Congressional Record, Volume 161 Issue 53 (Tuesday, April 14, 2015)

[Congressional Record Volume 161, Number 53 (Tuesday, April 14, 2015)]
[Senate]
[Pages S2156-S2161]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015

The PRESIDING OFFICER. Under the previous order, the Senate will
proceed to the consideration of H.R. 2, which the clerk will report by
title.
The senior assistant legislative clerk read as follows:

A bill (H.R. 2) to amend title XVIII of the Social Security
Act to repeal the Medicare sustainable growth rate and
strengthen Medicare access by improving physician payments
and making other improvements, to reauthorize the Children's
Health Insurance Program, and for other purposes.

The PRESIDING OFFICER. The majority whip.

Amendment No. 1114

Mr. CORNYN. Mr. President, I call up my amendment and ask for its
immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The senior assistant legislative clerk read as follows:

The Senator from Texas [Mr. Cornyn] proposes an amendment
numbered 1114.

The amendment is as follows:

(Purpose: To repeal the individual mandate)

At the appropriate place, insert the following:

SEC. __. RESTORING INDIVIDUAL LIBERTY.

Sections 1501 and 1502 and subsections (a), (b), (c), and
(d) of section 10106 of the Patient Protection and Affordable
Care Act (and the amendments made by such sections and
subsections) are repealed and the Internal Revenue Code of
1986 shall be applied and administered as if such provisions
and amendments had never been enacted.

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 1114, offered by the Senator from Texas, Mr. Cornyn.
The Senator from Texas.
Mr. CORNYN. Mr. President, Speaker Boehner and Leader Pelosi have
negotiated a package which enjoyed broad bipartisan support in the
House. The one missing element is a pay-for for the so-called doc fix,
for the sustainable growth rate fix. What my amendment does is offer
that pay-for so that this is a deficit-neutral bill if it is adopted.
In order to find that pay-for, we would repeal the individual
mandate. The latest CBO score shows it would save as much as $400
billion. It hasn't been scored this year, so the number may be off a
little bit, but there is more than an adequate amount of money to
offset the deficit caused by this permanent doc fix.
I ask my colleagues to join me, along with then-Senator Barack Obama
in 2008 in his campaign against Hillary Clinton, who when he was
running for the Democratic nomination campaigned against the individual
mandate.
Let's make that reality.
Mr. WYDEN. Mr. President, I urge colleagues to oppose this amendment.
What Senator Cornyn seeks to do is to strike an idea that originally
came

[[Page S2157]]

from the Heritage Foundation. If it is adopted, sick people will
definitely sign up, healthy people will stay on the sidelines, premiums
will skyrocket, according to the Congressional Budget Office, by as
much as 20 percent, and start then what amounts to a death spiral for
the affordability of American health care.
I urge my colleagues to oppose this amendment.
Mr. CORNYN. Mr. President, how much time remains?
The PRESIDING OFFICER. No time remains.
The question is on agreeing to the Cornyn amendment No. 1114.
Mr. CORNYN. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from Delaware (Mr. Coons) is
necessarily absent.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 54, nays 45, as follows:

[Rollcall Vote No. 137 Leg.]

YEAS--54

Alexander
Ayotte
Barrasso
Blunt
Boozman
Burr
Capito
Cassidy
Coats
Cochran
Collins
Corker
Cornyn
Cotton
Crapo
Cruz
Daines
Enzi
Ernst
Fischer
Flake
Gardner
Graham
Grassley
Hatch
Heller
Hoeven
Inhofe
Isakson
Johnson
Kirk
Lankford
Lee
McCain
McConnell
Moran
Murkowski
Paul
Perdue
Portman
Risch
Roberts
Rounds
Rubio
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Tillis
Toomey
Vitter
Wicker

NAYS--45

Baldwin
Bennet
Blumenthal
Booker
Boxer
Brown
Cantwell
Cardin
Carper
Casey
Donnelly
Durbin
Feinstein
Franken
Gillibrand
Heinrich
Heitkamp
Hirono
Kaine
King
Klobuchar
Leahy
Manchin
Markey
McCaskill
Menendez
Merkley
Mikulski
Murphy
Murray
Nelson
Peters
Reed
Reid
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Udall
Warner
Warren
Whitehouse
Wyden

NOT VOTING--1

Coons

The PRESIDING OFFICER. Under the previous order requiring 60 votes
for the adoption of this amendment, the amendment is rejected.
The Senator from Colorado.

Amendment No. 1115

(Purpose: To protect and retain our Children's Health Insurance Program
for 4 years (PRO-CHIP).)

