[Congressional Record (Bound Edition), Volume 161 (2015), Part 4]
[Senate]
[Pages 4756-4759]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            SGR LEGISLATION

  Mr. SESSIONS. Madam President, I would like to share a few thoughts 
as we head into this week, because we will be confronting the question 
of how to fix the payment to our physicians who treat Medicare and 
Medicaid patients. If we do not take action, there will be a 21-percent 
reduction in the amount of money they are paid to do the work for the 
Federal Government.
  This is an unacceptable alternative, but it is what current law says. 
Congress needs to fix it. In fact, we have been dealing with this for 
17 years. For 17 years, Congress has, in some way or another, fixed the 
doctor payment plan and raised their pay so that they do not take a 
cut. As years have gone by, the size of the cut that needs to be fixed 
has increased too, as I said, 21 percent today if we do not act. I 
think there is a uniform, universal belief that we should do that, and 
do it on a permanent basis so we do not have to have doctors calling 
Congress every year, saying: Are you going to change the law so I can 
continue to do Medicare work? If you do not change it and my services 
are cut 21 percent, I am out of here. I can hardly make a living now on 
what you pay me, and taking a big cut will not allow me to continue to 
offer Medicare services for people in need.
  It is a big issue and a real issue. I have favored a permanent fix 
for a

[[Page 4757]]

