[Congressional Record (Bound Edition), Volume 161 (2015), Part 4]
[Senate]
[Pages 4943-4949]
[From the U.S. Government Publishing Office, www.gpo.gov]




          MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to the consideration of H.R. 2, which the clerk will report by 
title.
  The senior assistant legislative clerk read as follows:


[[Page 4944]]

       A bill (H.R. 2) to amend title XVIII of the Social Security 
     Act to repeal the Medicare sustainable growth rate and 
     strengthen Medicare access by improving physician payments 
     and making other improvements, to reauthorize the Children's 
     Health Insurance Program, and for other purposes.

  The PRESIDING OFFICER. The majority whip.


                           Amendment No. 1114

  Mr. CORNYN. Mr. President, I call up my amendment and ask for its 
immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Texas [Mr. Cornyn] proposes an amendment 
     numbered 1114.

  The amendment is as follows:

              (Purpose: To repeal the individual mandate)

       At the appropriate place, insert the following:

     SEC. __. RESTORING INDIVIDUAL LIBERTY.

       Sections 1501 and 1502 and subsections (a), (b), (c), and 
     (d) of section 10106 of the Patient Protection and Affordable 
     Care Act (and the amendments made by such sections and 
     subsections) are repealed and the Internal Revenue Code of 
     1986 shall be applied and administered as if such provisions 
     and amendments had never been enacted.

  The PRESIDING OFFICER. Under the previous order, there will now be 2 
minutes of debate equally divided prior to a vote in relation to 
amendment No. 1114, offered by the Senator from Texas, Mr. Cornyn.
  The Senator from Texas.
  Mr. CORNYN. Mr. President, Speaker Boehner and Leader Pelosi have 
negotiated a package which enjoyed broad bipartisan support in the 
House. The one missing element is a pay-for for the so-called doc fix, 
for the sustainable growth rate fix. What my amendment does is offer 
that pay-for so that this is a deficit-neutral bill if it is adopted.
  In order to find that pay-for, we would repeal the individual 
mandate. The latest CBO score shows it would save as much as $400 
billion. It hasn't been scored this year, so the number may be off a 
little bit, but there is more than an adequate amount of money to 
offset the deficit caused by this permanent doc fix.
  I ask my colleagues to join me, along with then-Senator Barack Obama 
in 2008 in his campaign against Hillary Clinton, who when he was 
running for the Democratic nomination campaigned against the individual 
mandate.
  Let's make that reality.
  Mr. WYDEN. Mr. President, I urge colleagues to oppose this amendment. 
What Senator Cornyn seeks to do is to strike an idea that originally 
came from the Heritage Foundation. If it is adopted, sick people will 
definitely sign up, healthy people will stay on the sidelines, premiums 
will skyrocket, according to the Congressional Budget Office, by as 
much as 20 percent, and start then what amounts to a death spiral for 
the affordability of American health care.
  I urge my colleagues to oppose this amendment.
  Mr. CORNYN. Mr. President, how much time remains?
  The PRESIDING OFFICER. No time remains.
  The question is on agreeing to the Cornyn amendment No. 1114.
  Mr. CORNYN. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Delaware (Mr. Coons) is 
necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 54, nays 45, as follows:

                      [Rollcall Vote No. 137 Leg.]

                                YEAS--54

     Alexander
     Ayotte
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Coats
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heller
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kirk
     Lankford
     Lee
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Vitter
     Wicker

                                NAYS--45

     Baldwin
     Bennet
     Blumenthal
     Booker
     Boxer
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Donnelly
     Durbin
     Feinstein
     Franken
     Gillibrand
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Reid
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--1

       
     Coons
       
  The PRESIDING OFFICER. Under the previous order requiring 60 votes 
for the adoption of this amendment, the amendment is rejected.
  The Senator from Colorado.


                           Amendment No. 1115

(Purpose: To protect and retain our Children's Health Insurance Program 
                        for 4 years (PRO-CHIP).)

  Mr. BENNET. Mr. President, I call up amendment No. 1115.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Colorado [Mr. Bennet], for himself, Mr. 
     Brown, Ms. Stabenow, Mr. Wyden, Mr. Casey, Mr. Reid, Ms. 
     Warren, Mr. Menendez, Mr. Reed, Mrs. Shaheen, and Mr. 
     Whitehouse, proposes an amendment numbered 1115.

