 
percent to 13 percent increase is above what would happen if we do 
absolutely nothing. Yes, escalating health care costs are a problem, 
but this bill passed by the House last night, with these supposed fixes 
that are in here, will increase premiums 10 percent to 13 percent for 
individuals over what would have been done if nothing would have 
happened. It does not sound like a solution to me. There are solutions 
out there.
  The bill also contains provisions that will increase premiums for 85 
percent of Americans who already have health insurance. This bill does 
nothing to stop health care costs from increasing our national debt. 
The CBO estimates of the bill are required to ignore the issue of 
Medicare payments to physicians. Let's see, how many times have we 
ignored the Medicare payments to physicians? That is right, never. How 
do we fix it? We just need to come up with 300 billion more dollars. We 
had a chance to do that through the bill, keeping Medicare money for 
Medicare. But no, we took the Medicare money, and we decided to put 
that into new programs, new programs for the uninsured.

[[Page S1788]]

  There are solutions out there for making sure the uninsured are 
covered, too, and it did not have to come out of Medicare.
  The CBO estimates of the bill are required to ignore the issue of 
Medicare payments to physicians. The bill also does nothing to fix the 
scheduled Medicare payments to the other health providers. Does the 
majority believe the Medicare payments to doctors will be cut 21 
percent later this year? Not if history keeps itself up. But let me 
tell you, that $132 billion that it is supposed to reduce the deficit 
in the first 10 years in the Senate-passed bill is ignoring the need 
for $300 billion to fix the doctors. If we fix the doctors, we are $170 
billion in the hole. The President did not visit China and Secretary 
Geithner, on a separate trip, didn't visit China to go see the Great 
Wall. They were told to come over there by China so they could explain 
how we were ever going to pay for our bonds. Last month, they dropped 
about $38 billion in our bonds, and I noticed today we have this clamor 
that we want them to adjust their yuan, the value of their money 
compared to our money, and they said: You have to be kidding me, we own 
you. They didn't say it in quite those words, but that is what they 
meant.
  In addition to assuming massive reductions in Medicare payments to 
doctors, the health care reform bill also relies on budget gimmicks and 
other unsustainable payment cuts to allow its sponsors to argue it will 
not increase the deficit. As Ruth Marcus wrote recently in the 
Washington Post, claims that the bill will reduce the deficit are 
``premature at best and delusional at worst.''
  Rather than creating this new entitlement, we should be using the 
savings from Medicare to pay to fix Medicare's problems. These payments 
issues are not going away, and this, or a future Congress, is going to 
have to pay for them or increase the debt.
  We have maxed out our credit cards already. People coming in--this is 
the season for it--they come in and ask for increases in the programs 
they already have or they ask for new programs and the funding to go 
with that program because, of course, the Federal Government is known 
as the great piggy bank in Washington, and they know we just print 
money. They didn't know there could be a limit to how much money we 
print. I suggest those people kind of save their travel money and use 
it in their program because we are going to have to tell people that 
not only is the money not there to expand programs and to add new 
programs, we are going to actually have to cut programs. We are going 
to have to cut programs to stay solvent.
  They are looking at changing our bond rating. That means it would be 
less favorable for people to buy U.S. bonds.
  The reconciliation bill that will be before us this week, also raises 
taxes by $569 billion. If you can believe it, that is $50 billion more 
in new taxes than the original Senate-passed bill. So the ``fix-it'' 
bill we will have in front of us, will put even more pressure on small 
business owners and entrepreneurs who could help lead our Nation's 
economic recovery.
  This bill also does nothing to stop the billions of dollars in new 
job-killing taxes created by the Senate health reform bill. 
Unfortunately, the policies in this bill will only make this situation 
worse for workers and for businesses across America. This bill 
increases to $52 billion the new taxes imposed on employers, which will 
eliminate millions of American jobs and reduce wages for millions of 
other American workers.
  The Nation's unemployment rate is 9.7 percent. Millions of Americans 
have lost their job and millions more go to work every day worried 
