[Congressional Record (Bound Edition), Volume 157 (2011), Part 10]
[Senate]
[Pages 14084-14086]
[From the U.S. Government Publishing Office, www.gpo.gov]




                                MEDICARE

  Mr. NELSON of Florida. Mr. President, I wanted to call to the 
attention of the Senate the aftermath of having passed the health care 
reform bill. There was a great deal of consternation at the time, while 
we were deliberating, that Medicare was going to be cut. We will recall 
that $500 billion was cut out of Medicare over the course of a 10-year 
period, and the amount that was being cut was considered to be a threat 
to Medicare.
  As a matter of fact, when we passed it, the Medicare cuts came from 
providers--often providers that stepped up and offered to have greater 
efficiencies and therefore Medicare savings over the decade. For 
example, the hospitals of America came forth and said that we will save 
$150 billion. So one of the considerations in Medicare was that we were 
going to have to lean out the Medicare HMO Program called Medicare 
Advantage.
  If we will recall, back in 2003 when we passed the prescription drug 
bill, Medicare Advantage--the Medicare HMO--was actually given a bump 
up in Medicare reimbursement, some 14 percent over and above Medicare 
fee for service. As a result, people had the great incentive to go into 
a Medicare HMO because the insurance companies--the HMOs--were getting 
so much more per Medicare beneficiary. But the fact is, we saw, on a 
long, projected basis over time that it was going to be unsustainable 
financially for the U.S. Government to keep giving a 14-percent 
differential to insurance companies over what the average Medicare 
recipient would get in Medicare fee for service.
  That was one of the reforms of the health care bill--to take that 14 
percent differential and lean it down over time, but at the same time 
make it more efficient, make the health care benefits better by having 
a greater percentage of the actual delivery of that premium dollar go 
to health care instead of all the administrative costs and all of that 
of an insurance company.
  I am happy to report to the Senate that the Centers for Medicaid and 
Medicare Services came out last week with their new results on Medicare 
Advantage--the Medicare HMO Program--as a result of the new health care 
bill.
  Nationally, the premiums for seniors on Medicare Advantage have gone 
down 4 percent and the enrollment is up 10 percent. Now that is a 
significant little victory coming out of the new incentives that were 
put in the health care reform bill--new incentives to insurance 
companies to improve their Medicare Advantage; nationally, 4 percent 
down in premiums, but they are becoming more attractive and so the 
enrollment has gone up 10 percent. I am happy to tell you, in my State 
of Florida, where there are more Medicare Advantage enrollees than any

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other State--over a million--the premiums are down 26 percent and the 
enrollment is expected to go up almost 20 percent because of the 
incentives in the health care reform bill.
  What in this reform bill has given new life to insurance companies to 
improve their Medicare coverage that would cause the premiums to come 
down and the enrollment to go up? Because CMS has now instituted a 
series of financial incentives for the insurance company. And that is, 
if the insurance company boosts the quality of the service to its 
Medicare enrollees, then it will get a bonus per Medicare enrollee. So 
if it is rated as a 3-star or higher, each additional star gives more 
of a bonus and incentive to the insurance company, responding to the 
fact they have increased the quality. That is a good thing. The 
insurance companies that are only rated 2\1/2\ stars now have the 
financial incentive to get to 3 stars.
  What we have is a win all the way around. We have a win, clearly, for 
the enrollees, who are the Medicare beneficiaries, because they are 
getting better quality and their premiums have gone down in Florida by 
26 percent. We have a second win for the insurance company, because now 
the higher quality it achieves, it is getting reimbursed from Medicare 
all the more as a reward for having a higher quality plan. The third 
win is to the U.S. taxpayer. It lowers the overall amount the U.S. 
taxpayer is going to have to pay as a result of the greater 
efficiencies in the Medicare Program. I wanted to come and share with 
the Senate this win-win-win--triple win--as a result of our having 
passed the health care reform bill a couple of years ago.
  Mr. President, I yield the floor, and 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.
  Ms. LANDRIEU. 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.