number of years. I would offer, though, to my colleagues that many of 
us who have been concerned about the financial condition of our country 
have successfully insisted each one of those 17 times that the new 
money that is needed to pay the additional funding be paid for, that 
is, by finding wasteful spending or other spending somewhere else in 
the government of this country and use that money to make up the 
difference.
  We have refused to pass it by just borrowing the money. Remember, 
this is an entitlement. By that, it means once the government says what 
the rate will be, the doctors will go out and do the work, they will 
demand payment whether the government has any money or not, whether we 
are running deficits or not. If the government does not pay them the 
rate agreed upon, they can file a complaint and the government will 
have to come up with the money.
  What we really needed to offset this was a real finding of wasteful 
spending, or spending in other areas to divert that money to pay for 
this increase in pay for doctors on a permanent basis. It appears that 
Speaker Boehner and Democratic Leader Pelosi in the House got together 
and agreed on a bill. They passed it in the House with a big vote. Even 
most Democrats voted for the bill.
  It was sent to the Senate as we were voting, at that very time, that 
very day, on the budget resolution for the Senate. We were proud of our 
budget. It was not a perfect budget. I supported it. But it balanced. 
If we follow the plans put forth in the budget resolution that passed 
the Senate--if we follow those--we would be on a path to a balanced 
budget. We would be spending about $4,000-plus billion 10 years from 
today. We would be increasing spending all right, but not as much as 
has been projected, but we also see a $3 billion surplus in the final 
year of the budget window. So instead of having a deficit in the 10th 
year, we were going to have a $3 billion surplus. That is something to 
celebrate after decades of deficits, trillion dollar deficits, $1,000 
billion deficits. I think we have averaged $1,000 billion deficits for 
the last 6 years. Unbelievable.
  We are committed to the American people to do something about it. The 
Budget Control Act and other efforts have reduced our spending from 
what it might otherwise have been. The House decided to send H.R. 2 to 
the Senate. They passed it with a big vote. This bill, over 250 pages 
in length, was sent to the Senate the same evening as our budget vote-
arama. We had over 750 amendments under consideration that evening. We 
finished the budget process at 3 a.m. What many wanted us to do was 
just pass this bill at 3 a.m. with hardly any knowledge of what was in 
it and without a real understanding of how much it was going to cost. 
We were told by a number of people that it was ``paid for.'' ``Don't 
worry about it.'' ``It has been taken care of.''
  So there was concern about that. Senator McConnell did not bring it 
up at 3:30 in the morning right before we did our recess. It was 
unseemly to have done that for a whole host of reasons. But we are 
coming right up to the deadline. The deadline was March 31, but I 
understand that there was a 14-day window whereby Congress could 
consider a fix before doctors were impacted. We need to get this taken 
care of. But we need to do it responsibly, in a grownup fashion.
  The House Members really did not have the bill to study. They just 
followed mainly talking points, which if you read their talking points, 
I may have voted for it, based on what they were telling their Members. 
The talking points said this: First, it told House members that the 
bill pays for all new future spending.
  To not have a 21-percent cut, but to pay them at a more appropriate 
rate, this bill is going to cost more money. But, they were told that 
all the new future spending would be paid for.
  Second, it said it allows ``Congress to go through regular order and 
legislate thoughtfully.'' So we were going to pass it at 3:30 in the 
morning without it having gone through a committee and without having a 
real, firm, long-term cost estimate from CBO as to what it would 
actually cost?
  Third, they also said in their talking points, ``It offsets all new 
spending.'' What that means, to Members of Congress, is that it would 
not add to the debt because somehow the increase in spending would be 
offset by a reduction in spending somewhere else.
  Fourth, they used the phrase we use around here, they claim it 
``bends the cost curve,'' it would bring down costs. But this is not 
accurate either.
  So here are the problems: This bill is not paid for. Our own 
Congressional Budget Office said it would add $141 billion to the 
deficit. Over 10 years, you add those up, $141 billion. They said the 
net increase to the debt would be $174 billion. How does it get to be 
more than 141? Well, when you spend $141 billion more then you have, 
you have to borrow the money. When you borrow the money, you pay 
interest on the money.
  The Congressional Budget Office said it would add an additional $33 
billion in interest payments just over that 10 years. Many promoting 
this legislation said: Well, there may be a shortfall in the first 10 
years, but over 20 years, the reductions in spending we found somewhere 
are going to bring in enough money to pay for it fully then.
  So what did the Congressional Budget Office say? The Congressional 
Budget Office said this. ``It will increase budget deficits'' in the 
``second decade.'' So instead of reducing the deficits or paying for 
the cost of this by changes now that benefit us 15, 20 years from now, 
it adds more.
  The Committee for a Responsible Federal Budget--a fine, responsible 
nonpartisan group headed by Maya MacGuineas--did a study of this. They 
said over 20 years it would add $500 billion to the deficit. Those 
numbers, to my knowledge, have not been disputed. I think that is a 
pretty accurate figure. It is not going to reduce the deficit. In 10 
years, it is going to add $174 billion--not going to reduce the deficit 
over 20 years, it is going to add $500 billion.
  So this violates the Budget Control Act that we passed in 2011 that 
is in law today. That is something we should not be doing. We need to 
adhere to that agreement which the President signed and we in both 
Houses of Congress agreed upon in a bipartisan way to hold spending 
down. It is not going to balance the budget, the Budget Control Act 
doesn't, but it helps a lot. We ought to at least adhere to it.
  So this violates the Budget Control Act and is subject to at least 
eight different violations--points of order, we call it, where you can 
object because it violates the budget. There are at least eight 
different ways in which this legislation violates the Budget Control 
Act and, of course, it violates the House and Senate budgets that we 
are just now in the process of adopting.
  The Senate has passed its budget. They had a $3 billion surplus in 
the 10th year. Listen, not paying down any of that debt except that $3 
billion in the 10th year--but just not having annual deficits--it would 
take us 10 years to finally balance the budget, which we need to do. 
Experts have told us we need to do so because we are on an 
unsustainable financial path.
  So our budgets go further than that. The House and the Senate budgets 
do so. If we pass a bill that adds $174 billion to the deficit, it will 
be at least $17 billion in the 10th year. So instead of having a $3 
billion surplus, we will have at least a $14 billion deficit. And the 
day we are celebrating the fact that we altered the spending course of 
our country and produced a balanced budget, that very day we were asked 
to pass a bill that would wipe out all of that. It is just not 
responsible, in my view.
  I am just not able to tout the fact that we passed a balanced budget. 
Maybe that is why they would like to pass this bill before the final 
agreement between the House and the Senate occurs in conference and we 
have a firm budget. We just now have a House budget and a Senate 
budget. Maybe they wanted to do that so the first thing we do isn't to 
bust the budget to which we just agreed.
  I wish I didn't have to say these things. I wish I didn't have to say 
this, but the truth is that this is not responsible. This is not 
maintaining faith