  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. BENNET. Mr. President, this amendment provides an additional 2 
years of funding for the Children's Health Insurance Program, or CHIP. 
I wish to especially thank Senators Brown, Wyden, Stabenow, Casey, and 
Reid for their leadership on this amendment.
  We have made great strides in recent years to ensure that Americans 
of all ages have access to quality health care, but a huge part of this 
success in increasing access for quality health care comes from CHIP, 
which provides insurance to low- and moderate-income children and 
pregnant women. We know CHIP works. The CHIP program serves more than 8 
million children, including more than 115,000 in Colorado. This is 
health care they might not otherwise have.
  Unfortunately, the House failed to take full advantage of this moment 
and this momentum for compromise and only extended funding for 2 years. 
CHIP is authorized through 2019. This amendment would extend it for 2 
additional years.
  The very physicians who would be helped by fixing the SGR would also 
see increased reimbursement when they treat these children instead of 
seeing millions of them lose access to affordable, comprehensive 
coverage.
  I ask my colleagues to support this amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, remember that 212 Republicans and 180 
Democrats supported H.R. 2. The decision to extend CHIP for 2 years 
with the current payment rate was part of the House bipartisan 
agreement. This amendment seeks to rewrite that amendment.
  This amendment is not a vote to show who really cares more about 
children's health because H.R. 2 extends the CHIP program for 2 years. 
Everyone who supports the underlying bill is supporting children's 
health. If my colleagues oppose this amendment, they are no less a 
supporter of children's health than the 392 Members of the House who 
supported H.R. 2, including 180 Democrats and Leader Pelosi. Are my 
colleagues really saying that Leader Pelosi didn't care enough about 
kids in forging this agreement?
  Mr. President, I rise in opposition to this amendment.
  I am a supporter of the Children's Health Insurance Program having 
participated in the initial creation of CHIP in 1997 and the 
reauthorization started in 2007. And while I am a supporter of 
children's health, this is not a

[[Page 4945]]

CHIP vote in a vacuum. This vote is in the context of the underlying 
bill and cannot be ignored.
  An overwhelming majority of the House supported H.R. 2. 392 Members 
of the House vote for H.R. 2; 212 Republicans and 180 Democrats 
supported the bill. That is a sign of bipartisanship that is, on a 
major issue, extremely rare in the House.
  The decision to extend CHIP for 2 years with the current payment rate 
was a part of the House bipartisan agreement. It is an agreement 
between House Republicans and House Democrats. This amendment seeks to 
rewrite that agreement.
  So let's talk for a moment about what this amendment is not. This 
amendment is not a vote to show who cares more about children's health. 
H.R. 2 extends the CHIP program for 2 years. Everyone who supports the 
underlying bill is supporting children's health. Mr. President, 392 
members of the House voted for this bill which extends CHIP for 2 
years.
  If you oppose this amendment, you are no less a supporter of 
children's health than the 392 Members of the House who supported H.R. 
2 including 180 Democrats and Leader Pelosi. Are you really saying 
Leader Pelosi didn't care enough about kids in forging this agreement? 
Again, no one should accuse anyone who votes against this amendment as 
being insufficiently supportive of children's health.
  I have also heard it said that Congress only authorizes 2 years now, 
there is little chance Congress will authorize two more years in 2017. 
That is a prediction, and as we all know, Congress can be hard to 
predict some times.
  In two years, we will be back to consider CHIP. We will also be back 
to consider therapy caps, rural hospital programs, home visiting, the 
special diabetes program, and community health center funding, to name 
a few programs extended in this bill. The House agreement intentionally 
aligned these programs to be considered in tandem in 2017.
  This amendment pulls one very specific provision out of that 
compromise. I have no concerns that CHIP can stand without the SGR. 
What we need to do is spend the next two years thinking about the 
future of health care coverage for children.
  MAC-PAC has done some very good work examining what CHIP provides for 
children that is different than the private market. The pediatricians 
are in town this week for a conference, and as they will tell you, kids 
are not just little adults. Benefits and services need to be tailored 
to make sure that kids grow into healthy productive adults. This is 
something we need to settle in the next two years. It is something we 
can and should do. Voting against this amendment does nothing to 
jeopardize that process.
  We have a choice here. We can pass the House bill without changes or 
we can amend its bill and send it back to the House. I urge Senators to 
support the agreement and vote against this amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, the pending amendment, No. 1115, offered by 
Senator Bennet, would violate the Senate pay-go rule and increase the 
on-budget deficit over the 10-year period of fiscal years 2015 to 2024. 
Therefore, I raise a point of order against this measure pursuant to 
section 201(a) of S. Con. Res. 21, the concurrent resolution on the 
budget for fiscal year 2008.
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. BENNET. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974 and the waiver provisions of 
applicable budget resolutions, I move to waive all applicable sections 
of that act and applicable budget resolutions for purposes of the 
pending amendment, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  The yeas and nays resulted--yeas 50, nays 50, as follows:

