S12462 CONGRESSIONAL RECORD — SENATE December 5, 2009 have decided that the profit they are be in the business of helping people America’s seniors and people with dis- making—and remember, more than $1 stay healthy when they are actually in abilities should be used only for those billion, with the boss taking home the business of making as much money precise payments. And today, we will more than $100 million—isn’t enough. as they can. They raise families’ rates continue to make it better with an So this multibillion-dollar company on a whim, deny coverage because amendment by Senator LINCOLN of Ar- found a clever way to make more someone has a preexisting condition or kansas that stops irresponsible tax money next year. How? Raising rates. they are a woman or they are too old, breaks for millionaire health insurance As one might expect with the insur- with concern for nothing but their own executives and starts to use companies’ ance industry, being as callous as it is, executives’ personal bank accounts. revenues to strengthen Medicare. those higher premiums are going to be The question before the Senate is, The fact is, our bill will, in short, too expensive for many. Some analysts How many more of our own citizens save lives, save money, and save Medi- say that as many as 650,000 people in- will we sentence to such a fate? How care. It will make it possible for each sured by this company will no longer much longer will we look the other and every American to afford to live a be insured by the company. They will way while our neighbors suffer right in healthy life. We can’t afford not to do have to find other insurance or go front of us? How much more are we this. without. Now, 650,000 is more than the going to charge those fortunate enough f entire population of North Dakota, to have insurance in order to cover the more than the population of Vermont, many who don’t? Right now, every in- RESERVATION OF LEADER TIME and more than the population of Wyo- dividual who has insurance pays at The PRESIDING OFFICER. Under ming. It is more than the entire popu- least $1,000 a year more because of the the previous order, leadership time is lations of Baltimore and Boston and uninsured going to emergency rooms reserved. Denver and Seattle. How many people all over the country. I ask my col- Mr. REID. Will the Chair now an- is this one company going to drop? You leagues, How much longer will we en- nounce the business before the Senate. could count every man, woman, and able the insurance companies to deny f child in Las Vegas and still have 100,000 health care to the sick? How much SERVICE MEMBERS HOME people left over. Las Vegas is as big as longer will we let those companies OWNERSHIP TAX ACT OF 2009 Boston, Baltimore, Denver, and Se- force thousands upon thousands of attle. But here is the worst part: That Americans into bankruptcy while they The PRESIDING OFFICER. Under shocking estimate comes directly from rake millions of dollars of cash into the previous order, the Senate will re- the president of the company himself— their pockets? That is the reality. sume consideration of H.R. 3590, which the man who made more than $100 mil- Opponents of progress have tried to the clerk will report. lion last year. That means the com- drown out this truth with distortions, The assistant legislative clerk read pany devised this strategy, crunched distractions, and dishonesty. But, as as follows: the numbers, and saw how many Amer- John Adams observed a long time ago, A bill (H.R. 3590) to amend the Internal ican families it was going to hurt. facts are stubborn things. Revenue Code of 1986 to modify the first-time Then the bosses shrugged their shoul- Here is one of the most startling home buyers credit in the case of members of facts: Last year, 750,000 people filed for the Armed Forces and certain other Federal ders and decided to go ahead anyway. employees, and for other purposes. We would hardly stand idly by as a bankruptcy. Seventy percent of those country if every citizen of one of our who filed for bankruptcy did so because Pending States was left out in the cold. And of medical expenses, and 62 percent of Reid amendment No. 2786, in the nature of that is, in fact, what we have here. We those who filed because of medical ex- a substitute. penses had insurance. What a sad com- Lincoln amendment No. 2905 (to amend- would never consider doing nothing if ment No. 2786), to modify the limit on exces- every resident of one of our biggest cit- mentary. In the year World War II sive remuneration paid by certain health in- ies was, in fact, hung out to dry, but ended, President Harry Truman warned surance providers to set the limit at the that is the equivalent of what just one that many of us were vulnerable to same level as the salary of the President of company is doing—just one of the what he called ‘‘the economic effects of the United States. countless health insurance companies sickness.’’ In the 64 years since, it has Johanns motion to commit the bill to the that care about nothing except profits. only gotten worse. Committee on Finance, with instructions. Others may suggest the system is Here are some facts—facts about The PRESIDING OFFICER. Under just fine the way it is. We on this side what our legislation will do: The legis- the previous order, the next 3 hours of of the Senate do not believe that. lation before this body will make sure debate will be equally divided between Why are they able to do this? Well, every American—nearly every Amer- the two leaders or their designees, con- one reason they are able to do it is ican, at least 971⁄2 percent—will be cov- trolled in 45-minute alternating blocks they are not subject to the antitrust ered with insurance. It will not only of time, with the majority controlling laws. They can conspire to fix prices, protect those seniors on Medicare, it the first portion of time. as we have indicated, and there are no will make it stronger. It will make Who yields time? civil or criminal penalties. sure more than 30 million Americans The junior Senator from Minnesota. Some may suggest the system is fine who don’t have health insurance now Mr. FRANKEN. Mr. President, I ask just the way it is. We don’t believe will soon have it. It will not add a dime unanimous consent to speak as in that. to our deficit. In fact, in the next 10 morning business for 5 minutes. Just this summer, the junior Senator years it will reduce it by $130 billion The PRESIDING OFFICER. Without from South Carolina said what we need and over the next 20 years by almost objection, it is so ordered. to do is ‘‘get out of the way and allow $3⁄4 trillion. (The remarks of Mr. FRANKEN are the market to work.’’ Well, the market We are even making this bill stronger printed in today’s RECORD under sure worked fine for this insurance than when it was introduced, this bill ‘‘Morning Business.’’) company. It is working fine right now. here. For example, because we have Mr. FRANKEN. I suggest the absence The problem is, it doesn’t work for the added Senator MIKULSKI’s amendment of a quorum. American people, only for the big shots to the legislation, women can now get The PRESIDING OFFICER. The of these insurance companies. the mammograms, checkups, and other clerk will call the roll. Just last week, my distinguished preventive tests they need in order to The assistant legislative clerk pro- counterpart, the Republican leader, stay healthy, at no cost. We made it ceeded to call the roll. said the health care crisis is ‘‘manufac- better by reaffirming our commitment Mr. HARKIN. Mr. President, I ask tured.’’ Those were his words: The to seniors who rely on Medicare and unanimous consent the order for the health care crisis is ‘‘manufactured.’’ Medicare Advantage, guaranteeing quorum call be rescinded. In one sense, he is right. It has been they will always get the care they need The PRESIDING OFFICER. Without manufactured by the greedy insurance and the quality of life they deserve. We objection, it is so ordered. companies, just like the one I men- made it better by ensuring that the Mr. HARKIN. Mr. President, first of tioned earlier, companies that claim to money dedicated to the health care of all, let me say I am glad we are here

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00002 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.001 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12463 this weekend. Oh, I know we like to be outrageous salaries that top executives their lack of health insurance cov- with our families, we have Christmas in these companies receive. Chief exec- erage, about the affordability of that shopping to do and things such as that. utive officers at the seven leading in- coverage and the quality of that cov- It is always nice to be with our fami- surance companies made a combined erage. Yet with all of this money that lies on the weekends. But think about $118.6 million in 2007 alone, an average is going to their CEOs and huge in- it this way: Millions of Americans of $11.9 million each. Let’s compare creases in the profits they make, our today are giving up their weekends, that to the wages of millions of Ameri- Republican friends on the other side of they are giving up their nights, their cans or the minimum wage. For some- the aisle say they still need a Federal holidays, because they are either out of one making the minimum wage, it handout. The industry cannot find a work, they are working part time, they would take nearly 800 years to make dime to bring down prices for con- are trying to do odd jobs to get enough what these insurance company execu- sumers but they can find millions to money together to keep their families tives make in 1 year. lobby for more special favors. intact. So they are working at nights, Again, here is the CEO compensation. The Wall Street Journal reported they are working on weekends. They For United Health Group, they made that the health care industry boosted are not taking time off. They are out $2.9 billion in profit in 2008 and they their efforts in lobbying this year. In a there looking for work now or out paid their CEO $9.4 million; WellPoint, quote from the Wall Street Journal: there doing odd jobs, whatever they $9.8 million; Aetna, $24.3 million; Overall, the health-care sector reported a can possibly do. They are making sac- Humana, $47.3 million; Coventry five percent increase in lobbying expendi- rifices. They are making sacrifices for Health Care, $11 million; Cigna, $4.4 tures to $133 million, making it the single their families, but they are also mak- million. That is the CEO compensation. largest spender on lobbying of the 10 major ing these sacrifices to pay their med- That probably is not the whole package industry sectors tracked by the Center for ical bills or to afford their needed pre- when you consider all the other bene- Responsive Politics. Health-insurance com- scriptions. It seems to me we owe them panies increased lobbying activity by 11 per- fits they get, deferred compensation cent to $7.8 million, according to the data. nothing less than the same level of and on and on—golden parachutes, all commitment to the task of bringing that kind of stuff. That is basically An increase of 11 percent. You won- quality, affordable health care within their CEO compensation for the year. der why all this health sector this year their reach. As you can see, they get paid pretty had $133 million in lobbying expendi- Our leader, Senator REID, was right tures. I think, if I am not mistaken, to call the Senate into session this well and $11.9 million is the average. Here is Aetna, $24 million a year. They the supposed, stated purpose of health weekend. We ought to keep at this bill, insurance is to protect Americans from this health care reform bill, working had a profit of $1.3 billion that year. So they did well, their shareholders did the cost of illness. Supposedly their hard, until the Senate finishes the job purpose is to keep the American people before us. Nothing less will do. well, their CEO did well. But how about the consumers, the working families? healthy and productive for the benefit I do not plan to spend a lot of time of society. Yet over some 60 years, this on the debate over Medicare Advantage In 2003, by the way, Aetna, this com- industry, the health insurance indus- that we had yesterday. However, after pany right here, making all this try, has transformed itself from an in- listening to the comments yesterday, I money, paying their CEO $24 million a dustry that is there to help you to an did want to mention briefly editorials year—in 2003 Aetna settled a lawsuit. industry that is there to take money that appeared in the Des Moines Reg- You know, usually when you settle from you when you are healthy and ister. The first was published 6 years lawsuits it is because you think you avoid paying your bills when you get ago when the Senate considered the are going to get hit worse down the Republican Medicare drug legislation. line. They settled a lawsuit brought by sick. This is an industry with armies of The major element of that bill was to who? Brought by physicians, a whole actuaries and functionaries whose job give outrageous bonuses to private group of physicians brought a class ac- is to prevent you from enrolling if you health plans in Medicare Advantage. In tion against Aetna because they had a have a preexisting condition. It is an criticizing that proposal, the Register history of shortchanging patient care. industry that looks at the fine details called on Members of Congress ‘‘to re- Aetna settled for $470 million, just to of your medical records when you get mind themselves their job is to serve get away from it, in 2003. sick so they can figure out how to can- the interests of the people, not indus- There was not any money to help cel your policy and leave you high and try lobbyists.’’ them afford the coverage patients need, dry when you need their help the most, Sadly, we didn’t heed that call that but they had billions for profits and as has been said many times around time, 6 years ago. Instead, Congress, they had millions for salaries—nothing here. under Republican leadership at that for working families. The majority, actually 62 percent of time, enacted a bill that provided a The reality for working families bankruptcies in America, is because of massive and unjustified windfall to the across America is simply this: Insur- medical costs, and 80 percent of that insurance industry. ance premiums have skyrocketed, out- group had health insurance. They actu- The Register revisited the same sub- pacing the growth in wages over the ally had health insurance, but they had ject in an editorial this year, May 31 of same period. Quality affordable health to file for bankruptcy because—they this year. Here is what they said: care is slipping further and further didn’t know it, but in their contract, in Congress encouraged private insurance from the grasp of middle-class Ameri- their policy, there was some fine print plans, known as Medicare Advantage plans, cans. Between 1999 and 2007, the aver- called a rescission clause, or there is which have cost taxpayers more than cov- age American worker saw wages in- fine print in there on terms of their an- ering seniors in traditional government-ad- crease 29 percent. Insurance premiums nual or lifetime caps, which most peo- ministered Medicare. ple do not even know are in their poli- Congress should not repeat the mistakes it during that same time rose more than made in 2003 when reforming Medicare—ca- 120 percent. They see the premiums cies. But when they got very sick, all tering to special interests and pushing peo- skyrocketing, but their health care is of a sudden their policy got rescinded, ple into private-sector insurance coverage. slipping away. which means when it came up for re- Our health bill, the one we have be- There is something else. The profit newal the insurance company didn’t fore us, heeds these words. We stand up margins of the insurance industry renew it, and here you are with an ex- to the special interests that even today soared. Over the last 7 years the profits pensive chronic disease or illness such are demanding billions of dollars in of the seven largest publicly traded as cancer or heart disease or disability, taxpayer funds to prop up their in- health insurance companies increased and they cancel your policy. You are flated profits. So yesterday was a good by 428 percent. Profits increased by 428 left with only one recourse—file for day. Yesterday we said no to giving the percent, from $2.4 billion to $12.9 bil- bankruptcy. insurance industry a $120 billion bonus lion. Yet look at what our workers’ This is an industry which defines for doing the same job that Medicare wages went up—29 percent. being a victim of domestic violence as can do for far less. Now you begin to understand why a preexisting condition. I spoke about Today we will consider a proposal people in this country are upset and this previously. Only in America, with from Senator LINCOLN to say no to the discouraged and outright mad about this health insurance industry running

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00003 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.003 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12464 CONGRESSIONAL RECORD — SENATE December 5, 2009 everything in terms of our health care It also ends the outrageous practice of The American people are looking to coverage, only here would we have a charging women higher prices for the us to get this job done. We are going to situation where a woman can be the same policy, the exact same policy a get the job done. No matter how much victim of domestic violence, be bat- man gets. I can remember, during my our friends on the Republican side tered, get medical help, go to the hos- town meetings back in August, talking want to delay, delay, delay, and try to pital perhaps, a victim of domestic about this issue. People were startled kill this bill, it is not going to happen. abuse, and then later on find that she to learn that an insurance company This bill is unstoppable because the can’t get her policy renewed because can charge a woman up to twice as American people are demanding that she has a preexisting condition, the much for the same policy—same age, we do something about it. We are re- preexisting condition of being the vic- all the same parameters, same occupa- sponding to that, and we are going to tim of domestic violence. tion, same kind of history. They can get the job done. You may think that is outlandish, charge a woman up to twice as much as I yield the floor. but it is true, and it happens. All we a man for the exact same coverage, the The PRESIDING OFFICER. The Sen- are seeking is competition, openness, exact same policy. We get rid of that in ator from Pennsylvania. transparency, and fairness. this bill. We do not allow that kind of Mr. CASEY. Mr. President, we gather The insurance industry, what are discrimination in any other kind of in- today on a Saturday which, as many they seeking? They are seeking to pre- dustry. Why should we allow it in this Americans know, is rare, but it is en- serve and protect a sweet deal they industry? tirely appropriate and essential that have been enjoying on the backs of Our bill provides better options for we make sure we spend the time on a middle-class Americans and seniors. individuals, small businesses, farms, weekend to debate this bill and to get The proposal Senator LINCOLN is offer- for the self-employed. I have said many the bill passed. I commend the words of ing says basically: Enough is enough. times the biggest winners in our health Senator HARKIN and his great work In defense of their outlandish salaries, care reform bill are small businesses over many months on this legislation. the insurance company CEOs cite the and the self-employed. Right now they We are grateful for his leadership. I difficulty of their jobs and the com- are sort of at the end of their rope. commend Senator LINCOLN on the plexity of their tasks. The President of They have no bargaining power what- amendment we will vote on today re- the United States probably has a pret- soever. Our bill will create exchanges garding executive compensation. ty difficult job. He has a few complex so they will be able to go on the ex- I rise to speak about children, as this tasks to confront. There is no reason change and pool with other people for bill affects their lives—in particular, insurance company CEOs should get a more options, more competition, more the lives of children who are particu- transparency available. tax break on salaries higher than the larly vulnerable. I have said a number Some places in Iowa we have only President’s. That is exactly what the of times in this debate that at the end one insurance company offering poli- of this debate, when the bill is enacted Lincoln amendment does. cies. There is absolutely no competi- I thank Senator LINCOLN for her com- into law, we should be able to say that tion. Setting up the exchanges will monsense proposal. I think consumers no child is worse off, especially a child allow our self-employed and small busi- across America should know that when who happens to be poor or has special nesses to get more bargaining power. needs. That is what I rise to speak of they pay their hard-earned dollars to These are the kinds of measures the this morning. cover the soaring cost of premiums, American people want and need to I had a joint resolution a number of they are not just chipping in to pay for make sure they get a fair deal on the months ago that was filed relating to the CEOs’ next new yacht or the new- coverage they buy. We need a health this bill. It was joined in by Sen- est Mercedes in the driveway. In homes insurance industry that is a partner for ators DODD, ROCKEFELLER, BROWN, across Iowa people are clipping coupons employers and ordinary Americans, WHITEHOUSE, and SANDERS. It was sim- and making do with secondhand, charges fair premiums, treats us right, ple. It basically said what this chart patching up instead of buying new. and pays our bills when we get sick. says: No child worse off at the end of They have had to make sacrifice after That is what our bill is all about. It is sacrifice to afford premiums that pro- to end a lot of these outrageous prac- the debate. It is a fundamental prin- vide coverage for their health care. It tices that have gone on for far too long ciple, but I also believe it is a commit- is outrageous that their hard-earned in the health insurance industry. ment we must keep. When we talk cash goes for gold-plated salaries and A lot of times people say: You are al- about the legislation before us, we are bonuses. Senator LINCOLN is right to ways beating up on the health insur- not talking about some new system. take a stand against these excesses. I ance industry. Not really. We are just We are talking about figuring out a urge my colleagues to support her taking them to task for where they way—and I think we have in the Sen- amendment. have gone. Years ago when they first ate—to fix what is broken and build The Lincoln amendment is consistent started out, they were doing a good upon what works. I believe that is what with a major theme of our legislation. job. Then the greed, the normal human we are trying to do. It is basically standing up to the nature and greed for more profits, When it comes to children, we have health insurance industry on behalf of higher CEO salaries, $24 million sala- special considerations, and we have to consumers. Her proposal will add one ries for CEOs, gold-plated benefits have unique strategies to make sure more important item to the list of ben- packages for all their CEOs and cor- they get the best health care possible. efits our legislation will bring to Amer- porate executives; it just got out of As so many child advocates tell us— ican patients. hand. It became a situation where al- and it seems like such a simple As I said before, this bill ends the most one health insurance company maxim—children are not small adults. practice of denying coverage because a was trying to outdo the others in terms That is a profound statement. You person has a preexisting medical condi- of how much money they could squeeze can’t just take a health care program tion. I would wager probably every out of the consumers. It is just a sys- for adults and overlay that on the Member of this Senate has some kind tem that sort of ran amok. health care that is provided to chil- of a preexisting condition of some sort, Now it is up to us in the Congress to dren. Children are not small adults. and every one of us could be turned rein it in, to make the health insur- They are different. The care they get down if we didn’t have the kind of se- ance industry what it ought to be—a has to be different. It has to be tailored cured program under the Federal em- fair and reasonable, competitive sys- and focused on their needs. The care ployees program. Why shouldn’t the tem for the consumers. That is what they get, especially a child who is vul- rest of the American people have the this bill does. To me, that is the Amer- nerable, is determinative of their life. same kind of security? ican way. That is why we have to stay If we don’t provide them the kind of This legislation ends the lifetime here on the weekends, if we have to. If care in the dawn of their life, as Hubert limits and bans unreasonable annual we have to be here today, fine; and to- Humphrey talked about, there is very limits. Our bill gives young people bet- morrow, fine; and all next week, fine; little after that we can do to save them ter options to stay on their family’s and next weekend; and, if we have to, or to allow them to reach their full po- and parents’ plan until they are age 26. right through the holidays. tential.

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00004 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.005 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12465 That bright light inside a child, if we We strengthen the pediatric work- But then Stacie goes on, and the lead miss the opportunity to care for that force. We can’t just say we need a lot of headline of this section is one word, child, will never be the same. We have pediatricians and hope it happens. We ‘‘Bankruptcy.’’ an opportunity in this debate, and at have to make sure we have a workforce During this time my husband had to take the end of the debate with the legisla- and a recruiter workforce to do that. family medical leave so we could take turns tion, to positively affect the lives of Senator DODD and I and Senator caring for our one year old son and our countless American children. BROWN—I know Senator DODD is on the twins— I have some changes I will propose to floor—added a loan repayment provi- These twins, as shown in these pic- the Children’s Health Insurance Pro- sion in the bill for pediatric specialists tures— gram, but I wanted to speak this morn- and providers for mental health serv- at the hospital. . . . For the 7 months my ing about parts of the bill that speak ices for children. husband was out on family medical leave, he directly to the needs of at least two I have two more items and then I will was able to maintain his employer based in- vulnerable children, two young girls by get to the story of Hannah and Mad- surance for us via $117.18 a month COBRA the name of Hannah and Madeline from eline. payments. Pennsylvania. We expand drug discounts for chil- My recollection is, COBRA was an I will get to their story in a moment, dren’s hospitals and finally increase ac- initiative by the Federal Government but their mother, Stacie, commu- cess to immunizations. The CDC will to make sure, if you lose your job, you nicated with us and a lot of other peo- provide grants to improve immuniza- do not lose your health insurance. We ple about their lives and their chal- tions for children and adolescent have to extend it right now—another lenges. I did want to first review some adults. government initiative that was helpful of the basic parts of the bill. We often But let me talk for a couple mo- here. say this bill contains consumer protec- ments—I know we have others who are After spending all our savings to pay the tions. That is a nice-sounding phrase, waiting to talk this morning—about mortgage and other basic living expenses we but when you talk about consumer pro- these two children: Hannah and Mad- had to rely on credit cards. tections in the lives of young children eline. The good news is—this picture is So a mother and a father who get such as Hannah and Madeline, it takes a dramatic depiction of what they were this diagnosis for their children at age on a whole new meaning. I will talk suffering from when they were diag- 4 have to rely on credit cards to get the more about them in a moment. nosed with leukemia at the age of 4. help their daughters need. I want to walk through some of the They are 11 years old now, and they are Stacie writes: basic provisions in the bill as they re- doing better, but they still have enor- In the end we had no choice but to file late to children and what we have in mous challenges in their lives. Their bankruptcy. And when you file bankruptcy the bill already. mother Stacie Ritter wrote as follows: everything must be disclosed, we even had to No. 1, the bill ensures pediatric input When my identical twins were both diag- hand over the kids’ savings accounts that into benefit packages so that the skill nosed with [a kind of leukemia]— their great grandparents— and the knowledge of a pediatrician And she talks about it— Their great grandparents— and the kind of care they can provide at age four, we were told they would need a had given them. . . . bone marrow transplant in order to survive. to a child is part of the benefits pack- Is this the kind of system we want, age. Again, children are not small Imagine that. I have four daughters, when a mother and a father are hit adults. The bill also ensures benefit and I remember when they were about with that diagnosis for their two packages that include pediatric bene- the age of 4. I never had to worry about daughters, when they are age 4, that we fits including critical oral and vision any of this. I never had to even think have a system that says: Do you know health care. about it. But if my wife and I—my wife what. We have to cap your coverage. We all remember the tragedy last Teresa and I—were given this news, we We can help you a little bit, but we are year of Diamante Driver of the State of would have been given coverage for a going to limit it. You will figure it out. Maryland, a young boy who lost his life condition such as that by an insurance Don’t worry. That is basically what the because his family did not have cov- policy because I happened to be a State system said to them. erage for an infected tooth and government employee, and now I am a So what are we doing? Well, we have couldn’t afford the care. We are talking Federal Government employee. So I a bill that happens to speak to these about a child in America who died from never had to worry about that diag- kinds of situations. It is ironic—I guess an infected tooth that would have cost nosis for my daughters. Other than the is the word—that on page 16 of the bill, $80 to treat. This horrible tragedy that challenge of the diagnosis itself, I did which is actually the second page of everyone in Washington was talking not have to worry about coverage. But the text, we have a provision that says about at the time was entirely prevent- Stacie Ritter and her husband Ben did. this: She says: able. We remembered his story and his A group health plan and a health insurance tragedy in the bill by making sure that I learned that the insurance company issuer offering group or individual health in- oral and vision health care are part of thought my daughters were only worth surance coverage may not establish . . . life- what we do. $1,000,000 each. It sounds like a lot of money. time limits on the dollar value of benefits In addition, the bill mandates pre- It’s not! for any participant or beneficiary. . . . vention and screenings for children. It She says that with an exclamation It is not complicated. It is not creates pediatric medical homes. Peo- point. legalese. It is very specific to the lives ple say: What is a medical home? That When you add up the costs involved in car- of these two children. The first provi- is not a place. It is a way to treat ing for a patient with a life threatening dis- sion in the bill says there are no life- ease like cancer $1,000,000 barely covers it. someone, so if an American, especially time limits. So you cannot say to Han- a child, has a primary care doctor, I think that is an understatement. nah and Madeline: Sorry, we know you which many of them unfortunately Fortunately the hospital social worker rec- have leukemia and we know you need don’t—and that is another part of what ommended we apply for a secondary insur- ance through the state considering the high- expert care and treatment, but we are we are trying to do—that primary care ly probable chance we would hit that [mil- going to limit your care. doctor should be surrounded by the ex- lion dollar] cap. And we did hit that cap be- So for those who think this is com- pertise we can bring to bear to help the fore the end of treatment. Thankfully the plicated and difficult in a lot of debate child. We have so much knowledge and state program kicked in and helped pay for here in Washington, it is not com- wisdom and ability when it comes to the remainder of treatment. plicated. If we had this provision as a our doctors. We have remarkable pedi- The State program—it sounds a lot matter of law in effect when Stacie got atricians whose sole focus is to help a like a public option, doesn’t it, an that diagnosis for her daughters, she child in one part of their needs, the awful lot like a public option. So at would not have had to worry about cov- health care needs of that child. Why least for this part of the story, they erage. She would not have had to use should not every child be surrounded were able to get some help through a credit cards and go into bankruptcy by that kind of expertise? That is what State program, a kind of public option. and take the savings these children we are trying to do. We will talk more about that later. were given by their great grandparents.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00005 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.006 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12466 CONGRESSIONAL RECORD — SENATE December 5, 2009 Why do we tolerate this system? Why RECOGNITION OF THE MINORITY ican seniors. Nearly 11 million seniors do we go, year after year, and talk LEADER on Medicare Advantage will see a re- about changing it, saying: Oh, isn’t The PRESIDING OFFICER. The Sen- duction in benefits. Hospice care will that terrible we have these situations ator from Kentucky. see massive cuts. Hospitals that treat and we let it go and we say that is too Mr. MCCONNELL. Mr. President, I Medicare patients will see massive bad we couldn’t get the bill passed; it am going to proceed on my leader time, cuts. Nursing homes are cut. More than got a little difficult in Washington. which I assume will not be charged on $40 billion is cut from home health care Well, the time for talk and debate this side. agencies—agencies that provide an ap- and discussing the finer points of this The PRESIDING OFFICER. The Sen- pealing alternative to seniors who is over. We have to act to make sure a ator is correct. His leadership time has would rather receive the care and at- family such as this never has to go been reserved. tention they need in the comfort and through what these parents went The Chair will note, there is 31⁄2 min- privacy of their own homes. through but especially what these two utes remaining on the Democratic side I hear from seniors all over Kentucky young girls went through. allocated on the debate; and then, of worried about the impact these cuts I will conclude with this: This pic- course, there is another 45 minutes, will have. ture, as dramatic as it is, I think con- under the unanimous consent agree- notes a lot of hope. Look at those two ment, that will be allotted to the Re- Anita, from Hebron, KY, says she is young girls, facing the most horrific of publican side of the aisle. worried about the impact these cuts circumstances, and they are smiling Mr. DODD. Mr. President, I would will have on her husband, a Vietnam and hopeful. But they still need help. like to yield my 31⁄2 minutes to my dis- vet with multiple sclerosis. Every 2 We are going to be spending time in the tinguished friend from Kentucky and weeks, she writes, a home health care next couple days getting this bill done my friend from Arizona and my friend nurse visits her husband to perform so we can make sure we help them in from Utah and my friend from Florida procedures prescribed by his doctors. the future. and my friend from Wyoming as well— Now Anita is worried those visits With that, I yield the floor. 31⁄2 minutes for all of them. might be limited or curtailed under The PRESIDING OFFICER. The Sen- The PRESIDING OFFICER (Mr. this bill. It is not clear they will not be ator from Connecticut. BEGICH). The Republican leader. because cutting $40 billion from a bene- Mr. DODD. Mr. President, before he Mr. MCCONNELL. Mr. President, we fits program is bound to affect the ben- leaves the floor, I wish to thank our all know the U.S. health care system is efits that people such as her husband new colleague from Pennsylvania. in serious need of reform. Costs are too receive. From the moment he arrived here, he high, they are rising, and if we do noth- Joy, from Somerset, KY, works for a has raised the profile of this issue in- ing, they will continue to consume a home health care agency. She wrote volving children and families. As some- larger and larger share of Federal dol- my office because she is also concerned one who has been involved, myself, for lars and of the budgets of millions of about cuts to home health care. She a long time chairing the Subcommittee middle-class American families, of asked me to protect the rights of the on Children and Families, and with the young workers trying to get their start chronically ill, elderly Medicare popu- help of the Presiding Officer and oth- in life, and, of course, of seniors. ers, we did the Family and Medical For months, the administration and lation that she and her colleagues care Leave Act back some 17 years ago; the its allies in Congress promised a solu- for every day in Kentucky through childcare legislation almost 25 years tion to these problems, a solution they cost-effective home health care. ago, dealing with infant screening, pre- said would lower costs and help the Robin, from Independence, KY, mature births, autism—a whole host of economy. They assured us that under writes that her father is almost 80 and other issues. their proposal anyone who likes the receives home health care twice a I wish to thank him for bringing health care plans they have would be week. She says he depends on a walker what has been a tireless effort since he able to keep them, and they said their and a wheelchair to get around and has arrived in this Chamber, adding yet proposal would save Medicare. that it is hard for him to get out of the another voice, another strong voice, on But, in the end, what matters is not house. Robin’s father is the kind of per- behalf of children in our country. JAY what we say. It is what we do. This son home health care is meant to help. ROCKEFELLER, our colleague from West week, the proponents of this plan did Frankly, I do not know what to tell Virginia, has been a stalwart for years more with a single vote than they did her—I literally do not know what to on these issues as well. I know all year in talking about all the things tell her—except that $40 billion in cuts SHERROD BROWN of Ohio is also work- their health care plan would do. to this program is not a very encour- ing very hard on these issues, and I How? Because in voting to cut a $1⁄2 aging sign for people such as her dad. wish to commend him. trillion from the Medicare Program for I noticed that some years ago one of So I wish to say thank you to my col- seniors, our Democratic friends under- the top Senators on this issue on the league from Pennsylvania. The points cut not only the roughly 40 million Democratic side used the very same that he raises are good ones. seniors who depend on Medicare, they image I have used to decry these cuts. I know our time has expired, and I also undercut their own promises about Back then, he warned, as I have in re- apologize for interfering with our other reform. colleagues’ time, but I wish to thank As I said, the President and congres- cent months, not to use Medicare as a him for his efforts. I cannot think of a sional Democrats have noted, again piggy bank. Yet that is precisely what more noble cause to be involved in. and again, that under their measure our friends are doing with Medicare. There will be a lot of debate about this those who like their plans will be able They are not fixing it. They are raiding bill, but we must keep in mind that the to keep them. After Thursday’s vote, it—raiding it—to create an entirely most innocent in our society, our chil- even Democrats are admitting that is new government entitlement program, dren, are born into circumstances to- no longer true. raiding Medicare not to help save tally beyond their own control. And Here is how one of our Democratic Medicare but to create an entirely new there are too many instances where colleagues put it: entitlement program. In fact, one of they are suffering from one problem We’re not going to be able to say that ‘‘If the largest single sources of money for after another. A great country such as you like what you have, you can keep it.’’ this 2,074-page bill is the money they this, with great resources and poten- Then he added: get from Medicare. tial, ought to be able to ensure that . . . and that basic commitment that a lot I am not sure what has changed since every child in this country—regardless of us around here have made will be called our friends decried cuts to Medicare as of the economic circumstances or the into question. immoral and irresponsible. But today I physical circumstances they are born As for the oft-repeated pledge to save would, once again, urge them to recon- into—gets the kind of care that Amer- Medicare, well, nobody buys that one sider their vote from earlier this week. ica can be proud of. I say to the Sen- after the vote on Thursday to cut it by They have voted now to cut Medicare, ator, you are a champion of that, and I $1⁄2 trillion. and they have now voted twice to cut thank you for it. These Medicare cuts will impact the the important Medicare Advantage I yield the floor. I66F quality of care for millions of Amer- Program for nearly 11 million seniors.

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00006 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.007 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12467 Today we will have a chance to re- The PRESIDING OFFICER. Objec- his drug benefit, assuming he is on store the cuts they authorized to home tion is heard. Part D. Maybe he isn’t. Maybe he health care. A vote in favor of the Mr. MCCAIN. Mr. President, I also hasn’t opted for it. But as a practical Johanns amendment is a vote in favor understand that Walmart sells health matter it was a very reasonable amend- of the men and women who have been insurance policies. They are based in ment. writing our offices, sharing their sto- Arkansas. I ask unanimous consent Now we are seeing, as the Senator ries about the benefits of home health that Walmart be included in this curb from Arizona has pointed out, a $460 care. Americans never expected that on excessive remuneration that will billion cut over the first 10 years of health care reform would mean that now place them under the same level. this bill; a $1 trillion cut in Medicare, they would have to give up the health The PRESIDING OFFICER. Is there $3 trillion over the first 20 years of this care they have and like. They didn’t objection? bill—$3 trillion—when we already know expect it because they were told it Mr. BAUCUS. Reserving the right to Medicare, according to this chart, is in- wouldn’t happen. Unfortunately, that object, to be totally candid, these are solvent to the extent of $38 trillion—in- pledge was broken this week. That stunt amendments which we have not solvent. Yet we are going to take this pledge was broken this week. Today seen. I have never heard of the amend- money out of Medicare, as the Senator our friends have an opportunity to help ments. from Arizona has pointed out, and we repair some of that damage. Mr. MCCAIN. It is not complicated. It are going to fund a brandnew entitle- Mr. President, I yield the floor. is pretty simple. It is people who sell ment. The PRESIDING OFFICER. The mi- health insurance. We are going to expand Medicaid to nority now has 45 minutes for debate. The PRESIDING OFFICER. Is there 133 percent of poverty with this money, The Senator from Arizona. objection? and we are going to create this Mr. MCCAIN. Mr. President, I ask Mr. BAUCUS. Reserving the right to brandnew entitlement which has noth- unanimous consent that the Senator object, because I have not even seen ing to do with Medicare. None of the from Utah, the Senator from Ken- these amendments, I object. people who are going to get this benefit tucky, the Senator from New Hamp- The PRESIDING OFFICER. Objec- probably have ever paid into the hos- shire, the Senator from Georgia, the tion is heard. pital trust fund, which is what funds Senator from Florida, and the Senator Mr. MCCAIN. I am sorry the Senator Medicare. That seems totally incon- from Wyoming be allowed to partici- from Montana cannot understand that sistent with the purposes of Medicare. pate in a colloquy. they are people who sell health insur- Shouldn’t Medicare funds benefit The PRESIDING OFFICER. Without ance as well. AARP does, Walmart Medicare recipients, I would ask the objection, it is so ordered. does. If we are going to have this kind Senator from Arizona or the Repub- Mr. MCCAIN. Mr. President, very of demagogic amendment, then we lican leader? If there are going to be re- quickly, I wish to remind my col- should include them, especially ductions in Medicare, should it not go leagues that the AARP continues to be Walmart, that does a lot of business. to make Medicare more solvent and referred to as endorsing this legislation Mr. MCCONNELL. Mr. President, I not to create a new entitlement? and supporting it and opposing amend- would ask the Senator from Arizona if Mr. MCCAIN. One would think so. ments that would have done things I may ask a question. I would ask the There are two doctors in the Senate; that they in the past have supported. Senator from Arizona, is this the same there are lots of lawyers, two doctors. So I urge my colleagues to look at this AARP that I recall opposed a $10 bil- Both of them have hands-on experi- Washington article—one of my favorite lion reduction in the rate of increase in ence. I don’t know if Dr. BARRASSO has sources of information and opinion, the Medicare spending back in 2005? seen this morning’s New York Times, Washington Post: Mr. MCCAIN. I would say to my col- another of my favorite sources of news But not advertised in this lobbying cam- league they not only opposed it, they information and opinion. On the front paign have been AARP’s substantial earn- got all of their members fired up in op- page this morning: ‘‘Home Care Pa- ings from insurance royalties and the poten- position to it. We all heard from them tients Worry Over Possible Cuts.’’ tial benefits that would come its way from back in 2005. These were reductions in I understand the purpose of health many other reforms. spending. This was not $438 billion care reform as proposed by the other So we have been looking into that, taken out of Medicare and put in to side is to reduce health care costs. Is and guess what. The AARP endorse- create a new entitlement program of there a way to reduce health care costs ment of more than $400 billion in Medi- $2.5 trillion. better than treating people at home care savings—according to its own fi- Mr. MCCONNELL. Could I ask my than instead of in a hospital? I am cu- nancial statements from 2008, AARP friend one more question? Is this the rious about the Senator’s experience. generated 38 percent of its $1.1 billion same bill that back in 2005 my counter- Mr. BARRASSO. Well, as the Senator in revenue or more than $414 million in part, the majority leader, decried as from Arizona knows, I have treated pa- royalty fees. They also obviously will— immoral? tients in Wyoming, families in Wyo- if we take away Medicare Advantage, Mr. MCCAIN. As I recall, that is ex- ming, for 25 years. The story in the then Medigap sales will have to go up actly it. I think the Senator from New New York Times has a wonderful pic- because that provides for the services Hampshire recalls that debate. ture of Bertha Milliard, a 94-year-old that are being taken away. So under Mr. GREGG. Mr. President, if the lady, who is very similar to many of the AARP, they would generate in Senator will yield, absolutely. I was the patients I have taken care of in their endorsements—they have gen- chairman of the Budget Committee at families in Wyoming who depend on erated $414 million, putting them in the time. As the Republican leader is this care. There is a picture of Bertha fifth place of all of the health insur- alluding to, we attempted to reduce the dealing with her nurse. Bertha greets ance companies in America behind rate of growth of Medicaid by $10 bil- the nurse who has come to check her United Health, Wellpoint, Aetna, and lion of a $1 trillion base over 5 years, condition and review the medications Humana. So we have before the body less than one-tenth of 1 percent, I be- she takes for chronic pain, for heart an amendment that would modify any lieve that was. It was opposed aggres- failure, and for stroke. Ms. Milliard health insurer’s remuneration to the sively by the AARP, and it was opposed says those visits have been highly ef- same level as the salary of the Presi- by the other side of the aisle. Not one fective, she says, in keeping her out of dent of the United States. Member of the other side of the aisle the hospital. So I ask unanimous consent at this voted for that. Do you know what that That is the whole idea: Keep them time that the AARP executives be change was going to be? It was going to out of the hospital so they can lower added in under the effect of this pend- require that wealthy people who bene- the cost of care. But the home care ing amendment from the Senator from fited from the Part D drug benefit that she receives could be altered, ac- Arkansas. would have to pay part of their pre- cording to the front page of the New The PRESIDING OFFICER. Is there miums rather than getting them all for York Times, under the legislation objection? free. So Warren Buffett, for example, passed by the House and pending on the Mr. BAUCUS. Mr. President, I object. would actually have to contribute to Senate floor today. The legislation

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00007 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.008 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12468 CONGRESSIONAL RECORD — SENATE December 5, 2009 would reduce Medicare spending on the deal was cut with the hospital asso- Does the Senator know that was the home health services, which is a life- ciation. But I know what the effect is. agreement that was reached? line for homebound Medicare bene- I know what the effect is. The bill Mr. MCCAIN. My quick answer is, I ficiaries which keeps them out of hos- would slice $55 billion—— don’t know what the deal was, but I pitals as well as out of nursing homes. Mr. BAUCUS. This is not on my time know the people who are in the home So there you have it. What could be because he is going to filibuster over health care business, who will see $43 better for our seniors than to have the there. billion in cuts to their business, the dignity of being in their own homes, to Mr. MCCAIN. The House bill would funding for their business, were not have someone coming into their homes slice $55 billion over 10 years for pro- there when the lobbyists showed up. to help them, to make their lives bet- jected Medicare spending on home We have already heard the stories of ter, and that is going to include skilled health services while the Senate bill the meetings you and the majority nursing care, physical therapy, occupa- would take $43 billion. I know that. leader have had with these people say- tional therapy, sometimes speech and But I don’t know the details of the deal ing: Get on board or when we shape the language therapy, and different med- that was cut over where the white final parameters of this bill, we are ical and social services? That is where smoke comes out. I don’t know what going to hurt you. the care ought to be given, in the the deal was. I know what the deal was We know they have been threatened. Mr. GREGG. I was wondering if that home. That is what we want for our with PhRMA. I know what the deal was was the deal. We know there are a lot seniors: the dignity at home, opportu- with PhRMA. They told them they of deals around here. I know the Sen- nities at home, to stay in their sur- would oppose drug reimportation from ator from Arizona pays a fair amount roundings. That is what we want for Canada, and they told PhRMA they of attention to earmarks and other not just all seniors such as Bertha, we would not allow competition for Medi- things done around here. I hope we will want that for our Nation because that care patients. get an amendment from the Senator will help keep down the cost of care. So I don’t know the deal that was cut from Arizona that lists the special This bill does the exact opposite. that bought them, but I know deals deals like the ones that exempted a few That is why we have to have this have been going on, and I know they States from the Medicare Advantage amendment that says don’t cut Medi- are unsavory. I know people, such as cuts, like the deals that got allegedly a care for our seniors and certainly not the lady who was just referred to, Ber- few votes on their side of the aisle so to start a whole new program. tha Milliard, are not too interested in we could get cloture and proceed to In the Wall Street Journal today is seeing their home health care cut. this bill. an editorial by the dean of Johns Hop- Mr. BAUCUS. If the Senator will Do you think it is part of the deal kins Medical Center, a wonderful, yield, with time being equally divided that they would not—if there really world class center: ‘‘Health Reform on both sides for this colloquy. was a deal, should we not put in here Could Harm Medicaid Patients.’’ Mr. MCCAIN. I don’t know what the that this money would go to benefit So we are taking the money from deal was—— Medicare recipients and not to create a Medicare, hurting Medicare patients, Mr. BAUCUS. I can tell the Senator new entitlement? If you were going to and they are using it in a way that is the deal. I am going to tell the Senator take $42 billion out of Medicare money actually going to make it worse for pa- the deal. going to home health, shouldn’t it have tients on Medicaid, as they have The PRESIDING OFFICER. The Sen- gone to making the system more sol- dumped 15 million people into this pro- ator from Arizona has the floor. vent rather than creating a new enti- gram that is absolutely broken. Mr. MCCAIN. I don’t know what the tlement with that and taking that Mr. BAUCUS. Will the Senator yield deal was, but we will find out, just like money from seniors and giving it to for a question? Will the Senator yield the deals that were cut with all of somebody else? Shouldn’t that have for a question? these other organizations. been part of the deal? Mr. BARRASSO. I will yield to the Mr. BAUCUS. I will tell the Senator Mr. MCCAIN. As is often said, it is Senator from Arizona. what the deal was. what it is. Mr. MCCAIN. If it is taken out of Mr. MCCAIN. This place is full of lob- The Senator from Georgia has a com- your time, just exactly as you re- byists. I can’t walk through the hall- ment. sponded when someone asked if you way without bumping into one of their Mr. ISAKSON. If there was a deal, it would yield for a question from them lobbyists. If the Senator keeps inter- wasn’t made with everybody. I have a yesterday. Is it taken out of your time? rupting, he is violating the rules of the letter that was sent December 4 of this Mr. BAUCUS. Yes. Senate. He needs to learn the rules of year to me from Judy Adams, execu- Mr. MCCAIN. I ask unanimous con- the Senate. tive director of the Georgia Associa- sent that the time for the Senator’s Mr. BAUCUS. Will the Senator yield tion for Home Health Care Agencies, question not be taken out of the time to know what the deal was? endorsing the Johanns amendment. So that is allotted to us. Mr. MCCAIN. I would like to finish they must not have been part of the The PRESIDING OFFICER. It will my answer to you, if I may; that is, I deal. They represent Georgia. Further, not be. don’t know the deal that was cut with in here—— The Senator from Montana. them, but we will find out. I know Ber- Mr. MCCAIN. They will probably be Mr. BAUCUS. Do the Senators realize tha Milliard was not there when the called up to Senator REID’s office very and do they know that yesterday the deal was cut that generated that letter. soon. Home Care and Hospice Association, That is my answer. Mr. ISAKSON. They estimate that 68 the National Association for Home Mr. BAUCUS. Will the Senator yield of the 100 Medicare-approved home Care and Hospices, the umbrella orga- for another question? health care agencies in Georgia will go nization for home health and hospice, Mr. MCCAIN. I will yield for one out of business. So if there was a deal, wrote a letter to me, which basically more, but we have other Senators who it wasn’t made with every State be- says: wish to speak. cause the State of Georgia is on record. [F]or all of these reasons, we support the Mr. BAUCUS. Does the Senator know I ask unanimous consent to have this provisions of your health care reform legisla- that the so-called deal was that where- letter printed in the RECORD. tion as it relates to home health care. as MedPAC and the administration and There being no objection, the mate- Is the Senator aware of that letter, the House wanted to make domestic rial was ordered to be printed in the the Home Care and Hospice Associa- cuts to home health care, but rather RECORD, as follows: tion’s support for this legislation? Is we went to the home health care indus- GEORGIA ASSOCIATION FOR the Senator aware of that letter? try, worked with them, and took two of HOME HEALTH AGENCIES, INC., Mr. MCCAIN. My response is, I don’t their major suggestions about fraud Marietta, GA, December 4, 2009. know what deal has been cut in Sen- and abuse as well as outliers, so we Hon. JOHNNY ISAKSON, Russell Senate Office Building, ator REID’s office, as the deal was cut modified so that the home health in- Washington, DC. with the pharmaceutical companies dustry thought this was fair and rea- DEAR SENATOR ISAKSON: The members of and the deal was cut with the AMA and sonable? the Georgia Association for Home Health

