[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Senate]
[Pages 28796-28798]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. KYL. Mr. President, I rise to talk about the health care 
legislation because in a few minutes the official debate in the Senate 
will commence. The American people will have before them the full 
panoply of arguments both for and against the legislation. They will 
make their judgment about whether we are in fact carrying out their 
will.
  According to public opinion surveys, the will of the American people 
is that this bill should not pass. According to a relatively new 
Rasmussen poll, by an 18-point margin, Americans say this bill should 
not pass. By 56 to 38, they oppose it. In terms of people in the 
middle, the independents or other voters not identified with either 
political party, the percentage of people who oppose the legislation is 
even greater. More than 3 to 1, Independents oppose this legislation. 
The majority believes it will both increase their costs and decrease 
the quality of health care. It is for these reasons that I indicated 
before--and I will say it again--I don't think this bill can be fixed. 
In fact, I don't think the majority will allow it to be fixed. That is 
why, along with my Republican colleagues, I believe we should start 
over and attack the problems that face our country in a more realistic 
way, in a step-by-step approach, first to win back the confidence of 
the people and then to provide elements of relief to each of the 
problems we face, rather than trying to tackle the entire health care 
system, the government programs, the private programs, the insurance, 
the physicians, the hospitals, trying to do it all in one giant bill 
that results in massive government takeover, over $1 trillion--in fact, 
$2.5 trillion--in expenditures, massive new debt, more taxes, higher 
insurance premiums, all of which will result in, ultimately, the 
rationing of health care which is, to me, the most dangerous part of 
this entire exercise.
  Somehow or other, we could probably pay the expense of this. Somehow 
or other we will survive. But we won't survive the life-and-death 
decisions that are made every day by patients, doctors, and families, 
if the government begins intruding between the patient and the 
physician, begins making decisions about what kind of health care we 
can have, what kind of health care the government will allow payment 
for and the like. Those become life-and-death decisions. That is why 
Americans feel so strongly and personally about this debate and about 
the decisions we are about to be making here.
  Let me address something the distinguished majority leader said a 
moment ago, and then I wish to talk a bit about Medicare as one of the 
aspects of this insurance debate.
  The majority leader said that Republicans have had a seat at the 
table. I am on one of the two major committees, the Finance Committee. 
I think one amendment was adopted. It was an amendment offered by a 
Republican and a Democrat on the committee. There were well over 100 
amendments that Republicans offered that were all shot down, defeated, 
largely on party-line votes. I say to my distinguished friend from 
Nevada that maybe we have a seat at the table but it is a little like 
the kids table at Thanksgiving dinner where you are told to mind your 
manners and keep the noise down. That is the way Republicans feel about 
our role at the table in fashioning this legislation.
  The majority leader himself would acknowledge that after the two 
committees in the Senate acted, he went behind the closed doors of his 
office and, along with representatives from the White House and a 
couple of other Democratic Senators, no Republicans at all, legislation 
was developed in his office that he then presented here on the Senate 
floor just before the Thanksgiving recess. That is how the legislation 
got developed. It was without Republican participation.

[[Page 28797]]