                      [Rollcall Vote No. 138 Leg.]

                                YEAS--50

     Ayotte
     Baldwin
     Bennet
     Blumenthal
     Booker
     Boxer
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Coons
     Donnelly
     Durbin
     Feinstein
     Franken
     Gillibrand
     Heinrich
     Heitkamp
     Heller
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murphy
     Murray
     Nelson
     Peters
     Portman
     Reed
     Reid
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--50

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Coats
     Cochran
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kirk
     Lankford
     Lee
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Vitter
     Wicker
  The PRESIDING OFFICER. On this vote, the yeas are 50, the nays are 
50.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The point of order is sustained, and the amendment falls.
  The Senator from Utah.


                           Amendment No. 1116

  Mr. LEE. I call up my amendment No. 1116, which is at the desk.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Utah [Mr. Lee], for himself, Mr. Sessions, 
     Mr. Cruz, Mr. Crapo, and Mr. Sasse, proposes an amendment 
     numbered 1116.

  The amendment is as follows:

 (Purpose: To strike the provision excluding the budgetary effects of 
                    the Act from PAYGO requirements)

       On page 261, strike line 21 and all that follows through 
     page 262, line 4.

  The PRESIDING OFFICER. The Senator from Utah.
  Mr. LEE. Mr. President, just 2 weeks after the Senate passed a 10-
year balanced budget, we find ourselves on the very brink of passing a 
bill that would promptly unbalance it. We find ourselves on the brink 
of passing a bill that would promptly unbalance the balanced budget we 
just passed to the tune of $141 billion over the next decade. This is 
exactly the kind of bait-and-switch behavior that has eroded the 
public's trust in Congress in recent years.
  To honor the promises we made to each other and that we made to the 
American people, my amendment would simply subject H.R. 2 to the same 
pay-as-you-go budget rules that cover other spending bills in Congress. 
Paying for the new spending in this bill is the right thing to do, and 
we just passed a budget promising we would do exactly that. My 
amendment does nothing more than hold us to this very promise.
  I implore my colleagues to join me in supporting this amendment.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, I rise in opposition to the Lee amendment.
  Colleagues, the Lee amendment is the bluntest possible instrument 
that would cut spending across government on every possible program. 
The SGR, the doctors reimbursement formula, has always been a fake. The 
$140 billion in this bill eliminates the budget fakery that Democrats 
and Republicans believe has gotten out of hand. The underlying bill 
gets rid of the budget fakery.
  I urge colleagues on both sides of the aisle to reject the amendment, 
and I yield back.
  Mr. LEE. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the amendment.

[[Page 4946]]

  The clerk will call the roll.
  The legislative clerk called the roll.
  The result was announced--yeas 42, nays 58, as follows:

                      [Rollcall Vote No. 139 Leg.]

                                YEAS--42

     Ayotte
     Barrasso
     Blunt
     Boozman
     Burr
     Coats
     Corker
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Grassley
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kirk
     Lankford
     Lee
     McCain
     Moran
     Murkowski
     Paul
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
     Sullivan
     Thune
     Toomey
     Vitter
     Wicker

                                NAYS--58

     Alexander
     Baldwin
     Bennet
     Blumenthal
     Booker
     Boxer
     Brown
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Cassidy
     Cochran
     Collins
     Coons
     Cornyn
     Donnelly
     Durbin
     Feinstein
     Franken
     Gillibrand
     Graham
     Hatch
     Heinrich
     Heitkamp
     Heller
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Murphy
     Murray
     Nelson
     Perdue
     Peters
     Reed
     Reid
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Tillis
     Udall
     Warner
     Warren
     Whitehouse
     Wyden
  The amendment (No. 1116) was rejected.
  The PRESIDING OFFICER (Mr. Rounds). The Senator from Washington.