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00008 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.010 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12469 Agencies, Inc. fully support Senator DC. Everybody in America needs to that, instead of saving money, the proposed Johann’s motion to commit Senator Reid’s know this bill will not help seniors at revenue raiser will force Medicare Part D Patient Protection and Affordable Care Act all. This bill takes money from senior costs to skyrocket as employers drop retir- back to the Senate Finance Committee with ees into the program. instructions to eliminate the home health health care. If there was a legitimate The careful calculation that was made in cuts. and straightforward effort to actually 2003 to minimize federal spending and maxi- According to a study conducted by the Na- help seniors, we would take Medicare mize private coverage will go out the window tional Association for Home Care and Hos- savings and keep the money in Medi- if this provision becomes law. Any short- pice, under Senator Reid’s bill 72.15 percent care. But, as our leader said today, we term cost savings that Congress gets by of home health agencies in Georgia will have are robbing the piggy bank, taking changing the tax provision will be over- whelmed by higher costs in the long run. negative margins by 2016 in the Senate bill, money out of health care for seniors and approximately 68 percent of the 100 Some members in the House want to miti- Medicare Certified home health agencies in and putting it into this new program. gate the cost of this provision by mandating Georgia will go out of business and the pa- Mr. MCCAIN. Let me remind the Sen- that employers maintain existing levels of tients they serve will be rehospitalized or ator from Montana, sometimes there is retiree coverage despite the reduced subsidy. forced to seek alternative more costly care. good news and sometimes it is bad. But it’s not that simple. A mandate would We appreciate the opportunity to offer our There was an article earlier this year increase costs on businesses, which in turn would make it harder for those businesses to support for Senator Johann’s motion and where the staff of the Senator from thank you for being an advocate for the sick hire new employees. The mandate would ef- Montana called in the high-paid lobby- fectively be a tax on employers that provide and elderly citizens of Georgia. ists and told them not to meet with Sincerely, retiree benefits; this in turn will simply in- duce some unknown number of employers to JUDY ADAMS, Republicans, saying that if they did, it Executive Director. would be treated as a hostile act. I can terminate their retiree drug programs before provide that article for the RECORD. I the mandate kicks in. Mr. LEMIEUX. If I may, I will follow In short, if the changes that are proposed up on my colleagues’ comments about hope it is not true, but I think it is. for employer subsidies in the current Medi- what happened in Georgia. Mr. BENNETT. I say to the Senator care Part D program are enacted, everyone I walked to one of the largest home from Arizona and others who have will lose. Unions will lose as employers seek health care providers in Florida. We commented, home health care is not ways to drop retiree drug coverage. Seniors have a letter to the editor in the Sara- the only way seniors will be hurt by will lose as employers drop them into Medi- care Part D. Medicare and taxpayers will sota Herald Tribune of November 16 this. I am quoting from an article by Tom Scully, one of the designers of the lose as they face higher costs. And employers where this person, who works for one of will lose as they find it harder to provide these home health care companies— Medicare Part D benefit, on the impact benefits. one of the bigger ones, which aren’t of this bill on Medicare Part D for sen- To make matters worse, accounting rules going to be in as much trouble—they iors. Let me quote the key points of for post-retirement benefits will require say: the article. I ask unanimous consent to companies that keep their retiree benefits to have the entire article printed in the record the entire accrued present value of Contrary to the other assertions that sen- the new tax the day the provision is signed RECORD. ior care will be unaffected by health care re- into law. This would cause many employers form in Florida, this scenario could be dev- There being no objection, the mate- to immediately post billions in losses, which astating for older Floridians. More than 56 rial was ordered to be printed in the could significantly impact our financial mar- percent of Florida’s home health agencies RECORD, as follows: kets. could be in the red as early as 2011. MEDICARE PART D ‘REFORMS’ WILL HARM There are many reasons to pass health- So we are going to take the smaller SENIORS care reform. There is no reason to hurt sen- iors, employers and taxpayers in the process. home health agencies—the mom-and- (By Tom Scully) pops—in Florida, we have 1.9 million Businesses are struggling, and the Medicare There is a little-noticed provision buried trust funds have plenty of problems as it is. small businesses. They are not going to deep in both the House and Senate health- It makes no sense to make these problems be able to function because we are care reform bills that is intended to save bil- worse. going to take this money out. lions of dollars—but instead will hurt mil- Mr. BENNETT. He says: I want to make a point, also, that lions of seniors, impose new costs on tax- There is a little-noticed provision buried payers, and charge employers millions in today in the New York Times, a good deep in both the House and Senate health new taxes. point was made that there is going to care reform bills that is intended to save bil- As part of the Medicare Modernization Act be no new insurance money coming in lions of dollars—but instead will hurt mil- in 2003, Congress created a new drug ben- for home health care agencies—or very lions of seniors, impose new costs on tax- efit—called Medicare Part D—for retirees at payers, and charge employers millions in little. It is not as if there are going to a cost of about $1,900 per recipient per year. new taxes. be folks having this new public option Many private employers already provided or new insurance-backed program be- drug coverage for their retirees, and the ad- Here is the core of it: cause home health care is for seniors. ministration and Congress did not want to This fall, congressional staff, looking for a There is not going to be any extra tempt employers into dropping their cov- new revenue source to pay for health reform, money. So what is going to happen? We erage. Actuaries calculated that if the gov- proposed eliminating the tax deductibility of the subsidy to employers. The supposed sav- are going to have our moms, dads, and ernment provided a subsidy of at least $800, employers would not stop covering retirees. ings were estimated by congressional staff to grandparents who are benefiting from The legislation created a $600 tax-free ben- be as much as $5 billion over the next decade. this home health care in Florida and efit (the equivalent of $800 cash for employ- It sounds smart—except that nobody asked across this country instead of having ers), and it worked. Employers continued to how many employers will drop retiree drug to go to a nursing home, instead of cover about seven million retirees who might coverage. Clearly, many will. The result is having to go to an assisted living facil- have otherwise been dumped into Medicare that, instead of saving money, the proposed ity away from their home and family— Part D. revenue raiser will force Medicare Part D It was a good arrangement for all involved. costs to skyrocket as employers drop retir- they are not going to be able to go any- ees into the program. more. An $800 subsidy is cheaper than the $1,900 By the way, I don’t believe that will cost of providing drug coverage. And mil- He concludes with this comment: lions of seniors got to keep a drug benefit save any money. I think that will in- There are many reasons to pass health care they were comfortable with and that in reform. There is no reason to hurt seniors, crease costs because we know nursing many cases was better than the benefit of- employers and taxpayers in the process. home care is far more expensive than fered by the government. Businesses are struggling and the Medicare home health care. It is estimated that But now that subsidy is coming in to be trust funds have plenty of problems as it is. 1 day of hospital costs, for example, is clipped. This fall congressional staff, looking It makes no sense to make these problems 43 times as much as home health care. for a new revenue source to pay for health worse. When you get rid of home health care, reform, proposed eliminating the tax deduct- So not only are the programs going you are actually going to increase ibility of the subsidy to employers. The sup- to be cut, but the drug costs are going posed savings were estimated by congres- costs. sional staff to be as much as $5 billion over to be dumped into the program, with I want to follow up on a comment, if the next decade. an increased number of people in- I can, of my friend from New Hamp- It sounds smart—except that nobody asked volved. You are going to see tremen- shire. I am new here, and I am still un- how many employers will drop retiree drug dous financial distortions as a result of derstanding the ways of Washington, coverage. Clearly, many will. The result is the passage of this bill.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00009 Fmt 0637 Sfmt 0634 E:\CR\FM\A05DE6.001 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12470 CONGRESSIONAL RECORD — SENATE December 5, 2009 Mr. MCCAIN. I yield to the Senator our friends on the left who in the share with my friends on the left. It from North Carolina for a question and past—not today—have supported sen- was an entirely different bill—No Child then the Senator from Tennessee. iors but today are willing to throw Left Behind. We were all for it on this Mr. BURR. I will make this point and them under the bus for a political vic- side of the aisle because our President ask this question: The President set tory? What drives them? had proposed it. My staffer said to me, out in this debate and targeted two Mr. MCCAIN. I do not understand it. listening to the debate: You know, Sen- things—quality and savings. He as- Perhaps my other colleagues can ex- ator, if President Clinton had proposed sured the American people that we plain it better. this, you would vote against it because were going to save health care and we I also want to return for a second to you would think it was too heavy- were going to maintain quality. the question of the Senator from Mon- handed with government interference. I Would it not be accurate to say that, tana. The AMA is a classic example. said: You know, you are right. I have as you take money away from home When I go back to Arizona and talk to to do the right thing. I was one of the health, one, you remove from that pop- doctors and providers, they say: What few Senators who voted against it. ulation that tool that maintains dis- is going on? You made a deal with the If we had proposed what the Demo- ease, that keeps that from getting lobbyists. That is my answer to you. crats had proposed, every argument we worse, and you chase seniors back to You made a deal with the lobbyists— are currently hearing from the right the hospitals for the services. So, one, not the home health care providers, side of the aisle would be coming with the acuity of the senior patient is not the nurses, not the doctors, the great roars and insistent statements on much worse and, two, the cost of the people who are the users of pharma- the other side of the aisle. But because delivery of the service because by the ceuticals who, this year, have seen an it is their President who proposed it, time they hit the hospital, it has dete- 8- to 9-percent increase in the cost of they are somehow keeping their con- riorated. So we flunk on both points. prescription drugs—because your deal sciences under control. I hope they will We don’t decrease cost by cutting home is going to protect them. My answer to recognize the irony of that and that at health, we increase it. From the stand- you is, I don’t know what you bought least one Senator—that is all we need point of the quality, the outcome of that letter for, but it was probably a in order to stop this bill—would recog- the patient is worse because we put pretty high price. nize that conscience ought to prevail them into a hospital setting. Is that The Senator from—— and this bill ought to be stopped. not what we are trying to eliminate? Mr. BAUCUS. Will the Senator yield? Let’s be clear. If this bill is stopped, Mr. MCCAIN. It seems to me, yes. I can answer the Senator’s question. health care reform will not die as a I yield to the Senator from Ten- The PRESIDING OFFICER. The Sen- cause. Indeed, health care reform will nessee. ator from Arizona has the floor. be reborn in a bipartisan sense of, let’s Mr. CORKER. I was watching this in Mr. MCCAIN. I know the answer to it. solve the problem, rather than in a par- my office. I just gave you the answer. tisan sense of, let’s jam something Mr. MCCAIN. It is a lot of fun, isn’t I yield to the Senator from Wyoming. down somebody’s throat. it? Mr. BARRASSO. I agree with the I hope that is what will happen, that Mr. CORKER. It is. I would rather Senator. It is astonishing that the Sen- conscience will prevail somewhere and not be any other place than on the ator from Montana would read a na- one member of the Democratic Party floor talking about the most important tional organization’s letter instead of who feels in his or her heart that this piece of legislation we probably will one from his home State. is a dumb idea will let his or her con- deal with in our tenure here. In Wyoming, we have 43 different science prevail. Mr. MCCAIN. Based on the principle home health care agencies, and some of I see the Republican leader. that a fight not joined is a fight not en- them are in communities that don’t Mr. MCCONNELL. Will the Senator joyed. even have hospitals. Therapists drive yield for an observation? Senator Mr. CORKER. I can tell. I have never long distances. We have colleagues MCCAIN has pointed out where the lob- seen the Senator from Arizona as from rural States here, and Montana is byists are on this bill. Senator ISAKSON happy as he is today in the fight certainly one of them. Those home has pointed out where the people of against something that is so dev- health care agencies know they are not Georgia are on this bill. Senator astating. even going to get paid enough from BARRASSO has pointed out where the I don’t understand what it is that Medicare to put gas in the car to drive people of Wyoming are on this bill. We would cause my friends on the left, on out to the ranches and the farms where also know where the American people the other side of the aisle, to throw people are who are staying at home, are. seniors under the bus. There is no trying to stay out of the hospitals and I have not seen a survey in months— doubt that there ought to be some nursing homes. We have home health in months—by anybody that indicates changes in Medicare to make it more agencies throughout the States, and the American people are for this bill. It solvent. We all want to ensure that they drive tens of thousands of miles is not in doubt. We have heard that seniors, down the road, have the ability every year, with therapists and nurses President Clinton came up to their to benefit from Medicare. no question. and home care aides going out to help lunch. The President may be coming I think we have all said from day one people stay at home and therefore give back himself. The argument they are that we want to join with Senator them dignity and allow them to keep making on the other side? Ignore the GREGG and others to make sure Medi- down the cost of care for everybody. American people, make history. Make care is here for seniors. Mr. MCCAIN. Mr. President, how history? What I hear the American peo- I do not understand—I listened to the much time remains? ple saying to us is: Vote for this bill last segment of my friends on the other The PRESIDING OFFICER. Twenty and you will be history. side of the aisle talking about the minutes 22 seconds. This is not in the gray area. The many needs in this country. Many peo- Mr. MCCAIN. The salary of William American people are asking us to stop ple don’t have health insurance, and B. Novelli, who has since stepped this bill and start over. They do not many of us have offered bills to solve down—an old friend—last year was want a 2,074-page monstrosity of com- that. $1,797,751. Mr. Tauzin, a pharma- plexity and Medicare cuts and tax in- I don’t understand, and I hope you ceutical research and manufacturers creases and higher premiums for every- can explain it to me, why the left lobbyist, only made $1.5 million last body else. They want us to stop and would be willing to throw seniors under year. Scott Serota, of BlueCross start over and get it right. the bus. Regardless of what you say BlueShield, made $1.6 million. Chicken Mr. MCCAIN. I ask the Senator from about the bill, they are being thrown feed. New Hampshire very quickly, is it your under the bus, and doctors are going to I yield to the Senator from Utah. understanding that AARP does sell get a 23-percent cut in a year, and they Mr. BENNETT. Mr. President, I health insurance and Wal-Mart sells are not even dealing with that, and thank the Senator from Arizona. health insurance? they are taking $464 billion out of My mind goes back to a personal ex- Mr. GREGG. Both of those are cor- Medicare. What is it that would drive perience I had that I would like to rect.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00010 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.013 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12471 Mr. MCCAIN. Then would it make tors got a 23-percent cut in a year, if he our Nation if we have people healing at sense they would be included in the ran on a platform of health care reform home, not in the hospital. amendment to modify the limit on ex- that did that—had unfunded mandates Mr. MCCAIN. Thanks to our crack cessive remuneration paid by certain to States, raised taxes—and told the staff who are a good example of the health insurance providers to set the American people while he was cam- success of work release programs, I re- limit at the same level as the salary of paigning that their premiums were mind my friend from Montana, a Roll- the President of the United States? going to go up, I do wonder if the out- call article as of June 11: Wouldn’t the CEO of Wal-Mart and the come would have been the same. Top aides to Senate Finance Chairman head of AARP, who only made $1.8 mil- As a matter of fact, I cannot imagine Max Baucus called a last-minute, pre- lion last year, fall under that um- a health care policy being presented emptive strike on Wednesday with a group of brella? that is more off base than the one we prominent Democratic lobbyists, warning them to advise their clients not to attend a Mr. GREGG. The underlying proposal are debating. But one that makes meeting with Senate Republicans set for is a blatant act to try to Europeanize Medicare insolvent, has unfunded man- Thursday. our economy and move us to a process dates to States when they are troubled, Russell Sullivan— where the government decides what the raises taxes and raises premiums. That Whom I don’t happen to know— market should do. But consistency is what we are discussing. Why my the top staffer on Finance, and Jon Selib, would require that both of those orga- friends on the left want to give our Baucus’ chief of staff, met with a bloc of nizations be included in that if the au- President a victory on that basis is as- more than 20 contract lobbyists, including thor is going to be consistent with the tounding to me. several former Baucus aides. theme of the amendment, which is ab- I don’t know, but since you were up Who have made a nice transition. solutely wrong in my opinion because close and personal to that, I wonder if ‘‘They said, ‘Republicans are having this there is no reason that we as a Con- you might respond. meeting and you need to let all of your cli- gress should decide the compensation Mr. MCCAIN. I thank the Senator ents know if they have someone there, that levels for people who are in the private from Tennessee. I am very reluctant to will be viewed as a hostile act,’ ’’ said a take a trip down memory lane again. Democratic lobbyist who attended the meet- sector. ing. Mr. MCCAIN. The Senator from Geor- Could I say, one of the phrases ‘‘Going to the Republican meeting will say, gia. throughout the campaign was: If you ‘I’m interested in working with Republicans Mr. ISAKSON. I want to put a face on like the insurance policy you have, you to stop health care reform,’ ’’ the lobbyist what home health care means to the can keep it. You tell me how people added. quality of health care and the lowering who now have Medicare Advantage can Again, PhRMA, the New York Times, of the cost of health care in America. keep it under this proposal? It is im- again my favorite. Tauzin, the $1.5-mil- My youngest son was in a horrible possible. lion-per-year representative of PhRMA accident in 1989. He was hospitalized Maybe the other side is right. Maybe said: for 8 weeks, had four surgeries, devel- these reductions have to be made in ‘‘We were assured: ‘We need somebody to oped an infection, and had some bone Medicare Advantage. Maybe those come in first. If you come in first, you will marrow threats. He was put in home changes have to be made. I don’t hap- have a rock-solid deal,’ ’’ Billy Tauzin, the health care after those 8 weeks. At a pen to agree, although cost savings former Republican House member from Lou- cost of pennies on the dollar, a visiting should be there. But no one can believe isiana . . . said. ‘‘Who is ever going to get into a deal with the White House again if nurse came and helped my wife and me that you can keep the same Medicare they don’t keep their word? You are just administer antibiotic drips periodically Advantage policy that 11 million sen- going to duke it out instead.’’ so he could continue to have the pro- iors in America have today under this They cut a deal. That is, again, in an- tection he needed to fight off the infec- proposal. It is impossible. swer to the Senator from Montana, tion. The Senator from Florida. that is probably how they got the let- The 8 weeks he was in the hospital Mr. LEMIEUX. If the Senator from ter, the same way Tauzin wrote his let- cost over $100,000. The 8 weeks fol- Arizona will allow, I want to ask one ter. lowing that, when he was at home, question of my friend, the medical doc- The majority leader—the minority home health care cost only a few thou- tor, about infections in hospitals. My leader, hopefully majority leader soon. sand dollars. understanding is that home health care Mr. MCCONNELL. I say to my friend We are taking an agency and a serv- is actually better for the patient, it is from Arizona, at the risk of being rep- ice that has provided to the American better for the efficacy of the treatment etitious, what we all know is going on people that greatly reduces the cost of because a big problem we have in hos- here is there is a total disconnect be- health care, improves the quality of pitals is that patients get staph infec- tween inside-the-beltway lobbyists who life of the individual and forcing the tions and other infections. In fact, it is cut their special deals and the Amer- only option for somebody hurt like one of the leading causes of death in a ican people who are speaking loudly to that to be in a hospital. Granted, my hospital. You don’t go in with this in- all of us in all of the surveys saying: son was not in Medicare, but people in fection, you get it there. Please stop this thing. Medicare are in accidents and have the Isn’t this proposal that is going to I have never been involved in an issue same type of thing happen. take people out of home health care in all the years I have been here, I say The patent effect of this is, on the and send them to hospitals going to ac- to my friend from Arizona and other one hand you save money to pay for tually hurt patients? colleagues, on which people spontane- somebody else’s government option Mr. BARRASSO. This proposal is ously stop me in the airport and say: health insurance, but you take away an going to hurt patients in a lot of ways. Please stop this bill. affordable, effective way to deliver It is going to hurt patients psycho- I am sure there are people in Ken- health care. logically. They are in a hospital when tucky who are for it. I have not met Mr. MCCAIN. The Senator from Ten- they want to be at home. It is going to one. There must be a doctor in Ken- nessee. hurt patients in terms of their health. tucky who is for this. I have not heard Mr. CORKER. I was thinking about The better place to be is at home, as from one. last year’s campaign. The Senator from long as somebody is coming around to This is an incredibly unpopular bill. Arizona was highly involved in that check on them. That is why for so Thus, their only rallying cry: Make campaign. I know he offered some many reasons, doctors have for decades history, ignore the American people. health care solutions that were greatly said: Try to help patients get home as What an act of arrogance. What an act maligned. But I think back on that, quickly as they can. That is the best of total arrogance. We know better and I wonder, had our sitting President place for them to heal. than you. Why don’t all you American run on a health care reform bill that We have heard from the Senator from people, all 300 million of you, shut up, took money out of Medicare, which was Georgia a remarkable story about pen- sit down, and we will do it for you. We insolvent, created a new entitlement, nies on the dollar, the effectiveness of will restructure one-sixth of the econ- hurt seniors through home health, this program. It is good for folks, and omy. We know what is best for you. eliminated choices, making sure doc- it is good for the whole health care of This is an act of total arrogance.

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00011 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.014 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12472 CONGRESSIONAL RECORD — SENATE December 5, 2009 As the Senator from Utah pointed ment is not adopted. But clearly it in the United States of America. Those out, we just need one Democratic Sen- should be consistent with all the dif- standards require that we plan and perform ator to say no: No, I am not going to do ferent interest groups. It appears it is the audit to obtain reasonable assurance this. I know the President would like not included because some deal was about whether the financial statements are me to make history, but this is wrong cut. Is that the implication here? free of material misstatement. An audit in- Mr. MCCAIN. The Senator from cludes consideration of internal control over for the country, and I will not partici- financial reporting as a basis for designing pate in it. Just one can make a dif- Utah? Mr. COBURN. If I might, I ask unani- audit procedures that are appropriate in the ference. circumstances, but not for the purpose of ex- mous consent to have printed in the Mr. MCCAIN. The Senator from pressing an opinion on the effectiveness of North Carolina. RECORD the consolidated audited finan- AARP’s internal control over financial re- Mr. BURR. The Washington Post in cial statements of AARP. They are the porting. Accordingly, we express no such October of this year, talking about the fifth largest insurance sales company opinion. An audit also includes examining, story on AARP, said: in America. on a test basis, evidence supporting the There being no objection, the mate- The group and its subsidiaries collected amounts and disclosures in the financial more than $650 million in royalties and other rial was ordered to be printed in the statements, assessing the accounting prin- fees last year from the sale of insurance poli- RECORD, as follows: ciples used and significant estimates made cies, credit cards and other products that KPMG LLP, by management, as well as evaluating the carry the AARP name . . . Washington, DC, March 30, 2009. overall financial statement presentation. We believe that our audits provide a reasonable Mr. MCCAIN. Wouldn’t that mean INDEPENDENT AUDITORS’ REPORT basis for our opinion. that AARP executive would naturally The BOARD OF DIRECTORS, fall under the Lincoln amendment? AARP, Inc. In our opinion, the consolidated financial Mr. BURR. Absolutely, because it We have audited the accompanying con- statements referred to above present fairly, solidated statements of financial position of says ‘‘the majority of its $1.14 billion in in all material respects, the financial posi- AARP, Inc. and affiliates (collectively, tion of AARP as of December 31, 2008 and revenue’’ that AARP collected, accord- AARP) as of December 31, 2008 and 2007, and 2007, and the changes in its net assets and its ing to the tax records, were made up of the related consolidated statements of ac- cash flows for the years then ended in con- sale of these insurance products. tivities and cash flows for the years then formity with U.S. generally accepted ac- Mr. GREGG. I think the Senator ended. These consolidated financial state- counting principles. ments are the responsibility of AARP man- from North Carolina has made an ex- As discussed in note 2 to the consolidated cellent point. Consistency would re- agement. Our responsibility is to express an opinion on these consolidated financial financial statements, AARP adopted Finan- quire for the AARP to be included in statements based on our audits. cial Accounting Standards Board Statement this amendment, if the amendment is We conducted our audits in accordance No. 157, Fair Value Measurements, in 2008. going to go forward. I hope the amend- with auditing standards generally accepted KPMG LLP. CONSOLIDATED STATEMENTS OF FINANCIAL POSITION, DECEMBER 31, 2008 AND 2007 [In thousands]

2008 2007

Assets: Cash and cash equivalents (note 2(c)) ...... $472,006 $325,154 Accounts receivable, net (note 5) ...... 70,419 79,122 Prepaid expenses and other assets (note 8) ...... 26,013 34,805 Prepaid pension asset (note 10) ...... 4,789 Investments (note 4) ...... 916,146 1,087,082 Property and equipment, net (note 6) ...... 315,166 304,778 Total assets ...... 1,799,750 1,835,730

Liabilities: Accounts payable and accrued expenses ...... 100,030 143,680 Insurance premiums payable (note 3) ...... 711,242 662,974 Deferred revenue and other liabilities ...... 31,701 25,057 Deferred membership dues ...... 435,597 388,280 Accrued pension liability (note 10) ...... 113,764 ...... Accrued postretirement health benefits (note 11) ...... 69,823 67,808 Notes payable (note 7) ...... 230,069 230,053 Total liabilities ...... 1,692,226 1,517,852 Net assets: Unrestricted: Undesignated ...... 17,186 101,481 Board designated (note 14) ...... 81,348 205,461 Total unrestricted net assets ...... 98,534 306,942 Temporarily restricted (note 15) ...... 8,990 10,936 Total net assets ...... 107,524 317,878 Total liabilities and net assets ...... 1,799,750 1,835,730

See accompanying notes to consolidated financial statements.

CONSOLIDATED STATEMENT OF ACTIVITIES, YEAR ENDED DECEMBER 31, 2008 [In thousands]

Temporarily Unrestricted restricted Total

Operating revenues: Membership dues ...... $249,314 ...... $249,314 Royalties (note 3) ...... 652,701 ...... 652,701 Publications advertising ...... 119,696 ...... 119,696 Grant revenue (note 9) ...... 89,649 ...... 89,649 Program income ...... 82,114 ...... 82,114 Contributions ...... 41,113 $879 41,992 Other operating income ...... 19,683 ...... 19,683 Net assets released from restrictions ...... 2,825 (2,825 ) ...... Operating revenue before investment loss ...... 1,257,095 (1,946) 1,255,149 Investment loss (notes 3 and 4) ...... (175,063 ) ...... (175,063 ) Total operating revenues ...... 1,082,032 (1,946 ) 1,080,086 Operating expenses: Program services: Programs and field services ...... 298,310 ...... 298,310

VerDate Nov 24 2008 02:34 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00012 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.015 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12473 CONSOLIDATED STATEMENT OF ACTIVITIES, YEAR ENDED DECEMBER 31, 2008—Continued [In thousands]

Temporarily Unrestricted restricted Total

Publications ...... 177,638 ...... 177,638 Member services ...... 284,086 ...... 284,086 Legislation and research ...... 58,844 ...... 58,844 Total program services ...... 818,878 ...... 818,878 Supporting services: Membership development ...... 114,096 ...... 114,096 Management and general ...... 204,879 ...... 204,879 Total supporting services ...... 318,975 ...... 318,975 Total operating expenses ...... 1,137,853 ...... 1,137,853 Change in net assets from operations ...... (55,821 (1,946 ) (57,767 ) Other income (expenses): Investment loss from sinking fund (notes 4 and 7) ...... (22,513) ...... (22,513) Income taxes (note 8) ...... (17,427) ...... (17,427) Charges other than net periodic benefit cost (notes 10 and 11) ...... (106,239 ) ...... (106,239 ) Change in net assets before effect of adoption of measurement provisions of FASB Statement No. 158 ...... (202,000 ) (1,946 ) (203,946 ) Effect of adoption of measurement provisions of FASB Statement No. 158 (note 2) ...... (6,408 ) ...... (6,408 ) Change in net assets ...... (208,408 ) (1,946 ) (210,354 ) Net assets, beginning of year ...... 306,942 10,936 317,878 Net assets, end of year ...... 98,534 8,990 107,524

See accompanying notes to consolidated financial statements.

CONSOLIDATED STATEMENT OF ACTIVITIES, YEAR ENDED DECEMBER 31, 2007 [In thousands]

Temporarily Unrestricted restricted Total

Operating revenues: Membership dues ...... $249,353 — $249,353 Royalties (note 3) ...... 497,635 — 497,635 Publications advertising ...... 121,518 — 121,518 Grant revenue (note 9) ...... 82,431 — 82,431 Program income ...... 90,850 — 90,850 Contributions ...... 42,353 $6,878 49,231 Other operating income ...... 2,938 — 2,938 Net assets released from restrictions ...... 888 (888) — Operating revenue before investment income ...... 1,087,966 5,990 1,093,956 Investment income (notes 3 and 4) ...... 79,951 — 79,951 Total operating revenues ...... 1,167,917 5,990 1,173,907 Operating expenses: Program services: Programs and field services ...... 302,518 — 302,518 Publications ...... 184,572 — 184,572 Member services ...... 294,631 — 294,631 Legislation and research ...... 60,581 — 60,581 Total program services ...... 842,302 — 842,302 Supporting services: Membership development ...... 112,960 — 112,960 Management and general ...... 204,079 — 204,079 Total supporting services ...... 317,039 — 317,039 Total operating expenses ...... 1,159,341 — 1,159,341 Change in net assets from operations ...... 8.576 5,990 14,566 Other income (expenses): Investment income from sinking fund (notes 4 and 7) ...... 4,479 — 4,479 Income taxes (note 8) ...... (8,902 ) — (8,902 ) Change in net assets before effect of adoption of recognition provisions of FASB Statement No. 158 ...... 4,153 5,990 10,143 Effect of adoption of recognition provisions of FASB Statement No. 158 (note 2) ...... (580) — (580) Change in net assets ...... 3,573 5,990 9,563 Net assets, beginning of year ...... 303,369 4,946 308,315 Net assets, end of year ...... 306,942 10,936 317,878

See accompanying notes to consolidated financial statements.

CONSOLIDATED STATEMENTS OF CASH FLOWS, YEARS CONSOLIDATED STATEMENTS OF CASH FLOWS, YEARS CONSOLIDATED STATEMENTS OF CASH FLOWS, YEARS ENDED DECEMBER 31, 2008 AND 2007 ENDED DECEMBER 31, 2008 AND 2007—Continued ENDED DECEMBER 31, 2008 AND 2007—Continued [In thousands] [In thousands] [In thousands]

2008 2007 2008 2007 2008 2007

Cash flows from operating activities: Net loss (gain) on invest- Accounts payable and ac- Change in net assets ...... $(210,354 ) $9,563 ments ...... 258,420 (19,554) crued expenses ...... (43,650) 2,139 Adjustments to reconcile change Deferred income taxes ...... 1,447 (327) Insurance premiums pay- in net assets to net cash pro- Amortization of premium on able ...... 48,268 50,331 vided by operating activities: investments ...... 18 120 Securities loan payable ...... — (41,506) Depreciation and amortiza- Changes in operating assets and Deferred revenue and other tion ...... 27,606 24,846 liabilities: liabilities ...... 6,644 2,484 Reserve for uncollectable Cash and cash equivalents Deferred membership dues 47,317 29,629 accounts ...... 248 (22 ) held as collateral ...... — 41,506 Accrued pension liability .... (1,408 ) — Effect of adoption of FASB Accounts receivable ...... 8,455 (24,173) Accrued postretirement Statement No. 158 ...... 6,408 580 Prepaid expenses and other health benefits ...... 4,540 5,336 Charges other than net assets ...... 7,345 1,325 periodic benefit cost ...... 106,239 — Prepaid pension asset ...... 4,789 4,570 Total adjustments ...... 482,686 77,284

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00013 Fmt 0637 Sfmt 0634 E:\CR\FM\A05DE6.013 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12474 CONGRESSIONAL RECORD — SENATE December 5, 2009 CONSOLIDATED STATEMENTS OF CASH FLOWS, YEARS going to hurt them. It is going to hurt They are taxing the American people ENDED DECEMBER 31, 2008 AND 2007—Continued the future of care. It is going to hurt through drugs and devices and more [In thousands] the future of Medicare in America. You money for their own insurance policies cannot take $464 billion away from so that government can have a larger 2008 2007 Medicare, a program on which the sen- hand in health care. Net cash provided by iors of this country depend, and say it You know what. At the end of the operating activities 272,332 86,847 will not affect their care. It will affect day, the American people realize now Cash flows from investing activities: them in the hospitals, it will affect that they are going to pay more and Purchases of property and equip- ment ...... (37,978) (31,350) them in the doctors’ offices, it will af- the quality of their health care is going Proceeds from sale and matu- fect them in the home, it will affect to go down. It is no more obvious than rities of investments ...... 995,414 1,304,705 Purchases of investments ...... (1,082,916) (1,358,527) them in the final days of their lives in the current amendment on slashing the Investment in joint venture ...... — (33) the hospices. That is what I hear about reimbursements to nursing homes or to Net cash used in investing across Wyoming. hospice or to any other area under activities ...... (125,480 ) (85,205 ) I have not met doctors who support Medicare. Net increase in cash and this—not at all. I have not met very This is wrong, it should be stopped, cash equivalents ...... 146,852 1,642 many patients who support it, and they and the American people’s voices Cash and cash equivalents, beginning of year ...... 325,154 323,512 are also told by others: We don’t want should be heard in this debate. this. The townhall meetings have been I thank the Senator. Cash and cash equivalents, end of C year ...... 472,006 325,154 overwhelming in opposition. Mr. M CAIN. It has been a great This is a bill that will be bad for our time. We are going to do it again, a lot, Supplemental disclosures: small businesses and bad for people between now and the time the vote is Cash paid for interest ...... 12,979 14,623 Cash paid for income taxes ...... 17,928 6,646 who want to get insurance. It will be forced, and the American people are on bad for people who have insurance be- our side. See accompanying notes to consolidated financial statements. cause they know their premiums are The PRESIDING OFFICER. The Sen- Mr. BENNETT. Mr. President, I have going to go up. It will be bad for people ator’s time has expired. enjoyed this colloquy. I have enjoyed who pay taxes because those are going The Senator from Montana. the enthusiasm that is here. I noticed to go up. But specifically for home Mr. BAUCUS. Mr. President, this is that the sense of passion to get some- health care, this will be awful. It will very frustrating because we have these thing done properly for the American affect small communities—in all of the blocks of time, with Senators lining up people is on this side of the aisle. A small communities of America, not to take control of the time and to great of sense of defensiveness is on the just in Wyoming. I can’t imagine any- make their points, and then they flee other side of the aisle. one in a small community being for the Senate floor and we cannot get into We all have an been caught one time this. a debate or a colloquy. We cannot or another in the struggle between sup- Mr. MCCAIN. And put more people in make points that rebut the points they port for a leadership position or a Pres- the hospital. have made because they have all left idential position and our own sense of The Senator from Tennessee. the floor. what is the right thing to do. I join Mr. CORKER. Mr. President, I have Mr. CORKER. I am glad to stay here. with my leader from Kentucky in say- been listening to the debate, and it is The PRESIDING OFFICER. The Sen- ing that the people of Utah have never seldom that debate on the Senate floor ator from Montana has the floor. been more worked up about any issue has much impact on me, I must add. Mr. BAUCUS. They all come in and than this one. I have never seen any But the fact is, I do think this amend- make their points and then they flee. circumstance where they have been ment—the Lincoln amendment—is a Mr. MCCAIN. We are here. more firm and unanimous in their de- terrible amendment. We should not be Mr. BAUCUS. Good, I am glad they mand that this bill be stopped. voting on compensation. are staying because I want them to The Senator from Kentucky said if But I am wondering, I ask Senator hear this. Maybe we will all learn there is somebody in Kentucky who is MCCAIN, if we should offer a unanimous something. for this bill, he has not met him. I have consent agreement to change the First of all, clearly, we all care about met some people in Utah who are for amendment to take into account home health care. I mean, let’s obvi- this bill. They have spoken to me AARP, PhRMA, and others. I wonder if ously agree that we all do. I see the about it, as I pass through airports or the other side would be willing to take Senator from Arizona nodding his head I walk down the street in the hearing that unanimous consent request. in agreement; he does care about home of other people from Utah. As soon as Mr. MCCAIN. Not to mention the health care. This Senator cares about anybody hears someone tell me, Vote chief executives of the pharmaceutical home health care. The Senator from for this bill, there is a chorus of voices companies. Why wouldn’t we want to Wyoming, Dr. BARRASSO—here he is, that spontaneously come up around bring them in on it? After all, they are over here—he cares about home health that and say: Don’t listen to him; lis- paying for lobbyists at $1.7 million care. He has talked about home health ten to us. This is a terrible bill. This is every year to cut these deals at the care. a terrible circumstance. White House that they describe on the We all know seniors would rather be I have been proud in the debate to front page of the New York Times. home than in the hospital or a nursing point out that in Utah, the Dartmouth I would hope the Senator would be home, if that is medically appropriate. study says we have the best health care glad to modify her amendment to in- We all know that. I know that person- available in the United States, and if clude all these other people who have ally. My mother was in the hospital 2 everybody got their health care there, gotten extremely wealthy—PhRMA, an weeks ago, and she is now, thank- it would not only be the best, it would 8-percent increase in drug prices in the fully—praise the Lord—out of the hos- be one-third cheaper than the national last year. Again, I refer to the New pital, and she is home. We have a home average. York Times. health care person coming in every day I have spent a lot of time talking Anyone else? Senator BURR. to see my mom. with the people who provided that re- Mr. President, how much time re- When I am there with the home sult. Unanimously they tell me this mains? health care person, I am very im- bill would damage that result. It would The PRESIDING OFFICER. One pressed. They do a super job. It is real- damage the quality, and it would raise minute. ly something to behold. My mother the price. Why in the world would we Mr. MCCAIN. Senator BURR will wrap loves it and I love it. We clearly are want to do those two things? it up. not going to do anything to cut home Mr. MCCAIN. Dr. BARRASSO from Wy- Mr. BURR. The Senator from Arizona health care. oming. has stated this case very well over a But another point I would assume all Mr. BARRASSO. It has been a privi- number of days, and it will continue to my colleagues agree with is that we lege to take care of patients in Wyo- be stated—they are cutting Medicare want to cut waste, if there is waste. We ming for the last 25 years. This bill is to fund a new government program. want to cut waste out of the health

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00014 Fmt 0637 Sfmt 0634 E:\CR\FM\A05DE6.014 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12475 care system. Why should we allow My approach, frankly, in regard to where between $300 billion a year to waste, as representatives of our peo- legislation, is to work with groups, to upper estimates of $800 billion a year. ple—the taxpayers? We want to cut out work with industries and talk to them It is waste, and we have to figure out a waste. Again, I see the Senator from and not just be draconian and not be way to get rid of the waste without Arizona is nodding his head, yes, that arbitrary in cuts or changes. You talk sacrificing care and actually, at the clearly we want to cut out waste that to them to see what accommodations same time, improving the quality of may or may not occur in the system. can be made consistent with your prin- care. That is the major goal. Now, the next question—and it is a ciples. So when you see reductions in some question—is, there are lots of forms of One of my principles is stopping a lot of the payments to providers, a lot of waste, and one is fraud—people just of the fraud and to see if there is a way that is an honest attempt to get rid of ripping taxpayers off and ripping sen- to cut excessive spending because the waste or excessive payments. Let’s iors off. That is clear. There is a lot of sometimes there is excessive spending take Medicare Advantage. Somebody waste. Let me take one small example around here, and that is what we have quoted Tom Scully today. I have a in the home health provisions in the done in the home health industry. quote from Tom Scully that says there Senate bill, and that is this: The Gen- I could go into more detail, but I is way too much spending in Medicare eral Accountability Office found that want my colleagues to know there is Advantage. I don’t have the exact in the home health industry there are real, solid, sound reason for these quote, but it is basically a public quote a lot of outlier expenditures which are changes in the home health provisions, that we should cut Medicare Advantage fraudulent; that is, some home health and it is my judgment this will not spending because there is way too agencies classify their expenditures for hurt home health care for patients. much expense in Medicare Advantage. home health as outliers—as extra pay- That is a very important point to It is a question of judgment as to ments—for very sick people. make. how much to cut, I grant you. But still In fact, there is one county in Flor- The same is basically true with the there are areas where there is excessive ida which accounts for 60 percent of all other industries—say with regard to spending, there is waste, and home outlier reimbursements, whereas they the hospital industry. We worked with health care is a good area where we provide health care for only 1 percent them and said: OK, we know you should worked hard to refine the changes to of the Nation’s people. The GAO has be cut. I talked to a lot of hospital ad- get rid of some of the fraud—the found lots of examples where the ministrators privately and said: What outliers I mentioned—but in a way outlier portion of home health is do you think? that helps seniors get good home abused. It is fraud. It is abused. Well, They said: Yeah, MAX, we should health care. guess what. The home health care in- take a haircut. Our hospital should The PRESIDING OFFICER. The Sen- dustry came to us and said: Gee, we take a haircut. ator from Tennessee. have some ideas how to stop that be- As you well know, you sometimes go Mr. CORKER. Mr. President, I no- cause we don’t like rotten apples spoil- to a hospital and you say: Good gosh, ticed the senior Senator from Montana ing our barrel. We want to stop this why do they have that big fountain out referred to us being here, and I wonder fraud that exists with excessive outlier front? Why do they have all that mar- if he would yield for a very short ques- payments. ble? Why does this look like the Taj tion. So they came to us with some ideas. Mahal? You don’t need that for health Mr. BAUCUS. I agree, so long as it I know it is easy to think that sugges- care. comes off their future time. tions might be classified as deals or So then they crank that back for the The PRESIDING OFFICER. Without whatnot, but that has not happened. need of their health care. Some of the objection, it is so ordered. They came with an idea of how to cut executives say to me privately: Yeah, Mr. CORKER. Well, I think we have a excessive costs in outliers, and we have there should be some reductions in hos- lot of time today, so I think that will done that. That is in this bill. There work. are a lot of other provisions with re- pital payments. So we go to the hos- pitals and say: What is reasonable? Re- Mr. President, I was wondering if the spect to home health care. Senator from Montana might educate I know the Senators have letters member, this is over a 10-year period. us—and all seniors in this country who from their home States. I don’t know if They say: We could take a $155 bil- receive Medicare—if his intent is to they are referring to a House-passed lion cut. But they say that, in part, be- bill, which is very aggressive in cutting cause they know what they lose on the make Medicare work better—and, by home health care benefits, or whether margin they can make up in volume the way, I think he is, in some cases, they have read the most recent lan- because of everybody’s health insur- working sincerely to do that—why is guage in the Senate bill, which essen- ance. That means, too, that we can get he taking those savings away from tially is much less aggressive because health care reform. Medicare? And being the distinguished in talking to the agencies, they were You know, it is hard to get the chairman of the Finance Committee, saying: Yes, we can live with these health insurance industry to work with he knows as well as anybody in this changes—such as rebasing and market us if there is no health insurance for country that Medicare is insolvent. basket updates, phasing them in in- most Americans. If there is no health Why is he not using whatever he be- stead of immediately—with the idea, insurance for most Americans, then lieves to be good savings—and we may again, of getting rid of excessive pay- the health insurance industry is in- disagree with those savings—to make ments and fraudulent payments. clined to revert back to their old Medicare solvent, or at least to pay the I say excessive because the home ways—or try to anyway—underwriting physicians who treat Medicare recipi- health care industry is enjoying an 11- insurance, denying policies based on ents? They are going to get a 23-per- percent growth rate annually, as it is preexisting conditions, et cetera. cent cut next year, and it will take $250 right now in dollars. Well, some think So this whole effort is to work with billion just to make them equal in 10 it is 17 percent. The chart I have is 11 groups—work with consumer groups, years. Why is he not using those sav- percent, but maybe 17 percent. Then with labor, with hospitals, doctors, the ings to actually make Medicare work the national health care spending rate, insurance industry, pharmaceuticals— for the people who are already receiv- spending for all care, goes up about 6 to see what is reasonable. That is de- ing it versus leveraging all the entitle- percent a year, about 6 percent a year mocracy—to try to get some kind of ment from one insolvent entitlement nationwide. Home health without re- broad-based kind of rough justice to another insolvent entitlement? Why form is between 11 and 17 percent. It is agreement to put this together. That is would the chairman of the Finance almost double. the effort we have undertaken in this Committee consider doing something Under this legislation spending will legislation. like that? be about 8 percent. Remember, na- I hear criticism, well, gee, we are Mr. BAUCUS. Mr. President, I would tional health spending is 6 percent, and cutting this and cutting that. But let’s very much like to respond to that ques- the home health industry did write a remember—and I know my colleagues tion. First of all, I appreciate the im- letter saying: Yes, we can live with agree with this—the waste in the plied premise in the statement that the that. American health care system is some- Senator agrees there should be savings.

