[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.
____________________