[Congressional Record Volume 163, Number 209 (Thursday, December 21, 2017)]
[Senate]
[Pages S8234-S8235]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            MEDICARE FUNDING

  Ms. COLLINS. Mr. President, I rise in strong opposition to the point 
of order that will be offered by the Senator from Kentucky, which would 
have the effect of allowing harmful, indiscriminate budget cuts to be 
triggered. While there are certain safety net programs like Medicaid, 
food stamps, and Social Security that are exempt from these automatic 
cuts, the Medicare Program is not exempt, and there are a number of 
other vital programs in addition to Medicare, including Federal 
education programs, agricultural support for farmers, and funding for 
Citizenship and Immigration Services, among others, that would be 
subject to immediate automatic cuts if we failed to take action tonight 
to avert that outcome.
  It has been deeply disturbing to me to see seniors frightened about 
the possibility that a $25 billion cut in Medicare--that is a 4-percent 
reduction--would be automatically triggered. By waiving this point of 
order, we will prevent such cuts from taking place, reassuring our 
Nation's seniors and their loved ones.
  Although the law that could cause this reduction has been waived some 
16 times--and indeed never implemented since it was enacted--I felt 
that it was essential that our leaders publicly commit that Medicare 
reductions would not be triggered, given the amount of fear, anxiety, 
and misinformation that is out there.
  I wrote to the Senate majority leader, urging that we immediately 
remove the threat of an automatic cut in Medicare's funding. In 
response, I am pleased to say that both the majority leader and the 
Speaker of the House released a joint statement that pledged this will 
not happen, and that is the issue before us tonight.
  Medicare provides essential healthcare benefits to our Nation's 
seniors. We must remove, immediately, the threat that an automatic 
reduction in the program's funding could occur, which would affect 
healthcare providers and diminish access that beneficiaries--including 
our seniors and disabled individuals--have to the services they need.
  Earlier this month, AARP sent a letter to the House and the Senate 
leadership, alluding and supporting my inquiry and warning Congress of 
the potential consequences. The letter says:

       The sudden cut to Medicare provider funding in 2018 would 
     have an immediate and lasting impact, including fewer 
     healthcare providers participating in Medicare and reduced 
     access to care for Medicare beneficiaries. Healthcare 
     providers may choose to stop accepting Medicare patients at a 
     time when the Medicare population is growing by 10,000 new 
     beneficiaries each day. . . . Furthermore, Medicare Advantage 
     plans and Part D prescription drug plans may charge higher 
     premiums or cost sharing in future years to make up for these 
     cuts now.

  These potential cuts would have an enormous impact on our hospitals, 
our nursing homes, our home health agencies, and other essential 
healthcare providers who play a critical role in providing healthcare 
services and also as important economic drivers in our communities.
  It is critical for Congress to act quickly, to act tonight before we 
go home, so seniors do not have the anxiety of wondering whether the 
tax bill will somehow negatively affect their healthcare. We can act 
tonight to remove that anxiety and assure them it will not.
  Mr. President, I ask unanimous consent that the exchange of letters I 
had with Majority Leader McConnell and also the letter from AARP be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                  U.S. Senate,

                                Washington, DC, November 28, 2017.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
       Dear Majority Leader McConnell: I write to express my deep 
     concerns with the Congressional Budget Office's determination 
     that an automatic four percent cut to Medicare, estimated to 
     be roughly $25 billion for fiscal year 2018, could be 
     triggered by the passage of tax reform legislation as a 
     result of the Pay-As-You-Go Act of 2010 (PAYGO) even though 
     there is no intention for such a reduction to occur.
       Since I do not believe it is anyone's intention to allow 
     automatic cuts to Medicare to occur, I urge swift action to 
     waive the PAYGO requirements. Medicare provides essential 
     benefits to our nation's seniors, and we must remove 
     immediately the threat that an automatic reduction in the 
     program's funding could occur.
       Since PAYGO was enacted, sixteen laws that would have 
     otherwise triggered PAYGO's automatic spending cuts have 
     included provisions to exclude all or part of the law's 
     budgetary impact, including the American Taxpayer Relief Act 
     of 2012 that was enacted under the previous Administration.
       I look forward to working with you to ensure that no 
     Medicare cuts are triggered under PAYGO, a goal I believe is 
     supported by members on both sides of the aisle. Thank you 
     for your attention to this critical issue.
           Sincerely,
     Susan M. Collins, U.S. Senator.
                                  ____