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00015 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.017 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12476 CONGRESSIONAL RECORD — SENATE December 5, 2009 The question is, Where should the sav- That is a judgment call. But I do be- hard to have a legitimate debate in the ings go? I mean, basically, the Senator lieve, when people have health insur- Senate when people speak and then is implying there should be savings, ance—those who do not now have it— leave the floor and we can’t actually and that is very good to hear. I think are going to be more healthy. I think test the things that have been said. that is a very constructive addition to that is a good thing. Hospitals will not One of the things that was said a mo- a part of this dialogue, this conversa- have to worry near as much about un- ment ago by the Senator from Utah tion, that we should take savings be- compensated care, which is a big chal- was, you cannot find any doctors who cause there is waste. lenge to hospitals these days. The aver- support this plan. Can you find doctors The Senator’s question is, OK, you age, I think, is about $1,100, $1,200 a who oppose it? Absolutely. I will give take the savings, what should we do year per family, when it comes to un- him that. But don’t come to the floor with the savings? That is the basic compensated care that private pa- of the Senate and suggest there are not question. tients’ pay. Then, after that, we open huge numbers of doctors across the The fact is, because of the reforms in up doors to delivery system reform. country who are desperately waiting Medicare, a couple things are hap- You get the system working a lot bet- for the Senate to pass health care re- pening. No. 1, we are extending the sol- ter, compensating more on quality out- form and, in fact, this plan. In fact, the vency of the trust fund; it is another 5 comes rather than quantity, et cetera. AMA—this is what the AMA says. They years. The Medicare trust fund will I know the Senator knows much about represent tens of thousands of doctors now be extended 5 years, so that helps all these things. across the country, and they said: seniors. I know the Senator didn’t mean this But it is a judgment call for those [We are] working to put the scare tactics savings. I am glad the Senator seems to bed once and for all and inform patients at all, but, rhetorically, earlier he said: about the benefits of health reform. Why does this side want to throw sen- to imply there should be or are savings, iors under the bus? I know he didn’t but it is a judgment call as to where We have heard an incredible amount mean that. I know he knows nobody is the savings go. of scare tactics, Senator after Senator trying to throw seniors under the bus, The 21 percent in docs, we are going standing there, jumping up, pounding nobody wants to do that in the Senate. to have to take that up after this bill. out one sort of misstatement or one But the fact is, these changes do ex- It is going to be difficult because some distortion or another. The bottom line tend the solvency of the trust fund. want to pay for it; some want to not is, they have stood there for the last Then he asked a different question, pay for it. I grant you, that is going to hour or so, claiming they are standing and it is a very good question. It is a be a huge battle. there to protect seniors. It is ironic, judgment call, what should be done You might ask: Why is that not in when one Senator, the Senator from with the additional savings? This legis- this bill? Arizona, who said yesterday and sort of lation takes those savings to help more Mr. CORKER. I did ask. repeated it today—this is what he said people get health insurance. One could Mr. BAUCUS. My answer to that is, yesterday: argue those savings should not be used A, it is not part of health reform. But, I will eagerly look forward to hearing from to help those without health insurance B, on the other hand, it is; they are the authors of this legislation as to how they get health insurance for them. They docs, we care about our docs and we are can possibly add $1⁄2 trillion in cuts without could go back to the Medicare trust going to have to find a way to pay for impacting existing Medicare programs nega- them and we will, I think, by the end of tively and eventually lead to rationing of fund, they could reduce the budget health care. . . . deficits—there are a lot of different op- this year because we have to. Docs— That is the Senator from Arizona tions here. But this is a health care re- there cannot be any reduction. Frankly, there is a partial fix in this today. form bill. In this legislation, we are Only a year ago, when he was run- trying to come up with a system, if you bill anyway. It is 1 year with an up- ning for President of the United States, will, that gets some coherence nation- date. At least this bill does take care of docs for at least 1 year and with an in- this is what the Senator proposed: wide in health care. We don’t have a ″ system today. It is a hodgepodge. It is crease. That is 1 year. The House wants John McCain would pay for his health plan with major reductions to Medicare and a collection. It is kind of a free-for-all. a permanent fix. Frankly, I would love to have a per- Medicaid,’’ a top aid said, ‘‘in a move that Docs do their things, hospitals do their independent analysts estimate could result things, nursing homes do their things; manent fix, but we are having a hard in cuts of $1.13 trillion in 10 years to the gov- each attempt to get health care based time finding the dollars to pay for it ernment programs.’’ on profit motive, but it is kind of inco- all, but this legislation does have a 1- Consistency, obviously, has never herent. There is no real—anything year fix for docs. constrained anybody in politics. We there. I yield to the Senator from Massa- know that. But to stand there, over the We say let’s try to look for coher- chusetts. last half hour or 45 minutes, and say: ence. We are the only industrialized The PRESIDING OFFICER. The Sen- Seniors are going to get hurt and sen- country in the world that does not ator from Massachusetts is recognized. iors don’t support this and we are here Mr. KERRY. Mr. President, just one have some system, some way where ev- to protect seniors—just a few days ago moment? erybody has health insurance. It seems the organization that represents 40 Mr. BAUCUS. If the Senator will to me we should try to see if we can million seniors in America, it is the yield, I thank my colleagues for stay- have some kind of system, some way, largest single representative group of ing on the floor. I appreciate that. where everybody has health insurance. seniors in our country—we all know it, Mr. KERRY. Mr. President, I just was I know it is extremely complicated. it is called AARP. It is the American notified—I wish to respond to a few of There is no doubt it is complicated. Association of Retired Persons. It rep- the things here. The Senator from Ar- But if people have health insurance, resents people from 50 years old on up. kansas has the pending amendment. that opens up lot of doors for other re- There are a total of about 90 million of My amendment is apparently not quite form; one is to prevent companies, those in the United States of America, ready to be called up. What I want to health insurance companies, from de- so they represent about half the sen- nying coverage based on preexisting do, if I can make a couple comments so iors in America. the conversation doesn’t stay where it conditions, health care status, and so Their interest, day to day, is making is, prior to the Senator from Arkansas on and so forth, because then what sure those seniors’ interests are not and then I will yield and then I would they lose on the margin, they can hurt by what we do here in Wash- like to be able to come back after that make up in volume because everybody ington. Here is what they said, on No- with my amendment. has health insurance. It is the same vember 20: with the hospitals, same with the phar- I wish to say to our colleagues on the other side of the aisle, I have listened Opponents of health reform won’t rest. maceutical industry, same with vir- [They are] using myths and misinformation tually all providers, the whole system. carefully, obviously, for a number of to distort the truth and wrongly suggest If everybody has health insurance, not days now. I notice most of them have, that Medicare will be harmed. After a life- most everybody—more have health in- indeed, disappeared—as the Senator time of hard work, don’t seniors deserve bet- surance the better the system is. from Montana suggested. It is pretty ter?

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00016 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.018 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12477 This is what AARP said a few days ends this process altogether. But they Mr. BURR. I would ask the Senator before that, on November 18: do not come to the floor of the Senate from Massachusetts, relating to the The new Senate bill makes improvements and show us how we could fix it more quote from Senator MCCAIN that he to the Medicare program by creating a new effectively and, in fact, serve seniors showed, is the Senator aware that the annual wellness benefit, providing free pre- better, rather than just embracing the day after that, factcheck.com said that ventive benefits and—most notably for status quo. Everyone in America was false? AARP members—reducing drug costs for sen- knows the status quo is unacceptable. iors who fall into the dreaded Medicare Mr. KERRY. What I am aware of is We cannot afford it. Medicare will go that the individual who was running doughnut hole, a costly gap in prescription bankrupt within the next 10 years, and coverage. for President of the United States then where are we going to be? never stood up and said it was false. I The Federation of American Hos- This is the time for responsible ac- don’t have any quote of Senator pitals said the following: tion, and every step we have offered of- MCCAIN ever refuting it. All I can say Hospitals always will stand by senior citi- fers that kind of responsible action is that throughout the campaign, that zens. without reducing care. was the operative language. It was de- They have no intention of pulling out I will make one last comment and I bated. It was never refuted. the support that exists today. will yield to the Senator from Arkan- The American Medical Association: sas and then come back and talk about I yield the floor. [We are] working to put the scare tactics further ways in which this, in fact, The PRESIDING OFFICER. The Sen- to bed once and for all and inform patients serves seniors and others more effec- ator from Arkansas. about the benefits of health reform. tively. But as they have talked, for the Mrs. LINCOLN. Mr. President, I am The Catholic Health Association of last moments they have been talking proud to join in this debate on an issue the United States: about home care cuts. that is absolutely critical to all Arkan- I have an amendment that shortly we The possibility that hospitals might pull sans and all Americans. I compliment will talk about that will prohibit any out of Medicare [is] very, very unfounded. Chairman BAUCUS because, as we talk reduction in home care, that will guar- Catholic hospitals would never give up on about this issue in terms of health care Medicare patients. antee we are clear that we are prohib- iting any reduction in home care. But reform, clearly, our delivery system in So everything we have just heard health care is broken. We have the best continues the scare tactics, trying to I have long been an advocate for better home care, more home care capacity. hospitals and doctors, research and gin anger in America that is un- technologies in the world. Yet our de- founded, based on the basics of this In the Finance Committee, I offered amendments to sustain that home care livery system is broken. For the last 24 bill. Let me call attention—this is the months, the Senate Finance Com- report this year in March that came quality. Nobody worked harder than our late mittee has held hearings and out from Medicare—it is about Medi- colleague Senator Ted Kennedy, with roundtables, summits, all kinds of dif- care payment policy. It is a report to whom I worked for years on this, to try ferent deliberative efforts working in us, the Congress, by MedPAC. As we all to extend home health care, protect partnership with associations that rep- know, MedPAC is the entity that over- home health care patients and aug- resent providers, advocacy groups on sees the administration of Medicare, ment home health care. Here is what behalf of patients, anybody who would and its concern is maintaining the via- the people who represent home health come to the table to talk about how we bility of Medicare, making sure Medi- care in America have to say. This is reform this system and make it better care patients are not hurt by a par- from the National Association for for the constituents we serve, the pa- ticular program. Home Care & Hospice, a letter they tients who are the ultimate recipients What is in this bill—that Senator sent to Senator BAUCUS. It was a letter of the health care system. I applaud BAUCUS and those of us on the Finance they sent yesterday. him and the work we have done. committee put in the bill—is precisely The National Association for Home Care & To anyone who says we are jumping what MedPAC told us we should do and Hospice supports making health care avail- in here and moving too fast, I have tre- could do without harming seniors. Let able to all Americans. We believe that every- mendous respect for the minority lead- me share, specifically, what they said one must be willing to sacrifice to make this er from Kentucky. My husband trained we should do: happen. [The National Association for Home Care & Hospice] has agreed to do its part by at Kentucky, did his subspecialty The recommendation is that Congress there. His admiration for one of those should eliminate the market basket increase reducing costs and payments in a manner for 2010 and advance the planned reductions that makes the Medicare home care program he trained with is a good friend of Sen- for coding adjustments in 2011 to 2010 so that more efficient and less susceptible to abuse. ator MCCONNELL’s. But the minority payments in 2010 are reduced by 5.5 percent We are grateful for the opportunity to make leader’s comment that we are saying to to 1990 levels. these improvements and at the same time our constituents, sit down and shut up, protect the thousands of ethical providers again, like the comment from the Sen- They suggested that. They did it be- who are participating in this important pro- cause they know it will make the pro- gram. We are pleased to have the oppor- ator from Tennessee that we are throw- gram sounder and it will allow them to tunity to work with your staff to make this ing seniors under the bus, we are in a make payments in other areas of Medi- happen. For all these reasons, [the National body that is here to be respectful of care that wind up taking care of Medi- Association for Home Care & Hospice] sup- one another, respectful of our dif- care beneficiaries more effectively. ports the provisions of your health care re- ferences, our different approaches, how They said: form legislation as they relate to home we come to the ideas we have of how health care. We look forward to working we solve these questions. The Congress should direct the Secretary with you and your staff . . . [of health and human services] to rebase Thank you for [the] important work [you The Senator from Massachusetts rates for home health care services to reflect are doing]. brings up a great point. Where are the the average cost of providing care. Who better to speak to the concerns suggestions from the other side of how That is precisely what we do here. of home health care? The folks who we solve this? Come to the table. Are But the other side jumps up, and they have continually been distorting this they going to come to the table with will take any change, anything that re- debate and who continue to try to ideas of how we do something other flects a shift from one place to an- scare people, or an association whose than just going with the status quo? other—they will exploit shamelessly in sole existence, whose payroll every day Clearly, Americans understand that we an effort to scare seniors and pretend it is put to the use of protecting the folks are not throwing them under the bus. is somehow going to affect them. they represent in home care? I think We are trying to figure out how we pre- What is interesting—and America the answer is self-evident to anybody serve a Medicare Program that is going ought to take note of this—they keep who wants to listen to common sense. to be bankrupt in 2017. How do we coming to the floor and they keep op- Mr. BURR. Will the Senator yield for make the difference in the delivery posing what is here. They keep wanting a question? system so we bring down those long- to strip something out. They keep Mr. BAUCUS. It will have to be on term costs in health care, so that we wanting to send the bill back so that your time. can actually preserve the programs

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00017 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.020 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12478 CONGRESSIONAL RECORD — SENATE December 5, 2009 that work and that are so meaningful I have to say to my friends over lier this year, this trend has translated to people in their lives. As we come to there, those over there who are defend- into a difference of several billion dol- this debate, I hope we will continue the ing the status quo on behalf of the lars in favor of insurance company age-old attitude in the Senate of being health insurance companies and their shareholders and executives at the ex- respectful for one another’s views and executives who are receiving these pense of health care providers and their one another’s efforts in trying to bring multimillion dollar compensation patients. It is imperative that we do about something that will make sense packages, it took nine of them at one what we can to reverse that trend, par- and that will be helpful, not throwing time, so it is a tough lift to be able to ticularly now when millions more people under the bus, not telling con- defend these executive compensations Americans will be purchasing their stituents to sit down and shut up, but for insurance company executives; oth- health insurance coverage as a result actually working hard to come up with erwise, nine of them wouldn’t have of this health reform package. Tax- some solutions. been down here trying to shift the con- payers are footing the bill for this sub- Senator MCCAIN was trying to call an versation to something else. sidy, and we must take steps to deter awful lot of people in Arkansas. My The American people do understand the health insurance companies from mother was one of those whom he tried that is out of balance. Here we are with further enhancing their profit margins to get in touch with to tell them that an opportunity to provide these insur- at the expense of the American people. something is wrong up here and that ance companies even more customers. We had a lot of Senators who came to we are not doing what we need to do. I We just simply want to be reassured the floor this morning on the Repub- certainly visit with my mom an awful that we are not, through taxpayers’ lican side to defend the status quo on lot. I hear about her experiences and dollars, subsidizing these enormous ex- behalf of the health insurance compa- the concerns she has about Medicare, ecutive compensation amounts and, nies and their executives who are re- which is a system that is great for her, more importantly, that the savings ceiving these multimillion dollar com- and I am proud I live in a country that that come from that are going to go pensation packages. Maybe they don’t provides her with that kind of care. into the Medicare trust fund to shore it understand that under current law, the She does believe very strongly in some up. American people are already footing of the things she has seen in her Medi- I appreciate everyone’s debate and the bill for this tax windfall for health care bill, inefficiencies that could be their efforts to come to the floor today insurance executive pay. As we move changed, ways that we could make it a and talk about a critical issue. I re- forward, it is going to be a greater ben- better program. I hope we will all come mind my colleagues, current law allows efit to those executives and the ability to the table here with good ideas and all businesses to deduct up to $1 mil- for these insurance companies to be ways that we can make a difference. lion annually per executive as a busi- able to do that. We want to keep those I notice that there was an effort or ness expense. That is a million dollar insurance companies in business. We certainly a concern about wanting to tax break per executive per company want to make sure they are there as add people to my amendment. I would that is subsidized by the taxpayers. providers. It is just a disconnect when welcome Republicans, if they wish to There are multiple more ways they can they say they have to cut 600,000 of offer their own amendment to include obviously provide greater compensa- their insured under the current system other entities, if they wish to do that. tion, and there are lots of loopholes in because their profits aren’t high I have worked on my amendment, and there that allow them to get tax sub- enough. Yet they are paying their top I like my amendment the way it is. I sidies for more compensation for their executive a $24 billion compensation think it focuses on an industry with executives. My amendment would limit package that is subsidized by the tax- the sole purpose to provide health in- this amount to $400,000, the very payers. surance. Their sole purpose is to pro- amount the highest public official in I hope we will work together to fig- vide health insurance. If they want to this land gets paid, the President, a ure out what is the right place to be add other people—— $400,000 salary for those health insur- here, if what we want to do is to make Mr. THUNE. Will the Senator yield? ance companies that will profit as a re- sure we are reforming health care, that Mrs. LINCOLN. I will continue vis- sult of the health insurance reform. we are asking everybody to come to iting for a moment, and then I will let Our objective is to get more people the table and make an effort in putting the Senator take time on his part. I am insured. Working diligently through all ourselves back on track. Ultimately, directing it solely to those businesses of these technicalities, trying to get we want that quality of life that a new, whose only purpose is to provide health more people insured, we are creating a reformed health insurance and health insurance for the people of this coun- new marketplace for them with more care delivery system can provide. We try. consumers, a tremendous amount. This also want to make sure we strengthen I refer as an example to an article is only in regard to health insurance our economy. Making sure we make that came out yesterday. It references companies. It doesn’t dictate what a good use of every medical dollar, that basically one of our large national in- business can pay an employee. It does we are getting the biggest bang for surance companies working hard, at limit the taxpayer subsidies for com- that buck is a critical part of putting least I hope they are, to do what is pensation. This is a fair policy. It is our economy back on track. right. I see that they are going to be aimed at encouraging health insurance The assumption on the other side has dumping 600,000-plus customers because companies to put premium dollars to- basically been based on the current and they don’t think their profits are big ward lower rates and more affordable broken marketplace where insurance enough. Yet I look at the record, and I coverage, not into their pocketbooks. companies really do bully their cus- believe their CEO actually, in 2008, They are complaining about profits. tomers and monopolize choices. I don’t made over $24 million. If they can pay Yet they are still paying these execu- know about their phones, but I hear a their top executive $24 million last tives a tremendous amount of money. lot on my phones and from my con- year but they are going to complain To be sure, there is evidence these stituents that they can’t get insurance. that their profits are not big enough, companies need the encouragement to They have a neighbor—a hard-work- that they have to dump patients, I do the right thing for consumers. ing woman who is a single mom—who would ask my colleagues, where do we Where health insurers spent more than cannot get insurance because of a pre- go to correct this imbalance, if it is not 90 cents per every dollar on patient existing condition. I have others who to a very plausible amendment? My care in the early 1990s, that number has have had insurance, and then when amendment does not restrict what in- decreased to just over 80 cents per dol- they did become ill, they got dropped. dustries, corporations can provide or lar. For every dollar they spend, only So our hope is we look at this in the give their executives in pay. It says we 80 cents of it goes back into their ef- context not of the broken marketplace are not going to subsidize that with tax forts to provide coverage for con- that exists today but of what we are dollars. The very American taxpayers sumers. That is in 2007. Those are the trying to create, and that is, a more ro- they are dumping are the ones who are numbers we have. bust marketplace, and one that makes subsidizing those incredible executive According to testimony delivered to sense both for insurance companies and pay amounts. the Senate Commerce Committee ear- for consumers as well.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00018 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.021 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12479 With insurance market reforms we have and come around in the next limit their taxes is one that has not plan to implement, along with more round. struck a deal with the committee. The consumer choices through the ex- Mr. BAUCUS. Fine. only one. Pharmacists are going to change, these insurance companies are Mr. DURBIN. I yield to Senator NEL- spend $70 million advertising for this going to have to work to keep up with SON. And I think Senator KERRY want- bill. The other industries are putting the business they have and to be able ed to lay down an amendment. up additional moneys to advertise for to be there for future customers. That Mr. BAUCUS. Thank you. this bill. The only industry that we are is a healthy marketplace. I do not Mr. NELSON of Florida. Mr. Presi- going to restrict is the industry that is think I will get any disagreement from dent, the Senator from Florida has 4 in opposition to what we are doing. It my colleagues on the other side that minutes? is interesting. competition and choice is the way to The PRESIDING OFFICER. He has Senator CORNYN made the point with go in the marketplace. That is who we 21⁄2 minutes. me a moment ago that we are going to are as Americans. It is to let those who Mr. NELSON of Florida. Well, let me take $450 billion, and we are going to have that entrepreneurial spirit—who say, the people of Florida gave me one give it to the very industry you are want to get in the marketplace and of the toughest jobs I ever had in my talking about. We are going to take provide a product at a reasonable life when they elected me the insur- $463 billion from Medicare and give it cost—to be an active part of the mar- ance commissioner 16 years ago of the to the same industry you are now criti- ketplace. That is what we are trying to State of Florida. I have some famili- cizing. encourage in this legislation. arity with the conduct of the insurance Senator BAUCUS said—and let me So the amendment I am offering companies, and it does not surprise me quote—he said: As we tried to work today would set the deduction cap at that the insurance industry is out to this, it was ‘‘rough justice’’ to put this the same level as the highest paid gov- kill this legislation and is spending agreement together. This is democ- ernment official, and that is the Presi- millions of dollars running TV ads. racy. dent. It is estimated to save approxi- It does not surprise me that the in- It was done behind closed doors. That mately $650 million over 10 years, and surance industry was very interested in is not democracy. It was done behind will place these savings in the Medi- this legislation to begin with, when we closed doors. The Senator from Arkan- care trust fund to further strengthen were going to expand all of those 46 sas asked why we have not brought for- the solvency of that fund and protect million people who do not have insur- ward something. The Senator from our seniors. ance, to bring them into private insur- Massachusetts asked. The first bill in- We want desperately to make sure we ance. troduced was the Patients’ Choice Act. protect our seniors. We know that in It does not surprise me that since I commend to my colleagues a white many instances there are Medicare they have calculated they have to do paper by Thomson Reuters, a very well Programs out there, unfortunately, their part, and that this bill will not respected firm, talking about the $600 that are oversubsidized, which means allow them to cancel policies in the to $850 billion worth of waste in the health care system today, entitled those who are in regular Medicare Pro- middle of somebody getting their ‘‘Where Can $700 Billion in Waste Be grams are having to pay for the out- health care—and we have heard those Cut Annually From the U.S. rageous subsidies in these other Medi- horror stories: in the middle of chemo- care Programs. We want to make sure Healthcare System.’’ therapy, suddenly, the woman gets the The reason we are concerned about we bring them to balance and create a notice that her insurance is canceled. better system for everybody out there. $465 billion coming out of Medicare, to We have heard those horror stories of be paid to the very insurance compa- That means bringing down long-term that little boy who was a year old and costs. It means making sure we are nies you are going after right now, is was heavy in pounds, and the insurance because we are not going where the protecting Medicare for all seniors. It company said: We are not going to means we do it in a deficit-neutral real waste is. The promise of the Presi- cover him. We hear the stories that: dent was to cut the cost of health care. way, which we have done in this bill Oh, no, we can’t insure you because and the other bills we worked on in the Right here is where it is. This bill does you have a preexisting condition. And Finance Committee. It means we work not touch it. when you look what that preexisting to put our best foot forward and bring- There is $175 billion a year in fraud in condition is, it was a skin rash. ing about partnerships between States the health insurance industry. You all Did you ever hear of the word cherry- and the Federal Government, as well as go after $2 billion of it—$2 billion. picking? That is the typical modus ope- with providers who understand this de- There is $175 billion a year in fraud. randi of insurance companies that livery system is broken as well. What is in it? Nothing. We are going to So in closing, the choice on this vote want to keep their profit. They cherry- manage to pay a private industry, but is very simple: either you support these pick the good risk, the healthy ones, only the private industry that will not revenues being placed in the Medicare and they deny insurance to the ones play along behind the closed door, trust fund or you support having the who need the health insurance. rough justice of democracy in this IRS write a check and sending it to So as we come to consider the country. health insurance companies to sub- amendment of the Senator from Ar- When Senator CORKER asked the sidize the multimillion-dollar salaries kansas, which I support, as we, many chairman of the Finance Committee, they are paying in their taxes. times, come to hear all of this extra- Why are you taking the money from I urge my colleagues to support this neous argument, come right back to Medicare and using it somewhere else, effort on behalf of the American tax- the main function. When you try to— rather than extending the life of Medi- payer and on behalf of our seniors, and The PRESIDING OFFICER. The Sen- care, he did not answer the question. to vote in favor of this amendment ator’s time has expired. The fact is, there is a $44 trillion—ac- that I feel has been structured in a Mr. NELSON of Florida. When you cording to the latest calculation, if you very fair way. try to reform the health care system, go to the Medicare trustees: $44 tril- Mr. President, I yield to the Senator look who is trying to kill the reform. lion—counting what has been bor- from Montana. Thank you, Mr. President. rowed—unfunded liability over the Mr. BAUCUS. Mr. President, I think The PRESIDING OFFICER. The Sen- next 75 years for Medicare. We are we have less than 4 minutes remaining ator from Iowa. going to take $1⁄2 trillion out of that on this side. I see someone else who Mr. GRASSLEY. Mr. President, I program that we all know is going wishes to speak. I promised him time, yield 5 minutes to Senator COBURN. wrong. And I do not doubt the motives and Senator DURBIN as well. I know The PRESIDING OFFICER. The Sen- of anybody here. I just think we are they are both eloquent orators. It is a ator from Oklahoma. misdirected. And we are going to take bit difficult here. So I will split it in Mr. COBURN. Mr. President, I thank that and spend it on another program. half, the time remaining, between each you. I appreciate it. I sat here and lis- That is where people ought to be con- of the two. tened to my colleagues to hear their cerned. Mr. DURBIN. I say to the chairman, input. I find it extremely peculiar that It is interesting—I will submit an- I would yield whatever time I would the only industry for which you would other document for the RECORD. This is

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00019 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.023 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12480 CONGRESSIONAL RECORD — SENATE December 5, 2009 a report from the Congressional Re- umns of numbers show the revised split be- not going after the outlandish salaries search Service, released December 1, tween public and private funds based on ap- of the companies that are going to 2009, at my request. plying the reasoning described above to tax spend $80 million to support this bill, I ask unanimous consent that docu- expenditures (the method is described below). the pharmaceutical companies. We are ment be printed in the RECORD. not going to go after the salaries of the There being no objection, the mate- TABLE 2—REVISED NATIONAL HEALTH EXPENDITURES BY people who run the hospitals who, on rial was ordered to be printed in the FUNDING SOURCE, 2007 average, make more than $1 million a RECORD, as follows: [Billions of dollars] year. We are not going to do any of MEMORANDUM those. Only the ones who say: Wait a DECEMBER 1, 2009. Source of funds Private Public minute. Maybe this is not such a good To: Senator Tom Coburn, Attention: Evan Private (CMS definition) ...... 894.8 a 310.7 deal. Feinberg. Out-of-pocket payments ...... 257.1 a 11.5 Mr. President, I commend to my col- From: Thomas L. Hungerford, Specialist in Private Health Insurance ...... 482.1 a 292.9 Other Private Funds ...... 155.7 a 6.3 leagues a document entitled ‘‘Impact Public Finance, Congressional Research Public Funds (CMS definition) ...... 1,035.7 Of The Patient Protection And Afford- Service. Medicare ...... 431.2 Medicaid ...... 329.4 able Care Act On Costs In The Indi- Subject: Public and Private Expenditures for Other Federal ...... 137.0 vidual And Small-Employer Health In- Health Care, 2007. Other State and local ...... 138.1 surance Markets’’ from Oliver Wyman This memorandum responds to your re- Total ...... 894.8 1,346.4 quest for information on total national and Associates, because what you health expenditures for health care and the Note: a The public portion is due to tax expenditures. claim you want to do is going to create Source: CRS analysis of CMS data. proportion funded by the federal, state and 11 million young people who are not local governments. In particular you are in- CMS attributes $268.6 billion of out-of- going to have insurance, and for those terested in incorporating tax expenditures pocket expenditures to private sources. How- who remain, their insurance is going to into the estimate of the proportion of na- ever, taxpayers are allowed to deduct out-of- cost twice as much. tional health expenditures coming from pub- pocket medical expenditures exceeding 7.5% The PRESIDING OFFICER. The Sen- of adjusted gross income on their federal and lic sources. It can be argued that some pri- ator’s time has expired. vate health expenditures should be attrib- state tax forms. The Joint Committee on Taxation estimates that the federal govern- Mr. COBURN. Mr. President, I thank uted to the public sector because of tax sub- the chairman for allowing me to re- sidies available for health care spending. ment lost $8.7 billion in tax revenue in 2007 Table 1 reports the breakdown of national from this deduction. Other tax expenditures spond. health expenditures by source of funds. In for out-of-pocket expenses amount to $0.3 Mr. GRASSLEY. Mr. President, I 2007, national expenditures amounted to $2.24 billion. State and local income tax revenues yield 5 minutes to the Senator from trillion, of which 53.8% came from private are about 28% of federal income tax reve- Georgia. sources such as private health insurance and nues; it is assumed that state and local rev- The PRESIDING OFFICER. The Sen- enue losses from tax expenditures will also 46.8% came from public (federal, state, and ator from Georgia. be 28% of federal revenue loss estimates. local government) sources. This breakdown, Mr. CHAMBLISS. Mr. President, I Consequently, it is estimated that state and however, does not take into consideration local governments lost $2.5 billion from these thank the ranking member on the Fi- the tax subsidies for private funding for tax expenditures. The total tax subsidy for nance Committee for allowing me to health care. For example, the exclusion of out-of-pocket health expenditures is $11.5 speak for a few minutes to simply re- employer provided health care provides a billion. spond to some of the statements, just subsidy for private health insurance, which The Joint Committee on Taxation esti- as Dr. COBURN has done, that were could be counted as public funds rather than mates that federal government forgoes $251.0 private funds. made earlier. billion in income and payroll tax revenue My friend from Massachusetts, whose Incorporating tax expenditures into the due to the exclusion of employer provided breakdown of health expenditures into public health insurance and other health insurance heart, I know, is in the right place, and private sources will change the results deductions. State and local government lose talked about the AMA, as if it were the that are reported in Table 1. The intuition $41.9 billion in income tax revenue because of last word in the medical arena, being behind the analysis is fairly simple. For ex- these exclusions and deductions. Con- in support of this bill. ample, take a dollar an employer pays for a sequently, $292.9 billion of the $775.0 billion Well, Dr. COBURN is a practicing phy- premium for an employee’s health insurance. for health insurance is classified as coming sician, and he can speak to this maybe This dollar is part of the employee’s com- from public funds. Other private funds for even better than I can, but what we pensation, but it is not taxed like other in- health expenditures include charitable con- know is that the AMA represents 10 come (at an average federal, state, and local tributions to hospitals and other providers. tax rate of 15%); it is excluded from income These charitable contributions are deduct- percent of the practicing physicians in for income tax purposes. In essence, the em- ible and reduce federal, state, and local tax America—10 percent. That means 90 ployee receives a 15 cent government subsidy revenues by $6.3 billion. This analysis esti- percent of the docs in America do not for this dollar spent on health insurance— mates that $310.7 billion of health expendi- belong to this group that sent this let- the government pays 15 cents and the em- tures that CMS attributes to private funds ter in support of the Senate bill. ployee pays 85 cents. This suggests that could be considered public funds. I speak to this with authority be- some funds that are classified as private in The last row of Table 2 reports the revised cause my phones have been ringing off Table 1 could arguably be classified as public breakdown of national health care expendi- the hook since this debate started funds. tures between private and public sources. It is estimated that public funding sources ac- months ago—the calls coming in from TABLE 1—NATIONAL HEALTH EXPENDITURES BY FUNDING count for $1,346.4 billion—60% of national docs around the State of Georgia, who SOURCE, 2007 health expenditures can be attributed to are violently opposed to the Senate public sources. bill—as it was being discussed and as it Amount Mr. COBURN. Here is what it says. I came out of the closed-door session Source of funds (billions) asked them what percentage of health that took place across the hall after Total National Expenditures ...... $2,241.2 care today is run through the govern- the leadership in the Finance Com- Private Funds ...... 1,205.5 Out-of-pocket payments ...... 268.6 ment. You might be interested to know mittee, after the leadership in the Private Health Insurance ...... 775.0 it is 60 percent. As the Finance chair- HELP Committee could not agree on Other Private Funds ...... 162.0 Public Funds ...... 1,035.7 man responded on why we were fixing the direction on which we want to go. Medicare ...... 431.2 it, we are going to create 70 new gov- The Senator from Massachusetts said Medicaid (federal, state and local) ...... 329.4 Other Federal ...... 137.0 ernment programs in this bill—70 new we are here scaring seniors. Well, I Other state and local ...... 138.1 government programs in this bill—and hope we are. Seniors ought to be Source: Center for Medicare and Medicaid Services, Office of the Actuary, we are fixing the government programs scared. They ought to be scared to National Health Statistics Group, National Health Expenditure Data, table 3, we have now. And we wonder why death of what is going to happen here available at http://www.cms.hhs.gov/NationalHealthExpendData/downloads/ tables.pdf. health care costs are out of control? because we are taking almost $500 bil- They are out of control because the lion out of Medicare, a program that a Table 2 reports the results of applying this reasoning to total national health expendi- government is running 60 percent of it bipartisan Medicare Commission has tures. The table shows the funding sources now, and there is no competition for said is going broke. And the Senator and public/private breakdown as reported by that 60 percent. recognized this: It is going broke. We the Center for Medicare and Medicaid Serv- Nobody is going to defend outlandish are taking $500 billion out of it. Wheth- ices (CMS) in the first column. The two col- salaries, but it is interesting, we are er you agree or disagree that the cuts

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00020 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.024 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12481 in Medicare proposed by the Democrats Georgia, do what they want to do, going to decrease. We need to make are legitimate, we ought to be taking which is stay at home for the most sure we are looking at all of the num- that money and putting it back into part and receive the good home health bers. Medicare to save that program for the care they are getting today which, CBO has very clearly stated that the long term. frankly, allows them to live a better average premium per person for new The Senator from Tennessee asked quality of life and a longer life. It is nongroup policies is going to be be- the right question to the Senator from pretty obvious—— tween 10 and 13 percent higher in 2016 Montana, and he took 10 minutes re- The PRESIDING OFFICER. The Sen- than the average premium. So we have sponding to the question. And Dr. ator’s time has expired. to say, well, what is the difference be- COBURN is right, he did not answer the Mr. CHAMBLISS. From this letter tween that statement and the state- question. There is a good reason why that is not going to happen. ment the Democrats have made saying he did not answer the question. Be- I yield back, and I thank the ranking that the premiums are going to de- cause there is no legitimate answer to member. crease by 14 to 20 percent? We have to taking this $500 billion out of Medicare Mr. GRASSLEY. I yield to Senator look behind the screen, behind the cur- and creating an entirely new entitle- MURKOWSKI for 5 minutes. tain. ment program that in and of itself is Ms. MURKOWSKI. Thank you, Mr. Two of the factors, administrative ef- destined to go broke. President, and thank you to my col- ficiencies and new enrollment, will If seniors are not scared by what we league from Iowa. make premiums go down, but these re- are saying, simply go to your doctor. In this morning’s Wall Street Jour- ductions are then overwhelmed by a 27- Go to your doctor and ask your doctor nal there is an article—actually, an to 30-percent increase in premiums be- about this. I know what happens to pa- editorial—and it starts out: ‘‘Another cause of the coverage requirements tients, Medicare patients who go to Day, Another Study,’’ confirming that that are mandated within the bill. The physicians who are generally in the Obamacare will increase the price of Democratic analysis that is out there range of 45 years or younger. Those health insurance. It goes on to talk omits this 27- to 30-percent increase, physicians are not taking additional about a Blue Cross study. It talks fundamentally flawing the analysis. Medicare patients or any Medicaid pa- about CBO numbers. But the reality is, What are some of the other things tients because they can’t afford it. The we have numbers all over. I think we ISER has taken a look at as it relates reimbursement rates to the physicians all recall the quote from Mark Twain: to this bill that is before the Senate are less than the cost of the services You’ve got liars, damn liars, and stat- right now? They have stated that be- they render. isticians. cause Alaska is a high-cost State, it is The Senator from Montana said: Well, I think we are caught up in highly likely health insurance plans in Well, we understand that, yes; there is that world now of dueling numbers. Alaska will become subject to the ex- $250 billion in reimbursements over the Our numbers say this is going to in- cise tax on health insurance sooner next 10 years that we need to take care crease your premiums. The other side’s than the U.S. average. The preliminary of. And we are going to take care of. numbers say it is going to decrease estimate is that roughly 50 percent of And I appreciate that because we need your premiums. So the real question is, health plans in Alaska will be subject to. But it is in the House bill, and the Who is right and whose numbers do you to the tax by the year 2016 compared to House bill is $1.2 trillion. It is not in look to? only a 19-percent average in the rest of this bill, other than the 1-year fix the Well, I think it is important, as so the lower 48. They have also indicated Senator alluded to. That is the reason many of my colleagues have mentioned that while the uninsured population the House bill is $1.2 trillion and this this morning, when we are talking will be reduced in Alaska, adding ap- bill is about $800 billion. That is the about whether it is the home health proximately 65,000 new enrollees to the sole difference in the two, basically. care statistics in a State they impact, market, their concern—and this is a But we are coming back, and in addi- to look to those States and what they statement I think is very important— tion to the $800-plus billion expenditure are saying the impact will be. So I have is that the newly enrolled Medicaid ex- in this bill, we still have a hole to be gone to our State’s think tank, if you pansion, and through the new ex- filled to try to take care of these docs will. The Institute for Social and Eco- change, will create a big surge in de- or there is going to be a wholesale re- nomic Research at the University of mand that could easily create what fusal on the part of the medical com- Alaska is the entity that does a lot of they call a ‘‘traffic jam’’ in the health munity to see Medicare patients. That analysis, not only on health care policy care system and send the Medicare should scare seniors. So I hope that and issues but other economic issues. I beneficiaries to the back of the line in message is getting out there. have asked them, let’s sort through Alaska due to Medicare’s low reim- I wish to close with one other re- some of these numbers. Let’s sort bursement rate. This is exceptionally sponse to my friend from Massachu- through some of the statements that important for us to understand. setts who said the National Associa- have been made out there. I think it is On today’s front page of the Wash- tion for Home Care and Hospice is the important to share this morning some ington Post there is an article about leading organization in America in of the statements coming out of ISER. Texas—— dealing with this issue, and we ought When we talk about the premiums The PRESIDING OFFICER (Mrs. to listen to them. Let me tell my col- Alaskans are going to face, instead of a SHAHEEN). The Senator’s time has ex- leagues what they say about what is statement, a very simple statement, pired. going on in my State. that, well, your premiums are going to Ms. MURKOWSKI. The only state- I quote from a letter that has already go down, what ISER is saying is, when ment we need to remember from this been introduced dated December 4 from we look to the CBO estimate of the in- article is that even with insurance, you the Georgia Association for Home crease in the average premium for the need somewhere to go. Health Agencies. In this letter the ex- nongroup market, what we expect to Thank you, Madam President. I yield ecutive director says: see is about a 12-percent increase by the floor. According to a study conducted by the Na- 2016. For single coverage, this is about Mr. GRASSLEY. Madam President, I tional Association for Home Care and Hos- $1,160 a year, and for family coverage it yield myself 5 minutes. pice, under Senator REID’s bill, 72 percent of is about $2,900 in 2016. The PRESIDING OFFICER. The Sen- home health agencies in Georgia will have ISER is still conducting the analysis negative margins by 2016 in the Senate bill ator from Iowa. and approximately 68 percent of the 100 to determine the extent of the sub- Mr. GRASSLEY. I rise to tell my col- Medicare Certified home health agencies in sidies that may be available for Alas- leagues why I am going to vote against Georgia will go out of business and the pa- kans that could, in fact, reduce those the Lincoln executive compensation tients they serve will be rehospitalized or premiums. But I think it is important amendment. This amendment picks out forced to seek alternative more costly care. to make clear that we are under- one set of executives in the entire Well, I don’t know how it is in the standing what we are talking about health care arena and singles out that other 49 States, but I want to see our when we make statements such as, one set of executives for limits on com- patients, our Medicare patients in well, this is going to increase or this is pensation. In the entire health care

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00021 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.025 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12482 CONGRESSIONAL RECORD — SENATE December 5, 2009 sector of the economy, this amendment and restore that amount of money to This will cause an increase in patients suggests that only one group of execu- the home health care agencies. seeking care in more expensive institutions tives warrants this sort of special Years ago I did some work with the which will only cause more of a drain on State and Federal budgets. treatment, and that happens to be the home health care agencies, and any- It is projected that over 58 percent of Kan- executives of health insurance compa- body who has been around them knows sas home health agencies will operate at a nies. This amendment then takes that these groups don’t operate on much of negative margin in 2010. . . . excess compensation that apparently a profit margin. They are frequently I noted to you the number that is Congress knows is the appropriate not highly capitalized. They are high going to go broke by 2016. This isn’t a amount for compensation and devotes on people and people skills. They take far-off prospect. This is even next year, that excess money to the Medicare care of folks in their homes. They do a under the current setting. Then they trust fund. great job of it. They take care of people are going to cut another $240 million Well, a very commonsense question where they want to be taken care of, from the Kansas ones that will cause in this town of nonsense is, why not which is in their homes and not in hos- even more of them to have great dif- limit compensation for executives in pitals or extended stay facilities. ficulty and financial trouble at this other areas of health care? What about Home health care and hospice fre- point in time. the executives of hospitals? Shouldn’t quently work with people in some of I ask my colleagues to revisit this their excess compensation go to pro- the most difficult times in their lives, issue. Vote for the Johanns motion tect Medicare? Why not executives of when they are facing those difficult, that supports home health care agen- nursing homes then? Why not execu- often final, illnesses and they want to cies. The Johanns motion is simple. It tives of medical device manufacturers? do it at home. They don’t want to be in says: Look, restore this piece. Don’t Why not limit compensation on the the hospital. They want to be at home take these moneys from home health people who run home health agencies? with family and friends around com- care agencies. For a number of us who Why not limit compensation for doc- fortable surroundings. In this under- represent a number of rural States, tors? Why not limit compensation for lying base bill, home health care is cut home health care is key. It can be ex- executives at the drug companies? $42 billion from the people who need it pensive in a rural setting. They need Well, let’s wait a second on that one. the most and from agencies that need the resources to be able to meet the We know the answer to the one about it the most and are in dire straits. needs of the seniors we have. why not include drug companies. This I have a chart up here which shows On top of that, in the overall cuts amendment can’t touch drug company the impact on my State, particularly that are taking place are key and executives because their industry cut a on home health care agencies. Roughly major cuts to Medicare Advantage pro- secret deal where they agreed to some $240 million in cuts to home health grams. Referring to the chart, there things in this bill, and they are going care agencies in the State of Kansas will be a 63.7-percent cut to Medicare to get a huge payoff in profits once this will take place under this base bill. In Advantage benefits that will affect goes into effect, as long as they don’t this base bill, 64 percent of the home more than 1 in 10 Kansas Medicare open their big mouth and fight this leg- health agencies in Kansas will go broke beneficiaries. A $1.5 billion cut to Kan- islation. by 2016, 64 percent by 2016. So just at sas hospitals is taking place and an Of course, this all adds up because if the point in time where you have a lot 11.8-percent cut in hospice payments. you are watching TV at home, or even of uptake and need for home health Home health care agencies often do here on the Hill, big PhRMA is running care for some people who are aging at hospice care as well. So this is a double ads all over the country in support of that point in time, you are going to cut cut for them. this 2,074-page Reid bill. and you are going to cut this much, Again, this is at a point in time in If the idea is for Congress to set the $240 million in my State, 64 percent of life where it is the most difficult. precedent of limiting compensation to them go broke, and for what? There is $124 million in cuts of skilled protect the Medicare trust fund, then Supposedly, it is to save a bunch of nursing facilities as well. This will shouldn’t we branch out even beyond money, right? Well, on top of this, the force more people into that setting. the health care industry? We could get CMS Office of the Actuary recently EXHIBIT 1 a lot of compensation—or we could get pointed out that the drastic cut to KANSAS HOME CARE ASSOCIATION, a lot of income into the Medicare trust home health care will not produce sav- Topeka, KS, December 4, 2009. fund by limiting compensation beyond ings to the Medicare Program. Accord- Hon. PAT ROBERTS, health care to say, for instance, execu- ing to OACT, the savings from perma- Senator from Kansas. DEAR SENATOR ROBERTS: On behalf of the tives of trade associations or union nent annual productivity adjustments Home Health Care and Hospice agencies of leaders or trial lawyers or baseball are unrealistic. Kansas, we would like to support the Repub- players or movie stars. But, no; this Again, that just stands to reason; if lican Senators motions to commit back to amendment focuses on one specific you are going to force people out of the Senate Finance Committee the HCR bill group of executives who weren’t going their homes into a hospital for ex- with changes that do not include cuts in pay- to be bought off by this bill. So let’s tended care because you are cutting ments to both home health and hospice agen- just call this amendment out for the home health care, you are not going to cies. save money in that system. You are This bill includes cuts to home health brazen political stunt it is, and if we do agencies that total $42.1 billion and cuts to that, vote it down. going to spend more money in that sys- hospice agencies of $7.7 billion. In Kansas a I wish to remind everyone in closing tem. This is not going to work. It is number of our member agencies service both that I asked the sponsor to include going to hurt people overall, and it is home care patients and hospice patients, so drug company executives in her amend- going to be at a point in their lives they would be hit twice with monstrous cuts. ment but was turned down. when they would rather be at home It is projected that over 58 percent of Kan- I yield the floor and yield 5 minutes than in the hospital. sas home health agencies will operate at a negative margin in 2010 and that number in- to Senator BROWNBACK. I think these are cruel cuts. I think The PRESIDING OFFICER. The Sen- creases significantly in years to follow. Hos- it is at a terrible time. That is just for pice agencies have already sustained cuts ator from Kansas. home health care, that alone, and then that have limited access to the Hospice ben- Mr. BROWNBACK. Madam President, with the hospice. I have a letter from efit, particularly in rural areas, which of I wish to thank the ranking member the Kansas Home Care Association course is much of Kansas. from Iowa for his comments on the that I wish to ask unanimous consent Last week Governor Mark Parkinson an- amendment. of the Presiding Officer to have printed nounced a 10 percent cut to Medicaid pro- I wish to speak on the Johanns mo- in the RECORD at the end of my state- viders in order to balance the state budget. tion and its effect on the State of Kan- ment. Agencies that provide services to Medicaid sas and the underlying bill in par- clients cannot sustain such drastic cuts and The PRESIDING OFFICER. Without access will be severely limited. This will ticular. Cuts to home health agencies objection, it is so ordered. cause an increase in patients seeking care in of $42 billion have a huge impact in my (See exhibit 1.) more expensive institutions which will only State, and I wish to urge my colleagues Mr. BROWNBACK. They say in this cause more of a drain on state and federal to support the Johanns amendment sentence, among other things: budgets.

