[Congressional Record (Bound Edition), Volume 156 (2010), Part 5]
[Senate]
[Pages 6337-6339]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       CMS REPORT ON HEALTH CARE

  Mr. BARRASSO. Madam President, I come to the floor as someone who 
practiced medicine in Casper, WY, for 25 years. I was an orthopedic 
surgeon for the people of Wyoming, as well as medical director of the 
Wyoming Health Fair Program, which reached across the State with low-
cost health care screenings, aimed at giving people the opportunity to 
take more responsibility for their own health and essentially keep down 
the costs and get down the cost of their medical care.
  Today, I come to the floor with a second opinion on what this Senate 
has passed, what the House has passed, and what has been signed into 
law by the President. I come today because I continue to believe that 
what is now the law of the land with health care reform is going to be 
bad for patients, bad for providers, the nurses and doctors, and those 
who take care of our patients, and bad for payers--the American 
people--who end up paying the bill for health care in this country--the 
taxpayers of this Nation, people who pay for their own care. I believe 
fundamentally, as this bill has been passed into law, it is going to 
result in higher costs for patients, as well as for taxpayers, less 
access to care for people all across America, and unsustainable 
spending at a time when we are running record deficits.
  That is not just my opinion. If you ask what the public believes, in 
polling across the country the American people have overwhelmingly 
rejected this bill that is now signed into law by the President, 
because they believe the cost of their own personal care is going to go 
up and the quality of their own personal care is going to go down. 
Fundamentally, they believe this bill was not passed for them but for 
someone else.
  The reason I come to the floor today to talk about it is because the 
report has just come out by the Centers for Medicare and Medicaid 
Services Actuary, Richard Foster, the Chief Actuary. He has come out 
with a report to go through methodically, page by page, what is 
actually in the health care bill. You will remember that when the bill 
was in front of the House, the Speaker of the House, Nancy Pelosi, said 
you will have to pass the bill before you get to find out what is in 
it. In a rush by this body to pass the bill--which to me was 
irresponsible--they have missed the things the Actuary has outlined now 
in a very thorough report to the American people. I want to go through 
that with you.
  Fundamentally, this says that health care costs are going to be 
higher, access to care is going to go down, and the spending is 
unsustainable. It is fascinating, because this is in light of a speech 
by President Obama in June of 2009, when he said if any bill arrived 
from Congress to his desk that is not controlling costs, ``that is not 
a bill I can support.'' He said it is going to have to control costs.
  Well, the Actuary tells us that the bill now signed into law by the 
President, as well as the additional bill, because there are actually 
two new laws--one the initial bill and then the fix-it bill--will 
increase costs, raise Federal spending, threaten access to care for 
seniors, and will result in higher insurance premiums.
  That is not a Republican Senator saying that; that is the Chief 
Actuary for the United States in charge of Medicare and Medicaid in a 
well-documented report that came out April 22, 2010.
  What is actually in the report? Let's go through it page by page. The 
first thing is, it says this is going to bend the spending curve--the 
rate at which we are spending on health care in the country. The 
President said we want to get the spending cost curve down. This says 
the opposite, that the cost curve is going to go up. That is on page 2.
  Turning to page 4, What about overall national spending on health 
care over the next 10 years? Between 2010 and 2019, national spending 
on health care is going to go up by $311 billion. The President said he 
wanted a bill that was actually going to get the cost of care and 
spending down on health care.
  Turn to page 7. The President said he wants to make sure if you have 
care you like, you can keep it--keep the care you like. We all heard 
that. We heard it time and time again. Yet, on page 7 in this report by 
the President's agency, it says about 14 million people will lose their 
employer coverage by 2019. Again, the President said if you like what 
you have, you can keep it. His Actuary, who actually did the numbers on 
the bill, said, sorry, 14 million people will lose their employer 
coverage by 2019.
  Let's turn to page 8. An estimated 23 million people will remain 
uninsured by 2019. This is at a time when the President said he wanted 
to provide coverage for all these people. But even 10 years out, 23 
million people will still remain uninsured in the United States. Many 
of them are going to have to pay a penalty because of that. They will 
be fined because that is how the rule and that is how the law has been 
written.
  I talked with a lot of seniors. I was home this past weekend in 
Wyoming

[[Page 6338]]

visiting with a number of seniors around the State. I was in 
Torrington, WY, and Casper visiting with folks. They are concerned 
about their Medicare.
  What does the report say about Medicare? Turn to page 9: 
Unsustainable. The cuts we are looking at are going to become 
unsustainable even within the next 10 years. With the cuts to Medicare 
of over $500 billion, one would think at a time when we are looking at 
more and more seniors coming of age to be on Medicare that we would 
have used that specific Medicare money to keep it in Medicare, use it 
to save Medicare, not to start an entirely new government program.
