[Congressional Record (Bound Edition), Volume 155 (2009), Part 16]
[Senate]
[Pages 21700-21702]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. NELSON of Florida. Mr. President, I am here to talk about health 
care and health care reform today. A lot is happening today. The 
chairman of our Finance Committee, Senator Baucus, is, as we speak, 
making his chairman's mark become available publicly. Then later on 
today, around noon, he is going to have a public statement about it.
  Clearly this is one of the most pressing issues. Throughout this long 
hot summer we have had, people across the country have debated this 
issue, discussed it. It has helped lay the groundwork for where we are 
right now on this historic issue. I personally believe the President of 
the United States is committed that we are going to pass health care 
reform legislation.
  I believe the President of the United States back in the early 1990s 
was equally committed, but it did not happen. I think the big 
difference between then, in 1993, and now is that in fact it is going 
to happen. I want you to know this Senator is optimistic that when it 
gets around to 60 votes in this Chamber in order to shut off debate, I 
think we will get those 60 votes, and I think we will get them in a 
bipartisan fashion.
  Of course, right now all the commentary you hear is what is this 
problem and what is happening on this fight and who is not on board, 
and so forth. That is all natural. That is natural kind of talk. But 
when the moment of truth comes in casting yea or nay on this floor, I 
think people are seeing, day by day, examples of why we have to have 
health care reform.
  This happened just this past week in my own State of Florida. A woman 
undergoing cancer treatments has a reasonable degree of success by 
virtue of the enormous advances in cancer treatment. As the research 
doctors will tell you, people can live with cancer now. This lady was 
told by her insurance company they were disapproving the payments for 
the continuation of her treatments for cancer. That is the kind of 
stuff we cannot tolerate. It is another example of how insurance is not 
available even if an American citizen can afford it.
  I will give another example. One of the prominent citizens in a big 
city in Florida told me, for her corporation the health insurance is 
being jacked up 47 percent. This is for a major telecommunications 
company that has thousands of lives they can spread the health risk 
over, and it is being jacked up 47 percent. She said they negotiated 
that down from 55 percent. The question of affordability is there as 
well as the availability. In other words, the American people need 
stability when it comes to them knowing that health insurance and 
health care are going to be there for them. That is what we do not have 
and that is why this Senator is optimistic that when the moment of 
truth comes that we have to indicate to the President of the Senate if 
our vote is yea or nay, we are going to have 60 votes to cut off debate 
to get to the bill to start the amendatory process.
  We are going to start that amendatory process in the Finance 
Committee of the Senate next week. The chairman is going to come out 
with a mark--the chairman's suggestion, called the chairman's mark--
today. There is a bunch of stuff in there this Senator doesn't agree 
with. But we are going to have an opportunity to change it.
  Every one of us has received a lot of commentary about this from our 
constituents. In our office, just in the last few weeks, just on this 
issue we have received 56,000 calls or e-mails or letters. I happen to 
think this is good. It is bringing out passions. Unfortunately, it is 
bringing out, sometimes, hot passions.
  During August I was inside giving a speech to the greater Miami 
Chamber of Commerce while outside on the road were demonstrators with 
signs. Along came a pickup truck, a fellow got out, got into an 
argument, and he hauled off and knocked out a 65-year-old demonstrator. 
Of course, the TV cameras arrive when the poor 65-year-old is just 
coming to consciousness.
  There is no place for that, but that indicates some of the hot 
passions this has brought out. Remember what President Lincoln said:

       With public sentiment, nothing can fail. Without it, 
     nothing can succeed.

  He was specifically talking about the way we do government and the 
way we make law in this country.
  Recall also what President Kennedy said about 50 years ago. He said 
specifically about health care:

       The consent of the citizens of this country is essential if 
     this or any other piece of progressive legislation is going 
     to be passed.