VerDate Nov 24 2008 01:12 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00022 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.027 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12483 On behalf of the Kansas Home Care Asso- and somehow they represent all sen- for service compensates doctors at ciation members, we applaud your efforts to iors. We know they have a blatant con- about 80 percent of what private insur- block cuts to home health care and hospice flict of interest in supporting this bill, ance does. That is why, in Texas, 42 benefits that the citizens of Kansas and the particularly as to stripping out Medi- percent of the doctors will not see a United States need and deserve. new Medicare patient under the Medi- Sincerely yours, care Advantage benefits so they can JANE KELLY, sell more of our seniors Medigap cov- care fee-for-service payment formula. Executive Director. erage, which Medicare Advantage Frankly, it pays so low that they can- The PRESIDING OFFICER. The Sen- eliminates the need for. not afford to see new Medicare pa- ator’s time has expired. We also know this bill provides more tients. The Senator from Iowa is recognized. power to Washington and is taking it That means, again, this fraud is per- Mr. GRASSLEY. Madam President, I away from individuals in other ways by petrated on the American people—our yield 10 minutes to the Senator from limiting individuals to only four dif- seniors—saying we are going to keep Texas. ferent options for what kinds of health our promise to them by providing cov- Mr. CORNYN. Madam President, I coverage they can get. There is no erage by effectively denying access to want to talk about the breathtaking room for innovation or flexibility. We care because the reimbursement rates audacity of this bill, in a takeover of know, ultimately, that drives up the are so low. This bill gives the government more yet another important sector of our cost for people who have insurance power over people, and it takes it away economy, at a time when our economy now—their health insurance premiums. from individuals in a number of other is in recession—and the President was We ought at least be as good to the ways. While advocates describe it as a wondering at his job summit just on American people as we are to ourselves way to create competition and choice, Thursday, how come the private sector as Members of Congress. We have al- the reality is it would drive out com- seems to be on the sidelines when they most 300 different health care plan op- tions under the Federal employees petition from the market and ulti- should be back in the game creating mately become the only choice for mil- jobs. This bill is exactly one of the rea- health care benefits. Why should the American people accept less choices lions of American people. The so-called sons for that outcome. public option, which sounds relatively This bill is chock-full of avenues that when it comes to their health care innocuous until people realize the ef- lead to more and more Washington than Members of Congress? They fect of that, and the pay-or-play man- should not. control over our health care system date on small businesses, which kills and our economy. The amendment of These health insurance market re- forms are designed to give Washington jobs, creates a rational decisionmaking the Senator from Arkansas would give process, and employers that will drop Washington control over how much more power. More and more studies have said new controls by Washington employees from the current private money health care executives would coverage, only to be left on a govern- make. But we know as a practical mat- will do nothing but drive up the cost of insurance. The Congressional Budget ment-run plan, the so-called govern- ter, in terms of limiting executive ment option, which will end up, in the Office said they will go up by $2,100 for compensation, section 162(m) has been end, being anything but optional—de- American families. A new study came a disaster. nying power to the individual to make out yesterday saying that, in Texas, Actually, in the past, when Congress their own decisions in consultation premiums would go up for 61 percent of has attempted to do this, it has exacer- with their doctor and family, and giv- individuals purchasing their insurance bated the problem by encouraging com- ing Washington more power over their panies to come up with different ways in the individual market. The President of the United States lives. of compensating their executives that There are good reasons the vast ma- said his goal for health care reform was would not be subject to those limita- jority of Americans don’t trust Wash- to lower the cost of health insurance tions. This is ineffective in accom- ington with running our health care for the average American family by plishing the goal the Senator claims system—an issue that so intimately af- $2,500. By that test, this bill fails to de- she wants. fects all 300 million of us in America. liver on the President’s promise. This amendment also adds to the We know Washington has a lousy Then there is, of course, the expan- complexity—it adds mud to the already record at managing spending. We have sion of other government programs muddy waters—by imposing complex a $12 trillion national debt and, before that, while they promise coverage, limitations on just one industry, as has the end of this month, the administra- limit access to care by the way they been described. tion and the majority leader will come are structured. This bill purports to I listened this morning—amazed— to Members of Congress and say: Would give 94 percent of the American people when there were offers to include other you please lift the statutory debt limit organizations such as AARP, which has health care coverage but does so by because we maxed out our credit card reaped hundreds of billions of dollars of putting 15 million more Americans on and we need to lift the statutory debt income from insurance sales, and ex- the Medicaid Program. Of the 31 mil- limit. ecutives at Walmart in the Senator’s lion newly insured under the Reid bill, Our entitlement programs are out of home State, who are also involved in the only choice of 15 million would be control, with Medicare running an un- the health care industry. Of course, Medicaid. Of course, we know Med- funded liability of $38 trillion. The ma- icaid—for example, in Dallas, TX, only those were rejected. Our favorite game jority wants to take $1⁄2 trillion from around here is to try to demonize cer- 38 percent of doctors will see a new Medicare and use it not to fix Medicare tain parts of the private sector and, of Medicaid patient because reimburse- but to create a new entitlement pro- course, if the private sector is not in- ment rates are so low that a doctor gram. Washington running health care volved in creating jobs, all that leaves cannot see Medicaid patients and leave means the personal health care deci- is the government. his or her door open to see other pa- sions will be impacted by lobbyists and In health care, all that will do—once tients. We, in essence, condemn low-in- special interests rather than the inter- there is no private health insurance come persons to a health care gulag, ests of the American people. That is available because of draconian man- where they are offered coverage but the reason the insurance industry has dates, taxes, and limitations on com- have no access to health care. For 60 been supportive of health care up until pensation—is eventually leave the gov- million Americans, Medicaid would be now. There is $450 billion in tax dollars ernment as a single-payer provider of their only choice. that will flow directly to the insurance health care in this country. I suspect The $120 billion cuts to Medicare Ad- industry under this bill in the form of that may be the ultimate goal. vantage that we talked about earlier tax credits. We already know the Reid bill will gives more power to Washington and The hospital associations cut a deal force millions of seniors to purchase takes it away from the individual. By so they would not be subject to the axe so-called Medicare gap products which, cutting the private part of Medicare of the so-called ‘‘independent’’ Medi- by coincidence, are sold by AARP. We under Medicare Advantage, it would re- care advisory board. have heard Senators come to the floor sult in seniors having no choice but Everyone has heard about the deal and quote AARP as if it was holy writ, Medicare fee for service. Medicare fee that the pharmaceutical industry cut,

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00023 Fmt 0637 Sfmt 0634 E:\CR\FM\A05DE6.007 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12484 CONGRESSIONAL RECORD — SENATE December 5, 2009 in which it would result in them run- DECEMBER 5, 2009. cars and the salaries of the folks who ning ads supporting Members of Con- Senator MICHAEL B. ENZI, drive around. We are not talking about gress who support this bill because Ranking Member, Committee on Health, Edu- profit. We are talking just about keep- they want to protect their special deal cation, Labor, and Pensions, Hart Senate ing doors open. Office Building, Washington, DC. cut behind closed doors. We heard Sen- DEAR SENATOR ENZI: Over the past ten As I think about the patients in Wyo- ator MCCAIN talk about the special years the Medicare home health benefit has ming whom I have taken care of over deal cut in this bill for Medicare Ad- taken a larger hit in spending reductions the years who have benefited from vantage beneficiaries in Florida—an- than any other benefit. As home health has home health services, who have been other special political deal in order to become an increasingly important part of able to receive care from nurses, thera- secure a vote to support this bad deal— our health care system with highly skilled pists, home care aides and allow them but it left out seniors in Pennsylvania and often technically complex services that to stay at home, to be more inde- enable millions of senior citizens and dis- and California. pendent—not totally independent but I believe if there is any special deal abled Americans to avoid being hospitalized or admitted to nursing homes, these home more independent—I think anything to be cut, every senior who is a bene- health services save Medicare millions of that cuts into this is not good for ficiary under Medicare Advantage dollars each year. America. ought to have the same deal, not any I believe that further reduction in home The PRESIDING OFFICER. The Sen- more of these behind-closed-doors spe- health payments would place the quality and ator’s time has expired. cial deals in order to secure votes. availability of home health services at risk. Mr. BARRASSO. I yield the floor. The PRESIDING OFFICER. The time I urge you to oppose the cut in Medicare dol- The PRESIDING OFFICER. The Sen- of the Senator has expired. lars for home health agencies through out ator from Montana. Mr. CORNYN. There is just one job- our nation. Sincerely, Mr. BAUCUS. Madam President, I killing policy after another in this bill, ask unanimous consent that we con- and this is the latest. MARI IRELAN, President, tinue with debate, and debate only, as Mr. GRASSLEY. Madam President, I Home Health Care Alliance of Wyoming. under the previous order, for an addi- yield the remaining time to the Sen- Mr. BARRASSO. This letter talks tional hour, with Senators permitted ator from Wyoming. to speak for up to 10 minutes each. Mr. BARRASSO. Madam President, about the devastating impact of the cuts proposed in this bill we are consid- The PRESIDING OFFICER. Without how much time remains? objection, it is so ordered. The PRESIDING OFFICER. There is ering today. There are 43 home health Mr. BAUCUS. Madam President, I 41⁄2 minutes remaining. agencies in Wyoming and a number of Mr. BARRASSO. Madam President, them are in communities—the occu- yield to the Senator from Michigan, you know as well as I that the Presi- pant of the chair is from a State where Ms. STABENOW, 5 minutes. dent promised the American seniors there are a lot of rural areas. A number The PRESIDING OFFICER. The Sen- that if they liked the care they had, of our agencies are in communities ator from Michigan. they could keep it. Nothing could be that don’t even have hospitals. So it Ms. STABENOW. Madam President, I further from the truth. helps people stay in their homes, in thank the distinguished Senator from Looking through this bill we are de- their home communities, stay out of Montana, who has been here morning, bating, there is an incredible amount the hospital, out of the nursing home, noon, and night counteracting false- of cuts to Medicare, which is a program and it gives them the dignity and the hoods and scare tactics on the floor seniors rely upon for their health care: opportunity and the independence they and putting forward what is really in $120 billion of cuts to Medicare Advan- need to stay at home. this legislation that is so important to tage. One in four people in America Yet this bill, according to the folks millions of people around the country. who depend on Medicare for their in Wyoming and the folks nationally, Everyone benefits, in one way or the health care—11 million Americans—are is going to make it that much harder other, by either costs coming down or on Medicare Advantage. The reason for our seniors to stay at home. by direct access to more affordable in- they chose it is because it is an advan- Taking $42 billion from home health surance. I thank our distinguished tage. It helps with coordinated care care, raiding that program to start an- leader from Montana. and preventive care. Having practiced other program, to spend it on a new We have talked so much about Medi- medicine for 25 years, I know the peo- government program is going to abso- care and Medicare Advantage, but I do ple at home get it. That is why they lutely impact the ability of home have to take a moment to respond to chose that program. It also cuts $135 health care providers in this country to what has been said over and over on billion from hospitals and $115 billion offer services. These nurses, therapists, the floor. It is very difficult for me— from nursing homes. and home care aides all drive hundreds and I know for others around the coun- I want to focus a little bit on the $42 of miles on a daily basis in Wyoming, try—to listen to our friends from the billion cut from our home health agen- going from ranch to farm, to help care other side of the aisle lamenting that cies. I don’t know how anybody on the for people and to help them stay at they want to protect Medicare, when it other side of the aisle can say with a home. It is all around the country. was a Democratic Congress and a straight face that the legislation before There is a front-page story in the Democratic President who created us doesn’t cut Medicare and doesn’t New York Times today, a wonderful Medicare, over the same objections, by hurt our seniors because it does. story of a delightful 94-year-old lady, the way. You can take a look at the ob- I will tell you, having taken care of Bertha Milliard. She lives in Maine. jections in 1965, the debate: The world people in hospitals, the services that There is a picture of her with her nurse was going to come to an end if, in fact, are provided through home health care during a home health care visit. Bertha we passed Medicare. Of course, Medi- is what helps get people out of the hos- is very worried that they are going to care has become a great American suc- pital sooner, gets them home faster, lose this service, which is the service cess story for tens of millions of sen- gets them out of nursing homes, and that keeps her out of the hospital. iors and people with disabilities. helps keep down their costs. These It just seems, as we look at this, that Our friends now talk about how they services include skilled nursing care, there is no way home health care agen- are going to protect Medicare, at the physical therapy, occupational ther- cies around the country are going to be same time that just a couple weeks apy, speech and language therapy, and able to sustain these kinds of cuts and ago, on the House side, 80 percent of medical social services. continue to remain available to the Republicans voted to do away with I have a letter from the director of Medicare patients who depend on home Medicare as we know it today and home health services of Wyoming, the health care. make it a voucher system and put in- Home Health Care Alliance. Even the National Association for surance companies back in control. I ask unanimous consent that it be Home Care & Hospice said that in a few One of the frustrations for me is to printed in the RECORD. short years, Medicare will be paying hear the unfortunate negative com- There being no objection, the mate- home health agencies less than it costs ments that have been made about a rial was ordered to be printed in the to even provide the services. We are very distinguished organization that RECORD, as follows: talking about less than the gas in the represents senior citizens across the

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.030 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12485 country, the American Association of lives were cut short because they did have risen to defeat his vision. They Retired Persons, that I might add, not have health insurance. I wish to are not compatible. when we were doing the prescription share one story. One, the basic promises he has made drug bill, my colleagues on the other The PRESIDING OFFICER. The Sen- financially under this bill cannot be side of the aisle used in every single ator’s time has expired. met. The numbers do not add up. They speech because they were supporting Ms. STABENOW. I ask for an addi- do not work. them at that time. Now they are sup- tional minute. Two, the present debt crisis we are porting our position. They disagree Mr. BAUCUS. I yield 1 minute. in, a crisis that will lead to doubling of with them. They have said: The PRESIDING OFFICER. Without the national debt in 5 years, the debt Most importantly, the legislation does not objection, it is so ordered. accumulated from the founding of the reduce any guaranteed Medicare benefits. Ms. STABENOW. One of those place Republic, will double in 5 years and tri- Now we are hearing how horrible settings was for a young man named ple in 10, according to our own Con- they are, which I think is a real dis- Dr. Joe Hines, from Okemos, MI. He gressional Budget Office. That does not service to a very important national was a recent graduate of dental school. include any money spent on this legis- organization. I think it is important, He had just completed his residency lation because it is not current law. It in the name of truth and in the name and had lined up a job in private prac- will only make it worse. The financial of fairness, to look at quotes that have tice in Detroit. He did not have health crisis we are facing makes it even more been made about AARP that are dif- insurance. He became ill. He called his important that we act with care and ferent from what we have heard on the mom who urged him to go to a doctor, caution before we move forward. floor today and since this debate but he did not have insurance. He wait- I also note that many people today began. ed too long, figuring it would pass and are happy with the quality of the Our distinguished colleague from Ari- it did not pass. It got worse. He died at health care they receive. They are zona, who sponsored an amendment re- age 27. nurses, they are doctors, the quality of lated to Medicare Advantage and has This legislation is about Joe Hines. It the diagnostic equipment, the hospitals been on the floor numerous times, in- is about his family. It is about every they have to utilize. They do not have cluding today, disparaging AARP, said one of the 45,000 families who lost loved any desire, whatsoever, for the Federal at an AARP convention: ones this year. It is about the 14,000 Government to take that over. I say God bless AARP— people who got up this morning— What they have been concerned This is the senior Senator from Ari- today—on a Saturday, with insurance about—and rightly so—are the rising zona. and will go to bed without it. Saving costs. But the promises in this bill to lives, saving money, saving Medicare, I say God bless AARP for everything they reduce costs for the average American are doing, not only for the present genera- that is what we are fighting to do. have not been achieved. Costs will con- tions of Americans, but for future genera- The PRESIDING OFFICER. The Sen- tinue to go up for average Americans. tions. That’s your duty, that’s your ator from Iowa. There are many flaws, many fictions strength, and that’s why I love to see you at Mr. GRASSLEY. Madam President, I in the legislation. Its promises sound every town hall meeting. yield to the Senator from Alabama 10 good, but reality, in fact, is interfering. The unfortunate thing is now our col- minutes. I will point out a number of promises leagues on the other side of the aisle The PRESIDING OFFICER. The Sen- that have been made and the facts that don’t want to see AARP at every town- ator from Alabama. dispute those. I will then point out hall meeting because they are not say- Mr. SESSIONS. Madam President, I what I think are the real facts. I will ing what they want them to say. thank Senator GRASSLEY, and I appre- ask and evaluate this bill on how well I also have to express concern that ciate his leadership on this very impor- it meets the promises that have been we had 6 years of our colleagues in full tant issue. made for it. From this analysis, it be- control of the Federal Government— As I have reviewed the legislation comes clear to me that it is an offer we the Presidency, House, and Senate— and looked at the analysis, the finan- can and an offer we must refuse. and we did not get legislation to bring cial accounting that has gone into it, I Fiction No. 1: The allegation has down health care costs or legislation to have been astounded, beyond my abil- been made and statements have been make sure every American, small busi- ity to express it, by the errors and fic- made from the beginning that the bill ness, and family could afford insurance titious promises that have been made would cost $848 billion. as we are doing today. So it is a little by the bill’s supporters. The facts are, when the new pro- difficult, even though we have come to- My colleagues and people listening to grams created by this bill are fully im- gether on other issues on health care, or reading these words may think what plemented, the bill will cost $2.5 tril- on this particular one it is difficult I am saying cannot be true, that this is lion. I think the sponsors of the bill ac- now to hear all the criticisms that are an exaggeration or has absolutely an- knowledge that. flying and all the things we should be other side to the issue. But the state- No. 1, is the cost $848 billion as prom- doing, but they were not brought for- ments I am making, I believe, are accu- ised? The answer is, no, it is much ward a number of years ago, when they rate, and if I am in error, I am glad to more than that. In fact, $2.5 trillion— actually were in charge and could have stand corrected. 2,500 billion dollars. done something about it. That is con- The numbers are so huge they can- How can we be that far apart? The cerning to me. not, in reality, be hidden. The numbers bill’s new benefits programs, the ex- This legislation is about saving lives, simply do not add up. President Obama penditures the bill calls for are not it is about saving money, and it is had a grand concept in his mind. He phased in until 2014, the fifth year of about saving Medicare. was following, I think, a great chimera the 2010–2019 period, during which the I wish to share one story because not of reform that he believed he could ac- cost of this bill is scored by the Con- too long ago—it seems like a long time complish. He was able to express it on gressional Budget Office. since we have been working so dili- the campaign trail with cadence, pas- For example, the insurance subsidies gently this week—it was just Thanks- sion, and skill. People liked those funded by the Federal Government do giving, and families all across America promises. As so often is the case with not begin until 2014. Also, according to came together to reminisce around the many of us, he came to believe his own the bill, Medicaid will be expanded up dinner table, to watch football, and rhetoric, his own words, and those to 133 percent of Federal poverty level, share a family meal. Even in tough words took on a reality of their own. but that does not happen until 2014. It times we stop, reflect, and give thanks But once one takes office, words is disingenuous at best—just not accu- for our many blessings. I know that is cease to be reality. Facts then domi- rate, some would say dishonest—for true for my family, and I am sure all nate. Promises easily made in the Iowa promoters of this legislation to claim our families. spring or the New Hampshire winter, if the costs of the bill are only $848 bil- This year, there were 45,000 empty not carefully constructed when made, lion, when they don’t begin to pay out place settings at tables across the become unreachable when a candidate the new benefits in the 10-year period country for men and women whose takes office. Realities, I have to say, until 5 years from now. So shouldn’t

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.032 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12486 CONGRESSIONAL RECORD — SENATE December 5, 2009 you score the bill from the time the that not one dime would be added to cause health care represents $1 out of benefits start and then for 10 years to the Nation’s surging debt. every $6 spent in America—one-sixth of get a 10-year honest score of the legis- Now, is that true or not? If it is not our economy. It is that big a deal. And lation? true, then I think people— we produced this bill, this 2,075-page The Reid bill that is on the floor The PRESIDING OFFICER. The Sen- bill, after the considered effort of today, that was written basically in se- ator’s time has expired. Democrats and Republicans writing it cret and added to this unrelated piece Mr. SESSIONS. Madam President, I over the course of 1 year. Yet the other of legislation to get it to the floor, this appreciate the opportunity to speak. I side says: Slow down. piece of legislation begins to collect will talk about the other points as the You know what, the American people fees from insurers, medical device com- time avails itself and we have the time ought to ask our Republican friends: panies, and others—they are collecting to do so. Where is your bill? Why haven’t you money in increased fees and taxes—as I yield the floor. prepared a bill? You have had a year to soon as 2010. But when the true 10-year The PRESIDING OFFICER. The Sen- do it. You knew this was coming. I score, when the expenditures start ator from Montana. know you have many ideas because we from 2014 to 2023—the first 10 years of Mr. BAUCUS. Madam President, I have heard them in speeches, we have real implementation of the bill—that is ask unanimous consent that Senator seen them in charts, and we have seen when the cost of the program is $2.5 ROCKEFELLER be added as cosponsor to them in press releases. But we don’t trillion. I don’t think that is disputable the Lincoln amendment, No. 2905. see a bill. Nothing. It leads you to two in any significant way. Maybe a little The PRESIDING OFFICER. Without conclusions—one of two. This is too here or there. I am just explaining objection, it is so ordered. hard to do, so they didn’t do it, too dif- what the facts are. Mr. BAUCUS. Madam President, may ficult to write a bill, so they didn’t do Overall, costs rise too. They do not I ask how much time remains on each it, or they really don’t believe we need go down. The Congressional Budget Of- side? to change the current system. Well, fice states that, ‘‘Under the legislation, The PRESIDING OFFICER. The mi- they are wrong. Federal Government outlays for health nority has 19 minutes 40 seconds re- Today, health protection for Ameri- care would increase during the 2010– maining; the majority has 231⁄2 min- cans is not affordable. The cost of 2019 period, as would the Federal budg- utes. health insurance is going up so fast— etary commitment to health care.’’ So Mr. BAUCUS. I thank the Chair. I faster than wages, faster than busi- the Federal Government spending on yield 10 minutes to the Senator from nesses can keep up with it—and people health care, far from going down, is in- Illinois. are being tossed aside, one after the creased under this legislation. The PRESIDING OFFICER. The Sen- other. Fourteen thousand Americans a We currently spend one-sixth of our ator from Illinois. day are losing health insurance be- total gross domestic product—one- Mr. DURBIN. I thank the chairman. cause they lost their job or the busi- sixth of the productivity of our econ- Madam President, the Senator from ness they work for says: We just can’t omy—on health care. How much more Alabama has just said to the Senate: pay the premiums anymore. That is can we afford to pay? And wasn’t it the Slow down; you are going too fast on the reality. original intent of the bill to rein in health care reform here. This bill makes health insurance health care spending to reduce the per- Today, across America, 14,000 Ameri- more affordable, No. 1 and, No. 2, this centage of GDP going to health care? cans will lose their health insurance. bill, at the end of the day, means that Wasn’t that one of the concerns our Tomorrow, 14,000 Americans will lose 94 percent of the people living in Amer- business community has had—that too their health insurance. Monday, the ica will have health insurance. We have much of America’s wealth is going to same, and every day of the week. never in our history ever reached that health care? They would like to see Are we going too fast? The first time level of protection—94 percent. I wish something that would reduce that. this issue came before us was over 100 it were 100 percent, but it is 94 percent. I suppose the fact that it utterly fails years ago. Theodore Roosevelt, a Re- Have the Republicans produced a bill in that regard and, in fact, increases publican, said: We need to talk about that adds health insurance protection the national health care expenditures health care for all Americans. It was a for anyone in America? No. Nothing. from 17 percent of GDP now—more cause that was repeated by Franklin There is something else this bill does, than any other country—to 21 percent Roosevelt, certainly by Harry Truman and it took a lot of hard work to is the reason groups such as the U.S. and Lyndon Johnson. For 100 years achieve it. This bill not only tackles Chamber of Commerce have said this now, there have always been voices in health reform, but it reduces our def- bill must be defeated and have aggres- the Senate who have said: Slow down, icit, and we should. This is a debt our sively opposed it. They do not always you are going too fast. kids are carrying. So Senator BAUCUS get engaged in these issues, but on this This year, 45,000 Americans will die and the Finance Committee worked question they are engaged, and they because they do not have health insur- with Senator REID of Nevada. This bill, have said it will not do and not meet ance. We are the only civilized country by the Congressional Budget Office es- the concerns President Obama re- in the world—the only Western indus- timates, will reduce the deficit by $130 flected upon. He talked about the need trialized, developed country in the billion in the first 10 years, $650 billion to reduce the percentage of GDP on world—where a person can die because in the next 10. How does it do that? health care, but it is going up under they do not have health insurance. Well, if the cost of health care goes this legislation, according to the scor- That is a fact of life. down, the cost of government goes ing of the CBO. Slow down, they say on the other down for the same health care—real One more question. If the benefits side of the aisle; you are going too fast. savings. Have the Republicans, who don’t start until after 5 years from Well, we are here on a Saturday. It is stand here day after day saying we today, why is it so important to pass a rare occurrence for the Senate to have to do something about the deficit, this monstrous bill today? Why can’t meet on Saturday, but I am glad we are produced a health care reform bill that we slow down a little bit? Why can’t we here. If there were ever a time we reduces it? No. Nothing. They have do exactly as we are asking and go step should be here, it is right now. And we nothing to bring to us. by step and find out the things we are here to discuss this bill—a 2,000- Let me talk about one other aspect know can work and do those things— page bill. You know what went into of this bill that is critically important. particularly those things we can do this bill? Two committees: the Senate This bill gives to the American fami- now—that don’t cost money but can ac- Finance Committee, under the leader- lies and consumers, for the first time tually help increase the quality of ship of the Senate Finance Committee in a long time, a fighting chance health care and maybe even bring costs chairman, MAX BAUCUS of Montana, against the health insurance compa- down? Why don’t we do those things? and the HELP Committee, now chaired nies. Do you know what they do to Fiction No. 2: The President said in by Senator DODD of Connecticut. They you? Do you know what happens when his State of the Union Address to the spent days and weeks preparing this you get sick? You not only have to bat- Congress, the joint session of Congress, bill. Why did it take that long? Be- tle your illness, you have to battle

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.033 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12487 your insurance company. Your doctor care. They opposed it when it was cre- I rise not to take on the Senate ma- says you need this prescription, your ated, they have tried to privatize it, jority whip at this point but I rise be- doctor says you need this surgery, and and they have basically ridiculed it as cause we keep hearing from the other then the doctor calls some clerk in a government health insurance pro- side about how premiums are going to some office in the middle of nowhere gram. But for 45 million Americans, it go down. I referred in previous remarks who says: Not covered. We are not pay- is a lifeline to insurance when they re- in this past week to a letter sent to ing for it. And do you know what hap- tire so that their savings don’t melt Senator BAYH that provides a very pens next? The battle rages. It isn’t away and disappear because of high comprehensive analysis of what health just you against the disease; it is you health care bills. insurance premiums will look like as a against your insurance company. Do Most of our colleagues have ignored a result of this Reid bill now before us. you know what they do? They turn you vote they just cast 2 days ago. One of That reminds me of one other thing down. They say: We looked at your ap- the most important votes we have had the Senate majority whip said, that we plication for insurance, and you forgot on the floor—in addition to Senator want to delay action on this bill. What to mention a preexisting condition, MIKULSKI’s amendment which helped we want to have is 99 Senators have the such as acne, when you were a teen- the women of America get preventive time to consider what is in this 2,074- ager. I am not making that up. You health services—was the amendment of page bill, when you have to remember didn’t take into consideration that Senator MICHAEL BENNET of Colorado. that in the secrecy of the Senate lead- there is a limit on how much we will He offered an amendment that basi- er’s office, Senator REID’s office, from pay, and when you get really sick, we cally said any of the savings that come October 2 until about the Saturday be- just stop paying. You didn’t realize forward out of this Medicare change in fore Thanksgiving, it took that long in that you thought your child was cov- this bill have to be put into giving secrecy to put two bills together out of two separate committees. That is one ered by your family health insurance sound financial footing to Medicare, Senator putting together the 2,074-page company, but your young son just more services for the elderly, and mak- bill we have before us. Don’t you think reached the age of 24 and he is not cov- ing certain we protect the services that that 99 other Senators ought to have at ered anymore. He is on his own. are already guaranteed. That passed least that same period of time to con- Well, we take care of every one of 100 to 0. My friends on the other side of those things in this bill. We give fami- sider what is in this bill? I think so. the aisle know that. They all voted for Anyway, getting back to the increase lies, for the first time in history, a it. in premiums and Senator BAYH’s letter fighting chance to take on these insur- So we are protecting Medicare. We from the Congressional Budget Office ance companies—real reform. I have are going to put it on sound financial saying that premiums are going to go yet to hear the first Republican come footing. And for the 45 million people up, I wonder if anyone has actually to the floor and endorse that concept. currently receiving it and those who read that letter. I hear a lot of people Why? Because the health insurance look forward to it in the future, this saying this letter proves that pre- companies hate it. This is how they bill will make Medicare stronger. miums would go down under the Reid make money. Slow down? No, we are not slowing bill, even though that is not what that Did you see what Aetna just an- down. This time, we are going to pass letter says. So I am here to tell people nounced? Aetna is one of the biggest health care reform. This time, we are what the letter says. The letter makes health insurers. Their CEO makes a going to make America a healthier it very clear that premiums will in- very modest $24 million a year in sal- country with quality, affordable health crease on average 10 to 13 percent for ary—$24 million. They had their most care for everybody. people buying coverage in the indi- profitable quarter ever, and they an- Madam President, I yield the floor. vidual market. I think you saw a spe- nounced they need more. So in order to The PRESIDING OFFICER. The Sen- cific figure given by the Senator from add to their profits next year and add ator from Iowa is recognized. Texas, that in his State for a large per- Mr. GRASSLEY. Madam President, I to the payments to their CEO and their centage of the individual market pre- yield myself such time as I might con- shareholders, they are going to take miums would go up, just for people in sume on this side. 650,000 people out of coverage at Aetna. the State of Texas. They are going to drop the people they I listened to the distinguished major- I have a chart here in case you think may just get sick someday. So ity whip. I don’t know how many times missed what this letter actually says. they try to cherry-pick the healthiest we on this side have to tell him that if The people who keep saying premiums people to keep their profits high. What they want to read Republican bills here are going to go down conveniently for- is going to happen to those 650,000 peo- is an opportunity to come and read get to mention this 10 to 13-percent in- ple? Do you think they are going to them. They do exist and they have ex- crease that is going to happen for the join in the chorus from the other side isted for a long time, going back to individual market. No, they would pre- that says slow down when it comes to some of their entries into the Senate in fer to talk about 57 percent of Ameri- health insurance for everybody in this the spring. cans in the individual market who are country? Of course not. Another thing I heard was that Re- going to get subsidies. Yes, it is true. Senator LINCOLN has an amendment publicans have no ideas, taking on the The Government is spending $500 bil- that challenges the CEOs of these insurance companies. I would refer him lion of hard-earned taxpayers’ dollars health insurance companies and says: to the Coburn-Burr bill that does away in addition to the cuts they are having Enough is enough. We will let you de- with the discrimination, that insur- in home health care that is a pending duct from your taxes, we will give you ance companies cannot deny health in- amendment before the Senate. These a subsidy for $400,000 in income for a surance because of preexisting condi- cuts and these tax increases cover up CEO of a health insurance company— tions. the fact that this bill drives up pre- that is how much the President gets I heard him say we are newfound sup- miums faster than current law. paid, incidentally—but beyond that, we porters of Medicare. Let me suggest to I repeat, premiums will go up faster will not let you deduct it. We won’t him that when we learned from the under this bill. Supporters of this bill subsidize these obscene bonuses and complaints of his party 4 years ago, are covering up this increase in costs payments to the health insurance ex- when they were berating the fact that by then handing out these subsidies. ecutives. That is part of this as well. we wanted to take $10 billion out of But if you are 1 of the 14 million people I also think it is great to hear our Medicare and how that was ruining who does not get a subsidy—well, colleagues on the other side of the aisle Medicare—we are faced now with $464 what? You are out of luck. You are with their newfound belief in Medicare. billion out of Medicare and we think stuck with the fact that this is 10 to 13 They come before us and say: You they have talked out of both sides of percent more expensive and, coupled know, we are standing here to fight for their mouth, in the sense that 4 years with it, an unprecedented new Federal Medicare. That is what this battle is ago, if Medicare would be hurt if $10 law that mandates that you buy and really all about. Historically, that billion were taken out, surely if $464 purchase insurance. party has not stood to fight for Medi- billion were taken out, it is hurting Some may say this is the individual care; they have stood to fight Medi- Medicare. market, it only accounts for a small

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The Congres- OK with the status quo, they are OK ensures that no beneficiary would re- sional Budget Office analysis says this with making things worse—higher ceive a reduction in their guaranteed bill maintains the status quo in the taxes, higher premiums, increased defi- Medicare home health benefit. small group and large group insurance cits and less Medicare. Just think, we Let me remind my colleagues again market. Is this something we ought to are approaching the Christmas holiday what will happen if we stick with the be celebrating, maintaining the status season and a Christmas gift coming status quo. The status quo means quo? Are expectations so low at this from this Senate, with a 2,074-page bill: Medicare will be broke in approxi- point that Democrats are celebrating higher taxes, higher premiums, in- mately 8 years. The status quo means that this bill will increase premiums creased deficits, $464 billion cuts in seniors will continue paying higher and for some 14 million people and main- Medicare and not doing anything about higher premiums and cost-sharing due tain the status quo for everybody else? inflation in health care costs. They are to wasteful overpayments to providers. I am being generous in using the celebrating that they spend $2.5 trillion The status quo means that each year phrase status quo, because this bill ac- to raise premiums for 14 million peo- billions of Medicare dollars will con- tually makes things worse for millions ple, not bending this growth curve, not tinue to be wasted on lining the pock- of people. This bill is so bad that cutting costs. ets of private insurance companies. Democrats are trying to convince the Don’t take my word for it. You have And the status quo means that seniors American people that this is more of to read this letter from the Congres- will continue struggling to pay for pre- the same when even that is not the sional Budget Office. It is there in scription drugs. case. black and white as evidenced by the The stakes for seniors and for the What happened to bending the chart I have here. Medicare Program have never been growth curve? In other words, the in- I yield the floor. higher. Senators have a choice: En- flation we have historically had in The PRESIDING OFFICER. The Sen- dorse the status quo or strengthen health care costs, going up three or ator from Massachusetts is recognized. Medicare. Regarding Medicare changes Mr. KERRY. Madam President, I will four times the rate of inflation, going for home health providers, let me de- yield myself such time as I will use. scribe what is in the Senate bill. up now 8 or 9 percent even when we There have been times during this de- have deflation in the economy at large? As most of my colleagues would bate that I have listened with astonish- agree, home health care is an impor- What about the President’s promise ment to the minority. They agree with that everyone will save $2,500? Accord- tant benefit in the Medicare Program. the diagnosis—that our health care Today more than 3 million Medicare ing to CBO, almost every small busi- system is in need of treatment. But ness will pay between 1 percent more beneficiaries receive home health serv- they offer no remedy, no prescription, ices across the country—including or 2 percent less for health insurance. no cure. That means compared to what busi- those with acute illnesses and injuries We don’t need a second opinion on and those afflicted with numerous nesses would have paid under current what the problems are with our health law, this bill will raise premiums 1 per- chronic conditions. care system. Our country leads the Across the country, more than 9,800 cent or maybe decrease them by a world in the advancement of medical home health agencies provide care to whopping 2 percent. That doesn’t sound science. We have the best doctors, the seniors in their homes. This care helps like this bill is providing real relief, best technology and the best hospitals seniors get better and avoid expensive and $2,500 in savings for every Amer- in the world. It is no surprise to see rehospitalizations. Home health pro- ican, as President Obama pledged re- kings and queens come to the United viders make a real difference in im- peatedly during the campaign, is not States for medical treatment. proving seniors’ health. We should sup- going to happen. But for all that, the system is dys- port their efforts. The larger businesses will pay the functional, wasteful and abusive. It re- While I have great respect for the same or up to 3 percent less for health wards quantity over quality. And it de- services of home health providers, we insurance. Once again, that doesn’t livers profits more than care. It is a also have a responsibility to protect sound like relief, it sounds like more of system in which too many American the Medicare Program. As part of this, the same. In fact, the Congressional families are just one illness or one in- we must make sure Medicare is paying Budget Office has confirmed that be- jury away from financial ruin. appropriately—and not overpaying—for tween now and the year 2016, premiums I would like to thank Majority Lead- Medicare services. We must also take will continue to grow at twice the rate er REID, Chairman BAUCUS, Chairman action to root out fraud and abuse in of inflation. DODD and Chairman HARKIN for getting the Medicare Program. I believe the I thought Congress was considering us to this important point in our long policies in the Senate bill achieve both health reform to put an end to the march toward a health care system goals. unsustainable premium increases. This that is affordable and available to all First, the Senate bill would ‘‘rebase’’ bill cuts Medicare by $500 billion, Americans. Their efforts have pre- home health payments to ensure pay- raises taxes by $500 billion, restruc- sented us an opportunity to cast a vote ments reflect actual costs of providing tures 17 percent of our economy, spends that will make life better for every sin- care. These changes are based on $2.5 trillion, and some of my colleagues gle American. It isn’t often that we get MedPAC recommendations, which is on the other side of the aisle are cele- a chance to do that. But we have that the nonpartisan group that advises brating that they have achieved the chance now. Congress on Medicare. status quo when in fact the situation I know the majority leader, the Sen- When the current home health pay- will be worse. I thought the status quo ate Finance Committee, and the ments were set, seniors received an av- was not something that was acceptable Health, Education, Labor, and Pen- erage of 31 visits per episode. Today, to most Members of this body. sions Committees have each tirelessly they only receive 22 visits. The Senate Our constituents want to lower costs. worked on the provisions in this bill bill directs CMS to ‘‘rebase’’ payments That is their main concern. That is and have taken great care to ensure to reflect this change. That is common what our constituents begged for, that Medicare beneficiaries will main- sense. lower costs. But this bill fails to ad- tain access to their guaranteed benefits The Senate bill also roots out fraud dress that concern. It raises premiums and will receive additional preventive in the system by revising how Medicare and, despite offering new ideas benefits and expanded prescription pays for ‘‘outlier’’ cases. Medicare pro- throughout the committee process and drug coverage. vides an extra payment today for pro- on the floor, Republicans are being ac- The amendment offered Senator viders who treat sicker or ‘‘outlier’’ pa- cused of supporting the status quo JOHANNS is very similar to the MCCAIN tients. Unfortunately, the GAO found

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.036 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12489 that some providers were gaming the improves the solvency of the Medicare didn’t say he was not going to reduce system and getting more outlier pay- Program by 5 years. It puts $30 billion the overall amount of money. What he ments than they deserve. back into the pockets of seniors in the said subsequently, and I am quoting For example, GAO found that in one form of lower Medicare premiums. It from factcheck.org—here it is as late Florida County, providers were receiv- makes prescription drugs more afford- as October 17, about 2 weeks before the ing 60 percent of all total outlier pay- able. It guarantees that seniors can election—Mr. Holtz-Eakin said in a ments—even though the county had continue to see the doctor of their telephone conference call with report- less than 1 percent of the total Medi- choosing. It provides free wellness and ers, representing the campaign for the care population. Clearly, something prevention benefits to Medicare bene- Republican party: was going on there that needs to be ficiaries. And it also includes fair and Any shortfall in McCain’s health care plan changed. appropriate changes for home health will be covered without cutting benefits by The Senate bill addresses this prob- that protect access to care. such measures as Medicare fraud and abuse lem by placing a cap on the amount The truth is the Johanns amendment reduction, employing a new generation of any individual provider can receive in is harming seniors, harming the Medi- treatment models for expensive chronic dis- outlier payments. In addition, it estab- care Program, and harming taxpayers. eases, speeding adoption of low-cost generic lishes a productivity adjustment for For this reason, I urge my colleagues drugs, and expanding the use of information technology in medicine. home health providers beginning in to oppose the amendment by Senator 2015. These changes ask home health JOHANNS and to support my home That is exactly some of which is hap- providers—like all other providers—to health amendment which ensures that pening right here—some of which is offer more efficient and higher quality no beneficiary would receive a reduc- happening right here. care over time. tion in their guaranteed Medicare Let’s get this conversation into a I believe the Senate policies are fair home health benefit. place of reality. Here is what happened and reasonable. In making these I just listened to my friend, Senator in arriving at the reductions in overall changes, we worked closely with the GRASSLEY. He and I have a good rela- Medicare expenditures, which does not home health industry to ensure these tionship; we work together here; we reduce any benefit to any senior cit- changes were reasonable and fair. On both serve on the Finance Committee. izen, which is why AARP, that rep- the rebasing policy, MedPAC rec- I have enjoyed a lot of the things we do resents 40 million senior citizens, is ommended we fully implement these together. Clearly, whatever I am say- supporting the Democratic legislation. changes in 2011. To ensure providers ing is going to be substantive, but They have written that to us as late as could adapt to the new payment rates, there is nothing personal in it. I have yesterday. the Senate bill phases-in the changes to say there is a lack of reality here in Madam President, $120 billion comes over 4 years. The home health pro- a lot of the comments we are hearing from reducing overpayments in Medi- viders support this phase-in. from our friends on the other side of care. Someone on the other side of the The outlier policy and fraud changes the aisle, and a persistance in perpet- aisle has to explain to me how you hurt were actually suggested by the home uating a myth. Medicare by stopping the charging of a health industry. The home health in- A lot have seen the politics of this $90 overprice of premium to seniors, dustry fully supports these changes. country where, if you say something which is what happens. Do you know For the productivity changes, the Sen- over and over, no matter how true it is, how the overpayments are paid for? ate bill holds off on applying these re- it can have an impact. I know that per- Every senior couple, in a traditional ductions while the rebasing policy is sonally. But let me tell you, I heard Medicare plan, pays an additional $90 taking effect. the Senator from Iowa say—I am going per year in order to finance the over- This will give providers extra time to to quote him; I wrote it down: payments. What they are suggesting is, adapt to the payment changes and is we shouldn’t cut overpayments. What much less aggressive than the pro- Certainly if $450 billion is being taken out of Medicare, it is hurting Medicare. they are suggesting is, Medicare is OK, posals put forth by MedPAC, the House That is what he said. Let me review paying seniors in a certain group an bill and the administration, which re- overpayment that doesn’t even go to quire all of these payment changes to what is happening here. I want to go back to the comments of the Repub- the seniors. Guess whom it goes to. It be implemented at the same time. goes to the insurance company. Are Finally, the Senate bill includes spe- lican nominee for President last year. This is a quote. JOHN MCCAIN, from an you telling me we ought to go to the cial protections for rural home health taxpayers and say: Hey, folks, we know providers. From 2010—2015, rural pro- article in the Wall Street Journal: John McCain would pay for his health care we are paying a 14-percent overpay- viders will receive a 3 percent extra ment for the service compared to what payment each year. This payment will plan with major reductions to Medicare and Medicaid, a top aide said, in a move that we pay for everybody else and we are ensure that rural providers are pro- independent analysts estimate could result going to keep on paying it. That is ex- tected as we reform the broader home in cuts of $1.3 trillion. actly what our friends on the other health system. In total, the Medicare After I said that on the floor, the side of the aisle are saying. delivery reforms in the Senate bill Senator from North Carolina, Senator What we are saying is: No, we think strike a fair balance between ensuring BURR, stood up and said: we ought to reduce that payment, and seniors have access to care, while also Have you seen factcheck.org? that is the $120 billion. That doesn’t rooting out inappropriate payments I said I haven’t read the specific arti- cut one benefit for a senior, but it from the system. makes the program more effective. The opponents of these Medicare cle but we didn’t see that corrected in Let me go further. Here are the peo- changes do not have a plan to protect the course of the campaign. ple who have come together in a series seniors and strengthen the Medicare Now I have seen the article. I wanted of meetings to say: Yes, we can live Program. They advocate doing noth- to know what the Senator from North with a reduction in our overall Medi- ing. The opponents of health reform Carolina was referring to, so I went and care payment because we can be more are now claiming that Medicare bene- got factcheck.org. Factcheck.org went efficient. The hospitals came to the ficiaries will be harmed by this bill. through the Obama campaign ads and White House and said: We are willing And here is what AARP—for example— their ads and fact checked what was to reduce the payments we are receiv- has said about these claims: being said. The McCain adviser is a fel- AARP: low named Holtz-Eakin. In a con- ing by $150 billion. Guess what. We are not even doing that. We are only ask- Opponents of health reform won’t rest. ference call with reporters after the ad [They are] using myths and misinformation was released, what he said was: ing them to reduce their payments by to distort the truth and wrongly suggesting No service is being reduced. Every bene- $106 billion. That is what is in this bill. that Medicare will be harmed. After a life- ficiary will in the future receive exactly the The hospitals have agreed. I represent time of hard work, don’t seniors deserve bet- benefits that they have been promised from hospitals in Massachusetts. We have ter? the beginning. one of the best hospital systems in I would like to remind my colleagues That is the same thing as we are America in the network of hospitals we of the positive changes in the bill. It doing. No benefit is being cut. But he have. People come from all over the