about keeping the job they have. Businesses of all sizes are struggling 
to keep their doors open and are finding it harder and harder to make 
ends meet.
  We have shed more than 3.5 million jobs since January of last year 
and the average work week is now down to 33 hours for the American 
worker. Yet the bill we will have before us will actually make that 
situation worse. The Congressional Budget Office has told us that new 
job-killing taxes in the Senate bill will lower wages across this 
country.
  Rather than addressing the issue and enacting reforms that would 
lower health insurance costs, the majority's health care bill instead 
increases the taxes these businesses will have to pay, taking money 
away from hiring new workers.
  When I am home in Wyoming, which is almost every weekend, my 
constituents are asking me: What does health care reform mean for me?
  Unfortunately, I have to tell them when the Senate bill becomes law, 
their jobs and their paychecks will be in danger. I also found it 
ironic that on the day the President signed a so-called jobs bill, 
Speaker Pelosi released a reconciliation bill that contained $52 
billion in job-killing taxes.
  These problems are the real reasons the American people oppose the 
Senate health reform bill. Unfortunately, the bill that will be before 
us fails to address any of the fundamental problems with that bill. If 
the legislation we are about to debate is enacted, taxes will still be 
raised by $569 billion, $525 billion will still be cut from the 
Medicaid Program, wages will still be reduced, and jobs eliminated for 
millions of Americans. Health insurance premiums will still be driven 
up--driven up more than if we did nothing at all--and 23 million people 
will still be left without insurance coverage. We need to do better 
than that. I believe we can.
  While most of the discussion this week will focus on health care, we 
must not forget that the reconciliation bill drastically alters decades 
of education and labor policy.
  Specifically, I am speaking about eliminating the 45-year-old family 
friendly bank loans for education program, called FFEL. I put initials 
on when it has something to do with government. This is one that works 
through the banks, which has successfully helped millions of Americans 
realize the dream of a college education, and the shift to a 
Washington-run direct loan program. This radical change is happening 
without a single Senate hearing, or a single markup in the HELP 
Committee, where I serve as ranking member, or any other committee.
  The administration and the majority have been promising students 
since the beginning of this Congress that their Pell grants would be 
increased dramatically so that college would be affordable. Even with 
this bill, this promise rings hollow. What does the transfer of $36 
billion to the Pell grant program get for students? Yes, $36 billion.
  First, it kicks the can down the road by only partially filling the 
unmet Pell obligation for this year which was promised in the so-called 
stimulus bill. The remainder only modestly increases the maximum Pell 
grant awarded by $50 a year. How much do you think tuition is going up?
  The Senator from Tennessee explained that every time we add people to 
Medicaid, that costs the States, and the only place the States have to 
cut is tuition, college tuition. If college tuition is cut, the board 
of the college has to raise the tuition. I will have a chart out here 
one of these times that will show what the difference is between how 
fast college tuition is rising compared to health care costs, compared 
to the cost of living.
  So we are going to kick the can down the road and only increase the 
maximum Pell grant by $50 a year. In exchange, students are forced into 
the one-size-fits all, government-run direct loan program while 
Congress continues to do nothing about the real problem, which is the 
runaway cost of college education.
  Schools have had the choice of switching to the direct loan program 
for nearly 20 years, but most, just over 4,000 as of March 1, have 
chosen to remain in the family friendly bank loan program for 
education. Why? Because the family friendly program provides services 
that meet individual student needs far better than the cookie-cutter 
approach of a government-run direct loan program.
  We have enough things the government is running, more this last year. 
This rushed and dramatic shift puts at risk the availability of 
guaranteed loans for thousands of students this fall. Under the terms 
of this bill, all 4,000-plus institutions of higher education, the 
family friendly program will be required to participate in the 
bureaucratic direct loan program as of July 1, 2010, a few months away, 
less than 4 months from today.