                           Amendment No. 1117

       (Purpose: To improve women's access to quality health care)

  Mrs. MURRAY. Mr. President, I call up amendment No. 1117 and ask for 
its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Washington [Mrs. Murray], for herself, Mr. 
     Wyden, Mr. Brown, Ms. Baldwin, Mr. Bennet, Mr. Blumenthal, 
     Mrs. Boxer, Ms. Hirono, Ms. Mikulski, Mr. Menendez, Mr. 
     Murphy, Mr. Sanders, Ms. Stabenow, Mrs. Shaheen, Mr. Franken, 
     Mr. Reid, Mr. Whitehouse, Ms. Cantwell, Ms. Warren, and Mr. 
     Booker, proposes an amendment numbered 1117.

  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mrs. MURRAY. Mr. President, many of us have been working for years to 
protect Medicare access for seniors, invest in our community health 
centers, and expand access to health care for our children. So I am 
glad Democrats and Republicans in the House were able to come together 
on these issues. But it is disappointing that in a bill which takes so 
many good bipartisan steps forward, Republicans have insisted on trying 
to score political points with their base on women's health.
  The House SGR bill includes language that is just one more example of 
using women's health as a political football. It is redundant, and it 
is unnecessary.
  I am offering an amendment tonight that shows we are making sure 
women have comprehensive access to health care. It focuses on moving 
women's health care forward by providing a clean extension of community 
health care funding for 4 years, not 2, to provide certainty. It will 
invest $2 billion in safety net providers for women and their families 
through title X clinics. Finally, it will invest in strengthening the 
women's health care workforce to make sure women have access through 
their providers.
  I hope my colleagues will support this amendment.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mrs. MURRAY. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, as has been mentioned repeatedly regarding 
the 10-day CMS hold, this 10-day CMS hold period will expire tonight. 
Doctors who serve our seniors will be facing a 21-percent cut.
  Senator Murray's bill costs $21.1 billion over 10 years, and it is 
not offset. Therefore, the pending amendment, No. 1117, offered by 
Senator Murray, would violate the Senate pay-go rule and increase the 
on-budget deficit over the 10-year period of fiscal years 2015 to 2024. 
Therefore, I raise a point of order against this measure pursuant to 
section 201(a) of S. Con. Res. 21, the concurrent resolution on the 
budget for fiscal year 2008.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974 and the waiver provisions of 
applicable budget resolutions, I move to waive all applicable sections 
of that Act and applicable budget resolutions for purposes of the 
pending amendment, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  The yeas and nays resulted--yeas 43, nays 57, as follows:

                      [Rollcall Vote No. 140 Leg.]

                                YEAS--43

     Baldwin
     Bennet
     Blumenthal
     Booker
     Boxer
     Brown
     Cantwell
     Cardin
     Carper
     Coons
     Durbin
     Feinstein
     Franken
     Gillibrand
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Markey
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Reid
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--57

     Alexander
     Ayotte
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Casey
     Cassidy
     Coats
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Donnelly
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heller
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kirk
     Lankford
     Lee
     Manchin
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Vitter
     Wicker
  The PRESIDING OFFICER. On this vote, the yeas are 43, the nays are 
57.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected. The point of order is 
sustained, and the amendment falls.
  The Senator from Arkansas.


                           Amendment No. 1118

  Mr. COTTON. Mr. President, I call up my amendment No. 1118.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Arkansas [Mr. Cotton] proposes an 
     amendment numbered 1118.