                            DISASTER RELIEF

  Ms. LANDRIEU. Mr. President, I wanted to get here a little earlier 
this morning, but I was chairing a panel and was unable to do so. I 
know I only have 10 or 15 minutes or so before the Senator from Texas 
speaks, so I appreciate the opportunity to say a few words about our 
disaster recovery and the debate going on between the House and the 
Senate about that.
  Yesterday, the House was unable to find the votes to pass the 
continuing resolution, and one of the issues of debate is how and when 
to fund our disasters. I know there are a lot of people following this 
debate, so I want to bring everyone up to date on a couple of recent 
developments.
  First, the Chamber of Commerce has submitted a letter to us, strongly 
objecting to the House using the Advanced Technology Vehicle 
Manufacturing Loan Program as an offset to fund disasters.
  Mr. President, I ask unanimous consent to have printed in the Record 
the letter from the U.S. Chamber of Commerce.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                        Chamber of Commerce of the


                                     United States of America,

                               Washington, DC, September 22, 2011.
       To the Members of the United States Senate: The U.S. 
     Chamber of Commerce, the world's largest business federation 
     representing the interests of more than three million 
     businesses and organizations of every size, sector, and 
     region, strongly supports disaster relief funding to assist 
     victims of natural disasters. The Chamber is also a vocal 
     proponent of fiscal responsibility and recognizes that 
     Congress must make difficult but necessary choices among 
     competing priorities.
       As Congress sets spending priorities, the Chamber wishes to 
     highlight a few important facts about the Advanced Technology 
     Vehicle Manufacturing (ATVM) loan program. First, the program 
     was authorized in the Energy Independence and Security Act of 
     2007, which was supported by both Republicans and Democrats 
     as an important step in reducing America's dependence on oil 
     from unstable regimes. Second, ATVM loans, which will be 
     repaid with interest, incentivize automakers and suppliers to 
     build more fuel-efficient advanced technology vehicles in the 
     U.S., providing new opportunities for American workers in a 
     sector of the economy that is critical to the nation's 
     recovery. Third, the fact that the Department of Energy has 
     yet to use the funds Congress appropriated for the program is 
     not the fault of industry; numerous loan applicants have been 
     in the queue for years, waiting for the Administration to 
     complete its due diligence.
       Again, while the Chamber understands the importance of 
     reducing America's unacceptable debt and believes that all 
     programs must be on the table, the Chamber urges you to bear 
     in mind the facts about the ATVM loan program, which promotes 
     manufacturing in the U.S. and is an important component of 
     America's energy security.
           Sincerely,
                                                  R. Bruce Josten.

  Ms. LANDRIEU. Mr. President, it is the position of the Democrats--and 
some Republicans have taken this position--that this is not the right 
way to go about funding disasters, by requiring offsets. It is not 
necessary, it has hardly been done in the past--it has been, but it is 
not routine--and it is not recommended for a number of reasons I have 
tried to explain on the floor. But adding to that debate now is the 
Chamber of Commerce saying that is not the right offset to use if you 
are going to insist on finding one.
  Secondly, I want to push back on the argument the House position will 
provide enough funding to get us through the next couple of weeks. That 
is only partially correct, and I want to be very clear. When people 
say, well, we can go ahead and pass the 2.65 they have in for 2012, 
which is an extension of last year's number, and then the extra billion 
they put in for 2011, and that will sort of get us by the next couple 
of weeks, let me be clear: It will get FEMA by. It will fill up the 
disaster relief fund, which is running on fumes today. We are now down 
to $227 million in the fund, the lowest balance in recent memory. It 
will provide a small amount of money relative to the core budget--$226 
million. But I want to be clear: There is no money in the House 
approach for agriculture, there is no money in the House approach for 
community development block grants--zero--and there is no money for the 
economic development grants that chambers of commerce all over the 
country, in areas and counties that have been hard hit, use to help 
their communities and their businesses get back.
  I just left a small business hearing, and the fact is, after a 
disaster, whether it is in North Carolina or California or Florida or 
Louisiana--and this is very sad, particularly in these economic times--
about 70 percent of small businesses never make it back. So at a time 
when we are trying to create jobs in America, help Americans get back 
to work and strengthen their businesses, the House wants to pass a 
continuing resolution with zero money for these economic development 
grants that chambers of commerce and other conservative organizations, 
as well as nonpolitical organizations, believe are very effective.
  So, please, if you are going to vote for the House position, don't go 
home and pat yourself on the back and say you took care of disaster 
victims. You might have filled up the FEMA fund temporarily, but you 
have not left here doing the job I think we need to do.
  The third point I want to push back on--and I know my time is 
limited--is this comment last night by several Members of the House 
that we have offset disaster relief before. Yes, we have, but not, to 
my knowledge, in the immediate aftermath of the storms. As these things 
have gone on over years--for instance, 4 years after Katrina we were 
trying to find money to rebuild one of our big military bases that 
collapsed, so we funded that through Defense and we found an offset. 
But that wasn't within the first couple of weeks of Katrina. That was 
after 4 years, and we couldn't find the money and we really wanted to 
find it. So there are ways you can offset sometimes in the distant 
future.
  I am going to remind people that after Katrina, in the first 3 weeks, 
the Federal Government funded $66 billion without an offset. After the 
collapse of the Twin Towers, we funded $40 billion, and sent that to 
New York after the collapse of the Twin Towers. After 2004, which was a 
very terrible year for Florida, this Congress sent $2 billion within