  We will have a chance to amend this bill. Maybe he will prove me 
wrong. Maybe he will demonstrate that we can fix this bill.
  I do, with all deference, disagree with his comment that the 
motivation of Republicans is to do nothing. Of course, he frequently 
says doing nothing is not an option. Nobody is arguing about doing 
nothing. Republicans have presented some very good ideas to do 
something, to do a lot of somethings. Our ideas have been rejected. 
Let's don't get into false debate about doing something or nothing and 
the only alternative is the bill that is on the Senate floor. There are 
alternatives, and I will discuss one group of alternatives we have 
presented in a moment.
  There will be a good test to see whether in fact we can amend this 
bill or if my prediction that there is no way to fix it will turn out 
to be true. That has to do, first and foremost, with what this bill 
does to Medicare, the program we have developed for seniors. Let me go 
over some of the Medicare cuts in this bill and then ask my Democratic 
colleagues if they are willing to join Republicans in restoring these 
provisions of Medicare--in other words, in striking these cuts--if they 
are willing to join Republicans in that effort. Then maybe the majority 
leader is right. Maybe we can fix this bill. If they are not willing to 
do that, then I resubmit that this bill can't be fixed, and it can't 
because our Democratic friends won't allow it to be fixed.
  Here are the ways this bill cuts Medicare benefits for seniors: 
$137.5 billion is cut from hospitals that treat seniors; $120 billion 
is cut from Medicare Advantage. I will return to Medicare Advantage in 
a moment. That is the private insurance company that somewhere around a 
quarter to a third of seniors take advantage of. Well over a third of 
the seniors in Arizona, approaching 40 percent of Arizona seniors, 
participate in the Medicare Program, the benefits of which are 
substantially cut. Continuing, $14.6 billion is cut from nursing homes; 
$42.1 billion from home health care, $7.7 billion from hospice care. 
That is a total of $464.6 billion in Medicare cuts. Seniors know we 
can't make these kind of cuts without jeopardizing the care they 
receive. That is the concern I have. We are not talking about cuts in 
the abstract. We are talking about delay and denial of care for 
American citizens. These folks wonder how it is fair or justifiable to 
cut the health care that has been promised to them in order to pay for 
some kind of new government entitlement.
  I receive letters and phone calls every day. I have quoted from many 
of these letters. Many of them have to do with the proposed cuts in 
Medicare, in particular to Medicare Advantage.
  I mentioned the percentage. In numbers, it is about 329,000 
Arizonans--329,000 Arizonans--a third of a million who enjoy Medicare 
Advantage plans. That is over 37 percent of overall Medicare 
beneficiaries in my State of Arizona. They know $120 billion in 
Medicare Advantage cuts will hit our State and, specifically, their 
coverage very hard. They worry that under the Reid bill, they will lose 
the low deductibles and the low copayments they enjoy under Medicare 
Advantage and many of the other benefits I mentioned a moment ago.
  They worry about losing the choices they have, which is one of the 
nice things about the Medicare Advantage plan, and the extra benefits, 
including things such as eyeglasses, hearing aids, dental benefits, 
preventative screening, free flu shots, home care for chronic 
illnesses, prescription drug management tools, wellness programs, 
medical equipment, and access to physical fitness programs. These and 
many more are the kinds of benefits that are included in the Medicare 
Advantage Program, and they will lose many of these benefits under the 
legislation that is before us right now.
  I think they have a right to be concerned about losing these 
benefits. If there is any doubt about this, incidentally, the 
Congressional Budget Office, which is a nonpartisan entity which serves 
both Democrats and Republicans here--it calls it straight; sometimes 
they give answers we do not like, but they provide the analysis of the 
costs and benefits--and the Congressional Budget Office has confirmed 
that under the Democrats' bill, Medicare Advantage beneficiaries will 
lose, and they will lose big. In fact, they will lose more than half 
their extra benefits under Medicare Advantage.
  Well, my senior citizen constituents do not like that, and they have 
let me know about that. Let me share a couple letters--just excerpts 
from letters from two of my constituents. The first is from Surprise, 
AZ:

       My mother is on Medicare Advantage, and I don't know what 
     she would do without it.
       The poor and middle class are already hurting much more 
     than government officials realize. We are on fixed incomes, 
     and have already cut back to bare minimum. What happened to 
     ``government for the people, by the people?''

  Another constituent from Gold Canyon, AZ, writes:

       I have been on Medicare for 11 years and have been 
     subscribing to a Medicare Advantage plan for the past 6 
     years. It has been excellent, and has provided substantial 
     savings for us. Now we understand that the government is 
     dropping its support of the plan. Please try to stop this. It 
     is very important to many senior citizens in Arizona.

  These constituents of mine, these senior citizens, know Medicare cuts 
will hurt seniors' care, and those who try to suggest otherwise are 
simply wrong. The Congressional Budget Office, as I have said, has 
confirmed it.
  One of the newspapers on Capitol Hill, Politico, recently provided a 
helpful summary of an actuarial report on the Democrats' health care 
plan, prepared by the Centers for Medicare and Medicaid Services. That 
is CMS. That is the outfit out of the Department of Health and Human 
Services that actually runs Medicare. According to page 8 of the 
report, as Politico summarizes, the Democrats' bill:

       . . . reduces Medicare payments to hospitals and nursing 
     homes over time, based on productivity targets. The idea is 
     that by paying institutions less money, they will be forced 
     to become more productive. But it's doubtful that many 
     institutions can hit those targets, which could force them to 
     withdraw from Medicare.

  We hear it all the time: physicians dropping or not taking any new 
Medicare patients; entities that are no longer going to be able to 
serve Medicare patients because they are not getting paid enough by the 
government for them to even break even.
  This report I am quoting from--the CMS report--according to Politico, 
says that by 2014, Medicare Advantage enrollment will plunge 64 
percent--we are not talking about just a few folks--from 13.2 million 
down to 4.7 million because of the ``less generous benefit packages.''
  One of the reasons this is being done is because those on the left do 
not like private competition for the government program, Medicare. What 
I think they fail to appreciate is what my constituents have 
appreciated, which is this private alternative to regular Medicare 
provides additional benefits, additional health protections. If they 
are willing to pay a little bit more for those benefits, why shouldn't 
they be allowed to take advantage of those benefits? No. Those on the 
left say: We don't want any private insurance companies competing to 
get Medicare patients. We want that to be strictly a government 
program.
  Well, if folks like it, why shouldn't they be allowed to keep it? 
Remember what the President said: If you like your insurance company, 
you get to keep it. No, that is not true, according to this. Medicare 
Advantage enrollment will plunge from 13.2 million to 4.7 million 
because of the ``less generous benefit packages.'' So I guess it is not 
true: If you like it, you get to keep it.
  The Washington Post--a newspaper here in Washington--wrote an article 
about the Center for Medicare and Medicaid Services report, the same 
one I have been quoting here, and the headline was ``Bill Would Reduce 
Senior Care.'' Well, that says it in a nutshell. The story goes on to 
tell us: ``A plan to slash . . . Medicare spending--one of the biggest 
sources of funding for President Obama's proposed overhaul of the 
nation's healthcare system--would sharply reduce benefits for some 
senior citizens.''
  ``Would sharply reduce benefits.'' So the Medicare cuts, as proposed 
by the