  The amendment is as follows:

(Purpose: To provide steady updates of payment rates under the Medicare 
                        physician fee schedule)

       Beginning on page 5, strike line 22 and all that follows 
     through page 127, line 6, and insert the following:
       (2) Update of rates for 2015 and subsequent years.--
     Subsection (d) of section 1848 of the Social Security Act (42 
     U.S.C. 1395w-4) is amended by striking paragraph (16) and 
     inserting the following new paragraphs:
       ``(16) Update for january through june of 2015.--Subject to 
     paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B), 
     (13)(B), (14)(B), and (15)(B), in lieu of the update to the 
     single conversion factor established in paragraph (1)(C) that 
     would otherwise apply for 2015 for the period beginning on 
     January 1, 2015, and ending on June 30, 2015, the update to 
     the single conversion factor shall be 0.0 percent.
       ``(17) Update for july through december of 2015.--The 
     update to the single conversion factor established in 
     paragraph (1)(C) for the period beginning on July 1, 2015, 
     and ending on December 31, 2015, shall be 0.5 percent.
       ``(18) Update for 2016 and subsequent years.--The update to 
     the single conversion factor established in paragraph (1)(C) 
     for 2016 and each subsequent year shall be 0.5 percent.''.

  Mr. COTTON. Mr. President, I want to replace the SGR permanently, but 
I also want to do it correctly. This bill

[[Page 4947]]

has two payment models in the future. The first 4 years would give 
physicians a half-percent increase. In future years, though, CMS would 
be empowered to issue qualitative, subjective rules purporting to 
evaluate physician performance and patient outcomes.
  My amendment would simply extend the half-percent increase 
indefinitely. I think there are many reasons to vote for this 
amendment. CMS has not effectively used a blunt bureaucratic tool, such 
as SGR, so we shouldn't give them a nuance tool; second, CMS itself 
predicts we are going to have future doc fixes, which is going to 
undermine the stability doctors and patients need; third, the 
complexity of the outyear model is going to further drive 
consolidation, especially for rural and independent doctors; and, 
finally, CBO estimates this bill saves $10 billion.
  I urge a ``yes'' vote. Let us have a permanent doc fix that works for 
all doctors and patients.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, I rise in opposition to this amendment. 
Today, the Medicare Program is a fee-for-volume system. The underlying 
bill junks this and turns out the lights on millions of users.
  The underlying bill before the Senate says the future will be about 
rewarding value and good quality care for our Medicare patients. The 
Cotton amendment embraces the outdated status quo and says there is no 
need to coordinate care, no need to pay for value, no need to pay for 
quality for our Medicare patients. I urge my colleagues to oppose this 
amendment.
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  Mr. COTTON. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  The result was announced--yeas 11, nays 89, as follows:

                      [Rollcall Vote No. 141 Leg.]

                                YEAS--11

     Boozman
     Cotton
     Cruz
     Inhofe
     Lee
     Paul
     Rubio
     Sasse
     Sessions
     Shelby
     Vitter

                                NAYS--89

     Alexander
     Ayotte
     Baldwin
     Barrasso
     Bennet
     Blumenthal
     Blunt
     Booker
     Boxer
     Brown
     Burr
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Cassidy
     Coats
     Cochran
     Collins
     Coons
     Corker
     Cornyn
     Crapo
     Daines
     Donnelly
     Durbin
     Enzi
     Ernst
     Feinstein
     Fischer
     Flake
     Franken
     Gardner
     Gillibrand
     Graham
     Grassley
     Hatch
     Heinrich
     Heitkamp
     Heller
     Hirono
     Hoeven
     Isakson
     Johnson
     Kaine
     King
     Kirk
     Klobuchar
     Lankford
     Leahy
     Manchin
     Markey
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Perdue
     Peters
     Portman
     Reed
     Reid
     Risch
     Roberts
     Rounds
     Sanders
     Schatz
     Schumer
     Scott
     Shaheen
     Stabenow
     Sullivan
     Tester
     Thune
     Tillis
     Toomey
     Udall
     Warner
     Warren
     Whitehouse
     Wicker
     Wyden
  The amendment (No. 1118) was rejected.
  The PRESIDING OFFICER. The Senator from Maryland.


                           Amendment No. 1119

       (Purpose: To repeal the therapy cap and provide for medical 
     review of outpatient therapy services)

  Mr. CARDIN. Mr. President, I call up amendment No. 1119.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Maryland [Mr. Cardin], for himself, Mr. 
     Vitter, Mr. Reid, Mr. Whitehouse, Ms. Hirono, Mr. Casey, Mrs. 
     Shaheen, Mr. Menendez, Ms. Mikulski, Mr. Brown, Ms. Stabenow, 
     Mr. Reed, Mr. Leahy, Ms. Cantwell, Mr. Bennet, Mr. Booker, 
     Ms. Warren, and Ms. Klobuchar, proposes an amendment numbered 
     1119.