[[Page S1789]]

  I do not believe these schools or the Department of Education have 
the time or capacity to successfully meet that deadline, and the 
experts at the Department seem to agree. According to a February 20, 
2010, Department of Education procurement document, schools need 
between 4 and 6 months to successfully switch to the direct loan 
program.
  As a result, many schools will not have in place what it takes to get 
needed aid to students this fall. Yes, it is true that reconciliation 
has been used to affect student loans in the past. However, in those 
instances, it was used to level the playing field between the two loan 
programs and provide greater access by students to loans.
  This bill is nothing more than a government takeover that will turn 
the Department of Education into one of the largest banks in the 
Nation--probably not under the financial reform requirements either--
and transfer billions of dollars from middle-class students and 
taxpayers to pay for only a modest expansion of the Pell grant program 
which does nothing to lower the cost of a college education.
  I will propose amendments that address out-of-control education 
costs, that give schools time to thoughtfully switch to the direct loan 
program, that make transparent the actual costs of the direct loan 
program, that fund an authorized and proven access and completion 
program, and put real money toward debt reduction.
  The majority will tell you what they are doing is being done at no 
cost to the taxpayer. Do you think America believes that? I, as the 
accountant in the Senate, disagree with this assertion. In the family 
friendly program, private lenders provide the capital necessary to fund 
billions of dollars to student loans each year. With the direct loan 
program, the Treasury will provide all the capital for these loans, 
which amounts to nearly $100 billion a year. Where does the money come 
from? It comes from increasing the public debt of the American 
taxpayers, many of whom do not have a college education. Shifting the 
financial burden from those who directly benefit from a college 
education raises concerns about equity, and again does nothing to 
address the larger problem of rapidly increasing costs for college 
education.
  This bill also removes safeguards against fraud and abuse from the 
Black Lung Benefits program. The Black Lung Benefits Act provides 
monthly payments and the cost of medical treatment to coal miners 
disabled from pneumoconiosis, black lung, arising from their employment 
in or around the Nation's coal mines, and provides monthly payments to 
surviving spouses and other dependents. This bill will establish a 
retroactive presumption of causation and entitle individuals to 
lifelong benefits which will be paid for by the employers, insurers 
and, in cases where the employer is already out of business, by the 
taxpayers directly.
  Taxpayers have already paid more for this program than they expected. 
The estimated benefits costs when it was enacted in 1975 were $3 
billion. However, by 2004 the Federal Government had paid out over $42 
billion. Last year, the taxpayers kicked in another $6.5 billion to 
refinance the program. The changes in this bill will send the program 
back into a debt spiral by eliminating any need to prove causation. I 
ask unanimous consent to have printed in the Record a letter from three 
prominent West Virginia doctors who also oppose the provision because 
it ``does not take into account the current state of diagnosis and 
treatment of Black Lung.''
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         Offices of the Insurance Commissioner, State of West 
           Virginia,
                                 Charleston, WV, November 6, 2009.
     Jane L. Cline,
     Commissioner, WV Offices of the Insurance Commissioner, 
         Charleston WV.
       Commissioner Cline: We are writing this letter to comment 
     on the changes proposed in the health care reform bill 
     regarding the Federal Black Lung benefits program. We are 
     concerned that the proposed changes to the benefits program 
     do not have sound medical basis and are inconsistent with the 
     stated purpose of the bill. The bill is intended to improve 
     access to health care for all Americans, to improve quality 
     of care and to reduce cost by emphasizing preventive care, 
     management of chronic diseases and utilization of the 
     principles of evidence-based medicine.
       The proposed Federal Black Lung changes would reinstate a 
     rebuttable presumption regarding the diagnosis of Black Lung 
     based on tenure in the mines and X-ray criteria. The proposed 
     changes would also restore the rebuttable presumption related 
     to death attributable to Black Lung as it affects surviving 
     spouse benefits.
       We have concerns about the proposed amendments because they 
     do not take into consideration the current state of diagnosis 
     and treatment of Black Lung and other diseases. It is very 
     clear that our medical knowledge and expertise in diagnosis 
     and treatment have expanded dramatically in the past 25 
     years. Our understanding of dust-related disease end other 
     pulmonary conditions has evolved significantly. Today chronic 
     diseases like diabetes, coronary artery disease, chronic 
     obstructive pulmonary disease and renal failure have become a 
     major focus of medical attention because they claim so many 
     lives. One in three individuals develops some type of cancer. 
     While the rebuttable presumption could have been appropriate 
     many years ago, our many advancements in diagnosis and 
     treatment render it unnecessary today and into the future.
       The West Virginia rules governing the medical care of 
     workers with occupational pneumoconiosis have increasingly 
     relied on functional parameters (like forced vital capacity, 
     expiratory volumes and diffusion capacity) in determining the 
     need for medical services. We still consider the exposure 
     data and ILO B-reading a critical piece of the picture; but 
     we view function as the issue that matters most to the 
     affected worker. We strive to apply sound medical evidence to 
     assure that all miners who have contracted Black Lung receive 
     prescribed benefits and that the funds are preserved for 
     those claimants. The inclusion of a rebuttable presumption 
     will hinder the achievement of that goal.
       In our opinion, changes in the Federal Black Lung benefits 
     program should take into account advances in our 
     understanding of the science and medicine of the disease, 
     Black Lung. We are most interested in seeing strong programs 
     to prevent disease through safety controls and education. 
     Access to medical services is critical for those already 
     affected. Though the diagnosis of Black Lung is statutorily 
     defined, there is an indisputable logic to basing the 
     diagnosis on the medical facts as we currently understand 
     them.
       We recommend consideration of significant changes in the 
     wording of this section of the bill to make this document 
     more than just a change in benefits programs. Ideally, it can 
     be a medically sound and forward looking document, consistent 
     with the issues of health care reform in general.
       Thank you for considering our comments.
     James Becker, MD,
       Medical Director, West Virginia Offices of the Insurance 
     Commissioner.
     Dominic J. Gaziano, MD,
       Board Certified Pulmonologist, Chairman of the Permanent 
     Total Disability Board, State of West Virginia.
     Jack L. Kinder, MD,
       Chairman of the Occupational Pneumoconiosis Board, West 
     Virginia.