[[Page 4758]]

with the American people who sent us to Congress.
  I think on both sides of the aisle--certainly on the Republican 
side--there were real commitments made to our constituents that if we 
were in Congress, we would do something about these deficits and we 
were going to bring this government under control and produce a 
budget--a budget that balances.
  In addition, it is claimed and asserted that this legislation 
represents a permanent fix--that we will not have to continue to come 
forward each year to come up with the funding or some legislation to 
keep the doctors paid at a reasonable rate. But it is not a permanent 
fix, either. It is not a permanent fix, as has been reported. It is 
only about 9 years, and there are huge, long-range concerns.
  There is another thing it does, and, colleagues, we have to 
understand this. Being on the Budget Committee, we went through it. It 
is so important. One of the greatest manipulations and gimmicks we are 
doing is in the way we are spending the taxpayers' money, why our 
deficits are so large and our debt has become $18-plus trillion--on 
which we paid interest--$220 billion last year, and it will grow every 
year, according to CBO.
  Why? We double count money. It is unbelievable.
  This is what they are going to propose. They are going to cut 
Medicare Part A in this legislation. That is the benefit that goes to 
doctors and hospitals. They will cut it about $55 billion--I believe 
the figure is--and then they will use this $55 billion to pay the 
physicians under Part B and D of Medicare--the non-trust fund money. So 
they are gutting the Medicare trust fund. That money is money that 
comes off of your paychecks every week and goes to pay for your 
Medicare when you retire. That money goes into a trust fund. It has 
trustees. If you cut the cost of doing business for Medicare, the 
sponsors of the bill say it will extend the life of Medicare 1 year.
  That is probably correct. If you cut what you pay to doctors or 
hospitals or medical devices or drug companies, you reduce what you 
pay, you could extend the life of Medicare, its financial solvency. It 
is becoming insolvent just as Social Security is becoming insolvent. So 
we need to do some things to help extend its life so our seniors don't 
have to worry about not having health care in the future.
  How is it double counted, Jeff?
  Well, they are using the money--the trustees. It is the trustees of 
Medicare's money that is being saved.
  How did it get outside of the Medicare trust fund and get spent for 
doctors in that part of Medicare? How does it get out of there?
  The trustees of Medicare loan the money to the U.S. Treasury. Now we 
have it, colleagues. The money that is used to pay the doctors that 
comes from Medicare cost reduction is borrowed money, just the same as 
if they had borrowed it from a financier in London or Beijing. Interest 
is paid to the Medicaid trustees.
  You cannot count the money twice. You cannot save the money here and 
say it improves Medicare--legally it does improve Medicare--but it 
provides no money to spend on new programs outside of Medicare, and the 
Congressional Budget Office has told us this. Yet they are scoring, I 
think, $55 billion they claim is going to pay for this new expenditure 
by double counting the money.
  ObamaCare did that, I believe--by about $500 billion. They cut 
Medicare expenses and used the money to fund an entirely new program. 
But the money didn't go directly to the U.S. Treasury. It went to the 
trustees of Medicare, who loaned it to the U.S. Treasury and double 
counted the money.
  If you would like to know why we are going broke, this is one of the 
big reasons this country is on a reckless course. Nobody wants to talk 
about it or confront it, because if you do, it reduces spending, and 
people around here like spending too much.
  By the way, I note our hospitals would like to see the doctors get 
paid more and have this problem fixed, but a big chunk of what is 
claimed of that portion of this new expenditure that is actually paid 
for appears to be $31 billion in cuts to providers such as hospitals. 
So we are cutting hospitals here to pay doctors, and our hospitals are 
struggling too.
  To conclude, this is why the American people don't trust Congress. 
Some of our Members get their feelings hurt when they go home and some 
tea party person or somebody else accuses them of wasting money, not 
managing well, and they are offended by it.
  I have to say the tea party got more right than wrong. This is 
another example of reckless, irresponsible spending.
  Before adjourning for our recess 2 weeks ago, in the middle of the 
night, at 3 a.m., we passed a balanced budget plan, and we were proud 
of it. We went home the last 2 weeks and told our constituents we were 
going to work to accomplish that balanced budget goal and try to make 
sure it becomes a reality.
  But what is the first bill we consider since adopting the balanced 
budget goal? What is the first bill? We are taking up a bill to dig us 
$174 billion deeper in debt in the first 10 years. The first major 
legislative accomplishment of our new Congress is going to be adding 
almost $200 billion to the debt over 10 years and then perhaps $500 
billion or half a trillion over 20 years.
  It is not necessary. I don't see how we can look our constituents in 
the eye and say we are producing a balanced budget, when, if this bill 
passes, we don't have a balanced budget.
  Well, was the plan really to balance the budget, people might ask, or 
just to use as talking points, just a fun campaign claiming we have a 
balance? Our new Congress was sworn in only 3 months ago, and we are 
already shattering our promises to our constituents.
  I think it is fair to say we are acting irresponsibly. Not only are 
we continuing to allow the debt to explode, but we aren't really being 
honest with our constituents about it.
  Before they cast their votes, House Members were told this bill 
``pays for all new future spending'' and that it ``offsets all new 
spending.'' But this is not accurate. It is not true. It adds to the 
deficit every single year.
  We are going to offer an amendment so that this bill lives up to the 
promises of the sponsors. A good amendment, a PayGo amendment that I 
think Senator Lee will probably offer which will put us on a path to 
ensure that this new expenditure is paid for.
  I think we need to have that vote, and I think it needs to pass. That 
would be responsible. Then we could honestly say we made choices. That 
is what you should do in this body. There is a limited amount of money 
and a virtually unlimited number of requests for good projects that we 
should spend money on.
  We are sent to the Senate to make choices, set priorities, do the 
right thing, and manage money carefully--that is why our constituents 
from all over the country sent us here, and they had their tax money 
extracted from them and sent to Washington--to be spent wisely and 
honestly, I suggest.
  One of the most amazing things is that we spend $3,800 billion a year 
now. We can't find $15 billion a year to fix the doctor payments? We 
can't find $15 billion in this whole $3,800 billion a year that we 
spend that will actually be able to fund the doctors in the way that we 
should fund them without adding to the debt?
  You bet we can. I have a list of them. Others have a list of them. 
There will be some suggestions as to how this could be done.
  We don't need to gimmick up this legislation, but it is legislation 
that undermines the promises we made that we are going to be fiscally 
responsible.
  We don't vote on talking points. We vote on legislation. Legislation 
can be studied, and it becomes law. Our Congressional Budget Office, 
and the Centers for Medicare and Medicaid Services, and Maya MacGuineas 
and the Center for a Responsible Federal Budget can read and add the 
numbers. They have read them, added them, and they don't add up.
  This is legislation. We are not voting on talking points.