Mr. BENNET. Mr. President, I call up amendment No. 1115.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Colorado [Mr. Bennet], for himself, Mr.
Brown, Ms. Stabenow, Mr. Wyden, Mr. Casey, Mr. Reid, Ms.
Warren, Mr. Menendez, Mr. Reed, Mrs. Shaheen, and Mr.
Whitehouse, proposes an amendment numbered 1115.

(The amendment is printed in today's Record under ``Text of
Amendments.'')
Mr. BENNET. Mr. President, this amendment provides an additional 2
years of funding for the Children's Health Insurance Program, or CHIP.
I wish to especially thank Senators Brown, Wyden, Stabenow, Casey, and
Reid for their leadership on this amendment.
We have made great strides in recent years to ensure that Americans
of all ages have access to quality health care, but a huge part of this
success in increasing access for quality health care comes from CHIP,
which provides insurance to low- and moderate-income children and
pregnant women. We know CHIP works. The CHIP program serves more than 8
million children, including more than 115,000 in Colorado. This is
health care they might not otherwise have.
Unfortunately, the House failed to take full advantage of this moment
and this momentum for compromise and only extended funding for 2 years.
CHIP is authorized through 2019. This amendment would extend it for 2
additional years.
The very physicians who would be helped by fixing the SGR would also
see increased reimbursement when they treat these children instead of
seeing millions of them lose access to affordable, comprehensive
coverage.
I ask my colleagues to support this amendment.
I yield the floor.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, remember that 212 Republicans and 180
Democrats supported H.R. 2. The decision to extend CHIP for 2 years
with the current payment rate was part of the House bipartisan
agreement. This amendment seeks to rewrite that amendment.
This amendment is not a vote to show who really cares more about
children's health because H.R. 2 extends the CHIP program for 2 years.
Everyone who supports the underlying bill is supporting children's
health. If my colleagues oppose this amendment, they are no less a
supporter of children's health than the 392 Members of the House who
supported H.R. 2, including 180 Democrats and Leader Pelosi. Are my
colleagues really saying that Leader Pelosi didn't care enough about
kids in forging this agreement?
Mr. President, I rise in opposition to this amendment.
I am a supporter of the Children's Health Insurance Program having
participated in the initial creation of CHIP in 1997 and the
reauthorization started in 2007. And while I am a supporter of
children's health, this is not a CHIP vote in a vacuum. This vote is in
the context of the underlying bill and cannot be ignored.
An overwhelming majority of the House supported H.R. 2. 392 Members
of the House vote for H.R. 2; 212 Republicans and 180 Democrats
supported the bill. That is a sign of bipartisanship that is, on a
major issue, extremely rare in the House.
The decision to extend CHIP for 2 years with the current payment rate
was a part of the House bipartisan agreement. It is an agreement
between House Republicans and House Democrats. This amendment seeks to
rewrite that agreement.
So let's talk for a moment about what this amendment is not. This
amendment is not a vote to show who cares more about children's health.
H.R. 2 extends the CHIP program for 2 years. Everyone who supports the
underlying bill is supporting children's health. Mr. President, 392
members of the House voted for this bill which extends CHIP for 2
years.
If you oppose this amendment, you are no less a supporter of
children's health than the 392 Members of the House who supported H.R.
2 including 180 Democrats and Leader Pelosi. Are you really saying
Leader Pelosi didn't care enough about kids in forging this agreement?
Again, no one should accuse anyone who votes against this amendment as
being insufficiently supportive of children's health.
I have also heard it said that Congress only authorizes 2 years now,
there is little chance Congress will authorize two more years in 2017.
That is a prediction, and as we all know, Congress can be hard to
predict some times.
In two years, we will be back to consider CHIP. We will also be back
to consider therapy caps, rural hospital programs, home visiting, the
special diabetes program, and community health center funding, to name
a few programs extended in this bill. The House agreement intentionally
aligned these programs to be considered in tandem in 2017.
This amendment pulls one very specific provision out of that
compromise. I have no concerns that CHIP can stand without the SGR.
What we need to do is spend the next two years thinking about the
future of health care coverage for children.
MAC-PAC has done some very good work examining what CHIP provides for
children that is different than the private market. The pediatricians
are in town this week for a conference, and as they will tell you, kids
are not just little adults. Benefits and services need to be tailored
to make sure that kids grow into healthy productive adults. This is
something we need to settle in the next two years. It is something we
can and should do. Voting against this amendment does nothing to
jeopardize that process.
We have a choice here. We can pass the House bill without changes or
we