  While everyone supports providing these benefits to qualified miners 
and their families, we should not strip out safeguards against fraud, 
waste and abuse in this program that were specifically added to the 
program by Congress with overwhelming bipartisan support.
  I have said numerous times during my tenure in public service that 
the first role of the government is to do no harm. While I know many 
people are well versed on the intricacies of how these programs 
operate, I have studied these issues in depth for years, and have a 
track record of legislative success on both the health and education 
front, because I first listen to my colleagues and regularly work 
across party lines. This legislation falls short on many fronts, has 
not been the subject of Senate hearings, is being jammed through this 
institution too quickly, and should be rejected by the Senate.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Arizona.
  Mr. McCAIN. I ask unanimous consent to address the Senate as in 
morning business for approximately 10 minutes, not more than 10 
minutes.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. McCAIN. I come to the floor to obviously comment on the events of 
the last couple of days in the other body. The Nation watched as the 
process went forward and the votes were

[[Page S1790]]

cast. My understanding is, according to the media reports, champagne 
was poured and the celebration went on inside the beltway.
  Outside the beltway, in the homes and offices and all of the 
residences and places where people gather across the country, there is 
a sense of outrage, and a sense of betrayal because, for the first time 
in history, we have enacted a major reform on a strictly partisan basis 
about which the process has angered the American people as much as the 
product.
  The deals that were made behind closed doors for individuals, the 
names of which we have all become familiar with--the ``Cornhusker 
kickback,'' the ``Louisiana purchase,'' the ``Gator aid,'' and also the 
purchases made of the various entities in the health care industry in 
America--most egregious probably is that of Pharma, but the list goes 
on, the AMA, the Hospital Association, it goes on and on.
  Americans are disillusioned and are angry and Americans are not going 
to forget it. There seems to be an inside-the-beltway liberal media 
view that, well, it is done, the American people will forget about it; 
they will appreciate it; and what a magnificent victory this is. It may 
be in the view of some a victory for the President of the United 
States. What it is is a defeat of the American people, because the 
overwhelming majority of American people, by 2-to-1 margins, said stop 
and start over. They said they did not want this and they did not like 
this process. They do not like the behind-the-closed doors foolishness 
that went on, that, in many peoples' minds represented an unsavory 
sausage-making process.
  This morning's Wall Street Journal opinion is entitled: ``Inside the 
Pelosi Sausage Factory'' and ``Michigan Rep. Bart Stupak Sold His Anti-
abortion Soul For a Toothless Executive Order.''