                                                  U.S. Senate,

                                 Washington, DC, December 1, 2017.
     Hon. Susan Collins,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Collins: Thank you for your letter expressing 
     concern about the across-the-board spending cuts. You will be 
     pleased to know that Speaker Paul Ryan and I issued the 
     following joint statement earlier today:
       ``Critics of tax reform are claiming the legislation would 
     lead to massive, across-the-board spending cuts in vital 
     programs--including a 4-percent reduction in Medicare--due to 
     the Pay-Go law enacted in 2010. This will not happen. 
     Congress has readily available methods to waive this law, 
     which has never been enforced since its enactment. There is 
     no reason to believe that Congress would not act again to 
     prevent a sequester, and we will work to ensure these 
     spending cuts are prevented.''
       Again, thank you.
           Sincerely,
                                                  Mitch McConnell,
     Majority Leader.
                                  ____



                                               AARP,

                                                 December 7, 2017.
     Hon. Mitch McConnell,
     U.S. Senate,
     U.S. Capitol, Washington, DC.
     Hon. Charles E. Schumer,
     U.S. Senate,
     U.S. Capitol, Washington, DC.
     Hon. Paul D. Ryan,
     House of Representatives,
     U.S. Capitol, Washington, DC.
     Hon. Nancy Pelosi,
     House of Representatives,
     U.S. Capitol, Washington, DC.
       Dear Majority Leader McConnell, Minority Leader Schumer, 
     Speaker Ryan, and Minority Leader Pelosi: On behalf of our 
     members and all Americans age 50 and older, AARP is writing 
     to express concerns about the potential for automatic cuts to 
     Medicare beginning in January 2018. AARP, with its nearly 38 
     million members in all 50 States and the District of 
     Columbia, Puerto Rico and the Virgin Islands, represents 
     millions of individuals whose health care depends on 
     Medicare. We urge you to act now to prevent these cuts to 
     Medicare.
       The Congressional Budget Office (CBO) recently provided an 
     explanation of the impact H.R. 1 and its $1.5 trillion 
     deficit increase will have on Medicare and other programs. 
     The CBO estimated that because of statutory pay-as-you-go and 
     the increase in the deficit, Medicare providers will be 
     subject to an automatic $25 billion cut in fiscal year 2018, 
     and additional cuts in subsequent fiscal years. According to 
     CBO, the automatic cuts, or sequester, would begin as soon as 
     January, 2018.
       In a statement responding to Senator Collins's inquiry on 
     statutory pay-as-you-go and the risk of Medicare cuts, Leader 
     McConnell and Speaker Ryan provided the following assurance: 
     ``Congress has readily available methods to waive this law, 
     which has never been enforced since its enactment. There is 
     no reason to believe that Congress

[[Page S8235]]

     would not act again to prevent a sequester, and we will work 
     to ensure these spending cuts are prevented.'' It is of 
     paramount interest to our members, and other older Americans, 
     that you act to prevent these spending cuts as soon as 
     possible.
       The sudden cut to Medicare provider funding in 2018 would 
     have an immediate and lasting impact, including fewer 
     providers participating in Medicare and reduced access to 
     care for Medicare beneficiaries. Health care providers may 
     choose to stop accepting Medicare patients at a time when the 
     Medicare population is growing by 10,000 new beneficiaries 
     each day. Cutting reimbursement in 2018, and possibly each 
     year thereafter, would discourage health care providers from 
     treating this growing population. We need to protect and 
     strengthen the Medicare program and ensure there is a health 
     care workforce able and willing to take on new patients. 
     Furthermore, Medicare Advantage plans and Part D prescription 
     drug plans may charge higher premiums or cost-sharing in 
     future years to make up for the cuts now. These cuts also 
     come at a critical time in the program when providers are 
     adopting the new payment systems according to MACRA (P.L. 
     114-10) which overwhelmingly passed Congress in 2015. An 
     across-the-board cut to provider reimbursement will leave 
     health care providers fewer resources to invest in their 
     practices, and make them less inclined to take on risk in new 
     alternative payment models. The sudden payment cut will 
     stifle the transition toward payment based on value, having 
     implications for future Medicare cost growth. In any event, 
     Medicare beneficiaries will pay the price for these sudden 
     and significant cuts.
       Our members and other older Americans are counting on you 
     to preserve their access to Medicare services, including 
     their doctors and hospitals. We urge you to act swiftly to 
     prevent automatic cuts to Medicare. If you have any questions 
     or need additional information, please feel free to contact 
     me or contact Joyce Rogers, Senior Vice President of 
     Government Affairs.
           Sincerely,
                                                Jo Ann C. Jenkins,
                                          Chief Executive Officer.

  Ms. COLLINS. I yield the floor.
  The PRESIDING OFFICER (Mr. Young). The majority leader.

                          ____________________