[[Page S2158]]

can amend its bill and send it back to the House. I urge Senators to
support the agreement and vote against this amendment.
I yield the floor.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. Mr. President, the pending amendment, No. 1115, offered by
Senator Bennet, would violate the Senate pay-go rule and increase the
on-budget deficit over the 10-year period of fiscal years 2015 to 2024.
Therefore, I raise a point of order against this measure pursuant to
section 201(a) of S. Con. Res. 21, the concurrent resolution on the
budget for fiscal year 2008.
The PRESIDING OFFICER. The Senator from Colorado.
Mr. BENNET. Mr. President, pursuant to section 904 of the
Congressional Budget Act of 1974 and the waiver provisions of
applicable budget resolutions, I move to waive all applicable sections
of that act and applicable budget resolutions for purposes of the
pending amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The senior assistant legislative clerk called the roll.
The yeas and nays resulted--yeas 50, nays 50, as follows:

[Rollcall Vote No. 138 Leg.]

YEAS--50

Ayotte
Baldwin
Bennet
Blumenthal
Booker
Boxer
Brown
Cantwell
Cardin
Carper
Casey
Collins
Coons
Donnelly
Durbin
Feinstein
Franken
Gillibrand
Heinrich
Heitkamp
Heller
Hirono
Kaine
King
Klobuchar
Leahy
Manchin
Markey
McCaskill
Menendez
Merkley
Mikulski
Murphy
Murray
Nelson
Peters
Portman
Reed
Reid
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Udall
Warner
Warren
Whitehouse
Wyden

NAYS--50

Alexander
Barrasso
Blunt
Boozman
Burr
Capito
Cassidy
Coats
Cochran
Corker
Cornyn
Cotton
Crapo
Cruz
Daines
Enzi
Ernst
Fischer
Flake
Gardner
Graham
Grassley
Hatch
Hoeven
Inhofe
Isakson
Johnson
Kirk
Lankford
Lee
McCain
McConnell
Moran
Murkowski
Paul
Perdue
Risch
Roberts
Rounds
Rubio
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Tillis
Toomey
Vitter
Wicker
The PRESIDING OFFICER. On this vote, the yeas are 50, the nays are
50.
Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
The point of order is sustained, and the amendment falls.
The Senator from Utah.

Amendment No. 1116

Mr. LEE. I call up my amendment No. 1116, which is at the desk.
The PRESIDING OFFICER. The clerk will report.
The senior assistant legislative clerk read as follows:

The Senator from Utah [Mr. Lee], for himself, Mr. Sessions,
Mr. Cruz, Mr. Crapo, and Mr. Sasse, proposes an amendment
numbered 1116.

The amendment is as follows:

(Purpose: To strike the provision excluding the budgetary effects of
the Act from PAYGO requirements)

On page 261, strike line 21 and all that follows through
page 262, line 4.

The PRESIDING OFFICER. The Senator from Utah.
Mr. LEE. Mr. President, just 2 weeks after the Senate passed a 10-
year balanced budget, we find ourselves on the very brink of passing a
bill that would promptly unbalance it. We find ourselves on the brink
of passing a bill that would promptly unbalance the balanced budget we
just passed to the tune of $141 billion over the next decade. This is
exactly the kind of bait-and-switch behavior that has eroded the
public's trust in Congress in recent years.
To honor the promises we made to each other and that we made to the
American people, my amendment would simply subject H.R. 2 to the same
pay-as-you-go budget rules that cover other spending bills in Congress.
Paying for the new spending in this bill is the right thing to do, and
we just passed a budget promising we would do exactly that. My
amendment does nothing more than hold us to this very promise.
I implore my colleagues to join me in supporting this amendment.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, I rise in opposition to the Lee amendment.
Colleagues, the Lee amendment is the bluntest possible instrument
that would cut spending across government on every possible program.
The SGR, the doctors reimbursement formula, has always been a fake. The
$140 billion in this bill eliminates the budget fakery that Democrats
and Republicans believe has gotten out of hand. The underlying bill
gets rid of the budget fakery.
I urge colleagues on both sides of the aisle to reject the amendment,
and I yield back.
Mr. LEE. Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the amendment.
The clerk will call the roll.
The legislative clerk called the roll.
The result was announced--yeas 42, nays 58, as follows:

[Rollcall Vote No. 139 Leg.]