[[Page 28798]]

majority, do, in fact, jeopardize seniors' benefits. The majority 
leader says we can amend the bill, and that is hypothetically correct, 
of course.
  Let's see how many of our Democratic colleagues are willing to join 
Republicans in striking these Medicare cuts, the cuts I have just now 
been referring to. If we do not do that, then I will repeat what I have 
said before, which is that we should start over because it is clear 
this bill is not going to be fixed and starting over would mean taking 
some of the Republican suggestions.
  Let me talk about one of these suggestions. My colleague from Florida 
was talking about the sorry state of real estate in his State of 
Florida, and I could have added my State of Arizona as well. I agree 
with much of what he had to say about that. But he also noted, with 
regard to health care, there is a subsidy in what those of us with 
private insurance pay because of the care that is given to others who 
cannot always pay for all of it. That is true.
  I would add, there is also a subsidy for what we pay in insurance 
premiums because of the government programs, such as Medicare and 
Medicaid, which, likewise, do not pay for all the benefits they 
provide. In fact, they only pay doctors and hospitals somewhere in the 
neighborhood of 70 to 80 percent of their cost, and we have to make up 
the difference in that in the private insurance premiums we pay. So 
increasing insurance premiums is, to a large degree, the fault of the 
U.S. Government, not the insurance companies.
  The Democrats say the answer is yet another government program, and 
they even have a government insurance program in the legislation they 
have introduced. Their other answer is to write insurance policies. 
They actually specify in the bill what policies have to include. These 
are called government mandates. What is the effect of these proposals? 
Is this the right way to go or is there a better idea?
  Again, the Congressional Budget Office, which the distinguished 
minority leader referred to a moment ago, in its most recent report 
said--and it said the same thing to the Finance Committee--the premiums 
for private insurance under this Democratic legislation will, what, go 
up. The average family is going to pay more in insurance premiums under 
this legislation, not less.
  What was the whole idea here? The whole idea of health care reform 
was to reduce the cost of health care, to reduce our insurance 
premiums. They are skyrocketing. My colleagues on the other side of the 
aisle say: Small businesses cannot afford to buy insurance for their 
employees; my constituents cannot afford their health insurance 
premiums, which are increasing in price. All that is true. They are 
increasing. So what should we be doing? We should be lowering them, not 
raising them. This legislation, according to the Congressional Budget 
Office, increases insurance premiums.
  What about the Republican alternative, the alternative that was 
presented in the House of Representatives by the House Republicans? 
That alternative, according to the Congressional Budget Office, reduces 
average insurance premiums by $5,000 a year. So on the one hand, you 
have the Democratic proposal, which increases insurance premiums; on 
the other hand, you have the Republican proposal, which decreases 
premiums.
  There is a study by a private consulting firm, Oliver Wyman, which 
breaks this down by State. The reason I am excited about this 
Republican idea is the average family in Arizona would see its premiums 
go down annually by over $7,400. So think about that. On the one hand, 
you have insurance premiums going up, under the Democratic legislation; 
under the other, you have insurance premiums going down, on average, 
somewhere in the neighborhood of anywhere from $3,300 to, in my State, 
up to $7,400. I think the average is somewhere between $3,000 and 
$5,000.
  The point is, you can cut insurance premiums with better ideas coming 
from Republicans, and I just ask my colleagues: Why wouldn't you do 
that as opposed to the complicated, costly, government-run kind of 
program you are trying to institute under this legislation, which, 
according to CBO, would raise insurance premiums?
  That is why the American people, by a significant margin, say: Do not 
pass this bill, why they appreciate it would raise their costs, it 
would reduce the quality of their health care, and why, therefore, my 
colleagues and I are going to try our best to persuade our Democratic 
colleagues to amend the bill. But if at the end of the day they are not 
willing to buy some of these good Republican ideas and instead insist 
on pushing right ahead with their legislation, at the end of the day, 
we will have to say: We are sorry, it does not appear this bill is 
going to be fixed and, therefore, we are going to follow the wishes of 
the American people and see to it that it does not pass.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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