  He was specifically talking about health care. So every one of us 
Senators can say, from the personal meetings, the calls, the letters, 
the e-mails--we can tell you there are a lot of folks out there who do 
not have access to affordable health care or in many cases to quality 
health care. We can tell you the stories we have heard about people 
being systematically excluded by some of the Nation's major managed 
care insurance companies and/or just insurance companies. 
Unfortunately, those are not rare cases. That is why we are here, to do 
something about it.
  Regardless of where you stand on the specifics of the issue, I think 
we can agree the current system, if continued, would be unfair, too 
costly, and as a result it needs to be fixed. It affects every one of 
us. It is also a truth that sooner or later every American, 9 out of 10 
times, 9 out of 10 of us are going to end up in the hospital at some 
point.
  What do we do? I think the President laid down a good marker. His 
speech before the joint session was excellent. It gave some clear 
answers about his views on reform. It is true he has been more hands-
off and is letting it be done by the Senate and the House. But, 
interestingly, when he got more specific, as he did in his speech to 
the joint session, he described or tracked pretty close to what is 
coming out in Senator Baucus's mark that the Finance Committee is going 
to take up next week.
  This legislation is going to let folks who are happy with their 
insurance keep it, including our senior citizens who are on Medicare 
and our veterans who have their health care. But it is also going to 
create a marketplace, a marketplace called the health insurance 
exchange, for those who do not have insurance. And in the case of the 
State of Florida, I will give you a percentage. That is 21 percent of 
our people who do not have insurance in Florida.

[[Page 21701]]