YEAS--42

Ayotte
Barrasso
Blunt
Boozman
Burr
Coats
Corker
Cotton
Crapo
Cruz
Daines
Enzi
Ernst
Fischer
Flake
Gardner
Grassley
Hoeven
Inhofe
Isakson
Johnson
Kirk
Lankford
Lee
McCain
Moran
Murkowski
Paul
Portman
Risch
Roberts
Rounds
Rubio
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Toomey
Vitter
Wicker

NAYS--58

Alexander
Baldwin
Bennet
Blumenthal
Booker
Boxer
Brown
Cantwell
Capito
Cardin
Carper
Casey
Cassidy
Cochran
Collins
Coons
Cornyn
Donnelly
Durbin
Feinstein
Franken
Gillibrand
Graham
Hatch
Heinrich
Heitkamp
Heller
Hirono
Kaine
King
Klobuchar
Leahy
Manchin
Markey
McCaskill
McConnell
Menendez
Merkley
Mikulski
Murphy
Murray
Nelson
Perdue
Peters
Reed
Reid
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Tillis
Udall
Warner
Warren
Whitehouse
Wyden
The amendment (No. 1116) was rejected.
The PRESIDING OFFICER (Mr. Rounds). The Senator from Washington.

Amendment No. 1117

(Purpose: To improve women's access to quality health care)

Mrs. MURRAY. Mr. President, I call up amendment No. 1117 and ask for
its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The senior assistant legislative clerk read as follows:

The Senator from Washington [Mrs. Murray], for herself, Mr.
Wyden, Mr. Brown, Ms. Baldwin, Mr. Bennet, Mr. Blumenthal,
Mrs. Boxer, Ms. Hirono, Ms. Mikulski, Mr. Menendez, Mr.
Murphy, Mr. Sanders, Ms. Stabenow, Mrs. Shaheen, Mr. Franken,
Mr. Reid, Mr. Whitehouse, Ms. Cantwell, Ms. Warren, and Mr.
Booker, proposes an amendment numbered 1117.

(The amendment is printed in today's Record under ``Text of
Amendments.'')
Mrs. MURRAY. Mr. President, many of us have been working for years to
protect Medicare access for seniors, invest in our community health
centers, and expand access to health care for our children. So I am
glad Democrats and Republicans in the House were able to come together
on these issues. But it is disappointing that in a bill which takes so
many good bipartisan steps forward, Republicans have insisted on trying
to score political points with their base on women's health.
The House SGR bill includes language that is just one more example of
using women's health as a political football. It is redundant, and it
is unnecessary.

I am offering an amendment tonight that shows we are making sure
women have comprehensive access to health

[[Page S2159]]

care. It focuses on moving women's health care forward by providing a
clean extension of community health care funding for 4 years, not 2, to
provide certainty. It will invest $2 billion in safety net providers
for women and their families through title X clinics. Finally, it will
invest in strengthening the women's health care workforce to make sure
women have access through their providers.
I hope my colleagues will support this amendment.
The PRESIDING OFFICER. The Senator's time has expired.
Mrs. MURRAY. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. Mr. President, as has been mentioned repeatedly regarding
the 10-day CMS hold, this 10-day CMS hold period will expire tonight.
Doctors who serve our seniors will be facing a 21-percent cut.
Senator Murray's bill costs $21.1 billion over 10 years, and it is
not offset. Therefore, the pending amendment, No. 1117, offered by
Senator Murray, would violate the Senate pay-go rule and increase the
on-budget deficit over the 10-year period of fiscal years 2015 to 2024.
Therefore, I raise a point of order against this measure pursuant to
section 201(a) of S. Con. Res. 21, the concurrent resolution on the
budget for fiscal year 2008.
The PRESIDING OFFICER. The Senator from Washington.
Mrs. MURRAY. Mr. President, pursuant to section 904 of the
Congressional Budget Act of 1974 and the waiver provisions of
applicable budget resolutions, I move to waive all applicable sections
of that Act and applicable budget resolutions for purposes of the
pending amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The senior assistant legislative clerk called the roll.
The yeas and nays resulted--yeas 43, nays 57, as follows:

[Rollcall Vote No. 140 Leg.]

YEAS--43

Baldwin
Bennet
Blumenthal
Booker
Boxer
Brown
Cantwell
Cardin
Carper
Coons
Durbin
Feinstein
Franken
Gillibrand
Heinrich
Heitkamp
Hirono
Kaine
King
Klobuchar
Leahy
Markey
McCaskill
Menendez
Merkley
Mikulski
Murphy
Murray
Nelson
Peters
Reed
Reid
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Udall
Warner
Warren
Whitehouse
Wyden

NAYS--57

Alexander
Ayotte
Barrasso
Blunt
Boozman
Burr
Capito
Casey
Cassidy
Coats
Cochran
Collins
Corker
Cornyn
Cotton
Crapo
Cruz
Daines
Donnelly
Enzi
Ernst
Fischer
Flake
Gardner
Graham
Grassley
Hatch
Heller
Hoeven
Inhofe
Isakson
Johnson
Kirk
Lankford
Lee
Manchin
McCain
McConnell
Moran
Murkowski
Paul
Perdue
Portman
Risch
Roberts
Rounds
Rubio
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Tillis
Toomey
Vitter
Wicker
The PRESIDING OFFICER. On this vote, the yeas are 43, the nays are
57.
Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
The Senator from Arkansas.