       Never before has the average American been treated to such 
     a live-action view of the sordid politics necessary to push a 
     deeply flawed bill to completion. It was dirty deals, open 
     threats, broken promises and disregard for democracy that 
     pulled ObamaCare to this point, and yesterday the same 
     machinations pushed it across the finish line.

  Then this same article goes on to describe how.

       For those who needed more persuasion: California Rep. Jim 
     Costa bragged publicly that during his meeting in the Oval 
     Office, he'd demanded the administration increase water to 
     his Central Valley district.

  By the way, a move that I strongly favored.

       On Tuesday, Interior pushed up its announcement giving the 
     Central Valley farmers 25 percent of water supplies, rather 
     than the expected 5 percent allocation. Mr. Costa, who denies 
     there was a quid pro quo, on Saturday said he'd flip to a 
     yes.
       Florida Rep. Suzanne Kosmas (whose district is home to the 
     Kennedy Space Center) admitted that in her own Thursday 
     meeting with the president, she'd brought up the need for 
     more NASA funding. On Friday she flipped to a yes. So watch 
     the NASA budget.

  Democrats inserted a new provision providing $100 million in extra 
Medicaid money for Tennessee. Retiring Tennessee Rep. Bart Gordon 
flipped to a yes vote on Thursday.
  The list goes on and on. And those are the ones we know about. Those 
are the ones that have been publicized. We know about Pharma. We know 
about the deal they got and about $100 million or so that they have 
spent on advertisements and paid ads touting this legislation, which 
will get them billions of dollars in profits, the same Pharma that 
changed the administration position on reimportation of drugs from 
Canada that is in direct contradiction of the position that then-
Senator Obama had, that we should be able to reimport drugs from 
Canada, the same administration that supported competition amongst 
pharmaceutical companies for Medicare enrollees and now changed that 
position as well. There will be months, even years, where we will find 
out what went on behind closed doors, either in the majority leader's 
office, the Speaker's office, or the White House.
  There are those who believe the attention span of the American people 
is rather short. I disagree. I was back in my home State of Arizona on 
Saturday, two townhall meetings, hundreds of people packed into the 
townhall meetings.
  Every one of them is angry about what this will do, what this will do 
to companies and corporations such as Caterpillar that announced it 
would cost them, in only 1 year, $100 million in additional taxes.
  People have figured out the gimmickry of imposing taxes and cutting 
benefits for 4 years before a single beneficiary receives any help, the 
myth that we will actually cut 21 percent from doctors' payments for 
treating Medicare enrollees that will take place this fall. Is there 
anyone who believes we are going to cut doctors' payments by 21 
percent? If so, I would like to meet them and hear from them. We are 
not. The word is out: Don't worry. We will fix it. And they will fix it 
because we can't do that to physicians. But yet they use that $271 
billion reduction in physicians' payments for treatment of Medicare 
enrollees as a way to disguise the true deficit. In fact, that alone 
would show that this legislation would have resulted in an increase in 
cost rather than a decrease.
  I haven't got that much time except to say that I want to make clear 
that the people I represent in Arizona are not going to sit still for 
this. They are going to want this repealed. We will challenge this in 
the courts. We will challenge this in the towns. We will challenge this 
in the cities. We will challenge this on the farms. We will challenge 
this all over America. The will of the people will be heard. They do 
not like this process, and they do not like this product. We will 
prevail over time. I am confident of that.
  I yield the floor.
  (Disturbance in the Visitors' Galleries)
  The ACTING PRESIDENT pro tempore. Expressions of approval or 
disapproval of statements on the floor are not permitted.

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