[Congressional Record Volume 161, Number 53 (Tuesday, April 14, 2015)]
[Senate]
[Pages S2147-S2149]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            SGR LEGISLATION

  Mr. SESSIONS. Mr. President, I have been a strong advocate and a 
believer that it is time for us to fix the physicians' payment method 
for Medicare and Medicaid--for the providing of health care by 
doctors--and put it on a permanent basis right now.
  We have 17 times passed last-minute legislation to avoid what now 
would be a 21-percent cut in doctors' reimbursement rates for doing 
Medicare work. That is not acceptable. We need to end that. They do not 
need to be worried every year whether or not Congress is going to cut 
their pay. In fact, they cannot do the work with a 20-percent cut. They 
will not do it, they can't do it financially, and it would be 
devastating to Medicare. I believe that, and I think all of us believe 
in that.
  The 17 different times when this issue has come up since 2003 we have 
paid for it. Republicans in particular have insisted that we will find 
the money through some sort of other reduction in government spending 
and move that over to pay for this critical need, without which 
Medicare would collapse.
  I thought now that we want to do it permanently, it should be done in 
a way that is financially sound and does not add to the debt and has 
good policy in it.
  Some of my colleagues have already talked about the policy that would 
be

[[Page S2148]]

in this legislation. I am not prepared to be a big critic of that. I am 
sure it could be done in different ways. My focus right now is just 
based on my experience from the Committee on the Budget and the 
spending we are doing in Congress to try to get the thing done right. 
It must be paid for.
  The bill to be advanced today contains over 250 pages. It was rushed 
through the House of Representatives with the promises that ``it pays 
for all new future spending'' and ``it offsets all new spending.'' 
Well, both of those statements are not true. That is just not true. The 
bill is not paid for and it does not offset the new spending.
  Because of a desire to get this fixed, an attempt was made by the 
House so the Senate, on the night we completed work on the budget at 3 
a.m. before recess, would pass this bill without even having a good 
official score--at least not one we were able to examine over a period 
of time--and without any knowledge of what was in the bill. Senator 
McConnell and Members of the Congress said: No, we are not going to 
rush this through--$200-something billion in expenditures over 10 
years--at 3 a.m. in the morning with nobody having had a chance to look 
at it.
  We had some 700 amendments filed to the Budget Act so we didn't pass 
it that night. It has been moved forward now, and we have a deadline 
tonight. Presumably, if we don't fix something tonight, physicians will 
begin to see cuts in their pay. Of course, too often that is what 
happens around here. Too often a bill that is not sound financially is 
moved at the very last minute and Members are told: If you don't pass 
it now, then something bad is going to happen. In this case, doctors, 
whom we respect and admire and need, are not going to be able to get 
the pay they deserve and have been receiving, and they are going to be 
hurt by these cuts.
  Well, there are opportunities to extend this. We could pass 
legislation this afternoon, tonight, that would extend this for a 
period of time, if need be, but the reason we are at the end, the last 
minute, is because it was designed that way.
  Only days after passing the Senate budget, that we were proud to see 
balanced with a $3 billion surplus, we are talking about passing new 
legislation that would add $174 billion to the debt over the next 10 
years. Another estimate shows that over 20 years it is a $500 billion 
addition to the debt of the United States--one-half of a trillion 
dollars.
  The bill violates the Budget Act. The Budget Control Act, which we 
passed in 2011, set a limit on how much spending could occur. There may 
be as many as eight--let me repeat, eight--violations of budget rules 
that are involved in this legislation. The Committee on the Budget is 
looking at this, and these are the numbers it may violate.
  One, it likely violates section 302(f) of the Congressional Budget 
Act by spending in excess of the budget allocation of the Committee on 
Finance for the next fiscal year, over the next 5 years, and over the 
next 10 years.
  Two, it may violate section 311(a)(2)(A) of the Congressional Budget 
Act by spending $7.4 billion in excess of the aggregate spending top 
line agreed to for fiscal year 2015--this year we are in.
  Three, it likely violates the Senate pay-go rules. The bill increases 
the on-budget deficit by $74 billion over both the 5- and 10-year 
budget periods, thus exceeding the balance on the Senate pay-go 
scorecard.
  Four, H.R. 2 increases short-term deficits. Over the 10-year budget 
window it would increase deficits by $141 billion.
  Now, $141 billion and $174 billion, what is the difference? Well, 
when you spend $141 billion more than you are supposed to over 10 
years, financed by deficit spending, all of that money, every penny of 
it, is borrowed in order to be spent, which means you have to pay 
interest on the money you borrow. So it is not $141 billion, it is $174 
billion. That includes the interest on the $141 billion over 10 years 
that has been accumulated and will continue to accumulate in the next 
decade and the decade after that.
  Five, the bill increases long-term deficits.
  Six, it may violate section 306 of the Congressional Budget Act by 
including language that falls within the jurisdiction of the Committee 
on the Budget that has not been reported or discharged from the 
Committee on the Budget.
  Seven, it likely violates section 303(a) of the Budget Act by 
creating new spending in a fiscal year without a budget resolution.
  Eight, it may violate section 401 of the Budget Act by creating new 
entitlement spending during the fiscal year.
  We tried to contain ourselves, and one of the things we rightly did 
was to create a budget violation aimed to prevent the creation of new 
entitlement programs during the current fiscal year.
  So these are not technical violations, as it might appear to some. 
They are mechanisms by which the crafters of the Budget Act 
deliberately tried to contain the Senate from figuring out ways to 
gimmick and get around spending limits. They created all these steps, 
each one based on history, for the most part in order to stop abuses. 
So it violates these provisions because it spends more money than we 
are supposed to be able to spend and more than what we agreed to spend.
  So H.R. 2 increases long-term deficits. According to the nonpartisan 
Congressional Budget Office's letter to Speaker Boehner, enacting this 
bill in its current form would increase the Nation's long-term 
deficits. Long-term deficits are those deficits created after the first 
10 years of the current budget window.
  A lot of times they will write a bill so it looks as if it is OK for 
10 years, knowing that in the future it will add to the debt. But 
nobody cares about that. So we made a budget point of order to try to 
identify long-term abuses--a good provision, I submit.
  About a month or so ago we had before the Budget Committee, a 
professor from Boston University, I believe, who talked about the real 
threat to America's financial condition. He said that we are on an 
unsustainable path, that we cannot continue on this path, and that it 
will result in financial dislocation and damage to America. And the 
most important thing to consider is this: What will a piece of 
legislation do to the long-term liabilities of the United States? Does 
it add to our unfunded liabilities or not? We need to be reducing our 
unfunded liabilities because they are so great--hundreds of trillions 
of dollars--and those unfunded liabilities financially threaten the 
very future of America.
  This adds to that. We need to be figuring out ways to reduce the 
unfunded liabilities. I thought that is what our goal was. That is why 
we passed a budget that balances.
  According to the Congressional Budget Office's analysis, ``taken as a 
whole, H.R. 2 would raise federal costs relative to current law in the 
second decade after enactment.''
  In other words, it increases the deficit in the second decade. Some 
have tried to argue that in the second decade there is extra money 
coming in, in some way, and it will all be paid for--not so.
  So let me explain. In its report to Speaker Boehner, the report that 
was used by the House as it proceeded to vote on this bill, the 
Congressional Budget Office indicated that not only would H.R. 2 
increase short-term deficits by $141 billion over the next 10 years but 
it would also increase long-term deficits over both, the first and 
second 10-year windows. The Committee for a Responsible Federal Budget 
estimates that this legislation would add a half trillion dollars to 
the debt in the next 20 years.
  Half a trillion is real money--$500 billion. We are struggling right 
now to figure out how we can permanently fix our highway bill so we 
have a long-term highway bill that is paid for. We need about $10 
billion, $15 billion a year to achieve that. We are seeing a reduction 
in gasoline revenues. Congress wants to spend more than that, and we 
are looking for that money. This is over $500 billion over 20 years, 
and $174 billion over 10. These are huge sums of money.
  The Federal highway bill is now under $50 billion a year. Federal aid 
to education is about $100 billion a year. This is just indicative of 
how much we are overspending.
  The Office of the Actuary at CMS--the chief financial officer at the 
Centers for Medicare and Medicaid Services--is responsible for 
conducting and