Amendment No. 1118

Mr. COTTON. Mr. President, I call up my amendment No. 1118.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Arkansas [Mr. Cotton] proposes an
amendment numbered 1118.

The amendment is as follows:

(Purpose: To provide steady updates of payment rates under the Medicare
physician fee schedule)

Beginning on page 5, strike line 22 and all that follows
through page 127, line 6, and insert the following:
(2) Update of rates for 2015 and subsequent years.--
Subsection (d) of section 1848 of the Social Security Act (42
U.S.C. 1395w-4) is amended by striking paragraph (16) and
inserting the following new paragraphs:
``(16) Update for january through june of 2015.--Subject to
paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B),
(13)(B), (14)(B), and (15)(B), in lieu of the update to the
single conversion factor established in paragraph (1)(C) that
would otherwise apply for 2015 for the period beginning on
January 1, 2015, and ending on June 30, 2015, the update to
the single conversion factor shall be 0.0 percent.
``(17) Update for july through december of 2015.--The
update to the single conversion factor established in
paragraph (1)(C) for the period beginning on July 1, 2015,
and ending on December 31, 2015, shall be 0.5 percent.
``(18) Update for 2016 and subsequent years.--The update to
the single conversion factor established in paragraph (1)(C)
for 2016 and each subsequent year shall be 0.5 percent.''.

Mr. COTTON. Mr. President, I want to replace the SGR permanently, but
I also want to do it correctly. This bill has two payment models in the
future. The first 4 years would give physicians a half-percent
increase. In future years, though, CMS would be empowered to issue
qualitative, subjective rules purporting to evaluate physician
performance and patient outcomes.
My amendment would simply extend the half-percent increase
indefinitely. I think there are many reasons to vote for this
amendment. CMS has not effectively used a blunt bureaucratic tool, such
as SGR, so we shouldn't give them a nuance tool; second, CMS itself
predicts we are going to have future doc fixes, which is going to
undermine the stability doctors and patients need; third, the
complexity of the outyear model is going to further drive
consolidation, especially for rural and independent doctors; and,
finally, CBO estimates this bill saves $10 billion.
I urge a ``yes'' vote. Let us have a permanent doc fix that works for
all doctors and patients.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, I rise in opposition to this amendment.
Today, the Medicare Program is a fee-for-volume system. The underlying
bill junks this and turns out the lights on millions of users.
The underlying bill before the Senate says the future will be about
rewarding value and good quality care for our Medicare patients. The
Cotton amendment embraces the outdated status quo and says there is no
need to coordinate care, no need to pay for value, no need to pay for
quality for our Medicare patients. I urge my colleagues to oppose this
amendment.
The PRESIDING OFFICER. The question is on agreeing to the amendment.
Mr. COTTON. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The clerk will call the roll.
The legislative clerk called the roll.
The result was announced--yeas 11, nays 89, as follows:

[Rollcall Vote No. 141 Leg.]

YEAS--11

Boozman
Cotton
Cruz
Inhofe
Lee
Paul
Rubio
Sasse
Sessions
Shelby
Vitter

NAYS--89

Alexander
Ayotte
Baldwin
Barrasso
Bennet
Blumenthal
Blunt
Booker
Boxer
Brown
Burr
Cantwell
Capito
Cardin
Carper
Casey
Cassidy
Coats
Cochran
Collins
Coons
Corker
Cornyn
Crapo
Daines
Donnelly
Durbin
Enzi
Ernst
Feinstein
Fischer
Flake
Franken
Gardner
Gillibrand
Graham
Grassley
Hatch
Heinrich
Heitkamp
Heller
Hirono
Hoeven
Isakson
Johnson
Kaine
King
Kirk
Klobuchar
Lankford
Leahy
Manchin
Markey
McCain
McCaskill
McConnell
Menendez
Merkley
Mikulski
Moran
Murkowski
Murphy
Murray
Nelson
Perdue
Peters
Portman
Reed
Reid
Risch
Roberts
Rounds
Sanders
Schatz
Schumer
Scott
Shaheen
Stabenow
Sullivan
Tester
Thune
Tillis
Toomey
Udall
Warner
Warren
Whitehouse
Wicker
Wyden
The amendment (No. 1118) was rejected.
The PRESIDING OFFICER. The Senator from Maryland.