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They don’t have wellness and campaign position paper on a specific protect the way we do that so it prevention benefits today. It provides plan of action lowering health care doesn’t do injury. for them. costs be printed in the RECORD. The insurers have come to the table. It guarantees they will see the doctor The PRESIDING OFFICER. Without Home health care came to the table. I of their choice. It actually puts $30 bil- objection, it is so ordered. read the letter earlier from home lion back into their pockets, and it There being no objection, the mate- health care services. It is from the also includes fair and appropriate rial was ordered to be printed in the President of the National Association changes for home health that actually RECORD, as follows: for Home Care & Hospice. He writes: protects access to health care. A SPECIFIC PLAN OF ACTION: LOWERING We support the provisions of your The truth is, the Johanns amend- HEALTH CARE COSTS health care reform legislation as they ment is the amendment that actually John McCain Proposes a Number of Initia- relate to home health care. That is would wind up hurting seniors. This tives That Can Lower Health Care Costs. If we act today, we can lower health care costs what we are debating on the floor. amendment provides additional bene- fits. We all understand the importance for families through common-sense initia- They do support it. tives. Within a decade, health spending will The fact is, the Senator from Geor- of this. The Senate bill releases home health care payments so those pay- comprise twenty percent of our economy. gia, who stood and said: In our State, This is taking an increasing toll on Amer- we have a letter that says—well, first ments actually reflect the real cost of ica’s families and small businesses. Even of all, that is based on an earlier as- providing care. We do that not in a par- Senators Clinton and Obama recognize the sumption. Secondly, we have no idea tisan way. We do that based on the pressure skyrocketing health costs place on what the assumptions are in the anal- nonpartisan MedPAC commission rec- small business when they exempt small busi- ommendations to us of how you can nesses from their employer mandate plans. ysis they made. Thirdly, it is based pri- Cheaper Drugs: Lowering Drug Prices. marily on the House bill, which has $13 improve Medicare. Our colleagues have a long way to go John McCain will look to bring greater com- billion more in reductions than we on the other side to begin to talk about petition to our drug markets through safe have. So before we get stuck there, we real health care change. This bill roots re-importation of drugs and faster introduc- ought to listen to the national associa- tion of generic drugs. out fraud from the system, revises how tion that is working with us on a daily Chronic Disease: Providing Quality, Cheap- Medicare pays for the outlier cases; basis, where we agree on what the re- er Care For Chronic Disease. Chronic condi- that is, the cases that treat the sicker tions account for three-quarters of the na- ductions ought to be. or what we call outlier patients. Unfor- tion’s annual health care bill. By empha- The skilled nursing facilities, the tunately, GAO found some providers sizing prevention, early intervention, rehab facilities, the long-term acute were gaming the system and getting healthy habits, new treatment models, new care hospitals have all come to the more outlier payments than they de- public health infrastructure and the use of table and said: We can do this. Is that information technology, we can reduce serve. Do they want us to continue to their preference? Do they love it? No- health care costs. We should dedicate more overpay people, providing service that federal research to caring and curing chronic body wants their budget to be tight- people either don’t need or charging ened, where they have to make changes disease. more for the service that they do need Coordinated Care: Promoting Coordinated to try to be more effective. But the but could have gotten at a lower price? Care. Coordinated care—with providers col- bottom line is, every single one of Those are the changes we make. The laborating to produce the best health care— them has agreed with what we are American people will be proud of it. offers better outcomes at lower cost. We doing on this side of the aisle. Notwith- Let me give an example. The GAO should pay a single bill for high-quality dis- standing that, our friends on the other found that in a Florida county, pro- ease care which will make every single pro- side of the aisle keep coming back and viders were receiving 60 percent of all vider accountable and responsive to the pa- keep trying to stand for grandma or tients’ needs. the other outlier payments, even Greater Access and Convenience: Expand- stand for some senior citizen who is though the county had less than 1 per- ing Access To Health Care. Families place a being falsely scared into believing cent of the total Medicare population. high value on quickly getting simple care. their benefit is going to be cut or that That is absurd. What we do is fix those Government should promote greater access Medicare is somehow going to be less kinds of absurdities that make Ameri- through walk-in clinics in retail outlets. available to them. cans so angry about the administration Information Technology: Greater Use Of My amendment, which we will ulti- of their tax dollars in Washington. Information Technology To Reduce Costs. mately vote on, will guarantee that no I believe the Senate bill addresses a We should promote the rapid deployment of benefit is going to be cut for any senior 21st century information systems and tech- number of these problems in a thought- nology that allows doctors to practice across under this plan. That is what we are ful way. state lines. going to do. We need to have a debate about what Medicaid and Medicare: Reforming the In addition to that, let me remind is in this bill and what the real impacts Payment System To Cut Costs. We must re- my colleagues and people listening are and what the negative impacts are form the payment systems in Medicaid and what this bill does. This bill actually of not doing these things. Our col- Medicare to compensate providers for diag- improves the solvency of Medicare. We leagues stand for the status quo. This nosis, prevention and care coordination. have heard any number of people say is going to be historic when we pass it Medicaid and Medicare should not pay for Medicare is going to go bankrupt by because it is going to benefit people in preventable medical errors or mismanage- ment. Medicare should lead the way in 2017. Indeed, it is. We stretch that out. so many different ways, getting rid of health care reforms that improve quality We improve that so we can then take preexisting condition restraints, not and lower costs. We need to change the way the improvements in the health care having people kicked off insurance providers are paid to move away from frag- system—— they thought they had but when they mented care and focus their attention on The PRESIDING OFFICER. The time get sick, they find it is gone. We end prevention and coordinated care, especially of the Senator has expired. that. We get 31 billion more people cov- for those with chronic conditions. This is the Mr. KERRY. I yield myself an addi- ered in a way that spreads the risk of utmost important step in effectively caring tional couple of minutes. being sick in a sensible way and re- for an aging population. We must work in a bipartisan manner to reform the physician It improves the solvency of the Medi- duces the costs for other Americans. care program by 5 years. It puts $30 bil- payment system, focus efforts on elimi- That is common sense. I am proud of nating fraud and move Medicare into a new lion back into the pockets of seniors in what we are doing. generation of coordinated, quality care. the form of lower Medicare premiums. The PRESIDING OFFICER. The Sen- Smoking: Promoting the Availability of It makes prescription drugs more af- ator from Arizona. Cessation Programs. Most smokers would

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Reserving the right to is that I never envisioned, nor do I be- of access, coordinated payments per episode object—— lieve the American people ever envi- covered under Medicaid, use of private insur- Mr. MCCAIN. The Senator from Mas- sioned, we would be ‘‘cutting’’ benefits ance in Medicaid, alternative insurance poli- sachusetts wants to distort my record, or, as the Senator says, making sav- cies and different licensing schemes for pro- and that is fine. But it gets a little—— ings in order to transfer that to a viders. The PRESIDING OFFICER. Is there brand new entitlement program. That Tort Reform: Passing Medical Liability Reform. We must pass medical liability re- objection to having the document is what the debate is about, whether we form that eliminates lawsuits directed at printed in the RECORD? are going to take a failing system that doctors who follow clinical guidelines and Mr. MCCAIN. As Ronald Reagan once in 7 years is going bankrupt, according adhere to safety protocols. Every patient said: Facts are stubborn things. to the Medicare trustees, and then take should have access to legal remedies in cases Mr. KERRY. Madam President, I am all this money, no matter how these of bad medical practice but that should not not going to object to putting some- savings are made—and I believe they be an invitation to endless, frivolous law- thing important in, but I would like are cuts of huge magnitude—and then suits. my colleague to stay for a moment be- fund a brandnew entitlement program. Transparency: Bringing Transparency To That is what this real debate is Health Care Costs. We must make public cause this is very important. more information on treatment options and Mr. GRASSLEY. Regular order. about. doctor records, and require transparency re- The PRESIDING OFFICER. The ma- I thank my friend from Massachu- garding medical outcomes, quality of care, jority’s time has expired. setts for his courtesy. I look forward to costs and prices. We must also facilitate the The Senator from Iowa. the rebuttal from the Senator from Il- development of national standards for meas- Mr. GRASSLEY. I yield the remain- linois, as well as the Senator from uring and recording treatments and out- ing time on our side to Senator THUNE. Montana. Thank you. comes. Mr. KERRY. I have objected to a I yield the floor. CONFRONTING THE LONG-TERM CARE statement being put in unless I have a Several Senators addressed the CHALLENGE chance to explain it. Chair. John McCain Will Develop A Strategy For The PRESIDING OFFICER. Objec- The PRESIDING OFFICER. The Chair is in doubt. Meeting The Challenge Of A Population tion is heard. Needing Greater Long-Term Care. There Mr. BAUCUS. Madam President, I Mr. MCCAIN. I ask unanimous con- have been a variety of state-based experi- suggest the Senator from Iowa be rec- sent that the Senator from Massachu- ments such as Cash and Counseling or The ognized. Program of All-Inclusive Care for the Elder- setts be allowed 3 additional minutes The PRESIDING OFFICER. The Sen- ly (PACE) that are pioneering approaches for and I be allowed 2 additional minutes. ator from Iowa. delivering care to people in a home setting. The PRESIDING OFFICER. Is there Mr. GRASSLEY. Madam President, I Seniors are given a monthly stipend which objection? yield the remainder of the time to the they can use to: hire workers and purchase The Senator from Massachusetts. care-related services and goods. They can get Senator from South Dakota. Mr. KERRY. I thank my friend from The PRESIDING OFFICER. The Sen- help managing their care by designating rep- Arizona because this is the way the resentatives, such as relatives or friends, to ator from South Dakota. help make decisions. It also offers counseling Senate ought to work. I totally agree Mr. THUNE. Madam President, this and bookkeeping services to assist con- with what the Senator said. I want the is a great discussion. I have to say the sumers in handling their programmatic re- Senator to know I agree with him. He fundamental point in this discussion sponsibilities. is correct that the statement in should not be lost on anybody in this SETTING THE RECORD STRAIGHT: COVERING FactCheck.org calls the Obama cam- Chamber or on the American people; THOSE WITH PRE-EXISTING CONDITIONS paign to account for a misstatement that is, whatever was said during the Myth: Some claim that under John about his proposal. I agree. It did that. course of the campaign last year was McCain’s plan, those with pre-existing condi- It did not recommend a reduction in said in the context of protecting and tions would be denied insurance. benefits. But that is not what I sug- preserving and prolonging the lifespan Fact: John McCain Supported The Health gested that it did. What I am talking of Medicare. Insurance Portability And Accountability about is, the Senator said—and his Act In 1996 That Took The Important Step Of Senator MCCAIN is very accurate in Providing Some Protection Against Exclu- staff insisted—he could get the savings the way he describes his position. But sion Of Pre-Existing Conditions. for his reductions that would benefit the American people need to under- Fact: Nothing In John McCain’s Plan Medicare from waste, fraud, and abuse stand what the other side is proposing: Changes The Fact That If You Are Employed from new treatment models, from ex- a $2.5 trillion expansion of the Federal And Insured You Will Build Protection panding the use of information tech- Government, financed with $1⁄2 trillion Against The Cost Of Any Pre-Existing Condi- nology and that there is a complete in Medicare cuts in the first 10 years tion. similarity between what we are doing Fact: As President, John McCain Would and, as the Senator from New Hamp- Work With Governors To Find The Solutions in order to achieve these savings and shire said, $3 trillion in the first two Necessary To Ensure Those With Pre-Exist- what he was doing. I am trying to point decades of this program—which does ing Conditions Are Able To Easily Access out the similarity, not the difference. I nothing to extend the lifespan of Medi- Care. am not here to debate the campaign ad. care by 1 day, nothing. What it does is Mr. MCCAIN. Then I ask unanimous I think it didn’t accurately reflect the it creates an entirely new entitlement consent to have printed in the RECORD Senator’s position. But do I believe, if program that is going to be paid for by a statement from FactCheck.org, of you read the whole article, which is future generations of Americans. October 20, 2008, that says: ‘‘Obama’s why I will not object to it being put in So Medicare, which is destined to be False Medicare Claim,’’ which were the there, you will see it clearly says he is bankrupt by 2017—is sitting out there attacks on me which were not based on supportive of savings in Medicare, so floundering with this huge unfunded li- fact. I quote from FactCheck.org: you can do it without cutting benefits, ability. It is going bankrupt. What we These claims are false, and based on a sin- which is exactly what we are doing. are talking about doing is piling a $2.5 gle newspaper report that says no such I yield the floor and thank my col- trillion new entitlement program on thing. McCain’s policy director states un- league for his courtesy. top of that. That is what this debate is equivocally that no benefit cuts are envi- The PRESIDING OFFICER. The Sen- about. sioned. McCain does propose substantial ator from Arizona. They can say these Medicare cuts are ‘‘savings’’ . . . Mr. MCCAIN. Madam President, I not real. But we have 11 million people I did propose savings, and we can thank the Senator from Massachusetts. in this country who get Medicare Ad- make savings. Nowhere in my wildest This has been a vigorous debate. I see vantage benefits, and if there is going

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Yes, health care agencies, like they do in competitive in the global marketplace and Montana, provide services to people in cost us good-paying jobs. without objection, it is so ordered. Mr. BAUCUS. Madam President, I rural areas. Some home care special- This is about jobs, and this proposal would just like to state as clearly as I ists have to travel 50 or 60 miles to does nothing to help small businesses possibly can, so people understand, the serve a patient in their home. What we create jobs. It kills jobs. That is why Medicare savings are being used for are talking about doing is cutting, in the National Federation of Independent Medicare. There is a strong implication my State, $35 million out of home Business, the Chamber of Commerce, 1 by many Senators that the savings are health care. These cuts are $ ⁄2 trillion. the National Association of Whole- Of course, somebody gets hurt by that. salers and Distributors—all the major not going to be used for Medicare, that But what is probably most troubling business organizations—are opposed to it will go someplace else. That is not of all, I guess, about the whole proposal this legislation. They know the impact true. The Medicare savings are going to the other side has made is, after all it will have on jobs. be used for Medicare. that—cutting Medicare, raising taxes— I want to read one final quote. This What are the savings? I think all at the end of the day 90 percent of the does not come from a business organi- Senators would like to reduce waste. people in this country either have their zation. This comes from the dean of the All Senators agree there is too much health insurance premiums stay the Harvard Medical School. This was in an waste in the current system. It makes same or go up—over 6 percent if you op-ed just recently in the Wall Street good sense to try to attack that waste, are in the small-employer market, 5 Journal: root out that waste, and where there percent if you are in the large- Speeches and news reports can lead you to are overexpenditures, to try to get the employer market—double the rate of believe that proposed congressional legisla- levels down to a reasonable level. Ev- inflation. That does not change any- tion would tackle the problems of cost, ac- erybody knows we have spent too many thing. cess and quality. But that’s not true. . . . So dollars on Medicare Advantage. Every- If you are a family today, and you the overall effort will fail to qualify as re- body knows that. That is why we are are paying $13,000 for health care insur- form. bringing that cost down. ance—this is according to the Congres- In discussions with dozens of health-care There is also waste and fraud—I leaders and economists, I find near una- know my good friend from South Da- sional Budget Office—in 2016 you will nimity of opinion that, whatever its shape, be paying over $20,000 a year for health the final legislation that will emerge from kota understands this—in home health insurance. That is a $7,000 increase. Congress will markedly accelerate national care agencies. In the State of Florida, Now, tell me how that reforms or helps health-care spending rather than restrain it. for example, the Government Account- anybody in this country? That is from the dean of the Harvard ability Office showed that in Florida 60 I want to show you how far we have Medical School. He goes on to say: percent of the outlier payments—the come because the President said, in This will make an eventual solution even extra money that goes for sicker pa- 2007, when he was campaigning: When I more difficult. tients—were in one county. That coun- become President, we will have a So these Medicare cuts are real. They ty has 1 percent of seniors. It had 60 percent of the outlier payments, ac- health care reform bill that reduces are $1⁄2 trillion in the first 10 years. As premiums for people in this country by the Senator from New Hampshire has cording to the Government Account- $2,500 per family and covers everybody. said, $3 trillion over the first two dec- ability Office. That is fraud. They root- We all know this bill leaves 24 million ades. It cuts Medicare Advantage. ed out a lot of fraud in home health. people uncovered, according to the There are 11 million seniors in this Home health is very good. My mother Congressional Budget Office. It raises country who get Medicare Advantage. is in home health right now. It works premiums by 10 to 13 percent for every- So do not say they are not going to get really well. I am very proud of the body who buys in the individual mar- hurt. Their benefits are going to go home health caretaker there who takes ketplace. It keeps them the same—and down. Of course they are going to get care of my mother. But we are reduc- when I say ‘‘the same,’’ there will be hurt. ing some of the overpayments. We are yearly increases of 5 to 6 percent year Home health agencies, nursing getting the waste out. And guess what. over year for this foreseeable future— homes, hospices—as I said, in my State Those savings, where do they go? They for everybody else. of South Dakota, home health care de- go back into Medicare. I repeat that. The best you can hope for, America— livery will feel an impact of $35 million They go back into Medicare. I do not 90 percent of America—is the status in an area of the country where we know if any Senator wants to open up quo. That is the best you can hope for have vast distances in geography and his ears or her ears and hear that. They under this bill. How does that change where we already have home health go back into Medicare. Guess what. the status quo? How is that reform? agencies closing up shop because the That is why the solvency of the Medi- You can call this an overhaul. You can reimbursements do not keep up with care trust fund is extended. call this a takeover. You can call it the costs, particularly when you have If these so-called cuts, which we hear lots of things. But it is not reform be- to travel the distances we have to in about on the other side, were really cause when the American people think our States. If you have to put them in cuts, as implied by the other side, you about reform, they are thinking about the hospital, the costs go up by mul- would think that would hurt Medicare. something that drives their health care tiples. It is so much more efficient to You would think that might reduce the costs down not up. have somebody served in a home health period in which the trust fund would be The Congressional Budget Office has setting rather than have them stay solvent; that it would go insolvent at said that under this bill, health care overnight in a hospital or staying suc- an earlier time, if we were really cut- costs in this country will go up by $160 cessive nights in a hospital. ting Medicare. No, it is the opposite. billion over the first 10 years, not So this is not reform. This actually These are savings in Medicare which down. If you are 90 percent of Ameri- keeps costs the same or drives them up extend the life of Medicare. cans, you stay the same or your pre- for 90 percent of Americans. It does Please, please—I see my friend from miums—at worst—go up by 10 to 13 per- nothing to preserve the lifespan—— Iowa. I think he understands, these cent. That is according to the Congres- The PRESIDING OFFICER. The mi- Medicare savings go into Medicare for sional Budget Office. nority’s time has expired. extending the solvency of the Medicare So I want to point out how far this Mr. THUNE. I yield the floor. trust fund. I see my friend from South debate has evolved from what the goals The PRESIDING OFFICER. The Sen- Dakota. I think he understands—he is were in the first place. I have some ator from Montana. sitting there and grinning at me now—

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.040 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12493 I think he understands those savings OBAMA’S FALSE MEDICARE CLAIM fits is a quote from McCain adviser Douglas go back into Medicare and extend the (By Brooks Jackson) Holtz-Eakin promising to maintain ‘‘the ben- efit package that has been promised.’’ The solvency of the trust fund. So let’s SUMMARY story quotes him as saying ‘‘savings’’ would make that very clear. In a TV ad and in speeches, Obama is mak- come from eliminating Medicare fraud and Second, we are using some of the ing bogus claims that McCain plans to cut by reforming payment policies to lower the money to reduce Part B premiums. $880 billion from Medicare spending and to overall cost of care. That helps seniors. If Part B premiums reduce benefits. OBAMA-BIDEN AD: ‘‘GOLDEN YEARS’’ A TV spot says McCain’s plan requires are reduced, that helps seniors. By how OBAMA. I’m Barack Obama and I approve ‘‘cuts in benefits, eligibility or both.’’ much? Madam President, $30 billion this message. Obama said in a speech that McCain plans over 10 years. That will reduce seniors’ ANNOUNCER. How would your golden years ‘‘cuts’’ that would force seniors to ‘‘pay Part B premiums. That helps seniors. turn out under John McCain? His health care more for your drugs, receive fewer services, plan would cut Medicare by $800 billion. That We are not taking money away from and get lower quality care.’’ seniors; we are helping seniors, giving means a 22% cut in benefits. Higher pre- Update, Oct. 21: A second Obama ad claims miums and co-pays. More expensive prescrip- more dollars to seniors in this legisla- that McCain’s plan would bring about a 22 tion drugs. Nursing home care could suffer tion. percent cut in benefits, ‘‘higher premiums and so could your choice of doctor. After a In addition, there are additional ben- and co-pays,’’ and more expensive prescrip- lifetime of work, seniors’ health care efits for seniors in this legislation. We tion drugs. shouldn’t be a gamble. John McCain’s plan, are starting to close the doughnut These claims are false, and based on a sin- it’s not the change we need. gle newspaper report that says no such hole—that is something seniors talk The fact is that McCain has never proposed thing. McCain’s policy director states un- to cut Medicare benefits, or Medicaid bene- about—in prescription drug benefits. equivocally that no benefit cuts are envi- fits either. Obama’s claim is based on a false They want that doughnut hole closed. sioned. McCain does propose substantial reading of a single Wall Street Journal I might add to that, there are other ‘‘savings’’ through such means as cutting story, amplified by a one-sided, partisan benefits: new preventive benefits under fraud, increased use of information tech- analysis that piles speculation atop mis- Medicare for mammograms, preventive nology in medicine and better handling of interpretation. The Journal story in turn screenings, colonoscopies, annual expensive chronic diseases. Obama himself was based on an interview with McCain ad- wellness visits—all new benefits. proposes some of the same cost-saving meas- viser Holtz-Eakin. He said flatly in a con- So I want to make it very clear that ures. We’re skeptical that either candidate ference call with reporters after the ad was can deliver the savings they promise, but released, ‘‘No service is being reduced. Every it is not true when some Senators say that’s no basis for Obama to accuse McCain beneficiary will in the future receive exactly we are taking money away from Medi- of planning huge benefit cuts. the benefits that they have been promised care and creating a whole new entitle- ANALYSIS from the beginning.’’ ment program. We are not taking The Obama campaign began the Medicare TWISTING FACTS TO SCARE SENIORS money away from Medicare and hurt- assault with a 30-second TV ad released Oct. Here’s how Democrats cooked up their ing seniors. We are reforming how dol- 17, which it said would run ‘‘across the coun- bogus $882 billion claim. lars are paid, taking the waste out, and try in key states.’’ On Oct. 6, the Journal ran a story saying extra, excessive payments, and putting ANNOUNCER. John McCain’s health care that McCain planned to pay for his health the money back into Medicare, back plan . . . first we learned he’s going to tax care plan ‘‘in part’’ through reduced Medi- care and Medicaid spending, quoting Holtz- for seniors, back for beneficiaries. health care benefits to pay for part of it. Now the Wall Street Journal reports John Eakin as its authority. The Journal charac- Also, not one penny of guaranteed terizes these reductions as both ‘‘cuts’’ and benefits will be cut. Not one penny can McCain would pay for the rest of his health care plan ‘‘with major reductions to Medi- ‘‘savings.’’ Importantly, Holtz-Eakin did not be cut. So please, people, understand care and Medicaid.’’ say that any benefits would be cut, and the that the savings go to help seniors, Eight hundred and eighty-two billion from one direct quote from him in the article with more benefits, extending the sol- Medicare alone. ‘‘Requiring cuts in benefits, makes clear that he’s talking about econo- mies: ‘‘Wall Street Journal, Oct. 6: Mr. vency of the trust fund. That is what eligibility, or both.’’ Holtz-Eakin said the Medicare and Medicaid we are doing. If we keep that firm John McCain . . . Taxing Health Benefits changes would improve the programs and . . . Cutting Medicare. We Can’t Afford John point in mind, then maybe we can go eliminate fraud, but he didn’t detail where McCain. address some of the next steps that are the cuts would come from. ‘‘It’s about giving OBAMA. I’m Barack Obama and I approved in this bill. But that is very important. them the benefit package that has been this message. The ad quotes the Wall Street Madam President, I do not know how promised to them by law at lower cost,’’ he Journal as saying McCain would pay for his much time I have. said.’’ health care plan with ‘‘major reductions to Holtz-Eakin complains that the Journal The PRESIDING OFFICER. The Sen- Medicare and Medicaid,’’ which the ad says ator has 16 seconds. story was ‘‘a terrible characterization’’ of would total $882 billion from Medicare alone, McCain’s intentions, but even so it clearly Mr. BAUCUS. Madam President, he ‘‘requiring cuts in benefits, eligibility, or quoted him as saying McCain planned on can probably extend a little bit. I see both.’’ ‘‘giving [Medicare and Medicaid bene- the Senator from Minnesota anxiously Obama elaborated on the theme Oct. 18 in ficiaries] the benefit package that has been sitting over there in the corner. Maybe a stump speech in St. Louis, Mo., claiming promised.’’ we could give him a couple—— flatly that seniors would face major medical Nevertheless, a Democratic-leaning group hardships under McCain: ‘‘Obama, Oct. 18: quickly twisted his quotes into a report with Mr. FRANKEN. Madam President, I But it turns out, Senator McCain would pay will just take the 16 seconds. a headline stating that the McCain plan ‘‘re- for part of his plan by making drastic cuts in quires deep benefit and eligibility cuts in The PRESIDING OFFICER. The Sen- Medicare—$882 billion worth. Under his plan, Medicare and Medicaid’’—the opposite of ator from Minnesota. if you count on Medicare, you would have what the Journal quoted Holtz-Eakin as say- Mr. FRANKEN. I do have the micro- fewer places to get care, and less freedom to ing. The report was issued by the Center for phone, and I thank you for the 16 sec- choose your doctors. You’ll pay more for American Progress Action Fund, headed by onds. your drugs, receive fewer services, and get John D. Podesta, former chief of staff to I would like to now—oh, I have used lower quality care.’’ Democratic President Bill Clinton. The re- it up. Update, Oct. 21: A second and even more port’s authors are a former Clinton adminis- misleading Obama ad begins: ‘‘How will your I yield my time. tration official, a former aid to Democratic golden years turn out?’’ It states flatly that Sen. Bob Kerrey and a former aid to Demo- The PRESIDING OFFICER. The Sen- McCain’s plan would mean a 22 percent cut cratic Sen. Barbara Mikulski. ator from Wyoming. in benefits, higher premiums, higher co-pays, The first sentence said—quite incorrectly— Mr. ENZI. Madam President, first, I and more expensive prescription drugs, and that McCain ‘‘disclosed this week that he ask unanimous consent that an article claims that both nursing home care and a would cut $1.3 trillion from Medicare and that was discussed earlier and had patient’s choice of doctor could be affected. Medicaid to pay for his health care plan.’’ some objection to it—but that objec- As the narrator says that McCain’s plan McCain said no such thing, and neither did tion has been resolved now—from ‘‘means a 22 percent cut in benefits,’’ the ad Holtz-Eakin. The Journal reporter cited a FactCheck.org be printed in the displays a footnote citing an Oct. 6 Wall $1.3 trillion estimate of the amount McCain Street Journal story as its authority. would need to produce, over 10 years, to RECORD. But, in fact, the Journal story makes no make his health care plan ‘‘budget neutral,’’ There being no objection, the mate- mention of any 22 percent reduction, or any as he promises to do. The estimate comes rial was ordered to be printed in the reduction at all. To the contrary, the story’s not from McCain, but from the Urban-Brook- RECORD, as follows: only mention of what might happen to bene- ings Tax Policy Center. McCain and Holtz-

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.041 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12494 CONGRESSIONAL RECORD — SENATE December 5, 2009 Eakin haven’t disputed that figure, but they it is possible that Obama will break his from Medicare under the House bill and haven’t endorsed it either. promise to raise taxes only on families mak- 9.4 percent of savings under the Senate Nevertheless, the report assumes McCain ing over $250,000 a year. We have no crystal bill. That does not make sense. would divide $1.3 trillion in ‘‘cuts’’ propor- ball, and we don’t pretend we can predict the Home health care has consistently tionately between the two programs, and future. But for Obama or American Progress comes up with this: ‘‘The McCain plan will to state as a matter of fact that McCain will proven to be a compassionate and cost- cut $882 billion from the Medicare program, be forced to cut benefits, or that he is pro- effective alternative to institutional roughly 13 percent of Medicare’s projected posing any such thing, is simply a falsehood care. In rural States where home spending over a 10-year period.’’ And with designed to frighten elderly voters. health providers have to travel long such a cut, the report concludes, Medicare Mr. ENZI. Madam President, I yield 5 distances to deliver care, the impact of spending ‘‘will not keep pace with inflation minutes to the Senator from Maine. these cuts will ultimately fall on our and enrollment growth—thereby requiring The PRESIDING OFFICER. The Sen- seniors because home health agencies cuts in benefits, eligibility, or both.’’ ator from Maine. simply will not be able to afford to ‘‘SAVINGS’’ VS. ‘‘CUTS’’ Ms. COLLINS. Madam President, I serve seniors who are living in smaller For the record, Holtz-Eakin said in a tele- thank the manager of the bill. communities off rural roads in isolated phone conference call with reporters Oct. 17, I rise in support of the motion offered parts of our States. after the ad was released, that any shortfall by my colleague from Nebraska to These deep cuts are completely coun- in McCain’s health care plan could be cov- ered, without cutting benefits, by such meas- commit this bill in order to strike the terproductive to our efforts to control ures as reducing ‘‘Medicare fraud and more than $42 billion in cuts in the overall health care costs. They also abuse,’’ employing ‘‘a new generation of Medicare home health benefit. place the quality of home health serv- treatment models’’ for expensive chronic dis- Madam President, you, too, come ices at risk, particularly given ever-ris- eases, speeding adoption of low-cost generic from a pretty rural State, so I know ing staffing, transportation, and tech- drugs, and expanding the use of information you understand just how important nology cuts. technology in medicine. home health care is to the seniors in As our Nation faces the continuing Interestingly, Obama proposes to pay for our States. Home health care has be- challenges of caring for an aging popu- his own health care plan in part through some of the same measures, particularly ex- come an increasingly important part of lation, now is not the time to be mak- panded use of I.T. and better handling of our health care system. The highly ing such deep cuts in the Medicare chronic disease. Whether either candidate skilled services and compassionate home health benefit. I urge support for can achieve the huge savings they are prom- care that our Nation’s home health the motion to commit introduced by ising is dubious at best. As regular readers of agencies provide have helped to keep my friend and colleague from Ne- FactCheck.org are aware, we’re skeptical of families together. They have enabled braska. Obama’s claim that he can achieve his prom- millions of our most frail and vulner- Thank you, Madam President. ised $2,500 reduction in average health insur- able senior citizens to avoid hospitals Mr. ENZI. Madam President, how ance premiums, for example. But achievable or not, ‘‘savings’’ are what and nursing homes and, instead, to re- much time do we have? McCain is proposing. It’s a rank distortion ceive care just where they want to be, The PRESIDING OFFICER. The mi- for Obama’s ad to twist that into a plan for in the privacy, comfort, and security of nority time has expired. ‘‘cuts in benefits, eligibility or both,’’ and their own homes. The Senator from Montana. for Obama to claim in a speech that seniors Moreover, by helping these individ- Mr. BAUCUS. Madam President, I will ‘‘receive fewer services, and get lower uals to avoid more costly institutional suggest the absence of a quorum. quality care.’’ care, home health saves Medicare mil- The PRESIDING OFFICER. The Update, Oct. 21: The Center for American lions of dollars each year. That is why clerk will call the roll. Progress Action Fund issued a rebuttal to The legislative clerk proceeded to this article, claiming our analysis is I find it so frustrating and so ironic ‘‘flawed,’’ that this article ‘‘relies solely on that once again the Medicare home call the roll. the denials of McCain senior policy adviser health benefit is under attack. The PRESIDING OFFICER. The Sen- Douglas Holtz-Eakin’’ and that we failed to The bill before us would cut pay- ator from Wyoming. conduct a ‘‘thorough analysis of the implica- ments to home health providers by Mr. ENZI. I ask unanimous consent tions’’ of McCain’s health care proposals. more than $42 billion over the next 10 that the order for the quorum call be We disagree. Our criticism of both Obama years. Moreover, these cuts are a dou- rescinded. and American Progress is that they them- ble whammy because they come in ad- The PRESIDING OFFICER. Is there selves misinterpret and misrepresent what dition to $7.5 billion worth of cuts that objection? Holtz-Eakin said to the Wall Street Journal in the first place. He was quoted in the Jour- have been imposed by the Centers for Mr. BAUCUS. As long as it is equally nal, and stated again to reporters in a con- Medicare and Medicaid Services divided between the two sides. ference call, that what McCain is proposing through regulation. Mr. ENZI. That would be fine with is to reduce the costs borne by Medicare and These cuts are particularly unfair me, and I would even allow the Senator Medicaid, and that benefits will not be re- and disproportionate for a program from Minnesota to go first. I would use duced. American Progress simply ignores that costs Medicare less than $16 bil- the same amount of time he uses. that clear statement in its analysis, and the lion a year. That is simply not right, The PRESIDING OFFICER. Without Obama ads take the extra step of telling sen- and it is certainly not in the interests objection, it is so ordered. iors that McCain plans to cut benefits, when Mr. FRANKEN. How much time do I McCain says the opposite. of our Nation’s seniors who rely on The American Progress argument rests on home health care in order to keep out have? Two minutes. the idea that because McCain has also prom- of more expensive hospitals, nursing The PRESIDING OFFICER. The Sen- ised to make his health care plan budget homes, and other institutions. ator from Minnesota. neutral—neither raising nor cutting total The Medicare home health benefit Mr. FRANKEN. Madam President, let federal spending—and that because Amer- has already taken a larger hit in spend- me use the 16 seconds I had but use it ican Progress’ analysis concludes that he ing over the past 10 years than any in a better way, so maybe it won’t be 2 cannot achieve the savings that he claims, other Medicare benefit. In fact, home minutes. I was going to talk about Sen- that McCain therefore must be forced to health as a share of Medicare spending ator LINCOLN’s amendment to limit tax break his promise not to cut benefits. We are also skeptical that McCain can has dropped from 8.7 percent in 1997 to benefits health insurance companies achieve such savings, and we said so at the only 3.6 percent today. receive on salaries for CEOs, but let me outset of our article. And we’ve twice called There was an excellent article in to- just talk about the nature of this de- into question the campaign’s claim that its day’s New York Times talking about bate. plan is budget neutral. But it is false logic to the disproportionate impact this bill My esteemed colleague from Arizona, conclude that Medicare benefit cuts would be would have on home health care. As Senator MCCAIN, quoted Ronald McCain’s only option should his promised the reporter points out, under this leg- Reagan saying facts are stubborn savings fail to materialize. McCain could islation, home care would absorb a dis- things. We just had my distinguished simply run up the deficit. Or he could choose to water down his health care plan to make proportionate share of the cuts. It cur- colleague from South Dakota say that it less expensive. rently accounts for 3.7 percent of the this bill does not extend for 1 day the It is certainly possible that McCain will Medicare budget but would be required solvency of Medicare. Well, according break his promise not to cut benefits, just as to absorb 10.2 percent of the savings to the Office of the Actuary for the

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\CR\FM\A05DE6.018 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12495 Centers for Medicare and Medicaid I urge you to oppose the cut in Medicare dol- a vote with respect to the above-ref- Services, it extends it for 5 years. Now, lars for home health agencies throughout erenced amendments and motion. facts are either stubborn things or they our Nation. The PRESIDING OFFICER. Is there aren’t. The Actuary for CMS is either The New York Times today pointed objection? the Actuary for CMS or not. You can’t out that in the Reid bill: The Republican leader. have a debate such as this and throw Home care would absorb a disproportionate Mr. MCCONNELL. Reserving the things around. Facts are stubborn share of cuts. It currently accounts for 3.7 right to object, and I will not be object- things. We are entitled to our own percent of the Medicare budget, but would ing, I also wish to make clear that the opinions. We are not entitled to our account for 9.4 percent of the cuts in the majority leader and I have an under- Senate bill according to the Congressional own facts. You cannot stand up here Budget Office. standing that we will actually have and wave your arms and say this four votes tomorrow—not just two, doesn’t extend Medicare 1 minute, 1 That is from the New York Times. four. Bearing that in mind, I do not ob- day, when the Actuary for Medicare The last time Congress made similar ject. says the bill extends it for 5 years. cuts was in the Balanced Budget Act in The PRESIDING OFFICER. Without I yield the floor. 1997 when about 15 percent of home objection, it is so ordered. Mr. ENZI. Madam President, how health agencies ended their participa- Mr. BAUCUS. Madam President, I much time do I have? tion in Medicare. So there is a history might say, that is our understanding The PRESIDING OFFICER. The Sen- on this that shows that if we do what on this side as well. we are talking about doing here, we ator has no time. AMENDMENT NO. 2926 TO AMENDMENT NO. 2786 Mr. ENZI. Madam President, the will put people out of business and we will put an end to services to seniors Mr. BAUCUS. Madam President, I agreement was that whatever time he call up the Kerry amendment which is took, our side would get. and the more rural—— Mr. BAUCUS. Madam President, if at the desk and ask for the yeas and The PRESIDING OFFICER. The Sen- nays. ator would then have 2 minutes. my good friend would allow me to in- terrupt to propound a unanimous con- The PRESIDING OFFICER. The Mr. ENZI. Thank you. clerk will report the amendment. Madam President, the first thing I sent agreement so Senators know when The legislative clerk read as follows: wish to do is mention that some of votes are going to come up, and then these things are facts, particularly if continue. The Senator from Montana [Mr. BAUCUS], Mr. ENZI. Sure. for Mr. KERRY, proposes an amendment num- you go to specific situations. In Wyo- bered 2926. ming, our home health care is a spe- Mr. BAUCUS. Madam President, I cific situation, and we have had letters ask unanimous consent that once this The amendment is as follows: pouring in. I have one here from the agreement is entered, it be in order for (Purpose: To protect home health benefits) Home Health Care Alliance of Wyo- Senator KERRY or his designee to be On page 869, between lines 14 and 15, insert ming, and I ask unanimous consent recognized to offer the majority side- the following: that it be printed in the RECORD. by-side to the Johanns motion; that SEC. 3143. PROTECTING HOME HEALTH BENE- There being no objection, the mate- the Senate proceed to vote in relation FITS. Nothing in the provisions of, or amend- rial was ordered to be printed in the to the Kerry amendment; and that upon disposition of the Kerry amend- ments made by, this Act shall result in the RECORD, as follows: reduction of guaranteed home health bene- HOME HEALTH CARE ment, the Senate then proceed to vote fits under title XVIII of the Social Security ALLIANCE OF WYOMING, in relation to the Johanns motion; that Act. no amendments be in order to the Wheatland, WY, December 5, 2009. The PRESIDING OFFICER. The Senator MICHAEL B. ENZI, Kerry amendment or the Johanns mo- question is on agreeing to the amend- Ranking Member, Committee on Health, Edu- tion; further, that upon disposition of ment. cation, Labor & Pensions, Hart Senate Of- the above-referenced amendment and The yeas and nays have been re- fice Building, Washington, DC. motion, the Republican leader’s des- DEAR SENATOR ENZI: Over the past ten quested. Is there a sufficient second? ignee be recognized to call up an years the Medicare home health benefit has There appears to be. amendment related to the Lincoln taken a larger hit in spending reductions The clerk will call the roll. amendment No. 2905; further, that on than any other benefit. As home health has Mr. DURBIN. I announce that the become an increasingly important part of Sunday, December 6, after the Senate Senator from West Virginia (Mr. BYRD) our health care system with highly skilled has resumed consideration of H.R. 3590, is necessarily absent. and often technically complex services that the time until 3:15 p.m. be for debate Mr. KYL. The following Senators are enable millions of senior citizens and dis- with respect to the Lincoln amendment necessarily absent: the Senator from abled Americans to avoid being hospitalized No. 2905, and the Republican amend- or admitted to nursing homes, these home Kentucky (Mr. BUNNING), the Senator ment identified above; with the time health services save Medicare millions of from Oklahoma (Mr. INHOFE), and the on Sunday equally divided and con- dollars each year. Senator from South Carolina (Mr. trolled, with Senators permitted to I believe that further reduction in home GRAHAM). health payments would place the quality and speak for up to 10 minutes each; that Further, if present and voting, the availability of home health services at risk. at 3:15 p.m., the Senate proceed to vote Senator from Kentucky (Mr. BUNNING) I urge you to oppose the cut in Medicare dol- in relation to the Lincoln amendment would have voted ‘‘yea.’’ lars for home health agencies throughout No. 2905; that upon disposition of The result was announced—yeas 96, our nation. amendment No. 2905, the Senate then Sincerely, nays 0, as follows: proceed to vote in relation to the Re- MARI IRELAN, [Rollcall Vote No. 363 Leg.] President. publican amendment related to the YEAS—96 Mr. ENZI. Madam President, the let- Lincoln amendment; that all of the Akaka Casey Gillibrand ter says: amendments and motions covered in this agreement be subject to an affirm- Alexander Chambliss Grassley Over the past 10 years the Medicare home Barrasso Coburn Gregg health benefit has taken a larger hit in ative 60-vote threshold and that if any Baucus Cochran Hagan spending reductions than any other benefit. achieve it, then they be agreed to and Bayh Collins Harkin the motion to reconsider be laid upon Begich Conrad Hatch As home health has become an increasingly Bennet Corker Hutchison important part of our health system with the table; that if they do not achieve Bennett Cornyn Inouye highly skilled and often technically complex that threshold, then they be with- Bingaman Crapo Isakson services that enable millions of senior citi- drawn; that prior to the second votes Bond DeMint Johanns zens and disabled Americans to avoid being Boxer Dodd Johnson covered in this agreement, there be 2 Brown Dorgan Kaufman hospitalized or admitted to nursing homes, minutes of debate; that after the first these home health services save Medicare Brownback Durbin Kerry Burr Ensign Kirk millions of dollars each year. vote, each succeeding vote covered here be limited to 10 minutes each; pro- Burris Enzi Klobuchar I believe that further reduction in home Cantwell Feingold Kohl health payments will place the quality and vided further that no other motion be Cardin Feinstein Kyl availability of home health services at risk. in order, except a motion to reconsider Carper Franken Landrieu

