[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Senate]
[Pages 24546-24547]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Ms. MURKOWSKI. Mr. President, I rise to talk about the hidden taxes 
that American families could be forced to pay under the Baucus proposal 
if Congress doesn't cut half a trillion dollars in Medicare services. 
Despite the score we saw last week by the CBO that there would be an 
estimated $81 billion in savings to the Federal Government, the fine 
print of that CBO letter paints a different picture and raises some 
real concerns about whether Congress has the stomach to cut $500 
billion in services to the elderly and the disabled on Medicare.
  This point was raised over the weekend. There were several editorials 
that ran in the Washington Post, Reuters, the Salt Lake Tribune, and 
the Colorado Springs Gazette, and they criticized the Baucus bill for 
unrealistically relying on $500 billion in savings in Medicare. These 
articles conclude that Congress is unlikely to enact Medicare cuts 
based on their annual action--our annual action--since 2003 that has 
stopped cuts to the doctors' reimbursement rates under the sustainable 
growth rates formula. This is what we call the SGR.
  In 1997, Congress enacted the SGR formula, which automatically cuts 
Medicare reimbursement rates when annual spending for doctors' visits 
exceeds the SGR target. Every year since 2003, Congress has stepped in 
to prevent these cuts from going into effect. The question should be 
asked whether it is wrong for Congress to prevent these cuts. I suggest 
no, absolutely not. In fact, there is virtually unanimous agreement 
among Republicans, Democrats, and the President that the fixes must 
happen because the SGR is a flawed formula that doesn't accurately 
account for Medicare practice costs.
  The SGR, however, is just one example of how Congress has been 
unwilling to not only prevent cuts to the Medicare Program but also 
unwilling to fix the flawed SGR formula. Except for 1 year, in 2002, 
when Congress allowed the 5.4-percent cut to go into effect, every year 
since then Congress has ``fixed'' the Medicare cut by affixing a band-
aid, which has resulted in artificially adjusting the Medicare 
reimbursement rates and pushing larger ``phantom cuts'' into future 
years. Will this year's 21-percent cut to Medicare provider 
reimbursement rates go into effect? It is highly unlikely. In fact, the 
Baucus bill contains another band-aid measure that pushes this year 21-
percent cut into 2010, with the notion that next year doctors will face 
an even larger, 25 cut under the Finance Committee proposal.
  While the past is not always indicative of the future, I believe it 
is highly unlikely that we in Congress will witness any willingness to 
make a game-changing ``audible'' that forces half a trillion dollars in 
cuts to services for our seniors and for the disabled. The CBO has 
acknowledged this in a letter to Senator Baucus when they discussed the 
budgetary impact of the health care bill. CBO said:

       The mechanism governing Medicare's payments to physicians 
     has frequently been modified (either through legislation or 
     administrative action) to avoid reductions in those payments. 
     . . .The long-term budgetary impact [of the Finance Committee 
     proposal] could be quite different if those provisions were 
     ultimately changed or not fully implemented.

  If, since 2003, Congress had stepped in to prevent Medicare cuts from 
going into effect, why should we expect Congress to now take the 
unprecedented step of cutting nearly half a trillion dollars from the 
Medicare Program? In fact, there was an editorial in the Washington 
Post last month talking about CBO's assumption of Medicare savings. 
They said:

       Many Medicare ``savings'' are probably phony. Congress is 
     likely to reverse them, as in the past. Put in that category 
     about $200 billion in ``savings'' over 10 years from lower 
     reimbursement rates for doctors, which Congress has 
     repeatedly prevented from occurring. A separate $180 billion 
     in ``savings'' from lower reimbursement for hospitals and 
     other providers are similarly suspect. Together, these items 
     provide about half the [Baucus plan's] financing. If half a 
     trillion is waiting to be squeezed painlessly out of 
     Medicare, why wait for health care reform? If, as Obama 
     repeatedly insists, Medicare overspending is breaking the 
     budget, why hasn't he gotten started on the painless billions 
     in ``waste and fraud'' savings?

  That was in the Washington Post last month.
  Just today, on the front page of the Washington Post, it was reported 
that the SGR fix included in the House bill, H.R. 3200, was stripped 
out of the health care reform bill that passed in three House 
committees of jurisdiction. Leaders in the House are citing the $240 
billion cost of the SGR fix as the main reason for removing this 
provision. I believe Congress is being shortsighted in not addressing a 
major concern in the Medicare Program--a concern that not only would 
address reimbursement decreases that doctors have faced every year 
since 2002, but also the concerns about access to doctors that is 
worrying more and more Medicare patients every day. By stripping this 
important provision out of the House bill, Medicare patients are left 
crossing their fingers in the hopes that the SGR fix will ultimately be 
included in the health reform bill. I believe removal of this essential 
and important provision, not only because of policy concerns but, 
rather, because House leaders want to stay below an arbitrary pricetag, 
simply shows Congress's unwillingness to address significant failures 
in a government health program that impacts the lives of some 44 
million elderly and disabled Americans.
  We know the government has been promising to cut from the Medicare 
Program, particularly in the areas of waste, fraud, and abuse, since 
the Reagan administration. Yet spending continues to rise. There is no 
reason to believe this is going to ever change. I will not support cuts 
in services under the Medicare Program. I will ask my colleagues to 
give weighted consideration to whether they would be willing to tell 
their Medicare seniors and disabled constituents that they voted to cut 
$500 billion from their Medicare insurance. Inevitably, if the Congress 
cannot pass a measure to cut from Medicare, then the money will have to 
be made up either through increased taxes on average American families 
or in the form of additional deficits that will burden future 
generations of Americans.
  Mr. President, with over $2 trillion spent on bailouts, stimulus, and 
cash for clunkers in just the past 22 months, we must be better 
stewards and more vigilant of the potential for additional costs to 
working families for expanding government services and creating more 
mandates for health insurance.
  With that, I thank the Chair and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. WEBB. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Udall of Colorado). Without objection, it 
is so ordered.
  Mr. WEBB. Mr. President, I ask unanimous consent to speak in morning 
business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Virginia is recognized.
  Mr. WEBB. I thank the Chair.
  (The remarks of Mr. Webb pertaining to the introduction of S. 1774 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. WEBB. Mr. President, I yield the floor and suggest the absence of 
a quorum.

[[Page 24547]]

  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. COBURN. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING Officer. Without objection, it is so ordered.

                          ____________________