[[Page S2160]]

Amendment No. 1119

(Purpose: To repeal the therapy cap and provide for medical
review of outpatient therapy services)

Mr. CARDIN. Mr. President, I call up amendment No. 1119.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Maryland [Mr. Cardin], for himself, Mr.
Vitter, Mr. Reid, Mr. Whitehouse, Ms. Hirono, Mr. Casey, Mrs.
Shaheen, Mr. Menendez, Ms. Mikulski, Mr. Brown, Ms. Stabenow,
Mr. Reed, Mr. Leahy, Ms. Cantwell, Mr. Bennet, Mr. Booker,
Ms. Warren, and Ms. Klobuchar, proposes an amendment numbered
1119.

Mr. CARDIN. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The amendment is printed in today's Record under ``Text of
Amendments.'')
Mr. CARDIN. Mr. President, I have explained this amendment a little
earlier.
I ask unanimous consent that Senator Klobuchar be added as a
cosponsor of the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. CARDIN. This deals with the therapy cap on which we now have had
12 patches. It is almost the identical problem we have with the SGR,
which is the underlying bill. It deals with seniors, Medicare
beneficiaries, having access to therapy services, those who have had
strokes, those who have serious issues and need rehab therapy.
The cap never made sense in 1997 when it was put into effect. It was
not the right policy. We have had bipartisan support to correct this as
we have the SGR, and my underlying amendment does that.
I ask my colleagues to support the amendment.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. Mr. President, this bill is far from perfect, but we
cannot let perfect be the enemy of the good on this bipartisan
compromise that passed the House with almost 400 votes.
The House leadership has made it clear to us, they will not pass
another package, and I don't blame them. Time is of the essence.
The therapy caps provision may not be the best policy, but it is in
place to ensure there is a governor on unnecessary utilization and
spending in the Medicare Program.
Congress should use the next 2 years to find a solution to this
problem and work to pay for that solution, and I intend to do that. But
to have that on this bill would be a catastrophe at the end of what has
been a really, really very, very tough-fought bill all the way through.
The pending amendment, No. 1119, offered by Senator Cardin would
violate the Senate pay-go rule and increase the on-budget deficit over
the 10-year period of fiscal years 2015 to 2024. Therefore, I raise a
point of order against this measure pursuant to section 201(a) of S.
Con. Res. 21, the concurrent resolution on the budget for fiscal year
2008.
The PRESIDING OFFICER. The Senator from Maryland.
Mr. CARDIN. Mr. President, pursuant to section 904 of the
Congressional Budget Act of 1974 and the waiver provisions of
applicable budget resolutions, I move to waive all applicable sections
of that act and applicable budget resolutions for purposes of the
pending amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The bill clerk called the roll.
The yeas and nays resulted--yeas 58, nays 42, as follows:

[Rollcall Vote No. 142 Leg.]

YEAS--58

Ayotte
Baldwin
Bennet
Blumenthal
Booker
Boxer
Brown
Burr
Cantwell
Cardin
Carper
Casey
Cassidy
Collins
Coons
Donnelly
Durbin
Feinstein
Franken
Gillibrand
Graham
Heinrich
Heitkamp
Hirono
Hoeven
Kaine
King
Kirk
Klobuchar
Leahy
Markey
McCaskill
Menendez
Merkley
Mikulski
Moran
Murkowski
Murphy
Murray
Nelson
Paul
Peters
Portman
Reed
Reid
Rounds
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Udall
Vitter
Warner
Warren
Whitehouse
Wyden