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.043 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12496 CONGRESSIONAL RECORD — SENATE December 5, 2009 Lautenberg Murray Snowe Mr. KYL. The following Senators are SEC. l. LIMITATION ON AMOUNT OF ATTORNEY’S Leahy Nelson (NE) Specter necessarily absent: the Senator from CONTINGENCY FEES. LeMieux Nelson (FL) Stabenow (a) IN GENERAL.—An attorney who rep- Levin Pryor Tester Kentucky (Mr. BUNNING), the Senator resents, on a contingency fee basis, a plain- Lieberman Reed Thune from Oklahoma (Mr. INHOFE), and the tiff in a medical malpractice liability action Lincoln Reid Udall (CO) Senator from South Carolina (Mr. Lugar Risch Udall (NM) may not charge, demand, receive, or collect McCain Roberts Vitter GRAHAM). for services rendered in connection with such McCaskill Rockefeller Voinovich Further, if present and voting, the action (including the resolution of the claim McConnell Sanders Warner Senator from Kentucky (Mr. BUNNING) that is the subject of the action under any Menendez Schumer Webb would have voted ‘‘yea.’’ alternative dispute resolution system) in ex- Merkley Sessions Whitehouse cess of— Mikulski Shaheen Wicker The ACTING PRESIDENT pro tem- (1) 331⁄3 percent of the first $150,000 of the Murkowski Shelby Wyden pore. Are there any other Senators in total amount recovered by judgment or set- NOT VOTING—4 the Chamber desiring to vote? tlement in such action; plus Bunning Graham The result was announced—yeas 41, (2) 25 percent of any amount recovered in Byrd Inhofe nays 53, as follows: excess of the first $150,000 recovered by such The PRESIDING OFFICER. On this [Rollcall Vote No. 364 Leg.] judgment or settlement, YEAS—41 unless otherwise determined under State vote, the yeas are 96, the nays are 0. law. Such amount shall be computed after Under the previous order requiring 60 Alexander DeMint McConnell deductions are made for all the expenses as- votes for the adoption of this amend- Barrasso Ensign Murkowski sociated with the claim other than those at- Bayh Enzi Nelson (NE) tributable to the normal operating expenses ment, the amendment is agreed to. Bennett Grassley Risch Mr. LAUTENBERG. Mr. President, I Bond Gregg Roberts of the attorney. ALCULATION OF ERIODIC AYMENTS move to reconsider the vote. Brownback Hatch Sessions (b) C P P .— Mr. BEGICH. I move to lay that mo- Burr Hutchison Shelby In the event that a judgment or settlement Chambliss Isakson Snowe includes periodic or future payments of dam- tion on the table. Coburn Johanns Thune ages, the amount recovered for purposes of The motion to lay on the table was Cochran Kyl Vitter calculating the limitation on the contin- Collins LeMieux agreed to. Voinovich Corker Lincoln gency fee under subsection (a) may, in the MOTION TO COMMIT Cornyn Lugar Webb discretion of the court, be based on the cost The PRESIDING OFFICER. There Crapo McCain Wicker of the annuity or trust established to make the payments. In any case in which an annu- will now be 2 minutes of debate equally NAYS—53 divided on the Johanns motion to com- ity or trust is not established to make such Akaka Franken Mikulski payments, such amount shall be based on the mit. Baucus Gillibrand Murray The Senator from Montana. present value of the payments. Begich Hagan Nelson (FL) (c) DEFINITIONS.—In this section: Bennet Harkin Mr. BAUCUS. Madam President, this Pryor (1) CONTINGENCY FEE.—The term ‘‘contin- is very simple. A vote for the Johanns Bingaman Inouye Reed Boxer Johnson gency fee’’ means any fee for professional amendment is a vote for the status Reid legal services which is, in whole or in part, Brown Kaufman Rockefeller contingent upon the recovery of any amount quo. What does that mean? It means Burris Kerry Schumer Cantwell Kirk seniors will continue to pay higher and Shaheen of damages, whether through judgment or Cardin Klobuchar higher premiums, higher cost sharing Specter settlement. Carper Kohl due to wasteful overpayments. A vote Stabenow (2) HEALTH CARE PROFESSIONAL.—The term Casey Landrieu ‘‘health care professional’’ means any indi- against Johanns means we can extend Conrad Lautenberg Tester Udall (CO) vidual who provides health care services in a the solvency of the Medicare trust fund Dodd Levin Dorgan Lieberman Udall (NM) State and who is required by the laws or reg- that helps benefits. Durbin McCaskill Warner ulations of the State to be licensed or cer- I think we are for seniors in this Feingold Menendez Whitehouse tified by the State to provide such services body. I urge a vote against Johanns. Feinstein Merkley Wyden in the State. The PRESIDING OFFICER. The Sen- NOT VOTING—6 (3) HEALTH CARE PROVIDER.—The term ator from Maine. ‘‘health care provider’’ means any organiza- Bunning Graham Leahy tion or institution that is engaged in the de- Ms. COLLINS. Madam President, Byrd Inhofe Sanders home health care is the compassionate, livery of health care services in a State and The ACTING PRESIDENT pro tem- cost-effective alternative to institu- that is required by the laws or regulations of pore. On this vote, the yeas are 41, the the State to be licensed or certified by the tional care. It allows our seniors to re- nays are 53. Under the previous order State to engage in the delivery of such serv- ceive care just where they want to be— requiring 60 votes for the adoption of ices in the State. in their own homes. Under this bill, this motion, the motion is withdrawn. (4) MEDICAL MALPRACTICE LIABILITY AC- home health care would take a dis- TION Mr. DORGAN. Mr. President, I move .—The term ‘‘medical malpractice liabil- proportionate cut. ity action’’ means a cause of action brought to reconsider the vote and to lay that Let me quote a home health care di- in State or Federal court against a health motion on the table. rector in my State who sums up what care provider or health care professional by The motion to lay on the table was the approach will be, what will happen which the plaintiff alleges a medical mal- agreed to. if this motion is agreed to. She says: practice claim. The ACTING PRESIDENT pro tem- Mr. ENSIGN. Mr. President, the Our staff is scared, but it is our patients pore. The Senator from Nevada. who will pay the price if Congress makes amendment I am offering is an amend- cuts in home care. AMENDMENT NO. 2927 TO AMENDMENT NO. 2786 ment on medical liability reform. I be- I urge support for the motion to com- Mr. ENSIGN. Mr. President, I have lieve meaningful medical liability re- mit offered by the Senator from Ne- an amendment at the desk. form should be included in any overall braska. The ACTING PRESIDENT pro tem- health care legislation that we do this Ms. COLLINS. I ask for the yeas and pore. The clerk will report the amend- year. I have a separate bill from this nays. ment. amendment, a complete comprehensive The PRESIDING OFFICER. Is there a The bill clerk read as follows: medical liability reform bill, which I sufficient second? The Senator from Nevada [Mr. ENSIGN] introduced earlier, known as S. 45. In There appears to be a sufficient sec- proposes an amendment numbered 2927 to an effort to find a compromise, how- ond. amendment No. 2786. ever, I am offering this amendment The question is on agreeing to the Mr. ENSIGN. Mr. President, I ask today. motion. unanimous consent to waive the read- This amendment was originally of- The clerk will call the roll. ing of the amendment. fered by Senator Edward Kennedy back The bill clerk called the roll. The ACTING PRESIDENT pro tem- in 1995. While many Members of the Mr. DURBIN. I announce that the pore. Without objection, it is so or- Senate, including myself, were not here Senator from West Virginia (Mr. dered. in 1995, 21 Members from the other side BYRD), the Senator from Vermont (Mr. The amendment is as follows: of the aisle were here at that time, and LEAHY), and the Senator from Vermont At the appropriate place, insert the fol- they supported this amendment. Those (Mr. SANDERS) are necessarily absent. lowing: Members included: Senator AKAKA,

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00036 Fmt 0637 Sfmt 0634 E:\CR\FM\A05DE6.016 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12497 Senator BAUCUS, Senator BINGAMAN, Ask yourself this question: What if the State enacted legislation that in- Senator BOXER, Senator BYRD, Senator you were in need of an emergency pro- cludes a cap on noneconomic damages CONRAD, Senator DODD, Senator DOR- cedure; what if you were the woman and a cap on total damages for trauma GAN, Senator FEINGOLD, Senator FEIN- who had a high-risk pregnancy and care. Several other States have enacted STEIN, Senator HARKIN, Senator could not find a specialist to provide similar reforms. INOUYE, Senator KERRY, Senator KOHL, you with the care you needed? This should not be a Republican or Senator LAUTENBERG, Senator LEAHY, The medical liability crisis is threat- Democratic issue; this is fundamen- Senator LEVIN, Senator MIKULSKI, Sen- ening patient access to reliable quality tally a patient issue. Simply put, the ator MURRAY, Senator REID, and Sen- health care services all over America. current medical liability crisis means ator SPECTER. I would hope these Mem- Additionally, costly medical liability patients cannot find access to care bers will today continue to support insurance premiums have forced some when they need it most in many areas. Senator Kennedy’s amendment from emergency departments to shut down Without Federal legislation, the exo- 1995. temporarily in recent years. dus of providers from the practice of Clearly, the issue of medical liability In my home State of Nevada, our medicine will continue, and patients reform is even more pressing today level I trauma center closed for 10 days will find it increasingly difficult to ob- than it was back in 1995. We, as Ameri- in 2002. This closure left every patient tain needed care. cans, spend more money on lawsuits within a 10,000 square mile area As we work on a comprehensive than any other country in the world unserved by a level I trauma center. healthcare reform bill, one of our pri- and more than twice as much as all but Unfortunately, Jim Lawson was one mary goals must be to enact meaning- one other country. According to a re- of those in need of the trauma unit at ful medical liability reform to help en- cent nonpartisan study, the direct cost that time. Jim lived in Las Vegas, and sure patients access to care. As you of health care lawsuits is around $30 was just 1 month shy of his 60th birth- know, President Obama addressed the billion a year. That is the direct cost day. He had recently returned from vis- entire Congress on health reform in to our health care system—around $30 iting his daughter in California. When September. During his speech, he said, billion a year. These costs are multi- he returned, he was injured in a severe ‘‘I don’t believe malpractice reform is a plied by indirect costs, especially doc- car accident. silver bullet, but I have talked to tors ordering costly tests out of fear of Jim should have been taken to Uni- enough doctors to know that defensive being sued. versity Medical Center’s level I trauma medicine may be contributing to un- Estimates of wasted money spent on center, but it was closed. Instead, Jim necessary costs.’’ I think that is quite unneeded tests range from over $100 was taken to another emergency room, an understatement. Talk to health care billion a year annually to $250 billion a where he was to be stabilized and then providers. It drastically contributes to year annually. Let me repeat those transferred to Salt Lake City’s trauma unnecessary costs, not just maybe con- numbers. The estimates range from center. Tragically, Jim never made it tributes. $100 billion to $250 billion annually in that far. He died that day due to car- The President went on to say that he unnecessary tests conducted by doctors diac arrest caused by blunt force from has asked Secretary Sebelius to move due to fear of lawsuits. physical trauma. forward on demonstration projects in In 2006, an article in the New England Why was Nevada’s only level I trau- individual States to test ways to put Journal of Medicine suggested that as ma center closed? Due to a simple fact: patient safety first and let doctors much as 40 percent of medical liability the doctors could not afford medical li- focus on practicing medicine. lawsuits are without merit. Medical li- ability premiums, and there were not Let’s face reality. There is no doubt ability insurance premiums are threat- enough doctors to provide care. Ulti- that defensive medicine occurs every ening the stability of our Nation’s mately, the State had to step in and day and that the costs to the health health care system. These rates are take over the liability to reopen the care system are staggering. As I men- forcing many physicians, hospitals, and trauma center. tioned earlier, tens if not hundreds of other health care providers to move More than 35 percent of neuro- billions of dollars are wasted every out of high-liability States, limit the surgeons have altered their emergency year due to the practice of defensive scope of their practices, and even to or trauma call coverage because of the medicine, largely in an attempt to close their doors permanently. This medical liability crisis. This means avoid frivolous, junk lawsuits. crisis is affecting more and more pa- that patients with head injuries or Just think of how many uninsured tients and is threatening access to reli- those who are in need of neurosurgical patients we could take care of with able, quality health care services. services must be transferred to other that money or how much cheaper pre- I have a good friend in southern Ne- facilities, delaying much needed care. miums would be for those who have in- vada who practices obstetrics. In his Dr. Alamo of Henderson, NV, brought surance. We must stop playing games practice, he specializes in high-risk another example of this problem to my and start doing something real to ad- pregnancies. Because of the medical li- attention. Dr. Alamo was presented dress this important healthcare issue. ability problems we have seen in the with a teenager suffering from myas- Unfortunately, the underlying bill past several years, his insurance com- thenia gravis. She was in a crisis and does not meaningfully address medical pany limits the number of high-risk in need of immediate medical treat- liability reform—it only contains a pregnancies in which he can assist. So ment. Because of the medical liability toothless sense of the Senate. The you have one of the best doctors prac- situation, there was no emergency neu- Sense of the Senate notes that Con- ticing obstetrics who—because of fear rologist on call to assist this young gress should consider establishing a of lawsuits by his insurance company— woman. State demonstration program to evalu- is limited as to the number of high-risk Dr. Alamo called several in the area, ate alternatives to the current civil pregnancies in which he can assist. and none of them wanted to take her litigation system. If you are a woman with a high-risk case because of the medical liability Let’s be honest with ourselves. This pregnancy, it would seem to me you situation. So Dr. Alamo had the young is just windowdressing. The Sense of would want the best doctors to take woman transported to California by the Senate is just fluff. It ignores the care of you. That only makes sense. helicopter to receive the medical care substantial progress that many States Because of the medical liability crisis she needed. Just imagine if that was have already made with medical liabil- we are facing in this country, however, your daughter or some close friend or ity reform. Capping noneconomic dam- the best of the best are limited to the relative. How would you feel? age awards has been highly successful number of cases they can handle. Be- These kinds of situations should not in a number of States, such as Texas cause of unaffordable medical liability happen and should not be forced to and is something that should be part of insurance premiums, it is now common happen because of the medical liability health care reform. for obstetricians to not even deliver ba- crisis we have in America today. Sto- But, if we cannot reach a consensus bies and it is also common for other ries such as these are all too common on this, then we should at least follow specialists to no longer provide emer- across our country. Senator Kennedy’s example and limit gency calls or to provide certain high- To address the growing medical li- the amount of attorneys’ contingency risk procedures. ability crisis in my State of Nevada, fees as an important first step.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00037 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.048 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12498 CONGRESSIONAL RECORD — SENATE December 5, 2009 Let’s do the right thing. Let’s enact obstetricians have grown by 27 percent; Congress adopted my full Medical Care real medical liability reform. 22 rural counties have added an obste- Access Protection Act, the deficit The amendment that I am proposing trician and ten counties have added would decrease by $54 billion over 10 today would place reasonable limits on their first OB; 23 rural counties have years. attorney’s contingency fees in medical added at least one emergency medicine It would also, according to the CBO, malpractice cases. The limit would be physician and 18 counties added their save the private sector about the same 331⁄3 percent of the first $150,000 of the first ER doctor. amount of money. So over $100 billion total amount recovered by the judg- In addition to improvements in ac- in savings that now goes to propping up ment or settlement. There would be a cess to health care, charity care has a lot of frivolous lawsuits across the further limit of 25 percent of any also greatly expanded due to medical country. amount recovered in excess of the first liability reform. Today, Texas hos- By the way, think about it. If you $150,000 recovered by the judgment or pitals are rendering $594 million more had medical malpractice committed settlement. in charity care annually than they against you, I believe you should have While helping to reign in the cost of were just 6 years ago. That is a 24 per- access to the courts. I believe you frivolous medical malpractice lawsuits, cent increase in charity care, which is should be able to sue. I believe you this amendment also ensures that due to liability savings. should be able to get just compensa- States’ rights are protected. This Liability savings in States across the tion. The problem is now, because our amendment explicitly allows States country have allowed hospitals to: up- courts are so clogged with all these that have different fee limitations to grade medical equipment; expand the frivolous lawsuits, it takes years if not keep them in place instead of these emergency room; expand outpatient up to a decade to be able to get caps. This amendment ensures appro- services; staff ER rooms 24/7 with high- through the court system. For many of priate State flexibility while at the risk specialists; improve salaries for these patients who were severely same time helping to improve access to nurses; and launch patient safety pro- hurt—many of them die before the case care and reduce health care costs. Let grams. is ever settled. That is another reason me repeat. Back in 1995 when Senator Without reforms and the attendant we need medical liability reform and Edward Kennedy offered this amend- savings, these healthy developments we need it now. ment, these 21 Senators, part of the would not have been possible. Lawsuit Let me tell you why I believe med- Democratic majority, all voted for the reform has been a magnet for attract- ical liability reform has been left out Kennedy amendment. ing doctors and the funding mechanism of this bill. Actually, I don’t want to To be clear, my Medical Care Access to improve access to care and enhance tell you why. Let me let Howard Dean Protection Act contains more detailed patient safety. tell you why. Howard Dean, obviously, limitations on contingency fees than Physicians have seen a decrease in is the former chairman of the Demo- those contained in the amendment I their medical liability premiums. Since cratic National Committee. I am going am proposing today. But in the inter- 2003, physicians in Texas have saved a to quote from him. est of finding a starting point on med- collective $574 million on their liability [T]he reason why tort reform is not in the premiums. Today, most Texas doctors bill is because the people who wrote it did ical liability reform, I am willing to not want to take on the trial lawyers in ad- start off the debate by enacting Sen- are paying lower liability premiums dition to everybody else they were taking ator Kennedy’s limitations first. than they were in 2001. All major phy- on, and that is the plain and simple truth. By the way, the other side is going to sician liability carriers in Texas have Now, that’s the truth. say that the trial lawyers need this cut their rates since the passage of the That is a direct quote from Howard money to be able to take these cases. reforms, most by double digits. Texas Dean, the former chairman of the Let’s face it, the trial lawyers are physicians have seen their liability Democratic National Committee. mostly the ones who get the money out rates cut, on average, 27.6 percent. I hope as this debate unfolds many of of these cases. We want to make sure Eighty-five percent of Texas doctors my colleagues on the other side of the that money goes mostly to the patient. have seen their rates slashed 30 percent aisle will change their minds about en- So when you see pictures put up by the or more. More than 43 percent of Texas acting serious medical liability reform. other side, you will notice that my doctors have seen their liability pre- I hope that at least these 21 Senators amendment would actually help those miums reduced in half. Twenty-five who voted for this amendment before very patients who are in the pictures rate cuts have occurred since the pas- will vote for it again when it comes to that those on the other side will put sage of the 2003 landmark reforms. a vote tomorrow. This isn’t a battle be- up. In my home State of Nevada, limita- tween the right and the left; it is a bat- Medical liability reform works, and tions on noneconomic damages has tle between right and wrong. it is already turning the tide against helped to stabilize the medical liability This amendment is a helpful pre- frivolous lawsuits and outrageous jury climate and allowed the Independent scription for patients. I know many on awards in some States. We have seen it Nevada Doctors Insurance Exchange to the other side of the aisle would like to in California, in Texas and in my home keep rates steady in 2008, following a 20 cap salaries of people who work in the State of Nevada, where the number of percent decline in 2007. And rates health insurance industry. I hope these medical malpractice lawsuits has de- stayed steady after years of increasing same Members would support this sim- creased drastically. It has been a crisis dramatically. ple amendment to limit trial lawyers’ driving doctors out of business for too In Mississippi reform in 2004 created contingency fees in a responsible man- long. It is time to protect patients a hard $500,000 limit on non-economic ner. across the country and ensure access to damages. Since that law took effect, I urge adoption of the amendment quality health care. the number of medical malpractice and yield the floor. To illustrate my point, I would like lawsuits has fallen nearly 90 percent, The ACTING PRESIDENT pro tem- to tell you about the success of medical which in turn has cut malpractice in- pore. The Senator from Illinois. liability reform in several States. surance costs by 30 percent to 45 per- Mr. DURBIN. Mr. President, I ask First, take the example of Texas that cent, depending on the county. unanimous consent that upon the con- passed medical liability reform in 2003. Ohio and West Virginia have also clusion of the remarks of Senator EN- To begin with, access to health care seen sizable reductions in frivolous SIGN, I be recognized for a period of has improved, with 18,252 new physi- lawsuits and as a result less costly time equal to that utilized by Senator cians coming to Texas. The number of medical liability insurance. ENSIGN; further, that upon the conclu- high-risk medical specialists in Texas These examples prove that lawsuit sion of my remarks, Members be recog- is growing. Since 2003, Texas has added reform can improve access to care, ex- nized in an alternating fashion and 768 emergency medicine doctors, 481 pand the number of doctors and types that they be permitted to speak for up heart doctors, 218 obstetricians, 212 or- of care that hospitals are able to offer, to 10 minutes each; further, if any ex- thopedic surgeons, and 48 neuro- and help reduce medical costs. tensions of time are requested, the surgeons. These additions are not lim- According to a conservative estimate other side be accorded the same addi- ited to metro Texas. The ranks of rural by the Congressional Budget Office, if tion; further, that the Democratic

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00038 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.049 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12499 speakers following me be as follows: tened, hoping that at some point he to get beyond lawyers and start talk- Senators FRANKEN, LAUTENBERG, would say: And in all fairness, we think ing about victims going into court- STABENOW, DODD, and KAUFMAN. defense attorneys should be limited in rooms. The ACTING PRESIDENT pro tem- what they are paid too. But I didn’t For the longest time, the argument pore. Is there objection? hear that because what it gets down to on the other side of the aisle has been, Mr. ENZI. Reserving the right to ob- is really not about attorneys. If we are if you go into a courtroom saying you ject, and I will not, I wish to make a about making it fair and equal for both are the victim of medical malpractice clarification that you wouldn’t object tables in the courtroom, we would and prove that you are, they want to to a couple of people without alter- limit both attorneys’ fees. No. What limit the amount of money a jury can nating so that we can have a couple of this is all about is to discourage attor- give you for your injury. They used to people who also go without alter- neys from representing victims, limit call it caps. Right now, if you are a vic- nating. Hopefully, we can make some the amount of money a plaintiff’s at- tim of medical malpractice and you are arrangements on the time. I would like torney can receive as a contingency successful in a courtroom, you are like- a provision that if one goes longer, the fee. ly to recover your medical bills and other side can go longer too. With that There has been a lot said about frivo- your lost income and some money for provision, I have no objection. lous lawsuits for medical malpractice. what they call noneconomic damages. The ACTING PRESIDENT pro tem- I want to tell you, as a person who did Those would be scarring, disfigure- pore. Without objection, it is so or- this for a living, the last thing in the ment, pain and suffering. So what most dered. world I would ever consider doing is of the effort has been on the other side Mr. DURBIN. Will the Chair inform taking a frivolous lawsuit. It costs a is to limit the amount you can recover me how much time the Senator from fortune. At the end of the day, you are for these noneconomic losses—scarring, Nevada used? likely to lose. You can’t keep the doors disfigurement, pain and suffering. For The ACTING PRESIDENT pro tem- open and the lights on in a law practice people who have proven they were the pore. Twenty-one and a half minutes. taking lawsuits that are going to lose, victims of malpractice, they have tried Mr. DURBIN. I thank the Chair. taking on frivolous cases. You care- to limit the amount they can take Mr. President, this issue is very per- fully weigh the cases you take because from a jury. In over half the States in sonal and very important. I know a lit- you, as a plaintiff’s attorney rep- the Nation, those limitations or caps tle bit about this because many years resenting a victim, have to make a have been put in place. ago, before coming to Congress, I was a massive time-and-dollar commitment What is the scope of this problem? trial lawyer. I spent many years de- to bring that case to trial, realizing The Institute of Medicine tells us—at fending doctors when they were sued that at the end of the day, if there is a least this was a finding they made back for medical malpractice, and I spent as ‘‘not guilty,’’ you are emptyhanded. in 1999—that there are up to 98,000 You have nothing to show for all of many years representing plaintiffs who deaths in America each year, prevent- that effort and all of that money spent. claimed to be victims of medical mal- able deaths, because of medical mal- That is what is behind contingency fee practice. I have literally been at both practice—98,000. When you look across cases. the board at the number of paid mal- tables in the courtroom. At least in a That is why the Senator from Nevada previous life, I knew a little bit about practice claims each year against doc- has focused on only one table in the tors in America, it is about 11,000. One this field of legal practice. courtroom—the victims’ table—saying What the Senator from Nevada is in 10 of the deaths and injuries—frank- we want to discourage lawyers from ly, a much smaller number than 1 in trying to do is to reduce the contin- taking on victims’ medical malpractice gency fee that can be paid to a lawyer 10—actually ends up in a lawsuit. So cases, we want to discourage them by the vast majority of victims of medical who represents a plaintiff. paying them less. Defense lawyers—no Here is how it works. If you believe malpractice don’t bring a lawsuit. Ei- limit whatsoever on how much the in- ther they don’t know they were vic- you or a member of your family has surance company can pay them. That been a victim of medical malpractice, tims or they decide it is not something is the Ensign amendment in summary. they want to do. A very small percent- where you have either been hurt or I am sorry in a way that Senator EN- someone in your family has died, you age do. SIGN has invoked Senator Kennedy’s What the Senator from Nevada did will go to a lawyer and say: I don’t name to support his effort. I am sorry not tell us is that since 2003, when this think I was treated right. that Senator Kennedy is not here be- issue has been addressed by so many The lawyer will say to you: If I think cause I think I know what Ted Ken- States, the number of medical mal- you have a good case we can prove in nedy, sitting right back here, would be practice lawsuits each year has gone court, I will represent you. But I know saying at this very moment. He would down and continues to go down. The you don’t have enough money to pay explain to the Senator from Nevada premiums for medical malpractice in- me my legal fee. I will take your case, that the amendment he is referring to surance have started to come down as accept your case on a contingency, was part of the Gingrich revolution, well. So there is a positive trend here which means if you win, I get paid, and which some may recall, which was an because of State reform and other cir- if you lose, I don’t get paid. attempt to change tort reform laws cumstances which have led to fewer That is what a contingency fee is. across America with some onerous pro- medical malpractice lawsuits. For most Americans who are not visions—removing, for example, the But make no mistake, there are still wealthy, this is the only way they can right of people to recover punitive victims and there still will be. We have get a good attorney to go into court, is damages in a lawsuit, all sorts of limi- to be honest about what those victims to pay a percentage if they win, a con- tations or bars against filing lawsuits. face and what the Ensign amendment tingency fee. That is one side, one It was an onerous law which Senator will mean. What the Ensign amend- table in the courtroom. Kennedy offered his amendment to in ment means is that many of them There is another table in the court- the hopes of slowing it down. Senator won’t be able to find a lawyer. Some of room. At that table sits the doctor or Kennedy was not successful. At the end them should. Let me tell you some hospital and an attorney. That attor- of the day, this bill passed, this Ging- real-life stories of victims of medical ney isn’t paid on a contingency fee; rich revolution bill passed. It was sent malpractice and what happened to that attorney is paid by the hour, by to President Clinton, who vetoed it. So them. the insurance company. No matter how to suggest this was Senator Kennedy’s This beautiful couple, Molly Akers of many hours that attorney puts into the life’s work—it was his attempt to slow New Lenox, IL, and her husband tell a case, that attorney is confident at the down a steaming locomotive coming story that is heartbreaking. Molly had end of the day he will be paid, win or through the Senate. It didn’t work. To a swelling in her breast, and her doctor lose. invoke his name at this point is to at performed a biopsy and determined she The Senator from Nevada comes here least not tell the whole story behind had breast cancer. She had several and says: We think it would be just to the amendment. mammograms which found no evidence limit how much victims’ attorneys can If you are going to tell the whole of a tumor. The doctors decided, how- get paid. I waited patiently and lis- story about this amendment, you need ever, that it must have been some rare

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00039 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.056 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12500 CONGRESSIONAL RECORD — SENATE December 5, 2009 form of breast cancer, and they said help induce contractions. Six hours neys’ fees and ignore the defense attor- that Molly, to be safe, needed a mas- later, Donna still hadn’t delivered, but neys’ fees is to ignore a mismatch al- tectomy. They removed her right her son’s fetal-monitoring system ready. The defense attorneys in Amer- breast. After the operation, the doctor began indicating he was in severe res- ica are being paid substantially more— called her into the office and revealed piratory distress. The doctor finally de- 50 percent more—than those who rep- that they discovered she never had cided it was time to perform an emer- resent the victims. breast cancer. Instead, the radiologist gency C-section but waited another In 2008, in Texas, medical mal- who reviewed her slides accidentally hour before she was taken to the oper- practice insurers earned $369 million in switched Molly’s slides with those of ating room. During that time, the doc- premiums. They paid out $17 million in another woman. Molly was perma- tor failed to administer oxygen or take losses. If one-third of that, say $5.5 mil- nently disfigured because of this mis- other immediate steps to help Martin lion, went to victims’ attorneys, how take, this negligence. breathe. much went to defense attorneys in She said: After Martin was born, he was in in- medical malpractice cases in Texas? I never thought something like this could tensive care for 3 weeks. Later, Donna Mr. President, $41 million. So $5.5 mil- happen to me, but I now know that medical learned that Martin had substantial lion for plaintiffs’ attorneys, $41 mil- malpractice can ruin your life. brain damage and cerebral palsy—a di- lion for defense attorneys. By the way, the other woman, whose rect result of the doctor’s failure to re- This amendment does not even ad- slides were switched with Molly’s, was spond to indications of serious oxygen dress the cost of defense attorneys. told she was cancer free. That was a deprivation and to deliver in a timely In Tennessee, in 2008 malpractice in- medical error that ended up injuring manner. surers paid $79 million in losses to vic- two people, not just one. Donna’s doctor told her not to have tims, so perhaps $26 million went to Is she entitled to her day in court? Is any more children because he said victims’ attorneys’ fees, and $83 mil- she entitled to be compensated for there was a serious problem with her lion was paid in defense attorney fees. There is no similar outrage on the what she went through? Is she entitled DNA which could result in similar dis- other side of the aisle when it comes to to have at least those responsible pay abilities in the future. how much money the defense attorneys for her medical bills, her lost wages, Well, that turned out not to be true. are being paid. pain and suffering, scars and disfigure- Donna has given birth since to three perfectly healthy sons who are shown In the State of Mississippi in 2008 ment? By most standards of justice, they paid out $874,000 in losses, and the answer would be yes. But if she in this photo as well. Donna sued the doctor responsible for Martin’s deliv- paid $4.1 million in defense attorneys’ isn’t rich enough to pay an attorney’s ery and received a settlement in the fees. fee, she walks in and says: The best I case. Here she is, a young mother who So it just goes on and on. The evi- can do is tell you that if I win, you win. is being told the problem was her prob- dence is clear. Overwhelmingly, in the It will be a contingency fee basis to the lem, and it turned out it was a problem courtroom, the race goes to the swift, lawyer. What the Senator from Nevada in the way she was treated when she and the swiftest are the ones with the wants to do is to reduce the likelihood went to the hospital. most resources—the most attorneys, that she will find a lawyer to represent Again, the Senator from Nevada the most discovery, the most expert her. would reduce the likelihood that witnesses, and they all cost money. This is another story of another per- Donna—the mother of this child who is Time and again, plaintiffs’ attorneys son from Illinois. Glenn Steinberg is going to face a lifetime of challenges— come into many courtrooms at a dis- shown here. In 2004, Glenn went for sur- would have the attorney to come to tinct disadvantage to the insurance gery in Chicago to remove a tumor court for reasonable compensation. companies that would be benefited by from his abdomen. Ten days after sur- These are real-life examples. I know this. gery, while he was still in the hospital, the other side—the Senator from Ne- Now, what are we going to do about he was having pain and problems. They vada said specifically: Oh, you are this issue? And it is an issue. Well, I did an xray of his abdomen and they going to hear about the victims, but think the President is on the right found a 4-inch metal retractor lodged this is really about lawyers. track. First, we know it is a State against his intestine that had been left These victims would not have their issue when it comes to medical mal- in his body after the surgery. A second day in court, would not have a chance practice. Historically, the States set surgery was performed to remove this to recover from medical malpractice the standards, and the States initiate metal instrument, during which time that was eventually admitted or prov- the reforms. A majority of States have Glenn’s lungs aspirated and he died. en if it were not for an attorney to already done that, limiting recoveries, Glenn’s wife Mary lost her husband. bring them to court. It does take a even limiting fees in some cases. They She said: long time. I will concede, the Senator have done it. Why would we come in at Not a day goes by that I don’t miss Glenn’s from Nevada said it takes a long time the Federal level and preempt that? companionship and the joy he brought to our on these cases. Well, I have been there, Secondly, the President said: Let’s home. Because of gross negligence, he was and I know why. The attorneys rep- encourage some positive thinking not here to support me when my son went off resenting the other side try to drag it about ways to end this. How can you to serve our country in Iraq. out as long as they possibly can, filing reduce the number of medical mal- A real-life story. This man did noth- motions and requiring discovery. It can practice lawsuits? There is one simple ing wrong—an innocent victim who, in go on and on. So an attorney who takes way, and many States have discovered our system of justice, is entitled to up one of these cases better not take it. It is when a doctor walks in and compensation. But if his widow didn’t up a frivolous case because it will be a says to a patient: I made a mistake, have enough money to pay the attor- lifetime of futility if you take that ap- and I am sorry. It sounds simple, ney’s fees and went in for a contin- proach. doesn’t it? gency fee, she might be limited because I took a look and asked my staff: It happened in my family recently. of the amendment offered by the Sen- Well, if Senator ENSIGN’s amendment is One of the members of my family went ator from Nevada. dealing with victims’ attorneys, are for back surgery and had complications This next case in Illinois involves they really getting paid a lot more afterwards. It went on for weeks. He children. I have met the little fellow compared to the defense attorneys? went in, and the doctor said: I am we are going to talk about, Martin Well, we went and looked at the infor- sorry. When I did your back surgery, I Hartnett. He is the second boy from mation. We found that in a recent year, should have cauterized you right then the right. When Martin’s mother, there was around $1.3 billion paid to and there rather than waiting through Donna, arrived at the hospital to de- victims’ attorneys who filed medical 2 miserable weeks until we finally did liver him, her labor was not pro- malpractice cases in America—$1.3 bil- it. It was my mistake. gressing. Her doctor broke her water lion. At the same time, $2.1 billion was Well, my relative did not file a law- and found it was abnormal. Rather paid to defense attorneys. suit. That doctor was honest. We know than considering a C-section, Donna’s So to argue we just want to reduce doctors are human. They make mis- doctor tried administering a drug to the plaintiffs’ or the victims’ attor- takes. Some States have protected the

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00040 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.057 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12501 doctors’ right to say: I am sorry. Many Mr. DURBIN. Nurses are not willing currently on a waiting list for medical times that is all that is needed. There to speak up, other colleagues are not procedures or referrals to specialists. are other cases where States have put willing to speak up, and they should Madam President, can you imagine together panels to review lawsuits be- for the sake of their own profession, waiting up to 6 months for a hip re- fore they are filed. They do it success- but certainly for the sake of the pa- placement or up to 6 months for car- fully. There are other cases where they tients. diac bypass surgery? What if you had have to file an affidavit from a doctor Mr. BROWN. So the Senator is argu- to wait up to 4 months to get an MRI. that says this is a lawsuit with a real ing that if there was a mechanism or People who live in countries that possibility of medical malpractice an environment where nurses and doc- have government-forced health care being proven. tors would be willing to speak up, if systems often wait, and then wait some All of these things are working, and there was a doctor, a surgeon who had more, for medical care. This chart we want to encourage them. But, a problem with alcohol, this issue shows typical patient wait times in please, do not close the door of the would not go away certainly, but this Canada. The blue bar shows median courtroom to victims and their attor- issue would be much less serious, the clinically reasonable wait times. The neys. Do not benefit the defense attor- issue of malpractice, the medical er- red bar shows actual wait times. So neys, the insurance attorneys, at the rors, the deaths, the injuries that come this, in the blue, is what a reasonable expense of the victims’ attorneys. from some kind of medical error? Med- patient wait time should be and what Mr. BROWN. Mr. President, will the ical malpractice would be much allevi- is shown in red is what patients actu- Senator yield? ated? ally experience. Mr. DURBIN. I am happy to. Mr. DURBIN. I am. If you look at this chart and study Mr. BROWN. I say thank you to Sen- I see my time is over. I thank the the wait times, you can see that in ator DURBIN. Senator from Ohio, and I would say every single one of these cases whether My understanding is, some States this is one part of the answer. But de- it is general surgery, gynecology, in- have stricter licensing requirements nying victims a day in court I do not ternal medicine, neurosurgery, or oph- for doctors, and that typically very few think brings justice to this country or thalmology, the actual wait times are doctors, relatively, commit significant, fairness, and I know Senator Kennedy always much longer than what a clini- repeated mistakes as they are prac- would be saying the same thing if he cally reasonable wait time should be in ticing medicine. But some small num- were here today. Canada. ber of doctors are responsible for the I yield the floor. For example, the median clinically large number of medical errors and The PRESIDING OFFICER (Ms. reasonable wait time for neurosurgery negligence and malpractice. STABENOW). The Senator from Wyo- is 5.8 weeks. But, as we see from this How important is it that the States ming. chart, the actual wait time is 31.7 strengthen their licensing require- Mr. ENZI. Madam President, I yield weeks. That is for neurosurgery. That ments so those doctors—the small mi- time to the Senator from Nevada. is shown on this part of the chart. Can nority of doctors—who really do seem The PRESIDING OFFICER. The Sen- you imagine having to wait that long guilty of the most malpractice are dis- ator from Nevada. for neurosurgery? ciplined either by losing their license Mr. ENSIGN. Madam President, For orthopedic surgery, the clinically or by being disciplined in other ways so there is an urban myth that people like reasonable wait time is 11 weeks. The they are not inflicting this on their pa- to talk about when they are discussing median actual wait time is 36.7 weeks. tients? health care reform. It is like one of This is hard to fathom. Mr. DURBIN. I think the Senator those rumors that runs rampant on the In Canada, the wait time depends on from Ohio has put his finger on a part Internet. Nobody knows where it start- many factors. Getting in to see a doc- of the problem. It turns out, the vast ed, but you are sure it must be true. tor depends on the province in which majority of lawsuits involve a very The story is about Canadian health you live, whether you are an urban or small percentage of doctors, many of care: everyone there is covered, and rural resident, the urgency of your whom are making errors repeatedly. I they have a progressive health care medical condition, and your age. would recommend to my friend from system that we should somehow copy. I want to encourage all Americans Ohio a book to read, and I know he Well, it is time to bust this myth and not to take my word for it on these reads them. It is called ‘‘Complica- tell the American people what a gov- wait times. You can go to this Web tions.’’ It is by Dr. Atul Gawande, who ernment-run health care system like site, http://ontariowaittimes.com, and is a Boston surgeon with whom we are Canada’s would mean for us in the it will actually tell you what the wait familiar. I read it, and it was an eye United States. times are for various procedures. opener about what a surgeon learns Canada and Great Britain offer what As a matter of fact, my assistant who and goes through. But he spends a is typically referred to as universal is on the Senate floor with me today whole chapter in there about doctors coverage. Universal coverage, however, broke her arm several months ago. In- and nurses of practicing doctors who does not mean unlimited access to care terestingly, she went to this Web site are not up to skill anymore because of or readily available care. Let me tell to find out how long her wait time age, alcoholism, and drug addiction, you why. would be for surgery in Ontario. By the and they are afraid to speak out. Let’s talk about spending first. The time she would have got in to see a That is not common. It is rare. But it U.S. spends about 16 percent of its doctor in Canada to have the necessary should not happen at all. Those doctors gross domestic product on health care, procedure conducted, her arm would who consistently make mistakes, con- while Canada spends about 10 percent. I have already healed. It would have sistently get sued, or have these prob- know some Members of this body have healed incorrectly, but it would have lems should be identified and removed been asking: If Canada can spend less already healed. from the practice until they can be re- money on health care, why can’t we? That is unacceptable, but that is typ- habilitated or go off to another job. Well, there is a right way to reduce ical of what happens in countries where Mr. BROWN. If the Senator will yield spending with technology, healthier be- there is government rationing, and for a moment, again, don’t the State li- haviors, common sense, medical liabil- where the government sets a global censing boards have the ability to do ity reform, other things I have talked budget. disciplinary action? I know in my about; and there is a wrong way. Think about how frustrated you State, in Columbus, they do. Are they In Canada, the government spends 10 would be if you had to wait that length not doing that enough? Is there a way percent on health care by setting a of time. Some Canadians get tired of to strengthen that? global budget. When the demand for this waiting. They leave the queue and Mr. DURBIN. The point Dr. Gawande health care exceeds that amount, the catch planes, trains, and automobiles makes is there is this conspiracy of si- Canadian Government does not in- to the United States to get medical lence, this fear of outing a doctor. crease funding. Instead, medical care is care when they need it most. Mr. BROWN. Nurses are not willing often delayed and/or denied. Some esti- The Mayo Clinic, for example, sees to speak up? mate that about 750,000 Canadians are about 2,000 Canadian patients each

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00041 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.058 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12502 CONGRESSIONAL RECORD — SENATE December 5, 2009 year. The Henry Ford Clinic in Michi- the founder of Timely Medical Alter- what did she do? As a matter of fact, gan saw 191 hospital patients from Can- natives said: she traveled to the United States for ada and had about 1,400 outpatient vis- The Canada Health Act is responsible for care—on the advice of her doctor. She its from Canada last year alone. more pain, more suffering, and more death went to UCLA for surgery and she paid Those numbers have increased stead- than any other piece of domestic legislation for that treatment out of her own ily over the past 3 years. In fact, rev- in Canadian history. pocket. I have a feeling that she came enue from Canadian patients has in- I am concerned that the inclusion of to the United States because she knew creased by $7.5 million at the Henry a government-run health plan in the that if she waited for care in Canada, Ford Clinic in the last 3 years. Al- Democrats’ health reform bill will de- the chances of her having successful though these major medical clinics do stroy the American health care system treatment would be a lot lower. not track why some Canadian patients as we know it today. Madam President, the wait to see a come to the United States for medical Section 1323 of this bill establishes doctor is not the only wait Canadian care, I believe the significant wait the community health insurance op- patients face. Canada and other coun- times in Canada are one of the primary tion. Don’t let the name fool you; it is tries with government-run health care reasons they choose to cross the bor- a government-run plan. States can opt systems are slow to adopt new medical der. out of the government-run plan if they technologies. And, access to the latest I also believe that Canadian patients enact a law prohibiting the offering of medical technologies is limited. As a come to the United States to reap the the government-run plan in the ex- result, patients often have to rely on benefit of America’s research and de- change, but I honestly expect that few old or outdated medical equipment for velopment and to access new break- States will take this course of action. treatment. throughs in medical technologies. Regardless of the language indicating Canadians have less access to MRIs, Many of my colleagues have heard that people won’t be forced to partici- CT scanners, and lithotroptors than pa- the story of Shona Holmes. Shona, a pate in a public health insurance pro- tients in other countries belonging to Canadian citizen, was experiencing nu- gram and won’t be penalized for not the Organisation of Economic Co-Oper- merous conditions, including head- participating, I still believe that some ation and Development. Lack of access aches, fatigue, and severe vision prob- individuals will be forced into this gov- to cutting-edge medical technology has lems. Her primary care doctor in Can- ernment-run plan. I also believe this is significant consequences. New medical ada ordered an MRI and the results just the first step toward a complete technologies can often provide faster suggested a brain tumor. Shona would government-run plan. and more efficient identification and have to wait 4 months to see a neurolo- Under the bill, the Secretary of treatment of disease. They can offer the patient safer, less invasive and gist or 6 months to see an Health and Human Services will be re- more comfortable treatments and care, endocrinologist in Canada. She quired to negotiate provider reimburse- as well as offering new treatment op- couldn’t wait that long. Since it would ment rates. The government typically tions where none previously existed. be illegal for her to see a doctor out- doesn’t negotiate with doctors and hos- What is the secret to other countries’ side the government-run health care pitals. The government would likely keeping costs down? One is refusing to system in her own country, she trav- resort to price-setting based on Medi- approve or cover new life saving drugs eled 2,000 miles to the Mayo Clinic to care or Medicaid or use existing gov- and medical devices. ernment programs as leverage for nego- Scottsdale, AZ, and paid for the visit In 2007, the United States had 25.9 herself. Doctors at the Mayo Clinic di- tiations, creating similar effects. Re- MRI machines per million people. Can- agnosed Shona with Rathke’s cleft member, Medicare and Medicaid cur- ada had 6.7 MRIs per million people and cyst. rently reimburse at much lower rates the United Kingdom had 8.2 per million Shona returned to Canada with her than the private sector. people. In 2007, the United States had Madam President, I ask for an addi- diagnosis and attempted to have sur- 34.3 CT machines per million people. gery under Canada’s government-run tional 3 minutes. The same year, Canada had 12.7 ma- The PRESIDING OFFICER. Is there health care plan. The Canadian Gov- chines and the United Kingdom had 7.6 objection? Without objection, it is so ernment wasn’t able to do the nec- machines per million people. essary surgery within a 6-month time ordered. It took France 5 years to approve the period. Since Shona’s vision was rap- Mr. ENSIGN. Madam President, endoscopy pill camera and 10 years to idly declining, waiting more than 6 Democrats claim that they will not be approve implantable defibrillators. weeks for surgery was completely un- putting private health insurance com- Japan is well known for refusing to pay acceptable. So her husband got a sec- panies out of business, but it seems to for the latest technologies because of ond job, took out a second mortgage on me that they are doing everything pos- budgetary constraints and has yet to their home, and borrowed money from sible to make it harder for these com- approve, for example, prosthetic tita- family and friends for surgery at the panies to stay in business. I also ques- nium ribs and imaging masks for head Mayo Clinic. Incidentally, the Mayo tion whether Members of Congress will surgery that have been approved in the Clinic recommended a second surgery be required to participate in this gov- United States for the past 6 years. to remove her adrenal gland. So Shona ernment-run program. We should be re- In my home State of Nevada, robot- went back to Canada and got in line. It quired to do so. If we decide that a gov- ics surgery has become an exciting new took 3 years for her to get her second ernment-run plan is good enough for frontier. Across Nevada, six hospitals surgery in Canada—3 years. the American people, then I believe are now equipped with the da Vinci In written testimony before the that Members of Congress should sub- Surgical System which allows patients House Energy and Commerce Com- ject themselves to the same type of access to cutting-edge minimally, mittee, Shona said: care. I know there will be an amend- invasive surgery. In all of Canada, the If I had relied on my own government-run ment to do just that. entire country, there are nine such ma- health care system in Canada, I would not be I want to tell a story about how fed- chines. The United States has 968 ma- sitting before you today. At the very best I eral government officials don’t always chines. Wouldn’t you prefer a system would be blind and at the very worst I would think that they should be subject to that thrives on innovation in medical be dead. the same type of care as their coun- technology? Where you have access to Shona isn’t the only Canadian citizen try’s citizens. Belinda Stronach, a the most cutting-edge technology that who has come to the United States for former Canadian Member of Par- can better diagnose and treat you? access to timely medical care. A pri- liament, opposed the privatization of Even with this clear discrepancy in vate company called Timely Medical Canada’s health care system. Well, technology investment, Democrats Alternatives was created in 2003 to help that was at least until she got sick. have argued that the United States Canadian citizens obtain medical care She was diagnosed with breast cancer spends more money than any other in the United States. Over the years, in June 2007. Although she had led the country on health care and gets worse the company has sent more than 500 charge against having a private system results. The implication is that we Canadians to the United States for in Canada, she didn’t want to wait in should look to other countries for guid- timely medical care. Richard Baker, line in Canada to obtain treatment—so ance on how to run our own system