[[Page S2149]]

directing the actuarial program for CMS and directing the development 
and analysis of health care financing issues.
  On April 9, Mr. Spitalnic released a review of the estimated 
financial effects of this legislation. Analysis conducted by the 
Heritage Foundation actuaries indicates that the drafters of the bill 
actually double-counted funds. While the bill anticipates higher 
premiums for Medicare Parts B and D and cuts to Medicare Part A, those 
savings would be $55 billion and $32 billion, respectively.
  Medicare Part A is the trust fund American working people's money 
goes into off their paychecks every week. So most Americans believe 
they pay for Medicare. And they do, for the most part, although we are 
now taking in less money than is going out to a significant degree.
  So what did this bill do? This bill cuts the expenditures for 
Medicare Part A, the trust fund part, and it claims that money--$32 
billion and $55 billion, respectively--is now available to spend on the 
physicians to pay for their fix. But the physicians' Medicare part--
when you go to a doctor and Medicare pays for that--that is not trust 
fund money. That is general revenue Treasury money.
  So what has happened? They are cutting the reimbursements of 
hospitals and doctors. They claim it won't affect the benefits accrued 
to people who need health care, but it probably will. To cut the cost 
of providers of health care services, in effect, reduces the benefits 
that actually go to the patient.
  So how does that money get from the trustees of Medicare--who are 
supposed to manage this program and take the money in that comes off 
our paychecks and goes to Medicare--to paying for something outside of 
Medicare Part A?