NAYS--42

Alexander
Barrasso
Blunt
Boozman
Capito
Coats
Cochran
Corker
Cornyn
Cotton
Crapo
Cruz
Daines
Enzi
Ernst
Fischer
Flake
Gardner
Grassley
Hatch
Heller
Inhofe
Isakson
Johnson
Lankford
Lee
Manchin
McCain
McConnell
Perdue
Risch
Roberts
Rubio
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Tillis
Toomey
Wicker
The PRESIDING OFFICER. On this vote, the yeas are 58, the nays are
42.
Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
The bill was ordered to a third reading and was read the third time.
The PRESIDING OFFICER. There is now 2 minutes of debate prior to a
vote on final passage.
Mr. REED. Mr. President, I am pleased to see that after 12 years of
temporary patches to delay cuts under the Sustainable Growth Rate,
Congress is finally acting to reform the Medicare physician payment
system for the long term. In so doing, we not only ensure access to
care for seniors but also help improve the quality of care they receive
through Medicare.
However, I am disappointed that the same certainty is not provided to
children and families impacted by the Children's Health Insurance
program, CHIP. This legislation extends funding for CHIP for 2 years
and continues policies that encourage enrollment in the program. But it
does not extend this critical funding for a much longer period of time,
like the 4 years my colleagues and I have been urging for months. We
are missing a crucial opportunity to ensure that children and pregnant
women have access to comprehensive, affordable health insurance
coverage for years to come. Currently, more than 10 million children
benefit from this program. In 2 years, funding for this program will
expire, putting children at risk of becoming uninsured once again.
Moreover, the bill takes the same temporary approach with respect to
the Maternal, Infant, and Early Childhood Home Visiting, MIECHV,
program, Community Health Centers, and other initiatives.
I am also concerned that Medicare beneficiaries will see increases in
out-of-pocket costs to help pay for the legislation. Faced with the
threat of looming cuts to health care providers and the resulting risk
of disruption of services should doctors withdraw from Medicare, we are
being forced to instead choose to increase costs on seniors, rather
than any number of offsets that could have asked the wealthiest
Americans or corporations to pay a little more to ensure that Medicare
is protected for everyone. Indeed, the majority in the other body
insisted on paying for this bill, at least in part, by increasing these
out-of-pocket costs. For a bill designed to protect access to health
care for seniors, it should not turn around and then demand they pay
more. We should be reaffirming our commitment to protecting Medicare
beneficiaries and these cuts do just the opposite. With these
provisions not taking effect until 5 years from now, I hope that gives
us ample time to revisit this.
After years of disagreements on health care issues, it is good to see
that we can move on this bill on a bipartisan basis. So while I have
the reservations I have outlined, and will support amendments to
address these issues, I will vote for this legislation.
The PRESIDING OFFICER. The Senator from Alabama.
Mr. SESSIONS. Mr. President, this legislation has not gone through
the regular order in the Senate. It will add $174 billion to the debt.
It is subject to seven different budget points of order. We have had a
series of budget point of order votes where we have affirmed the budget
and the responsibility we have to adhere to it. Let's do the right
thing. Let's tell the House, which tried to send this bill over at 3:30
in the morning for us to pass right before we recessed after the budget
votes, that, yes, we are absolutely committed to fixing the doctors'
payments and in a responsible, long-term way, but it

[[Page S2161]]

needs to be paid for in a responsible, long-term way. Upholding the
budget point of order does not kill the bill; it sends it back to
committee to make sure it is fully paid for.
So let's not be afraid tonight. Let's say to our House colleagues:
Colleagues, we agree with you on your vote, but we must pay for this
bill.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. SESSIONS. Mr. President, I need to make a budget point of order.
The PRESIDING OFFICER. There is still time remaining in favor of the
bill.
Mr. SESSIONS. Mr. President, the pending measure, H.R. 2, the
Medicare Access and CHIP Reauthorization Act of 2015, violates section
311(b) of the fiscal year 2009 budget resolution by causing a net
increase in the long-term deficit in excess of $5 billion in the 10-
year period of fiscal years 2025 through 2034. Therefore, I raise a
point of order against this measure pursuant to section 311(b) of S.
Con. Res. 70, the concurrent resolution on the budget for fiscal year
2009, and ask for the yeas and nays.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. I yield back the time.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. I move to waive all applicable sections of the Budget Act,
and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The senior assistant bill clerk called the roll.
The yeas and nays resulted--yeas 71, nays 29, as follows:

[Rollcall Vote No. 143 Leg.]

YEAS--71

Alexander
Baldwin
Bennet
Blumenthal
Blunt
Booker
Boozman
Boxer
Brown
Burr
Cantwell
Capito
Cardin
Carper
Casey
Cassidy
Cochran
Collins
Coons
Corker
Cornyn
Donnelly
Durbin
Feinstein
Flake
Franken
Gillibrand
Graham
Hatch
Heinrich
Heitkamp
Heller
Hirono
Isakson
Kaine
King
Kirk
Klobuchar
Leahy
Manchin
Markey
McCain
McCaskill
McConnell
Menendez
Merkley
Mikulski
Moran
Murkowski
Murphy
Murray
Nelson
Paul
Peters
Reed
Reid
Roberts
Rounds
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Tillis
Udall
Warner
Warren
Whitehouse
Wicker
Wyden