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00042 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.059 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12503 better. But if we look, for example, at quality care when they need it most? according to WHO, then why is there cancer survival rates, we see that the All Americans should think about that lower life expectancy compared to United States gets better results than as this bill is being considered on the other developed countries? Simple. Be- other countries that have experi- floor of the Senate. cause the numbers are wrong. Life ex- mented with broader government con- We should be very careful that re- pectancy in the United States has been trol of health care. forms to our health system do not lead rising as it has been in most of the de- International studies have found to reduced preventive care and poor ac- veloped world. All of the life expect- Americans have far better access to cess to lifesaving drugs. These reforms ancy statistics include accidental and new cancer drugs than do patients in have led to lower rates of survival in even intentional deaths that clearly Europe and the United Kingdom. The places with greater government control have no relation to the merit of our United States also has higher rates of over health systems. health care system. cost-effective prevention measures These reforms have also proven For example, if you remove car acci- that can detect certain cancers early unsustainable in other countries. The dents and homicides, both of which are when they are cheaper, easier, and British National Health Service trust higher in the United States for reasons more effective to treat. As a result of is issuing a report that says it will face unrelated to the effectiveness of health this superior prevention and treat- the most severe and sustained financial care, then the actual U.S. life expect- ment, the United States has higher shortfall in its history after 2011. In ancy is higher. Some economists rank cancer survival rates. fact, the NHS trust is asking staff to the United States near the top of world Madam President, I would like to work a day for free, take unpaid leave, rankings when that point is factored show another chart. This chart shows and carry forward their vacations in in. Moreover, the history of exception- the European cancer survival rates for order to save money. Germany’s new ally heavy smoking in the United the major cancers in comparison to the proposal to reform the health care sys- States and the recent increase in obe- United States. The United States data tem met with thousands of protesters sity means that diseases and shortened is in gold; the European Union data is because it faces a massive budget life expectancies related to these fac- shortfall due to rising costs. What are in red. This chart shows 5-year survival tors have little to do with the effec- they looking at doing? Introduce fees, rates. This part of the chart shows kid- tiveness of our health care system. raise taxes, and do away with private ney cancer survival rates. We have sig- That is why my approach to health plans to bring people with those plans nificantly higher survival rates in the care reform includes creating incen- into the public system. Sound familiar? United States for colorectal cancer, tives for people to make healthier France, too, has a gaping hole in its breast cancer, cervical cancer, breast choices. We need to get to the root of health care budget. France is looking cancer, and skin cancer. You name it, health problems, not chase phantom at cutting subsidies in order to stop across the board we have better sur- foreign statistics. the problem. Japan faces one of the vival rates because we don’t ration Another example is high infant mor- most difficult problems because of its care, we don’t delay care, and we have tality. The United States has a higher rapidly aging population. It too has access to better technology in the level than other countries in part be- budget problems and has to find a way United States. cause of the higher number of low to offset a 5-percent increase in next Madam President, I would like to be weight babies from teenage preg- year’s health care budget despite all of a little more specific when it comes to nancies. That social problem is not re- its massive price controls on doctor, these facts and figures. A study pub- lated to how effective our health care medical device, and drug prices. Is this lished in The Lancet Oncology found system is. In fact, a low birth weight that when comparing 5-year cancer the future of U.S. health care? These are not health care systems baby in the United States has a better survival rates, the United States had that we should want to copy. Contrary chance of survival than in Canada, but better outcomes than European coun- to the opinion of some, the United we have three times the quantity of tries. Among men, nearly two in three States provides among the best care in low weight babies as Canada does. American cancer patients survived for the world for patients. The World The bottom line is that the United at least 5 years, while fewer than half Health Organization identifies the States has the best doctors, nurses, of Europeans did. Among women, 63 United States as 37th in the world, but medical and nursing schools, medical percent survived for 5 years in the these ratings are faulty. The United research, medicine, hospitals, medical United States, versus 56 percent in Eu- Nations World Health Organization devices, innovative companies, and rope. According to the study, survival uses subjective criteria such as ‘‘fair- health care in the world. It is like that rates for breast cancer were 11 percent- ness’’ to rate many countries. ‘‘Fair- because we demand it. age points higher in the United States ness’’ means that any out-of-pocket ex- Every night on the news for the past than in Europe. Prostate cancer is even pense by a patient is regressive and month or so, there are stories about more alarming, with a 99 percent 5- therefore penalizes poor people more. the lines for the H1N1 vaccine. The vac- year survival rate in the United States So, in the view of the United Nations, cine supply has been slowly trickling versus 78 percent in Europe. Colorectal the United States is 54th in terms of out, and Americans are not accustomed cancer rates were 10 percentage points their view of fairness. Consequently, to waiting for their care. They are frus- higher in our country than in Europe. according to the WHO ratings, coun- trated about these lines and the pri- And, survival rates for kidney cancer, tries like Colombia, Cuba, Micronesia, ority groups that have denied some of cervical cancer, and melanoma were Mozambique, Saudi Arabia, Samoa, and them the vaccine. Welcome to govern- higher in the United States than in Eu- Uruguay are ‘‘fairer’’ and therefore ment-run health care. rope. better than the United States. Some- What Canada and Great Britain and Madam President, I think this body thing is wrong with that rating. other countries do with their health should take a look at what it would In contrast, the United States is No. care systems is their business. They mean for quality of care and access to 1 in responsiveness to patient care ac- have determined that they want the medical care in the United States if we cording to WHO. So, if you are sick and government at the center of their were to adopt a government-run health want the best care, even the United Na- health care system. The government care system. Many of us on this side of tions agrees that the United States is decides what treatments patients can the aisle are opposed to government- the place to be treated. have, how long they have to wait, and run health care systems. We don’t want Michael Moore’s movie ‘‘SICKO’’ ad- how much is invested in technology. these type of survival rates that are vertised how great Cuban health care Here in the United States, that is the common in the European Union. We is, but he apparently did not see the last kind of system we need. Instead, don’t want people from Canada coming system used by the 11 million ordinary we need to move to a patient-centered here and not having a place to go to ob- Cubans where patients ‘‘have to bring system. We want to continue to em- tain medical treatment. As a matter of their own food, soap, sheets’’ with power patients to make decisions about fact, if the United States ends up going them to the hospital. their own treatment, to be consumers to a government-run healthcare sys- Some of my colleagues ask, if the in the process, and to have access to tem, where will Americans go for high- United States is No. 1 in responsiveness the care they need.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00043 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.067 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12504 CONGRESSIONAL RECORD — SENATE December 5, 2009 The United States is home to some of I wish to speak about an amendment one illness away from losing every- the greatest medical advancements in I have—that is why I was going to thing. That is what I hear. That is the world. Turning away from that sys- change the subject—but let me talk a what I hear from Minnesota families, tem at a time of great medical promise little bit about tort reform, liability and this is a State that has less-expen- is not the direction we should be head- insurance. Senator DURBIN mentioned sive, higher quality health care than ing. Atul Gawande. He wrote that article in the rest of the country. If Minnesotans For generations, American research- the New Yorker. Senator ENSIGN are struggling, we know we have a cri- ers, scientists, physicians, and patients talked about how great the tort reform sis on our hands. have worked together to push the enve- was in Texas. McAllen, TX, has the That is why I am working to make lope on the best tools for diagnosis and most expensive health care in the sure this bill does everything it can to treatment. We have invested in finding country. What kind of progress is that? bring down costs, improve quality, and cures and vaccines for illnesses. We They have the most draconian medical hold private insurance companies ac- could be on the cusp of cures for can- liability reform. In Minnesota, we countable. cer, Alzheimer’s disease, Parkinson’s don’t have anything such as that. We The current reality is, most of us disease. The list goes on and on. But do it for a third of the cost that they don’t know where our health insurance what happens when we become a one- do it for in Texas and with better out- premiums go. It is difficult enough to size-fits-all, government-centered, bu- comes. understand a billing statement from reaucracy-run health care system? We The reason I actually asked for time your health insurer, much less track become like Canada and Great Britain, today is to express my support for Sen- where your money is spent. Well, we where wait times are unacceptable, ator LINCOLN’s amendment to limit the are going to change that. We are going where care is rationed, where tech- tax benefits that health insurance to change that with transparent re- nology and innovation are not a pri- CEOs receive—not limit their salaries, porting of how health insurance com- ority, where the doctor-patient rela- limit the tax benefits. This does not panies are spending your money. That tionship is devalued, and where pa- limit their compensation, as was is in this bill. Clear reporting, written tients have lost their say in their own claimed by the Senator from Nevada. in plain English will help us hold them care. So, it is not surprising that when Most Americans would agree that the accountable for every dollar we spend people in other countries want the government, though, shouldn’t be giv- on health insurance. But reporting best, they come here. ing tax breaks to insurance companies isn’t enough because, right now, some Madam President, let’s not put for lining the pockets of their CEOs at of the health insurance plans being Americans in a position where they the expense of working families who marketed and sold in this country are may have to wait weeks and even are forced to pay more and more as nothing short of a rip-off. months for medical care. Let’s not put their premiums spiral out of control. A recent report in BusinessWeek Americans in a position where they The savings from removing this tax de- magazine described a policy being sold can’t access the latest medical tech- duction in Senator LINCOLN’s amend- in Florida to college students in which nology or the best prescription drugs. ment will go directly to our seniors as only 10 percent of the premium went And, let’s not have government bureau- a direct deposit into the Medicare trust toward actual health services. Again, crats stand in the way of medical care. fund. This amendment is immensely only 10 cents out of every dollar goes This is about patients. This is about important because it reinforces one of to health care in this plan. The rest creating a patient-centered healthcare our primary goals with this bill, which goes to marketing, wasteful adminis- system. The bill before us is not the is to rein in the cost of health care. trative costs, and, of course, profits. answer. One of the key ways we can control And this is legal. It has been legal. It The PRESIDING OFFICER. The Sen- costs is by holding insurance compa- was legal when the Republicans had ator’s time has expired. nies accountable. the White House and controlled this Mr. ENSIGN. I thank the other side I am pleased to be working with Sen- Congress. We are going to make it ille- for their indulgence and I yield the ator LINCOLN on another effort to make gal. floor. our health care system focused on pa- I don’t think this is what we want for The PRESIDING OFFICER. The Sen- tients, not profits. Yesterday, Senator our children—insurance companies ator from Minnesota is recognized. As LINCOLN joined me, Senator ROCKE- pocketing millions of dollars at the ex- a result of the previous agreed-upon FELLER, and others in introducing an pense of our physical and economic conditions, 3 minutes will be added to amendment to require that at least 90 health. Is that the kind of country we the Senator’s time. percent of your premium dollars go to- want to be? I believe we can all agree Mr. FRANKEN. Madam President, I ward actual health services. We do that this health care reform bill must guar- actually was kind of feeling bad be- in Minnesota. We do that in Min- antee that Americans get value for the cause I thought I was going to be nesota—91 cents, actually. premiums we pay. changing the subject, when Senator I urge my colleagues to support both I implore my colleagues to support DURBIN said I would be the next Demo- our amendments to ensure we get the these efforts because health insurance crat to speak. Because our good col- highest possible value for our premium should be about providing the best pos- league from Nevada brought up an dollars because nobody can contest the sible health care, not about marketing, amendment on medical malpractice li- fact that for-profit health insurance wasteful administrative costs, CEO ability and the Senator from Illinois companies have been making obscene pay, and profits. responded to it and I thought the Sen- amounts of money, while Americans Madam President, I yield the floor. ator from Nevada was going to respond watch their premiums skyrocket. From The ACTING PRESIDENT pro tem- to his response with some factual infor- 2000 to 2007, insurance company profits pore. The Senator from New Jersey is mation or something, he completely rose 428 percent—in 8 years. During recognized. changed the subject. So he went from that same time, we saw more than 6 Mr. LAUTENBERG. Mr. President, the Canadian system to rationing, and million more Americans become unin- how much time is available? he will include his entire statement, sured. During that same period, Amer- The ACTING PRESIDENT pro tem- which included this: We don’t ration ican families saw their premiums al- pore. There is 41⁄2 minutes remaining. care here in the United States, we let— most double. Mr. LAUTENBERG. I ask unanimous meaning the government—we let the So nobody can stand on this floor and consent to be able to speak for up to 10 private sector do that. argue that American families aren’t minutes. It will be less, I promise. I They do a great job of rationing care suffering. No one can dispute what I think we had a little miscue in our in the private sector. That is where we hear from Minnesotans every day, that timing. Is there any objection to that? ration care in this country. They ra- in this economic downturn, one of the The ACTING PRESIDENT pro tem- tion it by cutting off your insurance greatest fears families have is: What pore. The Senator from Wyoming is when you get sick. They ration care by happens if I get sick? What happens if recognized. not giving you insurance if you have a my spouse or my child gets sick? We Mr. ENZI. Mr. President, reserving preexisting condition. are hardly holding on now. We are just the right to object, would it be possible

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00044 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.068 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12505 for the Senator from Arizona to do a 5- insurance company to $400,000 as the The ACTING PRESIDENT pro tem- minute speech and then the Senator amount that would be deductible to the pore. The Senator from New Jersey is from New Jersey do his speech? company as a usual and ordinary busi- recognized. Mr. LAUTENBERG. All right. If we ness expense. Here, a lawyer has just Mr. LAUTENBERG. Mr. President, I can be assured that the Senator who one case, and you can have many cases rise to speak in support of the amend- speaks will not take more than 5 min- in a year. He would be limited, in this ment proposed by Senator LINCOLN utes, I will consent to that. That in- particular situation, to $1.1 million. from Arkansas. I thank her for an ex- cludes a unanimous-consent agreement A lot of folks have been asked to sac- cellent idea. for me to have up to 10 minutes. I also rifice under this legislation—hospitals, At the outset, before I came to the see our colleague from Michigan, and I doctors, and States, by accepting more Senate, I was a founder and CEO of a don’t know whether that would disturb Medicaid patients under their program; major New York Stock Exchange com- her. seniors would face sacrifices because of pany—a company now employing over Mr. ENZI. I am willing to let her go the $500 billion cuts in Medicare; indi- 40,000 people. I say that because I do as well, and we will make up the time viduals would see their premiums rise; understand how business works. I know on our side after that. and small businesses would get hit. The we have to pay executives to encourage Ms. STABENOW. May I ask my one constituency that hasn’t been their full capacity. But the money friend a question. Do I understand it asked to sacrifice anything is the trial being paid to top health insurance ex- would be the Senator from New Jersey lawyers. I don’t think it is much of a ecutives is simply outrageous. and then the Senator from Arizona and sacrifice to say, when you get this kind Most of these companies where these then myself? of award—a $4 million award—for your executives work get subsidies from the Mr. ENZI. The Senator from Arizona, Federal Government through payments the Senator from New Jersey, and then client, your fees should not exceed a little bit over $1 million. to Medicare Advantage and Medicare the Senator from Michigan. Part D. Our tax dollars then wind up The ACTING PRESIDENT pro tem- Even Howard Dean stated: stuffing the pockets of insurance com- pore. The Senator from Arizona is rec- Tort reform is not in the [health care] bill pany executives. ognized. because the people who wrote it did not want Remember, these companies are Mr. KYL. Mr. President, I thank my to take on the trial lawyers. And that is the obliged to provide health care funding colleagues for their courtesies. I am plain and simple truth. when people are ill or need counseling sure the Chair will cut me off at 5 min- We know that to be the case. Surely, to improve their health and their lon- utes. it wouldn’t be too much to ask our gevity. I wish to respond to some comments trial lawyer friends to limit just a lit- The average compensation package made earlier relative to the amend- tle bit the contingency fees they make for the top five insurance chief execu- ment of the Senator from Nevada on in these cases. tives between 2006 and 2008 was almost capping attorney’s fees. We have an There is a study that was recently amendment we will vote on tomorrow $15 million a year. conducted by the Institute for Legal I think their services in these compa- that caps executive compensation, ef- Reform that found that medical liabil- fectively, and the response to that nies more closely resemble a fire de- ity lawsuits are being driven by the partment or an emergency response or- from Senator ENSIGN was, if we are plaintiffs’ bar. It cites all the adver- going to do that, let’s cap the attor- ganization than a traditional product tising costs and the increase in the producer or a Wall Street firm. These ney’s fees because we can accomplish amount of advertising they are doing. something by doing that in medical companies are not selling lawnmowers. That is where a lot of this money is They have a different obligation, to malpractice cases. We can make sure going—to advertise for these lawsuits. the people who were injured get more provide a guarantee to help people Additionally, it showed that spending maintain better health, which is essen- of the money coming from these for these ads has increased dramati- awards, with less going to the attor- tial for individuals and should be great cally in the last few years. for our country. Our country will save neys. The threat of these ‘‘jackpot justice’’ I think this would be a very salutary money by reducing overhead and im- suits against doctors is one of the rea- situation. This contingent fee system proving programs that will fight to sons health insurance premiums are can really result in some abuses. I will help people live better and longer. cite some statistics from the Jury Ver- rising faster than the rate of inflation. As their executives make millions of dict Research in a study done in 2005: In fact, a PricewaterhouseCoopers dollars every year, their customers are Fifty-two percent of all awards in med- study concluded that approximately 10 getting messages such as this: Sorry, ical liability lawsuits exceed $1 mil- percent of the costs of health insurance this operation or that operation is not lion. Think about that. Over half of the premiums are attributed to the cost of covered by your policy, or, we don’t awards in these malpractice cases ex- litigation and defensive medicine. pay for that kind of medication. ceed $1 million. The average award now An even bigger health care cost re- Here is an example that really lays it weighs in at $4.7 million. That is a lot lated to the threat of frivolous lawsuits out perfectly. of money. Obviously, juries have felt is the practice of defensive medicine. A There is a company called that is what the victims in these cases 2005 survey in the Journal of the Amer- UnitedHealthcare. It is a major health needed in order to be properly com- ican Medical Association found that 93 insurance company. After that com- pensated. percent of physicians reported prac- pany engaged in the practice of back- The Ensign amendment would limit ticing defensive medicine, costing the dating hundreds of millions of dollars the amount of contingency fees in health care system $200 billion annu- in stock options—and that was done to these kinds of lawsuits to no more than ally. get an even better price than the a third of the first $150,000 recovered We clearly need to reform the tort shielded gain they get—after back- and a quarter of any recovery in excess system, and not in the form of some dating hundreds of millions of dollars of $150,000. For example, an attorney sense of the Senate but in the way of of stock options, their CEO, William representing a client in this average something real. It seems to me the En- McGuire, was forced to quit for his case, with a $4.7 million verdict, would sign amendment begins that process by questionable performance. Despite this still receive $1,187,500 for his or her saying: Let’s at least allow the injured scandal, United gave Mr. McGuire a services under the Ensign amendment. plaintiffs in these cases to keep more golden parachute of more than $1 bil- That is not a bad deal with a $4.7 mil- of the award granted to them and have lion. Where did that money come from? lion verdict. The attorney gets $1.1 mil- less of that go to the lawyers who bring It came from the pockets of senior citi- lion-plus and the injured party, the the cases. Surely, it is an adequate in- zens and from the people who had pro- plaintiff, gets the remainder. I ask my centive that they receive about $1 mil- grams that were covered by this com- colleagues, in that situation, isn’t $1.1 lion out of a $4 million lawsuit. pany—$1 billion for an outgoing CEO million-plus enough compensation? I thank my colleagues from New Jer- who engaged in misconduct, while We are limiting the compensation for sey and Michigan for allowing me to hard-working, everyday Americans get an entire year for an executive of an speak first. turned down for needed and critical

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00045 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.060 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12506 CONGRESSIONAL RECORD — SENATE December 5, 2009 medical procedures. There was a dis- will present a Waterloo for President in terms of how they relate to their ease in that boardroom when they per- Obama, what they are seeking is a po- employer and their insurance company, mitted those inexplicable decisions. litical victory. They are not seeking to but they will see costs go down because While health insurance executives help people who are desperate. others will actually have insurance and have been gouging working families, More people are worried about the not be using emergency rooms inappro- they are gorging themselves with their loss of their health insurance than priately. outrageous pay, corporate jets, and they are about their jobs because a job We also put in place protections for other perks. A cancer victim may not of some sort often can be available. But consumers, basically those, as the Sen- get critical chemotherapy. A family if you lose your health care, if you ator from Minnesota was talking may not be able to cover the ravages of have a condition that the insurance about, who have a preexisting condi- a child with diabetes. But health insur- company is not going to cover, you are tion and cannot find insurance now. Or ance company executives draw down in deep trouble. somebody who has insurance. I don’t millions of dollars. It doesn’t add up. I plead with my colleagues and I know how many times I have heard This amendment will not tell insur- plead with the people across our coun- from constituents of mine who have ance companies what they can pay try who may hear our voices to protest paid all their life and said, I don’t have their executives. They can pay them this assault against logic, this assault a problem, I have insurance, and then whatever they choose to. But only against those who need help, those who somebody gets sick and somebody gets $400,000 annually can be treated as an understand that government can be dropped. They get dropped from their expense. That is what the President of better. insurance because the insurance com- the United States makes. The rest of it I was a young boy when I enlisted in pany does not want to pay for it. will be taxed, with those funds going to the Army, 18. My father was sick with People with insurance now will keep make Medicare more solvent. Again, cancer. He was 42 years old when he the system they have but will benefit the Lincoln amendment wisely uses was diagnosed with cancer. He was a from consumer protections and from that new tax revenue generated by this healthy man. He used to work out at gradually seeing costs come down be- measure to further shore up Medicare. the Y and take care of himself, but cause we are not paying for people who An observation I wish to make is cancer overtook him and after 13 are using other health care services in- that I have listened to the debate over months of illness—a painful illness be- appropriately. a long period of time—not just in re- cause they did not have the materials We have about 80, 85 percent of the cent weeks but long before that—about in those days to reduce the pain vic- public right now who are covered with getting health care improved for the tims felt—he died, leaving a 37-year-old insurance, either through their em- people across our country, the over 40 widow, my mother, who not only was ployer or through Medicare, the great million people who cannot go to a doc- grief-stricken but flat broke, no American success story we have been tor but who will go to an emergency money. She owed pharmacists. She talking about, or through Medicaid, room, draw a ticket as if they are wait- owed doctors. She owed hospitals. the VA, and so on. For the 15 to 20 per- ing for a table in a restaurant, and I learned then that if you cannot cent of the public we are trying to pro- hope they get seen before some critical turn to government in the United vide options for affordable insurance, disease gets worse. What we hear is ob- States, you are in bad shape. We have those are mainly people working. A jection after objection. They like the the means to do it, and we must do it. vast majority of the people we are status quo. They have their friends in I yield the floor. talking about work for a small busi- the industry. Look at the advertising The ACTING PRESIDENT pro tem- ness, they work part time, they work budgets we see and the percentage of pore. The Senator from Michigan. two part-time jobs, they work three commercials paid for by those who are Ms. STABENOW. Mr. President, I part-time jobs. opposed as contrasted with those who want to specifically respond to the desperately need the insurance. Senator from Nevada who was talking I have been hearing from small busi- We are seeing now, for instance, that about the Canadian health care system nesses for years: We wish we had the one element of our reform program is a little earlier. I appreciate the infor- same clout as big business. We wish we the government plan, the plan that mation, the education. Of course, it has could pool all the small businesses and makes the industry more competitive, nothing to do with this debate, but it the individuals, that entrepreneur the public option. We hear all kinds of was nice to hear. We now understand a working out of their garage, that real- reasons why that cannot be. little bit more about the Canadian tor who does not have a pool. Pool us What is the ultimate conclusion? It health care system. and give us the same clout as big busi- is that this lush field these insurance The great news for us is that what we ness. companies plow day after day, year are designing is a uniquely American That is what we are doing in this bill. after year, should be held intact. It is health care system. I want to walk Versions of this have been proposed by the wrong way to go. I say to them: through the elements. the distinguished Senator from Wyo- Stand up, say you don’t want 40 million About 60 percent of the folks of the ming. I know back during the Clinton people, or somewhere near that num- great State of Michigan get their years during the debate, Senator Bob ber, to get health care coverage. Say health insurance through their em- Dole proposed something similar. This they don’t deserve it because they may ployer. That will continue. We are told has been a Democratic idea and a Re- not be able to afford it. Say you don’t that either their premiums will stay publican idea for years. deserve it, you don’t have the money to the same or go down, according to the We are calling this an insurance ex- pay for it. Who do you think you are, Congressional Budget Office. And we change where basically if somebody citizens of this country. believe many of the efforts in this bill right now cannot find affordable insur- People who are here, who have will actually bring costs down. ance by going out by themselves in the worked, in many instances, who have One of the reasons that costs will individual market, they are going to be lost jobs in this recession, are being come down is those of us with insur- able to go to a place where companies told—they don’t use the language but ance will no longer be paying through will bid on the large pool of everybody the message is clear—you don’t deserve the back door for people who use the who does not have affordable insurance it. But they want the insurance com- emergency room who are sicker than now. Just like what we do for the Fed- pany executives to be treated particu- they otherwise would be. They use the eral Government, like our insurance larly well. emergency room and then the costs are plan, our Federal employee insurance We need clarification of the thinking shifted on to people with insurance. We plan, which is an insurance exchange, of the Republicans—and I have a lot of know there is about a $1,100 hidden tax someone will be able to go to a Web good friends over there, and I know we each pay on our premiums to pay site or be able to get information and there are a lot of good thinking people. for people right now who do not have be able to find out about the private in- But when the Senator from South insurance and use the emergency room surance companies that want to offer Carolina said publicly that if we can inappropriately. Those with insurance insurance to them through this insur- bring down this health care plan, we now will not see their insurance change ance pool.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00046 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.061 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12507 One of the things we are debating is We have a provision where the Fed- have to object to that kind of wording. whether there should be a public insur- eral Government will partner with a We could make a lot of insinuations ance choice for people. I believe there business, with an insurance plan to about who junk lawsuits are being sup- should be. I believe that in order to make sure the costs are lower for the ported by and where the money from provide competition for the for-profit early retiree. It is called reinsurance. those folks goes. The Democrats say: companies, we should have that. But But for higher cost procedures or epi- Well, the evidence is that the insurance the exchange is set up basically for sodes, the Federal Government will companies are putting so much money small businesses and individuals to come in above a certain level and cover into defeating this piece of legislation. purchase—and we are told that people the costs. It is a partnership between Well, I found out the pharmaceutical will see cheaper rates being able to do the private sector and the Federal Gov- industry is now so firmly in the Presi- that. And to be sure they are able to do ernment to make sure early retirees, dent’s camp that it is developing plans that, we are including tax cuts, refund- who are already being hit with a thou- to spend $150 million promoting the able tax credits for individuals, for sand different challenges as a result of plan on TV. That certainly makes me small businesses that cannot afford in- early retirement, can afford insurance. kind of curious as to why the Arkansas surance today, to help them afford in- This is a snapshot of what we are Senator did not include executives of surance. That is what the exchange is doing. Again, the vast majority of peo- pharmacy companies in her piece of about. That will affect 15 to 20 percent ple are in private employer-based in- legislation. of the public who do not have insur- surance today. That will not change, Mr. President, I don’t begrudge any- ance today. other than this will over time bring body anything that they make, but I do We also have in the bill another op- their costs down and it will give them find it interesting that the CEO of Ab- tion where a State could choose to new protections because if something bott Laboratories makes $28 million, take the tax credits available to people happens—and it is happening every sin- the Allergan CEO makes $14 million, in the exchange and could decide to gle day where an employer has to de- the CEO of Bristol-Myers Squibb pool those and do a basic health insur- cide, Do I pay the 30 percent increase makes $23 million, the CEO of Eli Lilly ance plan and negotiate with an insur- in premiums or do I keep people em- makes $12 million, the CEO of Johnson ance company to get a better deal for ployed? If people find themselves in a and Johnson makes $29 million—the people in their State. We also have something I wish had situation where their employer drops Senator from New Jersey was men- been in place a couple of years ago for insurance or drops employees as a re- tioning these things, so I checked—and my own children, and that is, we are sult of costs, they have another option. the CEO of Merck, which is New Jersey going to say to young people that you They have someplace to go where they based, makes $25 million; the CEO of can stay on your parents’ insurance cannot today. They can go into the in- Pfizer, $15 million; Schering-Plough, until your 27th birthday. We also have surance exchange. They can get tax $18 million; Valeant Pharmaceuticals, a policy that is more geared to young cuts that will help them purchase more their CEO makes $20 million; and people within the exchange that will be affordable insurance from a large group Wyeth Pharmaceuticals’ CEO makes less cost to them. pool as a big business does. $25 million. Can you imagine all of the young Let me say that bottom line for all of Why would we want to leave these people today, college or not, who come this for us, despite everything that is people out of the same formula? Is it out, get the first job, like my children, being said, is that this is about saving because they are taking the side of no health insurance, who will benefit lives, it is about saving money, and it passing the bill as opposed to the side by saying you can stay on your par- is about saving Medicare. Every year of opposing the bill and informing the ents’ insurance until your 27th birth- we are losing 45,000 Americans who are people? We ought not to be about that day? That is in this bill, and it is very dying prematurely because they cannot sort of thing. important. Also basically make Med- find health insurance and cannot get Mr. President, I ask unanimous con- icaid for low-income individuals a safe- the health care they need. We have a sent to have printed in the RECORD an ty net so that anyone below 133 percent variety of ways in this bill in which we article from CBS News titled, ‘‘White of poverty can qualify. What that says are saving dollars. We have analysis House & Big Pharma: What’s the is—and this is very important to people from the Congressional Budget Office Deal?’’ in my State where we have the highest and Joint Tax showing that. And fi- There being no objection, the mate- unemployment rate in the country—if nally, we are saving Medicare for the rial was ordered to be printed in the you lose your job, you are not going to future. RECORD, as follows: lose your insurance. It is a very impor- The ACTING PRESIDENT pro tem- WHITE HOUSE & BIG PHARMA: WHAT’S THE tant right for Americans. pore. The Senator has spoken for 10 DEAL? We are improving the Medicare sys- minutes. (By Sharyl Attkisson) tem. We have certainly talked about Ms. STABENOW. I yield the floor. While much of the health care debate has that for a long time on the floor. A lot The ACTING PRESIDENT pro tem- been carried out publicly, some very private of time has been spent on the Medicare pore. The Senator from Wyoming. negotiations have gone on too—between the Program. We are cutting out overpay- Mr. ENZI. Mr. President, I have White House and the pharmaceutical indus- try. So private, neither side will release all ments to insurance companies, the for- found this afternoon to be very inter- esting. We have actually two debates the details, yet they potentially involve mil- profit companies right now that are lions of Americans, reports CBS News cor- being paid more than they should be going on at the same time, and some- respondent Sharyl Attkisson. and putting that back into the Medi- times they do not seem very related, Sources say negotiations involving the care system to make it stronger for the but they are. White House and the pharmaceutical indus- future, to help pay for prescription One of the amendments we are debat- try shifted to fast-forward in mid-June. drugs and to create more preventive ing is the one authored by the Senator President Obama had just taken a serious hit care for seniors. from Arkansas, and it limits the de- on the escalating cost of his health care plan Then another very important piece I ductible compensation for insurance and needed a shot in the arm. Days later, he executives to $400,000. Then we have got it with the full backing of the pharma- was very proud to coauthor with Sen- ceutical industry and its promise to save ator KERRY relates to early retirees. the Ensign amendment which suggests Americans $80 billion in health care costs. We have a lot of folks who are retiring that we should do the same for lawyers ‘‘This is just part of the legislative proc- early not by choice. They are being bringing junk lawsuits, although it ess—working with industry, part of getting told they are going to have to retire doesn’t go quite as far or is not quite this done,’’ said Nancy-Ann Deparle, director early at age 55 or age 58 or 59. They as unreasonable in that it only limits of the White House Office of Health Reform. may or may not have insurance. If they it as a portion of the lawsuit. ‘‘And the great thing is the pharmaceutical do, they are a higher cost for their em- Of course, one of the reasons being industry and others in the health care sector are supporting reform this time.’’ ployer, and if they do not, it is ex- given on the Senate floor for sup- But what did the pharmaceutical industry tremely difficult to find affordable in- porting the amendment of the Senator get in return? Initial reports said the White surance for somebody more likely to be from Arkansas is that Republicans are House agreed not to seek price controls on using health care at that point. funded by insurance companies. Well, I drugs for seniors on Medicare and would not

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00047 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.062 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12508 CONGRESSIONAL RECORD — SENATE December 5, 2009 support importing cheaper drugs from Can- when I was working on health plans. I It is interesting to note that both ada. Both the White House and the pharma- did small business health plans, and lawyers who are with the insurance ceutical industry now dispute that. that is something that has been rat- companies and lawyers who are with But news of a backroom deal riled even tling around here for about 12 years. It the people who have been harmed don’t some fellow Democrats, including a key committee chairman Henry Waxman. still is, and now it is 15 years. Now, want to have tort reform. That kind of ‘‘We’re not bound by that agreement,’’ how that works is that it allows small surprised me. Then I thought: Well, Waxman said. ‘‘We weren’t part of it and we businesses, through their associations, they probably learned a lot of this in feel strongly that the drug companies to group together to form a big enough law school. In law school they probably shouldn’t get off with a windfall at the ex- pool so that they can effectively lobby are taught how important it is to pense of our seniors.’’ against insurance companies or nego- somebody’s retirement. Then I remem- Whatever the case, the pharmaceutical in- tiate with providers. They can make bered the Old West and the story about dustry is now so firmly in the president’s these associations across State lines, how when one lawyer comes to town, camp, it’s developing plans to spend up to even make them nationwide if that will $150 million dollars promoting it with TV he is broke. But if they can get two, ads. work better. they can both make a good living. It ‘‘The president and Congress have a plan,’’ Presently, they have to do it within does take lawyers on both sides work- reads one ad. their own State. That is the law that ing these lawsuits, and it does amount Consumer watchdog Dr. Sidney Wolfe says we have set up. But I found an example to a lot of money. there’s reason for the public to be skeptical. of one in Ohio that is very successful. So we do have to do something, par- ‘‘We’ll give you this, you’ll give us this,’’ It works well. That is kind of how I ticularly in the medical area, because Wolfe says. ‘‘All sort of off the record, not modeled my small business health really incorporated in any kind of legislation we could save $45 billion a year if we plan. When I did small business health were to have something done about and I believe in the long run a very bad deal plans, I was taking on the insurance for the American public even if it’s a good junk lawsuits, particularly with OB– deal for the drug industry.’’ companies. They were pretty upset GYNs. We are losing all of them in Wy- The president may have won crucial sup- that I was doing anything in that area, oming, and it is because there is such a port from the pharmaceutical industry but and they joined with some other people long tail on it. Somebody can sue for 18 the question is whether that could jeopardize to keep me from getting cloture on the years after they are born. So the OB– support among Democrats and the public. motion to proceed to the debate on GYNs have to pay a lot longer insur- Mr. ENZI. Mr. President, I am sorry that. So I know how tough health care ance tail than that. the Senator from Minnesota finished is to move along. We had one dramatic case of a doctor But Ohio has that association within his presiding in the Chair. I will still attending a basketball game in Doug- its State boundaries, and it works be- address the question to him—I did not las. The reason he chose to announce cause they have a huge population. We expect him to give me an answer at the his retirement is because he couldn’t have less than 500,000 people who live moment anyway—because he said there afford the insurance he had to pay. The in Wyoming, and so if you break that was a 428-percent increase in profits for reason he did is because he had birthed down by associations, it would be small the insurance companies. I didn’t quite almost every kid on both teams. So the pools, and you don’t get the actuarial get what the dates were, but he was mothers there don’t have OB–GYN help value out of it that you would if you go talking percentages. As the account- as a result of his retirement, simply be- ant, I like to talk dollars. I would like to a big population. But in Ohio they can do it within the State, and in Ohio cause of what it cost him for insurance. to know what those dollars were from The PRESIDING OFFICER. The Sen- they did do it within the State. It that first year to the final year be- ator’s time has expired. brought down the cost of health insur- cause, for example, if a person makes Mr. ENZI. I thank the Chair, and I ance. It brought down the cost. $1 in the first year and in the last year yield the floor. Now, not only that, the biggest sav- cited they make $5.28, that is a 428-per- The PRESIDING OFFICER. The Sen- ings was actually in administrative cent increase. If you start with the low ator from Ohio. costs. It costs a lot more to keep track number of zero, you can have an unlim- Mr. BROWN. Madam President, I of all of the claims and everything ited—or infinity—increase in whatever come to the floor pretty often reading from a small business than it does from year you pick after that, if they even letters from people in my State who a big business. The bigger the pool, make a penny. So percentages can give have had problems with their health again, the more capable you are of han- some bad numbers. insurance. What is interesting about dling unusual situations. But adminis- Also, the Senator from New Jersey these letters is that in almost every trative costs came down from 37 per- was talking about administrative case, if you had asked these people— cent to 12 percent, which is a 25 percent costs, and so was the Senator from Mary from Madison County, Ann from savings. Every business would like to Minnesota. I would like to get the fig- Montgomery, Sheila from Richland have that. But that is how much it ures from Minnesota to see how that is costs to administer small ones, so that County—a year or two years ago if working—to have a limitation of 91 is why they wanted to group together they were satisfied or happy with their percent of all insurance money going to form associations to form this big- insurance, most of them would have to evidently pay claims—because I am ger pool, which we haven’t been able to said yes. But today they say something not aware of the administrative costs do. very different, maybe because a baby being quite that low in almost any I would ask the Chair how much time was born with a preexisting condition, business. Again, as the accountant, I I have remaining? so they can’t get insurance now or find that most people—and when I say The PRESIDING OFFICER (Ms. maybe they got very sick and the in- most people, I would include my col- LANDRIEU). There is 2 minutes 15 sec- surance company took them off their leagues—think most businesses are onds remaining. plan, kicked them off their plan be- pretty simple. But when I visit one of Mr. ENZI. I do want to make some cause they were costing too much or those businesses, and I learn a little quick comments about the junk law- maybe they changed jobs and lost their about it, I find that when I scratch the suits. We do have to do something insurance or maybe they got laid off. surface, there is a lot going on that the about that. When I am talking about The other thing I noticed—and as the average person out there couldn’t han- junk lawsuits, I am talking about a Presiding Officer knows, from what dle. bunch of them being filed these days happens in Louisiana and the letters Some of that shows up in the legisla- that are $25,000, $45,000, $95,000, or you get from Baton Rouge and Shreve- tion that we do. For instance, Cash for whatever is less than what it would port and all over—is so many people Clunkers. That was supposed to be a 4- cost to defend that lawsuit because if it who are 58 or 62 or 63 years old, and month program. We ran out of money is less than what it would cost to do who don’t have insurance, they just in 4 days. That shows how much we the lawsuit, the insurance company is pray that they can make it until they knew about the car business. going to say: Let’s just pay them and are 65 because they know they have a So when we are talking about these we will be saving money. It is bad good strong public plan at 65 that different things, I got involved with precedent and it leads to more junk doesn’t deny people with preexisting some of these administrative costs lawsuits being filed. conditions. Medicare doesn’t do that, of

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00048 Fmt 0637 Sfmt 0634 E:\CR\FM\A05DE6.024 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12509 course. It is a plan that is predictable ably not going to happen if we have the business. You create a public option, it and they can stay with it and it will type of insurance reform we hope to doesn’t mean someone from Lebanon or help them. have because they will not make the Batavia or Cincinnati or Blue Ash or I want to share a handful of these let- kind of money to do that. Evendale or Middletown or Hamilton ters, Madam President, and I will start The next letter is from Sheila from has to take that public option. But it with Mary from Madison County. Madi- Richland County—Mansfield, my home- does mean, because of the existence of son is just west of Columbus. And Mary town—and Sheila writes: the public option, there will be more writes: I moved to Ohio five years ago to be with competition and the insurance com- For the past 26 years, I’ve worked hard and my grand-daughter. I’ve worked hard all my pany will behave better. You get better carried my own insurance. When I started a life, and now, I’m 60 years old still working quality, lower prices, and you will not home-based business, I joined my husband’s and paying for my insurance. The other day have these companies dropping cov- employer-based plan. But when he had an on I learned that my health insurance has dou- erage because of a preexisting condi- the job injury and went on Social Security bled. I am alarmed because I’m wondering how long I will be able to pay for my bene- tion. Disability in 2006, I had to find my own in- Let me add one other thing. There surance. Guess what? I was turned down by fits. I’ve talked to some other people my age almost every health insurance company be- and they are feeling the same way. I have al- was a Dow Jones story a couple of cause of a pre-existing condition—which was ways worked, never sat down, or expected years ago entitled ‘‘Humana’s Third a heart attack I had in 2004. The only insur- hand-outs. But insurance companies are Quarter Profits Up 65 Percent, Sees ance I could buy was a short-term policy. downright greedy. I do have a problem with Strong Medicare Advantage Gains.’’ Mary says she then got sick and had seniors being gouged because of age and Let me excerpt from the first few health issues. $40,000 in medical bills from a proce- paragraphs. Humana Inc.’s third-quar- dure, that she has wiped out her sav- I think that says it all. ter earnings rose 65 percent amid im- ings, and she says: Most of these people, as you can see, proved margins in government—i.e., happen to be women. Women are much I’m still unable to buy a major medical Medicare Advantage—segment. The policy. I am too young for Medicare and I more likely to write us about these company also gave an initial 2010 fore- make too much to qualify for Medicaid. problems, often not just for themselves cast in which the health insurance but often because they are taking care Mary is an example of someone who projects ‘‘substantial’’ Medicare Ad- of their families. They are the major would absolutely be helped by this bill. vantage membership growth, resulting caregivers and they are the ones who She could go to the insurance ex- in revenue of $32 billion to $34 billion— navigate their way through these com- change, choose a private company or well above analysts’ average estimate plicated policies to advocate for their choose a public option, and she could of 29 billion. Humana’s forecast takes families. These people who work hard make a decision based on what her into account reductions in Medicare and play by the rules—they do every- needs are whether she wants the pri- Advantage overpayments. thing we ask of them as American citi- vate or the public. She would know We were on this floor in the last few zens. We owe them a little better treat- that with the public option prices will days, listening over and over to my ment than that. be more stable and that the quality friends on the other side of the aisle de- This last one I will read is from will be better because there will be fend the insurance industry, saying if Kelly, from Delaware County, north of more competition than there would be you do this the insurance industry is Columbus. otherwise. going to be in such trouble and they Here is a letter from Ann, from I am a 39-year-old mother of two young will have to cut benefits. sons. My husband and I decided it would be The insurance industry under our Montgomery County, the Dayton area. better for me to leave my job and stay at plan will get 20, 25, 30 million new cus- She writes: home and take care of our children. tomers because all these people with- Our insurance premiums have nearly tri- But this also meant we would lose our out insurance are going to buy insur- pled in the last six years—going from about health insurance through my employer. ance. Of course we are putting some $560 per month to about $1,500 per month. At She had the insurance in the family. the same time, none of our benefits have in- new rules on them. We don’t want creased. Since we bought our policy, we have My husband works for a small business them to continue to deny care for pre- paid the insurance company $68,000 for the that does not provide benefits. existing condition; we don’t want them insurance. We ended up purchasing at what we thought was a reasonable price. But it tri- to continue discriminating against Then she writes as though she is pled within a year. women, as the Presiding Officer knows. writing in a magazine, and she says: In February 2008 I found out I was pregnant As a female, but as a good Senator, she Anthem’s total spending from my family’s and I inquired about the maternity coverage understands that women are paying of- claims since we bought the insurance: we added despite the high cost. tentimes way more than men for more $4,064.24. Anthem’s profit from my family: I was shocked to learn there was a nine- or less identical coverage and more or just under $464,000. Anthem’s CEO’s total month waiting period before the coverage less identical situations. The insurance compensation last year alone: $10 million. took effect—and that the pregnancy and companies will not be able to do that Now, clearly, one of the biggest, birth would not be covered because it’s a pre- existing condition. anymore. So they will have these new strongest supporters of my friends on That is $15,000 to $20,000 that would not be customers. We have some rules so they the other side of the aisle is the insur- covered. My husband and I talked about that will not be able to keep gaming the ance industry. They are as supportive if I needed critical medical care, could we system. of the insurance industry as the indus- end up bankrupt? Could we lose our home? My friends on the other side of the try is of them. Well, we do know that [How about] our child’s college fund? aisle I hope would sort of back off the if we do insurance reform right—as I That $15,000 or $20,000 obviously is defense of the insurance industry be- think we will—and the Presiding Offi- without major complications. cause that is not what we are here for. cer from Louisiana has been in a lot of By the grace of God my husband’s com- We are here to help make this insur- these meetings where we have dis- pany decided to offer health benefits and ance system work better for all Ameri- cussed some of these changes that we pregnancy was covered. cans. That is the reason for the public want to make—insurance companies Then she writes, thinking of people option. That is the reason for the in- are not going to be able to deny cov- other than herself—Kelly writes: surance reforms. It will mean people erage. When someone gets sick and Please take up reform in a serious manner will not be denied for a preexisting con- submits their claims, they are going to and consider among your reforms, a public dition, it means people will not have to get paid instead of having to fight over option. Why can’t insurance companies com- fight so hard when they submit their it. And we know if there is a public op- pete? What are they so afraid of? claims and have the insurance compa- tion, there will be more competition Kelly gets it. She understands that a nies turn them down. and that these CEO salaries are prob- public option will mean that insurance About a third of claims that people ably not going to be as high. The aver- companies will have to compete. submit to the insurance industry are age salary for CEOs of the top 10 health For instance, in southwest Ohio, the denied. That means on the initial insurance companies in the country is Cincinnati area, two insurance compa- round that people do not get reim- $1 million. That kind of salary is prob- nies have 85 percent of the insurance bursed for their expenses. It also means