  As you work your way through this, you say: What does this mean for 
seniors on Medicare? That gets us to page 9 and page 10 of the national 
report of the Centers for Medicare and Medicaid Services. These are the 
people who know. They looked into the numbers. They said they did not 
have time to do it while the House and the Senate were rushing to pass 
the bill. They said we should have given more thought and time to this 
bill.
  What happened when they actually looked at what has been signed into 
law? They talk about cuts to providers, to the people who take care of 
the patients on Medicare. They are expecting many providers, medical 
professionals to ``end their participation in the program.'' This is 
going to jeopardize access to patient care.
  The report says 15 percent of all the hospitals in this country, all 
the nursing homes in this country, and similar providers--we are 
talking about home health care agencies, that link, that lifeline to 
people who are at home needing care; hospice, for people who are in the 
final days of their lives--about 15 percent of all of them, as a result 
of the way this bill has been put together, are likely to be operating 
at a financial loss by 2019.
  Are they going to be able to stay open? Are they going to be able to 
provide care for people? Absolutely not. Are they going to close down? 
Very likely. Is that going to impact a lot of rural communities across 
this country? Absolutely.
  As we go through this actuary report, it brings to light what Nancy 
Pelosi meant when she said we have to pass the bill to find out what is 
in it. What a shame it is that the American people, although they 
sensed what was in it, had to wait until this point so they could 
continue to express their concerns to those who voted in favor of it.
  Let's take a look at some other provisions. Those who supported this 
bill said there are other Medicare savings provisions in the bill that 
will help save money and that will help control future health care 
growth. No--the report on page 13--they said those things people in 
this Chamber said would help control future health care costs would 
have a ``negligible financial impact over the next 10 years''--
``Negligible financial impact over the next 10 years''--even though 
Members of this Senate stood on the other side of the aisle and 
absolutely swore that this was going to improve care, as well as get 
down the cost of care.
  Let's turn to page 15 of the report, the CLASS Act. That is the long-
term care insurance program that so many in this Chamber thought was 
going to be a wonderful thing, and those on my side of the aisle said: 
This cannot work. The numbers are not going to work for our country. 
They are not going to work for this bill. Who are you trying to kid?
  The Democrats who supported the CLASS Act were not able to kid the 
people at the Health and Human Services Centers for Medicare and 
Medicaid Services. No, they saw right through it. But, of course, the 
report came out after the bill had been signed into law by the 
President.
  What the report says is that the CLASS Act faces ``a significant risk 
of failure''--``a significant risk of failure.'' It says there is a 
very serious risk that the CLASS Act program will be unsustainable. 
People on this side of the aisle said that. We said it before the vote. 
We heard from the other side of the aisle: Oh, no, you have it all 
wrong. People who looked at it and know--and these are the President's 
own people--said: Unsustainable.
  What about premiums for insurance? Last year the President said he 
expects to lower the health care premiums for the average family in 
this country by $2,500. That is an incredibly admirable goal, something 
all Americans would support because, after all, early on the President 
said: My goal is to get down the cost of care, clearly something he 
abandoned early on.
  What this says on page 17 of the report from the Actuary is that the 
new laws, fees, and excise taxes, higher drug prices, device prices--
this is all going to result in higher insurance premiums for American 
families, the exact opposite of what the President promised.
  Let's go to page 16 because we have talked about funds allocated for 
the new high-risk insurance pools. I think it is important to have 
these pools. They work well in various States. A number of States have 
these pools. It is a commitment by the State. We want to involve the 
Federal Government, have people working together with folks with 
preexisting conditions, people who absolutely need care.
  The CMS report says what this body has done is insufficient. It says 
the amount of money they decided to put in this program is going to be 
exhausted by the year 2012. Once again, this body who said they knew 
better than the folks who studied the bill, those who said we just have 
to pass it to get something done, have created a monster, and the 
American people are going to be paying the price for a long time.
  Let's look now to page 20. So many of the people who are going to be 
covered under this program, how are they going to be covered? The 
President said: I want to cover all these people. What he decided to do 
and what this body decided to do is to cram another 18 million people 
on to Medicaid, a program we know right now is fundamentally flawed. It 
is broken. Half the doctors in the country do not want to see patients 
on Medicaid because the reimbursement to them is so low. Hospitals tell 
you they lose money when those patients are in the hospital. Doctors 
say they cannot keep their offices open if they take more and more 
Medicaid patients. The only way they are allowed to see them is by 
charging other patients more--the cost shifting that happens in health 
care in America.