NAYS--29

Ayotte
Barrasso
Coats
Cotton
Crapo
Cruz
Daines
Enzi
Ernst
Fischer
Gardner
Grassley
Hoeven
Inhofe
Johnson
Lankford
Lee
Perdue
Portman
Risch
Rubio
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Toomey
Vitter
The PRESIDING OFFICER. On this vote, the yeas are 71, the nays are
29.
Three-fifths of the Senators duly chosen and sworn having voted in
the affirmative, the motion is agreed to. The point of order is not
sustained, and the motion is agreed to.
The Senator from Utah.
Mr. HATCH. Mr. President, we will soon be voting on final passage of
H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015.
As I mentioned earlier, this bill represents more than 2 years of
hard work on both sides of the Capitol. And, it represents a real step
forward for bipartisan health care policy. I am proud to have been one
of the authors of this legislation and I look forward to what I believe
we will see--the bill pass with bipartisan support.
I want to commend everyone who worked on this legislation. I
particularly want to thank Senator Max Baucus who worked with me from
the beginning on this effort here in the Senate. In addition, I would
like to thank the current ranking member of the Finance Committee,
Senator Wyden for all his work. I also want to thank our colleagues on
the House Energy and Commerce and Ways and Means Committees who also
worked very hard in crafting this SGR fix.
As with any major legislative effort, there are a number of
staffers--both current and former--who also deserve our thanks. From my
own Finance Committee staff, I want to thank Dan Todd, Kristin Welsh,
Erin Dempsey, Katie Simeon, Kim Brandt, and Becky Shipp for all of
their hard work. I also want to thank my senior team--Jay Khosla, Chris
Campbell, and Mark Prater. On the Democratic side of the committee, I
want to thank Karen Fisher, David Schwartz, Matt Kazan, Juan Machado,
Scott Levy, and Colin Goldfinch.
I also want to commend the efforts of Scott Raab and Monica Popp from
the Senate Republican leadership offices.
In addition, from the House side, I specifically want to thank
Charlotte Ivancic and Wendell Primus.
We have also gotten quite a bit of help from CBO in this effort. For
that, I want to thank Lori Housman, Tom Bradley, and Holly Harvey.
CMS also provided vital technical assistance as we put this
legislation together. For that, I'd like to thank Jennifer Druckman,
Ira Burney, and Anne Scott.
And, of course, we couldn't have done without the help of the
Legislative Counsels' offices, particularly John Goetcheus, Kelly
Malone, Ruth Ernst, and Phil Lynch on the Senate side and Jessica
Shapiro and Jessica Cross over in the House.
I wish to once again urge my colleagues to support this bill. It is a
monumental achievement. It is legislation that has been long in the
offing. I wish to thank everybody on both sides for the cooperation we
have had. I just want to personally express my gratitude for being able
to pass this bill.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, I will be very brief. I think tonight is a
milestone for the Medicare Program--a lifeline for millions of older
people. That is because tonight the Senate is voting to retire the
outdated, inefficiency-rewarding, commonsense-defying Medicare
reimbursement system.
As Senator Hatch noted, it has been bipartisan; it has long been
bipartisan. I think this is an important night for the Senate and it is
going to be long remembered.
I yield the floor.
Mr. HATCH. Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The bill having been read the third time, the question is, Shall the
bill pass?
The clerk will call the roll.
The bill clerk called the roll.
The result was announced--yeas 92, nays 8, as follows:

[Rollcall Vote No. 144 Leg.]

YEAS--92

Alexander
Ayotte
Baldwin
Barrasso
Bennet
Blumenthal
Blunt
Booker
Boozman
Boxer
Brown
Burr
Cantwell
Capito
Cardin
Carper
Casey
Cassidy
Coats
Cochran
Collins
Coons
Corker
Cornyn
Cotton
Crapo
Daines
Donnelly
Durbin
Enzi
Ernst
Feinstein
Fischer
Flake
Franken
Gardner
Gillibrand
Graham
Grassley
Hatch
Heinrich
Heitkamp
Heller
Hirono
Hoeven
Inhofe
Isakson
Johnson
Kaine
King
Kirk
Klobuchar
Lankford
Leahy
Manchin
Markey
McCain
McCaskill
McConnell
Menendez
Merkley
Mikulski
Moran
Murkowski
Murphy
Murray
Nelson
Paul
Peters
Portman
Reed
Reid
Risch
Roberts
Rounds
Sanders
Schatz
Schumer
Shaheen
Stabenow
Sullivan
Tester
Thune
Tillis
Toomey
Udall
Vitter
Warner
Warren
Whitehouse
Wicker
Wyden

NAYS--8

Cruz
Lee
Perdue
Rubio
Sasse
Scott
Sessions
Shelby
The bill (H.R. 2) was passed.
The PRESIDING OFFICER. The majority leader.
Mr. McCONNELL. What is the pending business?

____________________