  They take an oath to be responsible and faithful to the trust as 
trustees of Medicare. They don't give it to the U.S. Treasury. They 
loan it. There is a debt instrument. The money is loaned to them and 
the Federal Government pays interest. That is where we get the 30-some 
odd billion dollars in interest over 10 years--part of it.
  The money that is being used to fund the portion that they claim is 
actually paid for I say is not paid for. The Congressional Budget 
Office has told us this technique is double counting. The money cannot 
be used to benefit Medicare and, at the same time, fund a new 
expenditure. We really have to watch this. It is something I have come 
to realize is one of the biggest gimmicks the Senate uses.
  When ObamaCare was passed--on December 23, the night before it 
passed, we got a letter from the Congressional Budget Office at my 
request. I read it on the floor on December 24, the day the bill 
passed. It said, I think, there was $400 billion, $500 billion in 
double-counted money they said was available to fund the Affordable 
Care Act.
  Colleagues, we have got to be careful. A country goes broke by 
managing money this way--huge sums of money.
  Beyond this gimmick, CMS Actuary Spitalnic goes on to say that H.R. 2 
raises ``important long-range concerns that would almost certainly need 
to be addressed by future legislation.''
  When the bill's 5 percent annual bonuses in physician payments expire 
as scheduled in 2024--9 years from today--a major payment cut from most 
physicians would follow the next year, according to his report. The 
payment structure would also be troublesome in years with high 
inflation. So, in essence, by 2024, another round of doc fixes would be 
needed. In other words, not only does this bill add massively to the 
debt and engage in--I hate to say this--improper accounting, but it 
also fails to even provide the long-term solution it promises. It 
promises we are going to have a permanent fix of the payments of 
physicians. But this bill is not a permanent fix, and within 9 years we 
are going to be back in a situation that is unacceptable and has to be 
dealt with again by spending more money. By making these cuts in the 
outyears, the real costs are hidden.
  We have a proposal that provides increases for doctors for the next 9 
years and then begins to show reductions, and it claims, somehow, that 
this is going to pay for it. But Congress is not going to allow those 
reductions to take place either, because we are not going to be cutting 
doctors 5 percent a year for any 1 year, most likely.
  It is not too late to make things right. The bill needs to go through 
regular order. It hasn't gone through our committee in the Senate. The 
House said the bill was going through the regular order. It hasn't gone 
through the regular order. It hasn't been through a committee where 
members have the chance to offer amendments. It is coming up on the 
floor. We are hardly having any amendments. I understand maybe we will 
have three amendments on each side. That is a pretty minuscule 
discussion when it supposedly has to be passed in a day. So the 
discussions will take place at midnight tonight.
  Colleagues, we have to understand the importance of what we are 
doing. This legislation adds almost $200 billion to the debt in the 
next 10 years. It breaks our past commitment and the precedent we have 
established to pay for these doc fixes. In fact, I have been most 
insistent that before we put the extra money for the physicians, we 
find a pay-for--some responsible reduction in spending elsewhere--so we 
can set priorities and pay for the doctors. This is substantially 
abandoned in this legislation. I think it disregards Congress's 
commitment to honest accounting, the principles that we have 
established about how to accurately calculate the cost of legislation. 
It breaks the budget we had agreed to in 2011--the spending reductions 
in the Budget Control Act--and it violates the budget the Senate just 
passed a couple of weeks ago.
  We need to think this through. I hate to object because I truly 
believe we need to take care of physicians' payments. It is absolutely 
wrong, and Congress has been negligent in failing to address this for 
years. It has been over a decade that we haven't dealt responsibly with 
this.
  So I salute the House colleagues for saying we are going to develop a 
bill that fixes this over time. Unfortunately, it is not a permanent 
fix, as I originally thought it would be, but, it is also not a 
responsible fix, a grownup fix. The kind of action for which the 
American people depend on Congress, and hope to see, is not occurring 
because this bill adds to the debt.
  We want to do something. We want to fix the doctors' problem, but we 
don't want to cut spending anywhere else.
  Faced with that difficult choice, this legislation--at least to a 
two-thirds degree--does what we too often do: We just spend the money, 
commit to spending the money, and then add it to our credit card. We 
add it to the debt that is $18 trillion now and growing dramatically, 
producing for us an annual interest payment of $220 billion and putting 
us on a path--according to the Congressional Budget Office--of an 
almost $900 billion interest payment in 10 years. I believe that is not 
good management of the people's business.
  I appreciate the opportunity to share these grim remarks and to 
lament the difficult situation in which we find ourselves. I do believe 
the Lee amendment will fix this. Maybe other amendments will, too. But 
we certainly need to step forward and make sure we don't continue down 
this path.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. WYDEN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Ms. Ayotte). Without objection, it is so 
ordered.
  Mr. WYDEN. Madam President, I ask unanimous consent to speak in 
morning business for up to 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________