  Mr. CARDIN. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. CARDIN. Mr. President, I have explained this amendment a little 
earlier.
  I ask unanimous consent that Senator Klobuchar be added as a 
cosponsor of the amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CARDIN. This deals with the therapy cap on which we now have had 
12 patches. It is almost the identical problem we have with the SGR, 
which is the underlying bill. It deals with seniors, Medicare 
beneficiaries, having access to therapy services, those who have had 
strokes, those who have serious issues and need rehab therapy.
  The cap never made sense in 1997 when it was put into effect. It was 
not the right policy. We have had bipartisan support to correct this as 
we have the SGR, and my underlying amendment does that.
  I ask my colleagues to support the amendment.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, this bill is far from perfect, but we 
cannot let perfect be the enemy of the good on this bipartisan 
compromise that passed the House with almost 400 votes.
  The House leadership has made it clear to us, they will not pass 
another package, and I don't blame them. Time is of the essence.
  The therapy caps provision may not be the best policy, but it is in 
place to ensure there is a governor on unnecessary utilization and 
spending in the Medicare Program.
  Congress should use the next 2 years to find a solution to this 
problem and work to pay for that solution, and I intend to do that. But 
to have that on this bill would be a catastrophe at the end of what has 
been a really, really very, very tough-fought bill all the way through.
  The pending amendment, No. 1119, offered by Senator Cardin would 
violate the Senate pay-go rule and increase the on-budget deficit over 
the 10-year period of fiscal years 2015 to 2024. Therefore, I raise a 
point of order against this measure pursuant to section 201(a) of S. 
Con. Res. 21, the concurrent resolution on the budget for fiscal year 
2008.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974 and the waiver provisions of 
applicable budget resolutions, I move to waive all applicable sections 
of that act and applicable budget resolutions for purposes of the 
pending amendment, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The bill clerk called the roll.
  The yeas and nays resulted--yeas 58, nays 42, as follows:

                      [Rollcall Vote No. 142 Leg.]

                                YEAS--58

     Ayotte
     Baldwin
     Bennet
     Blumenthal
     Booker
     Boxer
     Brown
     Burr
     Cantwell
     Cardin
     Carper
     Casey
     Cassidy
     Collins
     Coons
     Donnelly
     Durbin
     Feinstein
     Franken
     Gillibrand
     Graham
     Heinrich
     Heitkamp
     Hirono
     Hoeven
     Kaine
     King
     Kirk
     Klobuchar
     Leahy
     Markey
     McCaskill
     Menendez
     Merkley
     Mikulski
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Paul
     Peters
     Portman
     Reed
     Reid
     Rounds
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Vitter
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--42

     Alexander
     Barrasso
     Blunt
     Boozman
     Capito
     Coats
     Cochran
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Grassley
     Hatch
     Heller
     Inhofe
     Isakson
     Johnson
     Lankford
     Lee
     Manchin
     McCain
     McConnell
     Perdue
     Risch
     Roberts
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker

[[Page 4948]]