  What does this say about Medicaid? Eighteen million more people are 
going to be put on Medicaid by the year 2019. Is that going to be care? 
The President talks about coverage, but he does not talk about care. 
These people are very unlikely to get care.
  This is what the report says on page 20: A significant portion of the 
increased demand for Medicaid services, because there are all these 
millions more people on Medicaid, the increased demand for Medicaid 
services could be difficult to meet. All these patients are going to be 
put on Medicaid, and they are not going to be able to get care.
  I say it is hardly fair and it is misleading to the American people. 
Everybody in Canada has coverage. They have coverage but they cannot 
get care. Madam President, 33,000 Canadians came to the United States 
last year to pay for their own health care because even though they had 
coverage in Canada, they could not get care there. So they came to the 
United States and paid for care.
  About a year ago when the President of the United States was talking 
about health care, he always held up the Mayo Clinic for excellent care 
in America, and it is a model for excellent care. The Mayo Clinic said: 
We do not want more Medicaid patients, because they lose too much money 
by taking those people, and they want to keep their doors open to 
fulfill their mission.
  Here we have the Actuary who is looking at this page by page--and, 
obviously, the Centers for Medicare and Medicaid Services knows what 
they are talking about. They looked at the numbers and item after item, 
page by page and said: This is not working.
  One of the things we talked about at the Health Care Summit was the 
issue of Medicare fraud. I sat at the table

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and discussed the issue with the President. This law does almost 
nothing--almost nothing--to limit actual fraud and abuse.
  Last year, Medicare paid $47 billion in claims that were suspect. We 
know in Florida, drug dealers have been moving from dealing in drugs to 
Medicare fraud. One may say: Why? Why would they do that? They are 
doing it for a couple of reasons: One, it is more profitable; two, it 
is less likely they will get caught; and, third, if they do get caught 
the penalty is less. They say: More profit, less chance of getting 
caught, less punishment. I think I ought to go into Medicare fraud. 
That is what they are doing.
  What does the Actuary say when he looks at the new bill? He estimates 
the fraud provision in the law will save only about 2 percent, only $1 
out of every $50 of Medicare fraud.
  As we look at this, it is no surprise the American people want a 
second opinion about this bill. It is no surprise the American people 
are saying it is time to repeal and replace the bill. That is why I 
come to the floor of the Senate with my second opinion, with 25 years 
of practicing medicine.
  On the way over, I picked up USA Today. It is so interesting, a big 
story in the paper today: ``Next Phase In Health Care War: Applying The 
Law.'' The subheadline is ``Cabinet''--we are talking about the 
President's Cabinet, the Cabinet of the United States--``Cabinet Braces 
For Lobbying Blitz By Industry Advocates.'' The Cabinet is bracing for 
a lobbying blitz. I thought the President of the United States said he 
did not want lobbyists in the White House, did not want lobbyists 
impacting on his Cabinet. They are weighing right in. Absolutely.
  The President did have them in the White House, obviously behind 
closed doors, cutting the deals. That is the way we ended up with a 
health care bill that is bad for patients, bad for providers, and bad 
for payers, the American payers, the taxpayers of this country, and the 
people who are paying for their health care. That is why I come to the 
floor to say it is time to repeal this legislation and replace it with 
legislation that is actually patient centered, that gives more 
responsibility and opportunities for individual patients, just what I 
tried to do through the Wyoming health fairs where we give people more 
information so they can use that information to get their cholesterol 
down, get their blood pressure under control, find out if they are 
diabetic and if they are, get their blood sugar under control, give 
people incentives to stay healthy and keep down the cost of their care.
  We need a patient-centered health care bill. We sure do not have one. 
We need a health care bill that allows people to buy insurance across 
State lines. That increased competition will drive down the cost of 
care.
  The University of Minnesota did a study: 12 million more Americans 
would have insurance today without this bill if all we did was allow 
Americans to buy insurance across State lines and allow small groups to 
join together to get better opportunities to buy insurance to get the 
cost down.
  Then, of course, we need to deal with abusive lawsuits that exist in 
this country which drive up the cost of care for patients because all 
the tests that doctors routinely order are not to help the patient get 
better but to make sure the doctor does not miss something.
  That is why I come here today to tell you, Madam President, that 
there are things that will work to get down the cost of care. There are 
things that will work to provide additional treatment for more people 
in America; more patients, better care. But they are not in this health 
care bill that passed the House, passed the Senate, and was signed into 
law by the President.
  That is why today I offer my second opinion that it is time to repeal 
this bill and replace it with what will work.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Udall of New Mexico). The clerk will call 
the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CASEY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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