[[Page 14086]]

a few weeks of four hurricanes hitting Florida. Had we not done that, 
that State would be in a very serious economic downturn now. It never 
could have recovered from four hurricanes in 1 year. They didn't hit 
Louisiana, they didn't hit Texas, they didn't hit Alabama. All four of 
them hit Florida. Did we bellyache about it? Did anyone say: Let's run 
up to Washington and find a $2 billion program that is not working and 
cut it out so we can go help the people in Florida? Absolutely not. We 
sent the money to Florida, and I know they were grateful for it. That 
might be one of the reasons Senator Rubio--who was not in the Senate 
then but now is--has voted for this position, because he knows. He 
remembers.
  I don't know what the House is going to do, and I most certainly 
don't think we need to shut the government down over this debate, but 
it is a very important debate to be having. I am proud to be leading 
the effort, along with many Democrats and some Republicans who are 
saying, in the aftermath of a year that was one of the worst on record, 
we do not need to find the offsets now.
  I hope the House will stand strong and beat back that position, 
because it is not right today, it is not going to be right tomorrow, 
and it is not right for the future.
  I just hope we can prevail.
  Later on, when we are looking to figure out how to pay for all this, 
we have time over the next year or year and a half or 2 or 3 or even 4 
years as we work on moving our deficit down. All of this is going to 
have to be paid eventually. But I believe very strongly that we must 
not think it is OK to get into a pattern of, when disaster strikes, 
instead of opening shelters, instead of giving people immediate relief, 
the first thing the leadership of this country does is run to 
Washington and try to gut several other programs overnight or quickly 
or without thought before we can fund disasters. That is not the way we 
should operate.
  I thank the Chair for being very considerate and giving me this extra 
time. I thank my colleagues; I know others want to speak. Again, we 
have a whole document here, which I have shown before, of projects in 
all of our States that have been absolutely shut down because we have 
run out of money. The only programs that are being funded are real 
emergencies on the east coast. Everything else in Missouri, Louisiana, 
California, and Texas has been shut down to fund what is happening on 
the east coast. This is no way to run a railroad. Let's get disaster 
relief now.
  I hope the House will reconsider their position. I thank the chamber 
of commerce for coming out strongly to remove that offset. Again, let's 
see if we can find some money for USDA--Agriculture--community 
development block grants, and economic development block grants. If 
they insist on doing it 6 weeks at a time, which I don't agree with, at 
least put in a little more money for these other programs so we do not 
shut down, and we will come back here in 6 weeks or 8 weeks and figure 
it out.
  I thank the Chair, and I yield the floor.

                          ____________________