  The PRESIDING OFFICER. On this vote, the yeas are 58, the nays are 
42.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected. The point of order is 
sustained, and the amendment falls.
  The bill was ordered to a third reading and was read the third time.
  The PRESIDING OFFICER. There is now 2 minutes of debate prior to a 
vote on final passage.
  Mr. REED. Mr. President, I am pleased to see that after 12 years of 
temporary patches to delay cuts under the Sustainable Growth Rate, 
Congress is finally acting to reform the Medicare physician payment 
system for the long term. In so doing, we not only ensure access to 
care for seniors but also help improve the quality of care they receive 
through Medicare.
  However, I am disappointed that the same certainty is not provided to 
children and families impacted by the Children's Health Insurance 
program, CHIP. This legislation extends funding for CHIP for 2 years 
and continues policies that encourage enrollment in the program. But it 
does not extend this critical funding for a much longer period of time, 
like the 4 years my colleagues and I have been urging for months. We 
are missing a crucial opportunity to ensure that children and pregnant 
women have access to comprehensive, affordable health insurance 
coverage for years to come. Currently, more than 10 million children 
benefit from this program. In 2 years, funding for this program will 
expire, putting children at risk of becoming uninsured once again. 
Moreover, the bill takes the same temporary approach with respect to 
the Maternal, Infant, and Early Childhood Home Visiting, MIECHV, 
program, Community Health Centers, and other initiatives.
  I am also concerned that Medicare beneficiaries will see increases in 
out-of-pocket costs to help pay for the legislation. Faced with the 
threat of looming cuts to health care providers and the resulting risk 
of disruption of services should doctors withdraw from Medicare, we are 
being forced to instead choose to increase costs on seniors, rather 
than any number of offsets that could have asked the wealthiest 
Americans or corporations to pay a little more to ensure that Medicare 
is protected for everyone. Indeed, the majority in the other body 
insisted on paying for this bill, at least in part, by increasing these 
out-of-pocket costs. For a bill designed to protect access to health 
care for seniors, it should not turn around and then demand they pay 
more. We should be reaffirming our commitment to protecting Medicare 
beneficiaries and these cuts do just the opposite. With these 
provisions not taking effect until 5 years from now, I hope that gives 
us ample time to revisit this.
  After years of disagreements on health care issues, it is good to see 
that we can move on this bill on a bipartisan basis. So while I have 
the reservations I have outlined, and will support amendments to 
address these issues, I will vote for this legislation.
  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. SESSIONS. Mr. President, this legislation has not gone through 
the regular order in the Senate. It will add $174 billion to the debt. 
It is subject to seven different budget points of order. We have had a 
series of budget point of order votes where we have affirmed the budget 
and the responsibility we have to adhere to it. Let's do the right 
thing. Let's tell the House, which tried to send this bill over at 3:30 
in the morning for us to pass right before we recessed after the budget 
votes, that, yes, we are absolutely committed to fixing the doctors' 
payments and in a responsible, long-term way, but it needs to be paid 
for in a responsible, long-term way. Upholding the budget point of 
order does not kill the bill; it sends it back to committee to make 
sure it is fully paid for.
  So let's not be afraid tonight. Let's say to our House colleagues: 
Colleagues, we agree with you on your vote, but we must pay for this 
bill.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. SESSIONS. Mr. President, I need to make a budget point of order.
  The PRESIDING OFFICER. There is still time remaining in favor of the 
bill.
  Mr. SESSIONS. Mr. President, the pending measure, H.R. 2, the 
Medicare Access and CHIP Reauthorization Act of 2015, violates section 
311(b) of the fiscal year 2009 budget resolution by causing a net 
increase in the long-term deficit in excess of $5 billion in the 10-
year period of fiscal years 2025 through 2034. Therefore, I raise a 
point of order against this measure pursuant to section 311(b) of S. 
Con. Res. 70, the concurrent resolution on the budget for fiscal year 
2009, and ask for the yeas and nays.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. I yield back the time.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. I move to waive all applicable sections of the Budget Act, 
and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The senior assistant bill clerk called the roll.
  The yeas and nays resulted--yeas 71, nays 29, as follows:

                      [Rollcall Vote No. 143 Leg.]

                                YEAS--71

     Alexander
     Baldwin
     Bennet
     Blumenthal
     Blunt
     Booker
     Boozman
     Boxer
     Brown
     Burr
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Cassidy
     Cochran
     Collins
     Coons
     Corker
     Cornyn
     Donnelly
     Durbin
     Feinstein
     Flake
     Franken
     Gillibrand
     Graham
     Hatch
     Heinrich
     Heitkamp
     Heller
     Hirono
     Isakson
     Kaine
     King
     Kirk
     Klobuchar
     Leahy
     Manchin
     Markey
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Paul
     Peters
     Reed
     Reid
     Roberts
     Rounds
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Tillis
     Udall
     Warner
     Warren
     Whitehouse
     Wicker
     Wyden