[[Page 4759]]

  Without change, it is a massive debt increase that puts a balanced 
budget even further out of reach.
  It means a lot to me that we, as a Congress, establish credibility 
with those whom we serve. One of the parts of doing that is to be 
honest and to say we do have a tight situation here. We are going to 
have to make some choices--but not brutal choices.
  We can find the money we need without doing anything but eliminating 
fraud, waste, abuse, duplication, and unwise spending. We don't have to 
savage children or the military to do so, but it is hard work. Every 
time you talk about reducing this program or that program, a group 
shows up and pushes back, but that is why we are here.
  As my wife says to me when I complain: Don't blame me; you asked for 
the job.
  That is what we asked for--to be in the Senate and make these tough 
choices.
  I hope, in the hours that are ahead, we will be able to have some 
amendments--and there are several that would fix this and would allow 
the doctors to receive the pay they are entitled to--and they are 
entitled to it--but at the same time would not add to the debt.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Coats). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SESSIONS. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SESSIONS. Mr. President, I would just add that this isn't just my 
opinion about these cost overruns in the legislation. Here is a Wall 
Street Journal article from a few days ago: ``Two-thirds of $214 
billion cost would be financed through higher deficits. . . .'' That is 
the subheadline on that. The headline is: ``Senate Wrangles Over 
Medicare-Payments Fix.''
  So I don't think there is any real doubt about that. The article goes 
on to say:

       The deal reached by House leaders would shift some of those 
     costs onto Medicare beneficiaries--

  So some of the Medicare benefits, such as Part C, are not part of 
trust fund money. It is not paid for when you have that withholding 
from your paycheck, and people with higher incomes probably ought to 
pay a higher percentage of the cost that they can reasonably afford, if 
they have a higher income, when they go see a doctor. I think we could 
use that. But at any rate, this bill would shift some costs to Medicare 
beneficiaries. The article continues--

     while providers such as hospitals also would shoulder some 
     costs.

  So they are paying for some of these costs by having reduction in 
payments to hospitals that are hurting this year. And the article 
states:

       The rest would be financed through higher deficits.

  No doubt about it.
  Forbes magazine comments here in an article by Stan Collender, saying 
that ``the procedural choices Congress is making all favor increasing 
the deficit rather than at least requiring it not get any worse.''
  This is what the article says about the SGR--the physician's payment: 
``The SGR change without a full offset is projected to add an average 
of around $14 billion a year to the deficit.''
  Here is a headline from The Fiscal Times: ``Medicare `Doc Fix' May Be 
No Fix at All.''
  Paul Winfree, an economic policy expert with the Heritage Foundation, 
said this:

       Rather than a permanent replacement to the Sustainable 
     Growth Rate--

  Remember, we have been promised this would be a permanent 
replacement--

     it is much more likely that the House doc fix will be a 
     shorter-term patch requiring another series of patchwork 
     legislation just nine years from now.

  They also conclude in this article that the permanent fix would ``add 
$141 billion to the deficit over the first 10 years and could go as 
high as $500 billion over two decades, as previously reported here.''
  I did want to emphasize it is really not $141 over 10 years, it is 
$174, because when you add up $141 billion in additional debt over 10 
years, you pay interest on that. You borrow that money and pay 
interest, and when you calculate the interest that is paid, the 
increased interest is $174 billion added to the total deficit of 
America.
  Colleagues, our interest payment on our debt is staggering. The 
highway bill is about $40 billion to $50 billion a year. Aid to 
education is nearly $100 billion a year, for example. The interest we 
pay annually on the current $18 trillion debt, in spite of the fact we 
have some of the lowest interest rates we have ever had, was more than 
$220 billion-plus last year.
  The Congressional Budget Office, however, says that 10 years from 
now, with interest rates projected to return to the mean and with the 
deficit every year out for 10 years, we will be over $900 billion in 
interest in the 10th year. That is just in 10 years. We go from $200 
billion to $900-plus billion.
  This is why the Congressional Budget Office Director, chosen by our 
Democratic colleagues, Dr. Elmendorf, a very capable, wise man, has 
said we are on an unsustainable path. This is a path of fiscal 
destruction. It is not responsible.
  So day after day, week after week, we in Congress are going to have 
to start saying, no, we don't have the money. Do you not understand? We 
can't keep digging the hole deeper. We are supposed to be trying to 
figure out a way to reduce deficits and balance the budget, not to pass 
more legislation that is going to cost more money than we have to spend 
on these things. The only way we will be able to honor that legislation 
is to borrow more. That is what we are doing.
  So I don't think there is any doubt about what I have said. If 
somebody can come down and prove this bill is paid for I will shake 
their hand and I will be happy because I want to do the doctors fix, 
and I want to be sure we do it in a responsible financial way. If not, 
we will have legislation, amendments will be offered that I think can 
fix it and that will require Congress to come up with the money in a 
proper way, do the assistance we need to provide to our doctors and not 
add to the debt.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________