VerDate Nov 24 2008 02:01 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00049 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.065 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12510 CONGRESSIONAL RECORD — SENATE December 5, 2009 people have to fight with their insur- where most of the fraud is. We have not ment on the floor and people have dis- ance companies, far too often, people begun to touch that, we have not at- puted it. in a situation where they should not tacked it. There is a minimal $2 billion Find me a doctor who has trained in have to do that, they are sick, caring over 10 years of direct fraud elimi- the last 30 years in this country, who for a loved one, whatever it is. nation in the bill we have on the floor. spent part of his training at a VA med- That is the reason this insurance re- Administrative inefficiencies. That is ical center, and ask him or her the fol- form is so important. I ask we move the bureaucratic paperwork that both lowing question: If you or your family forward and pass this bill. the hospitals and the doctors spend were sick and you had the choice of I yield the floor. money on to make sure they maintain where you trained at a VA hospital or The PRESIDING OFFICER. Who compliance with the regulation of med- any other hospital you trained, would seeks recognition? The Senator from icine—17 percent. That 17 percent you go to the VA hospital or would you Oklahoma is recognized. comes to somewhere between $100 bil- go to one of the private hospitals where Mr. COBURN. Madam President, I lion and $150 billion a year that does you trained? One hundred percent will ask unanimous consent that myself not help one patient get well. It doesn’t say no. and the Senator from North Carolina prevent one patient from getting sick. Our VA system has markedly im- consume the next hour discussing the In this unwarranted use happens to proved. I will readily admit, in certain health care bill. be the very thing that none of the bills areas, they are better than anybody The PRESIDING OFFICER. Is there attack, except our bill, which is the de- else, especially prosthetics, especially objection? fensive medicine costs in this country. post-traumatic stress disorder. They Without objection, it is so ordered. Why would it be important to fix that? are better. But on the vast majority of Mr. COBURN. Madam President, we Because it is close to $200 billion a the issues, they are not. They are run have been discussing health care in year. That is $200 billion of tests that by the government. Look at the Indian Washington for the past 8 months rath- are ordered on patients, on procedures Health Service. We have a profound er vigorously. Four years ago I started that are done on patients they do not legal treaty obligation to provide working on a bill with my colleagues in need, because the doctors need to do it health care to Native Americans. Yet the Senate and we introduced a bill 2 to prevent themselves being exposed to Indian health care is abysmal. That is years ago and modified it this year. It unnecessary litigation. That is $200 bil- a government-run program. Then look was introduced before the House bill, it lion a year, that is $2 trillion over 10 at Medicaid, which we are going to put was introduced before the Senate bill. years. Yet we do not address it, not one millions of people in. What happens? In It was introduced before the bill we iota in the bill we have on the floor. Medicaid, 40 percent of the doctors and have on the floor at this time. It is Avoidable care—those are complica- 65 percent of the specialists will not see called the Patients’ Choice Act. tions. Those are things that we cause. you. But we are going to say: We will Iatrogenic, they are induced complica- We have heard several times that the give you coverage in a system where tions. We are not going to be able to do Republicans want to stop this. As a you have access to only 60 percent of much with that. We could fix this— practicing physician, I fully recognize the doctors. That is not choice. That is lack of care coordination with account- the need to significantly reform health relegating you to a system that says able care organizations—by incenti- care. There is no question. I recognize you can’t get care. that. In that bill is a guaranteed vizing outcomes, by grouping in pay- I have talked on this floor about pe- issue—no preexisting conditions are al- ment for how we pay. But we have not diatric subspecialties. Because of Med- lowed in exchanges under our bill. But done any of that. icaid, we have an absolute dearth of pe- So here is Thomson Reuters that is I also recognize that as we fix health diatric subspecialties because the pay- showing if we want to drive down costs care, some of the things we cannot do ment mechanism is so low that nobody in our health care system, what do we are make our fiscal situation worse and have to do? We have to attack where will spend the extra time in residency also our inefficiencies worse. the waste is. There is nary a gnat’s to become a pediatric subspecialist. Earlier today I referred to research rear end of reduction in these things in Whether it is a cardiologist or gastro- put out and published in October of the bill that is before us. enterologist or pediatric neurologist, 2009, which is a white paper on the The other thing I referred to earlier we can’t find them. Nobody will go waste in our health care. This is Rob- today was a report by the Congres- there. The rates for reimbursement are ert Kelly, vice president, Health Care sional Research Service, which was set so low. So physicians graduating Analytics, at Thomson Reuters, a high- issued December 1, this year, last from medical school make an economic ly esteemed, reputable firm which says week. What did they say? The question decision based on the health and well- that every year between $600 and $850 that was asked of them: What percent- being of their family to not go into billion of money is wasted in health age of health care is run or funded by those areas because we have forced care. It is wasted. It doesn’t help any- the Federal Government today—or the them. body get well and it doesn’t prevent governments today? The number came What we know is, there are poorer anybody from getting sick. back—I have been quoting 61 percent health outcomes in Medicaid. That When you look at the breakdown of on my back-of-the-envelope calcula- should not be surprising. Some of the where that comes from, it is rather ap- tion. The number came back, as af- best doctors are not available to Med- parent that the largest component of it firmed by Congressional Research icaid patients because we will not pay is unwarranted use. They break that Service, that 60 percent of all health for their expertise. We also pay an down. What is that? That is me as a care in America is funded through or extra $1,800 per family, everybody in physician—I am a practicing physician, by your tax dollars funding through a this country who has insurance, be- delivered thousands of babies, cared for government organization. cause of the underpayment of Medicare thousands of grandmoms, granddads, The question has to be asked: How and Medicaid. Finally, with the large kids, set bones, done operations—old- well are we doing? Could there be any tranche of people under this bill who time, broad-based practice. coordination or connection to the fact are going into the Medicaid Program, But what is this unwarranted use? that the government is now running 60 we are going to break the States, if Madam President, 40 percent of $700 percent of the health care, and health they are not broken already. We are billion is $280 billion a year. They are care inflation is twice what all the rest going to cover it for 4 years. For cer- saying a total of $700 billion, times 10 of the inflation is? Could there be any tain States, we will do a whole lot bet- years in my math, at least from Okla- connection between the inefficiencies ter than that; Louisiana and a few oth- homa, is $7 trillion. that are in health care and the fact ers for which we have made special ex- We have not begun to touch in any of that we have bureaucracies that have ceptions. But we are basically going to these other bills this unwarranted use, themselves in between patients and transfer a load of fiscal responsibility, the fraud and abuse—19 percent—that their providers? I think the answer to call it equal, and put that load on the comes to $175 billion a year in fraud. that is an astounding yes. taxpayers of the individual States. Most of it is not in the private sector, I visited with a cardiovascular sur- As we look at health care, one of the it is in Medicare and Medicaid. That is geon, because I have made this state- things I wished to do was to talk about

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00050 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.070 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12511 the problems but also talk about the screening. That is what we said. We they are throwing people off the Massa- bill we have before us and make this voted for it. It doesn’t apply. Are we chusetts plan because they don’t have point. Are we better off with the gov- going to pass that every time? We enough money to cover them. ernment running health care or are we didn’t get rid of it. We didn’t get rid of Real health care reform means we better off changing the system in such the Medicare Advisory Commission. We are going to make sure every American a way so the patient is put first, the didn’t get rid of the Comparative Effec- has the resources to be covered or to be government is put last, and the doctor tiveness Panel. Every time they make able to pay out of pocket because the is a 100-percent advocate for their pa- a bad decision, are we going to pass a real boogeyman of health care today is tient? Which would be the better way? law and say: You were wrong or are we the cost shift. It is cost that is in- Knowing that we have $7 to $800 billion going to trust the professionals, the curred when a service is delivered to a year wasted, why would we not de- professional societies that guide my you that the person or the institution sign a system that goes after that practice of medicine today or are we delivering the service isn’t reimbursed waste and create the same opportunity going to have a bureaucrat and a bu- for. If they receive no payment for the for everybody? reaucratic system that says what you service they provide, then they have to When you look at the Patients’ will get and what you won’t? Under the shift the cost of delivery of that service Choice Act, which my colleague, Sen- bill we have, you are going to have over to somebody else. The somebody ator BURR, will talk about in a minute, that. We have taken the hot potato off else is people who privately pay. They there are some important things. First, the floor in terms of breast cancer, in either pay out of their pocket or they let me tell what the CBO says about it. terms of what they said. We said it walk in with insurance, and the cost of The CBO says it will reduce future doesn’t apply. We passed something for those services is shifted to everybody budget deficits, relative to protections women’s health which I applaud. But who falls into that category. under current law, by amounts that in- what about men’s health? What about Up until this debate, most Americans crease over time—the first 10 years, $70 children, what about prostate screen- had thought cost shift was only gen- billion. But what it will do for the ing for men? What about colon screen- erated by people who had no insurance. States is $1 trillion in savings the first ing for men? What about cardio- What we have learned in this debate is 10 years. It will lead to lower budget vascular screening for men? We didn’t it doesn’t stop there, that the cost shift deficits. That is what the CBO said. It do a thing. Why didn’t we? Because we is also initiated from somebody who is said it also would reduce spending on know a larger percentage of the emo- underinsured, meaning they haven’t health care because it will be more effi- tional attraction has to do with those got enough insurance to take care of cient spending. Then, finally, the Fed- things associated with women. So we the services they need. But it doesn’t eral contribution for Medicaid would pounded our chests and passed the Mi- stop there. For every beneficiary that grow at a lower rate, lower than health kulski amendment for preventative Medicaid covers, we reimburse at an care inflation, which means it is going care for women, and we ignored the average rate of 72 cents of every dollar to save a ton of money for the States. preventative requirements of every- of service provided, meaning for the The bill we have before us creates 70 body else. How does that fit with what millions of Americans who are covered new government programs. It has 1,696 we should be doing? under every State Medicaid plan, we times that we will write bureaucratic It doesn’t connect. It is political. It automatically cost shift 28 cents of rules and regulations that are going to makes good news. It satisfies vocal in- every dollar of service they get to the cause the government to step between terest groups. But does it fix the long- private side. the patient and their caregiver. It is es- term problem? As a matter of fact, for the 35 to 40 timated, right now, to add somewhere I yield to my fellow Senator from million seniors under Medicare, we re- around 20,000 new Federal employees— North Carolina. imburse at 91 cents for every dollar of we are trying to get a handle on that— The PRESIDING OFFICER. The Sen- service provided. Therefore, 9 cents is 20,000 new Federal employees to tell ator from North Carolina. shifted in some fashion to the private you what you will and will not do in Mr. BURR. Madam President, this pay side. No wonder health insurance your health care. It is going to create debate to date has not been about and the cost of health care has contin- at least $5 to $10 billion in new require- health care reform. It has been about ued to rise at an unsustainable rate. It ments for the Internal Revenue Service coverage expansion. We are learning is because we keep growing the pool of just to check on you. That is per year how expensive it is not to do reform. In people who don’t provide 100 percent of to check on you to make sure you are fact, incorporated in this bill, just the cost of the service provided. filling out the forms right. It will cre- short of $900 billion, we are required to We are here debating a plan that ate a massive disruption in the insur- offset 100 percent of it because you they say is a reform. Well, I will give ance market. don’t receive savings unless you re- them credit for this: They do cover 31 Nobody who practices medicine today form. million Americans who are not covered likes insurance companies. The very When Dr. COBURN and I started work today. It still leaves 24 million Ameri- fact that we would have our colleagues over 31⁄2 years ago to try to figure out cans uninsured, uncovered, but they do claim we are defending the process is how you change the health care system cover 31 million. Fifty percent of that absurd. What we are defending is allow- to the most efficient, yet maintaining number, 15 million Americans, are ing the free market, with legitimate the same quality of care and innova- going to be thrown into Medicaid in regulation, to allocate a scarce re- tion and breakthrough, we went on a the States they live in. If the attempt source without putting the patient sec- search. We went to States to look at is to reform health care, the first place ond. There is a big difference. I can tell creative things that States had done. I you start is with eliminating cost you horror stories about insurance daresay everybody trumpeted the re- shift. The first place they have started companies, but I can tell you worse forms in Massachusetts. What we is to take the least-efficient medical stories about the Federal Government learned very early on was Massachu- delivery system in the country, Med- and the fact that it denies twice as setts didn’t have any reforms. They did icaid, and jam 15 million Americans many claims per 10,000 claims as all the coverage expansion. Where they used into it. Forget the fact that it is an un- other insurance companies. to pay for it out of the right pocket, funded mandate to the States at some So when we are talking about access now they paid for it out of the left point, after the Federal Government to care, both of the bureaucracies are a pocket. They promised that coverage pays 100 percent of the initial charge. nightmare. Yet this bill creates the would be extensive and include every- We are exacerbating the problem that mother of all bureaucracies, the moth- one. exists in health care today because we er of all new programs. Where are we today, just a few years are putting 15 million new covered I will make one last point and yield later? The companies they said they lives into Medicaid, and we know for the floor. We have been down here fix- would never send bills to, they are every dollar of services they get, we ing things that are wrong. We fixed the sending an additional surcharge to the are going to cost shift 28 cents of that Preventive Services Task Force. We Massachusetts people, and they said over to people who pay out of pocket or said it doesn’t apply to breast cancer everybody would be covered. This year have insurance.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00051 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.072 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12512 CONGRESSIONAL RECORD — SENATE December 5, 2009 The direction we have started in is $900 billion to do it because there is no tive insurance market, then we will flawed because we haven’t tried to ad- savings because there is no reform. double the investment in your Med- dress the cost shift that exists in our So Senator COBURN and I went icaid beneficiaries so they can have health care system. Senator COBURN through that process, and we began to $10,000 worth of coverage through the and I attacked that. After we got past construct a bill. He did a majority of private sector. Massachusetts, we looked at innova- the work. What did we find? We found Again, we did not force them. We did tive plans such as North Carolina’s for that we needed massive insurance re- what Dell did, what companies did: we Medicaid, where they were making form in this country. As he said ear- gave them cash because we think we progress reaching new efficiencies and lier, you cannot be excluded if you can increase the quality and decrease last year saved $200 million in their have a preexisting condition. You can- the overall cost. health care plan. not be excluded because you get sick. Tort reform: Dr. COBURN has talked Most people don’t know it, but Med- What you have to have is competition. about tort reform. Every doctor has icaid is an opt-out program. States can Well, I will tell you, in this plan, talked about tort reform and defensive choose to opt out. where they say there is choice and medicine, how it has run up the cost of That word has been used a lot as we competition and innovation, they actu- diagnostic procedures because you have talk about health care reform in the ally mention choice 40 times, they to cover yourself for the one lawsuit United States, and that as long as you mention innovation 25 times, and, be- you get. do an opt-out, we will be fine for a pub- lieve it or not, they mention competi- We came up with quite a unique ap- lic option for the government-run sys- tion 13 times. Yet when they talk proach to it. We gave States three op- tem. Well, we have one of those. It is about taxes, fees, and revenues, they tions. We gave them the ability to have called Medicaid. It is an opt-out gov- mention it 899 times. That gives the arbitration, we gave them the stability ernment health care program. How American people some insight as to to create a health court, and we said to many States opt out? None. Why? Be- where the focus of this health care bill States: If you adopt any one of these cause the subsidy is so big they cannot is. three options, we will give you a 1-per- do it. Dr. COBURN and I went exactly the cent bonus on your Medicaid. You do But what happens when they want to opposite way. This is not a reform ef- not have to adopt the tort reform. But change their plans? Let’s go back to fort that needs to be dominated by gov- if you want the 1-percent bonus on North Carolina. North Carolina would ernment. We chose the carrot versus Medicaid, then you have to adopt one like to change their plan further, now the stick. In the bill on the Senate of the three options we have put into that they have learned things they can floor we are talking about, if an indi- it. So, in essence, what are the three do. They asked the Centers for Medi- vidual does not buy insurance, they are things we have done in our bill, which care and Medicaid Services for a waiv- fined. They are fined if they do not buy Dr. COBURN, once again, said was the er. Religiously, what happens? They insurance. We thought the Constitu- first bill introduced in the Congress of are denied the waiver to change their tion said that if you tax the American the United States? I have sat on this health care plan to raise the quality people, you have to do it equally. You floor, as Dr. COBURN has, as many peo- and to reduce the cost. have to apply the same tax to this ple have, and, yes; we have had a sharp Sound eerily similar to what we are group that you do to that group. exchange about what is in this bill and talking about, potentially, in a health Through equalizing the application of whether it is beneficial or whether it care plan we are going to roll out for taxes in this country, we were able to hurts. I happen to think it hurts. But I the rest of the country? Maybe an opt- come up with a plan that provided have also listened to folks on that side out plan where States could opt out, every American family $5,700 per year of the aisle say: When are Republicans where they say it is not a government in refundable tax credits. So every going to offer something constructive? takeover. Well, if you have to go to the American family would get that $5,700 When are they going to offer a path- government and ask their permission every year. way? to change it, to increase the quality of If, yes, we had that individual who We have. We were the first. We were the care and to decrease the cost be- was not married, and he or she got a ignored. We will get an opportunity to cause of the efficiencies you get $2,800 refundable tax credit, and they debate it as we go through this. We will through how you design it, I will tell did not use it, we gave the States the get an opportunity to vote on it, I can you that is a government-run plan, option that they could opt them in. assure you. I do not expect it to pass. plain and simple. They could actually enroll them with But there are a lot of good things in We talked to self-insured companies. that $2,800 into a high-risk cata- here. There was a gold mine of great ideas strophic plan. We did not penalize the Mr. COBURN. Madam President, will from companies such as Dell, SAS, individual. We took what the govern- the Senator yield for a question? Safeway, and Pitney Bowes, companies ment had provided and made sure they Mr. BURR. I am happy to yield. that had frozen their health care costs had insurance so that the next week- Mr. COBURN. Does the Senator re- year after year after year. We had one end, if they were riding their Harley- call the vote in the HELP Committee simple question. How did you do it? Davidson and they had a wreck and when this bill was offered—this bill They looked at us and said: We in- they ended up in the emergency room that allows you to keep whatever you vested in prevention, wellness, and with no insurance, at least for the have, if you like it; this bill that gives chronic disease management—even to $200,000 bill to get them well, the hos- no tax increases on American families; the degree that one company offered pital was not going to cost-shift that this bill with no increase in taxes on the employees who had chronic disease to somebody else because they were American business; this bill that low- the ability to have a program specifi- going to have catastrophic insurance. ers everybody’s health insurance pre- cally designed for them for free, if they Maybe the hospital had to eat the first mium; this bill that covers preexisting would enter into the program. Employ- $5,000. But after that, they had an in- conditions, period; this bill that pro- ees in some cases chose not to go into surance policy. tects seniors’ high quality of care and it. The company turned around and fi- But this is the difference in ap- keeps their choices; this bill that in- nancially rewarded them by writing proaches. We are not penalizing the creases personal control over health them a check to get into the program. American people. We want them to be care; this bill that does not do a Med- At one company, when they wrote part of a health care system that is re- icaid expansion but, instead, puts Med- them a check, they had 80 percent en- formed. icaid patients into real insurance so rollment, and in the first 18 months We looked at Medicaid. We saw this they can have the same choice as every they saved $1,782 per employee. That is problem with a 28-percent cost-shift. other American; this bill that protects real savings. That is bending the cost We said we have to reform Medicaid. physician-patient relationships; and curve of health care down. That is not How do you do it? We gave States the this bill that empowers patients, fami- what we are doing in this debate. Even option: If you want to enroll your Med- lies, physicians, and providers, but does the CBO says you are going to spend al- icaid beneficiaries into this new plan not empower the government—what most $900 billion and you have to raise that we created in this new competi- was the vote, does the Senator recall?

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00052 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.073 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12513 Mr. BURR. All the Republicans voted become law, but I expect reasonable Whatever you have today, if you like for it and all the Democrats voted people to accept things that really do it, you really can keep it. That is not against it. reform health care, and a lot of them true in this bill that is coming across Mr. COBURN. Exactly right. The dif- are in this bill. the Senate floor. There is an absolutely ference is, you can either trust people Madam President, I yield to my good zero tax increase on American families, or you can put all your trust in a friend. and it is not true in this bill on the nanny state, and the nanny state is Mr. COBURN. Madam President, floor. There is $500 billion worth of tax running 61 percent, 60 percent of our could I inquire of the Chair how much increases on either families or busi- health care today. time we have remaining? nesses. I thank the Senator for answering The PRESIDING OFFICER (Mrs. It lowers the cost of health insurance my question. GILLIBRAND). There is 24 minutes re- premiums. This one on the floor says, Mr. BURR. Let me conclude and give maining. at best, in the large group and medium the floor back to the Senator. Mr. COBURN. Madam President, I group market, it is going to be about There are three objectives Dr. want to go back over some of the the same trajectory of twice the infla- COBURN and I set out to accomplish for things in the Patients’ Choice Act be- tion rate. But if you are in the indi- all Americans in the bill. The first was cause people ask me why they have not vidual market, it is going to be 10 to 13 to cover all Americans, make sure ev- heard of it, and it is because the press percent higher. Our bill lowers erybody had the capability to access does not want to cover a commonsense everybody’s cost. It protects the sen- affordable coverage. bill that does not spend money. The iors’ high-quality care and choices Two, remember what the companies majority does not want to incorporate today. It doesn’t pick winners and los- that were self-insured told us: Invest in the ideas because it is not government- ers; it allows patients to pick what is prevention, wellness, and chronic dis- centered, it is patient-centered. We best for them. It increases patients’ ease management. The only direct cost have a bill on the Senate floor that is own personal control over their health savings in health care today is preven- totally government-centered. care, and it converts Medicaid to a sys- tion, wellness, and chronic disease But what does the Patients’ Choice tem where no longer are patients in management. There are a lot of indi- Act do? Senator BURR alluded to a lot Medicaid discriminated against be- rect savings—tort reform, insurance re- of it. But I want to go into it in a little cause what we do is we buy them an in- form, purchasing insurance across bit of depth. surance system—allow them to buy in- State lines—but the only direct savings What it does it is looks at the five surance where nobody will ever know comes from prevention, wellness, and preventable diseases in this country they are a Medicaid patient, so nobody chronic disease management. that consume 75 percent of our dollars, will ever know to deny them, because Third, and probably most important, five chronic diseases: heart disease, the patient rate will be equivalent to make sure it is financially sustainable. cancer, stroke, chronic obstructive pul- anybody else in the insurance market. Well, I do not know why, right now, monary disease, and diabetes. They So we give them the same access. we would create a health care plan in cause two-thirds of the deaths and con- We treat Medicaid as we treat Indian America that could not financially be sume 75 percent of our dollars. The Pa- health care: Here is your health care, sustainable for decades. Why would we tients’ Choice Act invests in pre- but it is not as good, so tough it. Here create a health care plan that for the venting those diseases. is your health care. We know the out- current generation entering adulthood The second thing it does is it creates comes aren’t as good. So what. Those would not live with that health care affordable and accessible health insur- aren’t Tom Coburn’s opinions. Those plan in a financially sustainable fash- ance options—not government-run, not are published data where we know the ion for their lives? This one will not. It government-mandated, but uses the ex- outcome in Medicaid isn’t as good as costs $2.5 trillion. It does not make it perience of 50 States through ex- any of the other insurance programs or through the first 10 years. changes and sets a floor. What is the it is not as good as people who are in Yet we have an option. It is an option floor? The floor is the same level of the cash market even though they pay that Republicans have already intro- care Members of Congress can get. more. It protects patients and their care- duced. We have let the American peo- That is the floor. But you get to givers’ relationship. Finally, it empow- ple see it. It is not 2,074 pages. I think choose. Nobody says you have to have ers patients. It empowers mothers to it is barely 240-some pages, and it in- this. make choices for their children; gives corporates much more. Oh, by the way, Do you realize that 15 million Ameri- them a broad array of choices. It em- it fulfills—it checks all the boxes the cans who are going to be forced into powers, but it doesn’t empower the President said we needed to do when we Medicaid in this bill will not have any Federal Government. started on health care reform. It covers choice? They will just say: You have The Federal Government is failing in all the American people, is financially Medicaid. And they will be denied 60 health care right now. It really isn’t sustainable, maintains the level of percent of the doctors in this country. my ingenuity that came up with this quality, and it bends the cost curve It eliminates preexisting conditions. chart, but since I am around my three down. It eliminates the ability of an insur- daughters and a lot of younger people What is the most disappointing thing ance company to drop you if you are who work for me on my staff, this is a out of this debate so far? It is that we sick. You get offered health insurance comparison of the Patients’ Choice Act do not have to get down here to tell the regardless of your age or regardless of or the act we have here. It is like com- American people this is going to cost your health. Yet we are saving tril- paring old Ma Bell to an iPhone. them more. They know it. They know lions, and they are spending trillions. The Patients’ Choice Act is the their insurance premium is going up if What is the difference? What is the iPhone. they have coverage today. They know disconnect? It gives you, as Senator A little over a decade ago, iPhones or the doctors are going to have to charge BURR talked about, an auto enrollment even cell phones in general—who would more because Medicare is going to cut mechanism. If you choose to be irre- have thought they would be so wide- its reimbursements. They know more sponsible, that is fine, but the rest of spread? Apple’s iPhone was the fastest doctors are going to drop seeing Med- us should not have to pay for your irre- growing smartphone of 2008, and its icaid beneficiaries because the reim- sponsibility. So if you do not sign up, 2008 sales were 21⁄2 times higher than bursements are going to continue to go you have an automatic enrollment 2007. Why the increase? Why did iPhone down. The American people get it. with your tax credit that puts you in a sales take off? What did they do? They That is why, in an overwhelming fash- very high deductible plan, so if you are hugely popular because they are ion, they are opposed to what we are have a catastrophic illness, the rest of user friendly and they allow tons of op- here debating. us do not have to pay for you. tions and you get a personalized My hope is that at some point in this It also allows States to join in pool- iPhone experience that you control. debate we will talk about some ration- ing arrangements, or regional areas, So what does an iPhone have to do al things, like what we have in the Pa- where they increase their buying power with health care? Both sides of the po- tients’ Choice Act. I do not expect it to through these exchanges. litical aisle rhetorically agree that

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00053 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.074 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12514 CONGRESSIONAL RECORD — SENATE December 5, 2009 American consumers prefer products mium is going to go up. So what is Mr. BURR. And save $2.5 trillion of that are personalized, that fit their available today because of the mix of the American people’s money. needs, that are affordable, and that are people who are in the broad group of Mr. COBURN. And save $2.5 trillion portable. It sounds a lot like an pools who are insured—we are going to and have the flexibility of choice based iPhone. As a matter of fact, my col- drop out young, healthy people, so that on what they need and what they per- leagues across the aisle are now using small younger group insurance is going ceive their children or family needs. the language ‘‘choice and competition’’ to go up. But because there are going So they do increase coverage, but to try to sell this monstrosity on the to be 6 million to 11 million fewer of how do they do it? They put you into a American people, the most massive ex- them and the insurance company keeps substandard plan. They put you into a pansion of Federal Government control them in the pot to lower the cost for plan that doesn’t give you the same ac- since Johnson’s Great Society. the older ones, the 65 and above, their cess Members of Congress have. They The problem is that the policies in premiums are going to go up. put 15 million people into that, and this bill would discard the iPhone’s in- So we are going to have exactly the they decrease the flexibility and choice dividual choices and consumer control. opposite effect because when you man- for those people, 11 million people, in But what it would embrace is Ma Bell, date coverage and you force people to Medicare, because we know better. the old land line black phone with a ro- buy it with a big government program, Mr. BURR. My good friend probably tary dial. That is what we are going to people are going to make an economic remembers the day we marked this up embrace with this bill. We are not decision—and the first year of this is in the Health, Education, Labor, and going to embrace the iPhone; we are $250 is all you have to pay, and it goes Pensions Committee. As a matter of going to embrace being locked to your up to $750—they are going to say: Why fact, it wasn’t a day, it was 31⁄2 weeks house with limited choices, limited ca- would I do that? I will buy the insur- and 561⁄2 hours, if I remember exactly. pability to expand your choices, and ance when I get sick. One of the amendments they accepted limited freedom. So what we are going to do is totally was an amendment that is titled this: Mr. BURR. Would the Senator yield disrupt—and it may be planned to be The 2220 rule. My good friend being a for a question? that way so we can come back and say: doctor would recognize this was a pro- Mr. COBURN. I am happy to. Well, look at the private insurance in- gram the Federal Government had to Mr. BURR. My question is this: It dustry. It is not working. The govern- allow medical students to delay the re- sounds as though the Patients’ Choice ment needs to take it all over. I don’t payment of their student loans until Act allows an individual to design the know that is the case, but the con- they actually got their practice up and coverage to meet their age, their in- sequences of what this bill is going to running. That was eliminated about 2 come, and their health condition. do—— years ago. I am sure the good doctor Mr. COBURN. Absolutely right. Mr. BURR. From the way the Sen- remembers that was accepted under a Mr. BURR. That is customizing your ator has described it, the current bill UC in the committee. But if you read health care choice. that is being debated in the Senate the 2,074 pages, it was noticeably ab- Mr. COBURN. It puts the consumer— really doesn’t benefit anybody. Every- sent in the 2220 rule. Yet, as you know, i.e, the patient—in charge of their body loses. we have less than a million doctors in health care rather than the govern- Mr. COBURN. Oh, yes, it does. We the United States of America trying to ment in charge of their health care. will have at least 20,000 new Federal provide medical coverage to 300 million Mr. BURR. So one could then con- Government employees. It will benefit people and growing. And some suggest clude that the current legislation we them. It will benefit the bureaucracies. that if this bill passed, we would lose 25 are debating in the Senate not only It will give them power to control. It is percent of our doctors in the first year limits but it takes away choices that not a soft control or a light control; it who decided: This is it. I am going to currently exist to seniors, to people is a heavy control. We will mandate on retire. I am out of here. who work, and to the younger genera- States bankruptcy through Medicaid— The 2220 provision is the only thing tion. mandate to the States—the mother of we had in our bill that actually created Mr. COBURN. I don’t think there is all mandates to the States. So it will an incentive for more individuals to any question that is going to happen. benefit the Federal Government and seek medicine as a career. Actually, it is even going to be worse the bureaucracy but will have minimal Mr. COBURN. Madam President, if I than that because we have shrunk the benefit for the patients in this country. may inquire how much time we have differential for young people. If you are Mr. BURR. So at best, we can claim remaining. a young person, listen to me. The cost that the bill being debated in the Sen- The PRESIDING OFFICER. Nine of your insurance is going to double ate is a $2.5 trillion bill designed to try minutes. under this bill. If you are a young cou- to stop waste, fraud, and abuse in the Mr. COBURN. Thank you. ple or a young individual—and I am health care system. Again, going back to incentive, car- talking 40 and under, 24 to 40—your in- Mr. COBURN. Supposedly. rots versus sticks, how is it that we surance is going to double under this Mr. BURR. Think about that. We are have a shortage of primary care physi- bill. What you are going to do, you are spending $2.5 trillion to try to get cians in the country? Why is that? We going to do this: You are going to say, waste, fraud, and abuse out of just the have put a lot of money into medical I am going to pay the tax rather than government side of health care. Yet the schools. The States have put a lot of coverage for insurance because it is fi- bill itself is making the government a money into medical schools. We have nancially much more important for me bigger factor in health care, which student loans for physicians who aver- to do that. And what we know is that means the likelihood is, because of the age about $170,000 in debt when they between 6 million and 11 million young design not changing, you have more get out of there. How is it that people people are going to cancel their insur- waste, fraud, and abuse. So there is no don’t want to be a pediatrician and a ance under this bill, according to a re- real value to the $2.5 trillion, except to general internist or a family practice port put out by—and I will reference it the government workers who are hired doctor? Why is that? here—Oliver Wyman and Associates. to either collect the fines and the new Mr. BURR. Reimbursements. Mr. BURR. But typically children are taxes or sit on the panels to determine Mr. COBURN. The reimbursements, a lot less expensive to insure because who gets coverage and who doesn’t. where you can invest 1 additional year they are younger and they are Mr. COBURN. Well, I wouldn’t go in residency and double the income you healthier. quite that far. There is no question can make from being a physician. Mr. COBURN. What do you think is that some people who have no coverage How did the payment rates get where going to happen? today will get Medicaid. But compared they are? Who set the payment rates? Mr. BURR. What happens? to the Patients’ Choice Act, they could The Federal Government set the pay- Mr. COBURN. What is going to hap- get a private insurance policy instead ment rates because 60 percent of the pen is the spread—the people who have of Medicaid. They would get access to payments to private physicians come insurance, if you are over 40, because all of the physicians, not just 60 per- from Medicare, Medicaid, TRICARE. these young people drop out, your pre- cent of them. Mr. BURR. Indian Health.

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00054 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.076 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 5, 2009 CONGRESSIONAL RECORD — SENATE S12515 Mr. COBURN. Those are contracted. happen to be on that side of the aisle, Mr. BURR. Madam President, this is Those are even lower. So they set or you don’t need help in your reelec- self-explanatory, I think. Today we are them. Private insurance sets all the tion, you don’t get that. borrowing 43 cents out of every dollar rates based on what the government Mr. BURR. If somebody didn’t have we spend; 43 cents of every dollar we does. So the government has created a Medicare Advantage as a choice, what spend in the Federal Government we shortage of primary care which we are insurance product would they have to are borrowing from somebody. You going to see just explode as we put go into the marketplace to buy? know, we talk about these unbelievable other people—the CBO has rightly said, Mr. COBURN. If they could afford numbers in Washington—billions and if you add lots of people, you will get it—and that is where a large number of trillions. The most popular bumper some increased utilization, a signifi- Medicare Advantage people will be sticker out there is this: Don’t tell cant amount. They are not there. They hurt; most of those people cannot af- Congress what comes after a trillion. are not there. ford to buy a supplemental policy. The Personally, I don’t want to know, be- So you take somebody in their late fifth largest seller of insurance policies cause I know if we get there, we are at fifties, mid- to late fifties or early six- in the country happens to be AARP. the point of no return. Senator COBURN Mr. BURR. AARP, yes. So to elimi- ties, who planned on practicing 10 or 15 and I are close to the same age. We nate Medicare Advantage is a tremen- years, and all of a sudden you say—and have kids just getting started raising dous financial windfall to AARP. families. We know what they are going we don’t in this bill. We had the claim Mr. COBURN. For AARP. to be faced with to raise their families, today that this extends the life of Mr. BURR. That association sup- Medicare. Well, here is how it does posedly looking out over the seniors in to make sure their children and grand- that. It uses the Medicare Advisory this country. children get educations, to make sure Commission to force cuts in Medicare, Mr. COBURN. We are fairly cynical, they go to college and have that oppor- not fraud necessarily, just cuts. It and we don’t mean to be. We need to tunity, and make sure they have an op- doesn’t pay for the doctor fix, which is wrap up, if we can. There are two ways portunity after that for a place to work $250 billion, and then it cuts Medicare. of fixing health care in this country. and an income. Do you know what is So the reason—and I don’t have any One is, we have the government run- going to be the thing that dictates problem extending the life of Medi- ning it—I make this point. Everybody most of what they are faced with? It is care—I think so—but it ought to be all agrees that in 2017 or 2019, Medicare right there on that chart. For every about fraud. It ought to be all about— will go belly up. Medicaid is already penny we borrow, it means we have an the vast majority of fraud in health belly up. They are all in trouble. They obligation to pay interest on that care today is through government pro- are running deficits. The Census is penny. Today interest is practically grams, not the private sector. The broke. Social Security is going to be zero. We provide, as a Federal Govern- fraud rate in the private sector is less broke. The U.S. Post Office is abso- ment, money to banks they can lend than 1 percent. Here we have $150 bil- lutely broke. Cash for clunkers was out, and we charge them practically lion. We could save $1 trillion over the broke before we started. The highway zero. That will not last forever. At next 10 years if we had an effective trust fund is $18 billion in the red. And some point, interest rates will go up. fraud program, which this bill mini- we are going to put another 16 percent Depending upon how much money we mally addresses, which our bill aggres- of health care—76 percent instead of have borrowed, that will dictate how sively addresses—aggressively address- 60—in the hands of the government. Or much we are obligated to pay in inter- es. We even have undercover patients, we can utilize what we know works, est. undercover doctors where we create which if you incentivize the manage- Mr. COBURN. Let me interrupt my sting operations to put people in jail— ment of chronic disease and incentivize colleague. Here is what the constella- not fine them, not ban them from prevention, incentivize transparency, tions show. Walk with me slowly. If Medicare; we put them in jail if you are and you create a way for people to have you are 25 years of age or younger stealing from the American people. access, the Patients’ Choice Act will today in America—and we go out 20 There is nothing anywhere close to insure 94 percent of Americans with a years—that will be 45 and younger— that in this bill. So, in fact, we are ag- real insurance policy, not Medicaid or that is 103 million Americans who will gressively going after the largest prob- Indian health care. be in that group. Here is what they are lem of the $800 billion that is wasted By the way, Native Americans, listen each going to owe based on the un- every year, which is fraud. up. Under our bill, if you are due funded liabilities of Medicare, Med- The second largest problem is we health care, you get a card and you can icaid, and Social Security: 103 million need to incentivize the States to fix go anywhere you want and it will be Americans, 45 years and younger, will the tort extortion that is going on in paid for. We need to do that for vet- each owe $1.119 million. That is what this country that causes people to have erans, too. they will be responsible for. They will The point is there is a choice. We can tests done on them, not necessarily have to pay the average interest on run a large government option or we without any consequence to their that, which will be about 6 percent. Be- can run a small government with 50 health, and money wasted on tests so fore they ever pay the first bit of in- States, incentivizing them to do the come taxes, they will have to cover the doctors can be in a better defensive right and best thing for their citizens, that interest; otherwise, that will position. where we will actually lower costs, in- grow. Mr. BURR. How could a group such crease access, and have better care, and as AARP, whose primary role, by de- How does that fit a young family 20 we won’t destroy the best health care years from now? We are talking about sign, is to represent our Nation’s sen- system in the world. tax rates that allow no increased iors, be in favor of a reform package I challenge my colleagues to come that doesn’t provide any additional down here to the floor and debate me standard of living. As a matter of fact, benefits to our Nation’s seniors? on that, because I guarantee you that they are rates that decrease the stand- Mr. COBURN. And it doesn’t reform. in their families I can find somebody ard of living by 35 percent. That is the I have wondered that. who was saved because they lived in heritage we are creating and what we Mr. BURR. As the Senator knows, we this country and, had they not, they are going to expand with this health drastically cut Medicare Advantage, would not be alive. It is the best health care bill the majority leader has the only private sector option that a care system in the world. Why should brought to the floor. We are going to senior has for coverage. We basically we destroy that as we try to fix what is steal the future and the opportunity eliminate that. That is 11 million sen- wrong in health care in America today? for those 25 years and younger today, iors in this country. Mr. BURR. I ask my colleague to put because we cannot live and make the Mr. COBURN. Well, we have pro- that next chart up. hard choices that are necessary, and we tected some through earmarks in this I ask unanimous consent for 5 addi- think the answer to every problem is bill—certain States; we have protected tional minutes. more government, rather than more some. In some States, if you have The PRESIDING OFFICER (Mrs. personal responsibility, competition, Medicare Advantage, you are pro- MCCASKILL). Without objection, it is so transparency in a market, and tected. In other States, if you don’t ordered. incentivizing people to do the right

VerDate Nov 24 2008 00:36 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00055 Fmt 0637 Sfmt 0634 E:\CR\FM\G05DE6.077 S05DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12516 CONGRESSIONAL RECORD — SENATE December 5, 2009 thing, rather than punishing them again this week. I have to say, they are brought back together with their fami- when they do the wrong thing. a remarkable group of people who want lies now. I urge the Government of Iran Mr. BURR. The Senator is absolutely nothing more than to be reunited with to make a humanitarian gesture and correct. What we can only hope to pass their children. On behalf of their fami- make that family reunion possible. on to the next generation is an oppor- lies, I have come to the floor today to f tunity equal to what we have had. To urge the Government of Iran to make a strap them with this debt, to continue humanitarian gesture and release these ADDITIONAL COSPONSORS to go down this road and pile on the ob- young Americans so they can be to- S. 605 ligations, we will limit the next gen- gether with their families again. At the request of Mr. KAUFMAN, the eration’s opportunity. As you choke As many of you know, Josh, Sarah, name of the Senator from Utah (Mr. that opportunity for them, you will and Shane were hiking near the Iraqi- HATCH) was added as a cosponsor of S. choke the fabric of this country in a Iranian border in a remote region that 605, a bill to require the Securities and way that the problems we are faced is famous for a beautiful waterfall Exchange Commission to reinstate the with today are minor in comparison to when they were taken into custody by uptick rule and effectively regulate what they will deal with in the future. Iranian authorities. The Iranians have abusive short selling activities. As we sit here and debate the pluses indicated that the Americans strayed S. 1857 and minuses of this health care legisla- across the border in this remote region. At the request of Ms. STABENOW, the tion, I remind my colleagues, when you There can be no doubt that it was an name of the Senator from Maryland talk about $2.5 trillion—and you prob- accident. Four months later, Josh, (Ms. MIKULSKI) was added as a cospon- ably never will save that money out of Sarah, and Shane remain in prison in sor of S. 1857, a bill to establish na- Medicare; you probably never will cut Iran. tional centers of excellence for the that doctors’ reimbursement quite as The Iranian Government has allowed treatment of depressive and bipolar much as in there—every time you don’t the Swiss Embassy, in its capacity as disorders. do that, we are borrowing 43 cents of protection power for U.S. interests in every dollar we spend. That is the obli- Iran, to have consular access to them S. 2833 gation our children will inherit from twice during the time they have been At the request of Mr. REED, the name us. held. I hope this will continue, and con- of the Senator from Minnesota (Mr. I am not willing to do that anymore. tinue more regularly. FRANKEN) was added as a cosponsor of I want to make sure we are focused on The Swiss have been enormously S. 2833, a bill to provide adjusted Fed- the opportunity that is there for them. helpful in working with us to resolve eral medical assistance percentage We can only do that if we do it in a re- the situation to bring these Americans rates during a transitional assistance sponsible way, do the right thing as it home. I have been assured by one of the period. relates to health care here. Swiss that Josh, Sarah, and Shane AMENDMENT NO. 2789 Mr. COBURN. I yield the floor, and I were all in decent physical condition as At the request of Mr. COBURN, the suggest the absence of a quorum. of the last visit. But it is also clear the name of the Senator from Wisconsin The PRESIDING OFFICER. The imprisonment is taking its toll on (Mr. FEINGOLD) was added as a cospon- clerk will call the roll. these young people. sor of amendment No. 2789 intended to The legislative clerk proceeded to The President of Iran has indicated be proposed to H.R. 3590, a bill to call the roll. that their case will be examined expe- amend the Internal Revenue Code of Mr. PRYOR. Madam President, I ask ditiously and with compassion, which 1986 to modify the first-time home- unanimous consent that the order for is encouraging. President Ahmedinejad buyers credit in the case of members of the quorum call be rescinded. first made that statement around the the Armed Forces and certain other The PRESIDING OFFICER. Without time the U.N. General Assembly met Federal employees, and for other pur- objection, it is so ordered. this past September. poses. Mr. PRYOR. Madam President, I ask These young American tourists find AMENDMENT NO. 2871 themselves in unfortunate cir- unanimous consent that no amend- At the request of Mr. BROWN, the cumstances. One thing is clear: These ments be in order to the pending name of the Senator from Maryland circumstances do and should have amendments prior to the votes on Sun- (Mr. CARDIN) was added as a cosponsor nothing to do with politics. I hope that day, December 6. of amendment No. 2871 intended to be Josh, Sarah, and Shane’s situation can The PRESIDING OFFICER. Without proposed to H.R. 3590, a bill to amend be resolved on the same basis—as pure- objection, it is so ordered. the Internal Revenue Code of 1986 to ly a human gesture by the Government f modify the first-time homebuyers cred- of Iran. I understand that people on all it in the case of members of the Armed MORNING BUSINESS sides tend to get caught in the middle Forces and certain other Federal em- of geopolitical events they have noth- Mr. PRYOR. Madam President, I ask ployees, and for other purposes. unanimous consent that the Senate ing to do with. That is a cycle that can AMENDMENT NO. 2882 proceed to a period for the transaction and should be stopped. We do not want of morning business, with Senators to perpetuate that cycle. Above all, I At the request of Mr. JOHANNS, the permitted to speak therein for up to 10 hope the Iranian Government will rec- names of the Senator from Kansas (Mr. minutes each. ognize that these Americans have com- ROBERTS) and the Senator from Geor- The PRESIDING OFFICER. Without mitted nothing more than an innocent gia (Mr. ISAKSON) were added as co- objection, it is so ordered. mistake and want nothing more than sponsors of amendment No. 2882 in- tended to be proposed to H.R. 3590, a f to be brought back together with their families. The Americans should be re- bill to amend the Internal Revenue AMERICAN HOSTAGES leased. Code of 1986 to modify the first-time Mr. FRANKEN. Madam President, I In the meantime, I hope Josh, Sarah, homebuyers credit in the case of mem- rise today to talk about Shane Bauer, and Shane will be able to speak with bers of the Armed Forces and certain Sarah Shourd, and Josh Fattal. These their families by phone immediately. other Federal employees, and for other three young Americans have been in That would be the first direct contact purposes. custody in Iran since July 31, 2009. they have had since their detention AMENDMENT NO. 2884 That is more than 4 months. over 4 months ago. At the request of Ms. STABENOW, the Shane is from Minnesota, where his As we approach the holiday season name of the Senator from Oregon (Mr. devoted mother, Cindy Hickey, still and the end of the year, this is an espe- WYDEN) was added as a cosponsor of lives. I have been in constant and close cially important time for families to be amendment No. 2884 intended to be pro- touch with Cindy over the phone, and together. That is not an American posed to H.R. 3590, a bill to amend the last month I was able to meet with all value or an Iranian value, it is a Internal Revenue Code of 1986 to mod- the families of the young hikers, and human value. It is my fervent hope ify the first-time homebuyers credit in they have been back in Washington that Josh, Sarah, and Shane will be the case of members of the Armed

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