                                NAYS--29

     Ayotte
     Barrasso
     Coats
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Gardner
     Grassley
     Hoeven
     Inhofe
     Johnson
     Lankford
     Lee
     Perdue
     Portman
     Risch
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
     Sullivan
     Thune
     Toomey
     Vitter
  The PRESIDING OFFICER. On this vote, the yeas are 71, the nays are 
29.
  Three-fifths of the Senators duly chosen and sworn having voted in 
the affirmative, the motion is agreed to. The point of order is not 
sustained, and the motion is agreed to.
  The Senator from Utah.
  Mr. HATCH. Mr. President, we will soon be voting on final passage of 
H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015.
  As I mentioned earlier, this bill represents more than 2 years of 
hard work on both sides of the Capitol. And, it represents a real step 
forward for bipartisan health care policy. I am proud to have been one 
of the authors of this legislation and I look forward to what I believe 
we will see--the bill pass with bipartisan support.
  I want to commend everyone who worked on this legislation. I 
particularly want to thank Senator Max Baucus who worked with me from 
the beginning on this effort here in the Senate. In addition, I would 
like to thank the current ranking member of the Finance Committee, 
Senator Wyden for all his work. I also want to thank our colleagues on 
the House Energy and Commerce and Ways and Means Committees who also 
worked very hard in crafting this SGR fix.
  As with any major legislative effort, there are a number of 
staffers--both current and former--who also deserve our thanks. From my 
own Finance Committee staff, I want to thank Dan Todd, Kristin Welsh, 
Erin Dempsey, Katie Simeon, Kim Brandt, and Becky Shipp for all of 
their hard work. I also want to thank my senior team--Jay Khosla, Chris 
Campbell, and Mark

[[Page 4949]]

Prater. On the Democratic side of the committee, I want to thank Karen 
Fisher, David Schwartz, Matt Kazan, Juan Machado, Scott Levy, and Colin 
Goldfinch.
  I also want to commend the efforts of Scott Raab and Monica Popp from 
the Senate Republican leadership offices.
  In addition, from the House side, I specifically want to thank 
Charlotte Ivancic and Wendell Primus.
  We have also gotten quite a bit of help from CBO in this effort. For 
that, I want to thank Lori Housman, Tom Bradley, and Holly Harvey.
  CMS also provided vital technical assistance as we put this 
legislation together. For that, I'd like to thank Jennifer Druckman, 
Ira Burney, and Anne Scott.
  And, of course, we couldn't have done without the help of the 
Legislative Counsels' offices, particularly John Goetcheus, Kelly 
Malone, Ruth Ernst, and Phil Lynch on the Senate side and Jessica 
Shapiro and Jessica Cross over in the House.
  I wish to once again urge my colleagues to support this bill. It is a 
monumental achievement. It is legislation that has been long in the 
offing. I wish to thank everybody on both sides for the cooperation we 
have had. I just want to personally express my gratitude for being able 
to pass this bill.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, I will be very brief. I think tonight is a 
milestone for the Medicare Program--a lifeline for millions of older 
people. That is because tonight the Senate is voting to retire the 
outdated, inefficiency-rewarding, commonsense-defying Medicare 
reimbursement system.
  As Senator Hatch noted, it has been bipartisan; it has long been 
bipartisan. I think this is an important night for the Senate and it is 
going to be long remembered.
  I yield the floor.
  Mr. HATCH. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The bill having been read the third time, the question is, Shall the 
bill pass?
  The clerk will call the roll.
  The bill clerk called the roll.
  The result was announced--yeas 92, nays 8, as follows:

                      [Rollcall Vote No. 144 Leg.]

                                YEAS--92

     Alexander
     Ayotte
     Baldwin
     Barrasso
     Bennet
     Blumenthal
     Blunt
     Booker
     Boozman
     Boxer
     Brown
     Burr
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Cassidy
     Coats
     Cochran
     Collins
     Coons
     Corker
     Cornyn
     Cotton
     Crapo
     Daines
     Donnelly
     Durbin
     Enzi
     Ernst
     Feinstein
     Fischer
     Flake
     Franken
     Gardner
     Gillibrand
     Graham
     Grassley
     Hatch
     Heinrich
     Heitkamp
     Heller
     Hirono
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kaine
     King
     Kirk
     Klobuchar
     Lankford
     Leahy
     Manchin
     Markey
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Paul
     Peters
     Portman
     Reed
     Reid
     Risch
     Roberts
     Rounds
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Sullivan
     Tester
     Thune
     Tillis
     Toomey
     Udall
     Vitter
     Warner
     Warren
     Whitehouse
     Wicker
     Wyden

                                NAYS--8

     Cruz
     Lee
     Perdue
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
  The bill (H.R. 2) was passed.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. What is the pending business?

                          ____________________