  That number is a little less nationwide, but if you take Florida as a 
bellwether, it is 21 percent who do not have insurance. This 
legislation is going to create an exchange, a health insurance 
exchange, for those who do not have it, cannot get it, or those who are 
unhappy with their coverage. They can go get it at an affordable price.
  It is a private sector solution of insurance companies competing with 
an insurance co-op, which is owned by the policyholders, not a 
government-insurance company, where in that competition of the free 
marketplace, they can offer insurance at lower prices. And for those 
poor souls who all they can get is not a group policy because they do 
not get insurance through an employer, the only way they can get it is 
to buy an individual policy, and, therefore, because it is an 
individual policy their rates are through the Moon--they are going to 
have an opportunity also to go into this health insurance exchange 
where they can get good coverage at a lower price. So what the 
legislation is going to do, in the creation of this health insurance 
exchange, it is going to hold the insurance companies' feet to the fire 
to require them to cover everyone and prevent them from dropping people 
when they get sick. That is called ``guaranteed coverage'' without any 
exemption from preexisting medical conditions.
  That is why a lot of people cannot get insurance. They have had a 
heart attack before or they had some malady or you have heard the 
horror cases that they had a skin rash previously 3 years ago, and the 
insurance company will not cover them because they said that is a 
preexisting condition.
  We are going to stop all of that with this legislation that I think 
will ultimately become law. It is going to contain several additional 
measures aimed at reducing other medical and prescription drug costs, 
and it is going to go right at the waste and the fraud in the system.
  This is a starting point. This is not the end all to be all. This is 
the starting point. We are going to do the amendments probably for 2 
weeks in the Finance Committee. Then it is going to come out here, and 
it is going to get amended here. Then it is going to go to a conference 
committee, and it is going to get amended more.
  There are some concerns I want to share with the Senate and anybody 
who is listening through the lens of that TV camera. We have emphasized 
the importance of making sure that the insurance available on that 
health insurance exchange is affordable. We emphasized the importance 
of addressing the high health care costs of retirees who are not yet 
ready, because they are not eligible, for Medicare.
  We have urged and expressed our concerns about how small business is 
treated under this bill. Then, when it comes to senior citizens, those 
who are on Medicare, who generally are very favorable about their 
Medicare coverage, it is certainly a concern of this Senator who has a 
substantial population in my State of Florida of senior citizens on 
Medicare that they not have something taken away from them they have 
come to expect and to rely on in Medicare.
  That particularly is so with regard to a program called Medicare 
Advantage, which is a fancy term for a Medicare HMO, a health 
maintenance organization. The way the system was set up in a bill that 
passed 5 years ago, which this Senator did not vote for because it was 
severely flawed--nevertheless, it is the law and it has been the law 
for the last 5 years. It set up a system whereby Medicare HMOs, called 
Medicare Advantage, bid for senior citizens by offering them attractive 
premiums that are below what the standard Medicare fee-for-service is 
in a community. The law requires whatever that differential is between 
what the Medicare HMO has bid and what the fee for service is, that a 
quarter of that has to be given back to Medicare, but 75 percent of 
that differential is given to the senior citizen's Medicare 
beneficiary, through either lower premiums or no copays, or through 
extra benefits, such as hearing devices, or eye glasses or maybe even a 
membership in a fitness club.
  Needless to say, the senior citizens who have this do not want it 
taken away from them. Although people will say these high subsidies to 
Medicare Advantage, to those insurance companies need to be adjusted, I 
think it would be intolerable to ask the senior citizens on Medicare 
who have it to give up substantial health benefits they are enjoying 
under Medicare.
  For hundreds of thousands of seniors who did not conceive of Medicare 
Advantage but who have come to rely on it, this Senator is going to 
offer an amendment that will shield them from those benefit cuts on 
existing senior citizens on Medicare. I do not think we can punish 
senior citizens who signed up, and if changes need to be made for the 
future solvency of Medicare, then the senior citizens currently with 
Medicare Advantage should be grandfathered in. That is what my 
amendment is going to be. It is going to say that on the date of the 
bill, once it is signed into law, those who have that benefit should 
not have it taken away, and that a competitive arrangement for Medicare 
Advantage in the future would be done on a going-forward basis.
  I have another reason I am offering that amendment, because Senator 
Claude Pepper was one of the people who nurtured me along as a young 
Congressman in the House of Representatives. A lot of young people 
today do not remember who Senator, then Congressman, Claude Pepper was. 
He had been a Senator back when Roosevelt was President. He came back 
into the Congress after a 12-year hiatus out of office as a new 
Congressman from South Florida. He became the champion of the seniors 
of America, first, chairman of the Aging Committee in the House of 
Representatives, and then as chairman of the Rules Committee of the 
House of Representatives.
  What Claude Pepper said everybody listened to, because he spoke with 
great credibility and he spoke with great passion and eloquence. He 
spoke for a good cause, and that was standing up for the rights of 
senior citizens. He had been there at the outset. He had been a Senator 
when Social Security came into being in the midst of the Great 
Depression. Claude Pepper, who died in office at about age 87, on many 
private talks would say: Bill, I want you to look out for our seniors. 
Someone has to look out for them.
  I have never forgotten those admonitions, those instructions that 
were done with such love and compassion. So I feel it is my duty to try 
to protect our seniors as we get into the midst of this debate.
  There are other areas where we can certainly improve what is expected 
to come out today at noon. Another amendment would require the 
pharmaceutical companies to provide rebates to Medicare, as they have 
been doing for years, for decades, to Medicaid.
  Medicaid has roughly 49 million people in this country. Medicare has 
roughly 44 million people in this country. We give big discounts 
because we are buying for 49 million Medicaid recipients. The drug 
companies give those discounts back in the form of a rebate to the 
governments, the Federal and State governments.
  Why shouldn't they do that with regard to the 44 million Medicare 
recipients? If it is good enough for Medicaid, and it makes drugs a lot 
cheaper, why not do it for Medicare recipients? By the way, it would 
save Medicare a ton of money.
  There are serious issues to be resolved. This Senator is optimistic, 
and I believe we are going to be able to achieve this goal of expanding 
affordable health care to nearly all Americans. We must do so without 
raising taxes on the middle class or upending their coverage. And we 
must do so without lowering the quality of health care for any 
American, including our senior citizens.
  I am, by nature, an optimist. In the midst of everything that is 
wrong about this health care bill, I remain an optimist. The moment of 
truth is coming when we cast that vote yea or nay.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Bennet.) The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. NELSON of Florida. I ask unanimous consent that the order for the 
quorum call be rescinded.

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  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. NELSON of Florida. Mr. President, how much time remains in 
morning business?
  The PRESIDING OFFICER. In the first segment of the time, 4\1/2\ 
minutes remains.
  Mr. NELSON of Florida. I ask unanimous consent to be recognized.
  The PRESIDING OFFICER. The Senator is recognized.

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